I just feel the need to clarify what I do. I had A day at work today and all my feathers are ruffled. The biggest thing a fellow healthcare professional can do to piss me off is either imply that I don't know what I'm doing (i.e. not understand what I'm trained to do) or call me a nurse. Today...I had both of those thing happen more than once and I came home with fire rolling from my head.
So...I'm a PA-C. Granted the one's that need to read this never do and I don't want them reading my blog anyway because I bitch about them here. But....PA-C translates to Physician Assistant Certified. The title is over 30 years old and began in 1967 with four Navy Corpman who were put through Duke Medical school in TWO years instead of 4. The skipped the first year's worth of general biology classes, and to this days, one can not begin PA school without having a strong background in biology/chemistry classes as PA schools assume a knowledge of the topic, hence the reason I curriculum is shorter than med school. It is also assumes one has PRIOR medical knowledge. We are then put through an intense 24-36 month long program in which the first year focuses heavily on clinical based school work. In other words, we cover head to toe what could go wrong with the human body and how to treat it. The remaining time is spent in clinical rotations where we put to practice all we learned and begin seeing patients, diagnosing patients, and learning clinical skills under the direction of preceptors. Most programs are family practice focused but we also complete surgical training as well.
Upon graduation, a PA is licensed at the completion of his/her boards to examine patients, order tests which we determine appropriate, interpret those tests, perform minor surgical procedures independently, first assist in the operating room, and treat our patients. Now, I currently have a boss who believes I paid $100,000 (yes, that is what I owe in stupid loans) to follow a resident doctor around the clinic and enter their orders into the computer. Obviously, Dr. T is clueless and would prefer that I was "just a nurse" because then I wouldn't question thing so much. He has called my supervisor and told him I'm "too ambitious" at one point in time. I'm over that, we agree to disagree and I do what I'm trained to do with or without his approval.
Today, a nurse called from a nursing home as I had written orders for a patient's PICC line (percutaneously inserted central catheter) to be removed. This line run from one's arm to one's heart. It is basically a really long IV. He stated he had called the infusion therapy clinic and they didn't want to send a protocol to him but that they would talk him through it on the phone. He didn't like that answer so he called us to ask us to order an appt for the patient to have it pulled. I called him back, explained the protocol to him....pull until it comes out. Seriously, that simple. Only risk is that the tip of the catheter break off in the vein if you pull fast. He started loudly yelling at me that he wasn't going to assume responsibility if this patient died if something went wrong. He said he just couldn't accept that. So, he laid the phone down, and said to his supervisor "some nurse is telling me to just pull it". Well, the supervisor got on the phone and I quite clearly introduced myself just as I had to the gentleman as Nicolle Hendrix, PHYSICIAN ASSISTANT with OTS. Fuck him for calling me "just some nurse". I repeated the "pull until it is out" instructions, told her to check the catheter tip, if she needed to make herself feel sure, get a chest x-ray when done and call me back. She was fine with that, asked me to write an order so I wrote pull gently until catheter is removed, dictated a note to cover my ass, and later this afternoon called to see if they had had problems. She had gone home so I left a message.
Problem #2. I wrote physical therapy orders for a demented woman that has fallen three times in the last 2 months resulting in one surgery and two other sets of fractures. She has a knee cap fracture and because of her mental state is not a safe walker. I wrote orders for her to be ambulatory only for short distances with family or nursing staff (bed to chair, chair to bathroom). She is to get therapy once a day only to walk a longer distance, with therapy in her brace. Nurse called to tell me they had been walking her with nursing four times a day and how could I write orders to move her backwards right that. I repeated my exact orders, told her why and she hung up. Five minutes later she had the therapist call me to argue, I didn't even bother, handed the phone to Dr. Mabry and let him explain the exact same thing I had just said! When I write an order, I mean it!
So, if you or a loved one sees a PA, please do not call us a nurse. Understand we have completed intense and extensive clinical and surgical training, are licensed at a national level to examine, diagnosis, and treat you with the direct supervision of a physician that we can call on at any time (as required by law) for anything we feel is out of our scope of knowledge. Only question our orders if they seem absolutely absurd, such as a typo or we identified the wrong extremity (we don't do that often) but just like the doctor most have on a pedestal, we are human and will admit any mistake we do make (at least the good one's will).
now off to the gym to finish my vent and then I'll be better.
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