Welcome to my crazy new life as a new Family Nurse Practitioner. Actually, I have been practicing now for a little over a year. So let's say I'm fairly new but with more confidence than that first day on the job. Let me give you a little background on myself: I'm in my 40's, happily married with two teenage boys. I was an ER nurse for way too many years before I decided to jump ship and try my hand at being a healthcare provider. I attended a prominent university and after 5 grueling years (I worked full-time while going to grad school) graduated at the top of my class. Early on as an FNP I realized that while I may have been an expert ER nurse (I was freaking awesome at my job!) I didn't know shit from shinola about being an FNP (we will talk more about my epiphany)! While I had read many NP blogs during grad school, they were mostly about the dry content of the job - you know, disease processes, new meds, healthcare reform, blah blah blah. Now don't get me wrong, all of that is vital to being able to perform your job well, but that isn't what I needed to read about in my darkest hours as a new FNP. I needed to hear that others had felt the same way I was feeling, that I wasn't alone, that I had made the right decision to take this career path. I needed words of wisdom that would quell the pit of fire that seemed to be burning incessantly in my gut. I did find one blog that was great, and it made me feel a little better, but it was a few years old and there weren't any new updates. So that brings me to my blog. Because I was feeling inept, dumb as hell and scared shitless when I started, I hope this blog will give you reassurance that these feelings are normal...and it will get better (it may take a while, and slowly but surely you will start to have those "aha" moments and realize that you know more than you ever thought you did)! Since I don't want to look like a giant run-on sentence, I will break down my first few initial posts.
How do you decide whether to become an NP or PA? Why should I even consider one over the other? Well, here's the skinny. I think it really depends on what you want to do. We all have our lot in life (taken from "A Bug's Life"). This means that while your interests and skills will steer you into pediatrics, mine will lead me to emergency care. So in my opinion, if you are geared toward primary care, community health, or the like, then NP school should be your path. That is a no brainer. But what about ER and Urgent Care? This is where it gets sticky and where if I had known then what I know now I would have gone to PA school. Now don't get me wrong...I love being an FNP! But the learning needed to perform the job in an ER or Urgent Care is best obtained, I think, thru the PA route. Now, this wasn't an option for me. Hell, I never really gave it a thought. I didn't have the luxury to quit work and go to school full-time, as is necessary in PA school.
So what's the difference? Basically, it is the approach to learning and ultimately, care. The nursing model vs the medical model. I didn't have any idea there was really a difference until I started working and was able to see first hand the difference in knowledge. So from an ER/Urgent Care perspective the medical model really does provide a better education. Again, my opinion. While PA school was teaching their students how to suture, perform digital blocks, reduce dislocations, treat ingrown toenails, ALL the bones in the body, well I was writing papers, and more papers, and even more papers (all APA format, because I am good at that shit!). How was I to know the importance of that little scaphoid bone and the potential for avascular necrosis if there is a fracture? I didn't even know such a bone existed! Well, I learned early on about nasty breaks to that crazy little bone (aka the navicular bone) and you can guaran-damn-tee this girl knows how to diagnose and treat it! But those damn ingrown toenails still stump me! I think it's because I have a wretching problem when I think about cutting that nail and literally pulling it out! Eeeew!
What makes the NP stand out? It's our bedside manner. We are nurses; we care, we are empathetic, we communicate. It is so important to make a connection and gain the trust of your patient. This is accomplished by effective communication, therapeutic listening, the touch of a hand, and establishing a bond with them. As nurses, this is how we are wired. We talk to them, we provide healing touch, we comfort them and we cry with them. While all of these nursing attributes are noble, they wreck havoc with your patient thru put times. PAs can get in and out in a nanosecond and there I am, talking and explaining the entire plan of care and how it's going to be accomplished. I still struggle with this. But you will find out quickly that your medical director is keeping a hawk-like eye on those times. Each minute you spend in one room can translate into one less patient you see, which translates into less money for the facility. This is a work in progress for me...I will keep you updated as to my progress. And, NPs freaking rock the charting! Our nursing background gives us an edge when it comes to putting pen to paper (or using those keystrokes!).
You are going to need to do some research and soul searching to figure out what is best for you. Now after having gained some experience (thanks YouTube, Google, and all my fav apps and skills workshops/conferences), I am much more comfortable.
So, let's start by talking about grad school, that perfect Nurse Practitioner Program. It's all real exciting in the beginning, until you realize that it's a money making machine and there is so much shit and fluff that goes on it's nauseating. I mean really, an entire semester on how to write an APA paper. Hello, I do have an undergrad degree and I did write countless papers. Give me some credit people, if I didn't know how to write an APA paper at this point we have problems. And PERLA is a great program that formats your papers for you...enough said.
So why may you ask did it take me 5 freaking years to finish this program!!!!! Aggravatingly enough, whether you are in undergrad or grad school (nursing school in general) there are a litany of BS classes (and I don't mean Bachelor of Science). Now, I know this is going to rub some people the wrong way, but don't get your panties all bound up just yet. I think the nursing profession is an extremely noble one and I am so proud to be a nurse, but this is the 21st century and we have come a long way baby! So let me get to my point. An entire semester on nursing theory. Oh the boredom! I totally get why we should have some knowledge of, and appreciation for, nursing theory...but an entire semester! This is covered in undergrad and that's where it should stay! While my professor kept asking which theorist we would be using in our practice, I kept thinking "um, none". Remember when I said 21st century? Healthcare delivery today does not allow you to apply anyone's theory. The only theory that matters is that you talk to your patient, lay hands on them, figure out their major malfunction, diagnose them correctly, and provide whatever they need to go home with...and do it all in about 15 minutes. And make sure you are following Evidence Based Practice and keeping them happy (totally another topic). Got that? So spending an entire semester discussing theorists and writing a Subtruction paper (wtf?) was inherently a waste of time. Not to mention those Benjamin's! How about we spend an extra semester on advanced patho, advanced pharm, and advanced health assessment. Novel idea! How about we don't cram everything into one semester! Let's throw caution to the wind and actually provide students with the knowledge they will need to properly care for their patient population. Nope, not gonna happen. Instead, the powers that be at these fine institutions of higher learning feel that teaching at warped speed is a much better method. Because of this Google and the various apps that I pay oodles of dollars for have become my new BFF's. How about a class in coding (ICD-9 at the time, but now ICD-10)? Gee, that might help me look a little like I know something and generate some bucks. I guess what you should take from this is this: you will learn only a minutiae of what you need to know to be a practicing provider in school. Hopefully, you have gained years of experience as an RN that you can draw from (again, another discussion).
And let me just throw this out there...you know the ole' adage "nurses eat their young"? Well they do that to in grad school too. You thought you were done with the mean girls? Wrong! These were the original mean girls. While it did not happen to me personally (I am a true believer in staying below the radar at all times), I have knowledge of this type of behavior against some of my classmates. For some it cost them the program and/or a substantial amount of money. My point is to keep your nose in the books, don't be all opinionated, and don't get that target on your back. Maybe my university was the rarity, but I doubt it. I've work with these types too.
Finally, clinical hours. Honestly, as big a pain in the ass it was, and as exhausted as I was, the more clinical hours the better. You can just write off any thoughts of sleep...this is Sleep Depravation Central. But this is where you will learn and you need to take advantage of learning from experts in the field. And when you're there, don't just follow the provider around. Jump in and starting examining patients and discussing the best treatment options. You will be amazed at what you will learn and retain.
Good luck and hope this helps!
