Bon anniversaire!

NewFNP celebrated five years of being newFNP today by hitting an 8AM spin class -- her first spin class in a year. Yowza.

A lot has changed in these five years. All of her friends from nursing school are married and most have kids or are pregnant (hooray nycPNP!!), whereas newFNP is bordering on cougardom. She has lost some of her closest loved ones and has gained others. She has visited three new countries, had three major hair-do changes and is on her third car.

But newFNP's most significant change is that she is confident in who she is as an NP. She is continually challenged by her patients, by working in community health and by keeping herself well while working in a dysfunctional environment.

But she is learning and she is capable. Just this week, newFNP diagnosed erythema nodosum and nephrotic syndrome -- both just known of but never seen differential diagnoses until now. That feels quite good. She saw what she thought might just be chancroid, which to hear newFNP's patient tell it feels not at all good, but might feel better after a change from acyclovir to azithromycin.

Now all newFNP is left to contemplate is where is this little endeavor -- the one you are reading -- going to go next?

A very happy 4th anniversary

Today is the 4th anniversay of newFNP. She is hardly new anymore, is she?

NewFNP's anniversary week has been graced by a long-time patient welcoming a new baby girl, another long-term patient hospitalized and dying, and by the always exciting return of one Ms. Cocoa Brown. A story for another day.

Because today, on her 4th anniversary, newFNP is dolling herself up for a celebration. She is so appreciative that her cousin and his fiancee scheduled their wedding on such a special day.

To her favorite ice climbing, engineering, post-doctoral molecular geneticizing couple - mazel tov.

Welcome back, my ass!

The rough thing about attending a posh CME in a serene location is that one tends to forget the reality of everyday work life in the ghetto. In case you had forgotten, allow newFNP to refresh your memory: it sucks.

NewFNP is right back in the thick of it: leaving an hour late, attempting to correct the fact that she had seven patients scheduled in the three o'clock hour today and dodging bullets fired by the ever-critical and sorely lacking in introspection OB-GYN. Hey sister, when you point one finger at newFNP, there are four pointing at yourself, you ho-bag.

NewFNP returned from her conference ready to take on the world. Well, the world has dealt newFNP a real shit-storm. So much so that newFNP has begun to question whether she really is doing well for her patients.

The OB/GYN is quick to point out the cazillions of flaws she sees in the care that newFNP and the other prenatal providers have delivered, yet this provider sees an average of 10 patients per clinical day. She is not at all hesitant to allow other providers to see the remaining patients on her schedule as she delves into every detail of her patients' care. NewFNP truly makes every effort to address all pertinent aspects of medical care as well as engaging the patient about social issues, but newFNP has a 30-patient schedule and, therefore, misses things sometimes. Does this make newFNP a bad, incompetent or inadequate provider? Is the OB/GYN right in just giving a big "F-you" to the rest of us while she assesses for every fucking hangnail that may trigger preterm labor, birth anomalies and the omnipresent threat of legal action?

Another new physician pointed out that newFNP's clinic is "killing" our patients because we cannot start diabetic patients on insulin if their A1C's are over 8.5 or 9. The reason newFNP is unable to do so is that a very small number of patients can afford blood glucose monitoring supplies. The new provider didn't mean it as a judgment, but rather as a statement of fact. However, newFNP feels acutely aware that she is between the proverbial rock and hard place. NewFNP can either slowly kill them with the ravages of hyperglycemia or quickly kill them with the rapid action of hypoglycemia. Talk about choosing between the bat and the belt! What a fucked up world we live in. Perhaps there is a program that would supply all of newFNP's DM patients with testing supplies and syringes, but newFNP doesn't have even five minutes in her day to research this.

NewFNP is uncertain what to do. She is at her two-year anniversary at her clinic. NewFNP is community health and had planned on staying at this clinic indefinitely. But how in the fuck can newFNP put up with all of this?

On the positive side, everyone loves newFNP's new hair-do - even the fashionable gay guy so newFNP knows that she is looking hot! Watch out!

Celebrating one year of newFNP

Three hundred and sixty-five days ago today, newFNP had just completed her first day as newFNP.

NewFNP saw five patients that day - today it was thirty.

NewFNP is certain of one thing - being nice to patients makes all the difference in the patient experience of their care. NewFNP had a patient last week with cerebellar ataxia. What is cerebellar ataxia, you might ask. That is precisely the question newFNP was asking herself as she sat staring at her patient. No matter, because newFNP was nice and took time to talk to this woman. Midway through her visit, she told newFNP, "I want you to be my doctor." Well, sister, newFNP can't be your doctor but she can be your FNP even if the only thing she knows about cerebellar ataxia is that she needs to get your ass to neurology.

NewFNP also has to remind herself that many people in her practice are, quite frankly, health illiterate. Many people do not know how to care for themselves; they don't know the difference between what is healthful and what is dangerous. For newFNP, that is sometimes hard to fathom. Before newFNP was newFNP, she knew that Gatorade was not a health drink. She didn't learn that in NP school or in MPH school - she just knew from sometime long ago.

This lack of basic health knowledge is frustrating to newFNP at times, such as today when she had an urgent walk-in for, no joke, a bruise. A run of the mill purple bruise. But as newFNP felt herself thinking, "What in the motherfucking fuck is this person doing here," she backed off that ledge and remembered that this person was in clinic to get newFNP's professional and educated opinion about her bruise.

Ah, the wisdom we amass.

Although newFNP has yet to submit her request for a salary increase, she did receive a brand new chair at the end of the day today. For the past year, newFNP has had this ghetto-ass hoopty chair. No more - newFNP is now ergonomically correct and does it ever feel good. Now if she could only get a computer.

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Thanks for sharing this year, newFNP readers.