The Under-appreciated Professions

The four occupations included in this blog are among the most under appreciated professions. They still can have people within the profession that are bad apples for the profession. Most are a credit to the profession and do their jobs effectively and efficiently. Physician's assistants, nurse practitioners, nurses, and pharmacists are the occupations for this discussion. All have national organizations for support and advocacy. With the looming shortage of physicians, these professionals will serve a vital role in medicine and seeing patients on a more active basis. Links to professional organizations will be the profession below.

Nurses, whether they are registered nurses or any of the 68 different types of nurses, they have a role to fill and in general do excellent in their profession. The list of 68 may not be inclusive, but shows many of the areas that nurses may become specialized for their profession. Under the physician shortages, they will need to step forward and learn how to handle an ever-increasing load. Those that can obtain some additional education quickly will be in line for promotions and work in this expanded need.

Nurse practitioners (NP) and physician assistants (PA) will find more physicians that are more willing to work with them and expand their roles under the physician shortage. They will need to be cautious, as there will still be some physicians that will not accept their role or even work with them. These physicians will do more to damage the medical reputation of themselves and those round them. Physician shortage will not be easy for those still practicing.

If some of the hurdles can be removed, nurses, nurse practitioners, and physician assistants will in some of the more rural areas, be spending more time visiting elderly patients in their homes and using video conferencing (telemedicine) or telephone if necessary. Except in the states that have passed laws requiring physicians to physically see the patients before they can issue a prescription, physicians in the rest of the states should be able to issue prescriptions with the assistance of nurses, nurse practitioners, and physician assistants. In a small number of states already experiencing physician shortage, there is some talk about amending the law to allow these medical exceptions when driving distance is an impediment to physically seeing a physician.

The position of pharmacist is still being discussed, but physician resistance for allowing any pharmacist to issue prescriptions is still strong. One state is considering situations where a pharmacist would be able to renew prescriptions especially for certain chronic diseases like diabetes. Another largely rural state is considering allowing pharmacists with certain qualifications to be able to work with physicians in a capacity like nurses. Pharmacists in hospitals, assisted living facilities, and nursing homes may be given more responsibilities and with continuing education expand their roles even further.

Some pharmacists are already expanding their own roles in some of the larger chain pharmacies and this should also be considered and supported. Too many patients do not utilize their pharmacists to prevent polypharmacy conflicts. I think that there needs to be restrictions placed on patients using one pharmacy for one medication and another pharmacy for a different medication. If nothing more, pharmacists need a technology system to be able to access by name and social security number all pharmacies within a certain parameter to search for medications being taken by a patient to prevent medications conflicts. It is not unreasonable to find patients using three or more pharmacies for prescriptions and I have a few acquaintances that use this to keep (supposedly) others from knowing what other doctors are prescribing. I suspect prescription abuse to be honest.

Depending on how critical the physician shortage becomes will determine much of the expanded role for nurses, nurse practitioners, physician assistants, and pharmacists. Those that are willing to seek additional education now will be able to capitalize later. I know of two nurses presently studying to become nurse practitioners. I have written about the role of pharmacists here and need to say that some of the questions have been answered, but not all have been explained to anyone’s satisfaction. Walgreens has even gotten even more secretive while other pharmacies have become more open and transparent in what they want for their patients. Some of this is good while some actions do raise more questions.

It will be interesting to see what happens during the upcoming physician shortage. How long will we need to wait to get an appointment, how long will it be between appointments, will emergency departments continue to exist in some rural areas, and how many minutes will we have available with the doctor during appointments? These and many more questions are clogging my brain. I can only hope that I am fortunate enough to avoid many of these problems.

Nursing Shortages – Oh Really?

Nursing shortage seems like another myth. In some areas of the USA, this is true. In other areas, there is an honest shortage, but it may not last long. What are some of the factors affecting the field of nursing? There are some obvious answers and some almost obscure answers.

Two of the most telling answers are one; older nurses are not retiring because of the economy and may well have a spouse without a job. The second and more frightening answer is hospitals are just not replacing nurses as they leave. Why you might ask? The reduction in profits is largely to blame and increases in hospital administrator salaries are adding to this pressure.

Although many hospitals have positions for nurse aids, more hospitals are adding them in place of nurses. This will increase the workload for remaining nurses, but the hospitals are striving to keep profits increasing. How are the hospitals determining this? They have people patrolling the floors of the hospitals, counting patients, watching nurse activities and other variables. These people report to the administration about their observations.

This may sound cruel, but many nurses have brought this on themselves by their actions or maybe I should say lack of doing their duties. I have been in a few hospitals and actually seen this and wondered how the hospital could make money with the nurses sitting around the nursing station. In one visit to a friend, the five hours I was there they sat and never made rounds. Call buzzers would go off and still they did not move. They would send an aid to check and only leave the nurse's station if it was something urgent. The patient I was visiting needed a shot every four hours, but while I was visiting, no shots were given.

Even a trip to the nurse station did not get a shot. In this case, I called the doctor and explained what had happened. The doctor said he would be there in a few minutes and he was. He came in an entrance away from the nurse's station and came directly to the room. He checked the chart and asked how long I had been there. Next, he headed to the dispensary to get the medication for the shot and the syringe. He asked why his patient had not been given a shot on time. The answer was it was not listed on the patient file. He came to the room, gave the shot, and then went back to the station with the patients chart in his hand.

I don't know more as visiting hours were over and the nurses were checking every room and making sure all visitors were leaving. The whole time I had been there, no rounds had been made by the nurses, but the aids had come and gone rather regularly. From what I observed, the five nurses had a gab fest the whole time and I don't think four had gone anywhere except to use the ladies' room and one to the cafeteria to bring back food for all.

In another hospital, I knew there were very few patients on that level, but the nurses were constantly checking rooms and I very seldom heard a call bell (or buzzer) sounding. About every 15 to 20 minutes, a nurse would be in to check on my wife, checking pulse and blood pressure and moistening her lips with water on a cloth. When shift time came, one of the day nurses stayed and two others reported in plus a couple of aids. Even they were making rounds and checking on the few patients. A very clear contrast when compared to my visit to a friend.

From the second article, this seems to be the case I have described above and varies from hospital to hospital. Some nurses are extremely busy and at some hospitals, it is difficult to see nurses at work. Even patients are complaining at these hospitals. Although this is seldom talked about, hospitals that have strong unions are where the most complaints originate. Others say it depends on the strength of the director of nursing. And, it may be a combination of these.

Either way there are several scenarios that may play out in the next few years. I disagree with the scenarios discussed in this blog, but he may be right as he is an insider and I am a patient. I suspect there will not be an oversupply of nurses because many will leave for employment that is more lucrative. Hospitals will work diligently to reduce the nursing staff and replace many with nurse aids to reduce labor costs and at the same time bring in pharmacists to administer medications and manage inhouse pharmacies. Unions will be either forced out or greatly weakened all as a means of increasing profits.