The Nurse Practitioner's Place

Nurse Practitioner's Response to The American Spectator's View Of The New House Health Care Bill

2009-11-11T18:09:00.008-05:00

Below is Peter Ferrara's opinion of the Health Care Reform Bill that is being considered. I am offended by two points that he makes while referencing health care providers. Read and then go to below to see what I was having a problem with..

One confusion arising from the House bill is that its provisions are phased in over several years. Over the first 10 years of full operation, the House bill actually cuts Medicare by $800 billion, as scored by CBO. The cuts for Medicare Advantage plans will be close to $200 billion, and despite President Obama's phony shtick that if you like your health plan you can keep it, the Administration itself estimates that 8 million seniors will lose their Medicare Advantage plan as a result, 73% of those with such plans.

This is the beginning of health care rationing for seniors, as the payments to their doctors and hospitals for the care that currently maintains their health will be slashed back. In addition, as Betsy McCaughey explains in the Journal, the House bill moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home." The medical home is this decade's version of HMO restrictions on care. A primary care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary care provider. Medical homes begin with demonstration projects, but… HHS…is authorized to "disseminate this approach rapidly on a national basis."

What this means is that your doctor is paid a flat monthly fee for your care, and referring you to a specialist or for a diagnostic test effectively comes out of his pocket. So if you need an MRI or a CT scan to see if you have cancer, or to check if that pain in your chest is due to clogged arteries, or if you need to see a specialist to treat cancer or heart disease, the doctor has a financial interest to delay or deny it. Financially, if you are actually this sick, he will be better off if you die sooner rather than later. That is the result of the perverted, inverse incentives the House health bill creates for medical providers.

I don't like the inference that one would have to "settle" for a Nurse Practitioner. If you ask my patients, they will tell you that they prefer to see a NP over a physician anyway.

His idea that primary care providers are the gatekeepers is nothing new. It's been that way since I can remember. Most specialists require referrals from a patient's primary.

My biggest gripe is the insinuation that ANY health care provider would EVER not use whatever resources it takes to accurately diagnose a patient. If a doctor or NP or PA ever kept a patient from being diagnosed because it would take money out of their own pockets, they should be run out of health care immediately! True health care professionals are not just in it for the money. They really like helping patients and feel a moral obligation to do so. Of course we all need to pay the bills and I can't afford to do it for free. One day, I will be able to donate my services as so many do. Till then, I will keep on taking care of the patients who prefer me! Carry on..

P.S. This is the response I left on this blog article.

I find it a little insulting that you think that patients "settle" for a NP. My patients prefer me to other physicians and will tell you so. I am a great health care provider with patients who actually come back and do the necessary maintenance to remain as healthy as they can be. I serve in a rural community who is having a very hard time attracting physicians. I find it appalling that you would think that any health care provider would keep a patient from appropriate testing in order to line their own pockets. If they are doing so, they need to be run out of health care. I take care of patients because it's a calling and not just because it pays well. I am curious to see if you have ever seen a nurse practitioner in action before you make snap judgments about the quality of our care.

Happy Nurse Practitioner's Week

2009-11-08T14:01:00.004-05:00

Once again it's Nurse Practitioner's week. Please take some time and visit your favorite NP and let them know just how much you appreciate their hard work and time taking care of you and yours. Also, stop by and leave a nice comment on your favorite NP's blogsite. They'll love it!

Sick of Pink By Crzegrl

2009-10-31T20:46:00.004-04:00

I am sick of pink.

Pink runs, pink toothpaste packages, pink yogurt.

I am sick of pink articles, pink signs, pink nail polish.

Every time I see pink it reminds me that my mom has cancer.

It reminds me that the first time an “expert” saw her breast mass two years ago they said it was nothing.

You bastard.

You fucker.

You may have taken my mother away from me. If you would have done your job she may not be going through chemo. She may have had no lymph node involvement.

TWENTY-TWO LYMPH NODES

EVERY

FUCKING

ONE

You should wake up for the rest of your life and explain to her grandchildren about why their first lesson in death wasn’t their dog, it was their Beama.

Please nurses, doctors, techs at Mayo Clinic.

Please, Please take care of my mom.

Please make up for the mistakes of another.

Please give her more Christmas mornings, more afternoons of knitting, more time to teach her grandchildren all of the things she has taught me.

I cannot fathom a day without my mom. My teacher, my guide, my wisdom, my strength.

Not yet.

Not now.

The pink that is so empowering, that gives hope.

Please be my hope too.

Go over and let her know that you are thinking of her and her Mom during these trying times.

Nurse Practitioner Has A Brand New Grandson!

2009-10-15T17:53:00.002-04:00

We are in St. Petersburg enjoying the arrival of our second grandson. His name is Edward Clayton Cunningham and is just as cute as I knew he would be. It was nice that his Auntie Ciara was able to come down to see him too. I can't believe that my first grandson William is already almost a year and a half. How time flies.

On the first smilebox, click on the button on the lower right side to turn the pages. On the bottom one, click on each pic to make them pull into the larger middle box. Enjoy!

Make a Smilebox scrapbook

Make a Smilebox postcard

A Nurse Practitioner Interview From Me For A Nursing Student

2009-10-03T22:59:00.003-04:00

The following was an email that I received from a nursing student and I thought that it would make a great post.

Hi there.. I am a nursing student and have to write a paper about advanced practice nursing including speaking to an advanced practice nurse. While researching, I actually ran into your blog a few times and enjoyed reading through your posts, so I figured I would just ask you a few questions, that is, if you don't mind of course. brief answers are sufficient - I know you're a busy woman! and I don't need to take up much of your time =)

I see from your blogs that you are an FNP in Florida in a rural health clinic and have your own patient base. Also that you were at the bedside for while before returning to school (with a
family!...there are no words to describe how much credit you deserve for finishing successfully and still working and maintaining a family- very impressive)

-How would you describe your roles and responsibilities in your current office?
My roles in the office include patient care, patient education, lab draws (the ones that the nurse can't get), and supervising the nursing staff. I also do callbacks to the patients for questions that they have, and consult with the MD on cases.

-What kind of experience and education was required for your degree. I started with my RN and then went on to complete my BSN and then my MSN. I worked in the hospital setting as a floor nurse for almost 7 years while completing my degrees. I served as a stand by charge nurse as well. This experience was vital in my education as an advanced practice nurse. In my opinion, to be a successful nurse practitioner, you must have the clinical experience to recognize the nuances in disease process in person. One cannot get this from book learning only. Often MDs say that nurse practitioners aren't as good at diagnosing patients because we didn't do a "real residency" in their traditional sense. Working in the trenches at the hospitals managing several patients daily plus doing clinicals side by side with other doctors while in school is a residency in it's self.

-What roles other than direct health care to find yourself providing obviously education is a big part of your service to patients, but do ever feel like a case manager or advocate to patients or an administrator in teh office, etc)
I do case management and advocate for my patients, especially for medications not covered by their plans (prior auths). I don't do much administrative duties because this is not my own practice.

-Who do you work with in the office?
I work with an office manager/front desk person and two LPNs and one medical assistant. I also have a MD that works in the office four days a week.

What impact does interdisciplinary relationships have on you or your practice?
It has a huge impact. If I don't get along with my coworkers or they don't work well together, it can hugely impact the flow and patient satisfaction. It can also seriously effect patient health if an office staff does not listen to a patient's concerns or pass on critical information.

-What are the benefits and challenges you run into?
The benefits are that I can FINALLY take care of my patients like I need to without having to ask for an order from a MD. Challenges I face is the fact that I cannot write for controlled substances which makes working in rural health very frustrating. If there isn't a MD on site to sign for controls that I cannot call in, then I have to send them to the nearest office that I am connected to. This is a hardship to some of my patients because of lack of transportation and money for gas. Some have to make the decision whether to eat, pay their rent or pay for their medications. Some actually walk more than a mile to my office to be seen for care. This is the reason why it's vitally important to contact our Florida congressmen and senators and let them know that we need the ability to write for controls. After all, all but two states have given NPs that right without any major events that I know of.
-Lastly, are there any major issues r/t current nurse practitioners that you are concerned about. (I did read your post about the article you found on MDs vs NPs capability to handle 'serious' patients vs 'snotty-nose' patients - how frustrating ! the author is obviously uneducated regarding np education and skill levels!)

From the above question, you can tell that not having controlled substance rights is a big one. I also have a huge gripe with pharmaceutical companies who advertise "Talk to your doctor" instead of saying health care provider. How hard it that! I think they would be shocked to find out just how many prescriptions we nurse practitioners write. Most insurance companies in Florida do not put us on their provider panels and therefore do not pay the pharmacies. They have to submit the medications under the MD's name so we don't get "the credit" and therefore are still under the radar. I actually think that we are very responsible prescription writers and take care to make sure that what we write is appropriate for our patients. In fact, I think that we write less medications due to the enormous patient education that we give the patient. Patients often take us seriously and follow our advice because of their trust in us as primary medical providers.

The Flu Is Here

2009-10-02T22:45:00.002-04:00

God, I'm tired. The flu has arrived during the last two weeks and several of my patients are sick. I started swabbing for the flu and am getting several negatives for either A or B. I am calling it the mystery flu. It has the exact same symptoms of both variants but is not testing positive on either test strip. Anyone else seeing this in their offices?

Symptoms reported so far:
First noticed is a scratchy, sore throat
Stuffy head with severe headache
Fever (variable level from low grade to almost 104)
Body aches (pretty severe)
Some are reporting nausea with or without diarrhea

These symptoms pretty much are the same for any type of flu. The only difference I have seen is that the A variant seems to be a little more toxic looking in the children.

I saw 31 patients on Monday. How's your week going?

Change of Shift is Up!

2009-09-18T23:47:00.001-04:00

Change of Shift is up! Go over and enjoy it!

Drivel In It's Finest Towards NPs Masked As Health Care Reform

2009-08-29T00:05:00.016-04:00

I was surfing the net for some articles on health care reform when I came across this article. At first glance, it looks promising and I agreed with the start of the argument.

The financial structure of most health insurance policies encourages overuse and misuse of the health care system, with resulting increases in health care costs, as well as pervasive inefficiency.

One consequence of third-party payment is that the consumer of the service (in this case, the patient) is shielded from the true cost of the service. If you ask most people what a doctor's visit "costs," they will probably respond with whatever amount their copay is. The true cost is much higher -- probably $100 for a 15-minute visit.

As a result of this "cost-shielding," people are much more likely to see a doctor, for many more reasons, than if they had to pay full price for a doctor's visit. Many visits to the doctor are due to the common cold and allergy symptoms, for which very little can be done to alter the course of the condition except for rest, proper eating and hydration, and over-the-counter symptom control treatments.

I actually agreed with the statements due to the fact that many patients that I see come into the office with minor ailments that would resolve on their own. But I also realize, as a nurse practitioner, that patients often come to the office seeking care that isn't just medical in nature. Some is stress relief and some is psychiatric. I have seen patients come in for what seems to be a trivial issue, but is actually an ailment that is actually quite complex and dangerous. These complaints occasionally go unlistened to and can be deadly.

Going further into the article, I came to read this:

Most common cold or allergy complaints do not require a visit to a highly-trained physician -- a nurse practitioner can treat the patient just as effectively, and at much lower cost. I would expect a comparable 15-minute appointment with a nurse practitioner would cost about $25.

So let me see... Scenario A- Patient comes to the office complaining of chest pain. The doctor does a history and physical. Doctor runs several differentials through their head, discusses with patient, does an EKG, writes a script and sets up follow up visit. 15 minute visit.

Scenario B-Patient comes to the office complaining of chest pain. The NP does a history and physical. NP runs several differentials through their head, discusses with patient, does an EKG, writes a script and sets up follow up visit. 15 minute visit.
Do you see any differences in these scenarios? Nope, didn't think so. What makes the author think that we are not able to perform the same tasks and NOT be highly trained? Why would he assume that I shouldn't be paid for my time appropriately just as well as the MD? I seriously don't think that I should just be delegated to treating the "snotty nosed colds" and leave the "big people stuff" like hypertension, diabetes, and COPD to the illustrious MD just because he went to medical school for a year longer than I did (if he is a family physician.)

RRRiiiight.

The point is that many office visits to physicians are unnecessary, with money and time being wasted by the patient. Additionally, the physician could be using his/her time on much more sick or injured patients. But, since it only costs $20 or $25 to see "the expert," why wouldn't you? People would certainly think twice about making an appointment if it would cost them $100, especially if appropriate care could be obtained for a quarter of the cost by a nurse practitioner.

Ummmm... First off.. Obviously, this author thinks that patients are just wasting doctors time. But an NP's time must be okay to waste? I certainly don't think that most of my patients are wasting my time. It's how I get paid. Supply and demand was the way of the free market system last time I checked.

NPs usually receive 85% of the billing that an MD does in most states. Why would my time and effort be delegated to 1/4 of the docs? Oh yeah.. the insurance company rules. Certainly not because I can't do the exact same job in the same amount of time. I am in NO way pretending to be a MD because I didn't go to medical school and didn't do the traditional residency. I, instead, did the NP track while working full time in the trenches of the hospital spending 12 hours at the bedside instead of the MAYBE 5-6 minutes that the MDs took. Some actually walked out in the middle of a patient's question which royally pissed me off because I know that they were running late to the office because their golf game ran over. I overheard plenty of those conversations as a floor nurse.

The second change, increasing the scope of services by nurse practitioners, is already gaining traction via some physician practices and urgent-care clinics. It only makes sense to have patients treated by a practitioner who is well -- but not excessively -- trained to provide the care necessary to heal the patient.

If you are hungry, in a hurry, and without much cash, it does not make sense to order a meal at a four-star restaurant; a fast-food establishment better meets your needs. However, if an important occasion is arriving, for which the added expense and time is worthwhile, then fast food might be counterproductive, and a fine restaurant is warranted. The same "triage" could apply to your choice of healthcare practitioners.

The net result of having the cost of office visits borne by the consumer/patient would be a greater ownership of one's health care. Office visits for (apparently) minor illnesses or injuries could be managed by a nurse practitioner. The nurse practitioner could triage the patient (via questions or observation), with potentially serious conditions being transferred to a physician.

From the physician's perspective, insurance compliance costs could be reduced, as fewer claims would need to be submitted and tracked. The physician would still "keep" the patient, but the nurse practitioner would be handling the majority of visits.

If you come to my office where I work side by side with an extremely intelligent physician with 40 plus years in medicine, who values my insights and opinions very much,and ask my patients if they care what letters are behind our names, you would get run out on a rail. I have my own patient base and my collaborating MD has his own patients whom we try to share on occasion because sometimes it takes more than one pair of eyes on a case. PSST! It's called collaboration. Some patients prefer to see me and some the doc. If I left the office tomorrow, probably more than half of those patients would follow me (the lowly NP). According to this author's opinion of NPs, we should just be happy to "handle" patients and let the MD do "all the stuff that requires any thought process and training."

I don't know about you. I would want a trained health care provider regardless of the initials behind their name who listens to my concerns and has excellent diagnostic skills any day. It's life and death out here buddy. Do yourself a favor and see an NP one day. They may save your life.

PS. This is what I replied on his blog..

I certainly think from this article that you have a huge misconception of what NPs actually do on a daily basis. I am offended that you seem to think that my time and expertise is considered 1/4 that of a MD. NPs and MDs collaborate with each other and I "keep" my own patients thank you very much.
There are providers in various levels of expertise who don't know what they are doing. It's very irritating that you want the docs to delegate the "snotty nosed visits" and leave the important visits to them to manage. My patients are not wasting my time and would be insulted if you suggested that they see a doctor instead of me. It's articles like yours that sets us further apart, when according to multiple studies, NPs give just as good care as physician. Wow...

Change of Shift is Up at Emergiblog

2009-08-20T22:06:00.003-04:00

Change of Shift is up over at Emergiblog! Check it out for the latest in nursing insights. Meanwhile, I will be continuing to recover from my car accident a week ago. It's definitely true that you hurt in places that you never knew you had.

How Not To Have A Good Day According To A Nurse Practitioner

2009-08-12T17:05:00.006-04:00

This was not my idea of having a good day this morning. I was on my way to work when a woman pulled out in front of me. I have a suspected navicular fracture in my dominant right wrist and my neck and right upper shin hurts. I got off easier than some because my car is (was, argh!) very heavy and has airbags. They both deployed. I was also wearing my ever trusty seat belt.

My husband and kids were pretty upset by the whole process. I felt kind of embarrassed because I was crying on scene because I was so stressed and worried that the other driver was hurt. She drove her car into the parking lot so I guess she was okay. It's typical that health care providers tend to worry about everyone but themselves.

My patients are going to freak out until I return to work. They don't like it when I'm out of the office. I'm sure that whoever covers for me will do just fine for a few days while I recuperate. The great thing is that my fingers still work and aren't cut off or mangled and I can get caught up on my blog buddies. My hubby did me the service of typing for me so that I could update everyone. Can't wait until things are back to normal so that I don't have to dictate stuff. My hubby hates when I "dictate things to him".

Get ready 'cause here I come!

Carol Glover Wedding

2009-08-09T19:19:00.000-04:00

This is my friend Carol. She works in one of the local surgeon's office as their office manager. She and her hubby got married this last weekend and my husband did their wedding pictures. I thought that this one was really pretty.

Letter From A Precepted NP Student

2009-08-07T23:26:00.002-04:00

I just finished with my first Nurse Practitioner student as a preceptor and she sent the following message to my bosses. I was very pleasantly surprised and I enjoyed every second of the experience. I can't wait until the next student and I hope that I get another as good as she was.

"I want to thank you again for allowing me to be precepted by another of your outstanding NP's. Jennifer provides professional yet personal care for the patients in Branford. I was amazed at the number of new patients that came in every day to establish care. She is amazing. It is very evident that she provides a much needed service for that community. Many of them depend on her professional knowledge and creativeness to provide the care they need.

As you know, many of these patients do not have the insurance or money to go to specialists for care and through her collaboration and coordination w/community resources and through her expertise, she is able to provide the care they need or get them to what they need. Everyday, the patients all told me they were so happy to have her and the clinic there, as traveling so far for quality medical care was very costly or becoming impossible for them."

There are few things as gratifying as that. Ahhh!!!

Nursing Bachelor Degree Programs

2009-07-25T22:01:00.004-04:00

A Bachelor's degree in Nursing is the fast-track to career advancement in the nursing field. To achieve a Bachelor of Science in Nursing and be eligible for state licensing examinations the student will need to meet the entrance requirements, as well as the graduation requirements of an accredited Bachelor of Science in Nursing program (BSN)). The academic portion for a Bachelor degree in Nursing may be satisfied by an online nursing degree program. However, there are clinical (hands on) requirements for all nursing degrees, and they must be satisfied on campus or as directed in the hospital and under the supervision of the nursing degree program.

Registered Nursing Degree Specialization
Many hospitals and clinics that employ nurses have tuition reimbursement programs to encourage the nursing staff to further their education including bachelor's degrees in nursing and specializations. Many career paths for the registered nurse are open only for those possessing a Bachelor of Science in Nursing degree or Masters of Science in Nursing degree. There are many advance nursing specializations as well. Some include Nurse Practitioners, Nurse Midwives, Nurse Anesthetists and Clinical Nurse Specialists. There are also certifications available for all nurses at all educational levels. Many nurses begin with a Nursing Bachelor degree and later continue for the Masters of Science In Nursing degree. It is often true, especially in nursing, that the more education a nurse has the greater the growth potential for their career.

Registered Nurses Job Duties and Responsibilities
Upon receiving a Bachelor's Degree in Nursing and state licensure, the registered nurse will have varying responsibilities dependent upon their employment setting. Many registered nurses are employed by hospitals, clinics, nursing homes and some are visiting nurses. Duties often include administering IV medications, explaining treatments to patients and families, assisting in performing diagnostic tests and help with patient follow-ups. These are just a few of the possible duties and responsibilities of the Nursing Bachelor Degree graduate.

Registered Nurse Working Environment
Most registered nurses will find themselves working indoors in a temperature controlled environment. Nurses working in direct patient care may need to be able to lift bend and stretch in order to move or reposition patients. Many nurses are employed within the hospital or long term care facility environment and may find themselves working shift work. Most nurses are employed full time.

Nursing Degree Graduates Employment Outlook

As with most careers within the health industry, the job outlook for the possessor of a nursing bachelor's degree or BSN is very bright and job growth is expected to be much faster than average. Advances in medical care as well as the growing population of elderly have ensured that the demand for registered nurses will continue to grow.

Salaries for Bachelor Nursing Degree Professionals

The salary ranges for the professional nurse with a BSN (Bachelor of Science in Nursing) vary with the region in which they live and the type of facility by which they are employed. However on average first-year graduates report an average of $20.83 to $27.43 per hour.

E-Trade Baby Nurse Practitioner Videos Are A Must See

2009-07-18T22:03:00.003-04:00

If you haven't seen these, you've missed something pretty hilarious. Unfortunately, they also have hit the mark with nurse practitioner issues in the state of Florida. We must be vigilant in contacting our representatives and senators and let them know just how much Florida needs to join the rest of the country regarding prescriptive authority. Enjoy!

Happy Anniversary to Change Of Shift

2009-07-12T02:09:00.002-04:00

I'm just a little late, but never to forget Emergiblog's Change of Shift. Kim is one of the premier nurse bloggers on the internet and still going strong. There are few nursing blogs that I frequent and she's the cream of the crop! I envy her writing style and laugh until I almost pee my pants at some of her posts. One day, I would love to meet her in person and say hello. Till then, I can admire her from afar.

I can really say that if I ever end up in the ER, I hope that the nurses who take care of me care half as much as she does about her patients and her blogging friends. I hope that she continues to keep Emergiblog going strong and continues her education and becomes a fellow NP when she finishes her BSN.

Top Colleges.com Gets It Totally Wrong

2009-07-11T21:36:00.002-04:00

Why is it so hard to figure out what nurse practitioners actually do? It's really not that hard. Pick up a telephone and call one if you really want to know. You can google the question and be brought to several sites, including mine, that can explain what we do and how to become one if you want.
The following is the explanation that Top Colleges.com has come up with for a nurse practitioner.

A nurse practitioner is an RN who has undertaken further training (such as a Masters degree) to provide similar care as a doctor (such as carrying out the same sort of non-emergency tasks that a physician may perform). In many states, nurse practitioners are able to write prescriptions for patients.

Go on over and leave a comment here and give your explanation like I did. Maybe they will change their definition.

10 Ways for Nurses to Unwind and Veg Out

2009-06-29T20:03:00.002-04:00

Nurses are everyone’s caregiver, from seniors to expectant moms to patients in the ER to sick kids to surgery patients. But who’s there to take care of you when you shed your scrubs and head home after a long day – or night—of work? Whether or not you have someone to come home to, here are 10 ways for nurses to unwind and veg out after spending hours patching other people up.

1. Treat yourself to a manicure. Have someone else buff, paint and trim your nails. Having someone else look after your physical needs is a real treat, even if you know the manicure won’t last long at your regular job.
2. Head to the movies. It’s one of the few places that’s dark, quiet and you don’t have access to your pager.
3. Watch nurse and hospital shows on TV. No matter how bad you’ve got it, you most likely didn’t have to deal with a burning school bus, a helicopter crash, a tornado, and a murdering nurse’s assistant on the same day.
4. Burn your scrubs. If you’re planning on throwing out a pair of scrubs anyway, go ahead and burn them. It just feels better.
5. Challenge yourself to avoid using any kind of medical lingo in everyday conversation. It’ll be hard at first, but you’ll feel more like a regular human.
6. When someone calls and asks for help, just say no. On your day off, it’s okay to stop being the hero every time someone needs one.
7. Go out with friends who aren’t nurses. You’ll finally get a chance to talk about things other than your job and free yourself of the everyday stresses that plague you.
8. Go out with your nurse friends. Every once in a while, have a party or go to happy hour with your nurse friends to rant and vent about the little things no one else will get.
9. Sit by the window. If you’re locked up in a hospital all day, you may not get a chance to monitor the weather or even tell if it’s day or night. Spend as much time outside or at least by a window on your days off.
10. Go shopping. Go shopping for clothes you can’t wear to work, and then plan out the trips and activities you’ll wear them to.
This post was contributed by Kathleen Baker, who writes about the ultrasound tech school. She welcomes your feedback at KathleenBaker3212 at gmail.com

Change of Shift

2009-06-27T13:36:00.003-04:00

Change of Shift is up over at RehabRN. Boy am I a little behind! I need to start writing again!

What Part of Heart Attack Don't You Understand?

2009-06-25T22:23:00.002-04:00

Too often I have patients who show up to the office with reports of symptoms that have been occurring over several days, weeks, months, and even years. With the amount of medical information that is blasted over the television and on the internet, it still is amazing how much patients still do not understand about certain medical conditions.

Patient X shows up to the office and reports having chest pain, sweating, nausea, pain radiating down the left arm but didn't think that it was REALLY a heart attack and just wanted to come see me to make sure. The pain had stopped by this time.

I asked the patient why they didn't call 911 during this episode. "I thought it would just go away."

Hmmmm. Yep. You almost "just went away yourself!" Now go to the hospital and get your enzymes checked to see if you are finished with your heart attack and get a cardiac cath preferably by ambulance from here.

"Oh I can't go right now. I have too many things to do!"

Are you too busy to die? What part of having a heart attack don't you understand?

Sigh....

Nurse Practitioner Has Some Awesome HomeGrown

2009-06-13T18:23:00.003-04:00

What???
Oregano, basil and thyme of course. You certainly didn't think that I was talking about marijuana, did you? Jeez... I started a victory herb garden a while ago and am reaping the benefits. They smell so good and I'm experimenting with the best way to dry them. I also have some yellow squash, banana peppers, and tomatoes growing as well. It's been years since I've dabbled with a garden and my hubby and I are loving it.

Other news on the home front is that there is another grandson on the way and is due in October from the oldest son and his wife. I can't wait! The first grandson William is walking now and is just the cutest thing with his big blue eyes and blonde curls.

Work is going well and busier than ever. I am eagerly awaiting electronic charting so that I can stop taking charts home to work on otherwise I would be drowning. We are in the process of merging with a fellow federally qualified rural health company making us the largest in North Florida. I'm looking forward to seeing how it helps my patients and how it may benefit me as an employee of the practice.

I did find out while trying to sign up for student loan payback on the federal level that you can't have accepted a sign on bonus. That really blows because I did when I signed a three year contract. Unless I can find a loop hole, I'm pretty much out of luck. Anyone know of any other programs or changes? Let me know.

Till the next time, keep up the great work as primary providers and mentors to fellow health care providers be they MA, CNA, LPN, RN, ARNP, PA, or MD.

Nurse Practitioners As Primary Medical Homes

2009-05-31T14:09:00.002-04:00

Over at DB's Medical Rants there is an entry regarding the primary care medical homes and whether NPs are capable of taking total care of their patients.

"We do not measure long tail events as a quality measure, because it would be very difficult to enumerate such events. So we have a classic important concept which is not easily measured. I will continue to insist that diagnostic errors are extremely important. I heard a colleague state that diagnostic errors are the most common reason for malpractice lawsuits. Yet our current quality measures ignore diagnosis.

Well trained physicians excel at diagnosis. I remember during training that the greatest praise for one of our heros was that he was a great diagnostician.

Our primary care debate often ignores this issue. I doubt that many NPs have the diagnostic acumen of well trained internists and family physicians. I might argue that long tail diagnosistics define a different level of expertise than the concept that primary care currently represents."

The following is my response to the above:

I think that any provider is only as good as their capacity to learn and evolve. I have seen both NPs and MDs who were content not to expand their knowledge base and therefore become stagnant. I pride myself in being an excellent diagnostician because that’s what I am most interested in. Not every doctor or NP or PA picks up on the nuances of patient’s complaints and there will be mistakes made. We are all human with weakness and false senses of pride. It needs to stop being a turf war and become about taking care of the patients in the best way we know how which is through collaboration.

What say you?

Just When I Think I've Seen It All

2009-05-30T17:39:00.003-04:00

I was poking around on the computer today and saw the promo for Nurse Jackie (played by Edie Falco) At first I thought "Oh goody, another nurse show to watch" then wham! I can't even tell you about it because it will give it away.

Click here to watch and then come back and tell me what you thought. Is it a total slam against nurses once again or will be a guilty pleasure that you won't be able to avoid watching...

Nurse Practitioner Finds The Best Cake I've Ever Tasted!

2009-05-09T22:54:00.002-04:00

The doctor that I work with at the office gave me an Amish Friendship cake starter. I figured if I didn't screw it up, I'd see how it went! OH MY GOD! I made my first cake today and it tasted like heaven! Anyone else ever tried one? It tastes like a spice cake and also like a cinnamon bun.

This is not good! I'm trying to lose weight and don't see any way of becoming tired of this cake!

I'm sitting here with the new laptop and loving it! It's a Toshiba and the keyboard is really smooth. I will be getting caught on some chart work this weekend after I get back from tomorrow's visit with my oldest son and his wife. (who's pregnant with my second grandchild, a boy we think)

Sorry this isn't a nursing post, but I haven't been in the mood. Blogging is like that. Dry spells happen. Next week, I'll get cracking! Any suggestions for posts will be appreciated!

A Great Edition of Change Of Shift Is Up!

2009-04-30T20:20:00.001-04:00

Change of Shift is up over at Codeblog. Get something great to drink and cozy up to the computer for a wonderful read! Click here.

How To Stay Busy In A Nurse Practitioner Office

2009-04-28T20:10:00.005-04:00

I stayed pretty busy today dealing with patients who are coming into the office with the same symptoms that I had Thurs-Sunday. It's not been overwhelming yet, but I can see it getting worse in the next few weeks.

I know that Swine Flu is supposed to be a respiratory illness, but I wonder if it's changed. I tried to talk to the health department about what I noticed in my office area, but they are not interested unless it's respiratory related with fever over 100.4.

I will swab the next pt with these symptoms and put a name to the one I'm seeing locally if I can.

I find it interesting that suddenly there is this much GI flu symptoms suddenly erupting?

Stay tuned!