More of a brainstorming question here. If you are familiar with my current project, then you know it deals with a young woman in the age bracket of 25-30 who's in a mandated drug rehab/mental health facility getting recovery help following a long history of substance abuse combined with an attempted suicide. Now, I had wanted her to be an Emergency Room/Trauma physician (full bore went through med school and all that jazz), however there's several other aspects of her life/back story that I'm wondering might be more logical posing this MC as an ER nurse rather than a doctor. 1.) Military service in Iraq. In her age bracket, having gone through uni and med school, I don't think she'd be out by the US Iraq campaign. To my knowledge, the Army will train you in medicine, but they keep you stateside and pay your tuition for the duration of your commitment. However, a combat medic is more like an EMT (according to Wiki, which can be unreliable, so I need back up info on this) and that doesn't require med school. 2.) If my research is correct, when her deployment was over it would be very easy for her to pass an RN course and go to work in a stateside hospital. 3.) A nurse with a booze/junk problem may be able to fly under the radar longer than a doctor. Again, need medical professionals to help me out here. 4.) It might also be easier for a nurse to steal narcotic painkillers from the hospital pharmacy(?) 5.) I don't believe there would be any of the vexing issues with the medical board I've been having. A nurse would be a straight hired/fired situation. (?) 6.) More chance to make a major medical mistake. The doctor orders the procedures, but most often it's the nurses that carry them out, so there is always that possibility of screwing up under the influence. 7.) Nurse sounds more down to Earth and not as (like we say down here) high falutin' as a doctor. Someone common the reader could actually relate to. What do you think sounds more reasonable given the situation? Doctor or Nurse? Which as a reader would you connect more with? Mind you, this is a self-published work to be released on Kindle, so I'm not really concerned with the publishing companies POV, simply your's as a reader.
In this state, combat medics can enter a PA program and become physician's assistants. To work as an ED nurse in most urban/suburban hospitals typically requires a license and experience. So you'd need to account for some time there. You might consider a PA. Whether the military provides the nursing education or one gets it elsewhere, you need to pass a licensure exam whether you are going to be in the military or not. From there all states in the US have reciprocity, meaning you need to do the paperwork but you don't take more tests. You cannot take the test for RN licensure without also having the education in an accredited nursing program. That take 2-4 years depending on the program. It's the other way around. A nurse has an employer and more supervision. A physician has peers who sometimes do not speak up. In some situations, maybe. Typically nursing staff with drug problems divert meds. They give the patient something else and pocket the narcotic. But physicians can order drugs for their office supply and account for them by as little as saying the drugs expired and were destroyed. There are more ways for the MD to cover up drug diversion, though it is not without some chance of being noticed. You can't fire a nurse with a union job as easily as you think. I don't know of a single hospital where floor, ED and OR nurses are not in a union. I think it's about equal. Ever seen a drunk surgeon? I have. And, passing out when you are on call, not responding to a page, I've seen not responding to a page result in a death twice. But yes, there are plenty of opportunities for a nurse to kill patients as well. Not necessarily. I've seen high falutin' ED nurses on more than one occasion. There really is little difference, IMO, both professions have all types.
check out the cable series, 'nurse jackie' to see how closely it fits your scenario... i'd go with a nurse, instead of a doctor, if i were you... nurses do have to be licensed, however... here's a good site for checking out how it works and general info on nursing: https://www.ncsbn.org/Nursing_Licensure.pdf
She could have been whiz-kid and gone through school quickly/early, if you wanted her to be a doctor. I'm thinking 'House', and just how much his being a doctor constantly covered his butt with his drug addiction.
You can go with either. I have plenty of colleagues (doctors) with a drinking problem, it's not uncommon, especially young ones doing ridiculous hours (like 80-90 per week), and A&E like to work hard and play hard. In terms of doctors ordering procedures, most procedures in A&E are carried out by doctors because nurses need lots of special training and accreditation for each individual one, whilst doctors are automatically accredited to do them all. It's not uncommon for doctors to have to figure out how to do a procedure from a book or the back of a packet (how I inserted my first suprapubic catheter one night at 3am, because there was nobody else available and the buck stopped with me). I imagine someone who is drunk at work would be very likely to make a mistake in that situation, but if it's something routine that they've done a thousand times, they might not be picked up for a long time. Doctors and nurses have equal access to drugs in A&E (you wouldn't be stealing it from the pharmacy but ward supply, trollies etc) but controlled drugs need to be signed off by two people, and any kind of regular theft is unlikely. On the wards, a couple of nurses have keys to the drug cupboard, and drugs are counted twice a day, so anything missing is quickly picked up (unless the one who is using is also the one doing the counting, still, there's usually two present at the time so it might get complicated). The only doctor opiate junkies I know of were anaesthetists, they have easiest access to that type of drug so someone who is already using might gravitate towards it in their career. It's still very rare for anyone medical to be a junky, but it happens. With the Army, this is based on Australia, the Army finances your studies, and as soon as you graduate, you go through officer training and indeed get deployed. A friend of mine went straight to Iraq, two years in a base, then did the rest of it (further 5 years) in rural Australia, and did his General Practitioner training during that time. After you 'work off' your time with the armed forces, you can stay or leave (most leave). I don't know that nurses would be less likely to be 'picked up' if they were addicts, people still know their job even if they have substance abuse problem, and there's a lot of 'blindness' to such problems in medical cricles, so anyone will probably fly under the radar until others around them simply can't ignore it. For some people, that's years. In terms of personality, I wouldn't stereotype either nurses or doctors. You have long winded bores who are nurses just as much as you have exciting, bubbly bimbos for doctors, and every shade in between. But doctors tend to be more ambitious personalities, on average, since they chose a much more academic path, with much more responsibility (since they are ultimately in charge of and responsible for patient's diagnosis and treatment). Both nurses and doctors have a board that regulates them, and procedures and proscribed code of conduct are similar, so either wouldn't escape problems if they were caught.
It's interesting that you'd bring that up since I actually have seen both young MD's and nurses alike doing that while I was admitted as a patient in the ER at LA County/USC Hospital (where my MC works.) That crossed my mind which is why while she has been able to hijack pharmaceuticals on one or two occasions she is mainly a street drug user. Heroin to be specific, coupled with cocaine & amphetamines (for those 80-90hr weeks you mentioned) mary jane and alcohol. In honest terms she will take whatever she can get her hands on short of ecstasy or LSD, or shrooms, or any other pscychadelics. That's based on a reflection of my own self, which I still don't know how I managed to stay functional enough to maintain a job repairing model trains (can be like watch repair or surgery at times ) I think it's the same in the States. From what I could gather from the US Army recruiting website, they will pay your tuition but I couldn't decipher really what happened next because it kept urging me to see a recruiter for more info lol. I'm wondering if it's the same here because it did day that you would enter as an enlisted officer in the reserve when you are accepted as an Army physician. My MC is about three years out of school (Age 29 as of the narrative start, 30 by the end.) So that's about how long she's been flying under the radar. I thought about it, but I didn't want her to be too special if you know what I mean.
@Alesia: I don't know how it works in the States (the whole 'pre med' is still a mystery to me), but elsewhere, you can get into med school as young as 17, but you have to pass the psych testing and an interview with three people, one of whom is a psychiatrist or a psychologist, another is just a prof/lecturer and the third a member of public. Medical school lasts 6 years, so she can be as young as 23-24 when she qualifies, and the Army would be taking care of her internship, possibly somewhere overseas, at an army base or similar. She would be around 29 by the time she works off her debt to the army and could become an addict due to stuff she saw in the war (just an idea). They do surprise urine drug tests in the army, so she'd have to clean up before she starts with them (cannabis can remain detectable for up to 60 days, coke and amphetamines and heroin can be detected in hair, so she'd be abstaining fro all illegal substances and cutting her hair short as well). Also, she'd have to be really fit to pass the recruitment. If she isn't fit enough, she'll be given time, and if she doesn't meet the standards, she'll owe them hundreds of thousands of dollars. I don't think it's possible to be a junky or an alcoholic whilst working for the Army (according to people who've been through it). Most of them actually looked forward to 'cleaning up' and getting into a healthy lifestyle. I don't think you need to make her a whizz-kid. The prerequisite to get into med school is to be in top 2% as far as the IQ and grades are concerned (at least where I went), other than that, you get all sorts. Rich kids, poor kids, streetwise kids, crazies, smartasses, comedians, you know, like any other course. It's really difficult to pass the exams even if you are straight and studying all the time, most kids will be pretty wild, but everyone turns into a nerd 1-3 months before an exam, so there's a limit to substance abuse if you want to graduate. I knew one guy who got addicted to diamorphine during his research year (we can do one year and get science degree as well). He was experimenting on mice and got totally soul-destroyed because of animal experimentation, and by the time I saw him again, he had a massive heroin and ketamine problem, not good at all. Everyone I knew who was actually a junkie or an alkie didn't make it past third year. I suppose she could be a drop-out from med school who joined the Army and got trained up as a field medic, but she would have to be sober for that so it comes out the same. Maybe she was an addict at Uni, sobered up for the Army then started again when she left?
Whatever country you are in Jazz, clearly the typical ED here is different from your Accident and Emergency departments there. Advanced practice nurses and physician's assistants here might be the only medical provider one sees in an ED, but it is still the nurses that carry out many of the procedures, in particular drug administration where diverting narcotics can occur. While the MD, NP or PA might be the one sticking a needle directly into a bladder, you would only infrequently find an MD inserting a catheter in a urethra. Typically an MD, NP pr PA would insert a central line, do an LP, and suture a wound. RNs would be the one to clean and irrigate a wound, start peripheral lines, administer code drugs, manage the ventilator if there were no respiratory therapists available, bag the patient during transport if needed, track the heart rhythms on the heart monitor except during a code where the MD running the code might be the one watching the monitor. The biggest technical error on the series, House and Gray's Anatomy, is having the interns and medical students doing jobs the nurses normally do. Myth: Doctors do all the work. RNs in the US military are also commissioned officers.
Ginger is spot on. I work in a US Emergency Department and I can tell you that the nurses do 97% of the work. The doctor will show up, come in like a whirlwind then tell the nurse what to do and then you never see him again.
@GingerCoffee: You know perfectly well what country I'm in, and we established clearly many times before, that where I work and where you work, is as different as it can get. I am not here to debate these differences with you, I am simply offering my medical knowledge to the fellow writers who asked for help. I won't be replying to any further comments from you, since we've been down that road before.
Oh yeah, JJ, been there, seen that. I've been in plenty of ER's and rarely did I ever see a full-blown MD other than for about sixty seconds. That's what I was looking at for her military service. To the best of my knowledge, you can enlist with little to no medical training and become a field medic (they will train you after BT I think) which is more like an EMT or Paramedic vs an RN or MD. Then, post service is when she would go through RN courses/licensing and subsequently get her employment at USC. This story takes place as of 2013, so there's plenty of time for her to do that. I'm thinking she enlisted young, like 18 or 19.
@Alesia: You can make anything work, you just need to write it convincingly. Depending on your setting, you need to research how things are done in that place. Clearly, US medical system is unique if indeed '97% of all ER procedures are done by nurses' , but it is what it is and if you are setting your story there, you need to make US audiences believe it, because they're the ones who will have experienced it first hand. I don't think people are looking for absolute accuracy in their fiction, as long as it isn't blatantly wrong. I'm sure you have a lot of leeway to make it fit with the story you are trying to tell.
I forgot, Isle of Wright or something? But you never seem to know anything about advanced practice nurses either in the UK or in Australia. Anyway, I was pretty careful only to state what nursing is like that wasn't consistent with your description. You can't expect me to ignore your assertions if you post weird things about nurses that aren't true.
You should take a look at the PA Program at the U of WA in WA State. They accept a lot of military corpsmen straight into the program and I believe the program is only one year long. The only minor issue is, PAs in this state have to be licensed under each physician they work under and MDs essentially co-sign all the PA's prescriptions. So if a PA changes jobs, they have to get a new license under the new physician that takes them on. That might be something that you can use in your story. As an NP, my prescriptive authority and practice are independent.
I'll look up the PA programs for USC. That's a specific part of her back story is having grown up in L.A. and attended school at USC. I believe if you go to SC it's easier to subsequently get a job at the hospital or they will place you. I spent a TON of time at County of L.A./USC hospital as a patient in various departments, so that's why I'm dead set on using that particular facility, since I know the grounds and layout very well lol.
Well, looky looky, not only are there advanced practice nurses in the UK, the specialty of APN in A&E exists. Imagine that? Things must have changed since you were last in an A&E department in med school. You did say you worked as a part time psychiatrist, right? Not really in mainstream medicine? In the psych hospital here where I am the infection prevention consultant, the ARNPs do the bulk of the medical exams and orders and the psychiatrists stick to the psych treatment. There's only one MD that does medical, a pediatrician. He defers all GYN exams to the NPs. The nurse working at an advanced level of practice - Advanced level practice encompasses aspects of education, research and management but is firmly grounded in direct care provision.
You can do so much drugs and alcohol in the army. So. Fucking. Much. There's actually a huge problem here with vets coming back addicted to pills that were so easy to score in the service, or just raging alcoholics.
@GingerCoffee: I think it's really interesting how you keep deliberately pretending I said something I never said, just so you can justify insulting my medical opinions. It's as fascinating as elaborately constructed delusions. Keep talking, though, I am sure you aren't finished yet @Jack Asher: I only know about Aussie army. It's scary if in the US they can get messed up like that, war and drugs are a bad combination.
My apologies to the other forum members who are tired of this kind of exchange. But when a condescending physician denigrates the nursing profession, it's hard not to reply. I'm pretty sure you made a deal with the mods not to start another argument with me. And I made a deal only to address things you posted that falsely portrayed nurses. And yet here you are again with snark that started with your answer to my innocuous post, which only said that nurses in US EDs do much more than in your description: If you recognized nursing for the skilled profession that it is, I can't see how that correlates with the above statement. I would have left it there, but you made another snarky comment and it didn't make sense to me nurses in the UK did so little in the emergency setting. So I decided to look into it and found out there were nurses in the UK that did just what I do, diagnose and treat patients, including writing prescriptions, independently of physicians. Have you forgotten these ad hominem fallacies you used to argue claiming nurses are not capable of advanced practice, dismissing what I posted about the lack of evidence for certain side effects from influenza vaccinations by claiming nurses couldn't evaluate research or understand medical practice. If you don't think there is such a thing as nursing science and you don't think nurses are qualified to do anything on the level of a physician then either you don't know what an advanced practice nurse does, or you didn't know they worked in A&E departments in the UK. I doubt there would be advanced practice nurses in the UK if nurses fit the description you posted that doctors do everything because regular practice nurses can't. Now, since you've made this personal again, belittling the nursing profession I have responded. Beyond that it's off topic and other members of the forum don't like it. If you denigrate nursing and nursing science, I will provide evidence that demonstrates you are wrong. If you post snark, don't expect me to ignore it. Think about it, Jazz, you've been seriously condescending beginning when I contradicted your claims about flu vaccine weakening the immune system. Your physician snobbery wouldn't be tolerated in most hospitals in this country. But to tell you the truth, I've only ever met a small handful of physicians with such disrespect for the skills and experience of nurses. Most physicians I know have the utmost respect for the nurses they work with.
Given the medical errors you've posted on this forum, I'm confident more than a few advanced practice nurses could provide better medical care than you can.
It's the evidence, not what I tell myself. I know of at least 4 clear cut medical errors you've posted on the forum. You don't want to push it.
Opinion at first, because I recognized your medical errors when I saw them, but I checked the evidence and confirmed that it contradicts your erroneous medical claims. BTW, even though you are intending condescension calling me, "nurse" it's not the least bit offensive. Of course you are also ignoring the fact I am an APN with 3 board certifications and a 20+ year successful independent medical/nursing practice, but the one thing I am not is insecure about my professional expertise, and it should be obvious by now, I'm proud that I'm a nurse.
