Nurses Masquerading as Doctors
The growing shortage of medical doctors, which will be made much worse by health care reform, will mean more and more patients are cared for entirely by “nurse specialists” and nurse practitioners, instead of physicians. Nurses are lobbying for increased prescribing privileges and for the right to be addressed as “doctor” in health care settings.This substituting of nurses for physicians is evidence of a two-tiered system of health care in America sure to become more obvious in the wake of Obama-care.
People who can afford to bypass insurance altogether and simply pay to see doctors will increasingly do so. Why? It’s simple: Doctors go to medical school, which is much more rigorous academically and intellectually than nursing school. They also were admitted to medical school, which is a much more competitive process than being admitted to nursing school. The average doctor has more training, relevant experience and raw intellect than the average nurse–period.
Saying such things plainly isn’t popular, of course. The fact that the health insurance premiums of Americans won’t even get them access to the minds of doctors in many clinics and ERs and even ORs (where nurse anesthetists work behind gowns and masks, just like anesthesiologists) is one of the “dirty, little,” gigantic secrets of how our health care system is giving consumers less for more. No one is supposed to offend anyone with the truth, anymore, after all.
Want a little truth right now? No man or woman in his or her right mind would prefer to routinely talk to an on-call nurse when his or her child is sick, rather than a doctor. No one sensible would want a nurse, rather than a doctor, assessing whether to get an MRI or CT scan or neither one after an episode of head trauma. No one would want a nurse, rather than a doctor, to decide whether to get a cardiac stress test in the setting of chest discomfort.
How come? Because doctors are the gold standard behind the devalued currency of your health insurance dollars. Everyone knows it, but people are too political to just say it.
How come no one is flying into an American city today to see a famous nurse, while people arrive from countries around the world to visit with noted American physicians? How come no one in Congress would be able to tell you a story about that incredible nurse who diagnosed the rare condition in his or her child? How come nurses either failed to be admitted to medical school or didn’t try? You think it’s because they thought nursing school would train them better to take care of patients? C’mon. It’s because nursing school is easier–as in, 10 times easier.
I almost feel sorry to be so blunt. I don’t want to hurt anyone’s feelings. If nurses stop impersonating doctors, I’ll stop writing about them impersonating doctors.
Until then, just follow the money; people with enough of it will hire physicians, every single time, when they have real health concerns. The vast majority of Americans, on the other hand, whose health insurance is rapidly costing more and buying them less, will see health care workers who chose not to go to medical school and probably would have been turned down, anyhow.
Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.
200 hospitals shut down on nurses’ lack
Brain drain or the loss of skilled intellectual and technical employees has plagued government and private hospitals in the last two years, causing the permanent closure of 200 institutions across the country and the partial shut down of another 800.
The partial closures meant that one to two hospital wards had stopped operating in the absence of doctors and nurses, who left for better geographic, economic or professional environments.
Former Health Secretary Jaime Galvez Tan, who served under the administration of former President Fidel Ramos, said in an interview that hospitals were forced to cease operations as doctors and nurses were no longer interested to work for them.
Hospitals affected by the migration of health workers, particularly nurses and doctors, are in the remote countryside where health care is badly needed, according to Tan.
Among the hospitals that closed were the Almagro Community Hospital in Western Samar, the Tapul Municipal Hospital, Tangkil Municipal Hospital, Pangutaran District Hospital, Siasi District Hospital and Panamao District Hospital in Sulu, and the Sergio Osmena District Hospital in Zamboanga del Norte.
“In Sulu, majority of the municipalities have only one doctor. The municipalities of Pata, Talipao, Lugus and Pandami have no doctors at all,” Tan said.
Partially closed were the Calbayog District Hospital, Gandara District Hospital, Basey District Hospital and Tarangnan District Hospital in Western Samar, the Malipayon District Hospital, San Jose District Hospital and San Andres District Hospital in Romblon, and the Jolo Provincial Hospital.
So far no hospital, private or government-run, has shut down in Metro Manila and the well-off provinces of Davao and Cebu because of the brain drain, Tan said. Health workers prefer to work for well-known hospitals that are popular among patients.
“Andito kasi ang pera at resources. Kaya nga may overflow ng health workers at pasyente sa mga ospital na ito (Here is where the money and the resources are. That is why there is an overflowing of health workers and patients in these hospitals),” Tan said.
But when one goes to Samar and other poor provinces, like Kalinga Apayao, Mindoro, Sulu and Agusan, and in the Autonomous Region in Muslim Mindanao and the Caraga Administrative Region, one can find areas with no hospitals, he said.
The latest statistics available from the health department and the National Statistics Office showed the majority of doctors and nurses are concentrated in the National Capital Region and in Region 4-A or the Southern Tagalog. As of 2007, there were 125,899 doctors and 5,426 nurses in the capital and 75,213 nurses and 3,876 doctors in Region 4-A.
In the ARMM there were 4,058 nurses and 2,726 doctors, and in Caraga were 8,854 nurses and 232 doctors. These were the regions with the least numbers of health workers.
Tan said all the hospitals that closed were licensed. “There is no such thing as fly-by-night hospitals, because before a hospital can operate it must have authority from the DOH, and accreditation from the Philippine Health Insurance.”
25 Things You May Not Know About What Nurses Know
Throughout the years, nurses have been associated with everything from cute little white dresses and matching hats, the mistaken impression that they have few skills beyond a friendly smile and the willingness to give bed baths, the distributors of medicine to make you feel better, or simply as doctors’ helpers. Of course I’m generalizing as much as the people who think these things are. When I worked as an RN, the “what do you know, you’re just a nurse” patients had definitely become few and far between. So what do nurses actually know? Some of it may surprise you.
1. Science – lots of it: Yes, being a nurse requires a science degree which of course entails a lot of science courses and science knowledge. A nurse’s head is jam packed with the finer points of biochemistry, nutrition, math, microbiology, pathophysiology and more.
2. Accountability: If a doctor writes an order – for medication or otherwise – and it’s incorrect or misinterpreted, and the nurse carries out that order, the nurse is held partially accountable for the error. This is one of many reasons nurses dole out the bucks for medical malpractice insurance.
3. Time Management: Nurses are masters when it comes to managing all the medical, procedural, pharmaceutical, personal and often emotional needs of upwards of 8 patients. Remember this, next time you’re in the hospital and it takes your nurse that extra minute to answer your call light.
4. How to lead a team: Just like Phil Jackson can pull together the Lakers and make sure everyone does their job and plays well together, a nurse is responsible for making sure their patients are getting everything they need from their care team (doctor, nutritionist, social worker, physical therapist, etc.).
5. Advocacy: When nobody else is there to speak for the patient – whether for long term care needs after leaving the hospital, home health services or further rehabilitation – the nurse is trained to step in and be their voice.
6. Thick Skin: When part of the nurse’s job is to wake doctors up from a sound sleep in the middle of the night (often after they’ve been awake for several days) – tact and a thick skin become vital. These qualities also apply to daily encounters with patients, their families and other hospital departments.
7. Stand Up Comedy: Laughter truly can be the best medicine when it comes to cheering up patients or breaking the ice with their family and friends. Nurses have quite a few tools in their “bag of tricks” and have a knack for using the right one at the right time.
8. How to be in nine places at once: Nurses don’t need any Star Trek technology to seemingly be in all their patients’ rooms at the same time. It’s all about mastering the act of juggling with finesse – and really comfortable shoes.
9. Drug Dealing: This is where all those math skills come in, because if one decimal point in the medication dosage calculation goes awry, a patient’s life could be in danger. The average nurse has an impressive bank of information about hundreds of different drugs, their most common dosages, side effects and more.
10. Delegating: Registered nurses (RNs) in particular often oversee license practical nurses (LPNs), certified nurse’s aides (CNAs) and even nursing students during a typical shift. The ability to apply critical thinking and decide which individual is best for which task is a mission critical skill.
11. Customer Service Skills: It may not seem like it sometimes, but health care is a business, the patient is a customer and since the nurse has the most direct and frequent contact with the patient, customer service is key to the job.
12. Patient Teaching: Once the doctor gives his or her medical spiel and leaves the room, the patient (and their family) often looks to the nurse to answer questions, fill in the blanks, reiterate the most important parts and generally break it all down layperson’s style.
13. Alternative/Holistic Medicine: They may technically work in the west, but nurses are trained in many of the essentials of eastern and other types of “alternative” medicine.” These may include everything from acupuncture, herbs, and chiropractics to music therapy, massage, and biofeedback
14. They can “feel your pain”: Nurses are extensively trained in assessing and managing a patient’s pain. They have the skills to observe whether a patient is in pain based on breathing, vital signs, gestures and facial expressions, without the patient ever saying a word.
15. Accessorizing: In the movie ‘Office Space’ servers at a family restaurant learn the important of “flair” – fun, colorful buttons tacked onto their otherwise uniform uniforms. Nurses have the same instinct, adding colorful jewelry and vests to their whites and selecting colorful scrub tops that fit their personality – all in good taste of course.
16. Improvising: Believe it or not, there isn’t always a medical device or procedure for every single that can happen with patients during a shift. As a nurse, I saw remarkable examples of creative problem solving by my colleagues (I was even known to do a little bit of it myself).
17. How to switch gears quickly: A nurse may have their entire shift organized at the beginning, by which patients need what and when. This plans usually lasts for about fifteen minutes. One new post-operative patient or another patient having a sudden crisis, and these patients become the new focus of the shift, while the nurse still attempts to juggle everything else in the original plan. This goes well beyond the definition of multi-tasking.
18. The infamous poker face: The rule of thumb is – even if you haven’t seen it all yet, pretend you have. No, nurses are not supposed to be unfeeling robots. However, they are able to keep their composure in the face of stressful situations enough to hold their own against the stony faced competitors in a poker tournament.
19. Handwriting interpretation: Yes, with electronic medical records, the classic issue of figuring out what the doctor actually meant to write on the patient’s chart is less of a problem. But the reality is, as long as the human beings are doing the care giving, and not the computers, a certain amount of a nurse’s job will involve deciphering a doctor’s hasty scribbles.
20. Learning new machines at the speed of light: Medical technology is moving faster than patients can find new ways to get sick. Therefore, most of a nurse’s training on machines like IV pumps, feeding tubes, heart monitors and other gadgets, comes after nursing school, on the job and quickly.
21. Writing: Ever wonder why so many nurses become bloggers (he-hem), authors of research studies and books, and journalists? Between countless nursing care plans in nursing school (a detailed plan of care for each patient), research papers and nursing notes, nurses have no choice but to develop a working passion for the written word.
22. Research: Contrary to the beliefs of many, nursing is about much more than simply following doctor’s orders and treating patients. Nurses, RNs especially, are expected to have an understanding of why they are doing what they’re doing; the intended effect on the patient and how to know if something has gone wrong. This means keeping up with the latest medical research studies and newest data in the field of health care.
23. Cutting through the media healthcare hoopla: As we learned in nursing school, the average mainstream newspaper story may get those all important numbers right from the latest New England Journal of Medicine study, but the actual health implications for patients? That’s a different story.
24. Speed reading: This is an academic survival skill picked by nurses back in nursing school just to get through the sheer volume of required science and clinical reading. Yikes – think I just had a flashback of those 10 pound textbooks!
25. Astute powers of observation: Along with pain assessments, nurses are trained to look for the little details that come from seeing the patient more than any other caregiver – color, changes in vital signs, mental status and much more.
Essentially, the individual in those nurse’s whites is a CEO, customer service manager, crisis coordinator, and medical professional all rolled into one. Be sure and thank a nurse next time you have the opportunity – we need them!
