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Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 6/3/16 at 9:36 am to Parallax
Posted on 6/3/16 at 9:36 am to Parallax
quote:
Do nurses make any decisions? I've asked this question in this thread several times.
Yes, many orders are nurse directed, standing delegated orders, etc.
The nurse based on his/her assessments can order labs, tests, etc under that window.
1
Posted on 6/3/16 at 10:48 am to Restomod
quote:
Do nurses make any decisions?
quote:
Yes, standing delegated orders,
I wonder if you stopped to consider who wrote and approved those standing orders that the nurse is carrying out? Go ask your Medical Executive Committee if they will provide you with all of the nurse signatures or votes for the last standing order instituted in your facility.
Most standing orders fall under "if /then" pattern of decision making. And in most cases the "if" is a quantifiable data point that is not generated by the nurse. Lab value, vital sign, patient history item, etc.
Posted on 6/3/16 at 11:06 am to Bleeding purple
quote:
I wonder if you stopped to consider who wrote and approved those standing orders that the nurse is carrying out? Go ask your Medical Executive Committee if they will provide you with all of the nurse signatures or votes for the last standing order instituted in your facility.
Most standing orders fall under "if /then" pattern of decision making. And in most cases the "if" is a quantifiable data point that is not generated by the nurse. Lab value, vital sign, patient history item, etc.
I'm not a nurse so make fun of them, IDGAF.
I never said nurses wrote the order, I was merely answering the question and said they DO make decisions when needed.
Some of you physicians really hate nurses and it's very appearant in this thread.
Posted on 6/3/16 at 11:07 am to Bleeding purple
LSUSETHEFORCE
please answer my previous question:
Please explain why you think this is a bad idea
Also, please stop mischaracterizing your role:
While many times that supervising physician is not an anesthesiologist, it is in fact still a medical doctor. Any data you present in support of the independent or unsupervised practice of CRNAs based on the safety outcomes of existing cases is biased by the fact that physician supervision was in place and has provided assistance when things went wrong to prevent poor outcomes.
please answer my previous question:
quote:
So inside of the VA system where complication rates are well known to be high across all specialties and patients, and where the best and the brightest are seldom found, you think it is a bad idea to specify that the physician oversight you are already required to practice under be from a physician in the specialty of Anesthesia?
Please explain why you think this is a bad idea
Also, please stop mischaracterizing your role:
quote:
Because we don't need supervision. Quite simple. In fact, like 65% of anesthesia is currently done this way....we seem to be doing fine despite yalls pleas that we can't. 65% of anesthetic delivery is done by CRNAs (under the supervision of a physician).....
While many times that supervising physician is not an anesthesiologist, it is in fact still a medical doctor. Any data you present in support of the independent or unsupervised practice of CRNAs based on the safety outcomes of existing cases is biased by the fact that physician supervision was in place and has provided assistance when things went wrong to prevent poor outcomes.
Posted on 6/3/16 at 11:13 am to Bleeding purple
quote:
Any data you present in support of the independent or unsupervised practice of CRNAs based on the safety outcomes of existing cases is biased by the fact that physician supervision was in place and has provided assistance when things went wrong to prevent poor outcomes.
Any data I present will be deemed uncredible or biased.....I'm gonna just let this one go.
The actual surgeons who work with CRNAs on a daily basis know what goes on with the model currently presented.....they just tow the line because they need people sleeping and speaking against it would breech comardarery.
I'm going to let this one sink into the abyss.
This post was edited on 6/3/16 at 11:14 am
Posted on 6/3/16 at 11:14 am to L S Usetheforce
Oh look, the doctors are dicking around on the internet during a workday again.
Posted on 6/3/16 at 11:20 am to L S Usetheforce
Seriously I hate this argument, but honestly, talk to a surgeon who medically supervises regularly WITHOUT an anesthesiologist in house. Ask them who preops, orders labs, deems the patient able to undergo anesthesia. Ask them who makes them wait 8 hours for patients who ate breakfast before an elective surgery but still wants to do the case. Ask them who manages the postop pain on the floor?
I'm not trying to get in a pissing match but it's not black and white. Sh!t happens differently outside your facility.
I'm not trying to get in a pissing match but it's not black and white. Sh!t happens differently outside your facility.
Posted on 6/3/16 at 11:35 am to Restomod
quote:
so make fun of them
I'm not making fun of anyone.
quote:
IDGAF
Many would assume that by your snarky reply and use of vulgarity you have already shown your hand on that topic.
quote:
I never said nurses wrote the order, I was merely answering the question and said they DO make decisions when needed
The decision was made by a physician or group of physicians to allow a nurse to institute a physician order (decision) based on quantifiable data points.
quote:
Some of you physicians really hate nurses and it's very apparent in this thread
You clearly have not read my posts. I like nurses, PA's, NP's, CRNA's, very much. They play a vital role in the delivery of health care. That does not change the fact that they are not physicians and do not have the training or skill we have. I do not like any of the above who ignorantly and openly claim they have equivalent education or capabilities as physicians, because I am a fan of the truth.
Posted on 6/3/16 at 11:37 am to Womski
quote:
Oh look, the doctors have free time because their Obamacare and Medicaid patients are dicking around and no showing appointments on a workday again.
Posted on 6/3/16 at 11:38 am to Bleeding purple
Also I'm not at work. I'm on vacation. I have 2 crnas covering for me. I assume all is well as I haven't heard from them.
Posted on 6/3/16 at 11:41 am to Bleeding purple
My doctor refuses to see Medicare patients.
I'm sorry you aren't a good enough businessman to avoid seeing the poors
I'm sorry you aren't a good enough businessman to avoid seeing the poors
Posted on 6/3/16 at 11:49 am to L S Usetheforce
quote:
The actual surgeons who work with CRNAs on a daily basis know what goes on with the model currently presented
Hi, I did 3 procedures/surgeries with CRNA administered anesthesia last week and 2 this week so far.
FWIW you still failed to answer the above questions about the VA
Posted on 6/3/16 at 11:52 am to Bleeding purple
Did you see the anesthesiologist?
Posted on 6/3/16 at 11:55 am to Womski
quote:
My doctor refuses to see Medicare patients. I'm sorry you aren't a good enough businessman to avoid seeing the poors
Oh the irony. 115 plus pages of people supporting non docs independinetly practicing because poor Medicaid and rural patients have a perceived lack of healthcare providers. Yet when a provider lives in a rural area and cares for all patients here partially due to Obamacare, Medicaid, and Medicare being the predominant payers, and in part because compassionately caring for all patients not just the well funded ones is why I went into office, we are laughed at.
of course, I am willing to bet my business sense has me in a much more financially stable position than you.
Posted on 6/3/16 at 11:57 am to Bleeding purple
I do like the team approach though. My job is 10x easier when I work my prn gig with this model. I do have to preop the patient though but as soon as the vitals are written in recovery I'm done. Any issues at that point become the anesthesiologist's problem until the patient leaves.
Posted on 6/3/16 at 11:58 am to Bleeding purple
quote:
The decision was made by a physician or group of physicians to allow a nurse to institute a physician order (decision) based on quantifiable data points.
So nurses are have no critical thinking skills, just follow a recipe of orders.
Got it
Posted on 6/3/16 at 12:03 pm to Restomod
Nope, I didn't say that.
Your example however of "nurse's make decisions they use standing orders" is just a very poor example.
Your example however of "nurse's make decisions they use standing orders" is just a very poor example.
Posted on 6/3/16 at 12:06 pm to Restomod
quote:
So nurses are have no critical thinking skills, just follow a recipe of orders. Got it
That is what you got out of what he sad? Wow, quite the reach.
Posted on 6/3/16 at 12:09 pm to L S Usetheforce
quote:
d you see the anesthesiologist?
Yep, but none of my patients had issues to warrant his intervention and the CRNA's handled the cases perfectly. Also had a discussion in the lounge with the CRNA about the management of a pt he had seen recently where he asked me to explain the anatomical and physiological implications of a molar pregnancy in a patient with underlying SLE.
now answer my questions about the VA
Posted on 6/3/16 at 12:20 pm to Bleeding purple
quote:
So inside of the VA system where complication rates are well known to be high across all specialties and patients, and where the best and the brightest are seldom found, you think it is a bad idea to specify that the physician oversight you are already required to practice under be from a physician in the specialty of Anesthesia?
Hasn't been a problem since 1945 in the current format....why change now?
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