RN vs. MD

[Deb in IA]

OK, not much time here (in between patients in a busy clinic this afternoon), and since I'm a pediatrician, I don't usually deal with CHF, A.Fib, etc.

But the case you gave describes my MOM almost to a T, so here's what I would do, in this order:

Pulse ox and O2
ABG's
Lytes, CBC
CXR

and presuming that she is in failure - SOB, pedal edema - give a dose of furosemide (Lasix).

Gotta run - I'll check back in on the patient later . . .

 

[Pea-n-Me]

I don't know about anybody else who read those four words, but I didn't think they were anything but a joke.

If you did, then that's a good thing.

But there are many out there who don't understand what nurses do. The whole purpose of this thread was to talk about the differences. RN vs MD

We also have a lot of people here saying they or their children are thinking about nursing as a career and heck, we need more nurses! (The average age for RNs right now is pushing 50 - when they retire, who will be there to take care of the aging population now becoming sicker and living longer?) I saw it as the perfect opportunity to discuss what it is we actually do.

We do have our own scope of practice, and that practice, as I alluded to before, is based on the nursing process and planning of care based on the individuality of each patients' needs.

As nurses, we're fighting against a LOT of stereotypes thanks to many factors, but especially the media portraying us as nothing more than handmaidens to doctors. I myself would not have gone into nursing if that was all it entailed.

My feeling when I read that response was similar to the doctors' and others' feelings who responded to the other post on this thread about doctors not being intelligent.

My sense of humor is alive and well. But my belief in nursing is stronger and my reaction to its misrepresentation more visceral. I believe it's a field that many would find quite fulfilling, but first, they need to understand why it's a worthwhile field to enter into. It's not all about standing around and waiting for the doctor to come. I would have a big issue with my nurses if that's all they did. We earn a good living because we deal with serious medical situations. We use critical thinking and make nursing interventions that matter in the face of a patient's health crisis.

 

[sbell111]

I've heard many nurses state there is more patient interaction/care-giving as a nurse than physician.

I know a few doctors who prefer that nurses have more patient interaction. It's a perk that the doctors enjoy.

 

[Pea-n-Me]

I know a few doctors who prefer that nurses have more patient interaction. It's a perk that the doctors enjoy.

Yes, I do think that's true.

 

[Pea-n-Me]

OK, not much time here (in between patients in a busy clinic this afternoon), and since I'm a pediatrician, I don't usually deal with CHF, A.Fib, etc.

But the case you gave describes my MOM almost to a T, so here's what I would do, in this order:

Pulse ox and O2
ABG's
Lytes, CBC
CXR

and presuming that she is in failure - SOB, pedal edema - give a dose of furosemide (Lasix).

Gotta run - I'll check back in on the patient later . . .

Ha!Thanks Deb. We'll keep an eye on things...

Now, where are the nurses?

 

[Aisling]

http://www.disboards.com/showpost.php?p=40716989&postcount=61



And your spelling "ain't" so hot, either!!

Oops! I meant to spell it like this: "behhhaving"!

 

[npmommie]

Mrs B. is an 84 year old who lives alone. Her daughter brought her in today because she found her mother at home with shortness of breath, bilateral pedal edema, new confusion and states she does not think her mother has taken her medications in three days, the time since her last visit. Vital signs are BP 188/122, HR 112-130, RR 30, Room Air Saturation 88-90%, Blood Glucose 246. Her rythm is Atrial Fibrillation. Past Medical History: Hypertension (HTN), Diabetes - adult onset (AODM), Congestive Heart Failure (CHF). Past Surgical History: s/p Coronary Artery Bypass Graft (CABG).

What are the standards of care for this patient?

ok I will play

I haven't written a nursing care plan in years, my role now is different and I would come at it the way Deb did,
but...........I will go back to my RN roots in acute care

after my Assessment of this patient I would have the following nursing diagnosis:
1.Decreased cardiac output
2.risk for impaired gas exchange,
3.activity intolerance
4.excess fluid volume
5.anxiety
6.risk for impaired skin integrity
7.Impaired knowledge.....self care deficit
8.confusion

I would plan the outcomes for each diagnosis my interventions for the patient to achieve the outcomes( goals).for each diagnosis
example for decreased cardiac output
interventions: assess heart sounds, rate and rhythm, monitor fluid output, monitor skin for cyanosis, monitor mental status, give meds as ordered, and O2.

evaluation is ongoing monitoring achievement of the outcomes.

 

[npmommie]

as an NP I would come at it differently,
my soap note would include the
subjective info ( history from the patient and family )
objective ( my physical exam /review of systems)
assessment ( my diagnosis)
plan ( treatment prescribed)

 

[babynurse1]

My feeling when I read that response was similar to the doctors' and others' feelings who responded to the other post on this thread about doctors not being intelligent.

And yet you chose to imply that I was less than intelligent when I jokingly said "call the doctor".

Thank you for that intelligent response.... Next!

The fact of the matter remains that we are not handmaidens to doctors, but we are nothing without them. We can not even give a Tylenol without their consent. I am not here to stir the pot. I saw the thread, found it interesting, and posted.

We obviously do not share the same sense of humor and that is fine. My co-workers (doctors and nurses and ancillary staff) appreciate not only my hardwork and knowledge of the nursing process, but also my crazy sense of humor.

It was nice hearing a different point of view though. Have a nice day to all.

 

[booger73]

Oooh.. fun, OK, I'll play:

Mrs B. is an 84 year old who lives alone. Her daughter brought her in today because she found her mother at home with shortness of breath, bilateral pedal edema, new confusion and states she does not think her mother has taken her medications in three days, the time since her last visit. Vital signs are BP 188/122, HR 112-130, RR 30, Room Air Saturation 88-90%, Blood Glucose 246. Her rythm is Atrial Fibrillation. Past Medical History: Hypertension (HTN), Diabetes - adult onset (AODM), Congestive Heart Failure (CHF). Past Surgical History: s/p Coronary Artery Bypass Graft (CABG).

What are the standards of care for this patient?

Medical thought processes:
1) Why is mom confused to make her go into failure - is she infected (high likelihood?) (check WBC, BC's, UCx, CXR) or did she just forget her meds (but why?) - is her underlying dementia perhaps worse. Dx: Delirium, but why, other than crappy controlled BP and hypoxia. Did she throw an embolic stroke (afib) - is her Coumadin off. Are her electrolytes off because she hasn't eaten/drinken! CT head... (does she have a bleed)

2) How to make her feel better: what Deb recommended of course - diuretic - have to be aware of possible underlying renal issues. Check a BNP - might help solidify dx. Does she need to be in stepdown or ICU - is she going to crash on me in the middle of the day, etc, etc

3) Monitor BS - hold metformin if on, needs less insulin if not eating -

4) Think also about Low Sa/high RR/tachy - impending sepsis - ? aspiration. consider Emperic Abx coverage -

5) Don't forget to talk to family
6) Don't forget to ask about code status
7) Don't forget to chart on patient
8) Don't forget coders want 'acute on chronic systolic chf' specifically
9) Don't forget to consider IV access needs - don't forget to monitor urine output
10) Don't forget she's at high risk for DVT - consider LMWH

And!! this doesn't include all the things nurses have already probably nicely considered for you..
1) They documented decubiti and skin changes
2) They documented family issues and contact info
3) They have already helped consider d/c planning, home health issues

The list goes on.. sorry, got to go to kid's karate.. but you get the idea

 

[Spoodleink]

Not at all. Why would I disparage him when I'm contemplating going to med school? I admire anyone who's gone through the rigors of medical school, residency, and now has the opportunity to set their schedule and live life how they choose.

Please don't become a doctor because you want to make a lot of money. If you're interested in the medical field and want to help people then I'd feel differently but doing something just because it pays well probably won't turn out for the best. I really wouldn't want to go see an orthopedic surgeon who went into the field because they make bank. I've been to plenty who were total jerks and did not seem at all happy in their filed or treating me. I'm an accountant I make a generous salary and I truly enjoy my job , I was clapping and yaying over a project I got this morning. Money should come in to career planning but it's not that only thing.

 

[DonDraper]

Please don't become a doctor because you want to make a lot of money. If you're interested in the medical field and want to help people then I'd feel differently but doing something just because it pays well probably won't turn out for the best. I really wouldn't want to go see an orthopedic surgeon who went into the field because they make bank. I've been to plenty who were total jerks and did not seem at all happy in their filed or treating me. I'm an accountant I make a generous salary and I truly enjoy my job , I was clapping and yaying over a project I got this morning. Money should come in to career planning but it's not that only thing.

I never said it was the only thing.

 

[singastory]

One situation that I was recently told about involved a young woman that we know who applied to vet school. This girl has spent her whole life working toward this goal and has worked in a vet's clinic for several years (weekends, summers, etc.). She was told that she did extremely well in the interview and that her credentials were equally good, but she didn't get in. She was later told, off the record, by someone involved in the process that there were so many females that they wanted to make room for more males in the interest of diversity (this person happened to be a friend of hers who worked in the office). I would guess that she was low enough down on the list that she got bumped. I have encouraged her to try again, but I don't know whether she will.

That's terrible to hear... My sister didn't get in to the music program at the school she wanted and so she left music all together and has moved on to linguistics. I think she got discouraged and rather than try again she just decided to give up. Music is her entire life and she is so talented, I think it's a shame.

When I was applying to vet schools I got two rejection letters in the span of a few short weeks after I submitted my applications. I was expecting it, but that didn't make it any easier. I was wait-listed at the third but too far down on the list to have a serious chance of getting in. I was down to only one school left, and luckily enough they accepted me. I remember a few classmates bragging about how they got offers from multiple schools and I had to restrain myself from getting into an argument because there are so many students who are dying just to get in anywhere.

 

[disfan07]

Please don't become a doctor because you want to make a lot of money. If you're interested in the medical field and want to help people then I'd feel differently but doing something just because it pays well probably won't turn out for the best. I really wouldn't want to go see an orthopedic surgeon who went into the field because they make bank. I've been to plenty who were total jerks and did not seem at all happy in their filed or treating me. I'm an accountant I make a generous salary and I truly enjoy my job , I was clapping and yaying over a project I got this morning. Money should come in to career planning but it's not that only thing.

That's a speech that one of my doctors gives to her first year med students every year. She tells them that if they want to be a doctor mainly to make a lot of money than maybe they should rethink where they are but if they want to help people and help make a difference in people's lives than they have chosen the right place to be. She's just gotten so sick of hearing med students only talk about money.

When it comes to medicine, helping people should really be the main reason to go into the field. The closest money should come is in second place. If it's the top reason....please rethink your priorities. It is obvious to patients which doctors are just in it for the money (at least it is to me)

 

[minkydog]

I'll give a fictional case study and you can briefly show what your diagnoses and plan of care would look like. (I am keeping it very simple - many patients have far more complex histories and presentations than this.)

Mrs B. is an 84 year old who lives alone. Her daughter brought her in today because she found her mother at home with shortness of breath, bilateral pedal edema, new confusion and states she does not think her mother has taken her medications in three days, the time since her last visit. Vital signs are BP 188/122, HR 112-130, RR 30, Room Air Saturation 88-90%, Blood Glucose 246. Her rythm is Atrial Fibrillation. Past Medical History: Hypertension (HTN), Diabetes - adult onset (AODM), Congestive Heart Failure (CHF). Past Surgical History: s/p Coronary Artery Bypass Graft (CABG).

What are the standards of care for this patient?

\

In my educated opinion, Mrs. B is a goner.

Thank you for that intelligent response.... Next!

How about we assume both the doctor and nurse are already there.

(Didn't think I'd need to say that. Unfortunate that decades of sterotypes about what nurses do were just completely reinforced with those four words.)

Any nurses here who can tackle this? Krista? Minky? Disney Doll? npmommie? laurie? MomRN? rolie? dackp? Hannathy? Others? Here's an opportunity to show what we do! Nurses DO have their own scope of practice.

And Dis Docs - Deb? booger? cm8? Let's hear it!

Sorry. I'm a pediatric nurse. I haven't laid a hand on an adult in over 25 years. Now if you ask about strep, ear infections, vomiting, MRSA, head lice, buckle fractures, and chicken pox, well I'm your girl.

 

[A_Princess'_Daddy]

That's a speech that one of my doctors gives to her first year med students every year. She tells them that if they want to be a doctor mainly to make a lot of money than maybe they should rethink where they are but if they want to help people and help make a difference in people's lives than they have chosen the right place to be. She's just gotten so sick of hearing med students only talk about money.

When it comes to medicine, helping people should really be the main reason to go into the field. The closest money should come is in second place. If it's the top reason....please rethink your priorities. It is obvious to patients which doctors are just in it for the money (at least it is to me)

I absolutely agree with this. Physicians can make very good salaries, but if somebody is primarily after money, there are many careers out there that pay as much or far more than medicine and don't require the years of schooling, sacrificed income and accumulated debt. I have half a dozen friends who went to medical school after college and they are basically just starting their careers now (all but one went for advanced sub-specialties). Most are truly passionate about medicine, so they are in the field where they want to be, but financially they are over a decade behind me and my friends who went into finance or investment banking.

A great career if you love it, but not the easiest way to make money by a long shot!

 

[justhat]

I work with MD's and it's not just the amount of school, but they then have residency, fellowship....it's not as if you graduate school and get a huge salary and the perks, it takes many, many years of experience to make any money after getting that MD Diploma on the wall.

Also, the MD's in my office work almost 24/7. Not exactly very friendly to a marriage or starting a family. It truly becomes your entire life.

Hillary, I completely agree with you! For the rest of our lives, my husband will have crazy work hours, overnight calls, have to work holidays, not be able to take days off without tons of notice, and even then, only if other people haven't taken that day, etc.

What type of office do you work at? What's the specialty? I shadowed an ophthalmologist and he works 12-5 everyday and then does surgery on Thursday. I think he's hauling in about 300k a year.

That is extremely rare to have such limited hours. My friend is an eye surgeon and works way more than that. And with 3 kids (and her husband's a radiologist), it's tough. Nor is she making that much money.

My husband is an anesthesiologist and his hours are, roughly, 6am-6pm daily, with overnight calls thrown in about once per week (he works for a large group, it could be more frequent). For him, overnights on OB mean sleeping at the hospital. Surgical calls can be taken from home since he works at a community hospital and not a trauma center.

I chose nursing because that's what I wanted to do. I didn't want to do what doctors do, just like I didn't want to be a lawyer, a teacher, or an engineer. Not that there's anything wrong with those careers, they just weren't what interested me.

Also, as far as medicine, residency is brutal. I can't handle sleep-deprivation; I would have killed someone! Four years of college, 4 years of med school, a 3 year residency, then possibly a fellowship, and you're 31 by the time you can ever start earning money, and that's IF you started when you were 18. If that had been my dream, I would have tried it, but it was NOT. I wanted kids before I was 31. Yeah, there are residents who marry and have kids while in the program, but I could not IMAGINE combining those crazy hours with pregnancy!

I completely agree. My husband just turned 31 last month and he's only been "working" since August. He finished his 4 year residency June 2010. And residency was brutal. Some months he overnight every 3rd night. And our 2nd child was born 1 month into his residency, so it was not only hard on him, but me too! We could never make plans because cases always came up, he'd be stuck at the hospital late, etc. It's mildly better now that he's an attending, but still no walk in the park.

 

[justhat]

Not at all. Why would I disparage him when I'm contemplating going to med school? I admire anyone who's gone through the rigors of medical school, residency, and now has the opportunity to set their schedule and live life how they choose.

Setting your schedule is very, very dependent on your field. My husband cannot remotely set his schedule as an anesthesiologist and he works for a private group. If he worked for a hospital/university, he'd be even worse off.

 

[DonDraper]

I absolutely agree with this. Physicians can make very good salaries, but if somebody is primarily after money, there are many careers out there that pay as much or far more than medicine and don't require the years of schooling, sacrificed income and accumulated debt. I have half a dozen friends who went to medical school after college and they are basically just starting their careers now (all but one went for advanced sub-specialties). Most are truly passionate about medicine, so they are in the field where they want to be, but financially they are over a decade behind me and my friends who went into finance or investment banking.

A great career if you love it, but not the easiest way to make money by a long shot!

Investment Banking has an extremely high burnout rate and creates a work life that is MUCHHHHHHH worse than that of a physician. By the time an investment banker hits 40, physically they feel like they're 60. I know plenty of them and yes their bank accounts are loaded but they don't even have time to enjoy the money because they're so busy with work.

 

[DonDraper]

Setting your schedule is very, very dependent on your field. My husband cannot remotely set his schedule as an anesthesiologist and he works for a private group. If he worked for a hospital/university, he'd be even worse off.

And everyone will know what the field lifestyles are like prior to matching. If you want a family and regular hours, you know which areas to go after. If you don't mind all nighters, then you'll know which areas to go into as well.

As it stands right now, Dermatology and Radiology are the two most desirable areas based on pay and hours.