Tuesday, December 6, 2016

I'm Baaaaack

Hello world!  I decided to stop blogging and focus on other things.  What I have learned in my time away from here is that I missed blogging!  I have transferred from private practice to corporate convenient care.  It's nice enough and it pays the bills.  I get to have some regular patients and build a small rapport, but it's not private practice.  There are many perks of working for a giant corporation, like benefits, matching 401K and paid time off (which I haven't had in 10 years!).  It is very reminiscent of hospital nursing with shifts, trading and competing time off and lots of paperwork.  However, there is no, I mean no office politics(love!love!love!).

A new demention I have ventured into is the front office.  As a retail nurse practitioner, you are the front, middle and back office.  I now get to check in, assess and treat and collect the copy at the end.  I take vitals, which I never have to question or ask to be repeated.  I don't have to wait until my patients are checked in by the front, and while checking in I can start screening.  I have been able to learn how to basically run my practice with the outline layed out for me.  I wouldn't recommend this position to a new grad, although many of my collegues have only worked in retail.  I feel like the experience I gained in private practice has helped me to develop my skills working in the retail clinic on my own.  It makes me a better practitioner recognizing the warning and danger signs and knowing when to refer to ER versus, urgent care, versus we can handle this over the weekend until you get into your primary physician on Monday.

Retail gives you guidelines, but having practiced in other settings, they truly are guidelines and not the holy grail of practicing medicine.  However, many nurses have also developed these skills in their previous settings as well, not just being an NP in private practice.  But, for me I think that helped.  I want to start consulting and branching to other fields of nursing now and I thought blogging would be a nice way to get some attention and make some more headway.  Hope you enjoyed this one and there should be a steady stream to follow.

Friday, August 16, 2013

A Nurse Practitioner's World: Things they never teach you

A Nurse Practitioner's World: Things they never teach you: Now that my collaborating physician may be going VIP, this gives me the opportunity to learn how to do my own marketing.  These are the thin...

Things they never teach you

Now that my collaborating physician may be going VIP, this gives me the opportunity to learn how to do my own marketing.  These are the things they never teach you in school, whether you graduated from nursing or medical school.  I have been researching and reading websites like never before.  I have been taking blogging classes and reading tips for free and cost effective advertising.  Just when you think you can't think of anything else you find out there is more.  Take a few deep breaths, collect yourself and keep going. Here are a few things I picked up along the way.
1.Facebook is free, connect with your friends and hopefully they will tell their friends and so on.
2.There are free websites out there and you don't have to know computer language or codes.  It will do all the work for you and you fill in the rest to customize.
3.There are blogs for people who are trying to start a business and they have done more research than you.
4.Get people's opinions and have them proofread your stuff.
5.You are a nurse practitioner or other professional, a spouse, and probably trying to raise your kids, and you are not an expert at everything. It's ok to get a little free help from family and friends.
6.Everything is better after a good night sleep.

Tuesday, May 21, 2013

Who's guiding the guidelines?

How does everyone feel about guidelines?  I have recently started working with a physician who disputes these guidelines.  He has some very valid points and he has been in practice for many years, so these points are intelligent and well thought out.  The problem comes in where my training is based primarily on following the guidelines.  If you don't follow the guidelines, then you may be held accountable in a law suit.  I was trained, if you follow the guidelines, they will set you free (with in reason).

 As I look at the hard data, the guidelines also make sense.  I feel that the future of medical care in America has to look at the risks and benefits of having or not having certain tests done.  They also have to look at cost effectiveness.   Is educating the patients regarding the guidelines enough to allow them to make their own decisions? Is an expected life span of 10 years or less enough reason to encourage people to stop screening?  I would think that if I could get 10 more years with the people I love, that would be a good thing, but is it good enough for the government to approve payment for your testing?  Is a lifetime worth more than a healthcare spending budget or the other way around?

From a medical standpoint when the numbers are showing that testing 100, 000 we will catch only a small percent, then why bother, it doesn't sound so bad.  However, when you are sitting across from a patient that landed in the 1-10% and you have to tell them that they are going to die because we didn't screen for this, it doesn't seem so rational now.  My employer has some stories like this.  He has tested patients outside the guidelines and caught quite a few prostate cancers in the early stages in men under the age of 45.  He has many years in Medical Practice, looks at the research and the numbers, but he has been in that chair across from patients that would otherwise not have been screened.

My collaborator and I are constantly debating about the new gynecology guidelines and whether to pap or not.  He disagrees with the 21 and up first time pap smears for sexually active women and young girls.  Should they be subjected to a screening exam because they are being responsible and seeking birth control methods?  Does the birth control effect the changes in cervical cancer or the progression of HPV into invasive cancer enough to withhold until further testing is sought and that would include further invasive procedures?  Furthermore the guidelines never suggest discontinuing OCP usage in women who do test positive with HPV high risk or otherwise.

As I struggle with the decision to base my practice on guidelines or not, I wonder who will be "set free."  I started this article 2 months ago and as I struggle to get tests ordered for my patients and insurance companies are arguing with me. They insist on negotiating to get more tests done instead of just covering the test that I am ordering, now I begin to see the light that is "guiding" my collaborating physician.  I know better than to challenge him on most subjects, because he has 25 years of practice over me, but that doesn't mean that I'm going to stop trying.

Latest research on mammograms and late stage

Thursday, February 14, 2013

Thank you Senator Bill Galvano

There is a new piece of legislation being worked on to keep nurses from using the title "doctor" even if they are graduates of a doctoral nursing program.  A Florida Senator is trying to make it a 3rd degree felony.  A charge up next to burglary, elderly neglect and animal cruelty ending in death.  Sure, that makes perfect sense.  Hey, because I am might be  PhD and say "I'm Dr. Jones" I should share a jail cell with someone who tied a pit bull to a fence and lit them on fire.

I have met Medical Assistants and RNs who call their selves "nurses" and "PAs" and they are not even close to having completed an educational track that could be mistaken as such.  They were not bad people, and they were not trying to pull the wool over someones eyes.  They were simply saving a lengthy explanation of what their actual job entails.  Anyone who has an occupation outside of the doctor seems to need to carry around a job description in order to get patients to understand what their role is.

The hardest position I have ever held is one as a Nurse Practitioner.  The one of the hardest parts of my job is trying to explain to the patient that they don't have to consult with the doctor after seeing me.  I'm not there to take their blood pressure and I'm not going to get the doctor to come in and check up on our plan that we just established for treatment.  I'm not a student doctor, a helper or an assistant.  People who don't work in the medical field (and even sometimes people who do) just don't get what we do.

All that being said, should we make it a 3rd degree felony for saying that we hold a title that was rightfully earned?  We are not ashamed of our titles and we actually want you to understand our roles, but it is really difficult to do in the small time frame which insurance companies and government allot for us to spend with each person.  I actually haven't met a Nurse Practitioner yet that doesn't correct patients or other practitioners when referred to as a medical doctor. I have not met a nurse who has complained when others who do not hold the same level of education refer to their selves as "nurses."  People throw around the title "nurse" constantly without a second thought.  I don't see a law being discussed to make that a felony or any other penalty for that matter. https://www.change.org/petitions/senator-bill-galvano-stop-sb-612-the-doctor-title-bill#share.

Thursday, August 16, 2012

Keep your friends close and your preceptors closer!

The old saying, "keep your friends close and your enemies closer,"  never mind that, keep those preceptors in your pocket.  They know what they teach you, see how you catch on and watch you grow and learn.  What better way to find out if you make a good fit for each other?  This will be the second time a preceptor has come through for me and I am so grateful for that!  I ended up taking some time off for my kids and I am ready to go back to work soon, I just have one problem. I have one year of experience in a specialty and nothing else. 

Oopsy.  I can't go back to my old job because they have filled the position with an MD who is able to deliver babies and take call for surgeries and it seems like a million other skills that I didn't have, she does.  I have interviewed for other doctors' offices that I did not know and they wanted tons more experience, some one eager to roller skate from each exam room, and a 90 hour work week.  Oh, and my second problem?  I have a new baby at home, that I don't want to leave for 90 hours a week.

The good news is that I have kept really good contacts after graduating.  I certainly wanted see how my preceptors were doing and if they needed any help at the moment.  Sure, I have one year of good experience in a narrow specialty, but my preceptors saw what I was capable of and we already know we get along with each other.  I know the pace of the office, and he knows my home situation and is willing to accommodate me.  We have already interviewed each other in the past! Here's another saying my dad has always used to warn me, "be careful of the toes you step on today because they might be connected to the ass you have to kiss tomorrow."  So glad I never took my clinicals for granted.

Monday, May 7, 2012

Networking for the ages

Having lunch the other day with one of my nurse practitioner classmates, we were discussing nurse practitioner and nursing groups.  We both agreed after spending our first year out of school and trying to be active in our organizations, we need a group we can apprecate.  Where are all the young nurse practitioners?  We went to numerous dinners and society meetings, but the members were mostly comprised of our grandmothers.  Ultimately, our goals for nursing rights and nurse practitioner scopes of practice are the same, but there is a significant difference in opinions on how to achieve those goals.

Just like when I was a new nurse, there is this wall up between new graduates and seasoned practitioners.  There should be a network of newbies who can help guide each other, but still be connected to some seasoners who know what they are doing.  There are so many questions...Should I try to start up my own practice, where are the good reasonable doctors, who is willing to train, any good conferences out there, where did you learn how to do that???

I would be interested in joining a group of relatively new nurse practitioners with experience of less than five years.  I think that it would be a great opportunity to get together and discuss trials and tribulations, stumbles and falls and find out who is mentoring them.  Perhaps this smaller "sub group" of newer graduates could piggy back to some meetings with more seasoned nurse practitioners and we could network together.  We love you, Granny, but we never could fully relate.