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.