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Posts Tagged ‘FNP’


Monday in a rural health clinic is, well, interesting. As in the old Chinese curse “May you live in interesting times”. I am sitting in my little office cubby at the back of the building tackling the teetering pile of charts that have messages or lab and test results to be read, when I hear a panicked voice yelling “We need you NOW!”. Dashing out, I am directed to the waiting area where a young man is laying on the floor and the other patients who were waiting to be seen are backing out the door, wide-eyed.

The man was unconscious, not responding and his breath whistled whheep, whheeeep, wheeep, like a kid with epiglotitis. Oh, crap, he probably has something lodged in his throat. I turn him around to check his airway, and check his mouth and he coughs a little, mucous tinged with blood dribbles out. I put him back on his side. Panicked staff crowd around, “What do we do?” one yelled. “Call 911, get me oxygen and the ambubag!” I replied.

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He is still not responding, though the wheeping is slowing down a little, and suddenly stops. “Shit, he stoppped breathing!”, I have a sinking feeling in my chest, this guy is going to die on me. I grab him by the shoulders and shake him. “Don’t you DARE stop breathing!” I yell into his ear. He suddenly gasps a little, with a more normal sound, and starts to come round, his eyes open. He whispers “Anxiety attack”. The 911 crew arrives, just as he is starting to sit up. They ask the story and I tell them what happened. At the mention of the words “anxiety attack”, their interest cools considerably. A staff member hands me the patient’s chart, as they now know who it is. He has esophageal ulcers, asthma and GERD listed in his problem list. I pass this information along to the now bored EMTs. I mention they might want to check his lungs as possibly he may have aspirated some stomach acid, they say “thanks, sure” and out they go.

Two days later, the guy shows up for an office visit with his mom. She thanks me profusely for saving his life. When I asked him what precipitated his anxiety attack, he said “Nothing. I was just driving along and started coughing, I couldn’t catch my breath and then the panic started.” I see on his med list he is supposed to be taking Advair for asthma, and Nexium for acid reflux and the esophageal ulcers. He admits to not taking his medicine, that he didn’t feel it was necessary. I explained that a combination of refluxed stomach acid and bronchial spasms from the asthma had probably led to his coughing and panic attack. His mother gave him the stink-eye and said “I TOLD you to take your medicines!” The guy sheepishly promised to take all of his meds in the future.

Later, a guy walks in with a hospital gown on over his jeans and a hard neck brace on his neck. He hands me a pile of papers which are hospital records from an ED visit last night. The records show he has a transverse C4 fracture, nondisplaced. The story of how he got the broken neck was colorful and included beer, motorcycles and police officers and a total lack of memory about how it happened. There were multiple scrapes, bruises and marks on him, one of which looked like a boot print. Quite a night.

“I was supposed to see a spinal surgeon today,” he tells me. “But, the one I was told to see doesn’t take Medicaid. He said I had to get a referral from my primary.” That would be us. The nearest spinal surgeon that accepts Medicaid is at Shands, which is over an hour away. The patient would have to drive himself. When our scheduler called Shands, they told us they would call back to set an appointment after noon tomorrow. Our scheduler “suggested” that she would fax the referral and the pertinent information from the hospital records now and she would call them first thing in the morning to see what time the patient should show up tomorrow. We’ll see how well that goes. I pointedly reminded him to keep the brace on and not try to turn his head until seen by the spine doctor.

The sad part is, if the hospital had admitted him, he could have been seen by the local spine surgeon in the hospital, had his surgery and it would have been covered by Medicaid.

What is wrong with this picture?

 

 

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Sorry I haven’t blogged for a while. I had to make a trip to Europe as my mother as very ill, and did pass away. In a way it is a relief as she had been ill and in pain for quite a while. She is at rest now. My family and I have to deal with international laws about wills and estates, which has taken up a lot of time and energy. Mom wasn’t quite as organized as we would have liked.

Back at home, I am still loving my new job. I get to see all the basic day-to-day health issues. Last week was allergy and sinuses week, seasoned with occasional bronchitis. This week was thrush and cerumen impaction week. There also has been an increasing stream of PAPs, the ladies are catching on to the fact that there is a female provider in the house now. I did request, rather strongly, that I wanted to have the clear plastic speculums (specula?)and not the ancient metal ones I found in the drawer. They complied, thankfully. It is hard enough to peer down a vagina and locate a cervix with the lamp over your shoulder, without also having to deal with old-fashioned metal speculums. This IS a rural health clinic, but I have to draw the line somewhere. 🙂

It is great getting positive feedback. The assistants and the PA and physician all keep telling what wonderful things the patients are saying about me. Someone get a pin, my head is getting bigger. This afternoon, a patient was dropping off his Hemoccult cards (he refused a colonoscopy even though he has a history of polyps), and the nursing assistant said he didn’t look too good. The patient agreed to come back and let me have a look at him. When I walked into the room, he told me “My wife thinks you walk on water.” Well, that is tough to live up to, and I remarked that I hoped I wouldn’t fall off that pedestal, to which he replied, “well you wouldn’t drown if you did.” The hemoccults came back positive x3, his labs which I had ordered the last visit showed anemia. A glance at the last two notes showed a weight loss of 8 pounds in a month, and he was complaining of some vague abdominal “twinges”. I wasn’t able to locate the site of the pain when I palpted his abdomen, but I thought I felt something, well, thick. I told him about the hemoccult tests and the anemia. He agreed to go to GI to be checked out. I told the girl p front to make sure that he got an appointment as soon as possible. I am frankly worried about him.

This afternoon, when I was getting ready to leave, the physician sat down next to me and said “Did you hear about the 85 year old woman you sent to get an ultrasound of the abdomen and pelvis because she had some tenderness and a little vaginal bleeding?” I hadn’t, she had come back while I was away. “I just wanted to let you know that she has ovarian cancer and is getting surgery soon. I am glad you caught that.” Wow.

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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!

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I just signed up to take my certification exam through AANP next Friday. Until then, I will be wearing headphones to my personal CD player listening to the Fitzgerald review lectures. Wish me luck. This is the big one.

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Well, my last term starts Monday. I just got back from a week of vacation in upstate South Carolina, again. We do love it there. I managed to wash and dry my cell phone (we thought the dryer was clumping kind of loud) and so no-one could call me. That actually was kind of nice. We took walks in the woods with the dogs, explored the area and discovered some new things. Generally relaxed and lollygagged (also gained a few pounds, oops). I took several school books with good intentions of doing some reading. Yea, right.

Now, I am home again, faced with the pile of books I meant to do some reading and studying in and the new term looms. I was good today, read a few chapters in my orthopedic book. Orthopedics is one of my weaker areas and I need to bone up a bit. It seems strange that there is only one more term, 15 more weeks. I am so not ready to go out there and BE a nurse practitioner. Emotionally scary, that. I suppose that is how all new grads feel when they go out there, so I will try not to perseverate about it.

My big concern this time is the SCHOLARLY PROJECT…..the dreaded thesis of yore. A classmate who is a term ahead of me stated she almost threw up when she read the syllabus and expectations of the scholarly project. Okay, I suppose that is good to know ahead of time. She did say to really work your ass off the first week to fill in the “matrix” and the rest would flow.  Now if I could just think of a good subject, which is a little hard to do if you don’t know the expectations. I have fiddled with the ideas of diabetic foot care, the shingles vaccine, medication compliance issues and fall prevention in the elderly. 

Last term I was still excited about getting the books and prepping my work space. This term is different, motivation seems to lower. The difference must be pretty much sheer exhaustion, mental and physical, and also the realization that, once this is done, I need to go out there and apply for jobs. Yuk, I hate applying for jobs. In the past, every time I thought I was getting a good one and the people seemed nice and all that, the job turned into a disease. The employer owned you for a salary, and always took advantage. I am too damn old for those games now. I hope that I can find a nice quiet little corner to do my thing, working with nice people who appreciate me. Is that too much to ask? Hopefully not. I work hard, I am honest, I care about how and what I do. Sending up prayers, God, that the right place will come up for me. Heaven knows I have worked hard enough to get to where I am educationally.

So, here we are, sitting at the desk. It is dusty, there are coffee rings on the surface. The books are stacked a little haphazardly. The pencils are not sharp. Piles of old clinical log sheets and papers take up half the space. The laptop is new, the old one fell off the sofa and died a spectacular death. I never saw such weird patterns on the display before…at least that was after I took my final. Do I feel like making it all pretty and tidy? Not this time. The piles of papers will have to go on the floor to make room for the new ones. I will push enough stuff aside to make space for the new stuff, and I will continue to plug away at all of this, including the “matrix”, until is done. 15 more weeks…

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I am assuming that uconn stands for University of Connecticut, also assuming it is the medical school. I have recently received several really nasty comments on my postings from email addresses with uconn.edu as the place they came from. I am choosing not to allow the comments as they contain words like “cowards” “phonies” and “losers” and other such names.

I am hoping that this is not the average med student’s mentality. God help us if it is…I would think the real loser is someone who stoops to petty name calling when speaking to people who are trying to do some good in this world by caring for and about others.

I would have hoped someone who is in medical school would be above kindergarten name calling. Unbefrickenlievable!

 

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Knowing that I can say I graduate this year is very liberating. There is light at the end of the tunnel. The weight of all this is not quite so heavy, though I still feel a bit stretched thin. I decided to take today off.

Yesterday I posted the case study response, logged my patients for the week and sent in the time sheet for the clinical hours. Today, I decided to give my brain a much-needed rest. Of course, I fell into the trap of responding to “Bob” who commented negatively on the “Nurses masqurading as doctors” post. Oh, well, at least I didn’t get steamed up about it. There will be “Bobs” forever. The good news is, I surround myself with positive people who see the value in NPs, who are great clinicians and willing to share their pearls instead of assuming I am too “logic-impaired” to understand.

Life is good. I am learning every day. The book knowledge is turning into actual experience, the “oh crap, what do I do” moments are getting fewer and far between. I have helped people, have gotten lots of thank you’s and “good luck in school” from patients. My years of nursing experience have been augmented by new skills and knowledge, it’s all cool. I know I will never know it all, and learning will continue until the day I retire (hopefully around the time I turn 90).

So today will be spent hanging sheets on the line out in the beautiful sunny day we are having (there is nothing like fresh wind-blown sheets on the bed), watching a movie, sitting outside with a book, a cup of hot tea and watching the birds, hugging my long-suffering husband, having friends over for dinner, and just generally doing nothing related to healthcare.

Tomorrow I will study some more. Still sorting out the million birth control options and diabetes management which seem to be the top two things at the health department clinic…

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