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Archive for July, 2010


What a relief, the semester is winding to a close. Both my final exams are done, and I passed creditably. All that is left is a group case study which is pretty much finished, I need approval from two group members and we post. Then, I am completely finished with this term.

What will I do with myself for a whole month? Let me think…

  • I will go grocery shopping and cook some meals. I like to cook and though my wonderful husband has been doing most of it recently, his repertoire is getting a little thin: spaghetti (with spectacular meat balls, I have to say), salmon cakes, hamburgers. My kitchen doesn’t recognize me anymore.
  • Go to the library and get some FUN books. I think my card expired, it has been so long.
  • Play with my dogs, who still love me in spite of the fact I haven’t been any fun for them recently.
  • Drag out the sewing machine and work on my neglected quilt.
  • Go to our cabin in South Carolina for a week. Well, it isn’t exactly our cabin, we rent it. But to us, it is our favorite vacation spot, tucked in the woods, absolutely private and quiet. I can already see myself sitting on the deck out back drinking my morning coffee while the birds fly by. Trees, I love trees.
  • Do some catch-up house-cleaning.
  • Maybe I will try to do the Tai Chi video again

I have a life again, for a month anyway. Heaven…

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I keep receiving long and involved comments from mostly medical students to tell me why nurse practitioners should not do what they do. The latest was one from someone at  University of Connecticut. I trashed the comment, and will trash all further comments regarding MD superiority in all ways to us measly little nurse practitioners.

As I started to read this comment from the, I assume, med student at University of Connecticut (God forbid if it was an instructor!), I realized that I don’t have the time or energy to keep responding or even acknowledging these types of comments. The treatise was pages long, rambling, incoherent in many respects and about equal to what a high school student would put out. I pray that his term papers for med school are a little better put together.

In the end, I didn’t even get through it all, not interested in reading why all the studies I had put forward (I had not included any studies by nursing researchers, of course) did not apply. If it didn’t fit with their world view, it was obviously a trash study.

Now, I have never indicated that NPs are better than MDs, only excellent in their scope of practice, which overlaps to some degree with the role of a primary care MD. I never said we were more intelligent or superior, or out to take the place of MDs. I only state, as I believe most NPs would agree with, that we are a part of the health care team, filling our niche in a positive way for the patients.

We need all the good health care practitioners we can get, MD or NP, or PA for that matter. In the end, it is the patients who decide what practitioner they want to see, and any person who walks around with such a God Level 5 attitude, is not going to be liked by the patients, either. This is not the 1950’s anymore. 

So, to all of those med students who have HOURS to put together comments about how puny they think NPs are in response to my little blog, and who have probably never even touched a patient yet, I suggest they get out their Harrison’s and get back to studying. They also need to realize that it is the registered nurses in their rotations who are going to be their best teachers, and they should probably get off their high horses and be a little more humble. If it is an already practicing physician who makes those comments, shame on you. NPs are just part of the team, we are not after your job. Sheesh! There are plenty of sick people to go around.

Remember, we are there for the patients, we are not supposed to be there to stroke our egos. So, get on with your med school and strive to be the best physician you can be, and I will continue to strive to be the best nurse practitioner I can be, and the patients will win as much as we do.

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I just posted my “Application for Graduation”. Now, that doesn’t mean I am graduating just yet, but the school wanted it at least six months before graduation, so of course, I did it a year ahead of time. It was kind of cool to “write your name as you want it to show on your diploma” and read about the Master’s hood and the ceremony. It just warms the cockles of my heart. Maybe this will actually all come to and end and I will finally achieve my goal.

This isn’t the first time I tried to achieve this. I started in a FNP program in Pennsylvania back in 2002. It was an RN to MSN program since I had gotten my RN back in the days of the “diploma school”. My husband got sick and we ended up moving to Florida when he recovered. I had racked up enough credits to get my BSN, summa cum laude, thank you very much, and stopped any further classes. When we got down here, I worked for hospice, lived through Hurricane Charlie, and finally taught LPN students. Budget cuts cost me that job and I decided it was time to try again.

So, finally, I am within a year of achieving that coveted FNP-MSN. I am looking forward to this last year, clinicals will seem so much more real to me than all the book work. Of course, the book work was necessary, but clinicals give you the opportunity to hone skills and actually see patients and help them. That is what I have been wanting to do for so long. Being an RN has been great, but moving up to this new level will be so much more rewarding for me. I anticipate getting back to more patient contact, as the current role of RN is so much paperwork and less actual hands-on patient care. It seems that CNAs and med techs are doing what nurses used to consider part of their job, and RNs are acting more in the administrative capacity and as data collectors for goverment, regulatory agencies and insurance companies. (Don’t let me get started on that.)

So, bottom line: there is a light at the end of the tunnel! WooHoo!

PS: Thanks to Frontier School of Midwifery and Family Nursing  for giving me my busiest blog day ever by recommending my blog as interesting to read. Here is a link to their webpage in return: http://www.midwives.org/home.html

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Blogging as a family thing


My husband decided that I was having too much fun with blogging and decided to start his own. He is an amateur radio afficianado, and has been tinkering with them since 1968. Now, our garage, guest room and various corners of our house are filled with beautifully restored “boat anchors”.

A boat anchor is a radio big and heavy enough to be used as an anchor. Most of these radios are black or grey, huge, and military in origin. When watching movies with a military flavor, such as Memphis Belle recently, we always look for the radios. It is kind of a neat thought that most of these pieces have been flown over Europe, dragged through Viet Nam jungles or sailed on Navy ships, and were the communication link that saved many a soldier’s, airman’s, or sailor’s butt.

So, I include a link to his new baby blog, and hope that he has as much fun with his as I have had with mine. My only concern is the part where he says he BUYS stuff.

We need a bigger house.

http://randysradios.wordpress.com

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My shopping trip went well and I actually found some decent clothes at a store where my size was the smallest, but the clothing was cut to actually be comfortable and stylish. Sweet.

So, off I go to the pediatrician’s office in my new duds, only to find out it was casual Friday and everyone was in capris and jeans. Oh, well, better dressier than scruffier. I was introduced to the staff and my preceptor-to-be, everyone was very nice and welcoming. I started feeling better about my future already.

We spent the morning looking at rashes (ptyriasis, saw it in the book. Now, it means something and I will recognize it in the future), lots of cranky babies with sore ears (it turned out to be ear infection day), diaper rash, a strep throat, 3 well baby checks and teens with headaches (2). This office did everything on computer, it was actually pretty user-friendly, and efficient.

Out to lunch with everyone in the office, and three more patients in the afternoon. My preceptor stated it was a slow day.

End result: I actually was remembering things when I saw the patients, got to see tympanometry and insufflation, and learned a lot in just one day. What fun. I think I can actually do this! Yes!

And yes, you do get to see what the presenting complaint is before you go in, and you do get a chance to formulate a plan. Okay, I’m cool with all of this.

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I just took a test in pediatric gastro-intestinal and musculoskeletal issues. After intense reading and studying about scoliosis and projectile baby puke, I am a little punchy, but I passed the test.

Recently I ordered a new stethoscope, my doctor recommended the Littman Classic II SE. I just got it in the mail and now I am wondering what things I can do with my old one.

First of all, the old standby: listening to stuff land in your stomach after you swallow something. You can actually hear the KERPLOP as the food lands in the pool of gastric acid. My kids always loved that exercise, and of course after drinking a full, tall glass of ice tea just to hear it land in your stomach it must be followed by jumping up and down on the bed to hear the  sloshing. You don’t need the stethoscope for that part.

My husband, the ham radio operator likes to use it to hear which of the glowing tubes are not humming. Or transisters or some such electronic thingamajiggy No hum, no work good. Hmmm.

Well, my idea for a witty and fun list of things to do with a stethoscope had just come to a screeching halt. I guess they are only good for what they are designed for: listening to the inner workings of your body and making you look properly medical when you have it hanging around your neck.

It lets you hear bowels sounds and lung sounds and heart sounds and vascular sounds. It actually is an amazing tool. It can tell you if your lungs are filling with fluid, or collapsing or if the airways are too tight and air can’t pass through efficiently. It can tell you if your heart valves are not closing correctly and blood is leaking around them, or that the sac that the heart sits in is inflamed and rubbing on the heart itself (which it isn’t supposed to do) or it is beating too fast or too slow, or not pumping regularly. It can tell you if the bowels are functioning correctly or too fast or too slow, or stopped altogether. You can tell if a major artery like the aorta has a bunch of plaque built up creating a turbulent flow which puts you at risk for a stroke. It lets you hear the pulse you need to hear when you take a blood pressure.

I love to watch the actors on TV pretending to be doctors or nurses using them the wrong way around, or listening for a half second and announcing solemnly “This patient is not going to make it. The aneurysm is about to blow.”

Did I mention it makes you look all medical and cool when you have it hanging around your neck? I got stopped at a sobriety check point late one night, and the cop peered into my car with his flashlight and saw the stethoscope. “Late shift at the hospital, ma’am? You just go on through.” Cool. (Not that I was drinking, don’t even THINK that. It was just nice not to have to go through the whole rigmarole, it had been a tough shift.)

Stethoscopes are cool…just as an FYI, they were invented because a Victorian doctor was embarrassed to put his head on the lady’s chests to check their heart function.

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I just realized today, that in only seven weeks I will be seeing actual victims, I mean patients.

This thought is exciting and scary. Will I have a chance to see the chart and presenting complaint before I get into the room, so as to formulate something approaching a plan? I visualize me entering a room with a flustered parent holding a screaming infant, and I just freeze. No clue as to what to do next. That would really, well, not be fun, let’s say. The parent is expecting me to do something useful, and I stand there, hopefully not looking like a blithering idiot. Does anyone know what blithering means? Whatever it is, I am afraid I will be doing it.

The idea of doing an exam and then telling the patient to dress, and I’ll be right back sounds very appealing. This gives me the opportunity to look stuff up to make sure I am doing it right. Of course, I expect there will be something I forgot to examine or do, I just know it. I hope there will be a way to kind of sneak that in when I go back into the room without them knowing I forgot it in the first place.

Being a beginner again at my age is something that I don’t look forward to. I will be entering “The Discomfort Zone”. Do not attempt to adjust the situation, we are in control of what happens to you, hahahaha. (evil laugh). I am in that place where I had my students (I taught LPN students for a while.) I knew they were scared, but I told them “Act as if you have been doing this procedure for a hundred years, pretend. The patient won’t know the difference, you actually know how to do this, so just do it.” So, I have to eat my words, because now I am in the same boat. “Just go in there and examine that patient, you know what to do, just do it. Pretend you are confident.” Deep down I know this is good advice, and after a while in clinicals, the nerves will pass, the labels on the boxes in my brain will mysteriously reappear, and I will actually start to feel useful again.  I just have to open the red door and go through.

The syllabus states ” The student is expected to bring ALL books from previous classes with them to clinical.” I somehow think I can leave my APA manual, the nursing theory books, the evidence based practice and research books behind. This should save about 20 pounds, but it still leaves me with about 60 pounds of books to cart in. Thank goodness I have a wheeled suitcase. I will need to sew my “Student FNP” patch onto my white lab coat. I haven’t decided if that makes me feel more professional or not. I never liked wearing a lab coat. I always prefered scrubs. Scrubs are cool, comfortable, cheap and washable. They come in fun colors and patterns that express your personality. If a baby pukes on you, no big deal. A white lab coat is, well, white and clinical. Doctors don’t even wear them in their offices anymore, only in hospitals , to look doctorish and not be confused with lower chickens in the pecking order. It seems a lot of patients like the white coat. A survey once stated that the majority of patients feel that a medical person looks more professional and confidence-inspiring in one.

The good news is that in my first clinical, at a pediatric office, they do not want me to wear “the uniform” because it scares the kids. Cool. Bad news, I must wear “professional” clothes. (Ones that need to be dry-cleaned if a baby pukes on you). Up to now, scrubs were my professional clothes. I only have two outfits that could be remotely called “professional”. Crap. I have to go shopping. I HATE shopping for clothes. If  I was twenty-something and skinny, this would not be a problem. I am fifty-something, not anywhere near a size 10, or 12, or … and I am also unfashionably tall, being a Viking and all. The fashionistas have decided that anyone over the size of 10 and height that can be called petite, has no taste and must wear a mumu printed with zebras and iguanas in loud colors. I had hoped to find a Lane Bryant or something, but no luck with that around here. Sigh. This is not going to be fun. Even that fashion model who was considered “plus size” at size 14, has gotten skinny again and forsaken all of us normal women who have some actual padding covering our pointy bones. Another wall to surmount. I will let you know how it goes.

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