Tuesday, June 24, 2008

A Day In The Life Of A Family Nurse Practitioner

Braden over at 20 out of 10 has requested that I submit a post about what a nurse practitioner does on a daily basis. I will attempt to break down my average day, but keep in mind the location that I am working in is a new branch of a Federally Qualified Health Clinic that is just starting over the last 6 months, so it isn't a typical regimen for a fully loaded practice.

08:15- Come into office. Check phone and desk for messages. Check the labs that came across from the day before, and write out instructions on lab letters to be sent back to the patients. Draw labs on patients that my nurse can't "hit".

08:30- First patient of the day. (new pt visit 30-45 minutes) Complete history, including medical, surgical, and family history. Head to toe review of systems. Head to toe physical exam. Address any new symptoms or chronic symptoms. Refill or write any prescriptions needed. Educate about all disease processes and about what each prescription is for. Review if any preventative care has been completed such as mammogram, Pap, colonoscopy, bone density, etc. Request record release so that I can obtain prior records to review. Ask is there is anything else that they wanted to ask me. Explain our "open access scheduling (same day) to set up follow up. Off they go!

09:15- Back to the desk to do paperwork, write referrals, review records, check messages, call back pts to answer questions.

09:30-Next visit (established 15 minutes)- Medication review, ask if any changes in ROS since last visit. Address new problem or review established problems. Review any test results since last visit. Reinforce education about disease processes.

09:45- See 09:15 slot.. This process happens throughout the morning until 12:00 when we break for lunch. I usually eat in 30 minutes (left over from the hospital days- eat fast whatever is available). Use the rest of the lunch break to do any of the never ending paperwork.. I REALLY HATE THIS PART!

From 1:00-4:15 see patients throughout day varying from pediatrics to geriatrics. I also see minor emergencies such as I&D, suturing, stapling etc. Refer to Emergency Department any cases needing such expertise (You're up all you emergency room nurses! Keep my patients safe and healthy!) We often get cases as a walk in basis that are serious because patients wait too long before being seen. That's a story for the next edition..

04:15-05:00- Email or call my collaborating MD to discuss any difficult cases dealt with during the day. Return other physician phone calls if arise. Read through consultation notes received. Discuss the cases encountered during day with my nurse to encourage her to expand her knowledge base as well as pick her brain when needed.

That's pretty much a day in the life of a Family Nurse Practitioner. I love my job and really enjoy building relationships with my patients and watching them respond to the treatments I recommend. I am taking care of entire families now and that's what it's all about!




26 comments:

  1. Anonymous9:37 AM

    thank you very much.
    I had to do a project on this job, and you really saved me with this.

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  2. Anonymous10:52 PM

    thank you for sharing about your day! I'm looking forward to starting an FNP program this fall =)

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  3. Anonymous12:42 AM

    Thank you for taking the time to share. I have been contemplating going back to school for a while now but don't really now what the job would be like once I got there. Thanks for helping seperate the fantasy from reality.
    J

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  4. Anonymous 1, Glad to be of help. Hope you did well on your assignment.

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  5. Anonymous 2, I'm glad that you are starting your program in the Fall! I hope that you have a great program to attend and learn a lot.

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  6. J, It's important to talk to as many real nurse practitioners that you can so that you will avoid misunderstandings as a new hire.

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  7. Anonymous1:49 PM

    Hi, Thanks for this post! It's good to hear a health care professional say that caring for families is what its all about!
    I would like your insight:
    I am 25, have recently completed a Master of Social Work degree (also hold a BSW) but strongly interested in pursuing a career in nursing after working in two medical settings as a social work intern and finding that I crave more direct patient contact. I am also passionate about health education & prevention. I am just not sure which route would be the best way into nursing. In my state I have the following options:
    --entry level MSN (become an RN in the first year, 2nd yr study focus on clinical nurse leadership)
    --Accelerated 15 month BSN (plus about 2-3 semesters of pre-reqs)
    --Second degree BSN (pre-req+nursing courses,3 years)
    --2 year Associate's Degree in Nursing Program
    --A nearby university in another state, Vanderbilt offers an entry level MSN NP program (3 yrs with pre-reqs).
    Which program would you choose if you were in my situation. . .btw I am a single mother of a 7 year and need to start working ASAP--but not at the expense of sacrificing a quality education.

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  8. Anonymous, it depends on what type of nursing you are looking to become involved with. If you are looking to diagnose and treat patients, the NP route. If you want to work in a hospital setting or office setting in a fast time frame, do the RN route only and then go back to school later if you decide that you want to further your degree. The entry level MSN that focuses on clinical leadership means management areas usually I think.. Hope you figure it out and welcome to the nursing field when you finish!

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  9. Anonymous2:20 PM

    how much money do you make an hourrrrrr?

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  10. Anonymous, I just got a raise last year and I make approx. 40.00 an hour. I can't give an exact amount due to my contract. I made just over 20.00 an hour at the hospital as a nurse on the floor. I don't actually work a 40 hour week when you take into consideration the amount of take home work that I do and the amount of after hours call backs. A doctor makes somewhere around 60-75 dollars an hour I guess? Hope this helps..

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  11. Anonymous10:15 AM

    Anomymous,HI I AM STUDENT CURRNTLY ENROLLED IN TCC/PRE-NURSING program. I wanted to transfer over to NSU and recieve my BSN. I know the nursing field is a great field with many opportunities and advancement.I want to become a nurse practitoner as well.I was wondering if I would have to gain experience before working as a nurse practitoner straight from college.

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  12. Anonymous, you will have experience as a BSN as you do clinicals. I highly recommend that you work in the hospital setting as a nurse regardless of what degree before you attempt to work as a NP in an office or hospital setting. Some degrees are letting people with a non nursing degree fast track into NP programs but I'm not sure that the students get enough experience to be beneficial to themselves and their patients. Hope this helps!

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  13. Anonymous8:56 PM

    Hello,
    I don't know if you are still answering this post (it was put up awhile ago!), but I am looking into accelerated NP programs and having a hard time deciding. The whole story is that I was accepted to medical school this year, and am not sure if I want the long training and lifestlye of a physician. Being a NP would allow me to still do the work I am so interested in - patient care - with about 7 less years of training (during which time I'd like to start a family, etc.,which doesn't seem to mesh too well with 80 hour weeks in residency). If you could go back and do it again, would you still choose to become a NP? Do you think it is a good career for some one who is family oriented?

    Thank you!

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  14. Yes, I am still answering posts! To do it all over again, I would still pick the ARNP route. Less schooling and more family time for sure. Less headaches about whether to do private practice vs starting your own business with all of the overhead. The money is less but so are the student loans.. 250,000 vs about 83,000.. I love the flexibility of being a family NP. I can change areas from pediatrics to geriatrics without having to do another round of schooling unless I want to pursue another kind of NP such as midwife.. I support both MD and NP so it is totally up to you as to what you want to do. Follow your true calling and you won't go wrong!

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  15. Anonymous11:55 PM

    Hello,
    Out of curiosity, what state are you in? I ask because I know that some states are more restrictive of NPs than others.

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  16. I am in North Florida. What state are you in?

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  17. Anonymous8:57 PM

    Hello,

    I just came across your posting and it has been very helpful and a really good read. Once again, I'm not sure if you're still answering posts but I am debating between becoming a nurse practitioner and a physician assistant. I have been struggling with the decision for quite some time because I am unsure about the lifestyle of being a PA. All I am interested in is patient care and time for family. I know you're a nurse, but do you have any suggestions for someone like me deciding between the two?

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  18. The decision between the two boils down to autonomy. Right now PAs are more restricted and cannot have total independent practice any state that I know of. Right now 13 states have given NPs those rights. We both do the exact same things as providers. Taking care of patients is the ultimate goal so any way you get here is fine as long as you do!

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  19. Such a helpful post! Thank You! A couple of questions, understand if you don't want to answer them in such a public forum.

    How Long were you on the floor? How helpful was that time in your transition to your current practice?

    About how much does malpractice insurance run you?

    What parts of the job do you find frustrating?

    What was the 1st year of practice like, I would imagine that your employers just let you go out there and hit the ground running or was there some sort of orientation period?

    Do you have to take call?

    Are most MD's and DO's amenable to a constructive working
    relationship or is there push back?

    What would you say are the advantages (outside of the more flexible training) of being and NP over a MD or DO?

    I know that I have little to no interest in working in a hospital as an NP, in general must one " do their time" in the hospital as an NP?

    In your opinion the demand for NP's strong enough to warrant new people entering the field?

    About how may patients do you see on an average day?

    If you wanted to work more and see more patients is that an option?

    Wow, I guess that was a lot of questions. any thoughts you could give would be appreciated! Thanks again for your time!

    Colin

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    Replies
    1. Wow! Yes, so many questions. Many of which I wish that I had the answer to before I got started in the field. I will take a few at the time and answer them in the next few blog posts. I hope that you continue to stay tuned for the answers.

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  20. Thank You for the Post it is Very Helpful! I have a bunch of questions to ask would appreciate any inside you would be willing to give.

    About How many patients do you see a day?

    Other that the flexibility in training what do you feel is the major advantage of NP over MD or DO?

    Do you feel that your relationships with MD's and DO's are constructive?

    What kind of support system (if any) do you have your 1st year of practice? (I know that the answer to this and many questions is highly dependent on where you are working)

    What is the publics perception of NP's in Florida (The reason I asked is that I was shocked to find when I moved to NC that it seems like most people outside if healthcare have no Idea what an NP is or does it is a VERY PA heavy state.

    How much does malpractice insurance run you?

    I have read some say that NEW grad NP salaries are dropping while experienced NP's salaries are growing stagnant is this what you have seen?

    How long were you on "the floor" as an RN and how was that experience useful in your current role?

    Do NP's have to do time in the hospital (outside of clinicals) or can one go straight into a clinic setting?

    Once again thank you for he post would love to hear any thoughts you could offer

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  21. Thank's so much! Sorry I did not mean to post twice! I thought I had lost the 1st one and tried to rewrite it from memory.

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  22. Anonymous11:31 PM

    This comment has been removed by a blog administrator.

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  23. Anonymous10:39 PM

    Hello,

    I'm not sure if you are still answering posts or questions but I did want to ask you something. Right now I am in nursing school. I am half way through the program to become an RN. My original plan was to get my RN and then get my BSN while completing pre-med courses and apply to medical school. I have had a strong desire to become an emergency physician since I worked as a tech in the ER. However, I have a three year old daughter and a husband and I plan on having more children. I'm starting to think that maybe even though I want to be an ER physician, it might be better for my family if I went the FNP route. It would be half the amount of time in school not including the added residency of MD and much less of the cost. The thing I struggle with is that I am not sure I would be satisfied with this choice. I was thinking of talking with some NPs and MDs and see about shadowing some of each next summer to maybe help my decision. And I know that I ultimately have to make the decision but I was hoping for a little insight from a nurse practitioner. Do you have any thoughts you could share on this besides what you've already mentioned?

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  24. I always reply to legitimate comments! I am asked daily if I will ever go back and get my MD and I tell people no because I can do what I need to do for my patients without going back to school for another 8 years. I'm too old for that (45 now) and I don't have any issues taking care of my patients with my current degree. The company I work for treats me as an equal with the docs and I have a lot of autonomy in the practice. I know several NPs who work in the ER setting and love it. If you are trying to have a larger family, I would go the NP route and you can always decide to go to med school later if you feel like you still need to do the doctor route. The only things I can't do as a NP in Florida is write controls ( I call them in under my collaborating MD with discussion), I can't sign a death certificate( he does that if I need him to), I cannot technically Baker Act someone ( I call a police officer and they take care of it) and I can't write home health orders (doc cosigns what I want). I do everything else myself without having to ask permission to treat. I order my own testing, EKGs, diagnose and see my own panel of patients. 99% never have to lay eyes on my collaborating MD. I have WAY less malpractice insurance cost and my patients like that I take the time to educate them (comes from my nursing background). Follow some NPs and MDs and see how they work and you will find your way. Hope this helps!

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