Post by Hunter....here are a couple of old questions I was meaning to ask for a long
time: What does a Physician's Assitant-Jeanie's old job-do? It sounds
like it could be a halfway point between a nurse and a full blown doctor.
:-) And dies he/she "outrank" a R.N.?
It really doesn't fit to describe one of these jobs as 'outranking' another,
they are entirely separate occupations and it's not a question of which one
is 'better'. They handle different situations, comparing them on a relative
scale is an apples and oranges situation.
A physician's assistant basically gets a bachelor's degree and takes a
series of exams allowing him/her to practice basic (primary care) medicine
under a physician's direct supervision. They are often allowed by law to
prescribe medications to treat uncomplicated conditions, they usually don't
prescribe narcotics. Licensure laws vary from state to state.
Physician assistants serve as 'physician extenders' which means they work
with a doctor, usually seeing and treating patients with uncomplicated
issues which frees up the doctor to handle the more complicated, sicker
patients. A lot of hospital ER's are inundated with patients with minor
problems such as earaches, strep throats, sprained ankles and such and PA's
are often used to triage and handle these minor cases. However, everything
they do must be reviewed by an MD who bears responsibility for their
actions. Here in Ohio, anyway, a PA may not practice unless a physician is
on the premises and immediately available during the time the PA is working.
A family practitioner who went to med school with me actually lost his
medical license because a PA employed by him was caught by the state board
seeing patients when he was not present. The board takes this stuff very
seriously.
Nurses, on the other hand, could attend a nursing school for 2-3 years and
become an LPN or RN but most these days are attending regular colleges and
getting bachelor's degrees in nursing rather than just being a 'diploma'
nurse. My hospital and many others won't even hire RN's who don't have a
bachelors and it is nearly impossible for a diploma nurse to become an
administrator without the BS.
In a setting like the ER, a nurse would follow the PA's orders, which would
ultimately have to be cosigned by a doctor. However, there are advanced
practice nurses who practice independently and would function very much like
PA's in that they would care for their own patients, write prescriptions and
the like. They, too, must have physician supervion, although, in Ohio at
least, the doc doesn't have to be on site, he/she can serve as a consultant.
Nurse practitioners, unlike PA's, usually have specialty training in a
single area, like nurse midwifery, family practice, pediatrics, gynecology,
etc. and stick to their specialties unlike PA's who tend to provide more
basic care but in a variety of areas.
Post by HunterIn the same vain, does a paramedic "outrank" a nurse? That is if a
paramedic and a nurse are traped in an elevator with you badly injured,
who will take orders from whom? We know that a doctor would take over for
both of them if he/she was there....
--
----->Hunter
I don't think that can be adequately answered with a 'one size fits all'
explanation. It would probably depend on the training and experience of
both individuals. When an EMT is called out on an official run, he/she
answers to no one, including anyone who steps up and says they are a doctor.
Nor should they; I am a doctor, but I haven't treated anyone having a heart
attack in more than 20 years; I sure wouldn't want me in charge of a cardiac
arrest over an EMT who sees the situation regularly.
As a resident, I got reported by an EMT for telling him to bring a laboring
patient directly to the hospital rather than delivering her at home. He
called into L&D to say they were in the house, the baby was visible and they
were going to do the delivery there. Fine, very appropriate. When we had
heard nothing for an hour and a half, I called the house where the senior
EMT said the patient was 'crowning', he could see the baby's head and he
would not transport. I suggested that it was highly unlikely that a woman
having her fourth baby would be crowning for an hour and a half (5 minutes
or less is typical) and that something might be wrong in his assessment, ie,
he might be looking at her vaginal wall and mistaking it for the head, or
the baby might be breech or have a birth defect or something else that was
impeding progess. They ended up staying there, telling the lady to push for
a total of nearly 4 hours until she finally delivered. When they got to the
hospital, he turned the patient over to me. She had a huge cervical tear,
indicating that she was pushing before she was completely dilated, she was
also very swollen. And, because she'd had a bunch of kids, her bladder was
sagging and could easily be seen bulging through the vaginal opening. I
told him it looked like she was told to push before she was dilated and
pointed to her bladder and asked if that is what he saw 'crowning' and
mistook for the head. He was a cocky SOB who made it very clear that he was
not going to listen to a mere girl and denied it. I pointed to the baby,
who had a thick head of hair and asked his partner if what he stood there
and watched crown for 4 hours had hair or was it bald like her vaginal wall.
The partner then 'fessed up that they spent hours and hours trying to
deliver her bladder before the actual baby was visible. His paramedic pal,
still full of himself, reported me to the fire chief for 'disrespect'.
Unfortunately for him, as soon as the case was reviewed, he was the one who
got reprimanded.
Sharon