tag:blogger.com,1999:blog-5779260.post8918848808116071357..comments2024-03-19T05:45:33.244-04:00Comments on the underwear drawer: where context is keyMichelle Auhttp://www.blogger.com/profile/04938937923678734252noreply@blogger.comBlogger68125tag:blogger.com,1999:blog-5779260.post-58352549927386148702013-06-18T14:14:19.924-04:002013-06-18T14:14:19.924-04:00Hello, i feel that i noticed you visited my web si...Hello, i feel that i noticed you visited my web site thus i came to go back the <br />favor?.I'm attempting to to find issues to enhance my web site!I assume its adequate to make use of some of your concepts!!<br /><br />my web page :: <a href="http://www.free-press-release-wire.com/An-Increasing-Availability-Of-College-Scholarships-May-Help-Empower-Current-College-Freshmen.htm" rel="nofollow">grants</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-4975411193614545992013-05-17T00:05:54.784-04:002013-05-17T00:05:54.784-04:00An impressive share! I've just forwarded this ...An impressive share! I've just forwarded this onto a coworker who has been conducting a little research on this. And he actually bought me dinner due to the fact that I found it for him... lol. So let me reword this.... Thank YOU for the meal!! But yeah, thanks for spending time to discuss this subject here on your website.<br /><br />my web page - <a href="http://www.vdonest.com/RustyOsbo" rel="nofollow">http://pornharvest.com/index.php?m=2339630</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-11088075891222616772013-04-17T11:59:49.207-04:002013-04-17T11:59:49.207-04:00I will immediately grasp your rss feed as I can...I will immediately grasp your rss feed as I can't in finding your email subscription link or newsletter service. Do you have any? Kindly allow me recognise in order that I may just subscribe. Thanks.<br /><br />Visit my web site ... <a href="http://Thedeal.my/index.php?do=/profile-6723/info/" rel="nofollow">click this</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-25567184410116616572013-04-17T00:08:01.915-04:002013-04-17T00:08:01.915-04:00I'm really enjoying the design and layout of y...I'm really enjoying the design and layout of your site. It's a very easy on the eyes which makes <br />it much more pleasant for me to come here and visit more often.<br />Did you hire out a designer to create your theme? Outstanding work!<br /><br /><br /><br />my weblog <a href="http://www.spot100.com/xe/index.php?mid=star_a3&page=1&document_srl=229955" rel="nofollow">Oovoo chat - chatclimax.com - www.gsokoreanschool.org</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-3751918567676933152013-04-16T19:44:16.177-04:002013-04-16T19:44:16.177-04:00This is my first time pay a quick visit at here an...This is my first time pay a quick visit at here and i am actually <br />happy to read everthing at alone place.<br /><br />Check out my page - <a href="http://www.iopescocosi.com/blog/?p=1019" rel="nofollow">2013 at 8:44 pm</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-26233340146933164602013-03-21T09:08:46.565-04:002013-03-21T09:08:46.565-04:00Amazing! Its really awesome piece of writing, I ha...Amazing! Its really awesome piece of writing, I have got much <br />clear idea on the topic of from this piece of writing.<br /><br /><br />my page ... <a href="http://diggsites.info/story.php?id=194000" rel="nofollow">A Grants</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-34444056497532159542011-12-31T12:47:40.611-05:002011-12-31T12:47:40.611-05:00For those who are interested in the policies, the ...For those who are interested in the policies, the ENA and the AANP both have position statements and scopes of practice for NPs in the ER setting and here are some references:<br />http://www.ena.org/SiteCollectionDocuments/Position%20Statements/Advanced_Practice_in_Emergency_Nursing_-_ENA_White_Paper.pdf<br /><br />ENA NP competencies: http://www.ena.org/IQSIP/NursingPractice/advanced/Documents/ENANPCompetency.pdf<br /><br />AANP scope of practice statement: http://www.aanp.org/NR/rdonlyres/FCA07860-3DA1-46F9-80E6-E93A0972FB0D/0/2010ScopeOfPractice.pdfLauriehttp://www.fit4d.comnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-85190419806282014962011-12-31T12:46:38.714-05:002011-12-31T12:46:38.714-05:00Hello,
I am a Masters NP in emergency medicine, w...Hello,<br /><br />I am a Masters NP in emergency medicine, where I can assure all I have my own liability insurance and can expect that both I and my "collaborating physician" would be involved in a suit should there be one. Yes, they sign my charts and this suggests that they are involved directly in a patient's care. Their signing my charts is in fact a requirement of our employer and has more to do with billing than collaboration; I am fully licensed to practice and bill independently, but FYI, my reimbursement is lower for the “same” care (face it, I can take care of a sore throat or suture a simple wound as well as my physician colleagues, but would not attempt to perform or bill for a chest tube insertion). Most often are not directly involved in the care of the patients that I see, but in the interest of excellence in patient care (and a cautious, CYA attitude) I do often ask them to see a patient and add their knowledge to my assessment; in those cases they will most often write their own note. They are all trained, board certified, and experienced in ER care, whereas I have 5 years of OJT after 3 in primary care. That said, I am the go to person for diabetes care for many of them, because I have an expertise in that area of medicine; we are a TEAM. <br /><br />One thing that is often overlooked in NP training is that we have a lot of experience when we enter NP education. Although there are now contiguous degree programs (student to RN to NP in 4-5 years, which interestingly most NP's who came up the traditional way don't agree with *smile*), most schools have a minimum practice requirement of 2 years as an RN before enrollment. In the program that I attended the average number of years’ experience in my group was 13; I personally practiced as an RN for 16 years, 13 in a combined ICU-CCU nurse in a community hospital (on the night shift-we were the cowboys, LOL) before going back to school. So I think there should be a nod to the fact that most of us are not starting from scratch when it comes to patient assessment, care, and clinical knowledge. Most of us do have a little over the first year medical students. By the way, those fast-track RN, BSN to NP degrees are one "solution" to the primary care MD practitioner shortage; at least the nursing profession is offering one. When medical education becomes more affordable and if it continues to take the direction that is has in the last few years with more emphasis on whole patient care and disease prevention rather than disease repair (this is a VERY short version of another whole debate) then maybe more individuals will be drawn to medical, rather than nursing school education. Personally I chose nursing for what I perceived as a more holistic approach toward patient's care when I entered nursing school 32 years ago. If fact, since I admire the advanced knowledge of my ER colleagues in our environment I'd love to have the option of a residency program that was affordable, worked around my current schedule, and ended in a DNP degree. Unfortunately as my nursing colleagues have pointed out, this is not the direction the DNP programs have taken and I am personally thankful that I will not be forced to obtain this degree. I am too old to explain my (theoretical) doctorate to anyone, and already get fatigued explaining to patients that yes, I am a nurse, AND I am also trained and licensed to assess their symptoms, order tests, diagnose their illness and prescribe medications. I also tell them that I'll be arranging their follow-up and have talked to their PCP, or that I have talked to specialist XYZ about their care, or that my ER physician colleague and I have consulted about their diagnosis and that he or she will be examined by that physician if I have asked for that consult. That is how we work as a team.Lauriehttp://www.fit4d.comnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-37850471870368418252011-10-22T12:25:03.003-04:002011-10-22T12:25:03.003-04:00I appreciate your position on this matter, especia...I appreciate your position on this matter, especially since you practice in the hospital where my oncologists, nephrologist and cardiologist are likely to refer me too. And god forbid that I ever end up in your operating room, I promise not to introduce myself.Lisa https://www.blogger.com/profile/09324961653370110887noreply@blogger.comtag:blogger.com,1999:blog-5779260.post-34573803894340154472011-10-11T23:32:22.573-04:002011-10-11T23:32:22.573-04:00Just today a nurse practitioner called, introduced...Just today a nurse practitioner called, introduced herself as the "attending nephrologist", and proceeded to demand that a repeat study --which served no purpose except exposing the patient to unnecessary radiation --be performed emergently. I know it's one thing to ask to be recognized for the doctorate-level work you put in, and another to lie outright in the name of expediency, but it nonetheless comes down to this--titles have power, and people asking for them know this.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-77666944190575710022011-10-09T18:36:58.365-04:002011-10-09T18:36:58.365-04:00Optometrist and ophthalmologist is on the forefron...Optometrist and ophthalmologist is on the forefront of this title confusion. Ophthalmologist has a lot to lose other than title. In many states, optometrists are allowed to treat and prescribe medication even though they never went to medical school. They can see patients without a referral from the Primary care Practioner. In some states they are even allowed to do lasers. They claimed that they have six years of concentrated eye training and even though ophthalmologist went through 12 or more years (if you do a fellowship like Joe), they did not spent as much time on the organ called the EYE. Why are they gaining so much power? The answer is, they have more representation in the Congress. Ophthalmologists, wake up. We have have getting cuts in reimbursements over the years. When I first got out thirty years ago, a cataract surgery was paid at $3000.(medicare and medicaid combined), Now the reimbursement is around five hundred.an ophthalmolistnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-50356843552782741682011-10-09T12:33:05.140-04:002011-10-09T12:33:05.140-04:00I prefer the term doctor to be used only as a job ...I prefer the term doctor to be used only as a job title. Much less confusion this way.Ellizabethhttp://www.cashadvanceoverthephone.comnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-60819565277327200212011-10-07T19:32:52.457-04:002011-10-07T19:32:52.457-04:00Especially since the job description of a physicia...Especially since the job description of a physician involves, as you mention, being ultimately responsible for the patient and the outcome, the term "doctor" implies all of the above. In addition, as a family physician in urgent care who works with many different types of providers, there is an assumption that physicians have a certain level of training and expertise. Some other types of providers have this, but the truth is that not all do. <br />This is just a fact, that sometimes there is less required training, which can at times lead to a less... involved... medical diagnosis. Yes, some nurse practictioners or P.A.'s have as many years of training, but many do not. I have seen this many times in my 14 years of practice. This is why non-physicians are supposed to have a physician sign off on their work. It's just the way it is. But the funny thing is, I'd almost recommend my own daughters be a P.A. rather than an M.D., just because there is tremendous stress that goes along with this responsibility that we as physicians carry. If a person makes a choice to get a doctorate in nursing, wonderful- but be proud to be a nurse. I think patients are also very aware of all of this, and would make many wrong assumptions if everyone introduced themselves as "doctor".Lauren Chasin, M.D.https://www.blogger.com/profile/08234158126896004255noreply@blogger.comtag:blogger.com,1999:blog-5779260.post-44514424854764501172011-10-07T16:52:34.847-04:002011-10-07T16:52:34.847-04:00yupyupAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-92182474540525935142011-10-06T13:04:46.161-04:002011-10-06T13:04:46.161-04:00I think this whole debate can be summed up in what...I think this whole debate can be summed up in what Michelle said (I'm paraphrasing) above: For the DNPs, dentists, lawyers, et al., "doctor" is an *honorific*. For the physicians and surgeons, it a *job title*. Think about it.Sarahhttps://www.blogger.com/profile/10951727241312929481noreply@blogger.comtag:blogger.com,1999:blog-5779260.post-3972342288244477432011-10-06T08:32:41.457-04:002011-10-06T08:32:41.457-04:00I spent a few years teaching clinicals for a local...I spent a few years teaching clinicals for a local nursing program. One day a student asked, "all the other instructors wear lab coats, why dont you wear a lab coat?"<br /><br />I replied, "cause I don't work in a lab".<br /><br />People who wear them to keep their clothes protected, I can understand. I am way too hot natured to wear a coat while working in Florida. I also think it looks odd to wear with scrubs. Plus when they get all dirty with stains and ring around the collar it is just disgusting!Wicked Wandanoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-56729103261238097522011-10-06T02:00:24.348-04:002011-10-06T02:00:24.348-04:00@Anonymous 6:02pm
Pharmacists wore long coats his...@Anonymous 6:02pm<br /><br />Pharmacists wore long coats historically because it provided them and their clothes the best protection against whatever medicine they were trying to compound. Now that pharmacists are moving onto clinical roles on the wards, many of us are ditching the cumbersome white coat for comfortable business attire.<br /><br />@ Everyone: Dentists are often addressed as Dr. So and so, but are obviously not medical practitioners. Given this debate on who should be addressed by the term "Dr", where do people stand with regards to dentists? Is there any potential for confusion, given that dental practitioners can also be found in the hospital environment?pmmastanoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-52958803139288686832011-10-05T23:29:42.095-04:002011-10-05T23:29:42.095-04:00I think the belittlement comes from the other prov...I think the belittlement comes from the other providers wanting to own the "doctor" designation. I am sure it is not nurses and pharmacists clamoring for the limitation of the use of the title.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-45686145285473193722011-10-05T21:03:27.005-04:002011-10-05T21:03:27.005-04:00I don't think it's belittling to call some...I don't think it's belittling to call someone a NP, that's not the argument. I think you'd be hard pressed to find an NP who isn't proud of that title. Nursing is not the same as being a physician-- it's not meant to be. The theory is all very different. <br /><br />Personally, I'm indifferent to being called a "doctor" just because I would have a doctoral degree, but that's not the point. It's a matter of respect and acknowledging that all people work very very hard for that doctoral degree, not just physicians.AllieRNhttps://www.blogger.com/profile/13612105796271480596noreply@blogger.comtag:blogger.com,1999:blog-5779260.post-91418689249833574952011-10-05T20:51:26.485-04:002011-10-05T20:51:26.485-04:00I am writing this while currently hospitalized. (I...I am writing this while currently hospitalized. (I am also a PhD and third year med student). I actually appreciate the designation of position (I am a surgical fellow, physical therapist, anesthesiologist) more than I care about title. Each day I am being seen by no less than 5 MD/DOs. Each of my providers has a different level of skills even within the "MD/DO" world. I am at a teaching hospital and I want to know if I am seeing an intern, resident or fellow. All of those are doctors, but have no where near the level of education and experience that *my* doc has. <br /><br />I am seeing multiple types of doctors. Knowing exactly who they are is rather important so I ask the right question to the right person. Discussing my Orthopaedic Surgical complications with my GI Doc isn't likely to net me the information I want/need. Discussing my surgical complications with the PhD RN who is caring for me tonight (and who has worked with Med/Surg patients for 30 years), is much more likely.<br /><br />So what information is the term "doctor" really supposed to give me?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-29904438937914393392011-10-05T18:51:49.854-04:002011-10-05T18:51:49.854-04:00I guess I don't understand how it is perceived...I guess I don't understand how it is perceived as "belittling" someone to refer to them as an NP or a PharmD or what have you, if that's indeed the designation they have earned. Why is being referred to as "Doctor" an honor, but being referred to as a "Nurse Practitioner" insulting? I have worked with and learned from many excellent nurse practitioners, as well as from many brilliant pharmacists, respiratory therapists, and physician assistants, and their positions or how they chose to refer to themselves had nothing to do with how much I respected their work, nor did it in any way detract from the good they did for patients.<br /><br />Transparency in team role and structure does not belittle any member of the team, nor is that my inent. And if a nurse practitioner (or other non-physician provider) feels that it lowers their worth to be referred to as such, perhaps this is more an internalized stigma than an external one.Michelle Auhttps://www.blogger.com/profile/04938937923678734252noreply@blogger.comtag:blogger.com,1999:blog-5779260.post-40962758159079258522011-10-05T18:02:22.694-04:002011-10-05T18:02:22.694-04:00Why are RT's, pharmacists, food service worker...Why are RT's, pharmacists, food service workers, and seemingly EVERYONE else who isn't a medical doctor allowed to wear long white coats? This has also confused me on a million different occasions, so I wonder how the patients feel.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-51044324776121614912011-10-05T09:49:25.026-04:002011-10-05T09:49:25.026-04:00Reading your post I agreed with your position. Ho...Reading your post I agreed with your position. However, with a bit more thought I am starting to lean the other way.<br /><br />An NP, CRNA, PT, etc.. should be using the professional designation that they have earned, if that be at the doctorate level then it is what has been earned. perhaps, additional explanation should be made to describe the role of the individual when interacting with patients.<br /><br />It cannot be justified for a physician or facility to mandate that a provider not use the distinction that has been earned. Individuals spend lots of time and money advancing their own education and should not be made to sit at the back of the bus because a few physicians feel it encroches on their perceived authority.<br /><br />Bottom line is that healthcare is a TEAM approach and to belittle certain members of that team is not advancing anyone's cause.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-78101082014446418432011-10-04T23:37:19.286-04:002011-10-04T23:37:19.286-04:00Hi Leslie-
I should have been more specific. In m...Hi Leslie-<br />I should have been more specific. In my state, NPs can do almost anything under their supervising physician's license if he or she agrees to it. I don't think that should be how a profession with a terminal degree defines how they practice. NPs should practice independently, but they need to describe explicitly what they ARE and ARE NOT trained to do in nursing school (and, IMO, one lecture on chest tube insertion does not cut it). Likewise, their training should mostly be from other nurses, not physicians.<br /><br />Do you have a link to a defined nursing scope of practice? I'd love to see it. All I can find on the internet is very vague language and a reference to which states require physician supervision or not.<br /><br />Sincerely, <br />Anon 3:09, RNAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5779260.post-33174850401584741352011-10-04T21:39:02.840-04:002011-10-04T21:39:02.840-04:00I talked about this with my dad, who is an attorne...I talked about this with my dad, who is an attorney. He laughed when I asked if he thought his clients should be calling him Doctor. He said he didn't want the responsibility that came along with the title ... irregardless of the diploma hanging on the wall that confirms he is in fact a juris doctor. :)Janehttps://www.blogger.com/profile/12996804670882312289noreply@blogger.com