National NP Week is Not a Box of Chocolates

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November 9th-14th is National NP Week.  No this is not supposed to be a Hallmark holiday filled with chocolates, free lunches and thank you cards. That’s for Secretary’s or Bosses Day (which I think is bogus but that’s fodder for another post).

NP week was designed to be an Awareness Campaign to help educate the public about NPs, and to remind lawmakers of the importance of removing outdated barriers. This year is especially momental as it marks the passing of the NYS  Modernization Act: Effective Jan 1, 2015,  this new law removes the requirement of a written practice agreement between an experienced nurse practitioner and a collaborating physician as a condition of practice.

what's it like?

The one thing I was completely sure of when I began my career as a Nurse Practitoner was how much I didn’t know. The classroom time, credit hours, and clinical experiences satisfied my state’s requirement for NP licensure and national certification, but it would be a long while before I would be comfortable in my “new shoes”.

dansko

Preventative care, acute and chronic illnesses, childhood ailments, common health problems, medical mysteries, and terminal disease were to me a murky land and I was a pilgrim. When I began this adventure twenty-three years ago, there was no Epocrates, UpToDate, or other Medical Apps to sift through differentials and no google images to help identify rashes.  It was just me and my Hoole, and a collaborating physician who had faith in me.

My hands shook when I wrote a prescription. My heart pounded when I heard the complaint “chest pain”.  How could I do this? I wanted to run, throw my lab coat in the dumpster, and find a job at a coffee shop. I could do that, make a good cup of coffee.

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A year passed, things started becoming easier, and I grew in confidence. Year two, I no longer felt like an alien, I had gained experience. The fog of greenness had lifted. I had become a Nurse Practitioner.

Now it’s two decades later and National NP week.  I almost forgot about it, again! Then I saw a shout-out email sent to my department with me and fifty of my colleagues listed. It read,

National Nurse Practitioner Week. Please join me in celebrating the many accomplishments of the Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants in our Department. Their expertise, commitment, and team spirit are often the wind beneath our wings.

Despite the fact that last sentence starts Bette Midler singing in my head, that was gracious, and sufficient.  I don’t need candy, or to be taken out to lunch. This week is not about recognition, it’s about awareness. There are many misconceptions about who we are and what we do. NP’s are not MD’s. We have similarities, we are different.  We are not a replacement for doctors, rather we are a branch of the same tree: health care providers.

NP,  MD, DO, PA, CNS, CNM, CRNA, RN: Our Health Care Rock Stars  who do life saving, life-changing , ground-breaking, rad work. I applaud them all!

Being a nurse practitioner is not easy work. I think only another NP can appreciate what I mean by that. I don’t work in a posh office with Stickley furniture and catered lunches. No banker’s hours for me.  I have a ten-minute walk from my parking space to the hospital entrance. And when I greet my first patient,  it’s game on.  From the first to the last it’s all about them, not me. I listen, support, hold a hand, give a hug, look in eyes, encourage, reflect, help, guide, teach, smile and do what I can, with what I have, where I am.  And when I’m extra tired or feeling worn and thinking,  I need to retire , a patient will say something to snap me back to why I love my job.

“Thank you.  Can you always take care of me? You don’t know how much this means to me. You’re the first person that didn’t treat me like an addict.  Yes, I think this might work! I’m so glad you’re still here. You are good at what you do. I appreciate your kindness.”

Now that’s recognition. Hearing those words keeps me coming back. I chose this career, if I could go back in time I would choose it again in a heartbeat.  Kudos to my fellow NP’s and let’s not worry about whether or not we get a card, a latté, chocolate, or a thank you email. That’s for Hallmark fluff holidays. National NP week is about education and awareness.

All about NP’s: Downloadable Infographic

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Could You Survive a Stroke?

body models

Recently a patient thanked me for saving his life. You don’t hear those words everyday. How did I save your life I asked? Two years ago I saw him for a physical. His blood pressure was 220/110. Absolutely I remembered him.

I took his blood pressure at least six times in various positions over a forty-five minute time frame. It stayed the same. How long has your blood pressure been this high I asked him.

I didn’t know it was high.

I feel fine.

He sat there relaxed, not a bead of sweat on his forehead, wondering why I was making such a fuss calling my collaborating physician, calling his physician, and asking him over and over: How do you feel? Do you have chest pain? Headache? Dizziness? Nothing? Really, you feel fine?

blood-pressure

That’s how it is with hypertension (high blood pressure). It’s earned the name silent killer for a reason. You can walk around with a blood pressure as high as this gentleman and feel nothing. Yet, you are a time bomb. No one knows if and when one of your arteries rupture or become blocked and you stroke, have a heart attack, or drop dead. It took over a year to get this patient’s blood pressure somewhat under control. Still, he suffered a stroke. A non-life threatening one, but a life altering one.

How do you know it’s a stroke? What do you do?

The stroke damaged a part of my patient’s brain. He has trouble expressing himself, is unsteady, and has problems with his memory. But he survived, he’s receiving rehabilitation and he’s grateful to be alive.

What can you do? Stay educated on matters of your health.

 

  • Check your blood pressure and see your provider if it’s higher than 120/80
  • Maintain a healthy weight
  • Don’t smoke
  • Eat right
  • Exercise

Take care of your body-it’s the only place you have to live. Jim Rohn

One Disease You Definitely Don’t Want

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It’s been called consumption, the white plague, pott disease, and phthisis. Once thought a romantic disease, notables such as John Keats, Percy Shelley, Robert Louis Stevenson, Emily Bronte, Edgar Allen Poe, and Frederic Chopin either died from it or suffered with it. Ancient treatments ranged from using special gold pieces around victims necks or inhaling smoke from burning cow dung.

tuberculosis

Tuberculosis (TB) is a nasty disease caused by the bacteria Mycobacterium tuberculosis  spread from person to person through airborne droplets. According to the CDC, 10,528 TB cases were reported in the United States in 2011- which is the lowest number since reporting began in 1958. A little over five hundred people died from it in 2009. In the 18th/19th centuries, the numbers of deaths were staggering.

tb prevention

Typical scenario of how it spreads: your infected neighbor coughs, sneezes, or spits while talking to you and you breathe his droplet in.  Poor unknowing bystanders (crowder elevator) have no idea they may have just been blasted with mycobacterium tuberculosis. Another good reason to take the stairs.

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No, it’s not that common (in developed countries), but it is often fatal if not treated.TB infects the lungs, but it can also affect other body parts like your brain, kidneys, or the spine.  How do you know if you’re infected? The most common symptoms are weight loss, fever, night sweats, fatigue, and coughing up blood.

What is the Difference Between Latent TB Infection and TB Disease?

People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not active.  This person will have a positive TB (PPD test). They have no symptoms, and can’t spread the infection to others. But, there is a chance they can develop TB in the future. That’s why antibiotics are usually given for a positive TB screening – it’s insurance for the future.

People with TB disease are sick from TB germs that are actively multiplying and destroying organ tissue. If you have been exposed to a person with TB disease, you can get infected too. You need to get to your primary care provider or local health department for follow-up testing.

Once a person is infected with TB bacteria, the chance of developing TB disease increases with:

  • HIV infection
  • Presence of additional health problems such as diabetes or a compromised immune system.
  • Abuse of alcohol or illegal drugs

wasting away 2

As a health care provider, my institution requires me to be tested yearly, and I also screen all my patients at the addiction clinic annually with the PPD test. A positive test means the person has been infected with TB,  It does not tell whether he has TB disease. Next step would be a chest x-ray and probably the course of antibiotics for 6-12 months.  If you test positive once for TB, you will always test positive, so it should be noted and then the test should not be given again.

Modern medical advances have helped millions of people live longer, healthier lives. We owe these improvements to decades of investment in medical research. Ike Skeleton

A Cup is a Baseball

All you need is love. But a little chocolate now and then doesn’t hurt. Charles Schulz

A cup and a baseballIf you haven’t already, chance are you will be completing  a health survey next time you enroll for your health insurance.  Fail to meet the “healthy” criteria and you’ll forfeit a substantial discount.  Plan on reporting your cholesterol levels, last eye exam, dental and medical check-up, weekly exercise total, daily food intake, smoking status, alcohol consumption, and recreational drug use. The one area I scored poorly on was diet – Since the 2011 demise of the food pyramid, I admit I haven’t nailed down the proper number of food group servings I should be eating.  Now that I’m nutritionally savvy from my sleuthing,  thought I’d share my findings with you.

The foundation of your diet should be a healthy plate, each meal (plate) should be 1/2 full of fruits and vegetables, 1/4 grains, 1/4 protein, and include a serving of low-fat dairy. Half of your grains should be whole-grains.

Servings for an average adult:

  • Fruit: 3 (serving=1 cup or 1 whole piece) may be fresh, canned, frozen, or dried
  • Vegetables: 3 (serving=1 cup of raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens)
  • Dairy: 3 (serving=1 cup milk/yogurt, 1.5 oz. hard cheese, ½ cup cottage cheese)
  • Grains: 6 (serving=1 oz which is any of these: 1 slice of bread, 1 cup cereal, ½ cup cooked rice/pasta/cereal/oats)
  • Protein: 5 oz total (serving: any of these is a 1 oz serving: ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter, ½ ounce of nuts or seeds)
  • Oils: You are most likely to get your daily need (5 tsp) in food preparation.  Only eat  MUFAs – Mono-unsaturated fatty acid and PUFAs-polyunsaturated acids.                    Trans fat=death trap.

Sorry, there is no RDA for chips, candy, sweets, soda, sugar, or any other lusciously decedent dessert. Indulge at your own risk.

Nothing beats properly measuring your food, but considering most of us don’t carry tablespoons and measuring cups in our laptop bags, here are some visuals to help you eyeball portion sizes:

  • 3 ounces of meat=deck of playing cards
  • 3 oz of fish=checkbook
  • 1/2 cup=tennis ball
  • 1 ounce of cheese= six dice
  • 1 ounce of nuts=handful
  • 1 tablespoon=tip of your thumb.
  • 1 bread slice=DVD
  • 2 tablespoons=ping pong ball
  • 1 cup=baseball
  • 1 teaspoon=1 die
  • 1/4 cup=golf ball

More information on MyPlate:

 

Explosive Potty Humor and Buddha was a Thin Man

Uncle John’s Fully Loaded 25th Anniversary Bathroom Reader

I’ve had my fill of toothpaste and cold medicine instructions. Never one to bring a book or newspaper (unless we’re out of toilet paper) to the bathroom, when things are taking a while, I resort to reading whatever I pull out of the cabinet.  Get in and get out is my usual philosophy.  But, isn’t it nice to have reading material handy for those occasions when our digestive systems are sluggish? Why not take maximum advantage of the predicament –  read an anecdote, eye witness account, learn some frivolous trivia, or a dumb joke to make you feel like you haven’t wasted time sitting around waiting for something to move. With over 600 pages of witty sayings, conversation pieces, and collections of wacky and sometimes useful information, this loaded reader will provide entertainment when you need it most.

Here’s a sampling of my favorite nuggets: Lost in translation (signs):

I like your smile but unlike you put your shoes on my face.

Sorry we’re open.

Please do not feel or scare the animals.

Because I do not have a tissue always ready in this restroom, please buy used one.

Foreign language insults/threats.

Fantong! Mandarin for useless (literal: rice bucket)

Nameh Ten-No! Japanese for you want to fight? (literal: what are you licking?)

Sutki Pala! Polish for chill-out (literal: your nipples are burning)

 

Want to brush up on your bowling lingo? Say this next time you’re at the alley:

“Look at him reading the lane with his benchmark ball, I bet he’s a squeezer cranker bound to get a clothesline or a 7-up.”

And one of my favorite sections: dispelling myths. I was shocked to learn that Buddha, traditionally depicted as a fat god, was actually tall and lean. With 600 pages, so much time suck awaits you. The Bathroom Reader might even make it out of your bathroom and into the main living areas of your home. If it sounds like one of your family members is having a good time in the john, let’s assume The Bathroom Readers’ Institute is to blame. And just so I can feel like I’ve offered you a little preventative medicine, here’s some tips to  avoid irregularity from the makers of the OTC product I recommend to my patients with constipation.

Miralax 

 

Ignorant People are Dangerous

Ignorance: lacking knowledge or information as to a particular subject or fact, showing lack of training

 

If you aren’t consistently seeking to improve yourself, pursue new information, or explore the latest trends in your field, more likely than being lazy, you might be dangerous.  And, you may slowly waste or fade away like an old photograph.   I think of my 82 year old mother – I have never known her to take a class, attend a seminar, or research something she knew nothing about.  She gains her education through reading tabloids and watching junk TV.  And she wonders why her life savings is gone and she makes decisions that she consistently regrets.

That’s just the way I am.  I can’t help it.  I’m too old to learn.  What’s done is done.   He’s the expert. They say.  I read somewhere.  I’m not going to change now.

Information is everywhere.  You are limited only by your own lack of interest.  No money?  No computer? No excuse.  Try the library.  It’s been around since 1731 and is still the best thing since Starbucks Americano with room.  For my nursing colleagues, I have added below links to several of my favorite sites for free CEU’s. My medical institution requires 60 a year. I do well over that and have never paid a cent. In my field, it is dangerous not to stay informed.  You may not cause harm to anyone if you don’t continue your education, but won’t you feel like you’re missing out? Whatever you do, wherever you are, be all there, and do it better every day.

It is impossible for a man to learn if he thinks he already knows.  Epictetus

 

Sources for free CEU:

Medscape

Discovery Channel 

CMEcorner

Cleveland Clinic

Medpage Today 

Neurosciencecme

Powerpak

Nurses Who Eat Their Young: The Dirty Secret of Bullying

Those who can, do. Those who can’t, bully.

Last night I went to my local nursing association’s business meeting.  I enjoyed a glass of wine over a lovely dinner while engaging in long overdue conversations with colleagues and friends.  Then the presenter began the evening’s topic on horizontal violence (AKA workplace bullying). It wasn’t long before smiles faded, heads dropped, and yes, tears flowed.  The air chilled as we sadly shared with one another our early experiences with bullies.  First as children, then later as new nurses, we told tales of being victims of lateral violence. Here we sat, a room full of education, degrees, awards, diversity, and experience – several had more than thirty years in the field.  But we all had one thing in common – we had either been eaten, or we were the ones who ate their young.

One of the presenters, a May 2012 nursing graduate, did her capstone honor’s project on horizontal violence.  She spent a year collecting data from a local hospital’s acute care unit. 82% participation disclosed over 50% of the nurses reported being bullied by a manager or colleague.  And then her research became reality – just two weeks into her dream job at a high acuity ICU she became a victim.  She had come full circle and wondered how her life dream could turn into a present day nightmare.  Even with her years worth of knowledge in identifying and confronting this malignant nursing behavior, she felt powerless, alone, and desperate for a solution.

By definition, workplace bullying is ““Persistent, offensive, abusive, intimidating or insulting behavior, abuse of power or unfair penal sanctions which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress.” (MSF Union, 1994) Examples of such behavior include eye rolling, frowning, shouting, sarcasm, passive aggressiveness, gossip, exclusion, derogatory comments, failure to communicate patient information, intimidation, silent treatment, excessively critical. Key word: Persistent. Everyone has a one time temper tantrum or bad day. But if it is ongoing, there’s a problem.

Why would a nurse engage in such contemptible behavior?  Many factors can contribute; high stress, short staffed units, job dissatisfaction, personal troubles, isolation, and the all too common nurse manager who’s a top notch nurse but knows nothing about management. Whatever the reason, it is shameful, dangerous, damaging to both the patient and victims, and has got to stop.

So what do we do? Is there any hope for us? Can we work together and put aside our differences and personal baggage and make our workplaces a healthy, inclusive environment? Though our nursing careers varied, we all agreed that what kept us in the profession was our commitment to our patients – they were the reason we do what we do.  For their sake, we must change.

Here are some ideas on how to keep the mothers from eating their babies:

  1. Acknowledge the problem.  If you see a repetitive bullying behavior, it needs to be addressed. Whether it is you or one of your co-workers, it’s time to take action.
  2. Confront the bully. In a respectful manner say something like , “I sense you disapprove of my performance with….you might not have realized when you said I was inexperienced it made me feel bad and has since continued to bother me. Let’s talk.”
  3. Document. Keep track of the incidents adding as much specifics as possible, along with dates/time/shift/witnesses/etc.  Log your actions and attempted discussions.
  4. Know your institution’s policy and follow it. Go up the ranks until you find someone who will intervene.
  5. Band together.  It’s easy to bully one, it’s harder to take on a team.
  6. Request training in horizontal violence. Give your continuing education department a head’s up that  you have a dysfunctional work environment and need serious help.
  7. If you’re the bully, admit it and stop. Seek help.You are a care giver who needs care.  It takes more courage to repent than to keep on sinning. Your fellow nurses will forgive you.
  8. If you are a manager, learn how to manage. It takes more than seniority and a MSN to be a good manager. Get some training and make a promise to improve your weak areas.
  9. Network. Join your local nursing organization and get involved.  You’d be surprised how many nurses are going through exactly the same thing you are. Talk to each-other, form friendships, and believe that things can change.
  10. Don’t give up. Unless you are out of options and your health is suffering, believe in yourself, your dream, and continue to give outstanding nursing care to your patients.  They need you.

Based on our dialogue last night, the consensus was there is a ton of work ahead, but with a united front, and empowering ourselves through education and support, we can overcome. Rather than eat them, nurses will teach their young. And when the fledglings are ready to soar, we will contentedly smile and remember why we chose to be nurses:

“To know even one life has breathed easier because you have lived – that is to have succeeded”. Ralph Waldo Emerson