Nursing Stories in the Top 100 Best Blogs


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First, I am excited that there are 100 best nursing blogs.

Wow. Great job nurses!

And I am pleased that my blog, Nursing Stories, has been included in this group.

And, yes, I am boasting.


Nursing Stories

Nursing Stories is a heartfelt blog about one woman’s experiences in nursing. Marianna Crane, the blogger, has been in nursing for over 40 years, and she now uses her blog to share her stories from the past and present. She has been a certified adult nurse practitioner since 1981, and she has a passion for writing that is evident in her blog posts. Marianna says, “My goal for this blog is to encourage nurses to boast.” You can get inspired to be a better nurse thanks to this woman and the great stories she shares on her blog. Some of those stories include:

Make My Mother Proud


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I’ve mentioned that I’m rewriting the manuscript that I thought I had completed. Besides adding more about gerontology, I am digging deeper into the dichotomy between my bent for caring for older persons and my difficulty getting along with my own aging mother.

Living with Mom had never been easy. Being an only child of a narcissistic woman meant everything I did, or didn’t do, reflected on her self-worth. Back in my blue-collar Jersey City neighborhood in the early ‘60s, where most of my peers didn’t seek education beyond high school, the fact I had become a nurse was a gold star on my mother’s bib apron. I walked the three blocks to and from work at the city hospital in my white uniform, carrying my starched white cap, sometimes stopping to chat with neighbors and fend off questions about health issues.

Soon after I had graduated from nursing school, my mother and I were visiting a cousin. My cousin was much older than I. I had spent summers with her and her husband while growing up, escaping the hot city and my overbearing mother. We sat in the kitchen of her Levittown home drinking coffee and finishing off the last of her home made pineapple upside down cake.

“What should I do about all this drainage coming from Sugar’s ears?” my cousin asked me. My mother leaned back from the table waiting for me to expound on possible causes. She wanted me to know all and be an expert on everything so I could spout off advice and make her proud. She didn’t react when I claimed I didn’t know what was going on.

But later, as we drove home, she reprimanded me. “Why couldn’t you just tell her what was wrong with Sugar?”

“Mom,” I argued, “I know nothing about dogs.”images-1

Sugar was a Cocker Spaniel.

Just a Nurse


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bookmrk-sm1This is from Suzanne Gordon’s Blog. Ms Gordon is a journalist and stanch supporter and promoter of all things nursing.

Recently she asked nurses to respond with their version of “Just a Nurse.” I am delighted to see their feedback. May nurses continue to tell the public what they do and how important their job is.

I would like to post all the Just a Nurse submissions people have sent me.  See below.  What do you think?  I think they are all great.  Thank you so much, all of you.

Suzanne Gordon

I’m just a Pediatric Intensive Care Nurse. I just manage my patients’ drips to keep to their vital signs in a stable range. I just make sure their medications are safely administered. I just make sure the physician is informed of any small but meaningful change in their condition so we can work together to prevent catastrophes. And I just make sure that the patient and family aren’t terrified by all of the beeping alarms and alarming equipment. Kateri Allard, RN

I am just an Emergency Department nurse who recognizes that you are short of breath, listens to your breath sounds with my stethoscope, checks your oxygen blood saturation, and with my expertise and knowledge on how to treat respiratory distress, immediately initiates appropriate, life-saving treatments. But, hey, I’m just a nurse. From Kathleen Burke, RN

I am just a pediatric nurse practitioner. I immunize your child against life threatening diseases. From Suzanne Malloy, RN

I’m just a Nurse I make sure my patients do not die alone. From Aimee LeVasseur Desmarais, RN

Just a Nurse

it was JUST a nurse that held my hand when I got sutures for the first time

it was JUST a nurse that gave me a lollipop when those sutures were removed

it was JUST a nurse that explained in layman’s terms what my injury was

it was JUST a nurse that took away the butterflies before surgery

it was JUST a nurse that held my Mom when she was told Dad’s cancer was terminal

it was JUST a nurse that brought coffee and comfort during those long visits to the hospital

it was JUST a nurse that gave us smiles and understanding

it was JUST a nurse that gave Dad the dignity her deserved while he was dying

it was JUST a nurse that said “I’m sorry for your loss.”

it was JUST a nurse that said it was ok to cry when Dad passed

it is JUST a nurse that wears a uniform

and like most anyone in uniform, they are JUST heroes

From Liam Downey, RN

I’m just a nurse. I just help patients and families in their last hours of life and I just am there to welcome new babies into the world, and I just take care of everyone in between of every culture, race, socioeconomic status with love and acceptance. I am just a nurse. From Deborah Kloos, RN

Well, I’m a pediatric nurse. I just hold a crying parent in my arms after the doctor informs them that their child has a brain tumor…From Charmain Berrian,RN

I’m just a nurse, I’m the one who will make sure your surgery team knows everything about your history before you enter the OR suite. From Susan Bartlett, RN

I am a nurse…I care about people…I take care of people…it is not a job it is my life…24-7.  From Donna DiRusso

I’m just a nurse. I held my patient’s hand as she cried wondering how she would ever heal her debilitating wound. From Toni DiMar, RN

I’m just a nurse, I fixed a bowl of mixed up medication to be in a med organizer so my patient would take her prober meds and not die of an overdose. From Toni Di Mar, RN

As professional nurses we do “listen to the heartbeat,” not only of individual patients, but of entire communities. Nurses look for, find & care for the forgotten people. We advocate for homeless families and campaign for social justice. We practice compassion with persons affected by addictions. Nurses tend to the needs of people experiencing mental health challenges. We step up to the podiums at town halls and at our State Capitals. We are indeed front-line healthcare providers. Every Nurse a Leader! #rockthestethoscope  From Barb Enos, RN, MN

I’m just a nurse, I teach patients about their disease process, how their medications work alone & in combination with each other, review symptoms to monitor, and listen to their fears as they progress on their health journey while taking care of four other individuals. From A. B. Fay,RN

I’m just a nurse, when I nurture new interns and new nurse graduates, socialize them to the complexity of healthcare, and care for a full patient assignment. From A. B. Fay, RN.

I’m just a nurse. I translate medical jargon into simple understandable terms that people can understand.

I am just a nurse. I breathe life into people who have died.

I reduce the suffering of people who are dying making their last days comfortable.

I help families to share a common goal making their experience of a dying parent/child bearable.

From Patricia McNair, RN

I’m Just a nurse…I informed the ED attending that the patients cardiac monitor pattern had ST elevation and was a STEMI. I’m just a nurse….I questioned the dose of a resident’s order for a beta blocker that was more than double what should be given.  From Elissa Aldred,RN

Baby Found A Home


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UnknownThere is one story I wrote that still chokes me up every time I read it. How could it be that something that happened over 40 years ago could still feel so raw?

I walk down the hall of that ten-room pediatric unit in my mind—passing the linen closet on the left, the utility rooms on the right and a room directly across from the nurses’ station with a huge glass window for the sickest children. There weren’t pediatric intensive care units at the time and hospital rules prohibited parents from staying overnight. I, along with my nurses aide, had full responsibility for all the babies and children over an eight-hour night shift. I was twenty-one.

It was in that linen closet that the baby, covered with a blue baby blanket in an isolette, was left to die. I had all but forgotten about him until his story began to pull itself up from the catacombs in my brain, shake off the cobwebs, and demand attention.

I like to think that by writing Baby in the Closet I have honored his short life.

Thank you Hospital Drive for giving Baby a home.

Nurses Unite But Is It Enough?


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I have been following the brouhaha over the derogatory comments made by Joy Behar on The View about Kelly Johnson, Miss Colorado and a nurse.

I last saw the Miss America pageant sometime in my preteen years and caught snippets of The View as I surfed channels years ago so I am no expert on either venue. However, what I do know is that Ms. Johnson came on stage dressed in scrubs with a stethoscope around her neck during the talent part of the Miss America Pageant on Sunday September 13th and spoke about her love of nursing rather than dance, or sing, or play the trombone. Her concluding statement was “I’m a life saver. I’m never going to be ‘just a nurse.’”

The next day on The View her performance was the subject of mean, gossipy and clueless remarks made by the hosts, such as she wore a “costume” and a “doctor’s stethoscope,” and seemed like she was “reading her emails.”

You may be aware of all of this. And like me you were proud to see nurses pull together communicating under the hashtag #NursesUnite and demanding an apology for demeaning the nursing profession.

Nurses got results. The women from The View did attempt an apology. It may have been too little, too late since two sponsors have pulled out (Johnson & Johnson and Eggland’s Best) and there is momentum afoot to terminate of the program.

I was feeling pretty good about the power of nurses’ collective voice.Then I read this open letter on by a disillusioned nurse. I try to keep my posts short but I think this letter needs to be read in its entirety.

An open letter in response to #NursesUnite movement:

It is amazing that you have finally found a cause to unite over (#nursesunite), however, I find it hard to jump on board this superficial bandwagon that actually serves the nursing profession no purpose whatsoever.

I have pondered over the last week why it is that so many nurses take such offense to the few words of an ignorant television host, being that Ms. Behar has zero impact or influence on the healthcare profession or the role of nursing, yet they do nothing to end the many real issues plaguing the nursing profession.

The only conclusion that I can come up with is that nurses feel that they can’t do much to change the real problems in nursing, so they unite and attack over something that really makes no difference at all to us as a whole.

There are so many other REAL aspects of the nursing profession to unite over to influence change that will actually make a difference to nursing. There are many “dirty secrets” of nursing that go unspoken and ignored, many of which are cultivated by nurses themselves.Bullying, horizontal violence, inadequate training, nurses “eating their young”, 12+ hour shifts, no breaks, high acuities, too many patients per nurse, etc.

I went into nursing because I like to help people. I am empathetic. I am a quick thinker. I am smart. But that isn’t actually what makes a nurse successful in this profession, as I have come to find out. As I have come to find out, nursing has less to do with how competent or compassionate you are, and more to do with how much you can, or are willing to, put up with. The nursing culture is full of “suck it ups” and “oh well, it is how it is.”

What seems to make a nurse successful is the ability to withstand bullying, intimidation, being talked down to by supervisors, patients, family members, and doctors. The ability to get over inadequate training and support provided by management and your peers and to be okay with unsafe (patient) to nurse ratios. You’ll feel more confident in time, it’s just a part of nursing.

To be successful in nursing, you have to be okay with having zero time to take a break (even a bathroom break) and most times, taking your lunch sometimes 8 hours past your start time, or sometimes not even getting a lunch. You have to be okay with being dehydrated while hanging patient’s IV bags and shaking from not being able to take a break and eat while you are checking diabetic’s blood sugars and teaching the importance of proper urinary hygiene to avoid UTIs while you’ve been holding your own urine for the past 5 hours. Nurses are expected to just be okay with it. It’s just a part of nursing, right?

You have to be okay with coming in early to “get familiar” with your patient load and not getting paid for that time. You have to be okay with staying well past your shift to give report on a regular basis, taking your total time on the clock (and off) well into 14-15 hours, which means that you are so tired driving home that you hope you make it there without crashing because your brain is tired mush. But long shifts are just a part of nursing.

You have to be okay with having to do more with less, even if it affects patient safety and outcomes. You have to be okay with doctors yelling at you and treating you like you’re an incompetent idiot rather than a professional colleague in health care. You know that if you call a doctor to clarify orders or to update on your mutual patient, you may be met with disdain and sarcasm. But that’s okay too, because it’s just a part of nursing.

Nurses know this to be true. Nurses know these are the dirty secrets of nursing. Nurses know that bullying is rampant. Yet, the answer to this problem is “grow a thicker skin” or “you’ll just get used to it”.

Nurses know that understaffing is a given and that high acuity and high patient loads per nurse is more common than not. Nurses know this isn’t safe, they know the care being given isn’t what it should or could be, but they do not unite together against it and demand change.

Nurses know that there is often a lack of adequate training and preceptorship for new grads and new employees entering new specialty areas and that too many times nurses get thrown to the wolves and it’s a sink or swim mentality. But, this is just a part of nursing we accept.

Nurses know this. They live it. They experience it. It is the culture of nursing. Yet, there is no call to end it. No hash tag. No selfies. No viral campaign on social media. No standing up to it. Just the continued mentality that these things are just a part of nursing that you have to accept or leave.

So, instead of uniting together against something or someone that has no impact on nursing, why not stand up and unite against the things that are killing the nursing profession and demand they change?


A disillusioned nurse

I hope that nurses’ collective voice only grows stronger and wields the power it possesses to effect positive change in the nursing profession.


Rewriting the Book


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writing a bookI’m doing what I said I would never do. Rewrite my book. I completed my manuscript late last year, sent it out to 20 small presses and one agent. While I have been waiting for the results to trickle in—those returned so far have been rejections—I’ve been troubled by a lingering discomfort that I have left something out. Something significant. Something that I couldn’t, shouldn’t ignore.

So for the past few months I have been having an internal dialogue:

“Leave the book alone. You did the best you could do.”

“No, something isn’t quite right. I’m not happy with the final manuscript.”

“You could be rewriting this book for the rest of your life. Let it go. You don’t want to be that writer who never submits her book because it ‘isn’t good enough’.”

“Aha! I know what it is that’s troubling me.”

My book shows how I managed a Senior Clinic in a Chicago Housing complex. I was a new nurse practitioner (not a new nurse). I show the role of the NP. However, in writing the book, I had totally overlooked the fact that while I was indeed a new nurse practitioner, I was also practicing in a new specialty—Gerontology. I say this but I DON’T SHOW IT.

Why is this important? Well, because when I became a Gerontological NP in the early 80s, studying old folks was a rarity. Older persons were generally ignored or worse, discounted and ill-treated. The 1978 best seller House of God by Samuel Shem, an irreverent book about medical interns in an renowned teaching hospital first coined the derogatory term GOMER, meaning “get out of my emergency room.” A term used frequently to classify the old person as someone without worth to cure, much less treat in our medical facilities. Some believed most old folks disengaged from life, deriving no pleasure in longevity. The fact that elders over 60 would still be interested in sex was shocking. WY SURVIVE: BEING OLD IN AMERICAAnd in this same time period the groundbreaking book: Why Survive? Being Old in America by Robert N. Butler, M.D. discussed whether or not to introduce geriatrics in postgraduate medical education.

Nursing was early to recognize geriatrics as a specialty but thought that the medical definition—specializing in the treatment of existing disease in older adults—too narrow.

Nursing developed a much broader vision and used the term gerontology rather than geriatrics.

Gerontology encompasses the following:

  • studying physical, mental, and social changes in people as they age

  • investigating the biological aging process itself (biogerontology)

  • investigating the social and psychosocial impacts of aging (sociogerontology)

  • investigating the psychological effects on aging (psychogerontology)

  • investigating the interface of biological aging with aging-associated disease (geroscience)

  • investigating the effects of an aging population on societyapplying this knowledge to policies and programs, including the macroscopic (for example, government planning) and microscopic (for example, running a nursing home) perspectives. (Wikipedia)

In 1981, the American Nursing Association certified me as a Gerontological Nurse Practitioner. A Board Certification was developed by the Medical Community 7 years later.

After I rewrite my book, you will see a Gerontological Nurse Practitioner in action.



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stock-photo-doctor-with-mammography-292061516I’ve written in a previous post about my experience of being diagnosed with breast cancer 18 years ago. I’ve always wondered if I should have forgone a mastectomy and adopted a watch and wait stance. However, when my doctors never gave me that option and my family was aghast at my doing anything less than full warfare on the invading cells in my body, I gave in to surgery.

The type of cancer I had, ductal carcinoma in situ or DCIS, is still under investigation. Is it or isn’t it cancer? If it doesn’t leak out of the lining of the milk glands and metastasize, is it truly deadly? The treatments given to women can sometimes cause more problems than living with cells that, in some instances, resolve. So I was happy to see more attention given to finding answers in a new study about DCIS in the JAMA Oncology (online) August 20, 2015.

I had become an advocate of taking “cancer” out of DCIS label. That way women wouldn’t panic and rush to having mastectomies and in some cases prophylactic double mastectomies. Hopefully “watch and wait” would be an added choice rather than have women succumb to unnecessary treatment.

After I read the original article in JAMA—I am not going to tell you I understood all the statistics—I realized that DCIS is what most cancers are: complicated. Some types of DCIS can predict that a lethal breast cancer can occur in the future. I am more sympathetic of the tightrope that physicians and surgeons walk in counseling their patients.

The accompanying editorial by Laura Esserman in the same JAMA issue gives the following suggestions:

  1. Much of DCIS should be considered a “risk factor” for invasive breast cancer and an opportunity for targeted prevention.

  2. Radiation therapy should not be routinely offered after lumpectomy for DCIS lesions that are not high risk because it does not affect mortality.

  3. Low-and intermediate-grade DCIS does not affect mortality.

  4. We should continue to better understand the biological characteristics of the highest-risk DCIS (large, high grade, hormone receptor negative, HER2 positive, especially in very young and African American women) and test targeted approaches to reduce death from breast cancer.

Hopefully these suggestions will become a common practice in health care settings so women like me won’t be regretting a choice they made based on incomplete knowledge and overdiagnosis by the medical professionals.



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Joan Didion

Joan Didion

I am always on the lookout for positive trends in aging. Here’s what I found in Creative Review. The Age Issue, (June 2015) on page 40:FullSizeRender

Cooler older women are having a bit of a fashion moment. What started a couple of years ago as a trickle of magazine covers and ads featuring women over 60 has recently turned into a flood: Helen Mirren for L’Oréal, Charlotte Rampling for Nars, Jessica Lange for Marc Jacobs, Joni Mitchell for Saint Laurent . . . the list goes on. When Joan Didion was announced as the new face of Céline SS15, via an ad showing her looking almost unbearably hip in a photo shot by Juergen Teller, Twitter exploded with excitement. For those of us weary with the endless parade of blank-faced young models, the arrival of some older faces—complete with both wrinkles and a story to tell—comes as a relief. (Bold and italics mine). . . Could we finally be seeing a shift away from the obsession with youth and a renewed respect for older womenkind? Could we?

Later, I found an article in the Travel and Style section of the Wall Street Journal: Smith, Erin Geiger. “Websites Predict Your Perfect Dress,” The Wall Street Journal, (6 Aug. 2015), which discussed online shopping. One web site, MM.LaFleur, offers a “ ‘Bento Box’ of clothes and accessories ” based on a series of questions to discover the preferences of the prospective buyer. MM.LaFleur goes on to ask buyers to select their “girl crush.” (I take this to mean which woman you most want to look like). The choices are not supermodels but real people. Okay, famous people and some dead ones, but not with unattainable physical perfection or youth. People like Oprah, Sonia Sotomayor, and Amilia Earhart and wait for this, Joan Didion.

I can only surmise that there is a growing trend, however subtle, toward an expanding female ideal that includes, finally, older women with wrinkles, character and brains.

May this trend continue.



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I couldn’t pass up sharing this article in Consumer Reports about nurse practitioners and physician assistants especially since I just registered with my new provider, a nurse practitioner a week ago. She and a physician assistant cover for each other. Best of both worlds.

Check the comments, which are so positive.

When a nurse is as good as a doctor
Nurse practitioners and physician assistants can offer first-rate care
Published: July 14, 2015 08:00 AM BY

Across the country, nondoctor health care professionals—usually nurse practitioners (NPs) and physician assistants (PAs)—are turning up in a range of medical settings. We see those so-called advanced practice providers most often in primary care and family medicine practices, but they also work as specialists in hospitals and retail clinics, and more. In rural areas, they may be the only health care providers who are regularly available.

Their ranks are growing fast. In the past 10 years, the number of licensed NPs in the U.S. has almost doubled to 205,000. Between 2003 and today, the number of certified PAs grew from about 43,500 to more than 102,000.

One major reason: Demand for doctors, especially family physicians and internists, is outstripping supply. The Association of American Medical Colleges expects a shortage of up to 31,100 primary care doctors and up to 63,700 other physicians by 2025.

Advanced practice practitioners can make up the shortfall. But can they give you the care you need? And how does the care compare with what you’d get from a doctor?
What they do, what they don’t
PAs and NPs are handling many tasks that were once the exclusive domain of doctors: They can write prescriptions in every state. In 21 states and the District of Columbia, NPs can practice autonomously. Some NPs and PAs substitute for residents at academic medical centers.

But there are differences between them and doctors. One distinction: What advanced practice practitioners are permitted by law to do can vary from state to state and even from hospital to hospital. For example, NPs can’t prescribe controlled substances in Florida. In some states, a supervising physician needs to be on site when a PA treats you; in other states, it’s not necessary. Nationwide, an NP’s or PA’s authority to admit you to a hospital is up to the hospital.

Training differs, too. Doctors and PAs train under the so-called medical model (though primary care doctors have about 23,000 hours of education and training, PAs have around 3,000). That teaches physicians to “work through a diagnostic process that directs the questions you ask, the physical you perform, the diagnostic studies and treatments,” says Reid Blackwelder, M.D., chair of the American Academy of Family Physicians’ board of directors. Nurse practitioners are educated under the nursing model, which stresses health promotion and education.

Ultimately, what an NP or PA does in your doctor’s office will depend on his or her experience, the setting, and the speciality, notes Marc J. Moote, PA-C, chief physician assistant at the University of Michigan Health System in Ann Arbor. “Often, each physician/PA/NP team will decide the best use of everyone’s skills on the health care team, and this can vary from practice to practice,” he adds.

6 big benefits
NPs and PAs are indispensable in handling everyday problems such as sore throats or urinary tract infections, freeing primary care doctors to handle more complex conditions, says John Santa, M.D., medical adviser to Consumer Reports. They can also prescreen patients, make hospital rounds, do follow-up care, monitor treatment, manage chronic conditions, and have a place in specialty care as well. “They can be very good at the history taking, reviewing a patient’s records, and coordinating everything the specialist needs,” Santa adds. What’s more, many PAs work as surgical assistants. Though seeing an advanced practice practitioner is unlikely to lower your co-pay, it can help reduce overall health costs. Other benefits may include:

Shorter waits for appointments. Merritt Hawkins, a health care search and consulting firm, found that in 15 metropolitan areas, new patients wait, on average, 18.5 days to see a cardiologist, dermatologist, family physician, obstetrician/gynecologist, or orthopedic surgeon. But with more providers in the office, the PA or NP can see a patient if the doctor can’t.

A team approach. Having an NP or PA on staff makes some aspects of team-based health care more feasible. He or she can check a cough, cut, or sprain, and ensure vaccinations and blood pressure and cholesterol checks are done. A 2013 review in the Journal for Nurse Practitioners reported comparable blood glucose and blood pressure levels in people cared for by NPs as in people seen by doctors.

Convenient care. NPs and PAs staff some walk-in clinics at drugstores. So if you develop a urinary tract infection, for example, you can get the care you need ASAP.

Faster emergency-room treatment. Canadian researchers have found that in ERs with NPs and PAs on duty, people without life-threatening symptoms were twice as likely to be treated within 15 to 60 minutes.

Help with chronic conditions. Once you and your physician decide on a treatment, a PA or NP can make sure it’s going smoothly, for example, that your blood glucose levels are well-controlled.

APPs are especially helpful for seniors with chronic illnesses. A study in the Journal of the American Geriatrics Society noted that older patients managed by both an NP and a physician had higher quality care for dementia, falls, and urinary incontinence than those treated only by a physician. Co-management “is most appropriate for conditions that require a lot of close monitoring, patient engagement, and education,” says study co-author David B. Reuben, M.D., chief of the division of geriatrics at the David Geffen School of Medicine at UCLA.

Lower risk of hospital readmission. Leukemia patients in the hospital for chemotherapy cut their stays by about 6 days and were less likely to be readmitted within 14 days when cared for by PAs instead of doctors in training, according to a small study in the Journal of Oncology Practice. A 2013 study in the Journal of Thoracic and Cardiovascular Surgery found that when PAs make home visits to heart surgery patients as part of a PA home care program, it lowered 30-day readmissions by 25 percent.

See our Guide to Doctor Ratings and get advice on how to choose a doctor.

When to stick with a doctor
More research is needed to definitively assess when seeing a doctor might be preferable to seeing an NP or PA. Advanced practice practitioners have the know-how to play a primary role in diagnosing and treating common ills and an auxiliary role managing complex ailments, says Marvin M. Lipman, M.D., chief medical adviser to Consumer Reports. “Doctors are good for those 5 to 10 percent of patients whose symptoms don’t add up and need more detailed investigation,” he notes.

NPs and PAs say they can handle more than routine tasks. “It’s a misconception to assume they can’t diagnose or manage complex care,” Moote says.

That said, some research suggests physicians may be more skilled in some areas. For example, one 2013 study found that family physicians who referred patients to a medical center better understood what the symptoms might suggest and were more likely to order the right tests than NPs and PAs. The doctors’ referrals showed “a much more logical approach,” says William Mundell, M.D., assistant professor of medicine at the Mayo Clinic in Rochester, Minn. “They were getting closer to the diagnosis.”

Another key question: How many tests are different types of providers ordering? Recent research in JAMA Internal Medicine found that NPs and PAs tend to order slightly (less than 1 percent) more imaging tests than primary care physicians for similar Medicare patients.

The takeaway: All of those providers have an important place in health care. Make sure that you see the right one for you at the right time.

Editor’s Note:
This article also appeared in the August 2015 issue of Consumer Reports on Health.



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TEAMLast week, I attended the second and last part of the TeamStepps workshop. In another post (“Was I Dreaming?”) I described the first workshop and my surprise at how the doctors willingly and enthusiastically participated in the dialogue and group activities. What would I find this time around?

TeamStepps is a program that promotes teamwork and teaches “team strategies and tools to enhance performance and patient safety.” The audience was a group of professionals who worked in the surgical area of a large teaching hospital. I volunteer at the hospital and attended as an observer, although I did participate in some of the exercises.

The first thing I noticed when I entered the room was the empty chairs at each of the four tables. After we finished with introductions, it was clear most of the absentees were doctors/surgeons. I felt disappointed. Was their eager involvement at the last meeting just a charade?

This seminar was pivotal for implementing TeamStepps. The group in attendance—nurses, OR techs, surgeons, anesthesiologists—were to be the “coaches” who would model effective team work and help “change the culture” of the hospital. The leaders of the workshop, two doctors and four nurses, were poised to teach how to be an effective coach. Furthermore, there had been homework. Each table had been given a “discussion question” at the end of the last meeting with the expectation that the group would present a three to five minute demonstration. The occupants at my table included two nurses, one OR tech and an orthopedic surgeon who was preoccupied with the open laptop in front of him. I had already excused myself from participating in the skit.

When time came for the demonstrations to begin, those at my table seemed to be looking at the question for the first time. The other three groups appeared to be scrambling also. In the meantime, some doctors had slowly been slipping into their seats. Two appeared at our table and joined the activity. The surgeon at the end of the table had closed his laptop. Unbelievably, to me, each group, in turn, stood in front of the room and showed, as instructed, the right and wrong way to address their question.

(Our table was to communicate how the team would handle a situation when a necessary piece of surgical equipment fell to the floor and was contaminated).

In the skits, the surgeons played nurses, the nurses played doctors, OR techs were the anesthesiologists. The shows prompted much laughter and recognition of obnoxious and unprofessional behavior in the “wrong way” skit and applause for “right way” team interaction.

For the remainder of the meeting the leaders introduced peer-to-peer feedback, not easily understood by some of the surgeons who saw themselves as designated leaders and superiors and staff as subordinates. The coordinators, especially the nursing coordinators, gently suggested that the team was made up of peers regardless of occupational titles.

Like the first TeamStepps session, I was impressed with the positive vibes and enthusiasm from the audience. My world of hierarchical structure and deference paid to the medical staff was changing. I believe that this change in culture will bring a safer patient environment.

On the last page of the handout this statement stood out:

Important that staff realize this is not a passing phase—it is our model for patient safety moving forward.

 I think this model will indeed move forward at this hospital even though the ride may be a bit bumpy.


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