- Joined
- Sep 15, 2016
“Here’s a prescription of PREP while you’re at it, and if you have two credit cards, give me the one with the highest limit and lemme hold on to it for ya, till the next visit. See you in a month!”
Nurse practitioner delusion / "Noctors" / "Midlevel staff" - Nurses get a 1 year degree and start thinking they are better than doctors
- Thread starter Christopher Robin
- Start date
“Here’s a prescription of PREP while you’re at it, and if you have two credit cards, give me the one with the highest limit and lemme hold on to it for ya, till the next visit. See you in a month!”
- Joined
- Apr 6, 2019
PMHNPs- NPs who specifically treat psychiatric issues- are a true sign of what low regard our system has for mental health problems.
These are human pez dispensers, created to dole out medications according to an app with an algorithm, to line pharma's pockets without forcing any real medical professionals to dirty their hands.
These are human pez dispensers, created to dole out medications according to an app with an algorithm, to line pharma's pockets without forcing any real medical professionals to dirty their hands.
- Joined
- Aug 29, 2018
Yeah it's awesome.
Half my colleagues are faking panic disorder to get Xannies from a PMHNP. Other half's on Adderall. Love them algorithms and poor decision making.
- Joined
- Apr 30, 2021
Wouldn't that cause mania in someone with bipolar? I guess that's the joke?
- Joined
- Aug 29, 2018
Yeah. Even St. John's Wort will do it sometimes.
A lot of patients figure out they're bipolar when they're prescribed an antidepressant and fly into a manic episode...
- Joined
- Sep 5, 2019
Where would one procure the services of such a dispenser, exactly? Can you do it online?
- Joined
- Aug 29, 2018
Uhhh did you see what happened with Cerebral?
They may have calmed down since the feds are investigating them but otherwise it was fully staffed with FNPs and they'd just give you whatever you wanted.
- Joined
- May 12, 2021
With Covid it’s becoming easier, pill mills abound, but you generally have to show up in clinic with some sort of ‘issue’, though many low level psychiatric illnesses are easy to fake, like anxiety disorders. These people aren’t monitoring you 24/7, so it’s all based off of what you tell them. Benzos are exceptionally easy to get this way.
On the topic of NPs though. My cousin was a mid level nurse back home in a rural hospital. There is a doctor shortage there, as most doctors are educated in places like Europe or Egypt and have little incentive to return to a country with shaky foundations to treat Saif, who lives in the middle of bumfuck and just had his camel kick his teeth in. So naturally nurses fill a lot of positions that doctors should be taking instead. At my cousin’s hospital there is one doctor, and he retires for the evening shift, leaving the patients in the care of the orderlies and nurses. Now, she said that this isn’t all that bad considering he visits each patient (about 12 at capacity) each evening and types up a detailed care plan every night, one that a toddler could follow, and tells them to call him if anything starts looking drastic or if someone comes into the ED (he lived two houses down in the village). The issue was that after dark the lead nurse took over, and in her mind she magically became Doctor. My cousin has complained that Dr. Nurse would look at the care plans and then drastically change them, all the way down to meds. Once my cousin got pissed off when Dr. Nurse had scratched off blood pressure medication from one of her patient’s charts claiming ‘shortages’, even though the pharmacy stays fully stocked. When she confronted Dr. Nurse she said ‘This is a village hospital, people come here to die, that is all.’ My cousin eventually left the nursing profession after seeing some shit, can’t say I blame her.
- Joined
- Aug 29, 2018
This is actually fairly common in rural hospitals in the US too.
We had a really persistent problem with nurses trialing extubation at night when nobody was around.
- Joined
- May 12, 2021
Funny you mention that, because she said the exact same thing. It was always on patients who were at ‘the end’ of their stay, but she said she saw cases of hypoxemia and aspiration pneumonia as a result of nurses trying things on their own. Though she said the ‘swing bed’ type situations for wound care was the absolute worst.
- Joined
- Jan 30, 2015
Last edited:
- Joined
- Feb 25, 2021
Nothing to do with racial justice, but the magazine that hit my mailbox a week or so ago had this banger in it:
How can we reassure patients that we’re listening?
It's by a clipboard nurse who wanted to raise her facility's scores, and asked a bunch of over-50s what they wanted.By: Nancy E. Loos, PhD, RN, PHN, NE-BC
I believe that you’d want to know what those behaviors are so you can avoid them, just as you want to know which behaviors have therapeutic effects. The best way to know how patients, from their vulnerable position, perceive our actions is to ask them.
The issue I faced was extremely low nurse listening scores and a mandate to raise them quickly. I looked to the literature and found almost nothing on the subject, especially in a setting with patients and nurses. That challenged me to do my own research.
In a 2018, institutional review board–approved qualitative study, published as a dissertation in partial fulfillment of requirements for my PhD in nursing, I interviewed a group of adults (≥50 years old) recently discharged (≤6 months before) after an inpatient stay on a medical/surgical or telemetry unit. I asked the following questions:
Below I’ve listed answers (actual patient quotes) to the fourth question (What advice do you have for nurses as it relates to listening?). For clarity, I’ve placed behaviors in one of eight categories (make a connection, trust, patient environment, listening, time, patient perspective, what nurses should do, and what nurses shouldn’t do). Some of the behaviors listed may surprise you, but participants consider all of them to be listening-related.
Make a connection
According to the study participants, patients thrive when their connection with the nurse occurs early in the relationship. Once trust is established, patients are more likely to share information, partner in their care, and feel they can rest knowing someone is advocating for them.
Since first being included in the Gallup Honesty and Ethics poll in 1999, nurses have topped the list in all but one year—2001 when, not surprisingly, firefighters edged out nurses. I believe nurses rise to the top, in part at least, because we continually strive to be better. In our quest to provide the best possible care, I believe we need to ask patients how our behaviors convey (or don’t convey) listening. Those who participated in the study and shared their experiences provided us with insight into how patients view our behaviors and what we can do to enhance their healing journeys.
Nancy E Loos is the quality and patient safety program manager at Dignity Health – Northridge Hospital Medical Center in Northridge, California.
Let’s ask them.
Takeaways:- Nurses want to know how their behaviors impact care and how patients perceive them.
- According to research, 95% of patients believe being listened to is very or extremely important.
- The best way to know patients perceive nurse actions is to ask them.
I believe that you’d want to know what those behaviors are so you can avoid them, just as you want to know which behaviors have therapeutic effects. The best way to know how patients, from their vulnerable position, perceive our actions is to ask them.
Listening and the patient experience
My interest in this topic began as a result of a clinical issue I faced years ago as a nursing director when hospitals started measuring patient satisfaction. At that time, we took a prospective look at care (Did we meet your expectations?) rather than a retrospective look at the patient experience (Did we do what we said we were going to do?), as we do now. Nurse listening is tied strongly to patient outcomes, making it an important item in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. According to work by Wolf, 95% of patients (consumers) believe being listened to is very or extremely important—even a higher percentage than that for speedy pain relief. (See Patient experience matters.)
The issue I faced was extremely low nurse listening scores and a mandate to raise them quickly. I looked to the literature and found almost nothing on the subject, especially in a setting with patients and nurses. That challenged me to do my own research.
In a 2018, institutional review board–approved qualitative study, published as a dissertation in partial fulfillment of requirements for my PhD in nursing, I interviewed a group of adults (≥50 years old) recently discharged (≤6 months before) after an inpatient stay on a medical/surgical or telemetry unit. I asked the following questions:
- Which nurse behaviors implied listening had occurred?
- Which nurse behaviors implied listening had not occurred?
- How did the perception of listening and non-listening affect you, both in and beyond the hospital?
- What advice do you have for nurses as it relates to listening?
Below I’ve listed answers (actual patient quotes) to the fourth question (What advice do you have for nurses as it relates to listening?). For clarity, I’ve placed behaviors in one of eight categories (make a connection, trust, patient environment, listening, time, patient perspective, what nurses should do, and what nurses shouldn’t do). Some of the behaviors listed may surprise you, but participants consider all of them to be listening-related.
Make a connection
- “Engage us more so we will open up and tell you things that could help you care for us.”
- “Get to know us on a personal basis. It creates a personal bond of trust, and we will believe you more and answer your questions better.”
- “Do a proper introduction.”
- “Understand that part (maybe the most important part) of the healing process is connection, the presence that a care provider should have with a patient.”
- “Look at me before you look at the computer.”
- “Try to get to know us as individuals.”
- “Ask us how we are (it could affect how we respond).”
- “Control pain and give what is ordered (on time); don’t skimp—it builds trust.”
- “It is the nurse’s job to protect patients and bring them through with as much comfort as possible and create a trusting relationship.”
- “Listening builds trust.”
- “After moving patients around, leave them and their things as you originally found them.”
- “Take in the entire environment when you listen.”
- “When the patient uses the call light, there’s a reason. Please take it seriously.”
- “Be aware of sleeping patients at night, and curtail the laughing and talking where we can hear you.”
- “Listening brings out compassion.”
- “When you’re distracted, you’re only partially listening.”
- “The most crucial part of your job is listening to patients. To excel, you must first listen, then process what you hear, and then act.”
- “Nurses are no good to anybody if they don’t understand what the patient is saying or what the problem is. You must be listening.”
- “When you listen, I believe you will advocate for me.”
- “Spend just a little more time with the patient (Sorry…we know you’re busy!).”
- “Take a few minutes to get to know us a little bit.”
- “Take a few minutes to get some rapport going and your shift would be a lot nicer.”
- “Just because my body has failed doesn’t mean my mind has.”
- “Patients do not fit into a one-size-fits-all basket.”
- “I am not going to say something unless there’s something I really need.”
- “We are individuals—we don’t express ourselves exactly like you might.”
- “What we need to know is that we’re going to be ok and what to expect, even if it’s unpleasant.”
- “Listening puts patients at ease.”
- “We sense whether we’re getting cared for or not.”
- “Patients are fearful of the unknown.”
- “The most important thing for patients’ ‘satisfaction’ is whether the patients feel like human beings and that they matter.”
- “Understand that every patient is different; if you give us compassion, we will get well quickly.”
- “Be respectful.”
- “Sit down, even briefly.”
- “Look at the patient (me).”
- “Use kind words; they go a long way.”
- “Just touch someone and make sure he or she is ok.”
- “If you think my request is unreasonable, ask more questions before saying ‘no.’”
- “If I tell you something you don’t know, check it out!”
- “You can save yourself a lot of time/effort if you just do it right the first time.”
- “Repeat back what the patient said so we know you know what was said.”
- “Do as much as possible to prepare patients for what to expect since we’re not experts and have thousands of questions.”
- “Tell patients what their experience will look like; set expectations, narrate care, explain why you’re doing things, and give a full picture, not partial.”
- “Be honest.”
- “Positively impact the patient’s mental health.”
- “Treat each patient as if it is his or her first time there or find out what he or she knows.”
- “Look up from your screen, or leave the computer outside.”
- “You must invite the patient to talk to you.”
- “Lay out the plan so the patient understands it.”
- “Set realistic expectations with the patient.”
- “When the request is simple, just do whatever it takes, and you’ll avoid grief later.”
- “Present yourself as someone there to help.”
- “Ask what the best thing you can do for me is; you’ll see a difference.”
- “Partner with me in my care.”
- “Be a guide.”
- “Give excuses about why you can’t do something without looking for another way to meet the need.”
- “Make excuses; just make it happen.”
- “Disbelieve your patient; that is akin to calling them a liar.”
- “Talk down to me.”
- “Make patients feel like they’re interrupting your break or conversation when they call.”
Enhance healing journeys
The patients who responded to the survey had both good and bad interactions with nurses. Their answers told us how they want to be perceived and what they want. They want to be heard and to be “good” patients who don’t bother nurses. They also want their self-knowledge respected and incorporated into the plan of care and to have the nurse’s full attention for whatever length of time they’re together.According to the study participants, patients thrive when their connection with the nurse occurs early in the relationship. Once trust is established, patients are more likely to share information, partner in their care, and feel they can rest knowing someone is advocating for them.
Since first being included in the Gallup Honesty and Ethics poll in 1999, nurses have topped the list in all but one year—2001 when, not surprisingly, firefighters edged out nurses. I believe nurses rise to the top, in part at least, because we continually strive to be better. In our quest to provide the best possible care, I believe we need to ask patients how our behaviors convey (or don’t convey) listening. Those who participated in the study and shared their experiences provided us with insight into how patients view our behaviors and what we can do to enhance their healing journeys.
Nancy E Loos is the quality and patient safety program manager at Dignity Health – Northridge Hospital Medical Center in Northridge, California.
I don't know what it is about this writing style, and the people she's quoting, but it makes me fightin' mad.
"Look up from your screen, or leave the computer outside.” OK ANA, if we're about making Boomers happy with the medical service industry, does that mean you shits are gonna lobby to remove medication scanning as a quality measure?
“Control pain and give what is ordered (on time); don’t skimp—it builds trust.” I think what enrages me is that this is written like tips from experts, when it's just an executive taking notes directly from the worst kind of patients, nobody who actually works giving input. Who ever says "skimp" in the context of a dosage range? This isn't a cookie recipe. Grandma Karen has to be awake and breathing to get her PRNs.
I mean, at least it's not ~racial justice,~ but damn, why spend the money to print this and mail it to everyone? We already knew the ANA wasn't our side.
- Joined
- Sep 23, 2018
Look at the shadows on the heel of the hand, the reflections on the thumbnail, the way the middle finger is posed behind the forefinger… they're all the same on each hand. This is literally a single photograph of a hand, duplicated several times and posed in the shape of a heart, with some of the hands altered to appear to have a different skin tone… so some of those hands have either been whitewashed or are in the hand equivalent of blackface. Shameful.
- Joined
- Aug 29, 2018
@Aunt Carol
Hold on. Never skimp on pain meds...never assume a patient is faking anything?
Is fucking Purdue Pharma at it again
Hold on. Never skimp on pain meds...never assume a patient is faking anything?
Is fucking Purdue Pharma at it again
- Joined
- Sep 15, 2016
Kinda OT, but I never understood why some NPs/DRs/Nurses go out of their way to refuse pain treatment and bust supposed “seekers”.
1: You’re not saving anyone. Guess what. If a patient starts hitting up hospitals for pills, he’s already likely an addict.
2: You’re not helping anyone. Does anyone seriously believe their refusal makes the addict take their life up to review and make them find another hobby? Nope. He’ll steal some shit and either buy some fent on the street (in which case you’re likely to see him again for an entirely different kind of emergency) or buy some pills from an old lady who needs to deal in order to afford her 300$ Oxy ER prescription.
3: You’re probably missing out on an opportunity to help someone.
Addicts are a group that’s notoriously hard to reach for medical professionals. By being the opiate-Nazi you’re missing out on quietly pulling him aside, saying “I can’t help but notice this is the Xth time in a month you’re here for pain control…” and either help them to get into a legal dope/methadone programs or a detox program.
Yeah, addicts are gonna addict and for some reason some medical professionals take it really personally.
- Joined
- Aug 29, 2018
I used to just give them Dilaudid to get them out the door but it's a double-edged sword 'cause they'd descend on the ED like the fucking Night of the Living Dead when they saw my car in the parking lot.
Solving the opioid crisis is pretty easy because we need to make methadone clinics more accessible. Who the fuck wants to wake up at 6 AM to drive to the clinic to get your dose then get subjected to random piss tests.
- Joined
- Sep 15, 2016
Probably because the other docs liked to play opiate police. If everyone had adopted a similar attitude to yours, it might be different but I see your point.
Methadone clinics in the US, kinda like the few places in Europe that hand out actual diacetylmorphine, seem to turn being an addict into a job of sorts.
You need to show up every day, jump through all the hoops. No takehomes unless you check a multitude of boxes, etc. etc.
In Europe they tend to be more lax, and just hand out pills for a week at a time. Failing a drugtest (unless you turn out not to have methadone in your system!) isn’t the end of the world either and usually doesn’t mean termination.
Idk, I’m kinda split on methadone clinics. On one hand it’s a rational, humane way to deal with the issue.
On the other hand it’s hardly a solution to addiction, and is in reality giving up on people. You basically make a deal with them that goes: “We will be your dealer, in return you hopefully won’t commit as much crime!”
Beresford's Whip
kiwifarms.net
- Joined
- Jun 24, 2020
Part of what we ran in to ten, fifteen years ago was that the state was deciding to crack down on clinics that were writing the scripts. Everyone from normal GPs to the pill mills, didnt matter what kind of justification you had for writing them, you were most likely going to get investigated. Never really cared about busting them, we just didn't want to deal with the ever increasing hassle of it.
- Joined
- Feb 25, 2021
We went from the pharmaceutically-funded "pain is the fifth vital sign, give everyone OxyContin" to government investigation on prescribers writing for "too many" opiates, even in long-standing chronic pain patients, top-down without a plan. edit: @Beresford's Whip said it better.
Inpatient, man, if I have to sternal rub someone to get them to swallow a pill, I'm not waking them up for when their PRNs are "due." You gotta stay breathing (unless you have written permission to die).
When someone has their phone set to alarm for their PRNs availability, I'll make a note and tell the doctor, but I didn't come here to fight. Things might be a little late, but that's just a function of someone else on the team vomiting or having to get to the bathroom. If our patient population wants their opiates AS OFTEN AS LEGALLY POSSIBLE, they need to start lobbying for staffing ratios and maybe more aides.
- Joined
- Aug 29, 2018
We're on the trapezius squeeze now, keep up.
Like anyone wants to be in the hospital at 2 AM getting the fucking Vulcan nerve pinch. I worked as a nocturnist for a while and my only rule was let those fuckers sleep.