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First Year NP

Who Will be My First?

Published December 5, 2013 1:35 PM by Katrin Moskowitz
Throughout life we build our own individual skill sets. Often times we are our own guinea pig and learn from our own mistakes. Often times however, if we build skill sets based on our careers these trial and errors often affect others.

During nursing school I remember being overwhelmed by the amount of new procedures that I was being taught. Granted, we had the aide of models that provided the perfectly accessible orifices, but eventually we had to perform those procedures on live and anatomically varying people.

Over the past 6 years as an ER nurse I can say that I became pretty proficient at certain things; IV starts, foleys, colostomy appliances, code medications, etc. Nurse practitioner school definitely built on these skill sets but also added new elements.

I had always listened to the heart, but now I was doing it more thoroughly and diagnostically. I had to become comfortable with more intimate exams including rectal exams, pelvic exams and prostate exams to name a few. During our clinical intensive we lacerated and sutured cow tongues and lanced our homemade lotion abscesses, but my clinical rotations did not afford me the ability to practice those on live individuals.

Starting off the bat in urgent care I knew that procedures would be a daily occurrence and to be honest I was looking forward to this. I was honest during my interview to let them know that I had no experience in things like digital blocks, suturing or I&Ds on real patients. Show me and then give me the chance to try it on my own, and I would more than likely excel.

I have learned that you have to be confident in your perceived ability to perform a task. Without that internal cheerleader, you often are defeated before you even start. I have seen so many procedures during my nursing career that I inadvertently engrained some great tips and tricks into my brain.

A lovely patient became one of my firsts. He had the unfortunate luck of stepping on a piece of glass while traversing his kitchen barefoot. In his heel he felt that there was something there bothering him with each step he took. An x-ray did not show with foreign body but palpation of the heel elicited a nice pain response. Off I went to numb my first appendage and go looking for a normally invisible item.

It did not help that he had attempted himself to find said piece of glass leaving a pitted heel to guess which hole might hold that glassy treasure. Off I went. Infiltrating a heel with a needle was a little more difficult than I had anticipated but after that ordeal was accomplished I was ready to go.

I had seen another ER provider at one time use an 18G needle to explore a wound first to see if they could come across the change in texture. Sure enough this worked and I was able to manipulate the glass out without having to use a scalpel to cut into his heel. I have to say I was pretty proud of myself and I did end up telling my patient that he was my first in this endeavor.

Since then I have placed my first sutures, successfully irrigated cerumen impacted ears, hand expressed abscesses, removed sutures and seen my first complicated patients who are like those proverbial Pandora boxes.

Each and every day has been a learning experience. I have learned that I could suture all day long. As I said to my husband, "It is like arts and crafts on people," putting them back together again. I look forward to being able to add new files into my file cabinet of skills and of course share them to all of you!



So far I do feel as though I am respected. In my setting I am the only NP and then there are 3 ther PA's. A Physician only works a half shift a week. Therefore we are the primary providers in the setting. We don;t work on quota's or patients seen per hour which is nice. Is there always a goal that the urgent care is looking for per month? Absolutely, but as you know in Emergency MEdicine and URgent care, we rarely have the ability to influence the patient count per day (Unless of course they are return patients and are returning because of their previous positive experience.

Katrin Moskowitz December 23, 2013 7:27 AM

I am glad you are writing a blog about your experiences.  You sound a lot like me when I started.  I have been an ER nurse for 7 years and an ER NP for one.  How is the respect in your area?  Do your physicians respect your role?  or do they feel you are there to make more money for the practice at a cheaper pay scale?

Ellen December 15, 2013 7:58 PM

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