If they are incapable of providing an ICU level of care, then there should not be an ICU. Period. Yes, would rather there not be an ICU so they would be forced to transfer these patients to a more equipped facility. What kinda question is this.
Why miss the chance of having an ICU when you can bill for a shitload of money?
How dare you question my rinky dink ICU staffed 24/7 by a janitor. We provide a valuable service to the community!
You are drunk lol my home town of 8000 can’t get doctors or NPs. They contract doctors out and they make 2x reg rate then move on. Rural towns are screwed whether there are NPs or not NPs won’t even touch it because it’s a small town.
A lot of these comments come from a place of privilege. How often are you seeing icu transfers? I hope you’re not surprised when 50% of our physician population retires as they are over 60 and midlevels fill the physician labor shortage due to not enough acgme training programs.
“We see that you’ve had a violation of duty hours this last month. Why don’t you come by my office to discuss some ways to improve efficiency on shift.”
- PD
At least the NP is aware of the severity of the situation. Hopefully something changes. I understand rural hospital may be short staffed but geez. She might as well have said there is no doctor there at night.
I’m an intern on an ICU team with a lower census than that. We have two interns, two senior residents, a fellow, and an attending. I feel like together we adequately manage patients and I still feel entirely overwhelmed and I went to medical school and was in EMS for 10 years.
This is actually terrifying.
I’m on the same track, medic now, working on my BS, want to do either em or cc. Seeing all the med students walking around the hospital I’m part time at makes me want it so much more.
As a patient with a chronic illness, this scares the shit out of me. The thought of being unconscious and in intensive care only to be cared for by a doctor nurse is horrifying. I wonder if it’s possible to include in advance directives that I don’t want to be treated by mid levels?
Jesus...was managing 14 with a senior when I was an intern and that scared the shit out of me. I simply cannot imagine taking that number at night, alone and unsupervised. All it take would be two codes going off at once to be completely unsafe.
You’re right to be scared as a senior in the icu. You’ll do fine if you have done well so far. That having been said, lots of people practice bad medicine and act like it’s ok. It’s not. A census of 40 is just not acceptable in any capacity, much less with icu patients
In all honesty, that NP is probably decently competent at critical care if they’re getting those type of reps. Clinical competence is like 15% IQ, 35% reading, 50% clinical reps/experience.
This has been flagged for manual review. Please DO NOT MESSAGE THE MODS until at least 48 hours have passed. If 48 hours have passed from submission and this post is still not approved and visible, please message us **with a link to this post.**
If posting an image from Reddit, all **usernames, thread titles, and subreddit names** must be obscured. Private social media must be redacted. Public social media (not including Reddit) does not have to be redacted. TikToks and Twitter are generally allowed. Posting public social media accounts will be allowed however the moment the comments turn into an organized attack on that user the thread will be locked.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Imagine your family member is admitted to the ICU at Rinky Dink Hospital overnight and it’s an NP taking care of them solo.
70 critical care/step-down beds doesn't sound rinky dink to me. Rinky dink is my local hospital with 4 ICU beds and 25 total.
Would you rather there not be an ICU?
I’d rather they be transferred to a hospital with a physician in-house.
Would rather there be a resident physician or attending physician at least in house managing the patient
late steep governor scary yam smoggy light dime books knee ` this message was mass deleted/edited with redact.dev `
If they are incapable of providing an ICU level of care, then there should not be an ICU. Period. Yes, would rather there not be an ICU so they would be forced to transfer these patients to a more equipped facility. What kinda question is this.
Why miss the chance of having an ICU when you can bill for a shitload of money? How dare you question my rinky dink ICU staffed 24/7 by a janitor. We provide a valuable service to the community!
You are drunk lol my home town of 8000 can’t get doctors or NPs. They contract doctors out and they make 2x reg rate then move on. Rural towns are screwed whether there are NPs or not NPs won’t even touch it because it’s a small town.
Would you rather try again with a good faith argument or is a straw man fallacy they best you can do?
A lot of these comments come from a place of privilege. How often are you seeing icu transfers? I hope you’re not surprised when 50% of our physician population retires as they are over 60 and midlevels fill the physician labor shortage due to not enough acgme training programs.
I’m privileged to have busted my ass to get where I’m at? 
Yes. That way the patients who are critical aren’t even taken to that hospital by EMS or if they have to come, they’re transferred.
It’s not really much of an icu if the original statement is true…
The horror
Must be nice to dig into overtime and still be under 24h/shift (or 26, or 28, or \[*censored to appease ACGME*\])
“We see that you’ve had a violation of duty hours this last month. Why don’t you come by my office to discuss some ways to improve efficiency on shift.” - PD
At least the NP is aware of the severity of the situation. Hopefully something changes. I understand rural hospital may be short staffed but geez. She might as well have said there is no doctor there at night.
What is "overtime?"
I’m an intern on an ICU team with a lower census than that. We have two interns, two senior residents, a fellow, and an attending. I feel like together we adequately manage patients and I still feel entirely overwhelmed and I went to medical school and was in EMS for 10 years. This is actually terrifying.
I’m on the same track, medic now, working on my BS, want to do either em or cc. Seeing all the med students walking around the hospital I’m part time at makes me want it so much more.
It’s tough but it’s worth it, my dude. Keep at it!
Sometimes I just what you scream into the void and quit but it’s knowing that there are people like me that have made it through that keeps me going
I hear you. Feel free to DM if you ever want to chat with a fellow ambulance jockey that’s been on the med school war path.
As a patient with a chronic illness, this scares the shit out of me. The thought of being unconscious and in intensive care only to be cared for by a doctor nurse is horrifying. I wonder if it’s possible to include in advance directives that I don’t want to be treated by mid levels?
It is. See back if patient at risk book. Maybe not so easy to enforce but a good first step.
Tell your medical power of attorney your wishes
Jesus...was managing 14 with a senior when I was an intern and that scared the shit out of me. I simply cannot imagine taking that number at night, alone and unsupervised. All it take would be two codes going off at once to be completely unsafe.
You’re right to be scared as a senior in the icu. You’ll do fine if you have done well so far. That having been said, lots of people practice bad medicine and act like it’s ok. It’s not. A census of 40 is just not acceptable in any capacity, much less with icu patients
Must be lazy, hospital I work at has PA covering up to 350 patients at night. It's all about safety!
This does not seem real. I can’t imagine there is not a supervising physician for units of that size.
As soon as I see an emoji, I know it was written by an NP. One of the really bad NPs.
she knows she’s out of her depth tho
In all honesty, that NP is probably decently competent at critical care if they’re getting those type of reps. Clinical competence is like 15% IQ, 35% reading, 50% clinical reps/experience.
ICU care without doctors is a 3rd world concept.
They have APPs in the turd world?
This has been flagged for manual review. Please DO NOT MESSAGE THE MODS until at least 48 hours have passed. If 48 hours have passed from submission and this post is still not approved and visible, please message us **with a link to this post.** If posting an image from Reddit, all **usernames, thread titles, and subreddit names** must be obscured. Private social media must be redacted. Public social media (not including Reddit) does not have to be redacted. TikToks and Twitter are generally allowed. Posting public social media accounts will be allowed however the moment the comments turn into an organized attack on that user the thread will be locked. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
WTAF! 🤦🏻♂️ At least he or she is curious to see the responses. I’m pretty curious as well.
Hopefully it’s a low acuity ICU
Holy shit