A Letter to Nurses

17 Sep

stethescope pic

By now the ridiculous comments from the hosts of The View have been chewed, swallowed, and barfed out like the garbage they are.  Miss Colorado spoke about her experience being “just a nurse” and how an Alzheimer patient helped her to realize the importance of her work.  The View managed to mock her (probably jealous of her brains), and the outcry was more than impressive.  The public poured out their support for nurses.  Social media made it very clear that mocking nurses would not be tolerated.  And I joined in.  There were YouTube rebuttals and new memes created that were both thoughtful and hilarious.  I watched as my Facebook stream filled with nursing friends posing in scrubs with a stethoscope placed around their necks.  It was the perfect response to ward off ignorance about the profession and remind the public of the care nurses provide.

And yet I can’t help feeling a little disappointed.  A little betrayed.  Not by my nursing friends but by the nursing profession.  Physician Assistants are frequently misrepresented in media and the work that we do is often belittled.  Our work is viewed as a “stepping stone” to be fulfilled only after we complete medical school.  We get labeled as assistants that deliver coffee and can only handle scut work.  Where was the support from the nursing community when we were getting slandered?  Almost every day I hear stories from colleagues about how the lack of an MD behind their name causes patients to question them.  But we do not have the numbers or the lobbying power to put up much of a fight.  Our PR department doesn’t have much oomf yet so any strong statements we try to make are limited compared to the large nursing force.  Our field has only been around for 50 years so we are kind of the new guys on the block.  When we’ve been thrown to the wolves on many occasions all I heard from the nursing community was …..crickets.

I think that as healthcare professionals we should all be respected.  We made it through difficult training and clinicals. We’ve weathered traumatic patient encounters and watched death whisk people away.  I guess all I’m asking is for you guys to have our backs, like we have yours. 

I can educate patients until I am blue in the face about the scope of a PA. I can work my hardest to give quality care to the American public. My hard work would be so much more fruitful if the PA profession had more support from the nursing community.  When you hear a ridiculous characterization of a PA, call it out for the BS it is.  When it is National PA Week, maybe give it a brief spot on your Facebook page.  When you get wind of The View mocking the PA profession, be almost as mad as when they mocked your profession.  ‘Cause right now we are the underdogs;  Physician Assistants need a little support to make our profession better understood.  As the PA profession continues to be the bridge the between people and access to healthcare, spreading understanding of what we do will only benefit patients.  And I know the heart of nursing will always be patient care.  That’s my heart as well.

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Losing Control

10 Sep

Don’t you just love the smell of no kids in the house?  They went back to school in a flurry and now there is a moment to sit in a recliner and…sit.  Although the quiet is nice, there is something terrifying about the whole putting my kids in the hands of the educational system.  Last year, the school lost my five year old.  That’s right, you heard me. LOST her.  She was supposed to be attending a solar cars class after school.  I know, cool.  It was the last session and I asked her older sister to go with to make sure she didn’t get lost.  Even with that precaution in place, the teacher did not take any action when my older daughter brought my missing child to his attention.  Meanwhile, my little peanut was put on a bus and sent home.  No one was there to pick her up from the bus stop, no one was in the house.  Complete panic ensued and she started wandering the alley of a large metropolitan neighborhood.  Luckily, we know our neighbors and they were able to calm the sobbing, lost child until the nanny arrived.  

Twenty minutes.  That’s how long she was alone.  I start to shudder when I think of all the bad things that could have happened.  This isolated event made me question if I would ever be able to willingly let them grow up. How do we send our children out into this world of possibilities, both good and bad?  How do we let them make their own choices?  How do we let them fail?

One outcome of these questions is to be a complete control freak.  This need for control can seep into other areas of our lives.  When you step away from parenting and enter the clinical world, what is your style of medicine?  I think as PAs we may have a tendency to lean in the “freak” direction.  We like things to have good outcomes.  We like to help.  We like to control all the variables so that our patients have the best shot at recovering or even maintaining. At some point along the way, we realize how little control we have and how much of a patient’s health is dependent upon their choices.  This burns a little because we want so much to make a lasting change in people’s lives.  But sometimes, no matter how well managed they are from a medical standpoint, patients won’t get better.  This isn’t necessarily because we did anything wrong, but due to a multitude of things that were outside of our control, or even the patient’s control. This world isn’t perfect and doing everything right doesn’t mean everything will get better.

There may be a small part of us that wants good patient outcomes to reflect upon our stellar capabilities as clinicians.  Maybe just a little recognition hungry?  Not anything huge, just a brunch in our honor or a front page piece in the local newspaper.  I think we do the same thing with our kids.  When our high-schooler does well on the ACTs do we secretly believe that it is our accomplishment? On the other end, there is a tiny part of us that believes when Timmy bites Becky at preschool, it is because of our bad parenting.  Or when our 5th grader cheats on a test, it’s because we didn’t do a good enough job teaching them to be honest, or when our college kid drops out and starts using drugs it’s because we didn’t talk to them soon enough about substance abuse.

There is a point in which we need to separate ourselves from other people’s choices.  We give our patients and our kids the best tools we can.  What they choose to do with the tools is not up to us.  We protect our kids, we advise our patients, but the choices they make are not a direct reflection on who we are as people.  We can do everything in our power to help those who are in our professional or personal lives.  At some point we need to let go of the control that never really belonged to us in the first place.

Transitioning from the ER to Management

13 Aug

One of my greatest criticisms of my previous employers throughout my career was that they put people in management that had no management training.  The roles were picked haphazardly and it had to do with willingness to lead, rather than capability.  I am in week three of my new management position, now look who is wearing the asshat.

I leaned on the fact that I have natural leadership qualities, experience in education, and writing abilities.  As it turns out, managing is a complicated dance with the employees, system capabilities, money, and time….and that gosh darn computer.  I am learning that a significant part of my job thus far managing the PAs and NPs for eleven urgent cares requires learning computer programs.  Lots and lots of computer programs.  Scheduling, reimbursements, badge access, benefits…they all require skills and knowledge of different programs.  I am not a dummy, but the technical stuff is a little overwhelming right now.

Also, turns out that managing people requires the ability to adapt and connect with each one on their level.  Somehow, I am supposed to meet with and get to know 40 different people, with different schedules, different temperaments, and different levels of disdain for their leadership team.  Its difficult finding the right “tone” or body language to use when trying to build up a relationship of mutual respect.  I know I’m the new guy in town.  I know I am young, beautiful and intimidating. So the tricky thing is to try and be in a balance between advocacy and cracking the whip.

Luckily, the company I am working for is very supportive and giving me tons of training.  My career is changing and I am learning a new skill set that is very different from the one I use in the ER.  But, as it turns out, the PA world is indeed very small and I have run into numerous people that I worked with in my previous places of employment.  That makes site visits more like a reunion rather than a meet and greet.

My final issue with this new management position is that wearing my pajamas to work everyday is no longer an option.  I miss my scrubs desperately.  The items in my closet are a mismatch of old collared shirts that are definitely a shout out to my previous obsession with the fashion seen on “Friends”.  Jennifer Aniston has nothing on me.  I honestly feel ridiculous in some of my outfits, but the wardrobe will be upgraded once all my kids have their school supplies and clothes.  Sigh.

One aspect of working part time in management that I really like is the flexibility to continue working clinically in the ER.  That’s right, I couldn’t cut the umbilical cord.  My career birthplace was the ER and in the ER I shall stay, at least for now.  I will continue to remember my roots and I am dedicated to keeping up my clinical skills, because who wants a manager that can’t spout off the PERC criteria?  Not me!

10 Mistakes Not to Make in the ER

26 May

ambulance

The ER can be an intense place to practice medicine.  There are high-stress situations, high acuity patients, and fast paced decisions are constantly made.  Here are a few tidbits that I have learned over the years working in the ER.

1. Always remember to recheck abnormal vital signs.  You have a young healthy patient who has been barfing his guts out all night.  He looks dry and is tachycardic.  So you give him some nausea medications, throw in a line and give him some fluids.  Surprise!  The patient is all better!  But did you document that the vitals improved?  This is sloppy and to not document their improvement could be detrimental.  What if after 2 liters the patient now has a fever and is persistently tachycardic.  You might change your management, and he may need some further testing to get to the bottom of the abnormal vital signs.

2. Speaking of vital signs, lets talk about temperature.  You have an elderly patient who comes in for being weak.  Pretty common, right?  Well, they don’t have a fever so you get pretty comfortable in your work up and take it easy.  Until their white count comes back at 18000 and then you ask the nurse to do a rectal temp, which comes back at 103.  Suddenly you are racing against the clock to look for sources of sepsis and start administering antibiotics.  We rely too often on oral temps.  If someone has dry mucous membranes, their temp is not going to be accurate.  When in doubt, get a rectal temp.

3.  We miss a lot of valuable information if we don’t greet the medics at the patient’s bedside.  If you see an ambulance coming in, try to get the report directly from the medic.  We lose key portions of the history because we get the secondhand story from the nurse, who is also trying to settle the patient in.  You will have a lot more holes to fill if you don’t get the story firsthand from the medics.

4.  Trust the nurses.  They have a lot of experience and can give you good insight on the acuity of a patient or any underlying diseases that might be at play.

5.  Don’t do what you’ve always done.  Sometimes guidelines change, and you need to stay on top of those.  Remember when giving a beta-blocker was the standard for acute coronary syndrome?

6. Document the hell out of domestic/sexual assault cases.  I was called in as an expert witness and I was so RELIEVED that I wrote down every detail of the history and physical.  We see so many patients and these cases will often go to court.  It won’t be your supervising physician that gets summoned, it will be you.

7.  Distracting injuries- They are very distracting.   Whether its a trauma code or just a regular old open fracture make sure you get your own system and do you exams and work up the same on every single patient, every single time.

8.  Avoid burnout and take a break.  One thing I see a lot with new providers is that they take on way too many shifts.  The ER is exciting and it makes good money.  The more shifts the better, right?  Wrong.  You need to continue to develop other interests and have a good balance in order to be a good provider.

9.  Protect yourself.  If you are going to I and D an abscess, place a trach, intubate, or look into the throat of a coughing patient, you need to have the right gear.  You do not want to become a patient because you were stupid.  Eye protection, gloves and face mask, at the minimum.  Period.

10.  Don’t let patients get under your skin.  They are likely having one of the worst days of their lives.  They may be nasty, but don’t take it personal and don’t give it any emotional energy.

What other tricks of the trade would you add to the list?

Missing My Dad on Mother’s Day

11 May
mothersdayflower

“You Gnomes How Much I Love You”

My world filled with homemade cards and paper cups filled with dirt seedlings on Sunday.  My girls were happy to give me their sweet gifts on Mother’s Day, but it was short lived because I had to work a shift in the ER.  I had an unwelcome feeling creep into my gut on the way to work.  An unsettling darkness settled over my head and I soon recognized that grief was creeping nearby. This was the first Mother’s Day without my dad.  He passed away last June and my family is still wading through the muck of loss and trying to figure out life without him.

I couldn’t quite place why Mother’s Day was triggering such sadness for me.  After a while I realized it was because my dad was such a good partner to my mom.  He cared for her, cherished her, and appreciated her.  He was incredibly affectionate towards her I remember him often looking at her and saying things like “Isn’t your Mom pretty?”I felt sad that my dad wasn’t here to cherish her.  Her kids could do their best to make her feel appreciated and loved, but a big component of Mother’s Day is your partner celebrating with you.

My dad also taught me a valuable lesson growing up about how I should be treated.  I was able to watch a man love and care for his wife.  He was respectful and my parents truly were a team.  When I chose my own husband, I had something to model our marriage after.  I, too, chose someone that would love, respect and cherish me.  What unspeakable gratitude I have for my parents and the healthy marriage I witnessed growing up.

My dad wasn’t perfect.  Some of his purchases for my mom on Mother’s Day were absolutely cringe-able.  There were outfits that were quickly returned, jewelry with questionable metals, but the sentiment was always genuine.  I’m sure my mom had moments of feeling unappreciated, like we all do at times.  But I know she never questioned whether or not she was loved.

Its interesting what pieces of my dad that I miss, and when they show up.  I didn’t predict that grief would hit so strongly on a day that was supposed to be about celebrating ME and the other women in my life.  That I would grieve the loss of my mom’s husband, separate from grieving my dad.  It always catches me off guard and I never recognize grief right away.  Its like this nebulous emotion that seems to come out sideways.  But I acknowledge it and feel it, and try to move on because I think it would completely break me if I let it.

After working my shift on Mother’s Day I went home.  I snuck into my kids’ room at one in the morning and woke them up.  I know, bad mommy.  We hugged and kissed and I know they appreciate and love me.  Then I went and cuddled with my husband and felt thankful for him.  The loss of my dad still hurts and it grips me by my throat sometimes.  But the love of my family is a balm that soothes and makes death sting a little less.

Curing (Compassion) Fatigue – PAs Connect

29 Apr

There is a very serious epidemic out there right now among healthcare providers.  Compassion fatigue takes the joy out of what we do.  Here is my latest PAs Connect article.  Please share if you care 🙂

Curing (Compassion) Fatigue – PAs Connect.

Fresh Faced Students

19 Apr
frobaby

This is how old the college students looked to me!

I had the pleasure of talking to a pre-pa student group at the University of Minnesota Duluth.  On Thursday I picked up my girls from the bus stop and we had an impromptu road trip to the north shore.  My mom joined us and we made an event out of it.  We arrived at the hotel that had a ridiculous indoor water park and I left them to meet with the pre pa group.  I had a couple of observations about these college students.

First of all, they must have been uber smart because there was not a single one that looked over the age of twelve. They had bright eyes, and wore their backpacks correctly with straps on both shoulders.  The group consisted of mostly women, and they were eager!  One of them was going to graduate from college and then head directly into a PA program.  Others are only freshmen, already with a passion for medicine and the PA profession.

I talked a while about my journey to becoming a PA, my career, and briefly about my coaching business.  The thing they wanted to hear about the most?  Patient encounters.  The stories from the ER captivated them and they wanted more.  Storytelling is one of my favorite things to do, especially when I have a captive audience.  These students reminded me of my own drive that got me into PA school and my love of patient care.

I also felt a little anxious on their behalf.  What if they don’t get into school?  What if the academics prove to be too hard?  What if they are too young to know that this is the career choice that is best for them?  I took two years off after college to explore some of those questions and I knew the PA profession was right for me.  Sometimes I feel that PA programs are filling with younger and younger students that have the academic aptitude, but not the life experience that can be beneficial for a career in health care.

Here is a piece of advice from this old lady of 33 years.  If you are sure that you want a career as a Physician Assistant, go for it!  When you know, you know!  But if there is hesitancy, a small voice that says, “I’m not sure”, that’s OK.  It is wise to listen to that voice and slow down.  There is time to think, to experience life, to travel, to take more classes, before you make a decision that will affect your life immensely.  Going to grad school is big!  It is a significant financial and time commitment.  And the beautiful thing about PA school is that it will be there next year, and having some of those life experiences will look good on an application.  More importantly, those life experiences will shape you into a more mature and wiser person.

I finished with the pre-PA group and headed to the hotel.  The waterslides were wicked fun and I had a moment of being very thankful.   Thankful for my family, and thankful that I have a career that allows me to bring my kids for a fun overnight.  And I am thankful for the bright young minds that are going to be the future of the PA profession.

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