Current Events > I think being a Doctor is the hardest job in the whole world...

(+) Yeah! (+)

Nurses aren't given nearly enough physiology, pharmacology and pathology education to make complex medical decisions. That's not to say they can't question the doctor - that's good medicine. But like I said before, I had a nurse order a medication under my name that very well could've killed a patient because she had never heard of a QT interval. There are tons of fine details you have to know to practice medicine.

You don't immediately do a lumbar puncture in someone you suspect of meningitis. You have to check for brain edema and swelling, or you might cause a brain herniation and instant death due to the sudden drop in CSF pressure. That's life or death knowledge.

How do you treat someone who has critically low sodium? Give them salt? That's usually the wrong answer 99% of the time. In fact you may actually kill them if you do that. Sodium is usually an indicator of volume status, and it requires a good amount of knowledge of electrolyte abnormalities to understand what it means. You can cause brain death or locked-in syndrome by overcorrecting the sodium too quickly. This is the kind of stuff they don't teach nurses.
---

Coffeebeanz posted...

How do you treat someone who has critically low sodium? Give them salt? That's usually the wrong answer 99% of the time. In fact you may actually kill them if you do that. Sodium is usually an indicator of volume status, and it requires a good amount of knowledge of electrolyte abnormalities to understand what it means. You can cause brain death or locked-in syndrome by overcorrecting the sodium too quickly. This is the kind of stuff they don't teach nurses.

When it comes to electrolyte balance, the only thing I remember from my nursing education (Switched fields) was my pharm professor basically telling us "If you give IV Potassium I will hunt you down and murder you."
---

DrizztLink posted...

Coffeebeanz posted...

How do you treat someone who has critically low sodium? Give them salt? That's usually the wrong answer 99% of the time. In fact you may actually kill them if you do that. Sodium is usually an indicator of volume status, and it requires a good amount of knowledge of electrolyte abnormalities to understand what it means. You can cause brain death or locked-in syndrome by overcorrecting the sodium too quickly. This is the kind of stuff they don't teach nurses.

When it comes to electrolyte balance, the only thing I remember from my nursing education (Switched fields) was my pharm professor basically telling us "If you give IV Potassium I will hunt you down and murder you."

His was probably saying you shouldn't give an IV push of potassium. You can give potassium IV, but only over time mixed with NS.

A push of IV potassium is also known as "how a lot of states execute people"
---

CensorErik posted...

Here's a little fun fact for you, nurses do the bulk of the work the doctors get praised and paid for.

Thats ridiculous. Its akin to saying construction workers do the bulk of the work that architects get praised and paid for.

Nurses do the grunt work that doctors dont have time to do because they are actually planning and overseeing courses of treatment for their many patients, something nurses cannot do.
---

I miss the days when I knew absolutely nothing about medicine, so I had no idea how deep that rabbit hole went. When I was accepted to medical school I thought I was hot shit. Opening that Pandora's Box means a lifetime of realizing just how little you know. It is legitimately terrifying to see people on CE discuss psychiatric meds based on their feelings without any heed to what they could be doing to themselves.
---

Coffeebeanz posted...

Nurses aren't given nearly enough physiology, pharmacology and pathology education to make complex medical decisions. That's not to say they can't question the doctor - that's good medicine. But like I said before, I had a nurse order a medication under my name that very well could've killed a patient because she had never heard of a QT interval. There are tons of fine details you have to know to practice medicine.

You don't immediately do a lumbar puncture in someone you suspect of meningitis. You have to check for brain edema and swelling, or you might cause a brain herniation and instant death due to the sudden drop in CSF pressure. That's life or death knowledge.

How do you treat someone who has critically low sodium? Give them salt? That's usually the wrong answer 99% of the time. In fact you may actually kill them if you do that. Sodium is usually an indicator of volume status, and it requires a good amount of knowledge of electrolyte abnormalities to understand what it means. You can cause brain death or locked-in syndrome by overcorrecting the sodium too quickly. This is the kind of stuff they don't teach nurses.

At the hospital my friend works at, nurses can't order drugs under anyone's name. Doctors have to input all drug orders.
---

Nurses do about 7 years of school, doctors do 12(13?) I believe, correct me if I'm wrong please.

Nurse practinoers are around 10 I believe.
---

pres_madagascar posted...

Nurses do about 7 years of school

The Bachelor's of Nursing program at UNM takes 4 years and it's one of the top in the nation.
---

DrizztLink posted...

pres_madagascar posted...

Nurses do about 7 years of school

The Bachelor's of Nursing program at UNM takes 4 years and it's one of the top in the nation.

Best one in my state takes 7, it's weird I guess.
---

pres_madagascar posted...

DrizztLink posted...

pres_madagascar posted...

Nurses do about 7 years of school

The Bachelor's of Nursing program at UNM takes 4 years and it's one of the top in the nation.

Best one in my state takes 7, it's weird I guess.

That's hands down an outlier. BSN programs are more like 2 yrs not including pre-reqs, which take about 4 semesters in undergrad. All in all a typical BSN, which is the least restricted RN, training period lasts about 4 yrs after high school.

MDs/DOs are 4 yrs undergrad, 4 yrs med school, 3-7 yrs residency based on specialty, +/- extended subspecialty training as a fellow.

So, your unspecialized pediatrician is out practicing 11 yrs from high school. Your neurosurgeon who specializes in brainstem and basal skull is out practicing 16 yrs after high school. Your RN is out anywhere from 1 to maybe 5 yrs after high school depending on degree, but admittedly this discounts CRNAs and NPs.
---

megamanfreakXD posted...

Honestly, being a MS4 and literally like 1 month before match day, I still suck at doing nursing scutwork. I don't know how I would survive in a NYC hospital where the nursing staff is well known to be trash (because of the nursing union).

I have never placed a foley or drawn an ABG myself. But I have removed a foley safely once.

But @Antifar said unions are good
---

pres_madagascar posted...

Coffeebeanz posted...

Nurses aren't given nearly enough physiology, pharmacology and pathology education to make complex medical decisions. That's not to say they can't question the doctor - that's good medicine. But like I said before, I had a nurse order a medication under my name that very well could've killed a patient because she had never heard of a QT interval. There are tons of fine details you have to know to practice medicine.

You don't immediately do a lumbar puncture in someone you suspect of meningitis. You have to check for brain edema and swelling, or you might cause a brain herniation and instant death due to the sudden drop in CSF pressure. That's life or death knowledge.

How do you treat someone who has critically low sodium? Give them salt? That's usually the wrong answer 99% of the time. In fact you may actually kill them if you do that. Sodium is usually an indicator of volume status, and it requires a good amount of knowledge of electrolyte abnormalities to understand what it means. You can cause brain death or locked-in syndrome by overcorrecting the sodium too quickly. This is the kind of stuff they don't teach nurses.

At the hospital my friend works at, nurses can't order drugs under anyone's name. Doctors have to input all drug orders.

actually they do teach you information of this complexity if you work in an area where it's most pertinent. Additionally, electrolyte abnormalities in general are important to know for any nurse worth their salt (pun intended).
---

FLUFFYGERM posted...

megamanfreakXD posted...

Honestly, being a MS4 and literally like 1 month before match day, I still suck at doing nursing scutwork. I don't know how I would survive in a NYC hospital where the nursing staff is well known to be trash (because of the nursing union).

I have never placed a foley or drawn an ABG myself. But I have removed a foley safely once.

But @Antifar said unions are good

Well, if there aren't unions to ensure safe staffing, then you'll be dealing with some really bitchy, crabby, overworked nurses that don't give a damn what you want or don't want because they're in an ICU with 3 patients who are all critically ill and should be 1:1 assignments.
If you give a shit about patient safety, you need unions and/or similar organizations to push for adequate staffing and healthier job environments.
---

All this argument aside, I think that doctors have shitty schedules, and I'm happy with my 3 day work weeks as (almost) a nurse. I see what the doctors have to deal with, and the complexity of their decisions on loads of 20+ patients.
I like being able to go home and leave work at work. It's not that I don't care, it's that I don't have the mental cycles needed to deal with all the other bs that comes with being a physician. (Plus, I don't have money to go to med school sooooo)

And, no, someone out of high school for 1 year can't possibly be a nurse. Nursing assistant, maybe.
I chose to get my BSN, which is taking 4 years, I'm going back to get my Master's, and then, DNP. This could be a total of 10 years, depending on if I go to grad school immediately. However, my 10 years is nowhere near even close to what an actual physician receives in even 4 years in med school, and I respect that.
Midlevel providers (NPs, PAs) are another issue altogether, and I personally don't believe that they should have the same autonomy as MDs. NP education does tend to be subpar to that of a PA, which should change.
---

I haven't read most of these posts but I can tell you I've had to argue with nurses many times and almost every time I was right. One nurse was arguing with me about I don't need to check an abg on the patient because she's fine and it'll just cause her pain. I had the RT do it and the pH wasn't like 7.0 and I ended up upgrading the patient to the ICU.
---

DanHarenChamp posted...

I haven't read most of these posts but I can tell you I've had to argue with nurses many times and almost every time I was right. One nurse was arguing with me about I don't need to check an abg on the patient because she's fine and it'll just cause her pain. I had the RT do it and the pH wasn't like 7.0 and I ended up upgrading the patient to the ICU.

I'd say there is unfortunately a broad difference in knowledge from a floor nurse and an ICU nurse.
---

joestarrr posted...

DanHarenChamp posted...

I haven't read most of these posts but I can tell you I've had to argue with nurses many times and almost every time I was right. One nurse was arguing with me about I don't need to check an abg on the patient because she's fine and it'll just cause her pain. I had the RT do it and the pH wasn't like 7.0 and I ended up upgrading the patient to the ICU.

I'd say there is unfortunately a broad difference in knowledge from a floor nurse and an ICU nurse.

It was an ER nurse.

I've worked a lot with ICU nurses and yes, they are vastly better than any other nurse.
---

Soviet_Poland posted...

pres_madagascar posted...

Nope. Multiple family members are nurses in hospitals. Lots of lazy doctors who hate being disturbed.

With all fucking due respect, you have absolutely zero clue over the magnitude of considerations even a single patient has with regards to their management. There is a reason rounds every day takes hours just to discuss the previous day's course and the day's plan for every patient on service. Part of it is the medical education hierarchy of it, but seriously, if nurses thought they could do a doctor's job they'd literally murder half the patients on service because of the slightest oversight.

Nurses are incredibly important and a doctor couldn't do their job efficiently without them. But there is something to be said about carrying out orders as opposed to coming up with them yourself.

It's the whole tip of the iceberg effect and you don't know what you don't know. And that's fucking dangerous.

Same could be said about doctors.

This is one big ego trip topic, enjoy your day.
---

CountDog posted...

Soviet_Poland posted...

pres_madagascar posted...

Nope. Multiple family members are nurses in hospitals. Lots of lazy doctors who hate being disturbed.

With all fucking due respect, you have absolutely zero clue over the magnitude of considerations even a single patient has with regards to their management. There is a reason rounds every day takes hours just to discuss the previous day's course and the day's plan for every patient on service. Part of it is the medical education hierarchy of it, but seriously, if nurses thought they could do a doctor's job they'd literally murder half the patients on service because of the slightest oversight.

Nurses are incredibly important and a doctor couldn't do their job efficiently without them. But there is something to be said about carrying out orders as opposed to coming up with them yourself.

It's the whole tip of the iceberg effect and you don't know what you don't know. And that's fucking dangerous.

Same could be said about doctors.

This is one big ego trip topic, enjoy your day.

It is.. and I wish I could keep this alive alive a little bit more for people who need some info that might come in handy
---

Made a handy reference chart


---

Coffeebeanz posted...

Made a handy reference chart

This is amazing
---

So... where do midlevels fall under on that?

Also, the dick stroking is strong in this topic. Holy fuck.
---

Coffeebeanz posted...

Made a handy reference chart

lol
---

joestarrr posted...

So... where do midlevels fall under on that?

Also, the dick stroking is strong in this topic. Holy fuck.

About the same as residents. Maybe slightly more confident.
---

this is about doctor who right
---

Pretty much

-regenerates-
---