Change of venue

After a few months with the GI group, I made the decision (not easy) that it was not the place for me for various reasons, including that a specialty is not as interesting as family practice. The multiple MDs and lack of support in my role of new grad and new employee made for a large amount of stress. I was offered a position in a small rural health clinic nearby which had only one doctor and a PA, and a very friendly staff . Moving jobs was a no-brainer, especially as there is a good possibility that my student loans will get paid off by HRSA.

It seems that sometimes things are not as advertised. The place which seems really great at first, may not be a good fit after all. I suppose in retrospect, that my biggest concerns (the large amount of MDs and the fact that a specialty would require a lot more studying to catch up) were legitimate. The support promised did not materialize, and on top of that I ended up feeling quite alone, as I was in this middle area, not allowed to “socialize” with the staff, and not considered part of the MD inner circle either. Turns out, I was never actually in the loop af

So, now I find myself in a totally different environment, where we all feel like a big family with joking around a bit accepted, and a group of people willing to help each other out and work as a true team. The physician and PA are completely supportive. What a difference! It is nice to hear someone tell you did a good job at the end of the day.

And, being back in a family practice environment is great. Well, I had almost forgotten the “Oh and by the way, I also wanted to talk about…..” after the visit was over and the chart done. I am getting better again at the “well, we can make another appointment for you to go over that.”

I feel so much less anxious and stressed, I might be able to get back into more regular blog posts!

I wish you all a happy new year, and hope that  all of you had a fantastic holiday.


A moment to reflect

I recently met an 88 year-old survivor of the holocaust. This person survived four different extermination camps as a teenager. The only surviving member of his family. And a cancer survivor as well.

It makes me realize that nothing that could happen to me could even remotely approach the suffering this person faced in their lifetime. And he still smiled and joked with me.

“Humor is what keeps me going.” he said. I shared my favorite joke. He had already heard it, but that was okay, we still laughed together. I didn’t cry until I got home.

Office Politics

One of the hardest things to do when starting a new job, is to get a handle on the office politics. The difficulty level is higher when there is a large group of physicians, other mid-levels and a large assortment of assistants and office personnel. Add some new services being set up and the mix gets a bit volatile.

I have never been a real political person, so I would have had a real problem with all of this only a few years ago. After the rigors of post-graduate education, and the “Project”, it seems that I have developed some new skills in dealing with the politics, and a higher level of personal confidence. So far, things are going relatively smoothly, and I am learning who the movers and shakers are, how to keep myself in the loop, who are my allies and which people I need to be careful around.

All in all, considering the amount of people in the practice and the sheer amount of patients seen and procedures done, this three-ring circus operates quite smoothly, and I am feeling more comfortable each day in my new role. We are settling into our new community, making new friends and enjoying the outdoor activities and beautiful surroundings we have here. There is a 43 mile long bicycle trail which runs past lakes, parks, and forest near by which we are enjoying each weekend. Life is good.

I need a new bicycle…

One month in

It has been a month since I started my new position. Some days I feel great and other days, I feel totally stupid. Cirrhosis and NASH and the inflammatory bowel diseases are still a bit daunting. The physicians seem to be accepting me now, an are very willing to teach me the nuances of gastroenterology. There was about a week of “let’s see what this chick can do”, where I felt very scrutinized and alone. Evidently, I passed that little test and now I even hear an occasional “good job”.

Yesterday, I walked into an exam room and asked the patient my usual “What brings you here today?” He kind of gave me the stink-eye and said “Oh great, another uninformed health care person”. To which I replied “Sir, I always ask that question so I get a good idea of the patient’s expectations for the visit”.

After looking over his EGD results which showed gastritis and the pathology report which was negative for H Pylori, he asked me what reasons other than H Pylori could cause the gastritis. Seeing aspirin on his med list, I asked how much he was taking. Turned out, it was 325 mg of regular aspirin, because, he said, he heard it was good for you. Further questioning revealed chronic headaches and regular use of ibuprofen, Aleve and aspirin powders.

We discussed all of this, and the plan was to reduce the aspirin to 81mg of enteric coated, and avoid the NSAIDs. Use Tylenol instead, and to follow up on the headaches with his primary care provider.

When the patient left, he thanked me. I guess I didn’t look so uninformed anymore.

It feels good…

It feels good…….

During my first week as an NP, everything seemed difficult. The computer system was unfamiliar, the routine and forms also new and unfamiliar. I was a bit unsure of myself. The specifics of GI, a new territory, even with patients who had simple stuff like constipation, it just felt difficult.

Today, the first day of my second week, the routine is more familiar, the computer program do-able, the paperwork and forms are now not problematic. I am much more relaxed and able to interact with the patients in my normal way. I wrote my first order, woohoo! I get to see the patients first, then the physician gets my report and finishes up the plan. It is really nice when you tell the patient “I think the doctor will give you such and such drug/treatment”, and when he comes in, he says the same thing. Yes, validated! I guess I know something after all. There were a couple of times when he didn’t go in after me at all. Sweet.

Life is good. I have arrived. Still inexperienced in my new role, but I am feeling more comfortable. Everyone here is very nice, I couldn’t have found a better group of physicians to work with.

Clothing stores used to be hell, but now seem a lot more fun!

And, on a different subject, I went clothes shopping. I recently lost some weight on a low-carb diet. This is the only diet that has ever worked for me. My pants were getting a bit baggy, and besides, I deserve some new clothes. It’s been a long time! So, I go to the store and troll around looking for “professional clothes”, (and not in the “women’s” section this time) no more scrubs for me. I find some pretty tops and pants that looked good. I go to the fitting room with piles of stuff to try on, and….the best part is that I picked out some pants a size smaller than my usual, and lo and behold! They were too big, I had to go down another size! That has never happened before. And, they were long enough for a change (I am 5’9″).  For once in my life, I came home smiling with bulging bags after a clothes-shopping trip. I take all of this as a good sign. 🙂

Friday was my last day working as an RN. My feet will be happy. I mentioned after the first day, that I would have to put the gel insoles back in my sneakers , only to find out they were already in the shoes when I took them off that evening!

 I have to say, I love being an RN, and I hope that as an ARNP, I will get even more satisfaction doing patient centered care. I also hope that I won’t have to be quite as physically active as those days in the endoscopy lab turned out to be. I had worked a couple of days a week in the lab, ostensibly to see what the tests are all about so I can better educate and reassure my future patients(although, being a good girl, I have had my colonoscopy and knew that test personally), but also because I needed the moola. I learned a lot about the people working at my new place of employment: a lot of characters, but a great team. Being a bit of a character myself, I think I will fit in just fine.

Well, my ARNP license is finally in, after obsessively checking my application status online multiple times a day, it was there. It was so cool to see my name with credentials: Nurse Practitioner after it on the license verification form. WooHoo!

The head physician gave me a packet of papers to fill in, to get priviliges at the two hospitals we work in. I applied and got my NPI number. Tomorrow we will have to knock out a NP practice/collaboration protocol as required by the state of Florida. We NPs must be well “supervised” by the all-knowledgable MD. Frankly, at this point in my fledgling career, I am glad of all the “supervision” I can get! I was given two GI books to read, Lange’s current on GI and endoscopy and a book of “secrets” in GI practice. Again, I am amazed at how much I actually know, and how little I actually know.

Last weekend, I attended a GI conference in Orlando with some of the nurses and physicians from the practice, very informative. My favorite lecture was “Interesting anorectal cases”……With pictures………Right before lunch……I can’t even imagine what the staff of the ritzy hotel must think. We lined up for a group photograph by the pool, and some wit in the nearby crowd yelled “Say colonoscopy!”.

Tomorrow will be interesting, my first day as a “big person” as the RN supervisor put it recently.

PS: I just saw that I was listed as one of the best 25 nursing blogs. Wow, I am honored!

Waiting for the license

I have received my degree/diploma, my certification from AANP has come through. Now all I have to do is wait for the state to issue my license before I can actually start to work as an NP. Of course, there is still also the obtaining of an NPI number, which I understand is very quick, then the credentialing and practice protocol and credentialing at the hospital to do. I don’t have to worry about a DEA license, as Florida is one of the two backward states that does not allow NPs to prescribe controlled substances. This is a laugh as it is  a few unscrupulous MDs in this state that run the pill mills, not NPs.

Anyway, I got to spend a couple of days observing in the endo lab, which was fun and gave me a chance to see the procedures and get to know some of the other staff. An interesting moment when the nursing supervisor said to me, “We get a half-hour lunch, but, oh yeah, you are going to be one of the “big people”, so you can do what you want.”


I am looking forward to starting my new career. All of the staff and the physicians are really nice and supportive. It is all looking good.