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Sep 26, 2020 13 tweets 9 min read Read on X
@DocStrange_1 @GallaherCaren "However, our national organizations strongly oppose the view that emergency care is solely “physician-led” or that physicians should dictate education and practice standards for advanced practice registered nurses (APRNs). APRNs undertake rigorous preparation through their
@DocStrange_1 @GallaherCaren 2)education and clinical training through nationally accredited graduate programs, as well as pass national board certification exams. APRNs practice in accordance with the scope of practice determined by national standards and state law." I have no qualms in stating that there
@DocStrange_1 @GallaherCaren 3)is no emergency nurse practitioner(ENP) curriculum that can compare to the training required to become an emergency physician. Not even remotely close. If the AANP does not want physicians to dictate education or practice standards, then don't ask us to precept. Don't apply to
@DocStrange_1 @GallaherCaren 4)"residency" and "fellowship" programs developed by physicians in the ER. Because that is exactly what those programs, that have been supported by NPs, are doing. No one taught physicians how to train NPs because it was never supposed to be our job. I have always maintained that
@DocStrange_1 @GallaherCaren 5)the worst thing that ever happened to nursing education was when they allowed doctors to become the main educators for NPs. The best NPs with whom I have ever worked were trained by their own leadership. The physicians simply refined what was already present so that it fit into
@DocStrange_1 @GallaherCaren 6)their clinic practice model. Now docs are training nurses. So explain to me how a doc trains a nurse to be a NP when a doc has never been a NP? Therefore they must be teaching NPs to practice medicine because that is all docs know is medicine. Is that legal? Nope. But we do it
@DocStrange_1 @GallaherCaren 7)anyway because we think we know. There was no course or program that taught docs to transition from medical training to nursing training. And with the new NP grads from the degree mills today, we are teaching from scratch. The old school NPs knew their stuff--and their
@DocStrange_1 @GallaherCaren 8)limitations. The new grads--it is as if they never attended school. So imagine how smooth the transition is when a doc untrained in nursing is teaching a nurse poorly trained in nursing how to practice medicine. It's a joke. Education should not be a joke, especially when it
@DocStrange_1 @GallaherCaren 9)involves patient care. And as much as the AANP wants to spout nonsense about "rigorous education"--they know it it's inconsistent. Want to know who leads in ER nursing care? ER RNs, that's who. The ones who never get mentioned. Nothing like a good, seasoned ER nurse. I've
@DocStrange_1 @GallaherCaren 10)worked in EDs where it is just me and two ER nurses and been just fine. And those RNs never had a problem with me being the team leader. They also knew I could not do it w/o them. The NPs today don't have the RN experience to be good ER nurse, let alone a good NP. But the AANP
@DocStrange_1 @GallaherCaren 11)will never admit that, because if they do, they have to put a stop to their own agenda. That will never happen. The multitude of subpar NP schools need to go the way of Corinthian Colleges, Inc. because they are doing a disservice to nursing education and its reputation.
@DocStrange_1 @GallaherCaren 12)I agree with the AANP. They should direct their own education and practice standards. So just do it already.

Vanderbildt Emergency Nurse Practitioner and EM residency curriculums are attached. They are different because they are supposed to be. Two distinct disciplines.

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More from @Suburbanbella

Mar 25
@Cigna doing what they do best. Denying s**t. 3 mo old baby in respiratory distress-s/p open heart surgery 2 months before. Baby gets intubated at local ED & doc makes decision to transfer to a higher level of care emergently & arranges for air ambulance.
kffhealthnews.org/news/article/m…
2)Unsurprisingly, air ambulance is out-of-network. Mom and Dad get $97K bill. Cigna believes the pt could have gone by ground ambulance & whines that no records show that ground ambulance “would impede timely and appropriate medical care.” If a doc is transferring a patient Image
3)by air, it's f***ing emergent. We don't take that s**t lightly and we don't do it "routinely". We do it because it's necessary. Instead of having an actual EM Cigna doc talk to the doc so they can communicate the necessity of such a transfer, Cigna chose to deny the claim.
Read 11 tweets
Mar 3
Appears the NP who didn't recognize shingles(from my earlier post) was advised, by crowdsourcing, that the patient has shingles. One would think that would be enough. Nope. Now she asks how to treat. She has no idea how Acyclovir is metabolized(hint: it's not the liver) or how
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2)it's dosed. I will keep ridiculing this nonsense until dimwitted legislators stop enabling scope creep & nursing does something about it's trashy NP education. Improved access, but the quality of care sucks. No access is better than this s**t. midlevel.wtf/elite-np-would…
3)Why is it acceptable to "practice" this way on underserved/marginalized/disenfranchised populations? Let them go do this s**t on people in BelAir or the Hamptons for a change. See how that pans out legislators. I no longer redact names because the public needs to see it is not
Read 4 tweets
Feb 7
This is what bulls**t looks like. Lip service to appear important-but no receipts so the public can understand. Contrary to popular belief, PA school is not med school on steroids. Allow me to interpret the BS. If one is REQUIRED to apply to a med school, there is no "IF". Image
2)"If" implies the individual either does not know what the f**k they are talking or they are straight up lying through their f**king teeth. In the scope creep issue, it is both. "Regardless" is equivalent to "Anyway"...with an attitude. And no receipts.
3)Allow me to demonstrate receipts. Can't use PA programs in the UK because they are raggedy. There are 306 PA programs in the U.S. All are accredited(unless they are on probation). Below is the didactic/clinical curriculums of Duke's 2 yr PA program.
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Image
Read 9 tweets
Feb 5
What a move by the RCP. Totally antithetical to their core mission. Sellouts. PAs have been in the UK since 2005. Unregulated. Suddenly, regulation and prescribing rights are of the utmost importance. Let me say that as an EM doc, I have to be very familiar with pharmacology so
Image
Image
2)that I can intervene expeditiously in patients suffering from various toxidromes, in addition to "routine" medical management. Can't rush through learning that s**t. Ask a pharmacist. But a college that represents physicians is sanctioning expediting prescribing rights for a
3)"profession" with minimal pharmacology training. Like it's a piece of cake. I really don't understand why physicians endorse this s**t when they know full well it is not safe or in the best interest of the public. This is diabolic & reprehensible. Sigh...
Read 12 tweets
Feb 4
Some of you may recall the NP in California who impersonated a doctor online and in-person by not clarifying that she was a NP-as required by state law(Nursing Act). $20,000 fine by the San Luis Obispo DA. She had an "independent" medical practice(NPPs
2)cannot own medical practices in CA), writing prescriptions for everything under the sun w/o a protocol in place(also a violation of the law) & only notional supervision. Her "supervising" doc worked in Massachusetts. Welp, the doc has been fined $25K for failing to supervise.
Read 8 tweets
Feb 4
Listen, I have to get this s**t off my chest. Who the f**k actually believes it is acceptable to allow a so-called "health profession" to have access to patients, to do whatever the f**k they want, yet have no regulations or guidelines(so the public is not protected),
2)no CLEARLY defined scope of practice and NO LICENSE requirement?!! UK PAs, I'm looking at you👀. People, for the love of God, this is unethical as f**k. I cannot believe the commentary by physicians, who represent one of the most regulated, overly licensed & certified
3)professions in the f**king world, DEFENDING this s**t. I'm specifically speaking to the physicians who claim they have "trained" the PAs to be competent and provide high quality care. How the f**k is the public supposed to know that? Because you say so? There is no physician
Read 13 tweets

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