Struggling...opinions please!

[EMEDPA]

The easy answer: if you're dead set on NICU, go NP. As you've already recognized, there just aren't that many PAs in the neonatal unit.

agree.....

[EMEDPA]

would you guys say that if one is looking for autonomy, that as a PA or NP in the NICU, that might not be the place to find it?

I have never met a nicu pa.

the nicu np's at my place run the unit at night, do all the lines and intubations, respond to the er for critical newborns, etc. looks like a pretty good scope of practice.

I would imagine that a pa that went to the peds focus program in colorado then did the nicu residency in KY could do the same things but might have a harder time finding a job(outside of KY).

[EMEDPA]

i didnt even think about admits from ER.

yup. they run the resuscitations down there, put in the umbilical lines, etc

they get paged to the er for all the precipitous deliveries and anytime the medics call with a field delivery.

[Guest hubbardtim48]

As an RT I can diagnosis a patient with status asthmaticus, COPD (by PFT), hypercarbia blah blah blah...no one cares....it is when they need me at the bedside to make a vent change to correct the abg or do unconventional ventilation (APRV, VDR) or do other therapeutic modalities (IPV, ILV etc)...I am just stating that the "diagnosis" means a hill a beans to anyone...it is the specific areas one is trained in (RT, OT, PT, RD,etc) and that is when people need us to say ok you are the expert just do what u need to do and I will sign off on it. I do that every day of my life as an RT. No one but a pulm. doc touches our vents and when a pulm doc does that is <10% of the cases...we do everything on those vents and change parameters, modes, tell doc when "our side" is good to extubate etc....I just feel like the nursing model tries to put too many cards on the table and wear too many hats when truly they aren't doing anything "better" than anyone else...coordinating care and nursing care...? really... What is a nurses expertise? i.e. RTs = lungs, RD = nutrition, SLP = speech, etc...

[EMEDPA]

What is a nurses expertise?...

um. bedside pt care....tough iv's, foleys, hanging drips, etc

[Guest hubbardtim48]

I know that...procedures...but PAMAC seems to think that automony of a nurse is greater than any other profession so I am trying to figure out what RNs automony means...I am NOT putting down nursing, but can't get a good answer out of my wife because she hates nursing so I want some other RN to answer it for me...

[flyingsquirrel]

The easy answer: if you're dead set on NICU, go NP. As you've already recognized, there just aren't that many PAs in the neonatal unit.

 

Yes, most of the positions in the NICU are posted as NNP, but here's the problem with the advice given above. If you go to NP school not because you belive in the educational model or because you want to be an NP, but because "NICUs mostly hire NPs" you are only perpetuating this imbalance. If you want to be a PA and you believe in the education and training of PAs, then go to PA school, become a PA, maybe do a residency, and fight to change the culture of the NICU.

 

I want to go into pediatric critical care. There are VERY few positions for NPs or PAs (and the ones that do exist are mostly NP) in the PICU. I am anticipating having to create positions for myself and convince the medical establishment that 1) they need a PA working in their PICU and 2) that a PA can do the job just as well as an NP. You can do the same in the NICU. This is how the PA profession will continue to grow.

[Guest hubbardtim48]

Agree! Awesome post and good advice.

[Guest hubbardtim48]

NP and PA and DO and MD etc all have "narrow" scopes of practice...you can't know it all that is why everyone specializes...I could say the same about nursing and how I would hate to be a floor nurse and have a very limited scope of care, where I can, as an RT, go all over the hospital working in ER, CCU, SICU, NTICU, BURN, transporting, nebs, education, etc...Thats what I do now and don't think my scope of care is limited unless you are talking about anatomy of a human then yes I am limited to the lungs/heart, but I am OK with that because I know those things very well and again can't know all of it...

[Guest hubbardtim48]

PAMAC, btw you never answered any of my questions from the previous post....

[EMEDPA]

oh, you mean the one emedpa answered for you.....

hey, it takes awhile for the message to make it all the way up to north dakota...

[Guest hubbardtim48]

Nope not that one...."I am guessing not because we weren't even licensed...so how can you recognize someone in a health care field when they aren't licensed? It takes time to build a profession....i.e. like the PA or AA profession...Do u know what RTs do? Do you know what AAs do?" Since you were asking about UND and why they only accepted RNS blah blah blah...

[Guest hubbardtim48]

Don't live there...........

[Guest hubbardtim48]

RNs still don't know what we do...We employ 4 bronch nurses in our department and yes respiratory care PAYS the nurses and they are employees in RC. Anyways those nurses don't even know what we do except that we do bronch's...so if they don't even know why would other RNs know what we do when we are in and out of the room and go to a different floor for another patients care...even the professors @ UND are learning about RTs and see how well we have done in the past through the program and seeing our bedside skills, knowledge base etc being able to translate over to PA...I could care less if nurses know what I do because I care about the patient and the nurses just call when they need help with something or the patient is going down the crappier and RN + Doc needs another set of eyes...I am thankful that UND gave me a chance and so far RTs have not let them down the least bit...that is why 18 out of 60 are RTs...:)

[Guest hubbardtim48]

It is really neat and it is the way of the future...why don't you apply to the program, get accepted out of 2,000+ applicants and go through the rigors of UND PA school...then you can make fun of it...

[Guest hubbardtim48]

I think most people will agree that one could teach a monkey to do procedures...so I don't like saying I can do an ABG, bronch, intubation, etc. because if someone is taught proper technique and a little practice they could be doing just the same as an RT, CRNA, doc, etc....i like the critical thinking, so that is why I want to do family med so I can make a plan of action instead of doing repetitive motions of ABGs, bronch. blah blah blah....maybe I am just burned out! :) haha

[Guest hubbardtim48]

No I really got upset over the RD thing...

[Guest hubbardtim48]

Not burn nursing, just stating facts on what they really do and not all the hype the lobbyist gives nursing credit for...We all have our narrow field, but you made it sound like nursing was superior and did not have a narrow field of practice so I asked you what the heck does a nurse do? is the autonomy really there? I just think some people walk in others footsteps just mimicking their approach to life and follow what nurse organizations say nurses do…I just feel like nursing is and will always be a different allied health profession because they are the only ones that put too much time and effort into letting people know how much they do and all the jaz…I never seen/heard another allied health profession do this and when you actually look at it from any view point, do RNs really have all that crazy stuff they tell people they do/have etc…I have not seen it nor have heard/talked about it to my wife….she calls herself a pill pusher and thinks her 15 months BSN could have been cut in half because she never learned stuff after the first 2 semester except procedures or theory….

[LT_Oneal_PAC]

Any chance you two (PAMAC and hubbardtim48) would consider just putting each other on your ignore lists? Just askin' :heheh:

 

He's on mine. Best decision I made that week. His ignorance still pokes through on quotes. 5 bucks he hasn't ignored me. I know his type.

 

As far as the RD autonomy/step back thing. I believe the RD has as much autonomy as she says. Though I think she is confused on RN autonomy. Docs listened to my recommendations on extubation, narcotics, sedation, and more. I was able to draw labs whenever I thought something needed to be checked based on my assessment and treat electrolyte disturbances, with protocol, but they often listened when I asked to deviate based on renal/DKA/lasix gtt. Could I be over ruled, yeah, just like an rd could.

[Guest hubbardtim48]

Extubation...? In my neck of the woods the nursing staff stays far far away from my vent...the only thing I would ask the nurse is how much longer are we going to be on this sedative or has the doc changed pressor drugs because if not and the patient is vent ready and hemo ready I am extubating.

[Guest hubbardtim48]

Perfect...I just got from your words that you were a dominance nurse and glad to hear you are on a different road...I am fixing to go to bed, but interesting to hear about oneal...never heard of RNs extubating or making recommendations on extubation...and the doc listen...

[andersenpa]

If my nurses call me and tell me someone is ready to extubate- I listen. Or even better yet, the RT or RN call me to say "he's extubated"

[LT_Oneal_PAC]

AND ONEAL FROM OUT OF NOWHERE SCORES THE GOAL!

 

way to go, dallas! (hunt for red october)

 

;)

 

To be fair, the RD may have seen more med-surg nursing. It is the most common type of nurse and I was in cardiac/pulm ICU.

[Guest hubbardtim48]

Yes med-surg, but was it the role of the RT or RN to run the vent and extubate (not talking about hemo or drugs etc). I have worked in 4 hospitals and did clinicals in about 3 others and never seen/heard of a nurse running a vent (unless it was a CRNA) or evaluating for extubation...just wondering because my scope is limited to ONE state so it is a good learning lesson! :)

[LT_Oneal_PAC]

Andersen, I think of my nursing time and recommendations a lot like a comment in another thread here. I would make my recommendations and if I was right, then I got to do what I wanted. If I was wrong, thank goodness someone was there to help. I never felt squashed just because I was nurse. We had great docs.