As most of you know my husband is a paramedic and firefighter. With us both in the healthcare field we often download about our days, share stories, ask each other for advice, and compare our careers. Well a couple weeks ago he spouted off a joke that I just can't shake. I'm not sure what prompted it (probably that my hourly wage is higher) and he said, "All nurses can do is follow doctors orders. They can't even give a Tylenol without asking permission."
Well of course I was irritated, and offended, and incredulous. But damnit... I couldn't exactly argue with it. Paramedics don't have a physician within arms reach at all times to ask advice. They see a patient, make an educated guess of their diagnosis based off very little information, and treat according to their set protocols. Should they give lasixs or albuterol? CPAP or intubate? Versed or ketamine? Is it an overdose or a seizure? PE or MI? Asthma or anaphylaxis? The examples are endless. If they're really stumped they can call in to an emergency room physician for advice, but they rarely do. If a patient crumps there's no "code team" to call. It's them. They can independently intubate, cric, needle decompress, cardiovert, IO, and run a code and eat a sandwich at the same time. They get to do some cool stuff and they don't have to ask permission.
So here was my rebuttal to his heinous comment... "Oh ya, well I know lab values." **Crickets***
Since our conversation I have literally been trying to find a way to prove nurses have more impact than just following physicians orders. But every argument I come up with I hear his miniature self talking from my shoulder, "Ya that's still lame." I have now been reduced to thinking a trained monkey can do my job. I am literally questioning all I think I know about nursing. I wonder if the nurses student who skated by and knows very little is just as efficient as the valedictorian. Does being a good nurse really have anything to do with your knowledge and more to do with how good patients perceive you to be. Was my nurse nice, did they bring me my requests quickly, was my call light answered in a timely matter, did my shot hurt, and did they warm the wipes? Here are some examples of my WEEKS long internal debate with my imaginary husband on my shoulder about why nurses are invaluable. (Please realize my husband is not an asshole and didn't say any of these things!)
Well of course I was irritated, and offended, and incredulous. But damnit... I couldn't exactly argue with it. Paramedics don't have a physician within arms reach at all times to ask advice. They see a patient, make an educated guess of their diagnosis based off very little information, and treat according to their set protocols. Should they give lasixs or albuterol? CPAP or intubate? Versed or ketamine? Is it an overdose or a seizure? PE or MI? Asthma or anaphylaxis? The examples are endless. If they're really stumped they can call in to an emergency room physician for advice, but they rarely do. If a patient crumps there's no "code team" to call. It's them. They can independently intubate, cric, needle decompress, cardiovert, IO, and run a code and eat a sandwich at the same time. They get to do some cool stuff and they don't have to ask permission.
So here was my rebuttal to his heinous comment... "Oh ya, well I know lab values." **Crickets***
Since our conversation I have literally been trying to find a way to prove nurses have more impact than just following physicians orders. But every argument I come up with I hear his miniature self talking from my shoulder, "Ya that's still lame." I have now been reduced to thinking a trained monkey can do my job. I am literally questioning all I think I know about nursing. I wonder if the nurses student who skated by and knows very little is just as efficient as the valedictorian. Does being a good nurse really have anything to do with your knowledge and more to do with how good patients perceive you to be. Was my nurse nice, did they bring me my requests quickly, was my call light answered in a timely matter, did my shot hurt, and did they warm the wipes? Here are some examples of my WEEKS long internal debate with my imaginary husband on my shoulder about why nurses are invaluable. (Please realize my husband is not an asshole and didn't say any of these things!)
- Nurses monitor lab values and notify physicians of abnormalities and hold/administer medications based on such results.
- Oh what... like the physician doesn't see their own lab results? What did you save them? Logging on to the computer?
- Nurses give lifesaving medications.
- That the doctor ordered ding dong.
- Nurses notify physicians when a patient has irregular vital signs.
- Ya, CNA's can do that too and thats what... a 6 week program?
- Nurses titrate drips that have to be carefully monitored.
- Oh good, you can read an algorithm; SBP is 80, increase drip by 1 mcg/min
- Nurses educate patients about their conditions
- Isn't that what WebMD is for these days?
- Nurses provide a calming and comforting touch that physicians don't have the time to do.
- But did it save their life?
- Nurses daily care routines help prevent VAP, CAUTI's, CLBSI, DVT's, decubitus ulcers, delirium, aspirations, and other hospital related complications.
- Ya everyone knows nurses wipe butts.
So where does this leave me? In an existential crisis lead to believe that nurses' greatest contribution to healthcare is the patient experience... i.e. Press Ganey Scores. Which needs very little knowledge of medicine, or at least much less knowledge of medicine than I currently have. So I either need people to bring up some new arguments, pat my back, and fluff my ego. Or maybe I'll just become a flight nurse or PA or something. Or even better yet I can just have a another beer and be content in thinking the patient experience can be just as important as all of Jesse's life saving interventions. That warm blankets, back rubs, listening, and advocating are my forte; and whether less important than Jesse's career or not it still makes me happy... and hopefully my patients happy as well.
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