The Nurse Practitioner’s Place

Come into office. Check phone and desk for messages. Check the labs that came across from the day before, and write out instructions on lab letters to be sent back to the patients. Draw labs on patients that my nurse can’t “hit”.

New pt visit 30-45 minutes: Complete history, including medical, surgical, and family history. Head to toe review of systems. Head to toe physical exam. Address any new symptoms or chronic symptoms. Refill or write any prescriptions needed. Educate about all disease processes and about what each prescription is for. Review if any preventative care has been completed such as mammogram, Pap, colonoscopy, bone density, etc. Request record release so that I can obtain prior records to review. Ask is there is anything else that they wanted to ask me. Explain our “open access scheduling (same day) to set up follow up. Off they go!

Next visit (established 15 minutes)- Medication review, ask if any changes in ROS since last visit. Address new problem or review established problems. Review any test results since last visit. Reinforce education about disease processes.

This process happens throughout the morning until 12:00 when we break for lunch. I usually eat in 30 minutes (left over from the hospital days- eat fast whatever is available). Use the rest of the lunch break to do any of the never ending paperwork.. I REALLY HATE THIS PART!

See patients throughout day varying from pediatrics to geriatrics. I also see minor emergencies such as I&D, suturing, stapling etc. Refer to Emergency Department any cases needing such expertise (You’re up all you emergency room nurses! Keep my patients safe and healthy!) We often get cases as a walk in basis that are serious because patients wait too long before being seen. That’s a story for the next edition..

04:15-05:00- Email or call my collaborating MD to discuss any difficult cases dealt with during the day. Return other physician phone calls if arise. Read through consultation notes received. Discuss the cases encountered during day with my nurse to encourage her to expand her knowledge base as well as pick her brain when needed.

That’s pretty much a day in the life of a Family Nurse Practitioner. I love my job and really enjoy building relationships with my patients and watching them respond to the treatments I recommend. I am taking care of entire families now and that’s what it’s all about!

I had a question at my other blog site that I thought would be a great post for this one. 

If an individual is a Respiratory Therapist (RT) with an associates degree (with the possibility of doing an online completion program to make it a bachelors degree) is it possible to become a Nurse Practitioner without having to completely start from scratch in a nursing program? Like, go directly into the NP masters program? I do understand it is required to be an RN before going to NP school…but there must be SOME route around having to start all over…

Joe, You do have to become an RN before advancing into the Master’s level as a nurse practitioner. The good thing is that it is fast tracked in a much shorter program in many such as the one below that I found online. If you Google the subject, you will find many programs available. 

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 !