Therapeutic Comm

A patient came in with uncontrolled DM2, you know the type – the patient is trying her best to get her levels under control with diet, exercise and trying to adhere to the recommended pharmacologic therapy prescribed by her physician. Her sugar was well over 400 and she was spilling glucose into her urine. No bueno. In StudentFNP’s most crappy Spanish, she attempted to figure out why this lack of control was happening. Patient DM was just as surprised as StudentFNP to learn how high her sugar was despite the fact that she took her insulin and was fasting. Being that StudentFNP is new and all to this free clinic, she consulted one of the RNs who gave some delightful advice: tell the patient that if she wants to go blind, have lots of amputations and end up in dialysis for the rest of her life until she’s dead, tell her that’s fine, it’s up to her. Um, what? Sorry lady, but wasn’t there a discussion at some point in your learning about therapeutic communication? Your advice is most definitely not therapeutic. You didn’t even help or answer the question. Also, please stay away from the patients in the future.

Patient DM’s meds were switched around and she will be back, hopefully more controlled and all.

Save the Testicles!

You know what type of healthcare providers StudentFNP can’t stand? As an RN and as a patient you see them all the time. You know the ones. They come into a patient’s room, barely even look the patient in the eye, listen to one side of the lungs only, place the stethoscope on the chest long enough to look like they’re doing something, but not long enough to actually hear a freaking heartbeat. And forget telling them about any health concerns you may have.

A patient in his 20’s came in today for a regular physical because, thanks to Mr. Obama, he can now afford to go to a provider. Yay – win for the ACA! (although, my conservative friends and family don’t think so). While completing the history and physical, everything seemed peachy. Annual physical? Peace of cake!

Until it came to talking about the balls.

Patient casually mentioned that he had a hard lump in one of his testicles. Young male in his 20’s… testicular mass. The patient was concerned and rightly so. StudentFNP doesn’t have balls (oftentimes figuratively too, but we’ll get to that later) and hearing the words ‘mass’ and ‘testicle’ in one sentence scares her! The patient said that the last time he had a physical, the physician told him “Oh, don’t worry about it – it’s nothing,” and just waved it off sans an actual physical assessment or imaging. Together with PreceptorFNP, an ultrasound was ordered and guess what, the results came back with the words “possible malignancy” among a slew of other crappy and abnormal findings. So, a urology referral was given and the patient was sent off to a specialist to figure out what to do about a problem that should have been addressed long ago.

StudentFNP knows that she’s still learning and in the world of primary care she’s just a little baby. However, she knows that what the previous provider did was wrong.

See, those types of providers make StudentFNP really, really mad.

StudentFNP hopes that she never becomes like that. Ever.

Beginnings

StudentFNP has been wanting to create a blog about what it’s like to become a nurse practitioner for some time now. However, this blog was put off for 2 years because of silly little things like work, grad school, life in general and being a hormonally stable good wife to the hubs. She has one year left to complete her DNP degree and the intensity of clinical hours is far behind her. Although she is encouraged to engage in “scholarly discourse” throughout her graduate program, this blog will be everything but. There will be stories about crazy patients, venting about the difficulties of being a NP student, posts about StudentFNP’s own self doubts as a professional, and about that one time a classmate IN A DOCTORATE PROGRAM cried at the beginning of lecture because she couldn’t handle the stress (StudentFNP wanted so badly to yell, “There’s no crying in grad school!!” all in A-League-of-Their-Own style but held back because she has a bit of compassion). Oh, and she won’t be using identifiers like names, places or other specifics because there’s HIPAA and, you know, she don’t want to go to jail and all.

A little bit about StudentFNP: After forever telling people since she was 13 years old that she would become a doctor, all it took was a previous bachelor’s degree, 6 years volunteering at a children’s hospital in a large metropolitan area and a brief, but life-changing conversation at a Mexican restaurant in the middle of Bangkok to figure out that she wanted to be a nurse instead. She graduated from nursing school in 2010 and decided that being in school for 24 years wasn’t enough so she took a chance and applied to graduate school to become a nurse practitioner. Fast forward 2 more years and here she is, working on her doctorate project so that she can be forever finished with school (or so StudentFNP’s husband hopes). And because many people are visual – StudentFNP included, here’s an artist’s rendering of her which may or may not be accurate:

StudentFNP is still working at a hospital as an RN because higher education is not cheap, but can’t wait for that splendid hour in which she will turn in her 2 weeks notice and flip her bosses the middle finger (just kidding, they’ve been supportive of StudentFNP the whole way).

Here goes…