The Little People in Life

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Yes, it’s been forever since I’ve done a blog post. There are multiple reasons for this including finishing a whirlwind summer of clinical last year, graduating, having another baby, staring a full time NP position…etc. And I won’t promise that I’ll blog again anytime soon but I’d like to tell some stories now and then. I’ve had one story in particular on my heart and I want to share it because it links many pieces of my life together and illustrates how the most difficult things can turn into the most stunningly beautiful moments.

Last summer was one of the busiest seasons of my life. From May until August I was working 4-5 days at clinical per week along with 1-2 hospital shifts on the weekends. Yes, when you do the math it adds up to around 60 hours/week. There was a point where I didn’t have a day off for fourteen days straight. There was nothing I could do to change it. The hours had to get done and the shifts had to be worked and so everyone in my life put their big people pants on and we made it happen. My husband did all the household tasks, my mom helped take care of my daughter, and I powered through like a long-distance runner, focusing on the next step, the next day, afraid to look too far back or too far ahead. (Then I had to stay up every night entering my clinical logs thinking, WHY IN THE WORLD DOES THIS TAKE SO MUCH TIME? That’s a different blog post, though.)

Add on the fact that I was, oh yeah, pregnant in my third trimester. Yes, that’s right! I was giant pregnant, waddling around on swollen ankles as I pretended to be a nurse practitioner on weekdays and knocked out some ICU shifts on the weekends. People would often stop me and ask, “how in the world are you doing all of this?” and I would simply answer, “I have no idea.” Because honestly, I didn’t. I still don’t. God put the path in front of me and He made a way for me finish it. I have no better explanation than that.

Thankfully, my little guy was a trooper even in the womb. I had a breeze of a pregnancy and worked past forty weeks. (I took and passed my boards at thirty eight weeks and three days if you’re in the mood for something that might cause you have a panic attack. I burst into ugly, giant tears the moments the lady at the testing center handed me the paper that said, “passed” and everyone let out a high sigh of relief that I hadn’t gone into labor during my test). My little guy kicked and punched and learned how to be a NP right along with me like my own little stowaway. And at the end of it all, on my last day of clinical I went home and got promptly sick with a terrible cold, as if my body had been waiting until I was finally done to shut down. But we made it.

This point of this dramatic re-telling of my summer is not to look for some validation, not to search for pats on the back for making what seemed impossible possible. No, the point isn’t about me but it’s about my daughter, Evy. She is one of the real heroes of this story, the real trooper, and she deserves some praise for all that she had to go through last summer.

I’ll cut to the best part of the story. On the day of my hooding (a nursing tradition for graduate students, akin to graduation) the three of us (Evy, my husband and me) got up, got ready, and got in car. We drove to the campus. I put on my robes. And they snagged a seat in the auditorium. We all had to wait a long time as rows and rows of other graduates passed before me, each one waving wide, stunned smiles just like the one I had on my face. Family members were shouting out from the audience, some of them yelling things like, “that’s my wife!” or “that’s my sister!” garnering laughs from everyone in the audience. I sat in my seat thinking how surreal it was that I had finally, after three years, made it to the end of this journey and how miraculous it was that I was still healthy and pregnant. It all seemed like it had been too hard to be real and now too good to be true.

My turn came and I wobbled up the steps in line with the other FNP graduates. I waited for my name to be called and finally someone with a pleasant, punctual voice announced, “Natalie Bridges.” I had been trying to spot my family in the crowd but hadn’t been able to find them yet. I knew they were out there but I didn’t know where to look so I scanned the crowd as I walked across the stage, nearly blinded by the spotlights. The whole thing felt like a dream, like one of those moments that you know you need to remember but you still feel like is slipping through your fingers.

And then, just when I had given up on finding my family in the crowd, from the middle of the auditorium I heard a tiny voice that I recognized. It was the same voice that had asked me every night after work to, “tell me about your patients!” The same voice that had instructed me how to do check-ups on stuffed lambs and owls and baby dolls. The same voice that had never said an unkind word about me having been gone so much that summer, that didn’t know how to hold a grudge, that gave nothing but love to her mommy who was struggling to juggle so many balls at one time. And that little voice shouted, with all the pride she could muster, “that’s my mommy!”

As soon as I heard her I knew it was the last straw for my fragile emotions. I burst into tears, right there on the stage, completely forgetting what I was supposed to do as I walked toward the instructor at the other end. Evy’s voice was surprisingly loud in the midst of the crowd, carrying so far that the whole audience laughed. The instructor whispered in my ear that I had to lean down so that she could place the hood over me. I obeyed her, tears streaming down my face. And then Evy shouted it again, even louder this time, with her own little determined fervor, as if this was a message that could not get missed. “That’s MY MOMMY!!”

And as my heart ached with love, shreds of myself spilling out through my tears, all I could think was, “this is it.” This is why I did all of this. Yes, to help people. Yes, to find a fulfilling career. But what could top my little girl being proud of her mommy? She was telling me, and everyone else, in her own little way that I had done something valuable and that I was valuable to her. It was a thank you I hadn’t expected and one that I will never forget.

I will hold onto that day in my heart for the rest of my life.

She’s still offering me so much grace as I now work full time as a nurse practitioner. I’m away more during the week but home every night for dinner to tell her all about my patients, to teach her all my “diagnosis’s” and to explain, yet again, why patients don’t need antibiotics for a cold. She’s full of excitement and creativity and promise and I hope that I will inspire her to do something daring with her own life. She’s the encouragement that I still need as I take a step into a career that still feels very foreign and overwhelming.

It really is all about the little people in life. This precious daughter of mine who can already, at only four years old, do a dang good physical exam, and my little son who makes me feel like the most important person in the world every time he looks at me with those big, blue, inquisitive eyes. They give so much grace, so much love, and without them everything I have gone through in the past few years would have an entirely different meaning.

I enjoy my patients; I enjoy my job, but in the end, that little voice from out in the crowd means more to me than anything else in the world.

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April FNP Update

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Goodness, it’s been a long time since I’ve blogged. When I decided to resume blogging I had the best of intentions in chronicling my journey towards FNP but something got in the way. A lot of things got in the way. SCHOOL mainly. So instead of crafting an eloquent blog post about some existential nursing concept, I’m going to give you a stream-of-consciousness update and be satisfied with it because I’m already working on borrowed time. There’s an open review book waiting for me, scolding me with all the facts I do not yet know about rheumatoid arthritis. And you DO NOT want to ignore rheumatoid arthritis.

So what has been keeping me so busy for the past few months?

Working! What in the world do you think I’ve been doing?

I’m currently finishing up my second-to-last semester in my FNP program with a tentative graduation date of August this year. (OMG DID I REALLY JUST WRITE THAT?) I’m over a third of the way done with my total hours and the days seem to be flying by. As my cumulative hours sheet grows longer and longer, I grow one hour closer to freedom. One. day. at. a. time.

Clinicals have been an unexpected success- not that I always make the right choice, believe me, I’m made some epic blunders- but I am enjoying it more than I ever thought I would. The patients are wacky as ever, the complaints are unpredictable and varied, and the physical exam findings sometimes make me put on my ICU nurse face so that I don’t show that I’m HORRIFIED BY YOUR FEET RIGHT NOW. Or, I’M HORRIFIED BY YOUR LAB VALUES. Or, I’m HORRIFIED BY YOUR NON-COMPLIANCE. It’s the same face I put on in clinic when a patient asks me to look at something I never thought I’d see in a place I never thought I would have to examine. Primary care is awesome, never boring, always full of characters. It’s definitely where I want to be as a nurse practitioner.

Plus, sometimes I do make the right choice. I pend an order and then my physician says the exact same thing I just put in the computer. But I did it before he said anything! I proved to myself that I actually know something! I CAN take care of patients by myself! This victory over putting in the correct dose of valsartan (big time stuff, people) lasts for a brief period until I completely forget to address his preventative care needs or forget to ask him what his home blood sugars are or try to order two serotinergic drugs at the same time (gasp!). Then I come back down to reality and remember that I still have plenty of hours to go but that those small wins are not insignificant. I am learning and I am going to be the best NP I can be (insert girl scout wink).

Other than clinical, I’m working two shifts a week at the hospital in the ICU seeing the end result of all these complications that I’m trying so desperately to control in primary care. I’m also studying for board exams, going through my review book slowly, trying to jam all the details into my brain about lab testing for Hepatitis B and the difference between gout and pseudo gout (who gave them those names? Can I punch that person in the face?)

Oh and I have a husband and a daughter who like to see me once in a while when I’m not off saving lives acutely or saving lives preventatively (see self-inflamed pride above). In all seriousness, my family has been amazing throughout this entire process. My husband adjusts his schedule, cooks, does laundry, picks up my daughter and even scheduled me a nail appointment the other day after I thought I was going to lose my freaking mind. Even my daughter has been flexible in her own three year old way, telling me that she’s going to work at the children’s hospital while I go to work at the big hospital. She sends me a toy everyday in my bag so that I “have something to play with while I’m at work.” A big part of me is doing this for them and I couldn’t do it without them.

A few quick resources I’ve found helpful along the way:

The Curbsiders Podcast– If you’re going to be in primary care, you need to listen to this STAT, every episode. Seriously, you should’ve started yesterday. I have (more than once) pulled out an expert answer based on something I recently learned in one of the podcasts and impressed my physician with my vast knowledge of obscure details (yes, my preceptor DEFINITELY thinks I’m smarter than I am). The podcasts are funny, entertaining, and chock full of useful information. Plus, no one from your school is holding a letter grade gun to your head to do it, so the freedom to listen willingly is a plus.

This review book– There are several good review books out there but this is the one I got attached to so I’m talking about it. If you’re just starting FNP school you might want to get through the first few classes before you break it open but this is what I use to study and I wish I would’ve started reviewing it before I started clinicals. Most of the sections are short enough to where you can do it when you have a small sliver of time.

AAFP articles– After I read about a section in my review book I usually look up a AAFP article on the topic to give me more information and solidify what I’ve learned. The articles are simple enough to read and can usually be scanned quickly for the highlights. Top notch, in my opinion (my opinion that literally means nothing to anything).

That’s enough for tonight. I’ll try and share more consistently, even if it is short and sweet. There’s a part of me that comes alive when I’m writing and it’s especially important that I don’t let that flame die out under the oppression of my schedule and upcoming board exam. It doesn’t help anyone if I graduate in August as a talking shell of a FNP who can’t remember how to type her own name.

Thanks for reading!

 

 

 

The What, Why, and How of RN to FNP

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When I talk to people outside the medical profession, I often get asked, “so why are you becoming a nurse practitioner? Isn’t that a lot of school to essentially do the same thing you’re doing now?” I smile. I explain. I do my best to educate. But I still wince at that question because many, many people do not understand the difference between a nurse and a nurse practitioner. The tide is slowly moving in the right direction as nurse practitioners become more prevalent but there is still a huge knowledge gap in the public.

With my friends within the healthcare world, the questions are quite different. “Why did you decide to do FNP?” or “How much time do you really need to commit to school?” or “How in the world are you doing that school along with everything else in your life?” All valid questions based on real concerns. Deciding to become a nurse practitioner is a big career move requiring time, support, money and a huge portion of your sanity. This is part of my story along that journey.

Ever since I graduated from nursing school in 2009 I knew that I wanted to eventually get my master’s and become a nurse practitioner, even before I really knew what that entailed.  To be honest, I didn’t have a whole lot of backing behind that desire other than I had always been a “school person” and wanted to say I had a master’s degree. At that time I was nearly as ignorant as most people on the street about the qualifications, the education, the job description. I think I even revealed my professional plans in my “welcome to the unit” profile at my first job (so naive, not the smartest move). I just though it sounded cool and made me look like I had ambitions.

The WHAT: After a few years in the ICU I started to get a handle on where I could go with my career. I could stay in my unit and pursue a management position. I could go to CRNA school and live in the OR. I could stay where I was at as a RN. I could become a nurse practitioner. And a few more options that I never seriously considered.

After ruling out all the other possibilities for one reason or another, I decided on nurse practitioner only to discover that, like nursing, the NP job description varies intensely from position to position and environment to environment. I could become an acute care NP and work nights in the ICU responsible for thirty very sick patients. I could move to a specified clinic like nephrology or neurology and work solely with those patients. I could transition to outpatient and pursue a career in something completely foreign like family practice. And that’s ironically what I chose.

The WHY: Why did I choose family nurse practitioner over the other varieties? The standard reasons are obvious: no holidays, more money, less time on my feet, more responsibility. I wanted a weekday schedule with no weekends and holidays. I have a young family and it’s difficult for me to spend twelve-hour shifts away from my baby plus I’m tired of fearing that I’ll have to work on Christmas. I was also weary working in a job that required so much physical exertion. Turning large male patients, standing on your feet for hours on end, and sometimes not being able to take a lunch break until 3pm are all taxing on your body. I know I just turned thirty, but I could see the future and it was full of back problems and tired feet. I didn’t want all that exertion for the rest of my professional career.

The most professionally motivating reason for my career change was that I wanted more responsibility for patient care. I had finally gotten to the point where I wanted to write the orders instead of take them and felt that I had enough experience to take that step. I had always been afraid of such great responsibility (and rightly so) but I had gained enough self-confidence to know that I could learn and practice and become a proficient, caring provider. And while it’s the least romantic of my motivations, a better salary was definitely on the list. Getting paid more money for less physical labor is always a good thing.

But the question of why I chose FNP over ACNP (acute care nurse practitioner) also puts me in a honest place because I’ll have to give you an honest answer. The most compelling reason, the one that comes from a deep place in my heart, is that I was tired of seeing the worse case scenario day after day. I was heartbroken from seeing family members weep and watching people kiss their loved ones goodbye. As much as I loved the intensity of the ICU setting- the adrenaline of codes and the significance of standing in the gap during those crucial moments- I wanted something different. I wanted to work normal hours and to treat happy kids sometimes and to forget that those terrible, horrible things happen everyday. To those of you who are in that setting as ACNP, I respect you more than you can know. You’re dealing with vast responsibilities and dying patients and desperate families. You’re in a different spot than me and it’s a good thing we’ve both found our individual callings.

The HOW: So I applied for a FNP program at a local university, got accepted, and signed up for my first class. However, it didn’t quite work out like I had planned and I will tell you a slightly embarrassing secret about my journey through NP school. I took one class and quit in 2013. I had thrown myself into my nursing graduate research class for that entire semester only to discover upon completion of the class that I did not have the stamina for the program. There were many reasons behind my decision to not resume school, mostly to do with my tenuous health at the time, but I felt embarrassed. I had touted this new career ambition to almost everyone and then found myself backtracking, having to admit that it was too much for me right now.

When I think about that decision now, I see clearly that it was the right call. I wasn’t ready to take on life as a FNP. Two years later in 2015 I started school again and now here I am only two classes away from graduation. During that interim time period I took a new position in the ICU and gained valuable experience that I wouldn’t have had otherwise. So for those of you who find yourself in the same boat, don’t give in to the voices of guilt or shame or insufficiency. Maybe it’s just not the right time for you and there’s nothing wrong with that. Maybe it’s not the right career move for you at all and that’s ok too.

I’m not going to discuss choosing the right NP program because that is a whole other blog post in and of itself. There are a plethora of programs and they each have varied requirements, advantages, and disadvantages. Since I have a daughter, I chose a program that had all the didactic course work online followed by three intense semesters of clinical. I will say that online school is not for the faint of heart- you have to be disciplined and self-motivating. You have to make time when you don’t want to study. You have to stay up late and get up early and make your school work a priority in the midst of everything else you do in life. It’s grueling but in my case, it was worth it to not have to travel to school and find someone to watch my daughter. Choosing a program is a unique decision and you should be prepared to do some investigation.

Finding clinical preceptors is also an arduous part of this journey. Wait, let me rephrase that, an exhausting part of this journey. For my school, I was left on my own to find preceptors, which meant pleading for friends and family to help me. I emailed NPs and never got a response back. I cold called offices and never heard a thing. I did end up finding three fantastic preceptors in my area but that was only because of nice friends who put me in contact with their provider friends. This is where the word networking comes into play. You can never underestimate the value of establishing good relationships with other people in the medical world. If you’re trustworthy, kind and smart, they’re likely to endorse you to other provider friends but if you bad-mouth other people, seem uncompassionate towards your patients, or don’t care about your job, you may have a harder time finding someone who will spend a chunk of time investing in you. In short, make friends and don’t burn bridges.

Remember, preceptors for a NP program (MDs, NPs, PAs) aren’t getting paid to teach you (unless you’re involved in a paid preceptor program). They are giving of their time and energy willingly with no guarantee of a return. Ideally, I would like to get a job at one of the sites that I worked at during clinical because I already have an understanding of how the clinics work, the types of patients they see, and the responsibilities that I would be asked to take on. In this instance, it pays off for everyone because the clinic doesn’t have to spend as much time training you, but this isn’t the norm.

Making the jump into graduate school isn’t for the faint of heart. You have to have a clear vision for your future and be motivated enough to stick with it. You need the support of your family and friends and your job. You will have to give up some things now for a better return later. And if you stumble along the way? Forgive yourself. Nothing in life ever goes the way that we think it will.

I hope this gives you a glimpse of what it takes to go from a RN to a FNP. I hope you can understand my reasoning and my desires. And I hope, if you’re sitting at home contemplating these same things, that this helps you along your journey.

Go get that MSN.