Reflection

Being a Nurse Practitioner isn't all warm and fuzzy at times... You are faced with decisions that affect not only a patient but their family and future. You give bad news and good news. You are a member of a team that sometimes doesn't always see eye to eye.  You must interact with other disciplines that may not understand your perspective.  You must overcome a Health care system that is is dire straights and have to try to give the best care to someone who can't afford being cared for.

In the past few years I often think why did I do this.   I come home exhausted from the constant days interactions with patients, families, staff and other disciplines.  I lose sight sometimes in my exhaustion of why I decided to be a Nurse Practitioner.  I need to stop sometimes and smell the roses.

In the past couple weeks I have tried hard to think what good things have come to me each day.  Each day I always come back to the same thing.  I touched someone's life today.. Some days I may have touched more than one life.

At the end of the day, I sift through the fury of activities and am able to see what impact I have on my patients' lives.  It gets harder everyday when the challenges of the system you work in overpower the goodness you do.

I am really trying hard to grasp this concept.  The challenges of the health care system has made it difficult for providers to remember why they really are there.  It suffocates you sometimes.  It infuriates you with the mound of charting, communication and justification of why we are there to begin with.

So I come back to the question...why did I become a Nurse Practitioner....to be challenged, to provide good care...to continuously learn and be the provider to I would want for myself.  It is hard to keep this perspective especially when patients don't understand the constraints you are under ...and the system you work in may not truly know what you do on a day to day basis....But the person that it really matters is to me....I know...I put the best foot forward...try to keep perspective...and always remember at the end of the day.....why I became a Nurse Practitioner....was it worth it ....Yes...I am a better person today then I was 18 years ago .... I have grown to learn more than I ever dreamed of....I have become a person that I thought I would never been able to be....I have become someone that someday a patient, a family member, a staff member or a peer will say...She was the best Nurse Practitioner I have ever met.

Challenges of the challenges

No one ever prepares you when you are in school of the challenges you may have ahead of you.  Some of the challenges are unknown.  You are given tools to assess both through questioning and physical exam. The next step you are taught to make differential diagnosis and plan appropriate diagnostics and interventions. Are we ever to prepared to face the  the emotional challenges of patient's ..their demons...their addictions and past emotional problems  that mold them into  persons that they themselves can't face or deal with.


My week was spent working with a patient only experiences through the year could possibly prepare you. I can read about substance abuse, PTSD, anxiety, depression...but when you deal with a patient who has physically caused harm through his own hand of use of IV drugs...you need to dig down deep into the overall experience you have in your possession..rid yourself of making assumptions


IV drug use ..skin popping..do you know they can cause infiltrating infection to you skin...do you know you can potentially cause life threatening infection ...loose you limbs and even death

But you come to me to help you....Time, energy and empathy go into deriding the dead and infected skin from your limbs....time, energy, comfort and empathy go to into providing pain meds and dressing changes to help wound healing after dead and infected skin have been removed surgically

You are given over and above the pain medications that are allowed by CDC requirements and you want more....

You know what the consequences are if you jeopardize your care...but you do  it anyway...Leave the  prior to skin grafting that would protect the exposed muscle and nerves that are left after the infected overlying skin is removed ....saying you are going to another facility who provides conscious sedation during wound care....you leave saying you won't use any drugs until you get to the hospital


I go over and above to seek out a plan that would be amenable to you...go over risks vs benefits of leaving at this point..knowing the lost of your limbs and even death are possible


You....deny drug seeking behavior....you leave ...and don't go straight to a hospital


You are out there with your demons and your addiction.....when do you get it and enough is enough

For all those who work with the patient's who are suffering addiction....you know what I am talking about....you think they get you and  you get them....but some just are ready.


Be patient....and be there when they are ready to make the change

It Has Been A Long Week

Do you ever have those weeks where the days seem to blur together and you find yourself at the end of the week and you don't know how you got there?  Well, if you haven't I can tell you about my week.  It was centered around one patient. How can one patient take up most of your time.  They literally occupy all the energy you have.  They find ways to make them you. I can't go into much detail...but I can tell you ,that as much as you want to help a patient, they may not see your help as beneficial. They may have perception that you are not what they need nor know what you are talking about.  They exert all of their energy into things that are making them sicker and preventing them from getting better. Despite your help and professional expertise and attempting to educate them differently...they are on a  different wave length....This wave length may be attached to deep seeded emotional issues that prevent them from seeing the realism of their real problems.  Their perception  of what will help them is what will hurt them.  Despite your efforts and attempts to see you care...they despise  you and make you the enemy. It saddens me that I can't fix this....It frustrates me I can't help them realize....I will never understand how mental illness can affect an individual to not making the right decisions. Despite their competence, they emotions, personality and behavior supersede their best  judgment and overcome their actions and decisions.
It is frustrating and beyond my understanding how this can be.
Being a Nurse Practitioner sometimes sees those who despite wanting help can't be helped because deep seeded problems that they have yet to face .

It Has Been Too Long

Wow...I have been away for a long time.  I started to read my blog this past week and thought...I really did a great job and I miss this.
Needless to say,  a lot has happened since I last wrote.  In summary, my Dad past away December 16th 2014...He was everyone's rock and hero....I was with him when he passed. He was on hospice on the inpatient unit I had worked....It has been difficult with his passing.. Mostly, my Mom has had a lot of emotional ups and downs.. She also has had some minor physical ailments....We are all trying hard to help in what ways we know.

Work has changed significantly. I am still working at the same place and same unit; however, the patient mix is different. We are now a SNF instead of Short term medical unit. We had to downsize one provider and many nurses and bed count.  It has been a challenge.  I am still not sure administration knows what we are...I try my best to remember my priority is the patient....and stay out of the politics.
VA has finally passed ruling of Full Practice Authority for Advanced Practice Nurses.  Our VA is slow on moving on this..but we will get there.  I am sure there will be challenges on the way.  Most immediate is educating others on what this means...
My Daughter relocated 4 years ago to Indianapolis from Maryland....she finally is back on the East coast living in Baltimore...It is a good feeling to know she is close by. Most importantly, she has achieved a goal she has set out for herself ....So very proud of her.
I am a great aunt x2...Nephew 3 years ago and niece this past January....We also had 2 weddings in our family ( my niece and a nephew 2 years ago). Another wedding for next year (another niece).
My husband and I will be celebrating our 25th Wedding anniversary in November...We have tentative plans to celebrate with a dinner with close friends and family.

I have been precepting a lot of Nurse Practitioner students.  When I first started doing this, I wasn't sure if I liked it or not.   It has been a full filling experience....It is exciting to see how they grow throughout their time with me. The downsize on my unit gets stagnant with patient experience and it may not benefit in the NP students' learning experience in the long run.  I have decided to take a break from this for a semester or two....then we will see where time takes me.

My career is slowly winding down... I do feel burnt out sometimes.  I feel I have lost the effort to learn and be challenged.  I am growing tired of fighting with those who don't understand what I and my fellow peers do on a day to day basis.  I find myself constantly refocusing on what matters...my patients.

I am looking at retiring in the next few years, but I feel I still can share my thoughts and experiences until then.  I really missed this and I hope I you will enjoy my thoughts and experiences through this blog.

Back In the Saddle

I am sorry I haven't written in a while but life got in the way ...Mostly family things. My Dad was really sick last year and was in and out of the hospital. He had problems with CHF and kidney failure. The doctors tried to keep him comfortable on a medication regime as long as possible. However, in September, this was no longer working and he succumbed to dialysis. It was touch in go at first. His body took a while to get use to dialysis. There was even a point where the hospice word came up. It was very difficult being the daughter and keeping the NP role that I possess out of this but I succeeded. He is doing much better now. His quality of life has improved tremendously. He is doing things now that he couldn't do before.

As far as my life as an NP...I keep rolling..today was one of those days that it started before I was ready with a patient in respiratory failure and running a code to get this patient in a better place than where he was....we got him there and his respiratory status improved tremendously....I still have the fire burning despite a lot of days wondering when I can retire...today was a good day.. made me realize I have a lot to offer.....I am going to end with this but before I go...I would love to hear from you all regarding NP's as Independent License Practitioners....what are your thoughts about this???

Let me know.....until the next time...which will be a lot sooner that the last time

The Geek years...

Ok so not only was I a geek to be a volunteen...I became more of a geek in high school...I was determined to do well in school so I could go on to be a nurse...Let me back up a little and tell you about my scholar skills prior to going to high school...As I mentioned before, I was shy and clumsy and some would say not have much common sense...I didn't apply myself in school as much as I should..My school career didn't really get a good jump start...My parents sent me to parochial school...Let me first preface by saying ..parochial schools are very good and one could get a very good education..however, in the 1960's the class size was was over 50 kids in a class. Each class had the kids sit in alphabetical order. There were no teacher aides. Nuns taught the majority of classes and there wasn't any room for individualizing student needs....So my parents sent me from 1st grad to 3rd grade...Oh and did I mention there wasn't any kindergarten when I was little. So...it was up to Mom to teach you what would normally learn in kidergarten...Already that put me at a disadvantage...so needless to say.....my parents finally got the jist that I wasn't really learning well and they decided to put me in public school in 4th grade....I was really behind in math,reading and spelling and struggled to keep up with the rest of my class. I managed to improve in my learning through grade school....middle school got better but still was average...then I had a revelation...I need to be more organized in my studies...I need to study every night...and I need to read and comprehend every assignment..... I was very disciplined in highschool...wanting to keep up with my studies I would study my notes everynight...Read and re read my reading assignment....I would even study on the weekends....I did try to expand beyond my studies and get involved with Marching band in high school...but I pretty much limited my social scene to Marching band in the fall and concentrate on my studies pretty much the rest of them time....well by junior year it paid off...I got inducted into the National Honor Society and was ranked 6th in a class of 400 kids....I was able to take advanced science classes in my junior and senior year to preprare me for my nursing curriculum in college....I will never forget my chemistry teacher..he was the best and I did really well in chemistry.....I got an A ...and when it was time to take college chemistry I...believe it or not it was a review of my high school chemistry class....all the kids in my college chemistry class were struggling and I was brezzing through it....Needless to say my social lfe sucked in high school...I was a geek...everyone knew who I was but didn't want me to be in their "in" group....I didn't go to any proms or dances or wild parties....I couldn't wait to graduate from high school...I did make an impression on the school nurse... She helped my apply for a couple lf scholarships...I did manage to get one for 3 years of college....Oh did I say college...yes .....when I declared to my parents I wanted to go to college and not a 3 year nursing school they looked at me as if I had 3 heads...This was something new...going to college to be a nurse... I think it was as early as 1972 when the first college prepared program was developed. I graduated high school in 1976. My parents didn't know much about the college route...but I made sure they quickly learned... I was accepted to 2 different colleges ( not many were around) and was so excited when I got accepted to West Chester State College.... this was going to be my ticket to being a nurse...Alleluha...

The Revelation

So I am getting a little sentimental in my old age and want to share as much possible with the younger generation to help them put into perspective how things have developed into what they are now. I would like to share my story and my life with all of you. I want start at the very beginning because I still want to keep the Nurse thing in my theme ...So I will start where it all began...when I realized I wanted to be a nurse. I never thought of being anything else but a nurse...I can't remember when or how this thought came into my mind. I can't remember any particular event that made me want to be a nurse...I think I was just born realizing I wanted to be a nurse...No one in my family had any job related to the health care field. As far back as I can think, I always rationalized and did things differently than the rest of my family. I was clumsy, absent minded and shy...Unlike my siblings who were atheletic, percise and spoke their mind. Since I made my mind up about wanting to be a nurse, I thought it would be a good idea to be a candystripper. The hospital where I volunteered called us Volunteens and we didn't wear the pin-stripped uniforms as one would thinks. We wore a yellow apron instead. We would record our volunteer hours and at the end of the year receive awards for the amount of hours we volunteered.. I remember my oldest brother jeering at me says,"why would you want to volunteer instead of working somewhere and making money instead?" I would always brush him off. I knew deep inside that this is what I wanted. Money was not what I was interested in, the exposure was most important. So I would go in every Saturday from 1-3 and do my duty as a Volunteen. I would report to the unit I was assigned to shyly asking the nurses what they would want me to do. They always saved the water pitchers for me. Now, you need to know that the water pitcher were metal. They had a metal tray and the glasses were real glass. So I was incharge of collecting all of the water pitchers,trays and glasses. Then I would take them to the kitchenette and wash them with them with dish soap and water. Refill with water and ice. Then make sure everyone got a clean water pitcher,tray and glass. My next chore was to pass out the mail, water flowers. I would also help make beds every once and awhile. Do you know what was different about making beds back then. They used rubbber pad under the pull sheet. Imagine how hot that was for the patient.
I would volunteer on Saturday afternoons during school year. During the summer, I would volunteer several 1/2 days during the week. The most exciting assignment one summer was volunteering in the Emergency room. My biggist job in the ER was washing and wrapping instruments to be sterilized. Yes, no disposable suture kits, etc. All re useable. Even there syringes were glass. I was also incharge of stipping the liters and washing /clean them down after a patient was discharged from the ER....washing off dried blood from the litter frames were the toughest. The ER doctor would call me in to watch him suture...I was devasted the one time when I almost fainted. The staff took care of me but I was so upset that this meant I would never be able to be a nurse.....the staff assured me that this didn't mean anything and I would certainly be able to pursue my career goals.
The other place I liked to volunteer was Maternity....I loved taking the babies back to the nursery after their Mothers fed them....I never really spent anytime in the labor room...but got really good at making beds in postpartum unit and watching the babies in the nursery.....
I did get a lot of exposure during these years as a volunteen...The experience definitely confirmed my desire to be a nurse......So the journey began .....the next step was to do good in school and take the right classes so I could be accepted in nursing school...