Whatever you do….

"Whatever you do, work heartily, as for the Lord and not for men"  --Colossians 3:23

My road to becoming a nurse practitioner started out in February of 1999, merely 3 months before my high school graduation.  My sister had her first son and he was admitted to the NICU for apnea.  He stayed there for two months.  It was there, standing at his incubator that my love for healthcare stemmed.  Previous to that experience, my career goal was always to be a lawyer.  God was good to give me another path as I sure do hate public speaking and drawing attention to myself but then again my husband says I make a good defense attorney.  And some days, I wonder if it would have been better had I gone that route versus the one I chose.  But I remember standing up at my senior tea and declaring to my graduating class that I was going to be a neonatal nurse practitioner.  I don’t really know how I even came about that title.  I definitely didn’t know any NNP’s.  I didn’t know a single nurse at all, let alone an advanced nurse practitioner.  Although I had met the physicians caring for my nephew, being the physician was never a role I saw myself playing.  Whether it be that subconsciously I didn’t think I could afford all of the costs of med school or it just wasn’t something I wanted to do, it never crossed my mind to be the doctor.  

I started my way from the bottom.  I became a tech while I was starting out.  I worked in nursing homes and the hospital.  When I moved back from New Jersey, I started my life at CMC.  This is where I met Dr. Coldwell and felt more of a true team than I ever had before.  Even as a tech, I was respected.  My limited assessment was important to the nurses and the physicians.  And I loved those kids.  But I continued on my path to becoming a NNP so I took an extern position in the NICU.  There was a particular doctor who made his bedside rounds and took the time to actually get to know us.  In my previous weeks, no one had even bothered to talk to me, let alone ask me my name.  But he did.  He also remembered my name when he saw me in clinical at a different site.  But he wanted to know how I thought the baby did throughout the night.  How have feedings been? Output? Vital signs?  I mentioned the infant slept with her eyes open and that prompted a Rx for eye ointment.  Then on day two, the same baby spiked a fever of 105.  Why?  He worked his differential with me at the bedside.  Amazing.  I was part of his team.  This is how healthcare should be.  Did I find fault in him for asking me my opinion as to what was going on?  Did I think he was incompetent because he just didn’t know what was happening?  No!  I found it rewarding.  But most of all I found it to be one of the stepping stones of my career.  This physician thought enough of the nurse (not me but the nurse at the bedside) to listen to her and ask her opinions and to work through what might be causing the symptoms with her.  This was a team and even more reason to continue on this path because I was being treated as an equal.  I ended up going back to CMC when I completed my externship because that is where my heart was.  I worked along Dr. Coldwell, another physician who wanted to know what we thought.  He trusted us--which means a great depth coming from a man who is a metabolic genetics guru.  This was the relationship that I wanted.  Healthcare is a team.  It wasn’t me against the techs or against the doctors.  But we worked together and opinions mattered.  Assessment findings mattered.  We collaborated.  I continued on working towards the PNP role with hopes of maybe one day returning to CMC in my new found position.  

But the doors had since closed on CMC and the hospitals treatment of physicians had become so poor that it was no longer an organization that I wanted to work for.  I had no desire to work in a hospital again.  So I chose my career in the clinic.  I was the primary healthcare giver of many children.  I loved it.  I could collaborate with the physician and other nurse practitioners within our clinic.  I could see children independently.  There were definite issues and barriers as the nurse practitioner role was (and is) still new in this part of the world.  I had parents who refused to see me.  I had specialists who refused to discuss a case with me.  I had parents who would leave and come back the next day to see the physician only to be told the same thing I told them the day before.  For the most part, the flack just rolls off your back.  But somedays it builds up.  

Somedays I find myself thinking, “why didn’t I go to med school so I could be that physician who cared what the NP had to say, what the nurse had to say, what the tech had to say and not just what the physician has to say?”  Why didn’t my experiences with Dr. Anderson and Dr. Coldwell lead me to be more like them and not simply more accepting that my career path would be accepted.  

I still have physicians who refuse to discuss a case with me, although I ordered the work up and it was my initial suspicion that led us to a surgical conclusion.  But most days I’m okay with that because they aren’t very fun to talk to anyways and I am easily intimidated.  I have residents who ask me which physician I checked out my admit to as if I am not capable of determining that the the vomiting/diarrhea 5 month old who has had 10 diarrheal stools for the day and it’s only 2 in the afternoon needs to be admitted for dehydration and IV fluids.  And I still hear how some will never take their child to the nurse practitioner.  And somedays it gets really old and it gets really old quick.  And I find myself searching through medical school admission criteria, taking practice MCAT exams and starting to fill out med school applications.  Because I’m tired of it.  Am I the physician?  No.  Do I pretend to know everything?  No. Will I correlate with my attending when I am at a loss of where to go next?  Yes.  Will I get a second opinion when I’m just not sure?  Yes.  Am I willing to say, that’s outside of my knowledge base?  Yes.  I’m that person because the alternative scares me.  So if I am on the phone with you telling you the child needs to be admitted it’s because I have either made the clinical decision that I have been trained well to make or I have discussed the case in detail with the attending doctor and we have came to that conclusion together.  And if you can’t have a conversation about the details of a case and a possible surgical outcome with someone who is not on your pay grade then you are a poor communicator and a terrible teacher.  

I don’t know if I will ever go back to school.  I don’t think you are ever too old.  i just don’t know if I will truly pursue that path or if I will just continue to let things roll off the best I can and develop a thicker skin.  I just hope that in my day to day, the nurses know that I respect them.  I hope the techs know that I respect them.  Everyone brings something to the table and I want you to share it and I want to hear it.  we are much stronger as a team than as an individual.