Monday, May 11, 2015

my problem with the NP program and why I'm quitting (not really)

My problem with my chosen field
I like being a nurse. I’m not crazy about it but it’s ok. I like critical care, just not the hours. I’d prefer to be making more money, because duh, who wouldn’t? Thus, I’m in school to be a nurse practitioner. Nurse practitioners are mid-level providers, and in some states have independent prescription-writing authority, but not in my state. There is a huge debate between the nursing world and the “doctor” or physician world as to what the purpose and value of nurse practitioners really are. My personal dilemma is that I’m a nurse, and yet I side with the doctors for the most part when it comes to the abilities of the nurse practitioner.
Obviously, some doctors are great, some are terrible. Same with nurse practitioners. And yet… so many nurse practitioners think that they should be able to diagnose, order testing, and write prescriptions on the same level of physicians and even believe they deserve equal pay. I work with medical residents and can tell you, they are brilliant. They have undergraduate degrees in chemistry or biology, four years of intense and rigorous study of pathophysiology, and go on to devote three to four years of their life after that to residency, where they eat, breathe, and sleep medicine. Undergraduate nursing programs barelyprepare you for the field of nursing, let alone medicine, with one semester of rudimentary pathophysiology, and a lot of BS courses about nursing “theory”. Really, you learn from externships, a few clinicals that are one day per week for 5-7 hours, and then on the job wherever you are hired. After that, you can get some work experience and go on for an additional two years to prepare you for “advanced practice”, and this consists of one more semester of pathophysiology, pharmacology, health assessment, 500-700 hours of clinical experience (compared to over 12,000 hours of residency by doctors), and a ton of BS nursing theory classes, which are like brain-washing “nursing is holistic and wonderful” seminars.
Now, in spite of this, there are many truly knowledgeable and talented nurse practitioners out there doing great work, but were they prepared for medicine as physicians are? No fucking way. Do a lot of them have better people skills? Yes. I don’t know why, but the majority of docs are lacking in this area. But as far as diagnosing capabilities and knowledge of medicine? Not even close. A lot of NPs can gain this over the years by working with talented practitioners of all sorts, but out of the gate NPs are way, way, way behind new physicians. I hate that nursing school tries to tell me otherwise, as do some nurse practitioners. Having a doctorate in nursing is not even close to being the same as being a doctor of medicine (MD), and it’s appalling to me that some NPs insist on being called “Dr.”.
My problem with my current NP program
I chose this particular University because of the following reasons, and in this order: 1) They only required a stats class within the past 10 years instead of past 5 (mine was 6 years prior), 2) I went to this University for undergrad and felt familiar with its instructors and campus, 3) It was closer or as close as other programs, 4) I was very confident I would be accepted right away as it was a new NP program and I had contacts with professors from undergrad years.
I chose the adult-gerontology primary NP program because, um, that’s the only one this school offered, and I also thought it would suffice for my career goal of being a primary NP for the elderly. It may suffice, but as I’ve gone along in the program I’ve been unhappy that it is very difficult to find preceptors and also they offer no specialization in geriatrics or palliative care, my two main interests.
My other huge, maybe largest, gripe is that this program is so unorganized. This is perhaps due to the fact that I’m in only the second cohort of the NP program, so the program coordinators are sort of upgrading things as they go, but even so, I feel like they do not communicate expectations or requirements to us clearly. One professor took the time to tell us what we needed to do for clinical sites and such, but the program coordinators themselves never went over it with us. You always feel like you’re “lucky” to find out a bit of crucial information as to what you’re supposed to be doing. It’s crazy. No one in the program is happy, no one thinks anyone running it has a clue what’s going on. Plus, the University is not affiliated with area hospitals, which means finding a preceptor comes down to personal connections. It SUCKS.
Why I’m changing my career goals (somewhat)
I was so intrigued to find out that another University within the same driving distance as my current program (which is held offsite, an extra 25 miles in the opposite direction of the main campus) has an NP program that specializes in Palliative Care/Hospice and is also an Acute NP program. Acute meaning I could deal with chronic and acute illnesses (such as I’m used to) as opposed to outpatient, “I have a cold”, boring stuff. I can transfer 6 credit hours total to that school if accepted. So 2 of my 3 classes could transfer, not a total wash. I’ve decided to apply to their program, which is well-established and, I pray, more organized.
The University I currently work for, one of the best in the nation for medicine, also has an Acute NP program, and even though it doesn’t offer the additional “Hospice/Palliative Care” title, it would allow me to have preceptors in the actual areas I am interested in learning, rather than just taking whatever bone is thrown my way like I’m being forced to do now. These are top-notch, #1 nationwide, specialty areas, clinics, and treatment centers. Not to mention that if I got my foot in the door in this system I would keep my seniority and awesome benefits and retirement plan, plus remain in a strong union.
Now what?
So after all of that frank (and somewhat scathing) diatribe of NP positions and my current program, what have I decided to do about it?
I’ve been thinking hard all day. I am going to apply to both programs I discussed in PART 1, but that then begs the question: what do I do with the program I’m currently in? Do I stay in it until a for sure acceptance into the programs I really want? I can’t help but think this is a giant waste of money and time, since only 6 maximum credits would transfer (I’ve completed 9 total). Why waste energy, and more importantly, time away from my daughter if the credits don’t even transfer?
I hate being a quitter, but knowing deep down that this program isn’t for me, and isn’t bringing out the best of my abilities or talents, means that I need to leave it and pursue something better. I will probably not be able to start my new programs of choice until next fall, assuming I am accepted at all. But I am actually very optimistic, I believe I will get accepted to at least one of them, and in the meantime I won’t be wasting time away from my daughter. I know that the right career path is out there, and I feel like this last year has really revealed to me what I don’t want in a program and where my true interest lies.
Still, it sucks to officially “withdraw” from a graduate program, especially because I was so proud of being accepted. I have a 4.0 in all of my classes (because they were stupidly, moronically easy and worried me that they weren’t preparing me at all) and I really did love being at my undergrad alma mater. Staying is definitely not right for me, but leaving doesn’t feel good either.
In the end, though, if I’m going to do this, I’m going to do it all the way. Staying in this program would be easiest, but it would not take me where I want to be and it would not adequately prepare me or open doors for me in my desired field. If I lose a year, well, these are two year programs. It’ll be ok. I gain a lot of time with my daughter while she’s little, and am still on track to finish around the time she enters kindergarten. Nothing lost, but possibly everything gained.


Smack Talkin' Mama said...

Hey, Idk if this will work, if it will get to you or not - I wanted to just email you privately, but you (understandably) don't seem to prefer that option! I wouldn't either. I'm just worried about you after reading your "The Problem is Me" post. :)

The way you're feeling and struggling with where you're at in life (based on what you say, certainly not on any direct observation) is very familiar to me. I know you're a nurse, you're smart and have experiences I don't and didn't have, so I hope this doesn't come off as any sort of condescension to you, that is not what I intend.

But it just sounds like you're in a tailspin, very similar to the one I was in a few years ago, and frankly I had so much less to worry about than you do. I was a sahm, my husband provided for us financially - he was never home, he got home about once every two weeks and I was lonely and bored and struggling to find any kind of community, since we'd moved away from my family. That was my choice, my family drives me nuts and I didn't want my children absorbing their madness, but I didn't realize I was about to fall off of an emotional cliff at the time, or perhaps even my family's crazy would've been better than being alone?

The exhaustion, the drugged feeling, the going to doctors who only offered me actual drugs, so the drugged feeling could be real instead of imagined, the rage and hair-trigger temper, the trapped desperation, the anger at myself for not being what my children needed - and I *was* homeschooling (sorriest excuse for it ever but we were trying) and I had no extended family to take care of. My cats were kittens and never had accidents, our house was big enough the kids could play in the next room without making me crazy. We lived in the desert, so somewhat ironically, it was the heat that kept us inside instead of the cold... but whatever. be continued...

Smack Talkin' Mama said...

Anti-depressants (I tried at least five of them) were not working. I read something a few years after this time in my life that said people who had been diagnosed with PTSD didn't do so well on SSRIs? Idk how accurate that is - you may know more about that than I do - but having had PTSD since childhood, I wondered if that was part of my problem. I would spend all day trying to psyche myself up and get the kids and I out and to a park or a hiking trail once the sun was going down so we could get some exercise and a little sunlight.

And since my husband was never home, and I'd struggled to make friends - the homeschool groups were very exclusive or too weird, or too far away, our library didn't have a storytime per se, just a room with stories on video playing (???) and was over a half hour drive away. All of the closest churches were Mormon or just severely not our cup of tea, and driving an hour to find one that seemed about right early on Sundays once a week didn't feel like a solution. I was developing social anxiety that was affecting my ability to go grocery shopping, we were eating too much pizza and fast food, (I could handle deliveries and drive thrus, but going into a store became a serious issue.) and my kids were doing more cooking of nonsense like turkey hot dogs and baked beans than I was of anything at all. Plus my son needed to be on a restrictive, wheat and dairy free diet that ideally rotates among his allowed foods every 3-4 days, and I could barely manage to grab hot dogs and buns and run before I had a panic attack at the store.

So... in many ways it sounds like you're doing better than I was, lol, but with so much more weighing down on you - the sole support, needing daycare, feeling like all of it is just killing your soul with no relief. Aaaaand ohhhh, did I eat to make it all better - way too much crap at way too many drive thrus (damn you Dunkin Donuts!!) to try to reward myself for not losing it with the kids or making dinner or whatever, and you know what a vicious cycle that can be.

ANYWAY - I know you're a nurse, you know your shit, you clearly are a believer in allopathic medical models and so am I, I promise. But what turned out to be wrong with me was a hormonal imbalance that I found out about by going to a naturopath and doing saliva testing. Blood tests hadn't revealed anything being wrong, but the saliva tests said I was in perimenopause, at 35. Idk what you feel/know about that, and it was no quick fix, but just to know that I was on a path to making things better (It took about two years, but things fully turned around) helped. The two naturopaths that I have gone to (one in Colorado, one in Arizona) were both very nurturing, encouraging, somewhat therapist like, so it was kind of a twofer - some therapy, some physical treatment. I started with an ND because of my son's digestion issues - zantac wasn't helping and two incompetent doctors in a row just pushed me out the door and into crunchy land, basically.

Smack Talkin' Mama said...

I'm not saying this is for sure what's happening with you, and I know NDs don't take insurance, but since I didn't have insurance, it was actually cheaper to go there than an MD anyway. Maybe it would be something to explore?

And I wondered if your employer or insurance offered any paid for therapy appointments? Two of my siblings have been able to take advantage of free therapy offered through their insurance in the past year, so I just thought if that wasn't something you'd thought of, perhaps it would give you a little break.

I just remember how helpless I felt, how angry, how trapped, and you're dealing with at least three more ENORMOUS sources of stress than I even had to deal with, so I can imagine how much like a rat in a cage you must be feeling. And I know - I know how much you want to be who you are, really, for M. I know how much you love her and how much you must just see yourself in the mirror and remember Turkey and Nepal and think HOW THE HELL DID I GET HERE?? I joined the Navy when I was 18, I traveled almost totally in Asia, loved it, miss it, want so much to take my kids there. It's so hard to reconcile how life has brought you to where you are, so hard not to see months in this or that situation as a never ending nightmare, instead of the temporary situation it really is.

Of course, knowing part of your way out of where you're at will include more loss is devastating, and you've got grief coming at you almost everywhere you go. That's not easy either.

Fwiw, I'm a big fan of JUST GO. Korea has some bitter winters, but I hear they also have amazing malls with crazy things going on for entertainment during those winters? Don't quote me. I just got one day in Osan in the summer. Plus places like Guam and Okinawa would be short and sunny trips to take to break up the feet of snow. I still like the idea of you guys moving to the co-op, but I really love the teaching English idea - naturally, that has it's limitations, but I'm really hopeful that you'll find some solutions, if not before then, during your trip to Nepal.

I just think, you're not struggling with First World Problems that you need to suck up - I've been reading your blog since before M, but after you lost Avalon. This just isn't you or how you generally approach things - I think you've got some chemistry trying to drive you off a cliff, and it's not fair to you to think to yourself, "Just deal, First World Woman!" You need some relief, you need some help, you need some answers. YOU DESERVE THOSE THINGS, and so does M.

So, btw, this is Sarah, with the little pink WP design next to all my crazy long comments. I know I blather on, I just happened to catch up to like the past week of your posts and reading them all at once, I wanted to reach out. I guess the bottom line is with a buttload of supplements, things began to improve and I felt less trapped and was able to cope with the "domestic bliss" shitshow that I had somehow created, lol, and slowly we were able to climb back out of our hole and start engaging again.

I hope you get this, and I hope it doesn't come off as a lot of pandering nonsense. Feel free to delete it or not as you see fit.

Thinking all the good things in your direction!! <3