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.

what I'm learning from g̶r̶a̶d̶ ̶s̶c̶h̶o̶o̶l̶ YouTube

So yeah, as it turns out, my grad school program right now isn't so much "teaching" me anything as it is facilitating subjects and content matter for me to teach myself, and then get tested on (or assessed via paper writing). So the main way I "learn" in a "classroom" setting is via youtube presentations that I listen to on my phone with bluetooth while I drive to and from work or school. These are lectures presented by nursing or medical faculty for, I assume, their own college courses. Why don't the faculty at my program lecture? I have no idea. One of them creates powerpoints which she emails to us (fine, better than being read to!), and the other does a messy, sloppy facilitated discussion of the assigned reading materials in theory class, which I then have to clarify to myself by listening to a YouTube presentation by another institution's faculty member.

I guess this is part of the times, right? Finding resources. And I'm lucky there are so many free, graduate level presentations out there to just stream. I just, I don't know... why are these other grad students getting actual lectures, with explanations and examples and ideas, and my professors are just sort of... assigning things and hoping we get it on our own? I'm paying the same amount of money!

Fortunately, I'm good at finding the material myself and seeking out the information I need to understand. I guess that's what being a grad student is about, at least for me, in this particular program. Still, it would be nice if someone would teach me something, once in a while.

Ebola

This is The Thing right now in the world of nursing, especially the world of MICU nursing, where an Ebola patient seems bound to end up.

I work at a level 1 trauma center, a huge teaching university, a medical center that receives patients from the surrounding region on a daily basis. And in case you're wondering... no, we have not been trained or briefed or in any way notified of what we are to do should someone arrive with Ebola-like symptoms. Just yesterday the ED held an Ebola-preparedness drill. Just yesterday. For several weeks now, our nurses (part of a 4,000 strong nursing union) demanded preparedness information. Just yesterday Ebola was discussed in a general staff meeting on our unit, where we were told that ours is not to be the unit that accommodates an Ebola patient.

Still. The panic is rising among nurses. We are the ones suctioning sputum, wiping up vomit and puke, and breathing in droplet-laced air. We are the ones going in there every 2 minutes to adjust pressors, silence alarms, push meds, etc and so on. If anyone is going to contract Ebola, it's us. And now we're FREAKED. OUT.

I have no intention of caring for an Ebola patient. The rumor now is that only volunteers will be trained and utilized if an Ebola patient should come along. Trust me when I say I won't be among the volunteers.

Also: my dad just called to tell me to quit critical care nursing, and go work in a nursing home. Ebola or no Ebola... that's NEVER gonna happen!

these are not my people

These are not my people...

 

That's the thought I continuously have in my head during my first "graduate" class. My classmates, most of whom are practicing nurses, are not ICU nurses, and for that matter are first or second year nurses to boot. They don't understand my depraved ICU sense of humor. I feel like I'm surrounded by a different species of nurses. The funny thing is, many of them are interested in being nursing faculty.

 

I ask you, how can nursing faculty be effective in a field that is so intensively hands-on, learn-as-you-go, experience-based? Can a nurse with only two years of bedside experience in general med-surg really guide BSN or MSN level students who intend to practice at the bedside? Or are they simply considered theorists, leaving the rest to be learned by preceptors via clinicals?

 

I'm not a huge fan of academia. That being said, I find that I excel in it. Writing comes easy to me. I know what they want from an assignment and I give it to them. But I don't believe in it, necessarily. I don't think the focus is where it should be... the type of learning we should be experiencing, in my opinion, as nurse practitioners should be somewhat akin to med student and resident rounds. But maybe that's to come? This class on health status and trends seems more like the nursing profession indoctrinating its young, and less like preparation for actual advanced practice.

what's the matter with you? and you? and you?

No, seriously, you family members of sweet little old ladies who are floor status... what makes you think that it's ok to freak out and yell at nursing for the fact that your mom ordered white bread for her sandwich. She is totally with it, she totally ordered her own dinner. It is also so not ok to get me at the desk every 5 minutes because there is a spot on a pillow, or there is spit in your mom's mouth, or you dropped an ice chip on the bed. You are being obnoxious. You are not the only patient in the ICU, or the hospital, or the world. I'm not here as your personal servant, or your punching bag.

Call me a mean, bitchy nurse. I've given your moms every ounce of my compassion, care, and attention. I've helped them order food, bathed them, and answered all their questions. You may be scared or sad or nervous about them being in the hospital, but they are getting better and going out. The person in the next bed over may be agonizing over withdrawing life support on the parent of their young children... and you complain about this little shit?? Get it together. No one likes you. The patients yes, you, no. You are wasting our time and making it so that staff runs when they see you coming.

Please send in one of your saner siblings.

And yes, that was me, running across 5 lanes of traffic to get the fuck away from you. I hope tomorrow I do better in the patient family lottery.

when a nurse has to do what a doctor shoulda done

The doctors signed out for the day, a lovely warm Sunday evening with clear blue skies. The attending, who had promised to come back later, decided he wouldn't be returning after all. The cross cover team didn't know the patient, and besides, they were stuck in a room placing a difficult line.

It all fell to me to address the family's concerns and questions regarding the end of their loved one's life, and the removal of his life support. They had made him a full DNR, do-not-escalate care just yesterday. His daughter had panic attacks so bad this morning, when she realized he would not survive the day, that she retched and shook and had to go to the ED herself.

I have often participated in, or even led, these types of discussions. I have never held a family meeting to discuss end-of-life care all by myself. What choice did I have, though? They were ready to let him go, but they didn't know how. They didn't know what to expect or how they would survive it. They didn't know if they could even utter the words that would lead to the push of certain buttons, the end of his life support, the withdrawal of all that kept him alive.

I gave them that permission. I took away that awful choice. I told them that he had lost consciousness days ago, his body had made a decision for all of us. I told them that the doctors had already made the decision that everything that could possibly be done for him had been done. We could keep him going for another day, perhaps, on his current support. Or we could withdraw it and let him slip away peacefully in the next few hours.

I described what would happen to his vital signs. His breathing would quicken, and then slow. His heart rate would go through a variety of rates and rhythms, slow down, and stop. His blood pressure would drop quickly to nothing, as would his oxygen levels. He had already lost consciousness, and he would slip even farther from this world. I described that what we could do to keep him comfortable. They all looked at each other, nodded, and said yes. Let's let him go.

I reported all of this to the cross-cover team. I just needed them to enter the orders. I paged the attending, who still chose not to come in even though he had built a relationship with this family over the last week. I had just met them this morning. Nevertheless, I assured them that their emotions were ok. I said it was ok to cry, or not to cry. It was ok to stay in the room with him, or to leave. There was no right way, and no wrong way.

I was surprised that they chose to say goodbye and to wait outside of the unit. I stayed with him, holding his hand and rubbing his head, representing the Mother that we all call out to in our times of need. I hummed to him and sometimes sang. The family sometimes came in to kiss him and tell him they loved him. Ultimately, they were not there when he passed. I alone was there as his heart beat its final beat. I alone witnessed his exit from this world. And I alone went to the family to express my condolences, and to hug them.

The daughter said to me, through shaky tears, "thank you for being with him when we couldn't be".

This is the greatest work I do, that I've ever done.

back to school

I got admitted to grad school this fall! I applied for Winter, since I missed the fall application deadline. But they called me and told me they were willing to consider me for Fall if I was interested. And there you have it! I got the acceptance letter from the School of Nursing and I'm just waiting on the actual Graduate School to give me my ID and PIN and whatnot so I can register.

 

Every ICU nurse I know wants to go to CRNA school... and while I'd love to sedate people for a living (who wouldn't?!) it's just not feasible for me to devote that much time and energy to school while working full-time and raising a child. Plus, I love the elderly, especially dementia patients, and my school offers an NP program with a concentration in Dementia.

 

Besides the fact that I would love to work exclusively with the elderly, and the pay raise is impressive, I wanted to be an NP so that by the time my daughter is school-age, I'll be working "business" hours as well and can be with her in the evenings and weekends. Even working three 12s a week, I'm going to miss two weekends with her, and be off a lot of days while she's in school all day. It makes no sense to me. I'm always trying to figure out how to be with my little girl MORE. So while she's a baby/toddler it doesn't much matter which days I work, it will later on. I will also be looking for something that's closer to me, as in, not an hour away.

 

My thoughts prior to school are a mix of excitement (who doesn't love a fresh notebook?) and just a general sense of dread. Dread for the stress and additional work that has to be done on any given day. As it is, I can barely keep my house from looking like a disaster zone, the yard from looking like a jungle, or my kid from eating poison or jumping into bodies of water. It's difficult to manage everything just working three days a week and leaving that work behind me when I leave... not to mention that I miss my daughter and desperately want to be with her every second I can when I'm not working.

 

So I know this is going to be hard. It's going to require sacrifice (especially of sleep, god help me) but I'm only doing it because I think it will be worth it in the end. I think I will find my career more satisfying, my home-life more satisfying, and my bank account more satisfying in the end.