Tuesday, September 30, 2008

Lolly Lolly Lolly Get Your Mirena Here!

A while back, newFNP noted that she was caring for a pregnant seventh grader who was not on track to win any genius awards.  This young woman continued to astound all who came in contact with her throughout her pregnancy, which ended happily - though not without adolescent high jinx - on Saturday.

NewFNP's clinic contracts with one hospital.  This hospital is where each and every one of newFNP's prenatal patients are expected to deliver.  It is where they go on hospital tours.  It is where they pre-register for their intrapartum care.  

There is no equivocation in this expectation.  There is no gray area.  One.  Hospital.

So, when the anti-MacArthur Fellow went into labor, newFNP would have expected that she would grab her bag and her copied ACOG form, and would have said to her boyfriend (who, thankfully, was sprung from juvenile detention prior to the big event - WHEW!), "Hey stud, take me to General Hospital."  General Hospital, of course, meaning the one specific hospital where she was repeatedly told to present when the time came.

That is, in fact, not what she did.  Apparently, impending childbirth was not enough of an adventure.  These youthful imps decided to try a different hospital.

A convalescent hospital.  

Seriously?  Even if their combined IQ is still less than the price of a loaf of bread, one would think that they could appreciate the difference between a convalescent hospital (single story, wheelchairs and walkers strewn about, aroma of BenGay) and a regular hospital (multi-story, bright red 'emergency' sign, ambulances).

After a quick transfer via paramedics to a regular hospital, these Mensa members became parents.  

There are not enough hours in the day for newFNP to explain the many and multi-faceted reasons why this terrifies and concerns her.   

Are we still wanting abstinence only education?  NewFNP votes no.  In fact, she is thinking of running for mayor, congress, queen, master of the universe - whatever - on her free Mirena platform.  She'd run for president, but she's not old enough yet.  But son of a bitch if that isn't right around the frigging corner.  



Shana Tova!

Friday, September 26, 2008

Oh baby!

People, it is no great secret that people have complicated lives.  NewFNP has seen a shitload of this in her expanded role as prenatal care provider.  

Take for instance the 20-weeker who complained of daily anxiety and thoughts of fleeing.  NewFNP screened for abuse.  Denied.  Depression?  Denied.  Pre-existing stressor?  Affirmed.  What stress might that be?  Her on-going affair resulting in her unintended pregnancy resulting in her uncertainty as to half of her fetus's DNA.  NewFNP offered support and referral to counseling but felt a little relief when her patient flat out acknowledged that she had made her bed - no pun intended - and that she would have to find a solution.  True.  But take the referrals, hon.  Clearly there are some issues to be worked through chez toi.

Or the 17-year old pregnant woman who tested positive for HCV.  This 17-year old now has to worry about vertical transmission (0-8% risk), about breast-feeding (CDC and AAP say it's OK), about hepatocarcinoma (referral, viral load, genotype pending).  

Or the 30-year old G6P3 who recently separated from her partner, had an unintended pregnancy and - surprise!!  Triplets!

Now, newFNP has generally refrained from turning her blog into a platform for political musings, but here we are in an election where one ticket is opposed to abortion rights no matter what and supports the limited to access to birth control, where the VP candidate wants women to pay for their own rape kits and ban Are You There God, It's Me Margaret, and where the presidential candidate is a huge dick during the debate he tried to bail on.  OK, that last one isn't related to health care, but he was a dick, right?  Geez!  

Do they want more 14-year old parents with limited IQ and limited future prospects?  If newFNP were running for president, she would support free Mirena insertion at age 14 for all females.  Isn't it reasonable for the whole country to delay childbearing to age 19?  Just get through high school?  Fuck, get through middle school without getting knocked up.  

NewFNP was a die-hard Hillary supporter, but she does not at all understand these people who have jumped from Hillary to McCain/Palin.  What the fuck?  Women's rights people!  Remember 'women's rights are human rights'?  Taking care of the poor?  Gay rights?  Not screwing the middle and lower classes?  Valuing education?  Valuing science?  Promoting environmental awareness?  The economy?  Not having nuclear war with Iran?

Oh man, newFNP cannot imagine the consequences of a McCain/Palin White House.  The only good thing that could come of it is more Tina Fey impersonations and, as ridiculously great as that was, it's not enough.

Friday, September 19, 2008

Win-win situation

As many of you know, newFNP was in the midst of a crisis when she made the decision to make a change of venue.  She was really concerned that she had made a huge mistake in becoming an NP.  It was altogether quite unpleasant.

Well, that has all changed.  NewFNP cannot believe her new job. She cannot believe her new attitude.  And she cannot believe her new schedule.

 The downside of the new position is that is holds less responsibility than her clinical role. This will change when newFNP is not so new there, but for now newFNP is feeling a little underutilized.   The upside is every-frigging-thing else.  NewFNP went to lunch today with her colleagues.  Lunch.  Away from the clinical site.  With her colleagues.  The support staff are entirely competent and responsible in their roles.  NewFNP has been told by her supervisor to 'relax' and 'take it easy' - not just once.  Multiple times.  The job is all about attention to detail, about taking your time and doing it right.  It has EMR.  It's 2.5 miles from her apartment.  What's not to love?

And, sweet Jesus, the hours are 12-8PM.  To newFNP, this is a dream come true.  No more fighting in lines at the gym to get the good elliptical machines at 5:30PM, no more blowing off the gym to cry about one's shitty day.  Now the gym is a pre-work activity and not at 5:30AM and not when there are a million other people looking at newFNP is she tries to sneak in a 40 minute workout instead of a 30 minutes one.  Now she can guiltlessly enjoy her full 60 minutes of cardio.  She went to the grocery store - a perpetually crowded grocery store - and it wasn't crowded.  It's a whole new world!  

This must be what it feels like to find religion.

But maybe the best part about being at the new job is that newFNP enjoys the old job a million times more.  This is not to say that she does not experience frustration when she has three 1:30 appointments, but she has adopted a much more zen-like attitude about it.  Saying well, fuck it, I'm not here tomorrow qualifies as zen, right?  In the face of new responsibilities at the new job, newFNP is thankful to feel mastery, or at least competency, in her clinical role.  

Monday, September 15, 2008

Hello awesome!

Oh my god, newFNP never knew that work could be so good.  So fucking good.  So.  Fucking.  Good.

Sunday, September 14, 2008

New Job's Eve

NewFNP is nervous.

Sure, change is good, it helps/forces you to grow and learn, it broadens your horizons, it affords you a bigger paycheck and a shorter commute - at least in this instance.  But, fuck, change can suck.  Role transitions are challenges, even when we are prepared for them, even when we have been longing for them.  Being new anew.  Learning each and every aspect of one's position again. 

All of newFNP's friends and family are telling her that the new job is perfect for her - it's organized, protocol-driven and academic in focus.  Hell, that's a fairly decent description of newFNP herself!  

But, ugh, change.  Even though her new supervisor is all about easing newFNP into the job, there lurks that part of newFNP that is worried that she will fail.  Why would she fail?  Who the hell knows, but she's still scared of it.  

NewFNP saw some movies this weekend, bought some flattering black trousers and designer jeans and is enjoying her last night of vacation with a glass of wine and some EKG review.  

Shopping, wine, George Clooney and studying: something(s) old for tonight, something new for tomorrow.

Thursday, September 11, 2008

NewFNP: vacation lady

Quite a difference from an urban health clinic!

NewFNP loves vacation so much that she wishes she could turn it into a profession.  Alas, as newFNP's mom used to say, it's too bad that we weren't born rich instead of so good looking!

NewFNP has had a lovely time off and actually feels rested enough to start her new job as well as returning to her old clinic.  This fresh glow will fade rapidly, to be sure, once the pulls of clinical life begin anew, but that is in another five days, so in the interest of continued mental wellness, newFNP shan't focus on that.

In addition to spending a few lovely yet bearish and sometimes physically grueling days in a national park, newFNP had the pleasure of meeting a fellow alum of her nursing school - a woman, MLG, in her 90's who graduated in the 40's.  She currently lives in the same senior's community as newFNP's grandparents. When newFNP met her in the elevator, her enthusiasm was intoxicating.  NewFNP returned the next day to talk to her more.

MLG, after completing her bachelor's in English literature, headed to nursing school "to get away" from her family's expectations and to see the world.  She earned her first master's degree, then left the US to work as a war nurse in London.  She returned and worked as a visiting nurse for some years before heading across country to work at a very prestigious hospital as a pediatric nurse.  She left this position, however, when she disagreed with the policies of the ward - noting that they would give the active children phenobarbital in order to calm them down.  She moved to another hospital, where yet another alum was the head administrative nurse, and worked as the chief of pediatric surgical nursing.  It was here that she realized her passion - "the emotional life of children" - and used her GI Bill benefits to earn her MSW.  She spent the rest of her life as a social worker.  When newFNP explained to her that the school now has a child psych NP specialty, her eyes lit up.  She noted how many more options students have now.  

NewFNP noted the different paths that she and MLG took to the doors of the same institution.  MLG chose her path to leave behind and explore, whereas newFNP actively chose, sought out, was wait-listed and then finally admitted to the school.  It speaks to the growth of nursing as a profession, does it not?  Perhaps this only applies to academic nursing programs?

Unlike newFNP, this woman lived in the nursing dorm and had little contact with students from other academic foci.  The nursing and medical schools were separated from the main campus, as they are today, in a then-and-now seedy area.  NewFNP explained that, while there were still dorms for the health-professions students, she lived several miles from the school, in an apartment by herself.  MLG told newFNP that it sounded like newFNP had a lot more fun than she did during nursing school.  Probably very true; newFNP had more than her fair share of fun in school!

Like newFNP, MLG was a part of a group of six friends who have continued to meet regularly for retreats.  Like newFNP, she considers this group of women to have been one of the most valuable aspects of her time spent at this very prestigious and academically rigorous institution.  It's funny - newFNP considers her education to be vitally important, but she could have learned nursing at many institutions.  Her friends, however, are irreplaceable.  MLG's group now numbers only three.   

Meeting this woman was a gift for newFNP.  What a lovely experience to share.