New Grad NP

Reflecting on 2012

2012-12-27T20:25:00Z

Wow! What a year this has been and with each opportunity and experience I have been able to share, I have the ADVANCE community to thank for helping me to grow and be a better professional. I have met so many wonderful people who continue to offer support and challenge me with my every day struggles as an NP working in corrections. Over the past several months I have had wonderful experiences attending my local association of advance practice nurses as well as regional conferences. I enjoy education...(read more)

Advice for New NPs

2012-12-13T20:16:00Z

Time, because of its duplicitous intangibility and quantifiable nature is, to me, a perennially elusive phenomenon. You can measure it but you can't hold it and yet it dictates the rhythms of life. While I reflect on these ephemeral characteristics, the advent of 2013 ushers forth the commencement of my second year as a Nurse Practitioner. I still feel every ounce the neophyte but am pleased to share with any new clinician that as the days pass a feeling of authority and competence will slowly replace...(read more)

Uncooperative Collaborative

2012-12-06T14:24:00Z

Every day is an adventure at the correctional facility and at times it is not from the inmates. Oftentimes, it is from the person I like to call "The Lovely Doctor." I do not know why I call him that, but maybe it is because it is the nicest name I can call him...yes! It is sarcasm at its finest. One of the perks that has been rescinded while working downtown is our prime parking spots. Due to intense construction and what some call progress, the courthouse staff and medical staff have been relocated...(read more)

Treating Asymptomatic Patients

2012-11-23T14:51:00Z

I wrote a blog much earlier this year discussing the importance of abstaining from treating asymptomatic UTIs while making a feeble attempt to include a Harry Potter reference. This past week, a favorite patient of mine, an older woman who has been hospitalized repeatedly for an ESBL UTI and bacteremia called our office in a panic. She was scheduled for a cystoscopy and her urologist requested that she have a urine culture performed in advance of the procedure. Her urine culture revealed an Enterococcus...(read more)

Challenging Patients in the Correctional Facility

2012-11-15T16:46:00Z

Over the past month I have had some very challenging patients. I will often question, why and how did someone end up here at the correctional facility? I believe it is better I do not know. Actually, it is none of my business; it keeps the care unbiased and pure and it does not impact how I treat them. If one of the inmates upsets the correction officer (CO) or even the nurse for that matter, they have access to a program called JMS, which stands for Jail Management Systems. I thankfully do not have...(read more)

The Cost of Providing Care

2012-11-01T15:17:00Z

I was going to write a blog about neuro-syphilis because I just recently treated a 29-year-old patient for this condition, however, on reflection it seems more apt to discuss the enormous financial costs associated with her care. That being said, neuro-syphilis is a tricky diagnosis; I advise clinicians to read up on it. Syphilis is commonly referred to as the great imitator. In the case of my patient, she presented with symptoms of meningitis. As we began to peel back the layers of her presentation,...(read more)

My One Year Anniversary as an NP

2012-10-25T13:21:00Z

It's ironic that I wrote my last post on October 15, 2012, the 1-year anniversary of my one and only job as an NP. What a year! Or, rather, what a year and a half! The worst of times, yes (the end of a 30-year marriage in June 2011), but also the very best of times (Duke MSN/FNP in May 2011, certification in September 2011, dream job in October 2011), and everyday a new adventure of the heart and mind since! As noted in a previous post , I've been remiss in submitting posts due to time constraints....(read more)

When to Trust Patients in a Correctional Facility

2012-10-18T15:45:00Z

There was a disturbing incident that occurred a few weeks ago. I also look at this experience as an eye-opener for me. I have long come to this realization, but it was never more evident than when the incident happened. First, let me start off by stating, prior to my opportunity to work in corrections, I was judgmental and biased and I thought very little of the people incarcerated. I said and thought some very harsh things. Now, working in this environment, I am glad I am here because I find it...(read more)

The Power of Pill Boxes

2012-10-11T13:27:00Z

I was before, but now I am an even greater advocate of the pill box. Every patient with a lackluster memory, or taking multiple medications, or time sensitive medications should own one. There is nothing better than a physical reminder to keep a body on track. I was recently confronted with an HIV positive patient on a cocktail of anti-retroviral drugs that routinely forgot to take them or sometimes would take them all twice in one day because they would forget if they had taken them. Needless to...(read more)

Helping Students

2012-10-04T13:15:00Z

True friendship is a tremendous responsibility, a responsibility that I do not take lightly. My best friend has wanted to return to school for many years to pursue her master's in education, but due to life (married with children, work, financial) she postponed it until now. She states she has never been a good writer and looked to me for help. While I want to return to school to obtain another degree, I have found myself literally back in school helping her. I am not complaining; it feels very good...(read more)

Answering Patients' Questions

2012-09-20T12:16:00Z

Lately it seems a rash (no pun intended) of patients have asked me how it was that they contracted their Staph infections. Some had MRSA, others MSSA. Some suffered from bacteremia, others osteomyelitis, and others still were challenged by skin/soft tissue infections in the form of painful and unsightly abscesses. Some had recently undergone surgical procedures, some have a history of IV drug use, and others had not set foot in a medical facility in years - which is to say, they didn't have any recent,...(read more)

Benefits of the Affordable Care Act

2012-09-13T12:01:00Z

"America has spoken" says Nick Cannon from America's Got Talent and the winner is: The American People! This is the feeling of many when the Supreme Court ruled that the Patient Protection and Affordable Care Act (PPACA) is constitutional. Are the American people really winners? Absolutely! As the healthcare reform unfolds, nurse practitioners are poised to meet the challenges of emphasizing health promotion, disease prevention and effectively managing chronic disease. Approximately 80% of nurse...(read more)

Pain Patients

2012-09-06T17:29:00Z

My contact with pain patients was extensive during my residency in Aurora, North Carolina, a coastal town of about 400, with a patient population compromising of retirees, commercial fisherman and above-ground miners from a phosphate mine. I knew from that experience that even if I never found a job as an NP, I would not choose to do pain management. Of course, pain management is an invaluable specialty, but in its practice a few bad apples spoil the whole cart. So much unproductive time is necessary...(read more)

The Weight of the Nation

2012-08-30T12:45:00Z

I don't know how many of my fellow NPs and PAs have seen and or heard about HBO's four-part documentary on obesity in America, The Weight of the Nation , but I can't recommend it enough: it is an awesome and totally relevant examination of health in the States. So many of the individuals profiled in this series were reminiscent of patients whom I have treated for various infections complicated by their obesity and corresponding chronic illnesses, namely diabetes mellitus and hypertension. The series...(read more)

Repurposing Treatments

2012-08-23T13:35:00Z

Costs for healthcare are rising. There is not a revelation in this statement, but as providers, we have to be mindful of the dollars we use because it affects raises. My former mentor would drive that home for me. When I would order a test, she would ask, "Will that test change your treatment plan?" And if I responded with "no" then she would state, "Don't waste the dollars." She would follow with, "I am trying to get a CT machine for the facility." It would be nice, but it will never happen. Diagnostic...(read more)