PAs in ER

For the past year we have had physician assistants in the emergency room where I work. It hasn't gone well.

They see every kind of patient except mental health patients. Mostly they have worked in the main ER (non urgent care).  I know they work well in some ERs but after working with them for a year, I don't think they belong in the emergency room taking care of non urgent care patients.

In this day and age, ERs have changed.  They are no longer seeing fractures, lacerations and simple illness. We see acutely ill, complicated patients.  The acuity in ERs has gone way up.  I really don't think PAs are up to seeing these kinds of patients. I think they should be seen by docs.  I think patients in the ER expect to be seen by docs.

Physician assistants have a bachelors degree.  I'm sure the classes they take are pre med type classes. They don't have to have a major in a science as I understand it.  They then go to a 2 or 3 year program where they are trained in the "medical model" of medicine.

Two or three years isn't much to be caring for acutely ill, complicated patients. To be honest, they make me nervous as a nurse. I don't trust them like I do the docs.  Working with them feels like working with 1st year residents. You always have to be on your guard with them.  Docs supervise them, but  they are ordering stuff before they talk to the doc.

I think if ERs are going to hire non doctors they would be better off hiring NPs.  NPs have a degree in nursing, they have worked in a medical environment.  The thing is the reimbursement is less for NPs.

This whole thing has made our ER harder to work in.  No one likes it.  It has impacted patient care negatively.

yup

man candy saturdqy

help wanted:

Help wanted:

*someone who can sell ice cubes to an eskimo
*must me masochist
*former experience on garbage truck a plus
*6 months of bouncer experience helpful
*hazardous waste experience required
*waitress/waiter skills
*united nations workers welcome
*biotechnology degree preferred
*must be night owl
*former jugglers will be considered
*ex-zoo attendants encouraged to apply


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the vagabond hipster

You view yourself as some kind of vagabond hipster, hitching from town to town.  Free as a bird, nothing is going to tie you down.  You say you follow bands around the country.  

The thing is you have been here for almost a year.  You have been in jail for not paying bills you have managed to run up.  Even though you are pushing 40, you are some kind of man-child who roller skates in places that get you in trouble.

Today you are found rummaging through a dumpster looking for food, drunk as shit.  Looking for a place to sleep and a meal, you tell the police you need to see a psychiatrist.  You arrive with all your life possessions stuffed into a backpack  someone would use to go on a mountain hike. Tied to the backpack are your 1970's roller skates.

The sad fact is that you are mentally ill and an alcoholic living in a delusional world. Even though we discharge you to a place that could help you, you will refuse the help.  You prefer to live in your delusional world and the thing is, as long as you don't want to hurt yourself or others, you are free to continue doing that.  See you next week...