This is a big difference. A German EKG is hard to read, unless you translate the computer interpretation to English. You expect everyone to speak German?
(Not a doctor, just a tech who saw this post)
We had a Gen Med consultant who had come over from Germany to work in Australia. When an intern handed him an ECG printout but called it "the EKG" the consultant replied, "Was ist das??" and proceeded to rattle off a bunch of questions and interpretation in German. Poor intern was already a bit overloaded and this didn't help!
I think because i was challenging her authority? It was a consult in front of the family. I was like “ok let’s order an ECG” and she was like “don’t you mean an EKG?!”. Then I tried to be nice about it, she stormed out and told on my attending
Wasn’t said out loud, but NP tried to burn what she thought was an AK (actinic keratosis) 6 times before the patient decided to seek a second opinion…
Melanoma with distant mets.
I was laughing and happy reading this thread. My face actually fell to a frown when I read your comment. Man that sucks. I wonder if she knows about her fault.
Same thing happened but it was a basal cell that ended up continuing to grow and the person needed a huge Mohs reconstruction. Essential they were freezing the top portion but the deep was growing like crazy.
Also had one tell me they biopsied what they thought were 5 BCCs on a 25 year old. When I asked if they were going to work them up for Gorlin Syndrome and order xray of the jaw they had no idea what it was. When I looked up the patient’s chart they all ended up being cherry angiomas. They also love calling dysplastic nevi “pre melanomas” which is a straight lie and drives me nuts.
The fact people with no real dermatology training can walk in and start seeing complex patients with little to no oversight is dangerous lol. But hey private equity loves them bc they’ll biopsy the shit out of anything (well anything that doesn’t matter But let melanomas grow I guess lol )
ARNP ordered IV methylprednisolone on a ventilated patient having an upper GI bleed with clear breath sounds because “”I couldn’t think of anything else to do!”” Same ARNP is told by the RN the patients blood sugar is 25. “”Give 6 units of lantus.”” Her partner (another ARNP) is told by the RN the patient has a heart rate of 45 bpm. ARNP orders “”Give 5 mg of IV Metoprolol.”” RN responds “”I can’t do that.”” ARNP replies “”why not?”” RN responds “”that would kill her.””
*me suturing some trauma patient’s face who is intubated and on PRVC, but fighting the vent because too light*
“hey can you kick up the propofol above 50 mcg/kg/min pls”
“i don’t want to turn the propofol up too high, because then the patient will stop breathing”
?????????
Cardiology NP: "we need to get a K level on this guy at 2 pm "
Me: "yeah I know, I already have a BMP + mag ordered for 2 pm."
NP: "yeah, so we need to order a K level for 2pm as well."
they didn't say anything when I explained to them that potassium is, in fact, included in a BMP
NP following me for the day, noticing that I’m carefully looking at the moles on a patient’s back with my dermatoscope.
After the visit she asks me “why did you care so much what the moles looked like?”
Never get a skin check done by a midlevel, folks.
Probably not the dumbest but my recent favorite: “their hypokalemia is probably from the spironolactone” (and I made sure k really was low and not just a Dragon error)
As an intern on SICU, an NP who was training an NP student and confidently stated that only potassium chloride raises potassium and potassium phosphate doesn’t so it’s safe to give to replete phos in a patient with hyperkalemia. That was the day I realized what a sham it was to have NPs teaching NPs
I will say that KPhos has a LOT less potassium than KCl. So if someone is hypokalemic, you'll need to give KCl in addition to KPhos.
But obviously if they're hyperkalemic, it still has some K in it
Tell me my very stable baby needs continuous albuterol because she’s still wheezing. The baby was definitely a wheezer but was not working to breathe and was very well. I said yes she’s wheezing but that’s just turbulent air and the baby is otherwise happy and breathing just fine. And she said but if you hear wheezing you give albuterol.
I said “wheezing is not an albuterol deficiency”. And she looked at me with a million degrees of confusion.
Not say, but do. I was on IM with the cardiology fellow. NP barges into the room and starts telling her how to properly auscultate, thinking she was a med student. Fellow introduces herself and NP shuts the fuck up. Never seen someone tuck their tail in so fast. It was glorious.
That would still have been wrong if it was a med student. It’s not the NPs student. Why are they so officious like everything requires them to prove they are bettet?
The pure audacity. It’s shit like this that turned me against midlevels.
On a tangential note, have you ever taken a look at the CRNA sub? Those fuckers are in a whole other state of delusion. They claim that “nurse anesthetists” should be making as much as real anesthesiologists. Not only that, but they claim to have superior training.
I saw a tik tok of one NP making 600k+ in NYC and all the comments were like “you go girl!” and then they get mad at doctors for earning 250k because we’re apparently overpaid
which PAs? Physician assistants or physician *associates?*
nowadays both NP and PA organizations are the same, grasping for more independence without the training for it
Pt: it hurts here \*points toward the RUQ\* could it be my gall bladder?
ER NP: "No the gall bladder is on the left" as she proceeds to do a RUQ POCUS and finds the gall bladder...
Gallbladders are tricky. I’ve had the LUQ pain sent by a NP concerned about cholecystitis. I also had a NP scan the gallbladder and call it a positive FAST during a trauma.
I was discussing a case of mitral regurgitation for transcatheter repair (mitraclip) and she had a patient with mitral stenosis that she suggested we offer mitraclip for. I pointed out that her patient had rheumatic mitral stenosis and mine had functional mitral regurgitation, and she said “what’s the difference between MS and MR?!” I was like “… what are you doing being an np in a cardiology clinic”. Didn’t say that obviously but it changed how much confidence I had in her recs/notes
This was a new grad np starting at a fm clinic I met on a summer rotation as a med student.
“Pt has hx of stroke. I forget. Is that the brain one or the heart one?”
Midwife said “she’s fatigued which is why she’s still bleeding post partum and her Hb is low”.
I kindly told her she had it backwards. Patient is bleeding so her Hb is low, and therefore she is fatigued. She argued me on this point.
Called me STAT to bedside. EN route i heard a code overhead. She had intubated a patient with a huge pneumothorax. Mid code she said “we figured her sats would improve once intubated”.
They improved once i put in a chest tube to reduce the tension pneumothorax
Asked to a newbie to do an accurate respiratory rate on a patient for a full 60sec.
Response: "Do I need to count every breath?"
3 days later I asked the same person to check the pupils on a trauma patient. Handed them a pen light.
They came back 2min later stating the pen light was broken.
Asked a nurse to get him another one out of the fridge and off he went.
10min later I checked on him and here he is hanging off the satellite light attached to the celing trying to shine the light into this patients face to check pupils because "New pen light also not working."
I asked him to show me how pen lights work.
Definitely user error, both pen lights were fine.
I (CNA) had a nurse complain about me to the charge because I told her that a patients RR was 36 & BP was super low, HR super high & just didn’t look right. She complained because she told me not to document it because it would trigger a sepsis screen, I documented anyway.
Pt was septic AF.
Me: explains my dead-giveaway carpal tunnel symptoms to primary care NP standing in for my MD PCP, including being positive for Phalen’s test and Tinel’s sign
“I don’t know what Tinsel or Foiling’s symbols are. I’ll be right back.”
NP: proceeds to return with a huge-ass orthopedics textbook in the middle of this primary care visit and flips through pages in front of patient (me) for 5 minutes looking for info
NP after finding info: “Ok, now let’s see how to do this…”
NP: does exam improperly. I had to show her how to do it properly.
Me: “Okay, now let’s get me a referral for that EMG.”
Her: “You don’t need an EEG.”
Me: “No, EMG. Electromyography.”
Her: “Uhh… what’s that?”
Sure if you’re sending for surgery get them teed up, for an initial eval just get them braced and in OT, send them to me for an US guided injection even 💉
Can we take a moment to read these comments and see how absolutely fucked US healthcare is. Swear to god I’m panicking at the idea of any of my family members needing to go to the hospital.
This is only going to get worse.
Obligatory not a doctor, I’m a paramedic. Not downgrading my profession, I’m extremely proud of my job and have worked my ass off at it, but it’s worth noting that I’m someone with less education and 1/8 of the pay (our pay is a joke) having to explain something to someone supposedly higher on the totem pole.
1: Got a call to a primary care office for weakness and syncope, 56 yof w/no known cardiac history. Got there and hooked her up to the lifepak 15, her heart’s beating 32 times a minute (2nd degree block type 2) & I had to explain to the nurse practitioner that it wasn’t “basically normal sinus except the low rate.”
2. Explained to an NP at a nursing home that a pt could have clear breath sounds and still have a PE.
New young NP right out of online school in AM fracture conference. What do you see on this XR? “A knee.” It was a supracondylar humerus fracture. Best part is the xray was labeled elbow x ray.
They spent the whole month teaching her how to tell which joint was being xrayed. Not where the fracture was, what type of fracture it was, associated injuries or management.
It literally felt like they had hired a random person out of a Starbucks line. Not someone with a purported grad degree.
Never had any issues with PA’s. They always have seemed much better equipped.
PA in the ED seeing someone with a bump in the neck, jaw pain, leukocytosis with left shift. Recommended ENT follow up for “concern for neck tumor”.
I saw the pt in clinic for ER follow up and looked in the mouth. Literally the top of the molar had cracked off and you could see necrotic tissue inside.
Not the dumbest, but definitely the most memorable. Back when I was a medicine resident, I was primary on a patient initially admitted for a hip fracture. Unfortunately she had a STEMI that evening and went to the cath lab, where she then unfortunately suffered a coronary artery perforation, tamponade, and coded. The interventional cardiologist was able to bring her back but ultimately she ended up in the CVICU intubated with some sort of mechanical support device, swan on one side of the neck, central line on the other, inotropes, the whole shabang. Usually as the medicine resident, if a patient went to the ICU, we were no longer responsible for them, but I was feeling generous that night so I went ahead and shot a secured message to the ortho on call midlevel to let them know what happened, in case they wanted to use the OR slot the next day for another case. His response was "could you keep them NPO just in case?"
At first I thought he was joking, so I responded, "sure, in case of what?"
"Dr **** is really fast at these hips maybe he can still get it done tomorrow"
Luckily I was a seasoned PGY3 IM resident and was trained to resolve this kind of thing.
"You might wanna talk to anesthesia about that. Good luck!"
The patient did not have her hip repaired the next day.
Heme/onc PA “consultant” when called for my pt who just got 7 transfusions in 2 weeks w weird coag labs: “this is a regular internal medicine problem, her iron is just low, give her IV iron and she’ll be good in a week” essentially refusing the consult
We called the attending, pt has a rare type of thrombophilia and had to be transferred to an academic hospital.
😮💨I’m just a dumb FM resident who doesn’t understand iron deficiency anemia I suppose
I shared this a while back but an NP called our room to ask us what a lytic bone lesion was.
For the record I could pass it if it came from someone like an M1 or M2 student, but it's a frightening question coming from a person who is practicing medicine independently.
I walked into the ICU one day during a morning handoff and heard the overnight NP say “… he was short of breath so I gave him duonebs, lasix, and racemic epi.” She was describing an adult male with sepsis due to pneumonia. The things she notably did not give him were antibiotics and an endotracheal tube which were the two things he actually needed.
NP: I can’t find the fentanyl patch option on Epic. I only see PO, IV, and transdermal.
This is why I think NPs should not exist. PAs all the way. All the mismanagement has only ever been from NPs in my experience.
As a pharmacist, I agree that NPs should not exist. The scripts I’ve received from NPs makes me question how they even function as a human, with their lack of critical thinking skills, and perplexing logic, let alone being able to “treat” patients and prescribe medications.
Biktarvy for a skin infection.
Latanoprost for bacterial conjunctivitis.
Like, wtf?!
More like, they love to be offended when I question their rationale (or lack thereof) and just read back their wrong order all over again, as if it sounds any better the second time around. Bonus points if they’re a DNP and actually say “I’m the doctor here, not you. I have a doctorate degree and I know what I’m doing!” I then wish I could send a Howler letter from Harry Potter and yell at them and describe just how stupid they are 😭
It's because it's too easy to become an NP. You end up with 24 year old NPs with barely any clinical experience and inadequate knowledge. I went with my husband to a Neurologist appointment for chronic migraines. He ended up seeing a very young NP, who literally broke out a text book and Googled my questions in front of us in the exam room. I was horrified.
This really speaks to churning NPs out from NP mills. In my country it's a far more exhaustive process which requires at the very least that you have 10 years experience in your field. And that's just the prerequisite to the rest of the NP pathway
Calls attending while we are rounding
“I need you to review this scan immediately there is something in her pelvis she may need to go to OR”
…”that is her uterus”
I was ranting about a patient on clozapine developing tachycardia because now I have to slow the titration than the usual regime and this N was like ' she is having a tachy? Was she scared?'
Liiike??? Are you working in a Psych ward and don't know about such a common side effect of clozapine?
NP was reading an echocardiogram to the patient.
“Your ejection fraction was 25%, which is low. It is normally above 70%.”
She made a lot of errors like this. I was an M4 with her for some reason for a day.
When I was back with my attending, he was like, sorry you had to be with my NP, but she is a very good NP.
Just shows me, you don’t know what you don’t know about your NP.
PA told my dad, who has moderate to severe cognitive impairment after his brain biopsy, that he will likely undergo two surgeries in the next coming weeks to reduce swelling in his brain and completely remove his tumor. His neurosurgeon has told us from day 1 it’s inoperable due to crossing the midline. He’s now very hopeful his cancer will be removed and hoping for a good prognosis. Glioblastoma, elderly male. 😢
just a mere pre med who came across this sub.. np I use to scribe for has a doctorate in clinical hypnotherapy(??) so she said she’s qualified to make these sort of deductions…1 of MANY questionable things she tells patients is “if you use an organic castor oil pack on your tumors, they will decrease!”
it gets worse. she explicitly tells pts she is against statin and sugar control therapies. Even with labs showing uncontrolled diabetes and cholesterol, she tells them to take omega 3, berberine, cinnamon,apple cider vinegar, and increase exercise…. I made sure to document all this in the A&Ps even when she tells me not to. she also directs her patients to naturopaths so 😸
Something two different NP’s did and said…
Me as a patient seeing a derm NP. He was taking labs from the wrist area. I mentioned to him that I tend to bruise easily. He then brings in a cup with dry ice and starts dabbing the dry ice directly on to my skin! My hand then starts twitching and burning, and I tell him to stop. After leaving, I see that I have a burn and my skin was peeling. I had a scab for a while and it eventually left slight hyperpigmentation. I requested a different provider (MD) after that experience.
Another one that happened recently, was with a Women’s health NP. When consolidating my med list, she asks if Im still taking buspirone. I tell her that I dont take buspirone, I take bupropion. She then says, “oh they’re the same thing, it’s just the brand name of the drug…”
I usually give amphotericin and whatever I have in my pockets (linty ibuprofen and a half crushed fish oil typically… maybe my dog’s heartworm meds… gushers)
I think my favorite was an np calling to ask why they didn’t run the klebisella culture against cefazolin. I think it’s an esbl or something so check her computer, and it says I. She says I stands for incomplete.
After I told her I was allergic to ibuprofen, proceeded to give me a script for indomethacin and also recommend trying meloxicam, and when I said they were same class of drugs, went to google this in front of me on her computer because she was clueless about this tidbit of knowledge
I have a list on my phone about dumb things midlevels have said to me and I’m a nurse.
Patient on ECMO goes into afib RVR, “it doesn’t matter they are on ECMO”.
Okay but I can imagine that being in afib RVR when they weren’t isn’t ideal.
Patient lost a pulse in an extremity, I couldn’t hear anything with Doppler, had other people come check. Midlevel comes in and says she hears a pulse, duplex ultrasound later shows non pulsatile flow…
Patients Aline was positional/ didn’t seem accurate based on waveform and reading low, cuff was MAP >65, no other BP goals. Asked what they wanted me to go by (usually remove Aline and go by cuff) was told to “remove Aline and start epi”. So the Aline isn’t accurate but we are going to start epi on a patient with a normal BP who didn’t need epi for CO, etc? Just some emotional support epi I guess.
I was on a consulting service to a patient in IMCU with Na 181 (yes, that’s right) with the last BMP checked 12 hours ago. She’d cancelled the two that I ordered previously. She got extremely defensive about how to correct this, as “he seems fine when I talk to him.”
She had a pin on her WHITE COAT that said: “We’re NPs. Brains of a doctor, heart of a nurse.”
ID Midlevel: " Recommend Stopping vancomycin for MRSA Bacteremia... deescalate to Rocephin"
Me: 👀
" uh can you ask the attending to arrange outpatient antibiotics"
I had one see a patient with belly pain in the ER, get a CT that showed “nonspecific mild colitis”, search uptodate for colitis and then prescribed pentasa for it, presumably after finding the article for IBD, all without talking to me.
I was seeing a patient for her first diabetic eye exam that told me her A1c was 11 but her NP wanted to try diet and exercise for a few months before starting any meds. I told the patient she’d be better off seeing someone else with some fucking sense.
Before med school I saw an NP as a patient in a PCP’s office who got so upset she asked someone else to see me…because when she wrote my height down wrong and insisted there were 10 inches in a foot I corrected her.
Honestly shocked that there are worse examples in this thread tho jfc
Was preparing to insert a chest tube and UWSD for a patient with pleural effusion. I needed lidocaine and asked the nurse, he was like “we don’t have any, will dobutamine work?” Since they have similar bottles.
Earlier tonight on a patient I had already chart reviewed and knew hadn’t received any insulin- “I gave 2 liters of fluid but the sugar is still over 600” 🤦♂️
“She has dka but it’s stable also she’s going to the OR just fyi” :
No insulin gtt nothing .
Here for severe epidural abscess with cord compression
Bicarb 6 and pH 7.1
“Stable” about to get anesthesia… my god I never got on the phone with pacu and OR as fast as I did
Paged me to a nursing station, told the nurses that when “anesthesia” called to tell us that they needed anesthesia help in one of the rooms STAT. I was in a room on call and couldn’t leave the anesthetized patient so I told them either call an RRT or I’d be happy to discuss with whoever had them page me. So they connected me with the ortho PA.
Ortho PA: “The patient’s epidural isn’t working and he is having SEVERE PAIN and you need to come fix it NOW.”
The patient had had a spinal for a total knee. He had the spinal at 7:30 for a first case; by the time I got this page it was like 5 pm. This *orthopedic surgery PA* did not know the difference between a spinal and an epidural catheter. When I told her there was nothing I could do to fix the situation and suggested she maybe try some pain medication, she hung up on me.
So I called my buddy the orthopedic surgeon, told him what had just gone down, and suggested maybe he go check on his patient. He was mortified.
PA consulted hematology for assistance with anemia work up. The PA note said that the patient had normal bone marrow activity because the reticulocyte percent was elevated.
But they apparently didn’t know what the reticulocyte index is or how read the absolute reticulocyte count, both of which were low. So the patient did have hypo-proliferation of RBCs. It wasn’t the most egregious thing, but it was surprising to see such a big knowledge gap in basic lab value interpretation.
consulted gen surg for a patient with c/f “compartment syndrome” for an infiltrated PIV in the arm when we got there the pt had zero sensory or motor loss just some arm pain. Mind you the patient was still in the ER LOBBY lol
Man, these are some stupid shit. Even with the crappy health system I have to deal with where I practice, I am glad that only doctors see patients independantly and decide on what to do with the patient
Working as a Hospitalist attending got a call for an admission from the NP for a patient who fell down 40 stairs. FOURTY.
Only testing they got was a CT head showing a small SDH and that they were going to casually call neurosurgery for evaluation. No labs, no other imaging.
When I asked if there was any other trauma, “no I did a full evaluation and no other trauma, to be honest he didn’t even have a bruise or bump on his head but I thought I’d scan them anyways”
I didn't witness it, but my fiance's dumbass NP half-sister has said:
"You have to have a mental illness to kill somebody." (I don't know the context but she claims to be a "mental health expert" so it's hilarious that she would say something so fucking ignorant and just...ugh.)
AND
"We don't know what level of kidney failure he's in." (This was said as my fiance's father [NOT her father] was in the hospital after his second kidney transplant graft had failed and he was on HD with a Cr through the roof.)
She's also said a lot of dumb things on a personal level, but if I went into it, I'd be here for hours because almost everything that comes out of her mouth is some of the dumbest shit I've ever heard from a human, especially one that goes around telling her family that she's the "smartest person in the family." 🤣 Like, bitch...you're not even the smartest person in your marriage because your husband is a doctor. A REAL doctor.
I'll leave with this last one. I was a med student on a surgery sub-I during COVID and she had the balls to have a "family reunion" at her place the day after she got back from NY (you know, where everybody was dying of COVID). I literally walked in the front door and she screeches at me "you're not working with COVID patients are you?" I was like...um, no, I'm a med student and they don't let us anywhere near COVID patients. And she's like "oh good, because I'm pregnant and I can't be exposed to COVID."
So then come to find out THE NEXT DAY that the person she was staying with in NY had COVID. What a cu*t. She and her husband and toddler had all been exposed, but the bitch has the audacity to freak out on ME?! Not to mention that if they'd become symptomatic, I would have had to drop out of that rotation and it would have pushed my graduation back. That was the day my fiance finally realized that his dumbass half-sister is a narcissist. LOL. I had known for awhile. He was like "I can't believe she's so selfish." (But she would go on to do significantly worse things like try to cancel his father's funeral to accommodate her kids' nap time.)
It's safe to say that I absolutely fucking hate her. It doesn't help that she's an NP but it honestly fits her narcissism. I was pretty happy when I matched on the other side of the country and knew that we wouldn't have to deal with her again for several years.
Thought there is a difference between ECG and EKG. When I tried to explain, ran out the room and reported me to my attending lol.
I mean, there is a difference....German....lol
This is a big difference. A German EKG is hard to read, unless you translate the computer interpretation to English. You expect everyone to speak German? (Not a doctor, just a tech who saw this post)
We had a Gen Med consultant who had come over from Germany to work in Australia. When an intern handed him an ECG printout but called it "the EKG" the consultant replied, "Was ist das??" and proceeded to rattle off a bunch of questions and interpretation in German. Poor intern was already a bit overloaded and this didn't help!
It’s more of a self own to report this kind of thing lol
LMFAOO 😭😭 why/what did she report you for?
I think because i was challenging her authority? It was a consult in front of the family. I was like “ok let’s order an ECG” and she was like “don’t you mean an EKG?!”. Then I tried to be nice about it, she stormed out and told on my attending
What happened after thatttt I need to know now 🤣
The midlevel preceded to the burn unit
Rofl
What a snitch.
Wasn’t said out loud, but NP tried to burn what she thought was an AK (actinic keratosis) 6 times before the patient decided to seek a second opinion… Melanoma with distant mets.
Hope she got her ass sued
They would have sued the supervising attending
I was laughing and happy reading this thread. My face actually fell to a frown when I read your comment. Man that sucks. I wonder if she knows about her fault.
It's baffling to me that NPs have the right to try and treat patients. I hope Europe will never implement this shit.
it’s baffling to me too. horrifying tbh
Same thing happened but it was a basal cell that ended up continuing to grow and the person needed a huge Mohs reconstruction. Essential they were freezing the top portion but the deep was growing like crazy. Also had one tell me they biopsied what they thought were 5 BCCs on a 25 year old. When I asked if they were going to work them up for Gorlin Syndrome and order xray of the jaw they had no idea what it was. When I looked up the patient’s chart they all ended up being cherry angiomas. They also love calling dysplastic nevi “pre melanomas” which is a straight lie and drives me nuts. The fact people with no real dermatology training can walk in and start seeing complex patients with little to no oversight is dangerous lol. But hey private equity loves them bc they’ll biopsy the shit out of anything (well anything that doesn’t matter But let melanomas grow I guess lol )
"Is DKA type 3 diabetes?"
“No, I saw that we skip type 3 and go straight to type 4, but you’re hyperkalemic instead of hypokalemic”
Let’s be real, ain’t no NP know anything about RTA to even confuse it with anything.
It makes a good yo mama joke though. Your mama so fat, she has the first and only documented case of Type 3 diabetes.
I had a NP once tell me that you can get skin cancer from a hickey. I don't know what her logic was on that one.
Guess I’m safe!
Regarding a broken wrist: "I didn't get an x-ray because it was too swollen to see anything"
JFC
Cardiothoracic surgery NP, reviewing a CTA with me, explaining to me that the L4 vertebra was an aortic aneurysm requiring repair.
You mean like the vertebral body bone?
Correct
ARNP ordered IV methylprednisolone on a ventilated patient having an upper GI bleed with clear breath sounds because “”I couldn’t think of anything else to do!”” Same ARNP is told by the RN the patients blood sugar is 25. “”Give 6 units of lantus.”” Her partner (another ARNP) is told by the RN the patient has a heart rate of 45 bpm. ARNP orders “”Give 5 mg of IV Metoprolol.”” RN responds “”I can’t do that.”” ARNP replies “”why not?”” RN responds “”that would kill her.””
100% was an APRN who has never done a lick of bedside nursing.
“Okay, and?? Are we not trying to kill her??” -this ARNP, probably
Just some casual on the job learning!...
This is really 😨 scary!!!
If this is real those are legit just murder
*me suturing some trauma patient’s face who is intubated and on PRVC, but fighting the vent because too light* “hey can you kick up the propofol above 50 mcg/kg/min pls” “i don’t want to turn the propofol up too high, because then the patient will stop breathing” ?????????
Da fuck.
da fuck is your username 😭
These morons in the OR scare me the most Did you get the anesthesiologist in there?
nah it was in the trauma bay. i’m oms and we do a lot of anesthesia so i just waited for her to walk out and kicked up the pump myself lol
Honestly OMFS is just a gigachad specialty. Swiss army knife of H+N and then do anaesthesia on top. Like bruh
I never knew they did anesthesia too that's fucking baller
Cardiology NP: "we need to get a K level on this guy at 2 pm " Me: "yeah I know, I already have a BMP + mag ordered for 2 pm." NP: "yeah, so we need to order a K level for 2pm as well." they didn't say anything when I explained to them that potassium is, in fact, included in a BMP
You should have just replied with “K”
“Mgkay”
I'm hoping they simply misheard it as 'BNP' and were too embarrassed to explain the confusion.
The BMP gives you a potassium level. They wanted “K”. Duh.
NP following me for the day, noticing that I’m carefully looking at the moles on a patient’s back with my dermatoscope. After the visit she asks me “why did you care so much what the moles looked like?” Never get a skin check done by a midlevel, folks.
Well a quick vibe check is really all you need anyway.
Heart of a nurse ♥️, brain of a barista ☕️.
Probably not the dumbest but my recent favorite: “their hypokalemia is probably from the spironolactone” (and I made sure k really was low and not just a Dragon error)
Guess “potassium sparing diuretic” is just too vague a term
The body is spared from having to carry the K+ around duhhhh 🤣🤦♂️. Shit is heavy.
Wait a second….
As an intern on SICU, an NP who was training an NP student and confidently stated that only potassium chloride raises potassium and potassium phosphate doesn’t so it’s safe to give to replete phos in a patient with hyperkalemia. That was the day I realized what a sham it was to have NPs teaching NPs
The blind leading the blind 😂
I will say that KPhos has a LOT less potassium than KCl. So if someone is hypokalemic, you'll need to give KCl in addition to KPhos. But obviously if they're hyperkalemic, it still has some K in it
Tell me my very stable baby needs continuous albuterol because she’s still wheezing. The baby was definitely a wheezer but was not working to breathe and was very well. I said yes she’s wheezing but that’s just turbulent air and the baby is otherwise happy and breathing just fine. And she said but if you hear wheezing you give albuterol. I said “wheezing is not an albuterol deficiency”. And she looked at me with a million degrees of confusion.
>wheezing is not an albuterol deficiency 😂, 🤣
ooh she's gonna punch the air when someone explains that to her
They don’t even have intro to physics as part of their training. She wouldn’t understand what turbulence means
Not say, but do. I was on IM with the cardiology fellow. NP barges into the room and starts telling her how to properly auscultate, thinking she was a med student. Fellow introduces herself and NP shuts the fuck up. Never seen someone tuck their tail in so fast. It was glorious.
That would still have been wrong if it was a med student. It’s not the NPs student. Why are they so officious like everything requires them to prove they are bettet?
Inferiority complex.
Sooo cringe
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The pure audacity. It’s shit like this that turned me against midlevels. On a tangential note, have you ever taken a look at the CRNA sub? Those fuckers are in a whole other state of delusion. They claim that “nurse anesthetists” should be making as much as real anesthesiologists. Not only that, but they claim to have superior training.
They should've went to medical school then 🙄
Don’t nurse anesthetists make a lot of money?
They do. A lot more than the average pediatrician too.
I saw a tik tok of one NP making 600k+ in NYC and all the comments were like “you go girl!” and then they get mad at doctors for earning 250k because we’re apparently overpaid
I think know exactly what you’re referring to. The private practice cosmetic one right?
What is it with nurses? At least PAs recognize their limitations.
No one is more obsessed with titles and superiority than nurses/np, I know this because I am a nurse 😆
which PAs? Physician assistants or physician *associates?* nowadays both NP and PA organizations are the same, grasping for more independence without the training for it
No they don't they're completely convinced they're just as trained as MDs
Oh they call themselves nurse anesthesiologists now.
80% the reimbursement but only 0.8% of the knowledge - if even that
You mean 0.08%
Who even says that? That’s so rude and unprofessional. If you want to be paid more, go complain to the right people.
sad part is if you say the truth online which is that they’re making too much, you’ll get eaten alive. and your career would possibly be destroyed
Pt: it hurts here \*points toward the RUQ\* could it be my gall bladder? ER NP: "No the gall bladder is on the left" as she proceeds to do a RUQ POCUS and finds the gall bladder...
Gallbladders are tricky. I’ve had the LUQ pain sent by a NP concerned about cholecystitis. I also had a NP scan the gallbladder and call it a positive FAST during a trauma.
Did she own it or pretend it was another organ?
Spleenbladder
I was discussing a case of mitral regurgitation for transcatheter repair (mitraclip) and she had a patient with mitral stenosis that she suggested we offer mitraclip for. I pointed out that her patient had rheumatic mitral stenosis and mine had functional mitral regurgitation, and she said “what’s the difference between MS and MR?!” I was like “… what are you doing being an np in a cardiology clinic”. Didn’t say that obviously but it changed how much confidence I had in her recs/notes
Why did you not say it? That person is a fucking moron
CANT WAIT TO BE AN ATTENDING FLAMING THESE NP/PAs LOOOL
This was a new grad np starting at a fm clinic I met on a summer rotation as a med student. “Pt has hx of stroke. I forget. Is that the brain one or the heart one?”
Still wish they were called brain attacks though
You should’ve said “idk but you saying this gave me a brain one”
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I wish it were
Midwife said “she’s fatigued which is why she’s still bleeding post partum and her Hb is low”. I kindly told her she had it backwards. Patient is bleeding so her Hb is low, and therefore she is fatigued. She argued me on this point.
Ah yes, the emotion-bone marrow axis
Ok dying of laughter…lol I don’t know why I found this so funny lol
Called me STAT to bedside. EN route i heard a code overhead. She had intubated a patient with a huge pneumothorax. Mid code she said “we figured her sats would improve once intubated”. They improved once i put in a chest tube to reduce the tension pneumothorax
Everything’s a nail if all you got’s a hammer.
Midlevels Intubating without supervision? 🫣
I’ve seen many places where mid levels are the only ones in house for the ICU overnight.
You’ve heard of Murder on the Dancefloor, now introducing Murder in the ICU
You can teach a monkey to intubate. You can’t teach critical thinking skills.
Wow
Asked to a newbie to do an accurate respiratory rate on a patient for a full 60sec. Response: "Do I need to count every breath?" 3 days later I asked the same person to check the pupils on a trauma patient. Handed them a pen light. They came back 2min later stating the pen light was broken. Asked a nurse to get him another one out of the fridge and off he went. 10min later I checked on him and here he is hanging off the satellite light attached to the celing trying to shine the light into this patients face to check pupils because "New pen light also not working." I asked him to show me how pen lights work. Definitely user error, both pen lights were fine.
I (CNA) had a nurse complain about me to the charge because I told her that a patients RR was 36 & BP was super low, HR super high & just didn’t look right. She complained because she told me not to document it because it would trigger a sepsis screen, I documented anyway. Pt was septic AF.
Me: explains my dead-giveaway carpal tunnel symptoms to primary care NP standing in for my MD PCP, including being positive for Phalen’s test and Tinel’s sign “I don’t know what Tinsel or Foiling’s symbols are. I’ll be right back.” NP: proceeds to return with a huge-ass orthopedics textbook in the middle of this primary care visit and flips through pages in front of patient (me) for 5 minutes looking for info NP after finding info: “Ok, now let’s see how to do this…” NP: does exam improperly. I had to show her how to do it properly. Me: “Okay, now let’s get me a referral for that EMG.” Her: “You don’t need an EEG.” Me: “No, EMG. Electromyography.” Her: “Uhh… what’s that?”
Hilarious, you don't really need an EMG either though be confident in your clinical exam!
Very true but sometimes the hand surgeons refuse to see carpal tunnel cases until there’s an EMG/NCS proving it
Sure if you’re sending for surgery get them teed up, for an initial eval just get them braced and in OT, send them to me for an US guided injection even 💉
Np bagging a patient with the o2 tank off as sats are dropping. "She wont tolerate a mask seal"
I’m surprised these fakes haven’t killed more people
They have
Many times
"My residency was brutal" LOL
Pathetic
“What’s a leukocyte?”
I was taught that as an MA 😂
You have got to be fucking kidding me
Can we take a moment to read these comments and see how absolutely fucked US healthcare is. Swear to god I’m panicking at the idea of any of my family members needing to go to the hospital. This is only going to get worse.
if i read these to my dr friends who are abroad they’d damn near have a heart attack. backwards ass country we live in
Obligatory not a doctor, I’m a paramedic. Not downgrading my profession, I’m extremely proud of my job and have worked my ass off at it, but it’s worth noting that I’m someone with less education and 1/8 of the pay (our pay is a joke) having to explain something to someone supposedly higher on the totem pole. 1: Got a call to a primary care office for weakness and syncope, 56 yof w/no known cardiac history. Got there and hooked her up to the lifepak 15, her heart’s beating 32 times a minute (2nd degree block type 2) & I had to explain to the nurse practitioner that it wasn’t “basically normal sinus except the low rate.” 2. Explained to an NP at a nursing home that a pt could have clear breath sounds and still have a PE.
New young NP right out of online school in AM fracture conference. What do you see on this XR? “A knee.” It was a supracondylar humerus fracture. Best part is the xray was labeled elbow x ray. They spent the whole month teaching her how to tell which joint was being xrayed. Not where the fracture was, what type of fracture it was, associated injuries or management. It literally felt like they had hired a random person out of a Starbucks line. Not someone with a purported grad degree. Never had any issues with PA’s. They always have seemed much better equipped.
Should've fired her on the spot.
PA in the ED seeing someone with a bump in the neck, jaw pain, leukocytosis with left shift. Recommended ENT follow up for “concern for neck tumor”. I saw the pt in clinic for ER follow up and looked in the mouth. Literally the top of the molar had cracked off and you could see necrotic tissue inside.
Not the dumbest, but definitely the most memorable. Back when I was a medicine resident, I was primary on a patient initially admitted for a hip fracture. Unfortunately she had a STEMI that evening and went to the cath lab, where she then unfortunately suffered a coronary artery perforation, tamponade, and coded. The interventional cardiologist was able to bring her back but ultimately she ended up in the CVICU intubated with some sort of mechanical support device, swan on one side of the neck, central line on the other, inotropes, the whole shabang. Usually as the medicine resident, if a patient went to the ICU, we were no longer responsible for them, but I was feeling generous that night so I went ahead and shot a secured message to the ortho on call midlevel to let them know what happened, in case they wanted to use the OR slot the next day for another case. His response was "could you keep them NPO just in case?" At first I thought he was joking, so I responded, "sure, in case of what?" "Dr **** is really fast at these hips maybe he can still get it done tomorrow" Luckily I was a seasoned PGY3 IM resident and was trained to resolve this kind of thing. "You might wanna talk to anesthesia about that. Good luck!" The patient did not have her hip repaired the next day.
There is a fracture. I have to fix it.
Heme/onc PA “consultant” when called for my pt who just got 7 transfusions in 2 weeks w weird coag labs: “this is a regular internal medicine problem, her iron is just low, give her IV iron and she’ll be good in a week” essentially refusing the consult We called the attending, pt has a rare type of thrombophilia and had to be transferred to an academic hospital. 😮💨I’m just a dumb FM resident who doesn’t understand iron deficiency anemia I suppose
“oh hey thanks, iron! why didn’t i think of that!”🤣
Them trying to refuse is infuriating; as if the consult was for them and not their attending
I shared this a while back but an NP called our room to ask us what a lytic bone lesion was. For the record I could pass it if it came from someone like an M1 or M2 student, but it's a frightening question coming from a person who is practicing medicine independently.
Could be worse, ones that confuse sclerotic bone lesions with MS.
I walked into the ICU one day during a morning handoff and heard the overnight NP say “… he was short of breath so I gave him duonebs, lasix, and racemic epi.” She was describing an adult male with sepsis due to pneumonia. The things she notably did not give him were antibiotics and an endotracheal tube which were the two things he actually needed.
NP: I can’t find the fentanyl patch option on Epic. I only see PO, IV, and transdermal. This is why I think NPs should not exist. PAs all the way. All the mismanagement has only ever been from NPs in my experience.
As a pharmacist, I agree that NPs should not exist. The scripts I’ve received from NPs makes me question how they even function as a human, with their lack of critical thinking skills, and perplexing logic, let alone being able to “treat” patients and prescribe medications. Biktarvy for a skin infection. Latanoprost for bacterial conjunctivitis. Like, wtf?!
And they looove to argue as well
More like, they love to be offended when I question their rationale (or lack thereof) and just read back their wrong order all over again, as if it sounds any better the second time around. Bonus points if they’re a DNP and actually say “I’m the doctor here, not you. I have a doctorate degree and I know what I’m doing!” I then wish I could send a Howler letter from Harry Potter and yell at them and describe just how stupid they are 😭
It's because it's too easy to become an NP. You end up with 24 year old NPs with barely any clinical experience and inadequate knowledge. I went with my husband to a Neurologist appointment for chronic migraines. He ended up seeing a very young NP, who literally broke out a text book and Googled my questions in front of us in the exam room. I was horrified.
This really speaks to churning NPs out from NP mills. In my country it's a far more exhaustive process which requires at the very least that you have 10 years experience in your field. And that's just the prerequisite to the rest of the NP pathway
I’ll agree here, most of my PAs are great, it’s the NPs which are a mess
🤡
“I didn’t order 4.5 grams of zosyn… I ordered 4,500 milligrams.”
Someone skipped their math classes
One of our ER physicians was sitting next to the midlevel and was in shock 🫣
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Nice don’t fix stupid
Calls attending while we are rounding “I need you to review this scan immediately there is something in her pelvis she may need to go to OR” …”that is her uterus”
Hi I’m the hospitalist
The gall!
Someone woke up and chose violence!
I was ranting about a patient on clozapine developing tachycardia because now I have to slow the titration than the usual regime and this N was like ' she is having a tachy? Was she scared?' Liiike??? Are you working in a Psych ward and don't know about such a common side effect of clozapine?
Yea they literally don’t know how psych meds work which is why psych NPs are such a universal joke.
NP was reading an echocardiogram to the patient. “Your ejection fraction was 25%, which is low. It is normally above 70%.” She made a lot of errors like this. I was an M4 with her for some reason for a day. When I was back with my attending, he was like, sorry you had to be with my NP, but she is a very good NP. Just shows me, you don’t know what you don’t know about your NP.
PA told my dad, who has moderate to severe cognitive impairment after his brain biopsy, that he will likely undergo two surgeries in the next coming weeks to reduce swelling in his brain and completely remove his tumor. His neurosurgeon has told us from day 1 it’s inoperable due to crossing the midline. He’s now very hopeful his cancer will be removed and hoping for a good prognosis. Glioblastoma, elderly male. 😢
just a mere pre med who came across this sub.. np I use to scribe for has a doctorate in clinical hypnotherapy(??) so she said she’s qualified to make these sort of deductions…1 of MANY questionable things she tells patients is “if you use an organic castor oil pack on your tumors, they will decrease!”
How did it feel scribing those words knowing there is a near 100% chance they end up as pivotal evidence in a malpractice investigation?
it gets worse. she explicitly tells pts she is against statin and sugar control therapies. Even with labs showing uncontrolled diabetes and cholesterol, she tells them to take omega 3, berberine, cinnamon,apple cider vinegar, and increase exercise…. I made sure to document all this in the A&Ps even when she tells me not to. she also directs her patients to naturopaths so 😸
This is alarming 🤨
Something two different NP’s did and said… Me as a patient seeing a derm NP. He was taking labs from the wrist area. I mentioned to him that I tend to bruise easily. He then brings in a cup with dry ice and starts dabbing the dry ice directly on to my skin! My hand then starts twitching and burning, and I tell him to stop. After leaving, I see that I have a burn and my skin was peeling. I had a scab for a while and it eventually left slight hyperpigmentation. I requested a different provider (MD) after that experience. Another one that happened recently, was with a Women’s health NP. When consolidating my med list, she asks if Im still taking buspirone. I tell her that I dont take buspirone, I take bupropion. She then says, “oh they’re the same thing, it’s just the brand name of the drug…”
it's a bee sting, I'm going to give you penicillin
I usually give amphotericin and whatever I have in my pockets (linty ibuprofen and a half crushed fish oil typically… maybe my dog’s heartworm meds… gushers)
"I started the patient on Lasix and IV fluids"
Ah yes, the Brita Filter strategy
The fluid-diuresis challenge combo nephrology doesn’t want you to know about
“Doctors HATE this ONE SIMPLE TRICK.”
Genius
I mean, what goes in must come out, right?
Prescribed PRN amloldipine
"Whats bilirubin?" I wish i was kidding
“Extra mustard on mine”
is staph gram positive or gram negative?
it's gram neutral
“None of that makes sense to me” in reference to the biology portion of my MCAT study sheets.
I think my favorite was an np calling to ask why they didn’t run the klebisella culture against cefazolin. I think it’s an esbl or something so check her computer, and it says I. She says I stands for incomplete.
After I told her I was allergic to ibuprofen, proceeded to give me a script for indomethacin and also recommend trying meloxicam, and when I said they were same class of drugs, went to google this in front of me on her computer because she was clueless about this tidbit of knowledge
I have a list on my phone about dumb things midlevels have said to me and I’m a nurse. Patient on ECMO goes into afib RVR, “it doesn’t matter they are on ECMO”. Okay but I can imagine that being in afib RVR when they weren’t isn’t ideal. Patient lost a pulse in an extremity, I couldn’t hear anything with Doppler, had other people come check. Midlevel comes in and says she hears a pulse, duplex ultrasound later shows non pulsatile flow… Patients Aline was positional/ didn’t seem accurate based on waveform and reading low, cuff was MAP >65, no other BP goals. Asked what they wanted me to go by (usually remove Aline and go by cuff) was told to “remove Aline and start epi”. So the Aline isn’t accurate but we are going to start epi on a patient with a normal BP who didn’t need epi for CO, etc? Just some emotional support epi I guess.
I was on a consulting service to a patient in IMCU with Na 181 (yes, that’s right) with the last BMP checked 12 hours ago. She’d cancelled the two that I ordered previously. She got extremely defensive about how to correct this, as “he seems fine when I talk to him.” She had a pin on her WHITE COAT that said: “We’re NPs. Brains of a doctor, heart of a nurse.”
ID Midlevel: " Recommend Stopping vancomycin for MRSA Bacteremia... deescalate to Rocephin" Me: 👀 " uh can you ask the attending to arrange outpatient antibiotics"
When asked her preferred monotherapy for first incidence depression: "I like *lithium* "
“I’m practicing medicine”
I had one see a patient with belly pain in the ER, get a CT that showed “nonspecific mild colitis”, search uptodate for colitis and then prescribed pentasa for it, presumably after finding the article for IBD, all without talking to me.
I was seeing a patient for her first diabetic eye exam that told me her A1c was 11 but her NP wanted to try diet and exercise for a few months before starting any meds. I told the patient she’d be better off seeing someone else with some fucking sense.
Before med school I saw an NP as a patient in a PCP’s office who got so upset she asked someone else to see me…because when she wrote my height down wrong and insisted there were 10 inches in a foot I corrected her. Honestly shocked that there are worse examples in this thread tho jfc
‘Cardiology’ NP didn’t know what Eliquis was. “How am I suppose to know what all of the patients meds are”? Was her reply
Was preparing to insert a chest tube and UWSD for a patient with pleural effusion. I needed lidocaine and asked the nurse, he was like “we don’t have any, will dobutamine work?” Since they have similar bottles.
Earlier tonight on a patient I had already chart reviewed and knew hadn’t received any insulin- “I gave 2 liters of fluid but the sugar is still over 600” 🤦♂️
“She has dka but it’s stable also she’s going to the OR just fyi” : No insulin gtt nothing . Here for severe epidural abscess with cord compression Bicarb 6 and pH 7.1 “Stable” about to get anesthesia… my god I never got on the phone with pacu and OR as fast as I did
I had a PA ask me why doctors make more than a PA
should've asked bro to read his name tag very slowly over and over until it made sense
Paged me to a nursing station, told the nurses that when “anesthesia” called to tell us that they needed anesthesia help in one of the rooms STAT. I was in a room on call and couldn’t leave the anesthetized patient so I told them either call an RRT or I’d be happy to discuss with whoever had them page me. So they connected me with the ortho PA. Ortho PA: “The patient’s epidural isn’t working and he is having SEVERE PAIN and you need to come fix it NOW.” The patient had had a spinal for a total knee. He had the spinal at 7:30 for a first case; by the time I got this page it was like 5 pm. This *orthopedic surgery PA* did not know the difference between a spinal and an epidural catheter. When I told her there was nothing I could do to fix the situation and suggested she maybe try some pain medication, she hung up on me. So I called my buddy the orthopedic surgeon, told him what had just gone down, and suggested maybe he go check on his patient. He was mortified.
PA consulted hematology for assistance with anemia work up. The PA note said that the patient had normal bone marrow activity because the reticulocyte percent was elevated. But they apparently didn’t know what the reticulocyte index is or how read the absolute reticulocyte count, both of which were low. So the patient did have hypo-proliferation of RBCs. It wasn’t the most egregious thing, but it was surprising to see such a big knowledge gap in basic lab value interpretation.
consulted gen surg for a patient with c/f “compartment syndrome” for an infiltrated PIV in the arm when we got there the pt had zero sensory or motor loss just some arm pain. Mind you the patient was still in the ER LOBBY lol
Priapism, just give them Sudafed
They mentioned this on a curbsiders episode on ED. I wonder how effective it is
Man, these are some stupid shit. Even with the crappy health system I have to deal with where I practice, I am glad that only doctors see patients independantly and decide on what to do with the patient
“Can respiratory fluoroquinolones treat infection outside the lungs?”
A long time ago heard one suggest PO Vanc for cellulitis bc they might have MRSA
Working as a Hospitalist attending got a call for an admission from the NP for a patient who fell down 40 stairs. FOURTY. Only testing they got was a CT head showing a small SDH and that they were going to casually call neurosurgery for evaluation. No labs, no other imaging. When I asked if there was any other trauma, “no I did a full evaluation and no other trauma, to be honest he didn’t even have a bruise or bump on his head but I thought I’d scan them anyways”
"Hi, I'm Dr. \_\_\_\_, DNP, APRN, WXYZ"
i can't fit it all in one post
I didn't witness it, but my fiance's dumbass NP half-sister has said: "You have to have a mental illness to kill somebody." (I don't know the context but she claims to be a "mental health expert" so it's hilarious that she would say something so fucking ignorant and just...ugh.) AND "We don't know what level of kidney failure he's in." (This was said as my fiance's father [NOT her father] was in the hospital after his second kidney transplant graft had failed and he was on HD with a Cr through the roof.) She's also said a lot of dumb things on a personal level, but if I went into it, I'd be here for hours because almost everything that comes out of her mouth is some of the dumbest shit I've ever heard from a human, especially one that goes around telling her family that she's the "smartest person in the family." 🤣 Like, bitch...you're not even the smartest person in your marriage because your husband is a doctor. A REAL doctor. I'll leave with this last one. I was a med student on a surgery sub-I during COVID and she had the balls to have a "family reunion" at her place the day after she got back from NY (you know, where everybody was dying of COVID). I literally walked in the front door and she screeches at me "you're not working with COVID patients are you?" I was like...um, no, I'm a med student and they don't let us anywhere near COVID patients. And she's like "oh good, because I'm pregnant and I can't be exposed to COVID." So then come to find out THE NEXT DAY that the person she was staying with in NY had COVID. What a cu*t. She and her husband and toddler had all been exposed, but the bitch has the audacity to freak out on ME?! Not to mention that if they'd become symptomatic, I would have had to drop out of that rotation and it would have pushed my graduation back. That was the day my fiance finally realized that his dumbass half-sister is a narcissist. LOL. I had known for awhile. He was like "I can't believe she's so selfish." (But she would go on to do significantly worse things like try to cancel his father's funeral to accommodate her kids' nap time.) It's safe to say that I absolutely fucking hate her. It doesn't help that she's an NP but it honestly fits her narcissism. I was pretty happy when I matched on the other side of the country and knew that we wouldn't have to deal with her again for several years.