Category: Professional stuff

I am only a nurse practitioner

~ ladyquirky ~ 10 Comments

As I walk through the side entrance of the hospital, my white coat flapping in the Texas breeze, I am quiet and introspective. What will the day hold for me? Do I have the knowledge and skills necessary for assessing and diagnosing my patients? Will I know the current evidence based guidelines? Am I good enough to do this job? 

When my patients enter the hospital, they have a problem which is causing them physical or psychological distress. They did not come into my professional realm for a social call, they need me to intervene and fix the problem. Usually, by the time they are admitted to the floor, they have already been examined and assessed by a physician in the emergency room, and it was deemed necessary to admit them to the hospital for further evaluation and care.

I look over the information obtained in the ER and try to come up with a list of questions I need to have the answer to. I have to evaluate past medical history, family history, personal habits, current medication, and finally complete an interview which is followed by a physical examination. Sometimes, if I am lucky, there are symptoms and risk factors that are glaringly obvious and I know an effective treatment for the malady. Other times, most of the time it seems, I am handed a vague list of complaints which fail to give me a concrete diagnosis. Now, I have to evaluate the things I cannot see with the naked eye or hear through my stethoscope. Subjective complaints are the most difficult to assess. Is the patient telling me the entire story? Are they being truthful? What am I missing? How do I get more information? How can I get this quantified? Is this part of the story pertinent? What else do I need to know? How do I avoid offending or embarrassing this person that came to me for help? How do I bring up sensitive topics? How do I reassure this person that I care? How do I facilitate communication, while using time wisely?

Now, I am not usually seeing only one patient at a time, and all the information I need is not handed to me in a nice little package. I am waiting for diagnostic results and other professional opinions. I am also juggling the needs of the hospital, insurance regulations, personalities of the patients, their loved ones, other hospital staff, and a ticking clock. I make a decision based on the information at hand, and I have to trust my skills to obtain all the information.

I have taken my time to listen to the patient, asked invasive questions meant to probe and uncover the secrets their body keeps hidden in a shroud of mystery. I explain my plan of care and explain the results I am seeking from my interventions. I walk out of the room and sit down to record in the official medical record my findings. I have to maneuver my way through an electronic medical record that seems to have been designed to make finding the details of care difficult to find. I am granted peace and quiet, and no one ever interrupts me and breaks my train of thought. Oh, wait that is not true. I am constantly bombarded with questions and requests for my time, attention, and energy.

Constant terror that I missed some potentially fatal condition, or that I will not order the proper intervention or screening lies just under the surface. I find myself double checking and reviewing medications and test results. I discuss the case with my supervising physician. I waiver at times in my resolve. Then, I have to make a decision. I find myself reviewing the case with other members of the health care team and asking for their insight on the patient’s condition. I attempt to make sure the nurses concerns are addressed. I seek to educate and give them insight to the rationale for proposed treatment. I have to give them options and hope they are agreeable to the plan. I have no power to force compliance. So, my argument had better be convincing. I have to be able to communicate with people regardless of the language they speak, their cultural biases, and their education and intelligence level. I have to provide care that is accessible to everyone regardless of the barriers to knowledge. I have to find a solution for any roadblock. This requires extensive knowledge and comprehension of an unending list of resources and rules for utilization. It also requires the ability to overcome whatever social issues arise. I am tasked with having difficult conversations, while maintaining a professional manner.

One of the biggest issues I face is discharge planning, which actually begins the moment a patient enters the hospital. What has to happen in order for the patient to be deemed stable for discharge? What kind of follow-up care will they need? How am I going to plot a course of improved health for this individual? What are the financial implications? What resources are available? What are the rules for the care I seek? How do I properly justify medical necessity?

Oh! Don’t forget patient satisfaction scores affect every thing I do. If the patient is not happy with the proposed treatment, or if they feel something else would be more enjoyable, they can affect the amount of reimbursement the hospital receives in the future. How do I satisfy someone when they are sick? How do I explain the difficulties with pain control? Is it my job to somehow make you pain-free, when there is some part of your body malfunctioning? How do I make the patient understand they have to get out of bed when all they want to do is sleep through this process? How do I make them happy about the dietary restrictions for their particular condition?

Sometimes, I go and speak to a patient and spend a considerable amount of time with them, I explain my role and that I am going to be providing their medical care. Yes, I am operating under the supervision of a physician, and I would not have it any other way. After I have gone over every thing and I have documented the encounter adequately, and met with all the members of the healthcare team, I hear this statement, “The patient and their family are upset because no one has talked to them today.” I am sorry, but WHAT? I just spent an hour with this patient and their family IN THE ROOM. This is not including all the time spent with care coordination and other necessary actions. OH…. you want a DOCTOR. Okay. No problem. Now, I have to approach the physician who I have reviewed the case with, assured them I have it under control, and review and recap the entire case, explain exactly what I have done, and reiterate the entire conversation I had with the patient and the family. The doctor walks in the room and spends a couple of minutes, and magically every thing is right with the world.

I am left feeling moderately unimportant. I have spent time to pull up a chair, listened compassionately, and truly worked so hard to take good care of you. I feel like all of my hard work was for nothing. The patient and their family were not pleased with my efforts. They wanted a doctor. I get it. I really do. The problem is… if I am being honest, at times it hurts my feelings. I know it shouldn’t. I am able to think through it and brush it off, but I am left with a little bruise on my ego.

You see, I am only a nurse practitioner. I am not a physician. I am competent to provide medical care, and I know my limits. I have no qualms with admitting when I do not know the correct answer, and I am not afraid to ask for help. I crave and value the education my supervising physicians provide for me on a continual basis, and I am never offended when they provide alternative treatment plans or point me in a different direction. I am a physician extender. They are ultimately responsible for the care I provide. I respect that role. I respect my role.

I work hard to gain new information and to learn more about caring for patients. I like to gain new understanding from other specialities perspective. I look up the things I have never heard of or don’t particularly understand. I am exquisitely curious, and I am driven to constantly be better. My professional goals center on providing the best care possible for the patient. I am here to provide safe, competent medical care.

Due to my professional path, I am still a nurse. I have a complete grasp of the realities and responsibility of this role. I was also a unit secretary. I understand the complexities of the relationships between all the people on the team. Sometimes this is a hindrance. I held myself to high standards, and sometimes I find myself judging other people as harshly as I judge myself. I have to work continuously to encourage and promote open lines of communication. I want the other people involved in providing care to feel they can come to me with any issue or question that arises. This is difficult at times because I am entrenched in my own inner battle with my own insecurities.

I am not certain if the fear of making mistakes is normal for all healthcare providers, but I believe this fear keeps me on my toes. The balance between humility and confidence is sometimes difficult to achieve, and I fear I may fail to provide the necessary reassurance that I will do every thing in my power to meet your needs. It is difficult to be confident when every thing is so gray. I think this may be one of the most difficult parts of my job.

I have learned healthcare providers are just human. We are attempting to unlock the mysteries of your body, and there are infinite factors that must be considered. We are bound by limitations of medical knowledge, as well as the logistical nightmare of resource utilization. We can offer suggestions and proposed treatments, and we can attempt to forecast the results of those treatments. However, we are left powerless as to the actual outcomes. We do our best. We do what has worked the best in the most number of people possible.

Nothing is guaranteed, yet we are held responsible for the end result. If you live, God saved you. If you die, we killed you. This is a huge burden. The emotional toll it takes on me when there are bad outcomes has to be faced head-on. I have to process the feelings, evaluate the situation, and hopefully learn a lesson. Sometimes the lesson is simply a reminder of human limitations and the fact we are all mortal.

So, I live in constant fear and feel an enormous amount of obligation to provide the best care for my patients. I have to push my ego aside and bury my pride. I have to portray myself as competent to facilitate confidence in my abilities. I have to remember my limitations, while simultaneously trusting my skills and intuition. I will chase every resource available to improve your health or quality of life. Sometimes, the patient or their family’s wishes are in direct opposition to the best treatment. We are tasked to keep someone alive on life support when their quality of life is dismal. Or, we keep providing measures that simply prolong suffering when there is no chance of survival. These cases are distressing. Running a code on someone when in reality further care is futile seems like torture. However, we are not in charge of what care the patient receives. We offer advice and suggestions, everyone is allowed to make their own decisions. It is difficult to keep every thing in perspective when we are held responsible for the outcomes when the proposed plan of care is not carried out or the patient refuses to comply with instructions and advice.

Please do not forget the required tasks involved in maintaining licensure, hospital privileges, and employment. I have continuing education, certifications, privileges, and meetings I am required to attend. I have to juggle the business of being employed with providing patient care. I have to put my personal life on hold, and out of mind while I focus on life and death issues. I also have to make time for the people in my life who need me to be there. I cannot be preoccupied with work stuff. The amount of compartmentalization required to be a healthcare provider is enormous. I have to remind myself to put work on a shelf sometimes. It is difficult to not be consumed by it all. 

Please, just remember: The physicians and other members of your healthcare team are only human and we cannot perform magic. We do the best we can. I have to be remain constantly vigilant. After all, I am only a nurse practitioner.

Journalists are first responders too.

~ ladyquirky ~ 2 Comments

My heart is heavy today. Another senseless act of violence perpetrated in the most public forum possible. This shooter apparently had a long history of feeling persecuted, and he suffered professionally as a result. According to an article in Newsweek, Flanagan had sued a previous employer for discrimination in response to reported comments disparaging him because of his race. The case was settled for an undisclosed amount of money in 2000. A copy of the complaint is available on the Newsweek article. That’s enough about this dude, I want to talk about the parts I understand.

Yep, that is me- in the dog suit. Went to the fair, pep rallies, and even the MDA Telethon. The ice packs only helped a little. I complained bitterly about it, but who does not secretly dream of wearing “fur” in 100 degree weather? I secretly enjoyed it, but don’t tell anyone that.
I was incredibly fortunate as a teenager. I had a news director at my local TV station allow me to complete an internship in the news department. I was the first high school student to be granted this privilege. I learned so much during that semester, and the opportunity allowed me to gain employment as an associate producer at KLBK when I was 16. Most of my responsibilities were similar to my responsibilities when I was an intern, I ripped scripts, ran the teleprompter, pulled a few stories from the AP wire, and edited some of the video. Sometimes I got to tag along for special events, and I was the mascot (I actually wore a dog suit) for a short time.

I loved my job. It was exciting and fun. I learned a lot of skills which have proven useful in my current career. One of the most important skills I learned is how to deal with people who have (for lack of a better word,) strong personalities. I believe performing on air requires a certain amount of self importance, and self confidence in order to be convincing as a talent. Most of the people I worked closely with were (and still are) amazingly generous people, and I am a better person for having them in my life at such a young age. Tensions ran high frequently in the newsroom, and it is not a place for sensitive people. There are deadlines that cannot be missed, and you have to please a fickle public and more importantly, you have to please your advertisers. The ratings have to be considered, AND you have to use integrity and ethical reporting while not offending the public. Sure, it is a high stress environment.

While our journalists are not often considered “first responders” in the way healthcare providers and police officers are, they do put themselves in harm’s way in order to provide a public service. They are the information centers of our society. Even in our social media crazed society, we still turn on the local news when the weather is ominous. When there is a developing story involving active shooters or bomb threats (just an example), our journalists do not seek cover, they rush to the scene and deliver the most current updates. I like to believe they are acting to keep us safe.

Journalists are tasked with gathering information, and the public is constantly demanding more. We expect in-depth reporting, and exciting video to stimulate our constant craving for adrenaline. We reward the most daring journalists with our hits, tweets, and shares. Only the most exciting (or perhaps adorable) video goes viral.

I am one of the worst critics, and I tend to hold people (especially professionals) to high standards. I frequently forget to express my gratitude, and in light of this public tragedy, I want to now.

I don’t know what this guys problem was. Frankly, I don’t care. I think he is most likely an asshole with a mental illness. Keep in mind, not everyone who is mentally ill is violent. I could spout a bunch of crap on here about the need for gun control and reform for mental healthcare, but I am not.

I just want to thank all the journalists who provide this public service for me. I appreciate the work you do. I also appreciate all the people who took me under their wing when I was just a kid, and taught me so much about looking for the story. You were my first mentors.

Lastly, my thoughts are with the coworkers, families, and friends of the victims of this crime. I am so sorry for your loss. I appreciate the service your loved ones provided for the public.

Just a few thoughts

~ ladyquirky ~ Leave a comment

I am here to be of assistance.

How can I help you?

Is there anything else you need from me?

I will do my best to address your concerns.

This is why I am here.

 

My job is to provide a service. I am a resource. Let me know what I can do to help.

I am not here to get involved in drama. I am not here to compete in a popularity contest.

Your Nurse Practitioner is only human…

~ ladyquirky ~ Leave a comment

  I may have underestimated the power of human connection. As a Nurse Practitioner, I am fortunate to get to meet and know so many different people. You can try all you want to keep an emotional distance. You can attempt to maintain “professional boundaries.” You can almost convince yourself these patients and their family do not affect you.

Sure, this is reasonable. It is all about self-preservation. You have to be able to leave work at work. Otherwise, you would be entrenched in stress and grief all the time. I have to be able to laugh while I am at work. I cannot allow myself to be mired down in the misfortune of the sick and suffering. I am not only a Nurse Practitioner, I am also human and I cannot help but to forge a connection with people.

It may be your wit and charm. Perhaps you told me a dirty joke I was not expecting. Your face may light up when you talk about your children and grandchildren. It does not matter what causes me to allow you into my heart, it just happens. We are humans.

When I am at work, I pour most of my energy into evaluating what you may need. I am filled with self doubt, so I agonize over every decision. (Well, as I mature and have more experience the agony is decreasing.) I hold myself to nearly impossible standards. Sometimes I am inexperienced in your particular condition. The panic sets in and I have to start reading. I rack my brain and try in vain to remember everything I have ever heard about this situation. I do not take my ignorance or inexperience lightly. I ask questions and I am very forthcoming about my need for assistance. My ego is not so fragile that I can’t ask for help. I work hard to remain teachable.

Keeping in mind when I am at work and I make a mistake, the consequences can cost lives or cause irreparable harm. I am invested. The boundaries have to be blurred a little. This makes it difficult when a patient is not responding to the course of action we have laid out. It is especially hard when we run out of tricks to try. Sometimes there is nothing we can do. This is the hardest part of my job.

Now, if you come to me looking for answers and I reach out to the experts and there is nothing else to be done… what now? I don’t get to sign off and retreat back into blissful ignorance. I am now tasked with explaining the situation and helping you decide on which actions are appropriate for further care.

I find this job especially cruel when I think you are going to do well. I see initial success in our last-ditch efforts. The Hail Mary pass seems to be working. Then, despite the successful catch, we fumble the ball. I am going to scramble to try to recover it. Sometimes the damn ball just disappears.

This is the worst part. Dying is part of life. We are all going to die someday. Yes, we can try to help people live as long and healthy lives as possible. There is going to come a time when I have to be willing to sit with you and discuss whether or not you want to continue aggressive medical care. If you tell me you are done, I have an obligation to honor wishes and to support your family through that transition. It goes against every thing in my heart. I want everyone to live happily ever after.

I can try to have boundaries and walls. I can try to keep work separate from real life. Sometimes, I will fail. In order to heal from this grief, I have to acknowledge I am experiencing it. I have to allow myself to feel. I do not want to become a cold, unfeeling person. This opens me up to heartache. I am okay with that. It also opens me up to feeling sincere joy when my patients do well. It is not all just another sad day, there are lots of victories. I get to feel them too. Yeah, it is exhausting at times. It is hard. I would not want it any other way.

Finding Happy

~ ladyquirky ~ 1 Comment

I am finally in a place where my professional life is more secure. I am finding my confidence again. The last several months were difficult for me. I was under intense pressure at work, and it was spilling into every area of my life. I would be bouncing along and thinking every thing was better, then the rug would be yanked out from under me again. I became afraid to take a step. I did not want to fall.

I felt like I was trapped. I did not believe I had the ability to find another job. I did not believe I was good enough to work somewhere else. I had been told I was very good at my job clinically, however my personality and interpersonal communication skills were leaving something to be desired. In a nutshell, I was good at my job, but people did not like who I was! It was horrible. Talk about feeding into the negative self talk. Basically, it did not matter how hard I worked, I was not good enough.

I ended up reacting in unhealthy ways. I found myself locked into a pattern of wildly unstable emotions and I vacillated between wanting to quit my job and digging my heels in and wanting to fight for this job I had worked so hard for. I was losing my grip on reality. I was miserable. The funny thing about all of this is how I did not even know how unhappy I was. I cried at the drop of a hat, I could barely sleep, and I was not very interested in anything.

I find it interesting how a few negative comments can make you question every single bit of positive feedback you are given. It did not matter how many positive things I was told, all I heard was the negative things. It was a non-stop loop. “Nobody likes you. You are not wanted. You need to go somewhere else.”

Now, do not get me wrong I was working hard this entire time to find perspective and to make appropriate choices. I forced myself to try to be happy and to make healthy choices for my life. It was just a constant battle. Nothing came naturally.

The day came where I had to start making some decisions. Did I want to stay or did I want to go? It was horrible. I half heartedly started looking for a new job. I got some calls and offers. I started to find out how many opportunities there were for me. I talked to my family. I discussed it all openly and honestly with my mentors. I went on a job interview and was offered the job. I turned it down. That same week I had an interesting conversation with a recruiter. They had a position open and it sounded perfect for me. The terms were very good. I did not have to move.

So, I interviewed with this hospital over the phone. I really enjoyed the conversation and I was excited to see how it all panned out. It was all surreal. Was I really going to walk away from a full time job for a temporary Locum position? It actually turned out to be the best thing I could have done.

This week has been great. I am helping out at my old job as they are still looking for my replacement. I got to work with Work Mommy on Sunday, and this week has been Work Daddy. I felt like I had returned home. I do not have the panicky, scared feeling I had towards the end when I was leaving. I am simply doing my job. I am spending time with my mentors and I am loving my profession again. Perhaps full time employment is not what I needed.

It is dangerous to place your personal self-worth on your career. I had spent so many years focused on learning this role, and I had poured my heart and soul into it. I felt like a failure. I could not understand how anyone could care about me. I was not good enough.

What changed?

I stepped into a new role. I had very little training, and I was expected to utilize the skills I had acquired over the years. I had to be confident in my abilities or I would not be able to take care of patients. I had to trust people I did not know, and I had to be willing to pay attention and pick up new routines. I had to be okay standing on my own two feet.

Guess what? I did it. I was not perfect, and I found myself feeling inadequate. However, I have been receiving only positive feedback. The amazing part is how I am being supported at the new job, and at my old job. I feel like I have done a complete 180. I am finding my mojo.

I am more centered than I have been in over a year. I feel confident. I have hope for my future. I know I can do whatever I need to do to support my son, and to take care of my obligations. I am enough. I don’t have to be overbearing or demanding. I do not have to go into battle every day to prove I can overcome odds and obstacles. I can just do what I am supposed to do. It is okay to admit I need help. I can ask questions without being ridiculed. No one expects me to be perfect, that was probably all me.

Feeling appreciated is so powerful. It reinforces the benefits of working hard. I am also learning to stand up for myself and to look out for my own best interests. I do not have to ignore my needs to make sure that others are happy. I can be honest about what works for me, and I can insist on meeting my personal obligations as well as my professional ones.

I can make plans today. I can allow myself to do fun things and not feel guilty for not being at work every single weekend. I can take time off without shame. It did not matter how many times I was told to take off when I needed to, I did not believe it was okay. I always felt like I was doing something wrong.

I am learning so much about myself. I am learning to be content. I am finding an intense desire to have adventures and to live life to the fullest. I am curious about the world and my abilities again. I am interested in things outside my job again. I feel like a person again. I had lost all that. I was shrouded in failure. Now, I am so much happier since I shed the cloak.

bran pics for gradbook0127
This kid is back!

Turns out, I am good enough. I am enough. I am not too much and too little all at the same time. I am me. That is a pretty fantastic place to be. I am finding my happy.

bran pics for gradbook0151
I am remembering how to be happy and content. It is awesome. Finding the excited girl I used to be is awesome.

I am finally remembering what it feels like to be have an enormous weight lifted off my shoulders. It is perfectly acceptable to be happy and to love life. Life is good today.

Small town healthcare is different.

~ ladyquirky ~ Leave a comment

My professional life has undergone huge changes recently. Working as a locum has been interesting to say the least. This is my first assignment, and to be honest, I am having a blast.

The most interesting part has been some of the things I have learned.

I take knowing the specialists in an area for granted. Trying to keep a sea of new names straight and remembering the process for dealing with them is interesting. I am lost most of the time. (Good thing the nurses know what is going on. I am so grateful they are so helpful. I really think I would be drowning without their assistance.) You do not just consult nephrology, endo, or GI. THEY DON’T EXSIST! So, I am looking up a lot of things I just don’t do often enough.

Small town medicine is different from medicine at home. The best way to compare it to my past experiences is to remember what it was like before I moved to the ICU as a nurse. I remember the mystery and confusion about how things worked after I transferred patients to ICU. Later, I moved to ICU so I could understand how critically ill patients were treated. I feel kinda like I am back on the telemetry floor, most things can be treated on the floor until they require more specialized care.

There is no dialysis. I miss dialysis. Dialysis is my friend. There is also no cath lab. I am not sure if there is interventional radiology or not. (I am pretty sure not.) This means that patients who need these services have to go.

I have a whole new respect for the hospitals that serve as major medical centers. I used to think it was dumb these little hospitals could not handle these issues. DUH! They don’t have the numbers to justify the expense of highly specialized services. That is why you have the larger hospital to receive the funneled patients from a large area. (It’s all becoming more clear!)

Living in a medical hub is quite different from living in a small town. I am not sure which I like better. The small town is interesting, and requires a broad knowledge base. I would think more importantly, it requires a certain sense of humility and practicality. You cannot be afraid to collaborate, and to admit when you are in over your head. It is very likely there are not four or five physicians following each patient, so you need to have a good grasp of basic standards of care for so many situations.

At some hospitals knowing hospital employees makes you a VIP, in these small towns everyone is a VIP. I love that. I think it is exactly how people need to be treated.

Mostly, I am thrilled to see so many competent healthcare providers in this small town. I suppose I always assumed people settled in these rural areas because they could not hack it in a larger hospital system. No… not so much. They are providing services for these communities and I am impressed. I am glad to be here. I cannot wait to see what other adventures are in store for me.

 

Comfortable and friendly place to stay.

~ ladyquirky ~ Leave a comment
08-Hampton
Nice place to stay.

So, I am working out of town for ten days. I am staying at Hampton Inn in Mount Pleasant, Texas. Let me just tell you, it’s a pretty nice place. Nothing fancy, however the staff here is friendly, courteous, and helpful. I cannot stand it when people act like you are interrupting them when you need to use their services.

My room is always clean when I return, and my stuff is exactly where I left it. The bed is pretty comfortable, and the AC works well.

So, why does this earn a blog post? Well, I just had the most lovely conversation with a woman who works here, and she made me feel so welcome. It is the first morning I was not on the verge of a lonely little weep- fest. (Okay, that may be a slight exaggeration, but it is a little lonely without your family or any of your friends around.) I stood there in the breakfast area while she was working, and had a nice normal little chat. Now, I feel ready to start the day. (Ha! I am so glad I snuck in to steal a cup of coffee before breakfast time.)

It is so important for travelers to be welcomed into a comfortable, friendly environment. I imagine I would be miserable if my accommodations were not comfortable.

The hospital I am at this assignment is also nice. It has been a whirlwind of introductions, and I cannot remember anyone’s name. (Someone may be named Amanda- or that could be Katie. – Katie, if you are reading this, I hope you get a laugh!)

I am thinking I am going to like doing this kind of work. It is challenging and I am learning a lot. Maybe someday I will be a seasoned world traveller, and I will know all the tricks to making a hotel room feel more like home. Until then, I am just grateful for the friendly people.

Mi Vida Locums

~ ladyquirky ~ Leave a comment

So, the first couple of days were exceedingly hard. I was unsure of myself and I was afraid to make a move. Then, today was my first day really by myself. I did fine. I just did what I have been taught. Treating patients is not different just because I am in a different town. I still know what to do.

The only reason I know this is true, is because I have been taught to do a good job. I have been taught to treat the whole patient and to look at the whole picture.

This is a new adventure. By the way, there is not a Target here. I miss Target. It is my go-to when I am out-of-town.

Having fun, learning a lot, and to be completely honest, I can’t wait to go home and get some hugs from my people. I did not realize how much I hug people. If these strangers don’t watch out, they may be victims of the hugger. LOL. Here’s to new adventures.

My Last Day

~ ladyquirky ~ 3 Comments

IMG_9373

So, it’s been a week since my last day in the MICU. This has given me an opportunity to look back on the progress and growth I have experienced throughout my career.

Wow! I have changed a lot.

I remember when I started Pre-nursing courses. It all seemed so complex and difficult. Intro to Chemistry? I studied so hard!!! Looking back now, it is all elementary. (Thanks for that Dr. Watson.) A&P? Ugh! Terrible. I made a C the first time I took the class. Obviously, I took it again. I had to.

Then, fast forward through nursing school. It’s okay, most of it is a blur anyway. I got my first job in the medical field as a Nurse Tech on a Renal Telemetry floor. Let me tell you, this was the last place I ever dreamed I would find my first professional home. These patients were tough! I fell in love with the frenetic pace and the patients. They were mostly chronically ill, and they were often in the hospital way to much.

Perhaps my favorite thing to watch were Renal Transplant surgeries. There is a moment when the kidney is hooked back up, and it turns pink as blood is coursing through it. That is a magical moment.

I graduated, and became a grown- up nurse. After a little more than a year, I moved to MICU. I started the stressful times all over again. I used to cry all the time. I remember the day my first patient died. It was August 4. I think I cried harder than his daughter did.

Eventually, I learned to distance myself a little more from the grief. I learned how to be there, and not feel devastated every time a patient died. Unfortunately, there were still patients who haunted me. Times they hit a little too close to home. The young man who reminded me of my brother. The other young man who reminded me of my brother. The man who made me think of my granddad.

After a couple of years, I knew I wanted to be a nurse practitioner. So, I applied to school. I had already taken graduate level statistics, I was ready. (I really was not, but it was as good a time as any.)

Once the clinical portion of grad school started, I realized no one was going to teach me how to do this job, I had to pay attention and learn. I was so lucky to have wonderful teachers and mentors who were so dedicated to their profession. Dr. Rivas, Dr, Johnson, Dr. Smith, Dr. Kadiyala, Dr. Bradley, Dr. Simfukwe, and Ruan Reast were tireless. They taught me compassion, and they taught me how to look things up. They taught me how to be confident. I am so grateful for these people. I could have never done any of these things without their support.

Now, once I graduated… I knew what job I wanted. Unfortunately, they already had an NP. I waited. For over a year. It was the longest year of my life. Then, the position was open. Keep in mind, they had trained me for two years.

The transition from bedside nurse to NP was hard. Most likely, the hardest part of the battle was in my head. I may have felt I had something to prove. (I am not going to actually admit to that though.) There were times I had to show people I knew what I was talking about, and in my naiveté, I probably made mistakes in how I spoke to them. However, I would like to point out, it was not always unprovoked. Unfortunately, two wrongs never seem to make a right. I hate that. I really do. I want to have some justification for my defensiveness. There is none.

Here are some of the things I learned though.

  1. You do not have to prove you are right.
  2. Tearing someone else down is never the answer.
  3. Sometimes life is not fair.
  4. The patient may come first, but the entire team needs support.
  5. You cannot take back your tone of voice.

Perhaps most importantly, it is never okay to be unwilling to listen. These lessons are going to help me in the future. I am going to be a better NP for them.

Another lesson I learned, it is okay to move on. Your dream job does not mean you have to stay there forever. This has been emotionally difficult for me. There are times I have felt extreme guilt and shame at the thought of leaving. Why? I am not certain. I suppose I felt I owed it to the people who had taught me so much.

There was also a sense of righteous indignity at the way every thing had turned out. I felt the need to convince some people I had not had bad intentions, therefore I was not being difficult. Well, perhaps. Perhaps not. It really does not matter.

Here is the point. The transition from nurse to nurse practitioner is hard. So, very hard. The best thing may be to start in a place where they don’t remember you crying at the bedside because your filter tubing did not flow. (That was embarrassing- I did not know to open the vent.) Sometimes, it is easier to grow up, both personally and professionally when you are not surrounded by people who watched all the awkward phases of your maturation.

I imagine it is not unlike adult sibling relationships. You are still quick to bicker and squabble over the small things. However, when you meet people as an adult, you tend to forge more mature relationships.

While I am going to miss my friends and work family, I am so excited to move on to new experiences. I imagine the learning curve is going to be quite stimulating for me. I love a challenge. I have to admit though, I hope they don’t forget me.

Life is Good

~ ladyquirky ~ Leave a comment

IMG_9367I am a lucky woman. I am a single mom, and my son is the light of my life. I know, everyone says that. He has sacrificed so much for me to have a career, and he has been so gracious and supportive every step of the way.

I do not do it alone, my family has helped us so much! I could not have accomplished any of this without their support. I am so grateful. I swear, I don’t even have the words. What??? Nyki at a loss for words? 

Ty needed something to drive. I wanted something that included bubble wrap and a helmet. Turns out, those are not standard features on any vehicle. 

Here is the best part. We actually pulled off a surprise. My family took him to “look” at cars. I had him convinced I was looking at a car. He had told my mother he really wanted a truck, but he understood if I could not get him one. As if I would not do every thing in my power to get him what he really wanted… that is what I always do. 

Then, he was sitting in this truck. Just to see if he liked it. My brother told him it was his. The look on his face was priceless. He was SHOCKED! The way he said “It’s mine? Really?” He immediately dug in his pocket for his phone, and called me to tell me over and over how much he appreciated it. I think he may have been in shock a bit.

My job as a parent is not to give my child every thing he wants. There are many things he would like to have, and they are out of the question. I am lucky. I work hard, and I have good opportunities. I work a lot, and it takes me away from my family. My son could be bitter and complain about my work schedule. He doesn’t. He always understands.

There have been times in the past he and I have had plans that were canceled after I received a phone call about short staffing. He never complained or whined. He said “I understand. It’s okay. Your patients need you.”

When I went back to graduate school so I could become a nurse practitioner, my time was monopolized by my career even more. My son and my family were so patient and supportive. Even the times I wanted to quit. Without their support, I never would have made it through all of it.

So, now he has a truck. I can only hope he is careful, and the other drivers on the road are careful. I wanted him to have a reliable vehicle. I wanted him to have something to drive he was proud of. I wanted to see him smile. He may be a little spoiled. The good news is he is a good kid. He makes good choices most of the time. He has a huge heart. I am proud of the man he is becoming.

I think I am almost as excited about this truck as he is. I would do anything for him. It’s one of the perks of being an only child. Believe me, he wishes he was not an only child. I remember when he was about three years old, and he informed me he needed a sister. Sorry buddy, not happening. 

So, life is good. It is all worth it. I would do anything to provide a good life for my son.