Nurse practitioner delusion / "Noctors" / "Midlevel staff" - Nurses get a 1 year degree and start thinking they are better than doctors

[Cryin RN]

An actual real-life nursing video would be hilarious.

As long as they include trying to insert a Foley into a profoundly morbidly obese man. Although I guess this would probably be a fetish too.

I *wish* a TLC show could strap a GoPro to a night nurse on a dementia ward. Or an inpatient schiz unit. The general public has no idea.

 

[Autopsy]

They're pretty fucking bad. Last study I read was around 80% deathrate (this is almost twice normal) with some ER doctors explicit that you should not ventilate covid patients because it causes their alveoli to explode.

This terrible mortality percentage may partly be because being intubated is reported as agonizingly painful even in sedated individuals.

Your first two statements are persistent myths of COVID care from early 2020. Mechanical ventilation is the point of last resort, and so "80% deathrate" is not a reasonable assessment of the utility of intubation. You can frame electrical defibrillation in the same way; the "deathrate" of patients who receive defibrillation after the first 3 minutes of collapse is 51%.
What percentage would have survived without defibrillation? Approximately 0%. Intubation has more leeway, at least in the sense that doctors can't be certain which cases will become terminal. At the same time, of that 20% success rate you are referring to, I would attribute a vast majority (18%+) to intubation saving people what would otherwise simply die without it. Could this rate of success be increased? Yes, but that does not mean that the act of mechanical ventilation itself is causing the problem. In fact, many health systems did identify early problem of low success rate of mechanical ventilation care, and they used divergent tactics with intubated patients to try to solve it.

For this reason, studies on this subject have dramatic ranges in mortality, with a lot of that mortality having to do with the complex disease state advanced COVID present, and the difficulties of medical teams in addressing it. Even in the 2020 period, many health systems showed extremely high variance in outcomes, such as that one flipping the "80% deathrate" on its head. Though it's hard to distinguish a low mortality rate on vents from a health system that is over-intubating patients, there's really not much cause for such extreme pessimism.
The article you linked in particular was a major source of this misinformation in early 2020, because the headline and a few quotes imply something the details and source material don't, and skimming may confuse readers as to what is even being said. Here are some choice quotes from the article itself that re-iterate my points so far:

Doctors like Kyle-Sidell (who TIME could not reach for comment) argue these numbers are so high because physicians are ventilating patients as though they have a condition called acute respiratory distress syndrome (ARDS), when they in fact have a different type of lung damage that may not respond well to mechanical ventilation.

Note that this does not actually claim the vents are causing the problem, only that the problem was "misdiagnosed" and vents were not sufficient to correct the problem. His concerns are purely with optimization of care, and mostly relies on using intubation, simply in a different way. That's right: Doc Alveoli Explodes is saying that he wants people on vents. You can verify this yourself by simply watching the video, it's only six minutes.
His wanton speculation that the ventilation and high PEEP was causing the ARDS symptoms in and of itself was both flippant and premature. It's clear at this point that ARDS in COVID patients is entirely present in patients with or without ventilation in the late stages, that pressure is still a component of care, and that you still need at least moderate PEEP to keep these patients alive. This is true even if you add in HFNO, as he has taken to advocating. Dr. Kyle-Sidell was by no means alone in his observations or speculation even in 2020, but he is unique in the since that of the many physicians saying similar things, only he was (almost maliciously) quoted as the vents-make-your-lungs-explode guy, and he continues to be quoted as such- not for anything else he said, frankly. That puts a great deal of responsibility on his head, because you can't just make inflammatory claims like that willy nilly if you are putting the weight of your position and the public trust behind it. Medical communications is fucking hard. The press will stop at nothing to find a single doctor saying something stupid they can quote to write a dozen hysterical headlines, and the same goes for conspiracy theorists.

Yes, some health systems likely saved fewer patients than they could have by using conventional tactics for treating ARDS. No, it was not every health system. No, this outcome was not obvious or proven from the outset. This is the fallout of a country getting hit by a new, dare I say "novel" disease, which was spreading way too fast in a country that moves way too slow. If you ever want to shout at someone for doctors clinging too tightly to "traditional, guideline treatments," start with the dangers of the feds getting involved first, fear of doing harm second, and ego/stubbornness in a distant, distant third. There are good reasons not to be adventurous in medicine, even if most of them have to do with law enforcement.
Following that thought, some more perspectives from back in 2020:

“You have really sick people, [while] the people who have the best training are in short supply and ventilator management is not simple,” Hill says. If a dedicated lung specialist were available for each patient, he believes, outcomes would probably be better. [...] High ventilator mortality rates in New York City suggest “a health care system failing, and not a ventilator hurting people,” Hill says.

Dr. Ken Lyn-Kew, a pulmonologist at National Jewish Health in Colorado, agrees that there are some differences between classic ARDS and COVID-19, but he emphasizes that there’s a lot of variation among COVID-19 patients he’s treated. He says most still meet the criteria for an ARDS diagnosis. In his view, coronavirus patients likely have ARDS plus other issues, but they still have ARDS. [...] “The world is not a dichotomous, black-and-white place, but a lot of people are having trouble with that,” Lyn-Kew says. “We might be able to do better, but in the absence of data on the way to do that, we need to follow our societal guidelines and 25 years of research.”

These were not unreasonable opinions or evaluations at the time, and they are vindicated today.

Now that's out of the way, stress is a very real factor in disease and patient QOL is a priority for this reason. The study you cited is a very small retrospective study and while there is recorded trauma, they relate to the process of being intubated, as in, before the sedation was total*. These patients have presumably recovered since they were intubated, considering the fact they were capable of being interviewed, so they may not be the most conclusive measure on whether or not the stress of intubation at the time is affecting disease prognosis. An appropriate study would build on this suspicion by requesting data be collected on, or at least collect preexisting data for these four things:

1. Clinical outcomes of mechanical ventilation in COVID,
2. Timing of sedation,
3. Degree of sedation,
4. Dosages of sedative (or analgesic combinations)

Anything before such a study is run is still speculation, but I do agree it's a legitimate concern.

 

[Slobber Mutt]

didn't read all that shit doctor shlomo.

 

[Nate Higgers]

didn't read all that shit doctor shlomo.

Based and notmyproblem-pilled

 

[greenvector36]

The absolute state of modern medicine.

 

[haunted vagina]

I've never met a nurse who wasn't at least one of insane, treading water in their job until they could marry a cop, or if they were actually good at their career, able to find some way to completely burn their personal lives on their off-hours.

The two most medically competent and emotionally normal nurses I know are married to each other, have been working in mandatory-overtime ER positions for decades making $250K a year combined, and somehow have a negative net worth and are enrolled in all sorts of assistance programs because they cannot handle their money at all. They don't have a nice house or 5 new pickup trucks on financing, it's like they're just throwing their paychecks in a hole.

 

[Hurgle Blurk]

I've never met a nurse who wasn't at least one of insane, treading water in their job until they could marry a cop, or if they were actually good at their career, able to find some way to completely burn their personal lives on their off-hours.

I have.

Unfortunately, all of them are now in their 70s and have retired.

 

[John Andrews Stan]

I don’t know if it’s still this way, but a lot of nursing programs used to make you do your clinicals in nursing homes to sort the serious students from the fantasists. Only the serious ones would stick it out to dig impacted shit out of old men’s asses, treat old ladies’ yeast infections, and clean up all the nutters who play with their own poop and pee like they’re getting paid for making the biggest mess.

From what I’ve seen, the care part of healthcare has been cast aside in nursing programs over recent years. Only those with natural empathy and genuinely caring dispositions seem to display it these days.

Spoiler: Mild PL

During a lengthy hospital stay where I was on bed rest, I finally had a nurse come in to change my sheets. She was so legitimately caring that I realized just how shitty all the other nurses had been. When I told a doctor friend (who also worked at that hospital) about this nurse, she said, “Oh yeah, they don’t make nurses like her anymore. She’s the last of that kind.” I’m very tempted to send her the link to this thread.

 

[Aunt Carol]

I don’t know if it’s still this way, but a lot of nursing programs used to make you do your clinicals in nursing homes to sort the serious students from the fantasists. Only the serious ones would stick it out to dig impacted shit out of old men’s asses, treat old ladies’ yeast infections, and clean up all the nutters who play with their own poop and pee like they’re getting paid for making the biggest mess.

Nursing program here requires a CNA license before you apply to the program, so that bakes in those nursing home clinicals as well as hopefully not having to teach students how to take vitals. CNA time worked gets points on the application, but I've forgotten how many hours the increment is.



One of the problems in hospital nursing is that if Management catches wind of patient dissatisfaction, they will cheerfully "fix" it by sending out an email and assigning more charting to the nursing staff.

Patients need more nurse attention -> [black box for Management thinking process] -> add more mandatory computer charting of having given said attention. There's a contingent of nurses who need their butts pried out of the station, but someone like your nice nurse is usually clocking out and finishing her shift charting for free. This doesn't even touch things like routine care or someone's condition deteriorating or a goddamn fire drill.

It blows for patients and for people who signed up because they like Helping People Get Better. Dunno what the answer is, but for a lot of bedside nurses the answer is either home hospice or "get my DNP and get away from bedside."

 

[Christopher Robin]

In my country children learn about Alexander Fleming and his discovery of penicillin at the age of 12. They officially have a better medical education than this NP influencer. Why is this something you would want to bring up if not in an attempt try to normalise being a retard and relying entirely on your computer for diagnosing and prescribing?

 

[eternal dog mongler]

In my country children learn about Alexander Fleming and his discovery of penicillin at the age of 12. They officially have a better medical education than this NP influencer. Why is this something you would want to bring up if not in an attempt try to normalise being a retard and relying entirely on your computer for diagnosing and prescribing?

I'm pretty sure this stuff is on the actual NP exams so I think she's just making this up which is even weirder.

 

[Thirsty Kitty]

If she's just making that up its weird, but if she literally forgot one of the most important drugs there is, thats awfully telling

 

[Christopher Robin]

2022 reminder that these people are sharing intimate patient details on fucking Facebook and are crowdsourcing diagnoses and treatments as if they are sharing guacamole recipes or asking for coding advice on stack exchange.



I'm sure this inspired a lot of confidence. 'Hold on hun! Let me take a real quick picture so I can ask my friends on facebook what they think'



Stupid ~12 years of training psychiatrist knows nothing compared to a strong powerful 2 year NP Nubian queen. As if SSRIs aren't bad enough - no, lets get a 14 year old girl on 2 strong antiepileptic drugs at the same time! Why? Because risk factors due to family history are the only proof necessary! It's called a hunch, oldest of doctors, get ready for the new wave of medicine!




She need a get off da couch med the lazy old bitch! Who gives a fuck that she is 76 and her husband just died, there is no way this reaction is in the realm of normality, and has a solution based on emotional support. How many drugs can I give her?



'Elite' nurse practitioner prescribes for herself (already dodgy territory) and doesn't check the dosage of her pills until a week passes and realises she has been doubling her dosage. If this is the level of care they take when looking after themselves, I'm sure they put 10x times the effort into random patients.




Hi Friends! What happens in urgent care? I don't even need to comment on this one.

 

[Aunt Carol]

2022 reminder that these people are sharing intimate patient details on fucking Facebook and are crowdsourcing diagnoses and treatments as if they are sharing guacamole recipes or asking for coding advice on stack exchange.

I expect some lazy Internet brushing-up from anyone, but it's amazing that these people are doing this on Facebook, under their full names.

If you're going to fake it 'til you make it, get better at faking it.

Stupid ~12 years of training psychiatrist knows nothing compared to a strong powerful 2 year NP Nubian queen. As if SSRIs aren't bad enough - no, lets get a 14 year old girl on 2 strong antiepileptic drugs at the same time! Why? Because risk factors due to family history are the only proof necessary! It's called a hunch, oldest of doctors, get ready for the new wave of medicine!

Well, at least she didn't try to troon the kid out. I'm glad there's a psychiatrist overseeing here.

I hate saying this, but jeez, this is exactly the sort of thing that government regulations are meant to standardize.

 

[Catmannjew]

Imagine instead of a group therapy or pamphlets. You immediately jump to "get off the couch meds" for your geriatric patient, whose husband just passed.

 

[Aunt Carol]

Imagine instead of a group therapy or pamphlets. You immediately jump to "get off the couch meds" for your geriatric patient, whose husband just passed.

This might be more of a "welcome to America" thing.

Loosest slots in town for getting pills; jeez.

 

[eternal dog mongler]

This might be more of a "welcome to America" thing.

The US takes like 25% of the world's prescription drugs. It's pretty wild.

"Get off the couch med" is hilarious though. Is she a fucking time traveler from the 70s? We don't throw amphetamines at grandma anymore.

 

[Dan Abrams]

2022 reminder that these people are sharing intimate patient details on fucking Facebook and are crowdsourcing diagnoses and treatments as if they are sharing guacamole recipes or asking for coding advice on stack exchange.

View attachment 3055875

I'm sure this inspired a lot of confidence. 'Hold on hun! Let me take a real quick picture so I can ask my friends on facebook what they think'

View attachment 3055873

Stupid ~12 years of training psychiatrist knows nothing compared to a strong powerful 2 year NP Nubian queen. As if SSRIs aren't bad enough - no, lets get a 14 year old girl on 2 strong antiepileptic drugs at the same time! Why? Because risk factors due to family history are the only proof necessary! It's called a hunch, oldest of doctors, get ready for the new wave of medicine!


View attachment 3055876

She need a get off da couch med the lazy old bitch! Who gives a fuck that she is 76 and her husband just died, there is no way this reaction is in the realm of normality, and has a solution based on emotional support. How many drugs can I give her?

View attachment 3055879

'Elite' nurse practitioner prescribes for herself (already dodgy territory) and doesn't check the dosage of her pills until a week passes and realises she has been doubling her dosage. If this is the level of care they take when looking after themselves, I'm sure they put 10x times the effort into random patients.


View attachment 3055892

Hi Friends! What happens in urgent care? I don't even need to comment on this one.

This is embarrassing. Imagine thinking you can diagnose and treat patients on the same level as a doctor while you ask shit on Facebook that an entry level RN should know (fucking up your own medication math in the 4th pic, lol, im basically a doctor btw). The second one you can tell she just looked up those meds on Clinical Pharm or somewhere and has no real life experience with them (reminds me of the NP who refused to let me give a healthy 24 year old with nausea/vomiting Zofran "because it increases the QT interval"). I also had a dumbass NP tell me to turn off the Precedex drip on an otherwise agitated and combative patient because they were "bradycardic" (HR 56, asymptomatic, good BP). It's a side effect of the medication you retard.

The latest round of my coworkers where I work are lining up to get into NP school like fucking everyone else. Letting some of these people play pretend doctor is truly terrifying. Even more terrifying are the people who get their Master's in Nursing as a new grad nurse and go directly to NP school. They quite literally have no idea what they're doing.

 

[Mariposa Electrique]

This is embarrassing. Imagine thinking you can diagnose and treat patients on the same level as a doctor while you ask shit on Facebook that an entry level RN should know (fucking up your own medication math in the 4th pic, lol, im basically a doctor btw). The second one you can tell she just looked up those meds on Clinical Pharm or somewhere and has no real life experience with them (reminds me of the NP who refused to let me give a healthy 24 year old with nausea/vomiting Zofran "because it increases the QT interval"). I also had a dumbass NP tell me to turn off the Precedex drip on an otherwise agitated and combative patient because they were "bradycardic" (HR 56, asymptomatic, good BP). It's a side effect of the medication you retard.

The latest round of my coworkers where I work are lining up to get into NP school like fucking everyone else. Letting some of these people play pretend doctor is truly terrifying. Even more terrifying are the people who get their Master's in Nursing as a new grad nurse and go directly to NP school. They quite literally have no idea what they're doing.

Yup, it's dumb. NPs are basically oversaturating their own market. I got my doctorate last year, and I'm working in a leadership/ teaching roll to train NPs along side a physician. Some of these students are extremely ghetto and low life's, who had no business becoming nurses.

 

[Agent Abe Caprine]

The US takes like 25% of the world's prescription drugs. It's pretty wild.

"Get off the couch med" is hilarious though. Is she a fucking time traveler from the 70s? We don't throw amphetamines at grandma anymore.

Yeah. We throw meth at toddlers now.