The Nurse Practitioner’s Place

In an article that I recently read, I saw an interesting level of payscale for nurse practitioners. In the following table, NPs was supposed to be making an average of 87,000. I’d like to know where? I certainly don’t make that much money yearly, even with bonuses. Over at Nurse Practitioner View , he lamented the same subject (unfortunately, I can’t seem to find his article). I’m sure that the RNs are wondering where they are paid 60,000 on average as well?

A family nurse practitioner often sees complicated patients. There are two types of patients on a daily basis. The first is the younger patient who is usually seen for sick visits such as sore throat, ear infection, cough, and urinary tract symptoms. The other type is more complicated and has many morbidities such as diabetes, hypertension, hyperlipids, and COPD, usually in a combination of them. This patient is often labeled as noncompliant.

It is also a battle trying to obtain old records to see what testing has already been done or if there are any conditions that they forgot to tell me about. Sometimes they have been treated for a condition that they weren’t even aware of. Imagine that!

Education is one of the things that Nurse Practitioners do best. My patients have often told me that they learned more in 15 minutes than they have been taught in several years. It’s very important to explain disease processes in easy to understand terms. Too often we forget to “come down to the laymen’s level.” Too much information at one sitting can be too much to focus on and the patient will tune you out. Consider bringing them into the office for separate teaching visits. I am currently working on finding easy to understand patient education handouts.

I am a Family Nurse Practitioner that works in a rural setting providing care to many types of patients. I see pediatric patients all the way up to geriatric. I really like seeing entire families and learn something new every day about family dynamics.  I enjoy the different aspects of being a Nurse Practitioner. Some of them include:

Teaching- I teach my patients about their health conditions and how to better take care of themselves. I encourage all of my patients to “help me help you!” This engages the patient and lets them know that their health is ultimately their responsibility. The old saying “You can lead a horse to water, but you can’t make them drink” is very true on our profession. This leads to some frustration at times! 

Clinical investigation- This is the part of being a Nurse Practitioner that I learn the most from. Every day patients present with a mystery of some kind. Sometimes, it’s a really difficult process to finally put a name to a diagnosis because of very similar symptoms to other diseases. You must remain open to all potentials and never arbitrarily rule out things right off the bat. This is also the scariest part of my job because of the fear of misdiagnosis. I would NEVER want a patient to have a bad outcome because I missed an important clue to their problem. This is one reason why I take so much time with my patients. Yes, it makes me run behind, but I think they really appreciate it when it’s their turn.

Appreciation- I enjoy receiving the thank yous for taking such good care of my patients. I look forward to a smiling face coming back to tell me that they feel better than ever. There is also nothing better than seeing smiling children’s faces when they run up to hug their favorite NP. It still inspires me and gives me goose bumps and I pray that I never lose that feeling.

I hope you enjoyed hearing about why I enjoy my practice and look forward to any comments! Please feel free to let me know if there are any subjects that you would like to see covered.

Until next time, Stay healthy and happy!

I read recently about trying to improve doctor/nurse relations and the person’s director said that nurses should pay more attention to what doctors like to eat or drink. Maybe nurses should go back to being the handmaidens? I don’t think so!

I think to improve doctor/NP/nursing relationships, we need to respect one another and each other’s differences first. Giving us bribes of coffee, chocolate, sodas etc. really won’t change our moods. All we want is to have the right information at the right time for the right patient in a relevant manner. Nurses need to also remember that as primary care providers, we are responsible for hundreds of patients. We have many patients to care for at one time and we must keep them all straight. That’s why it’s important for you to give us the short and sweet info (the really important info!). We’ve already had several calls and have taken care of several things before your call happened.

Not too hard???

We Doctors and NPs also need to remember what it’s like out there taking care of 7-10+ patients on the floor, along with dealing with the families and the upper management at the same time for 12 hour stretches. If we all work together, things will move smoothly and the MOST important things will happen. Professional behavior is of the utmost importance. This is the only way that doctors, NPs, and nursing staff can keep from breaking the system. We all know that it’s broken enough already!

Let’s all work together!

Ever wondered what is on a controlled substance list? It’s especially hard when you are a new NP and don’t normally write for these and patients ask for different meds.
Here’s the link !

Here is a huge waste of medical resource money. The article discusses the use of “fake patients” to assess medical providers.
It boggles my mind that 35,000-60,000 is used to have these so called patients go into a practice and pretend to have symptoms in order to evaluate it. It’s some kind of mystery medical shopping. I have patients who can’t afford health insurance or the medications that they need and they are throwing money away like this! Send me the check instead and let me use it for my patients who really need the help and are REAL patients. ARGH!!

SINUS ALLERGIES CAUSES: Can be outside &/OR indoor, seasonal OR continuous, and the severity is related to INDIVIDUAL SENSITIVITY, AMOUNT, and TYPE of pollen/mold/mildew/dust/dander in the air. Once your nose is sensitized and swelling has started, even small amounts of extra irritation can cause problems with congestion. Check your home/work for triggers, may need air filter units, removal of carpets (esp in bedroom), vacuum with HEPA or water filter system, wet mopping, swiffer type of duster/floor sweeper. An excellent resource is www.allergy.com. WHY TO TREAT: If allergies are uncontrolled, will lead to sinus infections (viral then bacterial), scarring, growths, &/or polyps.
HOW TO >Start 1-2 weeks before season OR keep taking meds every day
TREAT: >Use LOWEST amount to keep control
>Each medicine works differently, so may need to use combinations for better control
>Taper or stop medications ONLY IF YOU ARE NOT HAVING ANY SYMPTOMS
>May need ENT &/or allergist referral if not controlled with medications
MEDICATION LADDER
MEDICATION TYPE
Nasal Steroid
*Start FIRST & Taper off LAST
Decreases irritation BEFORE SWELLING BEGINS, so best to use early before symptoms get bad. BEST FIRST MEDICATION IF NEEDING CONTINOUS OR SEVERE SEASONAL SYMPTOMS
Leukotriene Inhibitor
*Start/taper SECOND
Stops chemical reaction at start of swelling (before histamines are released), good for added protection if symptoms not controlled with other meds; Used for asthma and sinus allergies.
Singulair 10 mg PO QHS
Antihistamine
*Start/taper SECOND or THIRD
Stops chemical reaction that causes sneezing and MORE swelling, but won’t take care of major symptoms by itself
OTC = Claritin (loratadine)10mg PO daily
OTHER:
Decongestant
Alternative/Additive
*Use first if other meds not working, or after exposure to allergens to stop problems
Excellent for use alone or in combo with decongestants, OK if high BP; Rinses nose to get allergens diluted/out, naturally shrinks tissues with excess swelling/water pulled from tissues due to salt content. CAN’T OVERDOSE OR CAUSE MORE PROBLEMS
OTC = Ocean Mist, Ayr. 2 sprays to each nostril daily/BID
Decongestant
*Use if other meds not working.
Shrinks swelling, helps you to breath. *TAKE FOR ONLY UP TO 5-7 DAYS
**AVOID AFRIN TYPE SPRAYS
(worse congestion due to nose irritation)
***CAN’T TAKE IF HIGH BP
(unless OK with healthcare provider)
OTC = Sudafed, or other meds with Psuedoephedrine, etc

I will be posting healthcare educational handouts for NPs to give to their patients from time to time. Feel free to distribute them to others!
Diabetic Foot Care Information
People with diabetes experience higher than normal blood glucose
levels, which can affect the heart, eyes, kidneys and feet. This
handout focuses on why it is especially important that you take
proper care of your feet if you have diabetes.
Two Reasons for Foot Problems
One factor contributing to foot problems in diabetes is nerve
damage, which causes a lack of sensation in your feet. As a result,
you might not feel pain, heat or cold. A minor cut on your foot could
get infected, and you might not even notice.
Another problem you might have is decreased circulation, which
means that less blood flows to your feet, making it harder for
wounds to heal.
Common Foot Problems
If you have diabetes, you’re at greater risk for foot problems that
can lead to infection:
• corns and calluses caused by rubbing or pressure on the same
spot, forming thick layers of skin
• blisters caused by shoes that do not fit properly or by wearing
shoes without socks
• ingrown toenails, which are toenail edges that have grown into
the skin
• dry and cracked skin, caused when nerves in the legs and feet
do not receive the message to keep the feet soft and moist; germs
can then enter through the cracks
• athlete’s foot (caused by a fungus), leading to red, cracked and
itchy skin and thick, yellow and hard-to-cut toenails.
How to Care for Your Feet
Wash your feet every day using warm water and a mild soap.
Use your elbow or a thermometer to check the temperature of the
water — lack of sensation in your feet may prevent you from feeling
when water is too hot. Pat your feet dry with a soft towel.
If the skin on your feet is dry and cracked, use a moisturizing
cream. Check with your nurse practitioner about which kind to use.
Never put the cream between your toes, since this could create an
atmosphere for infection.
Inspect your feet every day for problems. You might need to use
a mirror or enlist the help of someone you trust. Do not try to treat
any foot problems with home remedies.
You may file corns or calluses lightly with a pumice stone or
emery board if your NP says it’s OK. Also, cut your toenails when
needed after you wash your feet, since the toenails will be soft at
that time. Trim straight across, and do not cut them too short. If
your toenails are thick or too hard to cut, your NP can help you.
Wear shoes all the time to avoid irritations that could worsen or
become infected. Do not leave your feet exposed by going barefoot
or wearing sandals. Even at home, you should at least wear hardsoled
slippers. Wear surf shoes at the beach, and remember to
apply sunscreen to the tops of your feet when you are outside to
avoid burns.
Finally, if you smoke, stop immediately. Smoking damages blood
vessels, decreasing circulation to the feet.
The Right Shoes and Socks
Poorly fitting shoes can cause injury or irritation. Buy shoes that
fit correctly — you should be able to wiggle your toes in them.
Avoid plastic shoes since they don’t stretch and your feet cannot
breathe. Instead, choose leather or canvas shoes to support your
feet and let air in and out.
Break in your new shoes gradually. In addition, inspect each shoe
every day before you insert your foot. Make sure there are no torn
linings or foreign objects, such as a tack or a pebble.
Always wear cotton or wool socks with your shoes to avoid blisters.
Socks should fit loosely and leave no marks on your skin.
Stockings can also be worn. Make sure they are not too tight — they
shouldn’t leave marks on your skin, either. In some cases, you may
need inserts or even custom shoes to help with your foot problems.
Avoid the Worst-Case Scenario
Schedule a visit with your NP if you are having a problem with
your feet that won’t go away. If you avoid treating the problems,
your feet could become infected, and poor blood flow could slow
the healing process. Make sure you get your feet treated so that you
can avoid severe complications such as amputation.
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