Thanks to Barbara Phillips for drawing my attention to this wonderful video! I hope that everyone will watch and learn just what we do for a living and understand that we are primary care providers who influence positive outcomes for patients.
Sunday, March 29, 2009
Thursday, March 19, 2009
Change of Shift Is Up At Emergiblog!
A huge turnout for this edition of Change of Shift. I sure hope that the next time I host I will actually receive some submissions instead of having to go ahunting myself. Enjoy this week's episode and please consider sending some submissions when it's my turn next!
Monday, March 16, 2009
Trust Is A Huge Responsibilty
I had a patient who came to me after having a stroke. His mood was being affected and his wife was having a hard time dealing with the damage (both emotional and physical). I put him on medication which evened him out and things have been going well.
Blood pressure controlled, taking his meds, coming in for follow ups and labs... Sounds great! Normally I would be singing his praises for finally getting the health care that he needs. So many of my patients have not seen a provider of any kind in years because of lack of funds or having had a bad experience with the last provider. (Note I'm saying provider, not doctor or NP, both can be equally bad.)
Enter the patient looking grey, pasty, and sweating followed by his wife and daughter. They were upset and worried and while the nurse was getting him set up for an EKG, I was getting a 18 gauge IV in his arm with saline and O2. I was asking him questions about location, intensity, exacerbating factors, shortness of breath etc and asked why he hadn't called an ambulance from home! His wife and daughter both piped up and said, "We tried to call. He wouldn't let us because he wanted to see you first."
The patient proceeded to tell me that he wanted to get my opinion on the matter because he trusted me. He said that if I told him that it was okay to go, he would but not until. I told him that yes, he needed to go into the hospital for evaluation and that he shouldn't have come to the office to ask my opinion because he could have died. Off he went by ambulance...
Well.. after the morphine was given in the ambulance, he got combative and a little belligerent. He got to the emergency room and after he settled down a bit asked "where the hell I was." The hospital told him that I didn't have admitting privileges and that I couldn't be the one to take care of him there. Wrong answer for him!
He checked himself out against medical advice and came to the office the next day.
Oh My God!!! I told him that he should have stayed in the hospital and been evaluated for his chest pain and reminded him that he could have finished having a heart attack and met his maker sooner than he wanted. He said that he knows that he should have stayed but he didn't trust anyone else but me to care for him. "No one listens to me like you do!"
I told him that I was humbled that he trusted me so much, but I didn't want to feel like I was responsible for his falling over dead for not seeking help from other providers. I told him that if he ever got into distress again, to call for an ambulance. He promised to do that in the future.
I told him goodbye and that I would see him after his cardiac evaluation.
"Okay Doc!", with a grin!
"You know that I am a nurse practitioner and that I will always remind you of that when you call me doc."
"I know, but you're MY doc anyway."
Sigh....
Blood pressure controlled, taking his meds, coming in for follow ups and labs... Sounds great! Normally I would be singing his praises for finally getting the health care that he needs. So many of my patients have not seen a provider of any kind in years because of lack of funds or having had a bad experience with the last provider. (Note I'm saying provider, not doctor or NP, both can be equally bad.)
Enter the patient looking grey, pasty, and sweating followed by his wife and daughter. They were upset and worried and while the nurse was getting him set up for an EKG, I was getting a 18 gauge IV in his arm with saline and O2. I was asking him questions about location, intensity, exacerbating factors, shortness of breath etc and asked why he hadn't called an ambulance from home! His wife and daughter both piped up and said, "We tried to call. He wouldn't let us because he wanted to see you first."
The patient proceeded to tell me that he wanted to get my opinion on the matter because he trusted me. He said that if I told him that it was okay to go, he would but not until. I told him that yes, he needed to go into the hospital for evaluation and that he shouldn't have come to the office to ask my opinion because he could have died. Off he went by ambulance...
Well.. after the morphine was given in the ambulance, he got combative and a little belligerent. He got to the emergency room and after he settled down a bit asked "where the hell I was." The hospital told him that I didn't have admitting privileges and that I couldn't be the one to take care of him there. Wrong answer for him!
He checked himself out against medical advice and came to the office the next day.
Oh My God!!! I told him that he should have stayed in the hospital and been evaluated for his chest pain and reminded him that he could have finished having a heart attack and met his maker sooner than he wanted. He said that he knows that he should have stayed but he didn't trust anyone else but me to care for him. "No one listens to me like you do!"
I told him that I was humbled that he trusted me so much, but I didn't want to feel like I was responsible for his falling over dead for not seeking help from other providers. I told him that if he ever got into distress again, to call for an ambulance. He promised to do that in the future.
I told him goodbye and that I would see him after his cardiac evaluation.
"Okay Doc!", with a grin!
"You know that I am a nurse practitioner and that I will always remind you of that when you call me doc."
"I know, but you're MY doc anyway."
Sigh....
Thursday, March 12, 2009
Google Ads Privacy Change on The Nurse Practitioner's Place
Google is soon coming with a new program that will track visitors to sites in order to serve the site owner's with more targeted ads.
"Interest-based advertising will allow advertisers to show ads based on a user's previous interactions with them, such as visits to advertiser website and also to reach users based on their interests (e.g. "sports enthusiast"). To develop interest categories, we will recognize the types of web pages users visit throughout the Google content network. As an example, if they visit a number of sports pages, we will add them to the "sports enthusiast" interest category."
What does this mean to you? Probably not much. Most sites track traffic in order to better serve you the reader.
What it means to me? Hopefully, more clicks on the ads from my readers so that I can pay off my student loans. I have actually done pretty well with the ads and hope to do even better with current and future readers. So, if you have been puttering around the idea of using Google Ads, do it and I'll support your endeavors as well..
"Interest-based advertising will allow advertisers to show ads based on a user's previous interactions with them, such as visits to advertiser website and also to reach users based on their interests (e.g. "sports enthusiast"). To develop interest categories, we will recognize the types of web pages users visit throughout the Google content network. As an example, if they visit a number of sports pages, we will add them to the "sports enthusiast" interest category."
What does this mean to you? Probably not much. Most sites track traffic in order to better serve you the reader.
What it means to me? Hopefully, more clicks on the ads from my readers so that I can pay off my student loans. I have actually done pretty well with the ads and hope to do even better with current and future readers. So, if you have been puttering around the idea of using Google Ads, do it and I'll support your endeavors as well..
Tuesday, March 10, 2009
The Nurse Practitioner's Place Interviews Stephen from NP View
1. What drew your interest into becoming a NP?
Conceptually, I loved the role nursing played as a patient advocate, educator and care-taker. I wanted to bring those aspects to the next level and thought that the NP role was an ideal synthesis of advanced practice. I always had a deep appreciation for the sciences and knew that I wanted to be in health care.
2. What is your worst pet peeve with the health care system?
Our health care system is in desperate need of reform. My biggest pet peeve? Oh there are so many. I would say that it really isn’t a “system” at all. I am not certain if a single payer system is the answer. However, our current mix of federal, state and privately funded insurance simply isn’t working. Trying to get anything done for our patients seems like an inherent road block. Pre-authorizations, pre-certifications and the like detract from patient care.
3. What do you think of the continuing NP vs PA issues?
I truly believe there is room for all of us. We are in desperate need of primary care providers and NPs and PAs alike can help fill that gap. I do think there are nuances in our practices that distinguish the two professions. This doesn’t make one better than the other, merely different. I think we need to be supportive and sensitive to one another.
4. Same for the NP vs MD?
Again, there is room for us all. I think a lot of physicians don’t understand the NP role (nor do some care to). I come across a handful of physician blogs that constantly put down the NP role and it is getting very tired. I make it very clear that I do not practice medicine, nor purport to, nor want to.
I have been extremely fortunate to work with physicians who understand and support the role of the NP and aren’t looking to “supervise” me. I collaborate with my physician colleagues and we exchange meaningful dialogue that is in the best interest of our patients.
I think what is even more important for the NP profession is to stand united and to truly advocate collectively for the profession. We must constantly strive for practice that is not with arbitrary barriers and is autonomous. There are some groups constantly looking to further limit our practice. For this reason, I feel it is imperative for us to be politically involved and unified.
5. If you could go back and change something about your education as a NP, what would it be?
I think the natural thing for most to say is that they wanted more clinical time and more experiences. I think it is normal for a lot of us to feel that way. However, it is impossible for our education to prepare us for every clinical encounter. I would say that I wish my clinical experiences were better focused and structured.
6. Do you feel that you were prepared for practice by your program?
I feel that I definitely had the knowledge base to build upon as I started my practice. I had a good grasp of what I knew and what I didn’t know. A new graduate NP needs support and guidance just as any other young professional needs.
7. What advice would you give those who are considering NP?
Being a NP is a wonderful profession and has unlimited opportunities. Please don’t enter this profession for the money since the level of responsibility doesn’t equate with the salary. Being a NP is hard work and one must be dedicated to life-long learning. However, it is very rewarding to work with patients, their families and the local communities in which we practice. I am fortunate to work with my patients recommending treatments, providing health education and making decisions with them in a patient-centered approach. Try spending some time shadowing an NP and understanding what the role consists of. Very few NP roles are identical which I think is a benefit. Finally, join your state and/or national NP organization as a student NP. They are of great benefit to network and will help to ensure barrier-free practice.
8. Do you still enjoy your work? Burn out an issue?
I still enjoy my work. Burn out certainly is an issue when there are never enough hours in the day to do all of the tasks that we are expected to do that goes along with patient care. I have the unique opportunity of being able to hold a management as well as clinical role and am involved in many different aspects of patient care. When I held strictly clinical roles, burn out certainly was possible.
9. How many hours do you actually put in a week vs how many you actually get paid for?
I probably put in about 60-65 hours of work per week and get paid for 40 weekly hours.
10. Do you have hospital privileges or do you even want them?
No and I don’t want them. I see myself as an outpatient primary care provider and my job is to keep my patients healthy and keep them out of the hospital.
11. Do you have narcotic prescription ability or do you wish that you didn't?
I do have this ability and believe it is essential requirement to practice and adequately care for my patients. Every NP that has the ability to apply for a DEA license should have one.
12. What is one thing that you would change about yourself as a provider?
As I am enrolled in a DNP program, I have learned to perform more self-reflection and to question aspects of my practice. I hate sounding pompous but I strongly feel that my FNP education prepared me for my role as a nurse practitioner. I wasn’t looking to go back to school for a program that was going to review what I already knew in practice. I was looking to bring my practice to a new level and to round out my experience. I am proud to say that I have already started looking at aspects of my practice from an evidenced-based and culturally competent perspective. Doing things the way we always have isn’t necessarily the best way to care for each of our individual patients who bring their unique perspectives and issues.
13. Why do you blog?
I blog because I love the opportunity of sharing my thoughts and opinions with others. Blogging is an amazing medium to accomplish this. I also discovered that there were way too few NP authored blogs and wanted to share my views on topics from a NPs perspective. I also felt the need to represent healthcare in a society that is often dominated with just one perspective.
14. How much time do you spend reading other's blogs?
I try to view my favorite blogs on a daily basis. Having tools such as Google Reader and my iPhone makes it possible to quickly glance at blogs and check them for current updates. I like to be aware of current health care issues and trends.
15. Do you find yourself looking at your sitemeter (if you have one) too many times a day?
This is a great question! Yes, I do check my site meter at least daily! Although I don’t have that much traffic to my site, I love being able to see what key words people are searching and how my blog comes up in that search. I’d also like to thank everyone (yourself included) that lists my blog on their blog roll and links to me. The sitemeter helps me to validate blogging.
16. Do you respond to your commenters on your blog? Is it important?
I will respond to commenters if they ask a particular (non patient specific) question. I think it depends on the particular comment as to whether it’s important to respond back.
Thanks to Stephen for taking the time to type an interview for me! It took me a while to post it and for that I apologize! Any other NPs out there who would like to be interviewed? Copy the questions, answer and feel free to ad lib and send it to npssavelives@npplace.com
I look forward to your submissions!
Conceptually, I loved the role nursing played as a patient advocate, educator and care-taker. I wanted to bring those aspects to the next level and thought that the NP role was an ideal synthesis of advanced practice. I always had a deep appreciation for the sciences and knew that I wanted to be in health care.
2. What is your worst pet peeve with the health care system?
Our health care system is in desperate need of reform. My biggest pet peeve? Oh there are so many. I would say that it really isn’t a “system” at all. I am not certain if a single payer system is the answer. However, our current mix of federal, state and privately funded insurance simply isn’t working. Trying to get anything done for our patients seems like an inherent road block. Pre-authorizations, pre-certifications and the like detract from patient care.
3. What do you think of the continuing NP vs PA issues?
I truly believe there is room for all of us. We are in desperate need of primary care providers and NPs and PAs alike can help fill that gap. I do think there are nuances in our practices that distinguish the two professions. This doesn’t make one better than the other, merely different. I think we need to be supportive and sensitive to one another.
4. Same for the NP vs MD?
Again, there is room for us all. I think a lot of physicians don’t understand the NP role (nor do some care to). I come across a handful of physician blogs that constantly put down the NP role and it is getting very tired. I make it very clear that I do not practice medicine, nor purport to, nor want to.
I have been extremely fortunate to work with physicians who understand and support the role of the NP and aren’t looking to “supervise” me. I collaborate with my physician colleagues and we exchange meaningful dialogue that is in the best interest of our patients.
I think what is even more important for the NP profession is to stand united and to truly advocate collectively for the profession. We must constantly strive for practice that is not with arbitrary barriers and is autonomous. There are some groups constantly looking to further limit our practice. For this reason, I feel it is imperative for us to be politically involved and unified.
5. If you could go back and change something about your education as a NP, what would it be?
I think the natural thing for most to say is that they wanted more clinical time and more experiences. I think it is normal for a lot of us to feel that way. However, it is impossible for our education to prepare us for every clinical encounter. I would say that I wish my clinical experiences were better focused and structured.
6. Do you feel that you were prepared for practice by your program?
I feel that I definitely had the knowledge base to build upon as I started my practice. I had a good grasp of what I knew and what I didn’t know. A new graduate NP needs support and guidance just as any other young professional needs.
7. What advice would you give those who are considering NP?
Being a NP is a wonderful profession and has unlimited opportunities. Please don’t enter this profession for the money since the level of responsibility doesn’t equate with the salary. Being a NP is hard work and one must be dedicated to life-long learning. However, it is very rewarding to work with patients, their families and the local communities in which we practice. I am fortunate to work with my patients recommending treatments, providing health education and making decisions with them in a patient-centered approach. Try spending some time shadowing an NP and understanding what the role consists of. Very few NP roles are identical which I think is a benefit. Finally, join your state and/or national NP organization as a student NP. They are of great benefit to network and will help to ensure barrier-free practice.
8. Do you still enjoy your work? Burn out an issue?
I still enjoy my work. Burn out certainly is an issue when there are never enough hours in the day to do all of the tasks that we are expected to do that goes along with patient care. I have the unique opportunity of being able to hold a management as well as clinical role and am involved in many different aspects of patient care. When I held strictly clinical roles, burn out certainly was possible.
9. How many hours do you actually put in a week vs how many you actually get paid for?
I probably put in about 60-65 hours of work per week and get paid for 40 weekly hours.
10. Do you have hospital privileges or do you even want them?
No and I don’t want them. I see myself as an outpatient primary care provider and my job is to keep my patients healthy and keep them out of the hospital.
11. Do you have narcotic prescription ability or do you wish that you didn't?
I do have this ability and believe it is essential requirement to practice and adequately care for my patients. Every NP that has the ability to apply for a DEA license should have one.
12. What is one thing that you would change about yourself as a provider?
As I am enrolled in a DNP program, I have learned to perform more self-reflection and to question aspects of my practice. I hate sounding pompous but I strongly feel that my FNP education prepared me for my role as a nurse practitioner. I wasn’t looking to go back to school for a program that was going to review what I already knew in practice. I was looking to bring my practice to a new level and to round out my experience. I am proud to say that I have already started looking at aspects of my practice from an evidenced-based and culturally competent perspective. Doing things the way we always have isn’t necessarily the best way to care for each of our individual patients who bring their unique perspectives and issues.
13. Why do you blog?
I blog because I love the opportunity of sharing my thoughts and opinions with others. Blogging is an amazing medium to accomplish this. I also discovered that there were way too few NP authored blogs and wanted to share my views on topics from a NPs perspective. I also felt the need to represent healthcare in a society that is often dominated with just one perspective.
14. How much time do you spend reading other's blogs?
I try to view my favorite blogs on a daily basis. Having tools such as Google Reader and my iPhone makes it possible to quickly glance at blogs and check them for current updates. I like to be aware of current health care issues and trends.
15. Do you find yourself looking at your sitemeter (if you have one) too many times a day?
This is a great question! Yes, I do check my site meter at least daily! Although I don’t have that much traffic to my site, I love being able to see what key words people are searching and how my blog comes up in that search. I’d also like to thank everyone (yourself included) that lists my blog on their blog roll and links to me. The sitemeter helps me to validate blogging.
16. Do you respond to your commenters on your blog? Is it important?
I will respond to commenters if they ask a particular (non patient specific) question. I think it depends on the particular comment as to whether it’s important to respond back.
Thanks to Stephen for taking the time to type an interview for me! It took me a while to post it and for that I apologize! Any other NPs out there who would like to be interviewed? Copy the questions, answer and feel free to ad lib and send it to npssavelives@npplace.com
I look forward to your submissions!
Thursday, March 05, 2009
Oh No You Didn't! Change Of Shift Is Up!
Welcome to The Nurse Practitioner's Place's first attempt at the Change of Shift!
Due to not having very many submissions this week, I went surfing for something to put on this edition. Thanks to those took the time to submit and without further ado, here's this week's entries.
I've heard of some smooth moves, but this is a great one!
Over at Mitch's Mom, here's a tale of what NOT to do to a laboring woman.
Image by stephenccwu via Flickr
Ethics in nursing is an important subject. Anyone offered to "help you out" during a test?
Disappearing John wonders what would you do if you are stuck in such an ethical quandry.
Are you wondering if the knowledge that you packed into your brain is just oozing away?
Pop over to New Nurse Insanity, Fundus Chop and find out how to remedy that problem.
Image via Wikipedia
A grumpy RN shows us once again that teamwork is alive and well in the hospital that he works in.
Are you a hypochondriac? Check out the nice list of tips to follow so that you can help yourself not to be so concerned about your health. Even if they used the term doctor
instead of health care provider (Sorry! It's one of my pet peeves!) That's a whole other topic!
Max E Nurse over at It Shouldn't Happen In Health Care says
"It’s flattering, but please don’t come and see me every time you sniff, just so you can flirt outrageously with me and then be happy when I say you don’t need any medication or advice you don’t already know, and just because I’m male and a nurse doesn’t mean I am gay…and even if I was…YOU wouldn’t be my type (real gay men don’t wear eye shadow and their mums perfume!!)!! If I was gay I’d be a lesbian!!"
Oh no he didn't!!!! Too funny!
Over at Nurse Ratched's new digs, she's talking about some doctors are asking patients to agree to what amounts to a gag order that bars them from posting negative comments online.
Ever been standing in front of your copy machine and thought "Oh no! Did I just send this to the right number?" Candy Goulette gives us advice about it here.
Image via Wikipedia
Alvaro Fernandez presents Centre for Brain Fitness at Baycrest: Interview with Dr. William Reichman posted at SharpBrains: Your Window into the Brain Fitness Revolution.
Chris presents Medical Tourism - 5 Reasons to consider Goa posted at nomad4ever.
Cory presents Exercising in a Recession posted at Eating Healthy.
Ashley presents Quick Home Meal Ideas posted at Frugal Girl Blog.
So ends this week's edition. I hope to host sometime when I'm in a better frame of mind. Please excuse.... Till then, get writing and submit something to the next carnival and make it easier on the next host.
Wednesday, March 04, 2009
Change of Shift Will Be Delayed By One Day
Image by Denis Collette...!!! via Flickr
Tosh Tucker (almost two) died in his sleep due to aspiration. We are awaiting the autopsy report and are praying with every bone in our body that there was no foul play involved. His father is devastated. Please keep them in your prayers and keep me there as well because I have to make it through his funeral tomorrow afternoon.
It's been especially hard on my 11 year old son who's not understanding why someone so young had to leave us so soon.
Sunday, March 01, 2009
U Promise- A Program To Help Pay Down Student Loans
Hello to all.. I have been thinking about using the U Promise program to get some of my student loan paid down. Have any of you used it?
There are several vendors such as CVS, Publix, Winn Dixie, etc who list it and also several online stores such as Walmart, Victoria Secret, Home Depot etc. so it must be a legit program.
To help a student save for college or one who has already graduated, you can also go online at this link and if you buy something from one of the many vendors, a percentage gets put toward paying the loans down.
There are several vendors such as CVS, Publix, Winn Dixie, etc who list it and also several online stores such as Walmart, Victoria Secret, Home Depot etc. so it must be a legit program.
To help a student save for college or one who has already graduated, you can also go online at this link and if you buy something from one of the many vendors, a percentage gets put toward paying the loans down.
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