Guest ERCat Posted August 10, 2016 Share Posted August 10, 2016 I work in an ER that hires both NPs and PAs. A few months ago my group hired a new grad nurse practitioner, despite their insistence that they only want to hire PAs from now on (they have had some major issues with the six or seven NPs they've hired in the past, stating that their lack of training is scary and that it doesn't even compare to PA training, but I digress). Immediately upon meeting this new NP I knew we were all in for a real treat. On her FIRST DAY - she was extremely aggressive and overly confident, walking in and acting like she already knew it all. On her FIRST DAY she was openly complaining about the schedule to multiple doctors, stating, "I am not going to work any nights, only the 9-5 shifts" and complaining about the pay. When I gave her the opportunity to shadow me she spent more time correcting me than asking questions (i.e. "You should have ordered a strep test on that 20 year old with belly pain). I was turned off. But as time goes by I have become more than turned off... I have become downright angry. Her lack of clinical knowledge IN COMBINATION with her overconfidence is completely dangerous. As new grads all NPs and PAs are supposed to staff all of our patients with a physician, who walks us through their thought process and guides us through procedures - basically a wonderful learning opportunity I would think any fresh and terrified new grad would love to have. This new grad NP has made a fuss about having to discuss anything with a doctor, citing her "independence" as a provider - which is ultra silly considering the fact that she completed an ONLINE NP PROGRAM!!! She has been told on six different occasions about this by me, the CEO, and her direct supervisor and still fails to staff any of her patients. She sneaks them out the door and then brags about it, saying, "I am seeing twice as many patients as the other midlevels and I haven't been staffing any of my cases with anyone." She is PROUD of this. And when she doesn't know something, she either guesses or she Googles it - instead of asking. I saw her prescribing Macrobid for dog bite the other day, and when I gently asked her why she wasn't using Augmentin, she said, "I don't know, I just picked an antibiotic, and I've seen some of the docs here using Macrobid for things." She had that same patient bounce back and it was later discovered by the doc that saw that patient that this NP documented a bunch of physical exam and review of systems points that weren't actually done. The NP didn't even seem to think false documentation was a big deal - she said, "Yeah, I thought it was OK to just use my general physical exam and review of systems templates for everything and I never thought about unclicking the things I didn't do. Now I know I am not supposed to document what I didn't do." We audit each other's charts and one of the worst things I see is that in ALL of her back pain patients she just focuses on back tenderness. I did not see one back pain chart in her few months of being here where she documented reflex, sensation, plantarflexion/dorsiflexion, lack of fevers/bowel or bladder issues/history of IV drug use/history of cancer/etc." She sends tons of old people with head injuries home without CT scans without documenting a full neuro exam or assessing for midline neck tenderness. The worst thing is she had a short of breath patient and DIDN'T ORDER AN EKG...three hours later, hands off the patient to a doctor to discharge the patient when the chest x-ray came back. The doctor realized she didn't get an EKG, ordered one, saw that patient was sitting on a STEMI for three hours in the ER - the patient died on the way to the cath lab and this NP didn't bat an eye or ask any questions when she heard about the death. At this point I am not only angry because of patient safety, I am angry that someone LIKE THAT gets to have the GIFT and PRIVILEGE of taking care of people and earning their trust. I feel angry that multiple docs and nurses have been making complaints about her but the head honcho just looks the other way. I realize not all NPs are like this. However with my experience working with NPs and NP students, it is VERY evident to both me and physicians that their clinical training and resultant knowledge base pales in comparison to ours. The NPs I have worked with have stated that NP school taught them more "patient advocacy" BS and very little actual medicine, making their skills as diagnosticians very poor. Even some of the more diligent NP students are feeling panicked as they realize they haven't been prepared for the real world. However there is a difference between an NP who cares enough to be humble and LEARN for the benefit of patients vs. someone who doesn't know what they don't know, and doesn't give a hoot about getting better because they are now an independent NP! Link to comment Share on other sites More sharing options...
LKPAC Posted August 10, 2016 Share Posted August 10, 2016 Rotten fruit eventually falls off the vine. The problem is that people are getting hurt. I assume you have shared your concerns with your CP. She needs to be fired, especially for her attitude. Link to comment Share on other sites More sharing options...
Guest ERCat Posted August 10, 2016 Share Posted August 10, 2016 I think she should be fired, absolutely. Unfortunately I was the one who brought the not staffing with a physician issue up first, and then the CEO and our direct superviser had a discussion with her about it. Since then I have pointed out on two separate occasions that she is still not staffing patients. At this point nothing is being done and I feel like if I bring it up anymore I just look like a bitter tattletale. Link to comment Share on other sites More sharing options...
CAAdmission Posted August 10, 2016 Share Posted August 10, 2016 "I don't know, I just picked an antibiotic, and I've seen some of the docs here using Macrobid for things." You just made me shoot coffee out of my nose. Maybe you could buy her one of these things to help with her med selection: Link to comment Share on other sites More sharing options...
sk732 Posted August 10, 2016 Share Posted August 10, 2016 Has anyone written a complaint to this clown's regulatory body? Definitely should be suspended or fired for violating all departmental policies... SK Link to comment Share on other sites More sharing options...
CoastalPalm Posted August 10, 2016 Share Posted August 10, 2016 What is the name of this "Eight week online NP program"? Link to comment Share on other sites More sharing options...
CAAdmission Posted August 10, 2016 Share Posted August 10, 2016 The worst thing is she had a short of breath patient and DIDN'T ORDER AN EKG...three hours later, hands off the patient to a doctor to discharge the patient when the chest x-ray came back. The doctor realized she didn't get an EKG, ordered one, saw that patient was sitting on a STEMI for three hours in the ER - the patient died on the way to the cath lab and this NP didn't bat an eye or ask any questions when she heard about the death. If a chart exists that documents these circumstances, you should contact the Board of Nursing and put a stop to this. Just make sure you don't log into the system and get your name on a HIPAA audit list. Link to comment Share on other sites More sharing options...
Guest ERCat Posted August 10, 2016 Share Posted August 10, 2016 https://www.gcu.edu/degree-programs/msn-family-nurse-practitioner Link to comment Share on other sites More sharing options...
CAAdmission Posted August 10, 2016 Share Posted August 10, 2016 https://www.gcu.edu/degree-programs/msn-family-nurse-practitioner Link to comment Share on other sites More sharing options...
sk732 Posted August 10, 2016 Share Posted August 10, 2016 https://www.gcu.edu/degree-programs/msn-family-nurse-practitioner Holy Phuque!!! Link to comment Share on other sites More sharing options...
CoastalPalm Posted August 10, 2016 Share Posted August 10, 2016 https://www.gcu.edu/degree-programs/msn-family-nurse-practitioner Did you actually click where it says "More Info" under the Approximate Course Length" section? If you did, you would see that it states "Online courses for this program are generally 8 weeks", and then lists the courses in the program that are not 8 weeks long. So, "8 weeks" is referring to the length of individual courses (presumably those are the core fluff courses, as the actual FNP courses are all listed, under "More Info", as being 16 weeks in length each) Further, a quick search of allnurses for people actually in that program demonstrates that the program is not 8 weeks long, as they talk about finishing the "first year". Anyway, I'm not saying that that program is a quality one, nor am I saying that FNP education in general is good enough for independent practice. Nor am I defending the NP described in the OP (assuming she exists). What I am saying is that there is absolutely no such thing as an 8 week online NP program. GCU's program is not 8 weeks long. Carry on. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted August 10, 2016 Administrator Share Posted August 10, 2016 I think she should be fired, absolutely. Unfortunately I was the one who brought the not staffing with a physician issue up first, and then the CEO and our direct superviser had a discussion with her about it. Since then I have pointed out on two separate occasions that she is still not staffing patients. At this point nothing is being done and I feel like if I bring it up anymore I just look like a bitter tattletale. When she kills someone else, you'll look like a witness for the plaintiff. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted August 10, 2016 Moderator Share Posted August 10, 2016 To be frank, if your hospital or physician group is putting up with everything you've described in your post, you need to leave the group. They've set a dangerous precedence by continuing to employ such a person. I just find all this hard to believe. You state your group has someone employed who: - Willingly ignores the edict that any new hire has to staff patients with a physician- and continues to do so despite repeated discussions - Willingly commits chart fraud which was discovered by a physician- which is illegal if being done on Medicare patients - Blows off complaints which has resulted in an actual patient death due to what you have described as gross negligence- which should result in a malpractice suit And your "head honcho" does nothing? Yeah- you need to leave. Link to comment Share on other sites More sharing options...
8404PA Posted August 10, 2016 Share Posted August 10, 2016 She has been told on six different occasions about this by me, the CEO, and her direct supervisor and still fails to staff any of her patients. What does "staffing a patient" mean? I haven't heard the phrase before. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted August 10, 2016 Share Posted August 10, 2016 The state board HAS to be mad aware of these activities. In Washington, MQAC won't do anonymous complaints unless a whistleblower fraud type thing. You would be identified if your state won't allow anonymity. But, for the sake of medical safety and ethics - she has to be turned in. If the CEO isn't doing anything - legal trouble awaits. Is there a risk manager or safety person on staff? Who provides the group's malpractice? Doctor's or Physician's Insurance? Maybe someone there will listen or take a tip. I feel strongly enough about a situation like this that my professional risk would be worth taking to right the situation. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted August 10, 2016 Share Posted August 10, 2016 What does "staffing a patient" mean? I haven't heard the phrase before. New grads, new hires and under certain bylaws require that PAs, NPs, medical students and residents and PA/NP students to "staff" or review their patients with a senior resident or staff provider. You present the patient and your tx plan and document that Dr X or Senior PA Y reviewed the case and concurred with dx and tx or wanted A,B,C added to plan. It is very common in new grad situations so everyone gets a feel for the style and expectations of the department or organization and to see if the newbie has a freaking clue - which in this case would have weeded out a horrible practitioner and bad hire. I still "staff" or more brainstorm tough patients with my partners whether DO or PA because two heads are better than one in tough situations. We ARE team members after all. Link to comment Share on other sites More sharing options...
8404PA Posted August 10, 2016 Share Posted August 10, 2016 Found this on the interwebs a while back, maybe it'll make you feel better XD http://nypost.com/2015/01/06/when-a-nurse-is-your-health-care-provider-youre-at-risk/ or scroll into the comments of this https://www.reddit.com/r/nursing/comments/2kwk37/why_the_doctorate_of_nursing_practice_is_a_giant/?st=irpj8pdc&sh=273273be PAs ROCK! Thanks for the answer RC2 Link to comment Share on other sites More sharing options...
delco714 Posted August 10, 2016 Share Posted August 10, 2016 Holy Phuque!!!The courses are either 8 or 16 week.. Not the program..though this is half the credits of my program.. Sent from my SM-N910V using Tapatalk Link to comment Share on other sites More sharing options...
Reality Check 2 Posted August 10, 2016 Share Posted August 10, 2016 So, the program appears to be 53 credits and I see the list of classes but I see NOT ONE clinical on-site rotation or requirement for such... Somebody check me here - does this sound correct??? THIS is my complaint about NP programs in general. PA programs are REGULATED and we all take at least a core of the SAME ROTATIONS in a clinical site. Did this person get the title NP without setting foot in a clinical rotation??? I still say - CALL THE NURSING BOARD OR MEDICAL BOARD POST HASTE AND GET THIS PERSON OUT OF THE MEDICAL PROFESSION BEFORE ANYONE ELSE DIES. Link to comment Share on other sites More sharing options...
Guest ERCat Posted August 11, 2016 Share Posted August 11, 2016 Yeah - thanks for catching that. Regardless of the time frame it is ONLINE. And then when they do rotations they have seem to do a quarter to one third of the clinical hours PAs do... Link to comment Share on other sites More sharing options...
CoastalPalm Posted August 11, 2016 Share Posted August 11, 2016 So, the program appears to be 53 credits and I see the list of classes but I see NOT ONE clinical on-site rotation or requirement for such... Somebody check me here - does this sound correct??? THIS is my complaint about NP programs in general. PA programs are REGULATED and we all take at least a core of the SAME ROTATIONS in a clinical site. Did this person get the title NP without setting foot in a clinical rotation??? I still say - CALL THE NURSING BOARD OR MEDICAL BOARD POST HASTE AND GET THIS PERSON OUT OF THE MEDICAL PROFESSION BEFORE ANYONE ELSE DIES. LMAO. All NP programs, whether "online" or not, require clinical rotations (yes, as has been hashed out numerous times, the hours are much less than that required for PA programs). If you click the actual course names for the course descriptions, you will see that the ones with a "C" in the course number (for..."clinical"?) are the clinical rotations. Link to comment Share on other sites More sharing options...
CAAdmission Posted August 11, 2016 Share Posted August 11, 2016 LMAO. All NP programs, whether "online" or not, require clinical rotations (yes, as has been hashed out numerous times, the hours are much less than that required for PA programs). If you click the actual course names for the course descriptions, you will see that the ones with a "C" in the course number (for..."clinical"?) are the clinical rotations. Without regard to the credits, length of time, or clinical experience, any program that turns out a clinician whose antibiotic selection is based upon what "sounds good" is a clusterfrack. They must have very esteemed faculty... Link to comment Share on other sites More sharing options...
sk732 Posted August 11, 2016 Share Posted August 11, 2016 One of my docs today took a call from the NP at the NP run Quick Care Clinic (an oxymoron in itself incidentally) down the street because a person had such bad otitis externa, she couldn't get the drops into the canals..."What do I do?". With an exasperated gasp he said "Don't send them here...call ENT because I don't have time for this". Come on, I used to know that you stick a little wick in the ear and let the drops soak in through that when I was a baby medic in the army...without a master's degree in primary care medicine (and this was a primary care problem). This is what happens when you don't do real clinical rotations IMO or do them over the internet. SK Link to comment Share on other sites More sharing options...
Reality Check 2 Posted August 11, 2016 Share Posted August 11, 2016 Ok, not completely trying to be snarky but this miffs me --- I read each clinical course on the website. 1. 682C - 200 hours of FP 2. 669C - 75 hours of geri 3. 667C - 75 hours of female health 4. 668C - 150 hours of peds 5. 675C - 150 hrs of Comm Health Center 650 hours 650/8 hr day = 81 days 20-25 WEEKDAYS per month = avg 3.5 MONTHS NOT ONE SHRED OF ER OR CRITICAL MEDICINE. No surgery, no ortho, no Internal Medicine focus. WHY WOULD AN ER HIRE THIS PERSON.?? Meanwhile I did 17 clinical rotations - 17 MONTHS!!! WITH ER, IM, SURGERY AND ORTHO. Guess what shows up in the ER?? ALL OF THE ABOVE.... This is ludicrous. She killed someone straight out of school in a job she wasn't remotely qualified for.... Pardon me, I have to go deal with my blood pressure and that bulging vein Link to comment Share on other sites More sharing options...
ndpa09 Posted August 11, 2016 Share Posted August 11, 2016 You just made me shoot coffee out of my nose. Maybe you could buy her one of these things to help with her med selection: I'm glad I am not the only one. I literally laughed out loud for about 2 minutes. Link to comment Share on other sites More sharing options...
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