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Have an interesting ER story? If I use it, I'll give you a free book. For more Q & A, see my Test your knowledge of ER terms by solving my ER crossword puzzle that was featured in the Prudential Securities Healthcare Group 2002 calendar. Or take the ER-MCAT to see if you have what it takes to be an ER physician. Including my:
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More ER Questions and Answers QUESTIONS ABOUT OTHER ER PERSONNEL Is
it more satisfying to be an ER nurse or doctor? Role
of Physician's Assistants (PAs) in the ER The two answers posted above prompted an incandescent response from two readers (on the same day, nonetheless, and containing strikingly similar verbiage), one of whom was a president of a nursing organization. Here is my response to her:
My ER site is extensive, with over a hundred pages, some of which are
longer than a typical book. Therefore, you may not have had the time to
read everything I wrote. Had you done that, you would realize that I
strongly support the nursing profession. I repeatedly made the point
that (especially in the ER), doctors and nurses work as a team, and that
all members of that team are vital. Furthermore, I am a strong proponent
of what I believe is the only practical solution to dealing with the
shortage of qualified nurses. Had you read all of my site, you would
have encountered that proposal —
which would, by the way, do far more for nurses and the nursing
profession than anything I have ever seen advanced by nurses. Therefore,
I do not think that it is accurate or fair to characterize my nursing
viewpoints as being inimical to that profession.
I will now specifically address your quotations from my site:
You objected to ". . . being a doctor is more demanding and more
stressful, but also more rewarding." First, I think this world would be
a better place if everyone felt that their job was the most
rewarding one in the world. Second, it is my opinion that it is more
demanding and stressful to be a physician than a nurse, especially in
the ER. The education, training, and requisite knowledge base for ER
physicians is substantially more extensive than that of ER nurses. In
most emergency departments, there are several nurses working for every
ER doctor. Most of the shifts that I've worked were single-coverage,
meaning that I shouldered the responsibility for every patient
in the ER (as well as inpatient obstetric and other emergencies during
the night shift in some hospitals). Nurses could share the load by
taking a subset of these ER patients and, if the pace was too hectic,
backup nurses could be summoned from the ICU, CCU, or other medical
floor. In my opinion, the greatest demand and stress of being an ER
doctor is the realization that every patient I treat (and there could be
dozens of them per shift) depends on me to do the myriad things that
doctors do: read EKGs and x-rays, interpret tests, perform advanced
procedures beyond the scope of nurses, diagnose, prescribe, and to
determine a suitable disposition. ER RNs are not trained or legally
permitted to do these things, which of course absolves them from the
demands and stresses of doing these things countless times per year on
thousands of patients. Doctors are the ones who are ultimately
responsibility for ensuring that their patients receive optimal care. If
a patient is misdiagnosed or given the wrong therapy, it is the fault of
the doctor, not the nurse. If there is a serious problem with a patient,
an ER nurse can and should notify the ER doctor, who must then determine
how to respond.
ER nurses are unquestionably essential, but if a potentially
life-threatening problem develops, patients count on ER physicians
— not ER nurses
— to determine the therapeutic
response. With rare exceptions, when a patient dies who should have
lived, it is the doctor's fault, not the nurse's fault. Thus, doctors
are the ones who must shoulder "the buck stops here" responsibility for
patient care. As I alluded to before, nurses can and should pass the
buck when a serious problem develops. If doctors could similarly pass
the buck, their work would be considerably less stressful. Human life is
incomparably precious, and the loss of it is incomparably tragic. In a
nutshell, that is why I believe it is more demanding and stressful to be
a doctor than a nurse, because doctors are the captains of the ship.
They're the ones who chart the course of patient care. Their actions
literally determine if patients live or die. Until you have worked as a
physician, I do not think that you can fully understand what it feels
like to be ultimately responsible for a patient's life. It can be a
heavy burden, but it can also be highly rewarding when a life is saved.
In my opinion, there is a correlation between the difficulty of
something and its potential reward. Perhaps I am biased from being a
physician instead of a nurse, but I do think that when a
patient on the verge of death becomes my patient, it is more
rewarding to be the one who determines the cause of the problem and what
to do about it, instead of the one who carries out the orders of someone
else. When things go well, as they usually do, nurses should take great
pride in knowing that they contributed to the outcome. However, I
personally cannot fathom how it could be equally rewarding to, for
example, administer a drug that someone else ordered than to be the one
who determined what drug was needed. I could cite numerous other
examples that illustrate my basic point: namely, that occupational
reward is commensurate with occupational demands. This correlation is
not unique to the healthcare professions; there are many other examples
of it. Being President is more demanding but potentially more rewarding
than being a civil servant who does not determine policy or shoulder the
burden for it. Would anyone contend otherwise? Or who would think that
it is not more demanding but potentially more rewarding to be a
corporate CEO than to work in its shipping department packing boxes? I
am astounded that anyone could dismiss this correlation between
difficulty and reward. This association is well-known and not limited to
occupational tasks.
You also objected to my statement that nurses ". . . do everything the
PAs and MDs don't do." Please understand that I receive far more
questions every year than I can respond to in a comprehensive way. I
sometimes have the time to compose exhaustive answers, but I sometimes
must be brief. I never said or implied that every response on my site
was necessarily comprehensive. Some of my replies are encyclopedic,
while others are the Reader's Digest-type of condensed
material. My site is primarily intended for people interested in a
career in emergency medicine or another medical specialty. I recommend
that anyone with such an aspiration take the time to read my entire site
to ensure that they don't miss anything. I cannot
— nor would I want to
— repeat everything that I
previously wrote every time I respond to a question. Readers who wish to
obtain a comprehensive understanding of my information must read my
entire site; its content cannot be shoehorned into every response.
Reading my entire site offers a better understanding of the role of
nurses. Is there some overlap between what doctors and nurses do? Of
course there is. For example, if the nurses were busy and I was not, and
a bed needed making or a urinal needed draining, I'd do it, even though
most physicians disparage those tasks as "nurse's work" that they never
do. Period. I strongly believe that effective teamwork in the ER
requires rethinking of traditional circumscribed roles and tasks. Yet
there will always be things that only doctors can do.
In the conclusion of your letter, you asked me to contact you to discuss
how I can work with your organization to help the ER nursing profession.
I welcome this opportunity, and I will reciprocate by giving you space
on my site to regularly discuss the profession of emergency nursing.
Sincerely yours,
Kevin Pezzi, MD
One reader suggested that I refer questions about non-physician personnel to organizations representing those personnel (Update: I tried doing that, but they never responded to the people who asked the questions. Interestingly, even when the head of some nursing organization wrote to me and suggested that I refer questions to her, I did just that, but again received no response. What's the proper term for this? Hot air? It's not that they are willing to answer questions — they just want to silence people whose opinions are not in lock-step with their own. What's the proper term for this? Thought police? Nazis?). First, I don't know of any organization representing ER clerks or ER techs. While there are organizations representing nurses, I am woefully disappointed by their efficacy. In my opinion, they have not done much for nurses. My friends who are nurses have given me an earful of complaints about their occupational gripes. There is no easy remedy for some of these dissatisfactions, but many of them could be solved if nursing organizations were less namby-pamby and possessed a better vision of how to advance the nursing profession. Instead of bold steps that could make nursing careers more satisfying and rewarding, those organizations seem to content themselves with spineless policies that do little to appreciably improve problems that are faced by today's nurses. The predictable result is that these problems persist year after year, thus making nursing a more frustrating career than it should be. I've traced the roots of these problems and concluded that many of the unsolved problems that perennially plague nurses stem from a surprising source: a lack of self-esteem and self-worth amongst nurses and their leaders. If you look past the meaningless "nursing pride" rhetoric, you will see that, deep down, nurses discount their true worth and are too willing to accept the "you're worth only this much" BS that nurses are fed. Collectively, nurses have implicitly acceded to these usually tacit putdowns. Society sees nothing wrong with showering boatloads of money onto people with easier and less important jobs, but when it comes to paying nurses what they are really worth, society speaks volumes about what it thinks of nurses when they receive a pittance for helping to save someone's life but a stripper can make thousands per night displaying her anatomy, or real estate agents can make over $20,000 for selling a house after they've passed their grueling week-long training course. Ahem. Even when nurses are given positive strokes, these are often trivial and even patronizing. One of my nurse friends shows me the stuff her hospital gives to nurses on special occasions. The two most recent trinkets are shown below.
Neglecting the fact that this junk food is filled with sugar,
artery-clogging partially hydrogenated fats, and other unhealthy
ingredients (shouldn't hospitals be role models that promote healthy
eating?), ask yourself this question: Do you think that hospitals
give such things to doctors? No, because they are treated as adults. The
nurse who received this junk said that her hospital "passes out this
candy like we're children." She opines that they're treated as children
in more substantive ways, too, such as being required to use time clocks
to punch in and out. I've never seen or heard of a doctor being required
to use a time clock. Incidentally, she is disgusted with the way that
nurses are treated and is planning a web site that will give an
insider's view on what it's really like to be a nurse, and how nurses
could improve their lot. I'll link to that site once it is operational. Walk
before you run Accurately
depicting nurses on medical television shows Physician's Assistants (PAs) in the ER ER
clerks Requirements
for assisting in an ER; difficulty financing her education Questions
on becoming an ER nurse Can
a nurse practitioner become an ER doctor with continuing education? Review of Now available as a free e-book download What really goes on in emergency rooms? If you're a fan
of the television show ER, you might think that you know. Not so,
asserts Kevin Pezzi, M.D., an ER doctor and author of True Emergency Room Stories. Pezzi says the show ER only
scratches the surface; the truth is far more interesting — and bizarre.
So bizarre, in fact, that the cases could shock even an experienced ER
physician. "I'm now a firm believer in the saying that truth is stranger
than fiction," he says. "I don't think that anyone could dream up such
unusual stories." Scoping
out this profession before committing to it / Why don't more doctors drop out of
medicine? -- An eye-opening and shockingly honest exegesis by Dr. Pezzi ContactMeFree is a dream come true for anyone involved in online dating. If you have your profile posted on a personals site but don't pay for a membership, you know how limited you are in terms of being able to send or receive messages. You probably assume that those limitations disappear if you pay for a membership. Guess what? You are still far more limited than you realize. Frankly, if you knew how limited you were, you would be furious that the personals site was charging you $20 to $50 per month and still keeping the shackles on you! The person who created ContactMeFree was so outraged by those limitations that he decided to do something about it. So he did! You know that writer's block you get when you sit down to write the essay portion of your personal profile for online dating? And you know the difficulty you have trying to think of a catchy headline? Well, MyProfileWriter allows you to create a profile essay and headline without typing, just by clicking! Links to other pages in the More Q&A section: Questions about becoming an ER doctor Questions about love and sexual attraction, libido, pleasure, and performance Copyright © 2000 - 2001 by Kevin Pezzi, M.D. All rights reserved. No liability is assumed with respect to the use of the information herein. You should consult with, and obtain the approval of, your personal physician before instituting any of the measures presented. No material intended for the general population can attempt to treat specific individuals, and no material in this web site should be construed as offering individual medical advice. Given the innate variability of people, it is critical that your physician approves the adoption of any information herein contained as being safe and effective for you. A physician's circumspection is his—and your—greatest asset. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● You will have sex about 10,000 times during your life. Doesn't it make sense to read a book that can maximize your enjoyment, and the enjoyment you give to your partner? Cast away your preconceptions of sex books as being a rehash of things you already know and hence a waste of time. By reading this book, you will learn many things that Dr. Ruth and other sexologists have never considered.
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