Nurse practitioner delusion / "Noctors" / "Midlevel staff" - Nurses get a 1 year degree and start thinking they are better than doctors

[John Andrews Stan]

My sister had a major operation earlier this year in NY. The horror stories from her 12 days in the hospital make me think no one has any idea just how screwed we are. Ticking time bomb to put it mildly.

A veteran nurse (in her 60s or possibly 70s) was subbing one Sunday in my sister’s post-hospital rehab. This woman said she works for the state of NJ and part of her role is inspecting and evaluating facilities. Boy was this an eye opening convo.

This old school black nurse said she gets called racist constantly because she speaks out against common practices related to hiring foreign staff. According to her 99.99% of these “medical assistants” coming over from Africa and Asia are not good enough to be working in a medical setting. She said there is no vetting or oversight of the foreign “training colleges” where these people get certificates but aren’t in the habit of washing their hands at work. It’s just their means of getting a U.S. visa.

She also told us that she doesn’t sub as a floor nurse often but had come into the (very fancy) rehab facility that night because the nursing manager was desperate. But she also said that she was going to go the next day and file reports against multiple staff at that very facility. Among their crimes was having nurses’ assistants in charge of prescriptions, injecting patients’ muscles instead of fat, and on and on. Boss bitch told us that nursing home staff make so many basic care mistakes that patients are constantly being taken back to hospitals and it’s bankrupting the entire system.

According to this seasoned nurse everyone in healthcare knows standards everywhere are in the gutter but there’s such a shortage of workers post-COVID vaccine nonsense that they have to take whoever they can get.

One nurse I know summed it up well. She said, “I am now advising people about hospitals what I have always told them about nursing homes: If someone you love gets sent to one, you need to be there as much as possible to make sure your loved one is safe and not being mistreated or neglected. You have to watch their pharmaceutical disbursements like a hawk. You can’t assume any of the providers cares one bit about any patient. Assume they are being mistreated more often than not.”

Sorry to be a downer but I hate everyone who’s even a tiny bit responsible for this.

 

[Larry David's Opera Cape]

We also had a phase when drug seekers were stockpiling Bupropion, injecting it and ending up in ICU with terrible abscesses.

But why.

If you want to diddle your dopamine receptors surely there are faster, stronger, and easier routes.

 

[GenericEdgelordSupreme]

My worst health care experiences have actually been with licensed doctors rather than nurse practitioners, strangely enough. I'll take an actual American non-doctor over an imported punjabi shitnigger who happens to have an MD any day. It's an enormous pain in the ass discussing prescriptions with someone who barely speaks your language. I can't argue with NPs having a lower level of medical knowledge than licensed doctors, but in their absence, a native NP is better than a foreign doctor.

 

[Mordecai "3 Finger" Brown]

But why.

If you want to diddle your dopamine receptors surely there are faster, stronger, and easier routes.

I assume it was because Bupropion is free on the government welfare drug formulary, while Z-drugs aren't and anything else fun gets tracked up the wazoo.

But I assume it's also a short-term play even if it does create some euphoria, since the government is also cheap and will likely deny your refill claim request when you submit one in a week rather than 90 days later.

 

[std::string]

I assume it was because Bupropion is free on the government welfare drug formulary, while Z-drugs aren't and anything else fun gets tracked up the wazoo.

Yeah, it's pretty much this. Same reason as why people doctor shop for gabapentin. Cheap, handed out like candy, doesn't raise any eyebrows.

Memantine abuse cases are always my favorite though, both for its effect and how literally nobody working in medicine seems to know it can be abused. It's an NMDA antagonist like ketamine but its half-life is just a smidge longer (45 mins vs 70 hours)

If they're hemodynamically stable and protecting their airway they're fine. Gonna be a while before they come out of that hole though.

 

[Sparkling Yuzu]

A veteran nurse (in her 60s or possibly 70s) was subbing one Sunday in my sister’s post-hospital rehab. This woman said she works for the state of NJ and part of her role is inspecting and evaluating facilities. Boy was this an eye opening convo.

This old school black nurse said she gets called racist constantly because she speaks out against common practices related to hiring foreign staff. According to her 99.99% of these “medical assistants” coming over from Africa and Asia are not good enough to be working in a medical setting. She said there is no vetting or oversight of the foreign “training colleges” where these people get certificates but aren’t in the habit of washing their hands at work. It’s just their means of getting a U.S. visa.

Based old black nurse.

---

My province has a big GP shortage and they are now letting pharmacists be primary care providers. I'm not sure how NPs are regulated here or how widespread they are. I think I would trust a pharmacist with my meds more than an NP though:
https://novascotia.ca/news/release/?id=20230426002 Does anyone else in the states have a system like this?

The latest numbers from Nova Scotia Health report that nearly 13 per cent of the population is on the list looking for a family doctor. That represents a 56 per cent year-over-year increase, with 46,643 people joining the list since January 2022

https://www.cbc.ca/news/canada/nova-scotia/family-doctor-wait-list-grows-nova-scotia-1.6709021
https://archive.ph/Gheph

 

[Tsukasa Kadoya]

I haven't had much drug-seeking behaviour with quetiapine, but at this point I'd believe anything.

I used to think the Z-drugs were a harmless alternative to benzos.

Until I was working at a doc-in-a-box clinic with paper charts, no individual patient files and all past records stored chronology beneath the desk in bankers' boxes.

I had some "labourer" try to hit me up twice in the same week looking for 90 Z-pills because he claimed to work at a fly-in work camp and his roommate snored.

I only caught on because he got brazen and greedy, with the same story, asking for the same pills I'd prescribed him just days before. The clinic's record keeping was so terrible that I couldn't pull the chart I'd wrote just a few days earlier in real time, so had to just rely on memory.

The drug seeker wasn't even upset when caught. He was downright arrogant. I told him to come back next time at least on a night I wasn't working.

We also had a phase when drug seekers were stockpiling Bupropion, injecting it and ending up in ICU with terrible abscesses.

Like quetiapine, I never considered DNRIs as drugs of abuse either. And they aren't even tracked since they aren't controlled.

Lemme guess, the abscesses were necrotic?
Shit sounds like a more official version of Krocodil, complete with infections.

 

[John Andrews Stan]

Based old black nurse.

She was awesome. Really validated a lot of what we’d noticed about the level of professionalism and care both in the shitty hospital (Mount Sinai, never again) and even in the high-end rehab/nursing facility.

That counted for a lot when so many of the medical staff acted like we were nuts for expecting a basic level of competent care. Management was scrambling to respond as we escalated complaints and you could tell they’re used to getting away with shitty practice because most of their patients are elderly with no family support present (and they are often ESL as well). This is the one area where people should have zero concern about being thought of as a Karen.

Spoiler

The nurse also told us about how her quiet working class neighborhood of responsible home owners had been ruined by just one Jamaican immigrant family moving in. (They’d gotten a lawsuit payout and used it to buy the house whereas everyone else worked to buy theirs, she said.) She said the Jamaicans’ 20-something sons lived in the basement and partied constantly and loudly. Their roughneck friends were constantly hanging out in their cars, blocking traffic and blasting nigger music with crazy bass 24/7.

The nurse said their elderly neighbors became afraid to go out for walks and she herself was scared to walk her dog. They also called the police constantly but of course the cops didn’t help at all.

Finally she said one night she’d hit her frustration and anger limit with them and was praying to God to take these people out of her life. It ended up raining hard all night and the next morning she saw the Jamaicans’ yard looking like a rummage sale — the sons and their shit had been flooded out. They moved and never came back. (Based Black Nurse 1, Niggers 0.)

 

[Dr. Ricearoni]

Oh god how have I not heard of this thread before. I work in a pharmacy doing contract work with nursing homes and rehab centers. A lot of the nurses and med techs can be pleasant but when they're bad they're bad. A lot of nurse practitioners will send us an invalid script and start ranting at us angrily about how it is valid and needs to be sent STAT, NOW NOW NOW! Eugh. They usually demand to speak directly to a pharmacist about the most inane things like "when is my delivery getting here" or "can you refill this medication" even though the pharmacists have nothing to do with when the trucks run or order entry. Sometimes they're just retarded but still nice and you can sweet talk them into letting you help them but other times they'll just start shouting at you because their problems are of the utmost importance and thus they need a PHARMACISS.
Yeesh.

 

[GenericEdgelordSupreme]

Yeah, it's pretty much this. Same reason as why people doctor shop for gabapentin. Cheap, handed out like candy, doesn't raise any eyebrows.

Memantine abuse cases are always my favorite though, both for its effect and how literally nobody working in medicine seems to know it can be abused. It's an NMDA antagonist like ketamine but its half-life is just a smidge longer (45 mins vs 70 hours)

If they're hemodynamically stable and protecting their airway they're fine. Gonna be a while before they come out of that hole though.

You're telling me I pay a dealer for ketamine when I could be getting memantine for free? Damn. Just tell all your patients that and we'll overdose ourselves to death and get out of your hair.

 

[std::string]

She was awesome. Really validated a lot of what we’d noticed about the level of professionalism and care both in the shitty hospital (Mount Sinai, never again) and even in the high-end rehab/nursing facility.

NYC hospitals are notorious hellholes. It's no big secret in my field. Mt. Sinai in particular is known for residents killing themselves by jumping off the roof.

The understaffing issue is because nobody in their right mind wants to work in them.

e:

You're telling me I pay a dealer for ketamine when I could be getting memantine for free? Damn. Just tell all your patients that and we'll overdose ourselves to death and get out of your hair.

You'd have trouble getting a script since it's only indicated for Alzheimer's. It's not scheduled in the US though so people just order it from sketchy Indian or Russian pharmacies. DEA don't care.

 

[Basil Julep]

One nurse I know summed it up well. She said, “I am now advising people about hospitals what I have always told them about nursing homes: If someone you love gets sent to one, you need to be there as much as possible to make sure your loved one is safe and not being mistreated or neglected. You have to watch their pharmaceutical disbursements like a hawk. You can’t assume any of the providers cares one bit about any patient. Assume they are being mistreated more often than not.”

So I'm not in the medical field. Aside from obvious mistreatment or neglect, and the pharmaceutical disbursements, are there any big things to check for?

 

[Woe-B-Gon (TM)]

https://novascotia.ca/news/release/?id=20230426002

Holy hell, it was bad when I left NS but I didn't realize how much it had deteriorated. This is a level of desperation I hadn't heard of before.

 

[John Andrews Stan]

So I'm not in the medical field. Aside from obvious mistreatment or neglect, and the pharmaceutical disbursements, are there any big things to check for?

I’m not in the medical field either, but I make it my business to monitor my and my loved ones’ care to the best of my ability. Sometimes the abuse and neglect won’t be obvious because many patients aren’t in a position to complain or explain what is being done (e.g. if they’re elderly or ESL, or have other communication issues). But off the top of my head, shit I’ve seen and put a stop to:

• Lack of punctuality with prescriptions, lack of fastidiousness around timing and/or contraindications when giving meds, utter lack of care about any of it
• Terrible hygiene, e.g. dropping ON THE FLOOR an unwrapped wick (for an external catheter) and intending to shove it into the patient’s vagina without so much as dusting it off; same caregivers dumped bedpan full of urine on patient on two occasions
• Ignoring pleas for help and painkillers within hours of major surgery for which narcotic pain relief was prescribed
• Caregiver ridicule — I might flip my shit if I go into detail but let’s just say the same cohort that enjoys slapping strangers around in the street also enjoys humiliating helpless patients (e.g. making them walk in front of people with their gown open and no underwear)

Just for starters. You cannot be passive about your care or your loved ones’ at this point. These pieces of shit are causing so much more suffering and death than we can ever know.

 

[Equal Rights for Androids]

I’m not in the medical field either, but I make it my business to monitor my and my loved ones’ care to the best of my ability. Sometimes the abuse and neglect won’t be obvious because many patients aren’t in a position to complain or explain what is being done (e.g. if they’re elderly or ESL, or have other communication issues). But off the top of my head, shit I’ve seen and put a stop to:

• Lack of punctuality with prescriptions, lack of fastidiousness around timing and/or contraindications when giving meds, utter lack of care about any of it
• Terrible hygiene, e.g. dropping ON THE FLOOR an unwrapped wick (for an external catheter) and intending to shove it into the patient’s vagina without so much as dusting it off; same caregivers dumped bedpan full of urine on patient on two occasions
• Ignoring pleas for help and painkillers within hours of major surgery for which narcotic pain relief was prescribed
• Caregiver ridicule — I might flip my shit if I go into detail but let’s just say the same cohort that enjoys slapping strangers around in the street also enjoys humiliating helpless patients (e.g. making them walk in front of people with their gown open and no underwear)

Just for starters. You cannot be passive about your care or your loved ones’ at this point. These pieces of shit are causing so much more suffering and death than we can ever know.

jfc and people bitch about police being bad. Have seen NO ONE bitch about nurses even though there's more of them and a lot more of them are power hungry/psychopathic.

 

[std::string]

Just for starters. You cannot be passive about your care or your loved ones’ at this point. These pieces of shit are causing so much more suffering and death than we can ever know.

Keep going I want to hear the next part about how organ donors are literally murdered and how palliative care is just homicide via morphine.

I got this bingo card going and I just need two more spaces

 

[Sleazy Car Salesman]

jfc and people bitch about police being bad. Have seen NO ONE bitch about nurses even though there's more of them and a lot more of them are power hungry/psychopathic.

Nurses occupy a similar place in society to school teachers and police, they have massive amounts of power which they can lord over the vulnerable and tend to be some form of megalomaniac. What makes nurses unique is that most people haven't had bad experiences with nurses and abuse of power by nurses is considered by most people to be an outlier rather than business as usual. Most people have had a first or second hand experience with an asshole cop or teacher though and the educational barrier for entry for a cop or teacher is often perceived as being much lower than anything working in the medical field.

I will say one (and only one) nice thing about nurses though; Nursing students are the easiest lay you'll ever have if you don't mind a pill addicted party girl.

 

[Diamond Homonculus]

I was looking a bit more into my serial killer nurse theory and found that there is a whole tv show called "Nurses Who Kill" https://www.imdb.com/title/tt6264964/

The one guy Charles Cullen confessed to killing 40 people but it's theorized he could have done more. He was also severely suicidal and tried to kill himself on multiple occasions. How have I never heard of this guy? We are just scratching the surface with nurses being pretentious and overestimating their own abilities, these people are horrorcows.

 

[Mordecai "3 Finger" Brown]

Lemme guess, the abscesses were necrotic?

I guess I never actually saw the rumoured abscesses when I think back.

I suppose it could've just been urgent care hallway ghost stories.

A lot of nurse practitioners will send us an invalid script and start ranting at us angrily about how it is valid and needs to be sent STAT, NOW NOW NOW! Eugh. They usually demand to speak directly to a pharmacist about the most inane things like "when is my delivery getting here" or "can you refill this medication" even though the pharmacists have nothing to do with when the trucks run or order entry.

I always felt a sense of dread when a receptionist told me a pharmacist when on hold on the phone.

Scratch that, I hardly ever was told who was on the phone asking for me. Our cheap clinic hired high schoolers to run the front desk, so I would be told "There's a call for you". Then I'd ask "Who is it?". And they would reply "I didn't ask".

It didn't matter how many times I'd explain to them how to do their fucking job, we were scraping the bottom of the barrel.

Anyways, I dreaded calls from pharmacy because it usually meant one of the dozens of decisions I'd made that day and then immediately forgot, was fucked up.

So I'm not in the medical field. Aside from obvious mistreatment or neglect, and the pharmaceutical disbursements, are there any big things to check for?

I would say to ask a ton of questions if your loved one has been put on a low-dose antipsychotic or is being recommended to be put on one for behaviour issues in dementia in a Skilled Nursing Facility or nursing home.

There's a pretty well established aggregation of data that putting seniors on these drugs like quetiapine increases all cause mortality with questionable benefits.

TBH, there aren't great drug alternatives for seniors with dementia behaviour issues.

But tons of these scripts get written because the nursing staff demand the doc on call "do something" about an unruly patient.

But there's also a lot of confounding between truly aggressive dementia patients and shitty/understaffed nursing care that can be papered over by sedating patients.

Some aggressive dementia patients probably are better off on a med that makes them more docile with the trade off of a shortened life, but there's obviously the potential for widescale institutional abuse due to understaffing, profit margins, shitty execs, underskilled nurses and aides, complex problems without really great solutions, etc.

 

[Sparkling Yuzu]

Some aggressive dementia patients probably are better off on a med that makes them more docile with the trade off of a shortened life

I wouldn't worry about their lifespan unless they have early onset dementia. What they are living is not life. Can they even tell if it's the antipsychotics that are shortening their life or if the more severe people that are more likely to die are more likely to be on them?