re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

UPDATE:
Even though the LANP announced they were pulling SB187, Rep Robert Johnson has decided to pull it back up and try to rescue it with a dramatic amendment that will supposedly "satisfy everybody". How he knows what will satisfy physicians is a mystery, since he is not including physicians in drafting the amendment.
SB187 has been called from and returned to the calendar once already today.

Sad is using the example of a nurse simply filling an order as independent decision making abilities.


If you want to look at independent decision making abilities you should reference ICU and CCU nurses that have the experience to stitch together a larger picture and decide when to call the doc with a request to revaluate the patient because the are making a negative turn, or the OB nurse that despite algorithms and specified rates of labor is able to access a laboring patient and decide to call the physician to come in to deliver even when she is only at 6cm because they realize she will progress rapidly, or the ER triage nurse who is able to identify the patient stratify the order patients need to be seen based on a decision of acuity which is not always a quantifiable data point, or the telemetry unit nurse who is able to differentiate and decide when the routine CP rule out admission with newly developed tachycardia, nausea, and SOB has anxiety induced sinus tach, newly developed afib rvr, or acute alcohol withdrawal, or the IMC nurse who is able to evaluate that patient and family with weakness and hypoglycemia and decide that they need closer evaluation for malingering and inappropriate insulin administration, or the post op nurse that is able to decide that the daily dressing change should be coordinated with the surgeon rounding and with pain medication administration.


Those are the decisions a good nurse makes. I work daily with a group of nurses that excel at these decisions. All of the physicians in our institution know which nurses are capable of this, which ones need support and encouragement in arriving at this capability, and which ones will simply never get there.


Instituting most routine orders however, is no more of a decision than a waitress deciding to tell the kitchen to make a hamburger when a patient asks for a hamburger. Sadly some nurses especially prn and temp nurses are incapable of correctly utilizing even standing orders.

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What you believe and what exist are two different things

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Comparison of Quality of Care
in VA and Non-VA Settings:
A Systematic Review

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Two articles pertained to cardiac surgery. Of these, one focused on patient perceptions of numerous
aspects of patient care after coronary artery bypass grafting in VA and non-VA hospitals. This
study found that, after risk adjustment, VA patients were more likely than non-VA patients to report
a problem with patient care. The second article compared severity adjusted mortality rates after
CABG among VA and non-VA hospitals. After adjusting for patient-level predictors and hospital
volume, the study found that the odds of death were higher in VA patients than in private sector
patients.

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Three of the four studies assessed risk adjusted mortality
rates and of these, two found no significant difference across settings. One study found significantly
higher risk adjusted rates of postoperative mortality among male patients at the VA compared with
the private sector. All four of these studies were part of the Patient Safety in Surgery Study.

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One of the pancreatic cancer studies based on the National Cancer
Data Base (NCDB) found no significant difference in postoperative mortality. The other study
on pancreatic cancer based on the Patient Safety in Surgery Study found increased risk adjusted
postoperative rates of morbidity and mortality in VA.

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Of course you have to take all the above with a grain of salt as we now know that the VA system was reporting greater patient satisfaction and better outcomes than what existed. So the real comparison may be even worse.










Still, why do you oppose working under an anesthesiologist's supervision when you are already required to work under physician supervision?

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So sicker patients die after surgery

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Are you being intentionally obtuse or is the randomization of patient variables in peer reviewed studies such a foreign idea to you because it was taught in those non needed medical school classes?





here ya go

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Of the 222 articles, mentioned above, 175 unique articles were identified and screened. Of these,
98 articles were initially rejected because there was no comparison of quality in VA and non-
VA settings in the United States. After 22 articles were excluded because the comparisons were
found to be non-contemporaneous, or had unequal or unrepresentative samples, used dissimilar
or indirect measures of quality, had methodological problems, or were published before 1990
(which was used as an a priori cut off point), our first data abstraction included 55 articles. The
55 articles were categorized as either addressing surgical conditions (n=17) or medical and other
non-surgical conditions (n=38).

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you think that proving va patients are sick

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The studies were representative populations not one healthy population to a non healthy VA population. You know this (or should).

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means that anesthesia needs to be under the supervision of ologist

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Nope, in fact I have repeatedly asked why you think it should not.

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You don't think I took research classes in CRNA school?

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Well, considering your dismissal of a VA prepared comparison of data as "but our patients are sicker" kind of drives home the point that you either were not exposed to the information, failed to learn the information, or are being intentionally obtuse.

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When in actuality there is no study that proves CRNA anesthesia kills va patients with comorbitites

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You noted multiple times that CRNA do 65% plus of anesthesia. Anesthesia is integral part of every surgery. Patient outcome rates in VA are worse with surgical conditions as listed above.

Why is making a change that may, or may not, make a difference in that higher complication rate inside a specific institution such an issue with you?

That still does not answer why you don't want an anesthesiologist to be supervising you when you already have to have physician supervision.

Your understanding of anesthesia related complications is flawed also with Asa III and IVs complications are prepared for and expected.

With Asa Is and IIs they are unexpected and therefore more dangerous because you shouldn't have complications in this population.

Wanna hear something crazy....I learned that from an anesthesiologist.

The neverending thread....

Until 3pm. Everyone's an expert after 3. "I'm going home. Call me if you need anything."