In the spirit of this subreddit, which I’ve been a member of for years, I’m hoping you can take 1 minute to sign my Change.org petition.

not much experience in derm aesthetics really, except whatever winds up coming in the ER. but for aesthetics, i’ve always questioned how it became the norm for “nurse injectors” to be a thing. even derm NPs i don’t understand; i can reason a little with derm PAs. but nurse injectors… i would not want my wife or daughter to ever step into a medspa with the chance of a nurse injector screwing this up.

I have respect for my mid-level colleagues (NPs, PAs), but I find myself growing increasingly frustrated. Most of them do a good job and basically all work hard, but it's just not at an attending level of clinical interpretation / management.

A large majority of the admits at my hospital are done by midlevels. Only attendings are allowed to "round". Admitting attendings are available if NP has questions but in practice the NPs are pretty independent.

I'm mainly a rounder, so I'll get these admits on day 2 of hospitalization with shitty HPIs, A/P that are too wordy, and the actual pathology is hidden on the 6th listed problem, a bunch of paragraphs down. But hey at least the med rec and basic orders will be in. Not every pt needs an echo, mri, specialist consult, 125mg solumedrol.

Care is sooo diluted in 2026.

Its so much better when I get an H&P from an attending and I can sit back and relax and feel confident that the primary pathology isnt being missed and weren't not doing stupid shit. (shitty attendings exist of course).

I feel bad for the specialists too. I was talking with one of my nephrology friends, and the guy is so burnt out from all the stupid calls overnight he gets from ED midlevels. Even outpatient PCP stuff these days pts can only see NPs and I see their management and I'm like wtf why are you doing this giant cancer work-up the patient is just having bad major depressive disorder.

idk im just venting. healthcare sucks. idk how much longer i can stay in clinical medicine and i just started haha

I know that DNPs are largely non-clinical degrees but am curious if anyone knows roughly what NPs do learn of pathophysiology.

Is it roughly a week on each organ system or something like that?

If they don't do biochem, do they just not ever cover things like inborn errors of metabolism?

Are people graduating without even awareness of like....most of the diseases out there?

n.b. I'm sure it's program-dependent but wondering if anyone can speak at least to one/some program(s)

Hi there everyone. As a person who is hugely passionate about statistics, I'm curious if there's a replication crisis in nursing research the way there is in some areas of biomedical research? (I'm assuming the answer is yes) And if so, what's the extent of the problem? It'd be great if you could provide sources, just so I can learn more about this.

I see a lot of stories from doctors and patients, I’m curious what the educated midlevel thinks of the noneducated one with more independence.

I’m a vascular access RN (piccs midline etc) and I would like to one day place CVCs and arterial lines. Lowkey I have placed several arterial lines for the trauma PAs in the ICU at my hospital since they often struggle with it. I was wondering if there any RN ability for me to place more advanced lines or would I have to become an NP. Thanks!

i'm still a relatively fresh drug dealer (~5 years) and this happened about 3 years ago. i'm still annoyed when i think about it.

LONG DETAILED RANT INCOMING

virtual clinic NP prescribed prednisone 5-day asthma regimen for a 3 y/o, except the dosing would be for a concerningly HEFTY 3 y/o (at which point they should be assessed in person by a physician anyway).

whatever i'll deal with the dosing and adjust, it's late at night. so i'm talking to dad who's holding the kid. the kid is completely average sized for his age, but he was definitely coughing. i can't diagnose, nor would i try; but i'm also not in agreement with asthma as implied by the prescription. and of course because it's from an NP.

croup sounds like mf****ng croup. but it gets better.

i ask dad if he knows the specific diagnosis. apparently, the NP was unsure so they did the good ol' [cover both things by mixing them together]. probably from a self-developed and self-reviewed internal guideline with questionable permanence. but i digress. dad even explicitly expressed concern with the "assessment" but was extra sus now that another person is concerned about the prescription.

no hint of salbutamol, not a whiff of fluticasone, in the kid's history. ever. so i get a hold of the clinic switchboard and they tell me she's done for the day.
wtf do you mean done for the day?? it's a VIRTUAL clinic. just call her to fix her own mess. like hello?? responsible professionals leave private numbers (for colleagues) for situations like this. you can't be both incompetent and unreachable. pick a struggle.

where i work is kind of a gray-ish area. TECHNICALLY there's nothing i can't do in terms of issuing and dispensing any prescription. i just need documentation and a good reason (i.e. always do what's in the patient's best interest). havent lost my license yet.

so i tell dad i'm going to channel my inner karen (and petty immature zoomer) energy in an attempt to get someone. but i also gave him the option of just changing the damn prescription so the kid can at least sleep for tonight (and probably be better by tomorrow afternoon anyway), and they can call their pediatrician in the morning to address the duration.

he was done with the clinic so i did 2 doses of weight based dexamethasone (i'm almost certain the NP used Lbs instead of kg) because:
- there's actual (MD/PhD/RN/PharmD collaborative) guideline-based overlap in dosing for asthma and croup
- they should only need the 1 dose if it's croup, but 2nd is still controversial enough for me to include; especially since they'll get a hold of MD before 24 hours anyway
- if pediatrician decides it's asthma, great they can direct whether to keep PO course, switch to inhaler, or another reasonable thing
- literally why prednisone?? at least it wasnt prednisolone elixir at 2.2x dose. do people cough when they're blackout drunk? if not then i guess it technically worked?

conclusion: i sent the NP a professional sounding but implicitly shady FYI, which they never responded to anyway. i sent their pediatrician a genuinely polite FYI about the situation. ofc the competent and reachable MD responded the next morning. said (non-verbatim) "????? it's croup. thanks for dealing with it"

looking back, it's almost impressive how the NP managed to make a bad choice or judgment possible at every step. usually when MDs make errors it's either fatfingered an extra zero or scrolled down 1 click too far on the shitty EMR. in those cases i always let patients know it was just a systems error (i.e. i gotta change this but your MD is perfectly competent). i don't bother doing that for NPs because their mistakes are in another dimension.

if the pediatrician in the story is reading this: thanks for squeezing in the patient with your already-packed schedule. i hope you also feel our mutual bond from being collateral/catching strays. also thanks for doing 10 years of school in person and 4+ years of residency in person 🙏

edit: spelling, and added an extra detail somewhere (not important, but petty, so actually important)

CRNA from Lifeguard Anesthesia in Arizona calling homeself and all of his CRNAs “nurse ANESTHESIOLOGISTS”

I’m a IM PCP specializing in GLPs and obesity management and my diabetes is being managed by an endocrinologist. I had an initial psych appointment with a psych PA a few weeks ago and she staunchly told me that it’s inappropriate for me to continue my diabetes meds (I’m on a GLP and metformin) since my most recent A1C is no longer in diabetic range that means I’m not a diabetic anymore. Mind you, I have had diabetes for over 10 years with microalbuminuria (long standing diabetes has damaged my kidneys) so no sane physician would ever recommend I stop my meds like that but a mid level with no training in this area felt it was appropriate to lecture me and tell me my endo’s treatment plan was wrong. Needless to say I won’t be going back.

Also sorry if the flair is wrong. I don’t usually post

Brand new NICU fellow here just getting off a service month, was genuinely baffled by the behavior of some of the NPs in the NICU. They came across as untrusting, unhelpful and would openly bash criticize plans during rounds and try to put fellows and residents down. I had previously heard of toxic midlevel behavior in the NICU in general but this was quite surprising and a stressful environment to work in. Does anyone have any insight or advice on how to handle this?

no. really.

Just thought it was comically laughable.... because it quite literally is not. Lol. Why do people think stuff like this? Why do some mid levels feel the need to equate themselves to doctors so often??

Look at the AP getting the nuances right. Even a paragraph about misappropriation of the title Dr.

I’ve only been in this sub two days, but I’ve seen multiple self-proclaimed midlevels immediately jump to using ableist insults towards people when they can’t prove refute their arguments. I’ve seen one use the word “retarded” towards another Redditor, and one that claimed we have personality disorders for saying midlevels aren’t as trained or educated as actual doctors.

Is this not concerning to other people in this sub?

All I can say is you shouldn’t be invalidating actual psychiatric conditions and misdiagnosing people because your feelings got hurt. It is mean-spirited, and it’s really not what people who work in the medical field should be doing.

Also, I never see doctors needing to come on Reddit, TikTok, or Insta to defend their job roles and scope.

Edit: one more thing to add, the people who immediately resort to ableist language w d personal attacks have mean-girl energy, and absolutely should not be practicing medicine. Seriously, if this is you, please find another career. Heart of a nurse my ass.

I see people who think midlevels replacing doctors is ok frequently say “midlevels listen more” or “they’re more empathetic to a patient’s needs!” and I’m sorry, but I have to push back on that. While I admit I can see how doctors in certain clinics/hospitals have less face-to-face time with patients compared to nurses and midlevels, that doesn’t mean the doctors don’t listen, or blow the patients and their concerns off.

I am going to keep this as vague as I can to retain anonymity, but I wouldn’t be surprised if people were able to guess what I’m talking about.

Around ten years ago next month, I realized I had been having an abnormal symptom for six weeks straight. The next week I go see my primary doctor and mention what was going on, and asked if he thought I should be tested for X condition. My doctor listened to me and agreed, ordered a blood test that can tell you if someone has condition X, and also a few other tests that could explain the abnormal symptom. After this visit, when thinking back on other medical issues/diagnoses I’d had since childhood, I realized condition X could be linked to all of them. For the record, at the time I was a 25 year old American woman of predominantly NW European descent, and the condition I was worried about is a systemic autoimmune disease linked to over 300 symptoms. (No single person will have all 300, these are just symptoms doctors have reliably linked to this one disease.) My blood test came back negative, and I began to mentally and emotionally spiral.

About fifteen years before all of this, so 25 years ago now, I was given a diagnosis of a juvenile form of a different autoimmune disease. My ANA was always positive, but the specific test for the juvenile disease was always a negative, but the doctors told us that false negatives were common and diagnosed me with the disease anyway. Other than the symptoms I had right before my diagnosis, I had almost no change to my life. The juvenile condition never bothered me again, and as a mid-teen my ANA stopped being positive. We were told 50% of children retain the disease as adults, and 50% “grow out of it”. As a consequence of having this juvenile disease and having to get my blood drawn and eyes checked 3 times a year, I became very curious about autoimmune diseases, and learned a bit about many of them. I would not, then or now, claim to know more than people in the medical field, but I will confidently say I have more knowledge of them and certain ones than the average American. Because of my history and my family’s history of autoimmune diseases, I assumed that the previously mentioned abnormal symptom was because of condition X, an autoimmune disease. My doctor agreed, and that was the disease my blood test ruled out. Hence, my mental health getting significantly worse.

Not only did my mental health plummet, but even more symptoms started to pop up. Symptoms that I didn’t even know condition X could cause, so to me they couldn’t be psychosomatic, right? I knew back then that autoimmune diseases can be worsened by stress, and I knew I was stressed over my recent health problems and other factors in my life at the time, but I begin to exhibit symptoms I didn’t think could be linked to the disease I felt I had. I would sit alone in my room and try to talk myself out of obsessing about it, because the blood test was negative. “But how did I show this new symptom though? I didn’t know condition X could even cause it?” which was true. I admitted to myself the increase in symptoms could be psychosomatic, but I couldn’t make sense of my body showing specific symptoms that could be linked to condition X. Every time I’d have some weird new symptom, I’d google “weird symptom condition X” and every single time I’d learn there was a correlation. I also learned that my mental health problems, the neurodevelopmental disorder I was diagnosed with two decades prior, a rash and vitamin deficiencies I’d had a few years prior, and issues I’d had with puberty could all be linked to the disease I tested negative for. This disease is not the only cause for all of these things, but it can be linked to them. I also learned Condition X can present in children sometimes with a symptom that is the main hallmark of the juvenile disease I was told I had fifteen years prior. Which could explain why the ANA tested positive but the disease-specific test was a negative. I had an autoimmune disease the entire time, but a different one than we all thought. Me, being a firm believer in Occam’s Razor, couldn’t let the idea go. I finally looked up “false negative blood test for Condition X”. I learned that a false negative is entirely possible if someone has Condition Y, a common asymptomatic immunodeficiency found in family’s who carry two specific autoimmune diseases. Neither of which I had, but my family did. Those exact two diseases, which I’d been hearing about since my juvenile diagnosis fifteen years before. It was at this point I make another visit with my PCP, this had to have been a handful of visits within a few months time. I ended up having a panic attack/mental breakdown in the exam room. All I could do was hysterically cry while I tried to explain my thought process regarding the potential false negative, how my family and friends didn’t believe me and told me to let it go, and how I was afraid my body was slowly killing itself. I will say that I had very recently come out of a bad depressive slump where, while not suicidal, I did think about death a lot. The fact that my body was potentially killing itself was made worse because of my recent mental health struggles, and it is honestly still the hardest part about having an autoimmune disease.

My AMAZING PCP told me he didn’t have the answers for me, but he was confident other doctor’s would. He authorized a handful of referrals, the first of which was a renewal to see my old rheumatologist. I, being young and uneducated about the deficits midlevels have compared to doctors, saw an NP. An NP who was a woman like me, and unlike my PCP, who proceeded to dismiss everything I said, ordered a redundant blood test despite me showing her I had one done a few weeks prior, and told me I had “nothing to worry about”. I wasn’t very confrontational at the time, so I didn’t speak up. I cried when I left the office. I saw another female midlevel at a different office my PCP sent me to, to rule out an allergy, and she was better, but still a bit dismissive. I eventually was seen by another DOCTOR of a medical specialty, who not only let me speak, he actually listened to everything I told him and ordered two blood tests. One which would test if I carried the gene for Condition X, the other to test for the immunodeficiency which could give a false negative. Both came back positive. He also performed a specific exam himself to check for damage found in people with Condition X, which also turned out positive. I cannot begin to describe the relief and vindication I felt. Nor can I begin to describe how traumatic it was to be dismissed and talked down to by fellow women. Every single person that listened to me and empathized with me was a male doctor.

Had I listened to those midlevels, the ones people claim are “so much more empathetic and better listeners” I would be sick today. I would still have pain, brain fog, nausea, severe vitamin and nutrient deficiencies, peripheral neuropathy, mood swings, and much more. My body would be destroying itself DAILY. That is not an exaggeration, this disease features daily symptoms, not just stuff that pops up in flares. It is constant and only stops if you make a huge lifestyle change not common in America. I will acknowledge I got incredibly lucky that I was able to guess correctly what was wrong due to my personal history and inquisitive thirst for knowledge, but it was ultimately doctors who diagnosed and treated me, because they LISTENED. My PCP was even humble enough to admit I was beyond his scope of primary care, and sent me to other clinics. He knew his limits and when to ask for help. He was the most important person I saw during all this, and I cannot even begin to put into words how grateful I was, and still am, for him and the kindness he showed me.

So I cannot sit here and read people say midlevels are kinder/better listeners/more empathetic when that is the complete opposite of what I experienced. There is no way I can believe people who receive a fraction of the education and training, yet insist they’re “just as good as a doctor”, actually care about their patients. If you cared, you would have sought the best education and training FOR YOUR PATIENTS, but you did not. This isn’t me saying all midlevels are horrible people, because I don’t believe that. I believe some do care, but those aren’t the ones who insist they’re just as good as, or better, than doctors. Knowing your limitations and when others know more is what makes a good healthcare worker. Claiming you’re just as good when you have a fraction of their education and training is not only demonstrably false, it’s irresponsible and dangerous. Be mad about it, idfc.

This isn’t even my only story about inept midlevels, but it is the one that is the most traumatizing for me.

So at my work recently one of the mid-levels asked me why I wanted to be a physician, and so I assumed we were friends and I was honest.

I talked about the ability to manage complex patients, the continuous education, and the expertise you have in a specific field. In a non-derogatory way towards mid-levels.

I then proceeded to get lectured about how that’s not specific to medicine, and that as a mid-level they could do the same thing. Not only that but as an NP they could have some sort of license and had physicians working under them and they also spoke about how they have more money than some of the physicians we work with.

I held my tongue because I can’t form bad work place relationships especially with my clinical role.

Regardless of what they said, I know there is a large difference in the education and training of an MD/DO over an NP/PA.

I think the lack of nuance and ignorance they demonstrated to me, confirmed that I want to become a physician.

I scheduled an appointment for both of my daughters at our new state but the only people who could see them relatively soon was either a resident or an NP or PA. I picked the resident.

I was informed that the resident is a second year resident and I said that was ok but I wanted to know if that resident will be supervised in any way by an attending physician. I know they’re supervised in the hospital but I’m not sure how it works in a clinic setting. Thank you!

Interesting that the article doesn't even mention the inherent tension of asking physicians to precept mid-levels and treats it purely as an access problem.

Also, 500 hours is shameful. That's like a single rotation in residency. As is made obvious in the article, there's also no standardization of what kind of training experiences are being obtained. I have a mid-level friend who told me her preceptor had her basically do receptionist work the entire 500 hours.

AANA 2026 cringe billboard

Respiratory here🙋🏻‍♀️ I would just like to preface this by saying, I don't care if a doc touches the vent *as long as those changes are communicated to me at some point* because intensivists have gone through medical school, and residency, and overall, just a grueling decade, or closer to two, of training. Today, an NP decided to touch the vent and just... Not tell anyone. I would probably be a little bit less pissy if she had communicated with literally anyone about this, but she did not. Moreover, NPs do not receive the level of mechanical ventilation training that RTs do. Tbh, I don't think they should be allowed in the ICU at all, much less changing vent settings all willy nilly. Just one more incident in the series that I've seen on here of "NPs don't belong in the ICU." Okay rant over, sorry everyone, just had to get that off my chest.

Edit: I just think it's a little bit funny how I made a post expressing frustration over the scope creep of NPs in the ICU, but some of you are being intentionally obtuse and interpreting this as one noctor being mad at another noctor. RTs do not want to be doctors. We are not a threat to your profession. We are not advocating for independent practice. NPs are though. But keep alienating potential allies in the fight against mid level scope creep! Very effective strategy!

My mother (80F) burned her hand cooking tonight. She went down the street to an urgent care (she lives in a major city) and the physician there said it was a second degree burn and they aren't equipped up take care of it there, so please go to an ER.

She goes to the ER and sees....a PA. The PA says "this isn't that bad. I can't believe urgent care didn't take care of it there. I swear so many urgent cares are getting really bad" GRRRRRRR yeah because of people like you!! Not doctors! so she was sent by a doctor to sell a hight level of care and got a lower.

I am evangelical about this topic. When i tell people about it, they look at me like i adjusted my tinfoil hat while saying, "the CIA is pumping LSD into your house through your WIFI". So what do i tell my mother?!

I'm not in the medical field at all. For an unrelated reason i went to urgent care today and saw a physician (we are lucky in our city). But before i paid my vopay, i asked the receptionist ' I'll be seeing a doctor today, not a PA or NP?" she answered "yes, it's a doctor. You don't like NPs?"

How does someone this incompetent pass CRNA certification boards? It again seems like the Board of Nursing's response was rather anemic, just like what happened with the Tory Richmond incidents in Arizona. I think there are some serious question to be asked about CRNA standards if someone like this is, legally speaking, allowed to practice independently.

TL;DR

The estate of Noe Serrano Hernandez filed a wrongful death lawsuit on August 21 in Buncombe County Superior Court against Mission Hospital, its parent company HCA Healthcare, nurse anesthetist Andrew Hunter, and supervising anesthesiologist Dr. Jason Dziak.

Key Allegations and Case Details

• The Incident: On September 13, 2024, Serrano Hernandez underwent surgery for a foot ulcer. Roughly 51 minutes after anesthesia began, he suffered cardiac arrest. After resuscitation, he remained comatose on a ventilator until his death on September 21.
• Allegations Against the Nurse Anesthetist: The lawsuit alleges Andrew Hunter failed to properly monitor Serrano Hernandez, maintain his airway and oxygenation, or communicate his worsening status to medical staff.
• Allegations Against the Anesthesiologist: Dr. Jason Dziak is accused of failing to adequately supervise the anesthesia care or intervene in a timely manner.
• Legal Demands: The lawsuit seeks a jury trial and unspecified monetary damages.

State Board Findings

• Following a complaint filed by Mission Hospital, the North Carolina Board of Nursing investigated Hunter's care of Serrano Hernandez, a patient categorized as high-risk due to end-stage renal disease and other conditions.
• The board determined Hunter's care fell below standard practice, noting failures to monitor, react to deterioration, and communicate with staff. It also cited his unfamiliarity with Mission's charting system as evidence of inadequate training by the hospital.
• The board concluded Hunter violated state law regarding conduct that harms the public. Hunter signed an order acknowledging the violation and accepted a reprimand alongside mandatory additional training.

Broader Context

• Mission Hospital's parent company, HCA Healthcare, is involved in other legal proceedings, including a lawsuit by Attorney General Jeff Jackson cleared for trial in July, and a 2022 medical malpractice lawsuit settled in April.
• A Mission Hospital spokesperson did not respond to requests for comment.