you are cutting your own throat

We are about to get PAs (physician assistants) in our ER.  They will staff part of the ER part of the day.  They will probably take on more of the ER as time goes on. Big change. From what I understand, this is being done because our doctor group doesn't have enough docs to staff the several hospitals they cover.

I don't like this. Seems like docs should staff ERs.  Here's the thing: You are not going to believe this but they don't give a shit what I think, here they come.  Its reality. So I will adjust and so will everybody else.

However, I wonder if by employing PAs, doctors aren't cutting their own throats. Lets face it folks, the vast majority of ER medicine is not rocket science. With a little experience, you pretty much know what the problem is. So PAs will do fine with their background. In fact, I would say that PAs and NPs could easily staff most ERs with a doc to supervise and handle the critical cases.

So really, is this what the future holds? Perhaps.  Health care costs will have to be cut.  PAs and NPs are a lot cheaper, will cost hospitals less, insurance companies and medicare/medicaid less. You can pay a PA/NP maybe $125,000 versus and ER doc $250,000, thats a lot of savings.

Like I have thought for a while, the future of general practice is PA/NP and perhaps some specialty areas too.  

oh no

Oh no. What has happened to one of my favorite blogs: Nurse in the hood?  Please, come back to me.

task monkeys

My ER is changing.  It is changing like all of medicine is changing.  I have been a nurse a long time. Things were different when I started. It wasn't a corporate run environment back then.   There was more of a kumbiyah feeling. 

Now it is a business. Plain and simple.  Its hard to adjust to the idea that medical care can be a business, but there it is, whether we like it or not.

The thing is nurses haven't adjusted to this new environment.  We want things to go back to what they used to be.  To a time when we had more time with our patients, where things weren't so complicated. The thing is thats not going to happen.  We will have less time with our patients and things will get more complicated.

In my ER, like most ERs these days, the bottom line is volume, patient satisfaction, in other words, money. I'm not saying we don't do great patient care, we do, but doing great patient care means nothing if nobody comes, they aren't happy and the bills don't get paid.  Its reality.

I see our doc group adjusting.  They are expanding their business to other ERs, improving their skills, trying to make the patients happy so they will come back.  They get monetary incentives to see more patients.  Everything they do, efficiency wise, is tracked.  They are adjusting to the new environment and trying to thrive within it.

There is a lot of talk in our ER among the non doc staff about how they docs don't really care  about anything but themselves. They only care about making money.  People think they treat us like task monkeys.

My thoughts: Docs have recognized that in this corporate healthcare environment, they have to look out for themselves. Nobody else will.  Nurses don't recognize that, at their own peril.  Nurse are definitely more than task monkeys,  they are the cornerstone of the healthcare environment.  IF we as a group don't start changing, promoting our profession, taking care of our own interests in this business environment, we will be gone, replaced by task monkeys.

We have to recognize that don't DESERVE anything, we have to prove our worth, change with the times, embrace change, help to create it.  The question is: Do nurses care enough about our profession to save it?

tomorrow isn't guaranteed

You don't realize it. Your family doesn't get it.  The doctor and I know you are not going to live past the next couple of days.

All you know is that you are having pain. Your family is in a state of shock. The things they say, the questions they ask, tell us they don't understand the seriousness of it.  The doctor ackwardly tried to explain to you and them that things most probably will get worse soon and decisions will have to be made that no one wants to make. He asks if you have talked about how much you want down regarding resuscitation, intubation. You and your spouse are old, but like most people you haven't discussed it. 

When the doctor leaves, I tell you that you are in very serious condition. Nurses do that. We feel we need to bring reality in, so you can prepare, even if it is hard.  We are the translators for what is going on.  I ask about children and tell your spouse that the needs to call your, tell him what is going on.

Its hard to understand when you are so stable, still understanding some, talking. Its hard for you to see what is coming. 

You go up to ICU, your pain is getting worse. When you get to ICU things are starting to  deteriorate and the doctor is called and you will have immediate surgery. You will probably make it through it, but because of other medical problems you have, you won't make it much longer.  I think about what your family will go through.  You are the kind of person I am thinking about a couple of days later.
You are the person who reminds me life turns on a dime.   

no shit rains down

Something happened the other day. I'm not quite sure if it was real. I went to work as usual, walking into the hospital wondering what shit  would rain down on me  today. As it turns out I was walking into a magical fairyland. Yes people my saggy, baggy, ratty, dirty, rundown old ER had turned into something else that day. A place I didn't even recognize. It didn't look any differnt.

Something was in the air that day. Something that I hadn't felt for years.  I didn't even realize how different that day  had been until I was in the car driving home. I was humming, feeling tired, but good.  I didn't feel that ugly, bitter, angry "I hate this motherf---king job" feeling.  I actually felt kind of good.

Wait a minute......SCREEECHHHH!!! STOP THE PRESSES!!! Yes, people I actually felt good about my day at work that day. I felt like I had accomplished something, done something worthwhile. No, I didn't sit on my butt all day because people trickled in. It was a steadily busy, post holiday type day. Lots of grandmas and grandpas.

I had sick patients, really sick patients, they might die sick type patients.  The kind of patients you are still thinking about a couple of days later, wondering what happened to them.

The point of all this?  I actually took care of  REAL emergency patients.  Patients who truly needed help.  No whiners, seekers, fools, crazies,  drunks, dopers.  It was actually like you think an ER should be. 

I doubt it will ever happen again.....in fact it may never have happened at all....maybe it was a dream.