Saved yet again

Last week, newFNP had had it. She never wanted to return to clinic again. She had one especially bad encounter with a patient that left both parties feeling upset and involved newFNP telling the patient, "Pregnancy is not a disability - you do not need to quit work yet" in a not-so-nice tone and the patient telling newFNP, "You don't understand -- your job is easy." To which, of course, newFNP had an internal fit of apoplexy. It is a damn good thing that newFNP does not know how to say, "You have got to be fucking kidding me" in Spanish.

That, coupled with a few other institutional issues, prompted newFNP to send her resume out early yesterday morning.

And then, newFNP'll be damned, but wouldn't you know it if a patient reached out and touched newFNP in a way that made her love her job all over again. No - in a way that made her want to stay in her job.

This patient is in her 60's, she is a university retiree from newFNP's public health alma mater, she has Crohn's disease, is a breast cancer survivor, fell and had a major knee surgery two months after her chemo ended and was determined to be unable to care for herself post-operatively in her home as she lived alone. Thus, adult protective services placed her in a hella ghetto senior's community a stone's throw from newFNP's clinic which, in case anyone has been sleeping for the past four years, is in one hell of a shithole area. Prior to this determination, she was living in a peaceful suburb in the foothills of newFNP's city. She hasn't had a mammogram in two years and she is only three years post-mastectomy. She hasn't had GI follow-up in over a year. She feels as though she cannot turn to her children for help.

As she recounted her story to newFNP, newFNP just took a moment to acknowledge the hell this woman had been through and asked her if she wanted to talk to a counselor. She made an expression that spoke of her pain, of her sorrow and of her relief in being offered .

She shook her head slowly, ruminatively. "I could use it," she replied, nodding. "It has been a really hard couple of years."

NewFNP put down her pen after having filled the past medical history form and then some on this woman's encounter form, leaned forward toward her patient and said, "I am going to help you." And she meant it -- she meant it more than she usually does. And she felt the importance of helping this woman more than she has in quite some time.

And she did help her. She got her a mammogram even though mammograms are booked through 2010. She got her a counseling appointment. She overstepped her bounds and gave her a friend's email address in the hopes that this friend had some insider knowledge regarding other communities available. She listened. She cared.

But equally as importantly for newFNP is that this woman helped her. She saved newFNP from utter desperation and frustration with her job.

What a wonderful gift newFNP received today. She is so thankful.

Bring it.

There are times in everyone's role transition in which they wonder if they are, in fact, cut out for the career they chose.

NewFNP had several such instances in which she thought - whoa pal... perhaps law school.

The first involved a patient who had a horrendous necrotic pressure sore that was so deep, it almost exposed the bone.  This woman also had MRSA which meant that all staff were on contact precautions which, in newFNP's training hospital, consisted of a mask, gloves and a plastic gown.  

It was the end of the day's rotation and newFNP had been busy as hell.  She hadn't eaten.  She was tired.  And the smell of that pressure sore plus the tenting of the skin as the physician cut away necrotic tissue plus newFNP's hunger plus the millions of people in the room causing increased temps (and smell) plus the plastic precautions gown equaled newFNP sitting on the floor with her head between her knees in an attempt not to pass out.

A successful attempt, but clearly not a shining moment in student nursing history.  

Another involved a patient who had undergone a partial pneumonectomy and, for reasons that now escape newFNP's memory, had failed to heal well.  As a result, he had what is best described as a gill-like slit in his side that moved in a gill-like fashion when he breathed.  And in that gill-like slit, there were strings of mucous that would quiver during respiration.  

The vivid recollection sends cold shivers down newFNP's spine.  

NewFNP left the room and told her preceptor, "I don't think I'm cut out to be a nurse" to which her preceptor raised one eyebrow - her way of saying that she disagreed.

NewFNP wrote about another unsatisfying olfactory experience three years ago.  NewFNP recalls feeling so disheartened.  How on earth would she take care of her patients if she could not even observe this procedure and remain on her feet? she wondered.  NewFNP's consulting physician attempted to console her by confirming that that was, in fact, a hella smelly abscess but it didn't really make newFNP feel much better.

NewFNP has come a long way, baby.  In these past three and a half years, newFNP has incised and drained her fair share of abscesses, but for the past year, the abscesses had dried up.  

Until today.

When newFNP hasn't performed a procedure in a while, she feels a tad apprehensive prior to embarking upon one.  Especially when it involves a scalpel and lidocaine and inflicting pain.  But the beauty of having a few years under one's belt is that it all comes back to you when you need it.  For better or for worse, even the inflicting pain becomes easier in one of those you've got to be cruel to be kind kind of ways.

And - gross though they may be - procedures are kind of fun.  They are so much better to perform than to observe.  In the case of an abscess, the results are immediate.  The smell doesn't seem to bother newFNP so much when she is doing the cutting, expressing, irrigating and packing.  

In fact, she wonders how her MAs are such tough asses in their assisting whereas newFNP has near syncopal episodes.

NewFNP is ready for more!  

Again, for those struggling students out there, it's worth it.  You'll be ready, too.

Money honey

NewFNP has read article after article lamenting the primary care physician shortage.  Often times, this is attributed to the high cost of medical school education. It's true - med school is expensive.  It's true - physicians can make more money in specialty practice.  

Nonetheless, these articles make newFNP a little pissy.

Jut hold up, mofos.  There are nurse practitioners out there who are thrilled to be primary care providers.  Nay, they chose to be NPs because they wanted to provide primary care.  They wanted to prevent illness, they wanted to treat the whole person and not the disease.  They wanted to be part of a health care team.  They wanted to judiciously refer to specialty when the situation necessitated the referral.  

And guess what?  They have debt.  They may even have a shitload of debt.

NewFNP's fancy NP school was seven semesters in length.  The total tuition cost was in the neighborhood of $98,000.  That's just the tuition.  That's no rent, no books, no required health insurance, no specific-colored scrubs so as to identify students as students, no RN license.  That's no red wine, no haircuts, no used book cafe coffee & treats with one's lady friends.  And, at newFNP's school, there were a fair number of us who had other graduate degrees and their associated student loans.  Thank heavens for the in-school deferment!

And thank heavens for loan repayment which mercifully wiped out quite a chunk of newFNP's debt, which now totals just a smidge over $60,000.  Ah - $60,000 - it seems so reasonable.

So what is newFNP saying?  She's simply saying: yo -- NPs!  She feels your pain.  You work hard, you take good care of your patients, you pay your six-figure student loan debt.  Keep it up.  

And for those of you in fancy and pricey NP schools, it's worth it.  It's totally frigging worth it.

Checklist

NewFNP likes to think that one day - one fine, sweet, sunny day - she will leave her current practice and enter into a world where practice isn't so, how might newFNP put this, fucked. When considering this throughout her workday, newFNP finds herself thinking that she should remember certain aspects of her current practice that are troublesome and should write them down in order to wean out practices that may continue to vex newFNP.

Given that graduation is right around the corner, newFNP thought that she would share some of these ideas with her readers. Now, when newFNP graduated almost two years ago, she felt as though she should pay someone just to hire her. That feeling lasted for all of three days of work and newFNP strongly recommends against feeling that very way.

Take heed, new grads. You will work your ass off.

Thus, point one. Research your salary. NewFNP's starting salary was reasonable, but she negotiated a big increase her second year based on internet research. In newFNP's clinic, the NP's see as many patients as the MD's and newFNP works damn hard. She, therefore, has no problem asking for big salary bumps.

Point two. Salary isn't everything. NewFNP is obsessed with saving for her retirement. 401k baby. Does your company match? Huge! Free money. Do they actually have a retirement plan because that would be spectacular!

Point three. Time off. Holy crap, will you ever need time off. So how much do you get? When newFNP begins her third year with her clinic, she will start to have three weeks of vacation per year, plus one week of CME allowance plus four personal days. It is newFNP's intention to use every single one of those days. NewFNP loves time off.

Point four. On call time. Will you be expected to have it? Is it paid? How frequently are you on call? Is there a service? What is the average call volume? Oh, how newFNP loathes her on call time.

Point five. Malpractice insurance. You need one with a tail.

Point six. Actual practice policies. Are late patients allowed in? NewFNP saw two physicals two hours late today. The receptionist did write the helpful note "patient filling up the paperwork" on the superbill, as though we are a Chevron station. When her 3:00 physical appointment showed up at 4:00, she told the manager that this was unacceptable. He basically told her to shove it. These are the types of policies that make newFNP crazy.

Point seven. Walk-ins. Is there time built into the schedule or do they just get squeezed in? In newFNP's clinic, they are squeezed in which is just a lousy system.

Point eight. Help. Who is available to you? Do you have access to databases like Cochran or Up-to-date? These are helpful. NewFNP's clinic doesn't have them.

Point nine. Licensing. Does your clinic reimburse you? They should because your DEA number and your licensing fees add up. They should also pay for CME's and the good conferences aren't so cheap. For instance, this summer newFNP is having a CME vay-cay in a relaxing location with one of her BFF's from grad school, BostonFNP. The conference is $600, the hotel is $1000. See, staying smart is pricey! Hanging out with your pal, learning and then lounging - priceless.

NewFNP is certain that she will think of more points during her days, but this is a good start. NewFNP is looking forward to taking her own advice!