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.

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.

It's about time

Third female lawmaker introduces bill to limit men’s Viagra access

By Liz Goodwin

National Affairs Reporter

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By Liz Goodwin | The Lookout – 4 hrs ago

http://news.yahoo.com/blogs/lookout/third-female-lawmaker-introduces-bill-limit-men-viagra-204340160.htmlhttp://news.yahoo.com/blogs/lookout/third-female-lawmaker-introduces-bill-limit-men-viagra-204340160.html

Democratic Ohio state Sen. Nina Turner is the third female lawmaker to introduce a bill that would limit men's access to Viagra and other erectile dysfunction drugs to make a statement about the dozens of anti-abortion bills that have passed statehouses around the country over the last year.

Turner is opposed to a proposed bill that would prohibit abortion after a fetal heartbeat is detected, which can happen as early as six weeks into a pregnancy. The Dayton Daily News reports thatTurner's bill would mandate that men seeking Viagra be "tested for heart problems, receive counseling about possible side effects and receive information about 'pursuing celibacy as a viable lifestyle choice.'"

Turner said on MSNBC Monday that the bill is about showing "men as much love in the reproductive health arena as they have shown us over the years. My Senate Bill 307 is all about the love and making sure we look out for men's sexual health."

Rep. Lynn Wachtmann, the heartbeat bill's sponsor, told the Dayton Daily News that the comparison between Viagra and abortions isn't valid.

Turner is one of several female Democratic state lawmakers who are wielding the power of sarcasm to protest a wave of anti-abortion legislation.

In January, Virginia state Sen. Janet Howell introduced an amendment to the state's controversial ultrasound bill, which required women seeking abortions to first undergo a vaginal ultrasound. The amendment, which failed, said that all men seeking Viagra would have to first get a rectal exam. The ultrasound bill passed after Republican Gov. Bob McDonnell successfully requested that the vaginal ultrasound requirement be removed. Women seeking abortions will still have to receive an external ultrasound under the new bill.

Earlier this month, Illinois state Rep. Kelly Cassidy introduced an amendment to another bill that would require women to get ultrasounds before being allowed to get abortions. The amendmentmandated that men seeking Viagra watch a graphic video about the drug's potential side effects. "If they are serious about us not being able to make our own health care decisions, then I'm just as serious about them not being able to make theirs," she said.

Missouri state Rep. Stacey Newman, a Democrat, introduced legislation that would allow men to get vasectomies only if their life depended upon the procedure, which was similar to Georgia state Rep. Yasmin Neal's bill. "In determining whether a vasectomy is necessary, no regard shall be made to the desire of a man to father children, his economic situation, his age, the number of children he is currently responsible for, or any danger to his wife or partner in the event a child is conceived," the tongue-in-cheek Missouri bill reads.

According to the abortion rights group the Guttmacher Institute, a record-breaking 92 new abortion-restricting laws were passed in 2011. Two of those laws mandated that women have ultrasounds and look at the images before being allowed to get an abortion.

Isn't it about time.

I agree there are many other pressing matters in congress that should be taking the stage.  I do admit, though, I am happy to see that there are women in Washington that I can agree with.  I can't help but think this is all a big smoke screen covering up the bigger issues in the US and around the world.  Sort of a "slight of hand" grabbing all of our attention while the government is slipping the people a mickey, and we are too preoccupied with our daily lives and struggles to notice.  God bless  America. 

http://www.usatoday.com/news/washington/story/2012-02-11/obama-birth-control-cpac/53046728/1http://www.usatoday.com/news/washington/story/2012-02-11/obama-birth-control-cpac/53046728/1

I cannot believe we are having this debate.  It's birth control, they are not talking about something new.

No Choice

http://www.ama-assn.org/amednews/2012/03/05/gvbf0305.htm

States challenge federal contraceptive coverage mandate

Seven states are suing the federal Dept. of Health and Human Services over the health system reform law's mandate requiring businesses to provide women insurance coverage for certain birth control without patient cost-sharing.
Florida, Michigan, Nebraska, Ohio, Oklahoma, South Carolina and Texas say the rule is unconstitutional because it forces religious schools and religiously affiliated employers to violate their moral beliefs by subsidizing contraception. The lawsuit, filed Feb. 23 in the U.S. District Court for the District of Nebraska, asks a federal judge to block the government's requirement.
The Obama administration recently released a proposed regulation to implement the reform law's birth control coverage mandate. In response to criticism of the initial rule, the administration said Feb. 10 that health insurance companies, rather than the religious institutions themselves, would provide employees with the contraceptive coverage. But some states and religious organizations said the compromise did not go far enough, renewing their call for a full exemption from the mandate for entities that oppose birth control.

Texas to ban abortion providers from Medicaid program

Starting March 14, Texas will exclude organizations that provide abortions from a women's family planning program, according to a decision by Texas Health and Human Services Executive Commissioner Tom Suehs. The state's Medicaid agency is defying a December 2011 denial by the federal Centers for Medicare & Medicaid Services of Texas' request to keep abortion providers out of the program.
The Medicaid Women's Health Program, funded in part by the federal government, provides birth control services, Pap smears and family planning counseling based on natural methods to more than 180,000 lower-income women. Single women who earn as much as $20,148 a year are eligible for the program. Texas' defiance of the CMS order could endanger the federal matching funds that help pay for the services.
The Texas Health and Human Services Commission is obligated to follow state laws, said commission spokeswoman Stephanie Goodman. "We have a state law that our attorney general says is constitutional, and it bans abortion providers from taking part in the women's health program. We can't violate a valid state law just to please Washington. We hope CMS will reverse its position and allow the program to continue."
However, federal law prohibits states from excluding health care entities from Medicaid programs for reasons not related to their qualifications to provide services, according to a Dec. 12, 2011, letter from CMS Deputy Administrator Cindy Mann to Texas' Medicaid agency. Goodman said certain federal court decisions have allowed states to exclude health entities from their Medicaid programs for any reason.
More information about the Texas women's health program is available online (www.hhsc.state.tx.us/Help/WHP/index.shtml).


(My Turn)

Is it just me or are we going backwards?  I find it extremely scary when the presidential candidates are talking about birth control and women's right to access.  Access is being limited to birth control, which means that the lower income families are having more trouble affording it.  Then to top it off, government wants to limit access to abortions.  So, let's stop a lower income family from being responsible, and preventing more hardships for their family so they can work on supporting the mouths they already are struggling to feed.  Then, if they do have an unplanned pregnancy (because the government has restricted them from family planning) they are unable to afford that too! Finally, the same presidential candidates are complaining about people soaking up government aid and "taking advantage of the system."  What the hell are people supposed to do? Preventing access to birth control is not going to prevent people from having sex!  Haven't we learned that from the Bush administration of preaching abstinence instead of education?

It seems like it's more than just pro choice and pro life.  It's more like no choice for poor life!

I do believe that Viagra is fully covered under Medicare, what does that tell you?  There doesn't seem to be a moral conflict over whether or not institutions should cover erections, but heaven forbid (pun intended) institutions cover responsible family planning.  I'm surprised that more politicians aren't for birth control and abortions. After all, most of them turn up in the news hiding scandals where illegitimate children are covered up after  having cheated on their spouses.  What is most appalling is the female support in Washington, we can't even blame it 100% on the men in Washington.  Is that what happens after menopause? You become an extreme conservative, disapprove health care coverage for children and have rapist children, oh, and don't support access to birth control or abortions (Jan Brewer)?   

Finally, I wonder if all these talking heads with no medical background or experience (similar to the folks who run our hospitals), take into consideration that birth control has other medical indications from just preventing pregnancy?  Did you know that birth control is used to prevent extreme pain associated with premenstrual syndrome?  It helps heavy, out of control bleeding during periods.  It also helps with ovarian cysts.  Anyone ever heard of a condition called enodmetriosis?  Do you know what first line treatment is?  You guessed it...birth control!  Abortions aren't just for irresponsible, disgusting, sluts either (Rush Limbaugh).  How about women who want nothing more than to have just one more child (or one child at all) and they get the terrible news things aren't going so well?  They have to make an agonizing decision about continuing with their pregnancy, after finding out that there are severe chromosomal malformations.  Their pregnancy may end in spontaneous abortion or a severely disfigured incapacitated newborn who may not live more than a few days after birth. 

You know, it's not just about preventing pregnancy and I'm sick of hearing about these discussions.

Psychological disorder or chemical exposure

http://www.usatoday.com/news/health/story/2012-01-26/Facial-tics-verbal-outbursts-perplex-community/52810214/1?csp=34news

I wanted to share this story. 12 students at one school have become suddenly stricken with symptoms of tics and outbursts that resemble Tourette's.  10 of them are being treated by the same neurologist, and he diagnoses them with a psychological condition.  The school swears there is nothing wrong with the environment, the superintendent is backing this claim.

One thing I don't understand is how easy it was for Erin Brockovich, with no medical background, to link their symptoms to a past chemical spill, but the neurologist has "ruled out any medical and environmental factors." What are the motives of the neurologist? I think that, as a nurse practitioner, if I had 10 patients walk into my clinic with the same symptoms, I would start trying to connect the dots. I feel like this "conversion" diagnosis, might be a bit hasty and more research is warranted before these kids get straddled with a psychological "disorder."

 According to the U.S National Library of Medicine "Conversion disorder symptoms may occur because of a psychological conflict. Symptoms usually begin suddenly after a stressful experience."  It states that, the symptoms are: blindness, paralysis, inability to speak and numbness.  Nowhere does it state that there are tics involved or Tourette's like symptoms. So, you mean to tell me that all these kids have been exposed to some major psychological conflict and everyone of them are suffering from the same symptoms as a result? I am only family nurse practitioner, I didn't specialize in psychology, so maybe it is more difficult for me to understand.

As a parent, I would start by taking my kids out of this school.  Second, I would take them to another neurologist for a second opinion.  As a nurse practitioner, I would certainly look at the the links that these kids had in common: same school, same town, same drinking water???  I know as a provider when you are in a situation it may be a little murky up close.  It is always easier to see things more clearly as an outsider.  Even if these symptoms are not directly linked to the chemical spill where the school is located, the chemicals have a laundry list of other adverse conditions they can cause.  These are certainly enough reasons to get these kids into another environment or at least another school district until things are sorted out.

Well...NOW you tell me

http://reesenews.org/2012/01/22/unemployed-and-unqualified-education-cuts-may-leave-nc-workers-without-jobs/29314/http://reesenews.org/2012/01/22/unemployed-and-unqualified-education-cuts-may-leave-nc-workers-without-jobs/29314/

I think this explains a lot.  It isn't that there aren't openings, the retired nurses and nurse practitioners are eating them up because they have to come out of retirement.  They come equip with experience and tons of knowledge.  How can newbies compete???  I don't envy them either, though.  After I worked for 20 or 30 years, I would be ready to take it easy and enjoy some quiet time, not return to the jungle and work my ass off some more.

Nurse Practitioners and birth control

Check this out:

http://www.theday.com/article/20120114/NWS01/301149898/1044

 State clinics report success providing contraceptives to high school students
TheDay.com
"This is about preventing sexually transmitted diseases and teaching about healthy relationships and abstinence and postponing sex, and preventing some high-risk behaviors," said Ruth Goldbaum, nurse practitioner at the school-based health clinics in ...
See all stories on this topic »

Are we teaching the right thing or sending the wrong message?

Starting out

My first job I landed as a nurse practitioner was working in women's health.  I was very fortunate to get that experience.  I had a blast too.  What better patients to relate to?  They have questions that I may have asked myself, they have parts that I can certainly relate to and they have concerns that I can sympathize with.  I spent my years in nursing in Cardiac, so the physical exam took a little while to learn how to do efficiently.  I was used to listening to lung and heart sounds, managing IV lines and monitors for the heart.  I could do an EKG in no time flat, but a pap smear, endometrial biopsy, interpret a transvaginal ultrasound?  That was going to take some getting used to.  We had to learn how to do paps in clincials during our last rotation in school, but there was always someone in the room there to help guide you to the correct angle to get the cervix into view.  There was an instructor there to hand you the instruments in the right order.  What am I going to do when I have to remember the order in which to proceed and find that retroverted anatomy with the difficult cervix that doesn't want to come into view without a fight?

My first week on my own was a rapid progression of successes and failures.  I think I did about 3 pap smears on my first morning before I was able to get the cervix to pop into view on my first try.  I was pretty impressed and I think I startled my patient a little bit with my outward celebration of identifying her anatomy without any assistance.  I was quick to reassure her that things were fine and her pap was a success(and that I wasn't a weirdo just happy that I did it on my own and I knew what I was looking at).  Other nurses and nurse practitioners know how it feels to have sat through hours and hours of lectures and clinical rotations watching others show you what to do and guiding your hands. It is only when you are in a room by yourself and run into difficulties and finding a solution for the first time while everything that you have learned is falling into place.  Those are the special moments that your patients may or may not realize that they are a part of.  It is about your patient and delivering the best possible care, but until that light goes off and everything that you have read about is finally making sense that you start to become the practitioner that you have been preparing for.

In my previous posts I have complained and put down nursing and the medical field, but ultimately I do think it is a calling and a special touch that you have to possess in order to make this work.  Nursing is one of those special fields where you are able to touch people's souls, but what you don't realize is that they are going to touch yours too.

Great Website

A great website that is free and offers a ton of tips and webinars on jobs, bosses and other situations.  Advance for NPs and PAs.  http://nurse-practitioners-and-physician-assistants.advanceweb.com/

100 Reasons

  Advance for NPs&PAs puts out their job outlook for 2012. There is a supposed bright future for nurse practitioners and PA’s. They state that there is “cause for celebration,” but could they be “speaking too soon?” There are plenty of projected job openings for 2012, but where are they? We keep hearing about Obama’s affordable care act and the projections on the shortages for physicians, Nurse Practitioners and PAs, but I do not see anything actually changing.

I feel like I have a better chance of getting traffic to my new blog than actually uncovering that hidden enigma of the “average salary for an Nurse Practitioner” of which this newsletter speaks. I would love to hear how others are faring out there. I remember my professors coaching us and saying not to settle for “less than…” When I actually got out there on my own, it seemed like the people hiring were not quite sure what to do with me, or what the exact duties a nurse practitioner should consist of, never mind what my actual salary should be.

I just found this website advertising schools for nurse practitioners and it listed 100 reasons to become a nurse. Each time I scroll down the page I ask, “are these 100 good reasons to become a nurse?” I need something to help me crawl out of this funk and learn to appreciate my profession the way others say that I should. Where is this prosperous, wondrous, fulfilling field they call nursing? And what am I missing?

"You want to make a positive contribution," and you want to "do something that matters." I would say those are two good reasons most of us become a nurse. Those are the top 2 reasons on the website list too. After about 6 months of nursing at the bedside that you realize, you are grumpy and over worked. There is nothing positive about your contributions and if feels like nothing you do matters. Now that you have established feelings of unhappiness with the health care system, you find the drive to become something more. Here is where the nurse practitioner starts to penetrate your thoughts and leads to the illusion of an escape.

There was a time when I was starting my classes for the nurse practitioner program when I would ask the nurse practitioners how they felt about their jobs. They loved it. They were so happy and they were motivation for me to keep going even when things were really tough. I was balancing school, work and home, and it was not easy. That's how most nurse practitioners do, though. It is not an easy process. I think that most people perceive nursing easier to get into than medical school and maybe it is. I will tell you that most doctors do not complete their schooling while working full time and raising their families. So, one would think that the end results would consist of mutual respect and understanding for one another. Where are those nurse practitioners that kept me ticking and where is the fountain that they drank from?

References

The 2012 Job Outlook for NPs and PAs.  Advance for NPs&PAs. http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/The-2012-Job-Outlook-for-NPs-PAs.aspx.  Accessed January 6, 2012.

100 Reasons to Become a Nurse.  Nurse Practitioner Schools, 2009. http://nursepractitionerschools.org/100-reasons-to-become-a-nurse/.  Accessed January 7, 2012.

A Nurse Practitioner's World: Not "just" anything...

A Nurse Practitioner's World: Not "just" anything...: Happy New Year, and welcome to 2012, nurse practitioners. We have another year to educate the public and our colleagues regarding nu...

Not "just" anything...

Happy New Year, and welcome to 2012, nurse practitioners.  We have another year to educate the public and our colleagues regarding nurse practitioners’ roles in the medical field. I realize I am a nurse and always will be.  That makes me happy, I don’t claim to be anything other than.  I do, however, get a little miffed when I am not acknowledged as a provider because there is “nurse” in my title. 

How often are other professionals asked if this is the best they are going to do with their career?  “So, when are you going to become a doctor?  You only want to be a nurse?  It can’t be that much more to go back to school.”  Is that supposed to be some sort of motivating speech to make me think about doing better with my life?  Thank you for bringing to my attention how unhappy I should be with myself at this moment.

It is also frustrating when other professionals in your field offer positions that you have gone to school to move up from.  There is nothing wrong with being an RN.  I went to school to become one.  I was one for many years and I could not be an NP without that.  I do, however resent the fact that I should be happy working as one after having completed my training to be a provider now.  RNs are great, but they do not have the same rights and responsibilities for which I have completed my training. 

I am a provider.  I am not “just” anything.  I want the position for which I applied, not something that you need to fill and think that I might be okay with.  If other professionals in my field don’t get it then how can I hold it against the regular public to understand why I am here?  My background is a nurse, now I am here as a provider to treat and manage medical conditions.