The following was an email that I received from a nursing student and I thought that it would make a great post.
Hi there.. I am a nursing student and have to write a paper about advanced practice nursing including speaking to an advanced practice nurse. While researching, I actually ran into your blog a few times and enjoyed reading through your posts, so I figured I would just ask you a few questions, that is, if you don't mind of course. brief answers are sufficient - I know you're a busy woman! and I don't need to take up much of your time =)
I see from your blogs that you are an FNP in Florida in a rural health clinic and have your own patient base. Also that you were at the bedside for while before returning to school (with a
family!...there are no words to describe how much credit you deserve for finishing successfully and still working and maintaining a family- very impressive)
-How would you describe your roles and responsibilities in your current office?
My roles in the office include patient care, patient education, lab draws (the ones that the nurse can't get), and supervising the nursing staff. I also do callbacks to the patients for questions that they have, and consult with the MD on cases.
-What kind of experience and education was required for your degree. I started with my RN and then went on to complete my BSN and then my MSN. I worked in the hospital setting as a floor nurse for almost 7 years while completing my degrees. I served as a stand by charge nurse as well. This experience was vital in my education as an advanced practice nurse. In my opinion, to be a successful nurse practitioner, you must have the clinical experience to recognize the nuances in disease process in person. One cannot get this from book learning only. Often MDs say that nurse practitioners aren't as good at diagnosing patients because we didn't do a "real residency" in their traditional sense. Working in the trenches at the hospitals managing several patients daily plus doing clinicals side by side with other doctors while in school is a residency in it's self.
-What roles other than direct health care to find yourself providing obviously education is a big part of your service to patients, but do ever feel like a case manager or advocate to patients or an administrator in teh office, etc)
I do case management and advocate for my patients, especially for medications not covered by their plans (prior auths). I don't do much administrative duties because this is not my own practice.
-Who do you work with in the office?
I work with an office manager/front desk person and two LPNs and one medical assistant. I also have a MD that works in the office four days a week.
What impact does interdisciplinary relationships have on you or your practice?
It has a huge impact. If I don't get along with my coworkers or they don't work well together, it can hugely impact the flow and patient satisfaction. It can also seriously effect patient health if an office staff does not listen to a patient's concerns or pass on critical information.
-What are the benefits and challenges you run into?
The benefits are that I can FINALLY take care of my patients like I need to without having to ask for an order from a MD. Challenges I face is the fact that I cannot write for controlled substances which makes working in rural health very frustrating. If there isn't a MD on site to sign for controls that I cannot call in, then I have to send them to the nearest office that I am connected to. This is a hardship to some of my patients because of lack of transportation and money for gas. Some have to make the decision whether to eat, pay their rent or pay for their medications. Some actually walk more than a mile to my office to be seen for care. This is the reason why it's vitally important to contact our Florida congressmen and senators and let them know that we need the ability to write for controls. After all, all but two states have given NPs that right without any major events that I know of.
-Lastly, are there any major issues r/t current nurse practitioners that you are concerned about. (I did read your post about the article you found on MDs vs NPs capability to handle 'serious' patients vs 'snotty-nose' patients - how frustrating ! the author is obviously uneducated regarding np education and skill levels!)
From the above question, you can tell that not having controlled substance rights is a big one. I also have a huge gripe with pharmaceutical companies who advertise "Talk to your doctor" instead of saying health care provider. How hard it that! I think they would be shocked to find out just how many prescriptions we nurse practitioners write. Most insurance companies in Florida do not put us on their provider panels and therefore do not pay the pharmacies. They have to submit the medications under the MD's name so we don't get "the credit" and therefore are still under the radar. I actually think that we are very responsible prescription writers and take care to make sure that what we write is appropriate for our patients. In fact, I think that we write less medications due to the enormous patient education that we give the patient. Patients often take us seriously and follow our advice because of their trust in us as primary medical providers.