Tuesday, January 06, 2009

Thirty five

NewFNP asked for it.  

She wanted to go part time to save her sanity and now her clinic days are jam packed.  Her days are busier than they ever were before.  It is nuts.  But newFNP is pretty cool with it.  

She's even cool with her depressed patients who can present a true challenge during busy clinic days.  

NewFNP must confess that it makes her a little frustrated and causes her to climb on her soapbox when she sees obvious somatic complaints and notes of 'depressed affect' time and time again in patients' charts yet no one steps up to the plate to frigging ask about it.  

Sure, it may feel as though there is not a lot that one person in a busy health clinic which lacks mental health staffing may do to help that patient.  And sometimes it's absolutely true that providers are just too stressed themselves to take on a depression visit.  But we can't be so stressed that we shelf it to the next visit every time.  That is just shrugging off the job and leaving sad, often ineffective and desperate patients in the same hole.  And it is not true that we can do nothing.  True, newFNP is no counselor, but the act of listening is powerful and making it okay for someone to cry, to disclose a crushingly painful secret, to release some bottled up hurt is therapeutic indeed.

NewFNP has been doing a lot of thinking about what kind of provider she is and what kind she wants to be since she has decreased her clinical hours to part time.  It is so obvious that a smile and handshake is a warm way to start a clinic visit, but newFNP can't honestly say that she was providing that regularly in her darkest hours of full-time employment.  She cringed as she read the NYT health blog and saw her bad behaviors in black and white.  Ouch.  She regained that warmth with her switch to part-time.  

And while she is pretty crappy at orthopedic issues, newFNP is damn good at assessing for depression and she does not want to be the provider who ignores it.  In fact, newFNP has found a new sense of purpose and satisfaction in seeing her depressed patients improve.  The change can be so dramatic - what a joy to see that in someone.  NewFNP has diabetic patients, on the other hand, whose A1Cs have hardly improved since being in her care.  That is not so joyous.

Thirty-five patients today.  And yet, newFNP is happy.  



Loving Pecola said...

35?! Thirty-friggin-five?!? OMG. Sigh. I'm getting closer to the real world and dreading it immensely.

Pam said...

Good for you, New FNP! Way to bust ass and appreciate the rewards of doing so. I'm in my last semester of an ASN program, and the attitude you show in this post is the one I want to have. Good luck to you!

Marty said...

I am glad you are assessing for psychiatric issues because they are out there. How you can do that when you are seeing 35 clients in a day is amazing. Sounds like a health care factory.

It never fails to amaze me that 10-30% of FNP clients have psych issues. I am 1/2 way through a PMHNP program and have done my physical assessment classes and clinical. In the spring I will take the general pharm classes the NPs take, which will touch on the psychotropic meds I will be studying all this quarter. Even though we are only admitting to the DNP for FNPs, they do not take a specific class on psych diagnosis or meds. Considering the amount of psych issues (including substance abuse) seen by FNPs on a dailey basis, I think this would be a valuable element to add to your bag of tricks.

Keep on trucking.


Candi said...

Ok, I have gone back & tried catching up on your blog & I believe I'm halfway through 2007, but I'm confused. I thought somewhere along the way you quit this job & went to another job?

Anonymous said...

I think she did quit the other job, but this one sounds more and more like it every day. What's up NewFNP? BTW, I've been reading your blog since grad school. You do a great job!

newFNP said...

New FNP is 3 days at the new job and 2-3 days at the old job. There aren't so many stories of research to share, so she has continued to share those from the community health clinic. Sorry for the confusion.