Reproductive health and more....

  1. First off, I in NO way am looking for debate in this thread. I hold no judgement at all toward any poster whose opinions and understanding on these topics are different from my own. That said, I want to very gently ask:

    In the world of primary care, specifically family practice, is it naive to think a person would be employable who doesn't want to prescribe certain treatments such as IUDs or the Plan B pill?

    And what if a provider feels it is in his/her patients best interest to vaccinate on an alternative schedule from what CDC guidelines are?

    I think these are some hot-button issues for some people. I guess my ultimate question is, Is there a place for an NP in family practice who has alternative viewpoints or moral questions regarding some of the daily stuff you'd see in a primary care office.

    I don't deal with this stuff as a critical care RN. Sure, there are ethical dilemmas in critical care -- and I guess I feel like I've learned to navigate those as best I can. Sometimes we get it right and sometimes we get it wrong.

    But I picture myself in a clinic setting talking about alternative vaccine schedules and my co-workers/colleagues eyes bugging out and them thinking, "what the heck are you even doing here?!"

    Regardless of where anyone lands on any of the subjects I mentioned (and I'm sure there are others I didn't mention), I really appreciate whatever constructive feedback is offered.
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  2. 22 Comments

  3. by   offlabel
    Prolife OBGYNS – AAPLOG – American Association of Pro-life Obstetricians & Gynecologists – Prolife OBGYNs

    Short answer is yes. Longer answer is you could have difficulty in training, depending on where you are. I've left very good jobs in anesthesia because of moral/ethical beliefs, but as a result of leaving those jobs, I now find myself in a place I couldn't have reasonably hoped for. It was worth it to be sure.

    Unless your work place allows a conscience based 'opt out' possibility, don't expect to find an understanding environment. If that is the area of practice you're most interested in, best to find a like minded practice, of which there are many.

    Good luck.
  4. by   WestCoastSunRN
    Thanks Offlabel. Of the entire scope of FNP practice, women's health appeals to me the least. I am not certain of this, but being that my uni is Catholic -- I may have support in not performing certain procedures such as IUD placement. It would be worth inquiring about. Ultimately, I want to avoid feeling any need to request special considerations at work. I want to work in a setting where I can pull the same weight as everyone else without qualms. I am not opposed to specialty practice at all, and maybe that would be a better fit than a family practice.
  5. by   Susie2310
    Quote from WestCoastSunRN
    First off, I in NO way am looking for debate in this thread. I hold no judgement at all toward any poster whose opinions and understanding on these topics are different from my own. That said, I want to very gently ask:
    Anyone can pose any question, but on a public forum debate is to be expected as people hold diverse views. I don't think you can reasonably only request replies on an internet forum from people who hold similar views to yourself. The TOS encourages debate of topics by people holding different views.
  6. by   WestCoastSunRN
    Hi Susie. I totally appreciate what you're saying. I guess what I meant by that is that I really do know my having any of these issues puts me in the minority. I didn't post the questions as a means to start meaningful dialogue about the subjects themselves. It was more questioning whether someone who has those kinds of alternative views has any business in family practice.
    I hope I'm explaining that well. It certainly isn't my desire to squelch debate -- and maybe my original wording regarding debate was poor. It just isn't the point of my post. Does that make sense? I'm sort of just looking for people's experience either being a provider who has alternative views or working with one, etc.

    Since I am the OP, I thought it would be ok to just ask a question and try to keep it as simple as possible by not needing to discuss the wrongs or rights of the subject matter-- to my knowledge that does not go against the TOS.
    Last edit by WestCoastSunRN on Sep 20 : Reason: clarification
  7. by   WestCoastSunRN
    Quote from Susie2310
    Anyone can pose any question, but on a public forum debate is to be expected as people hold diverse views. I don't think you can reasonably only request replies on an internet forum from people who hold similar views to yourself. The TOS encourages debate of topics by people holding different views.
    Hmmm. This is an important point. I, in no way, am looking for views only from people who have similar views to myself. I'm not sure what I said that would have alluded to that?
    I'm looking for anyone to chime in who has some experience or wisdom to share -- regardless of what they think about what I think.
  8. by   Susie2310
    Quote from WestCoastSunRN
    Hi Susie. I totally appreciate what you're saying. I guess what I meant by that is that I really do know my having any of these issues puts me in the minority. I didn't post the questions as a means to start meaningful dialogue about the subjects themselves. It was more questioning whether someone who has those kinds of alternative views has any business in family practice.
    I hope I'm explaining that well. It certainly isn't my desire to squelch debate -- and maybe my original wording regarding debate was poor. It just isn't the point of my post. Does that make sense? I'm sort of just looking for people's experience either being a provider who has alternative views or working with one, etc.

    Since I am the OP, I thought it would be ok to just ask a question and try to keep it as simple as possible by not needing to discuss the wrongs or rights of the subject matter-- to my knowledge that does not go against the TOS.
    It does make sense, but I think it would be good to be prepared for discussion on whether nurses who hold your views can really meet patients needs in a family practice setting, and for that discussion to include what people perceive to be the rights and wrongs of the matter.
  9. by   Susie2310
    Quote from WestCoastSunRN
    Hmmm. This is an important point. I, in no way, am looking for views only from people who have similar views to myself. I'm not sure what I said that would have alluded to that?
    You said that: "I in no way am looking for debate in this thread."
  10. by   WestCoastSunRN
    Quote from Susie2310
    It does make sense, but I think it would be good to be prepared for discussion on whether nurses who hold your views can really meet patients needs in a family practice setting, and for that discussion to include what people perceive to be the rights and wrongs of the matter.
    I think this is a great point. And one of the reasons I wanted to put this out there -- it is helping me process, for sure.
  11. by   WestCoastSunRN
    Quote from Susie2310
    You said that: "I in no way am looking for debate in this thread."
    Yeah. What I should have said was "I'm not trying to defend my beliefs on any certain thing in this thread". I can see how you could take "not looking for debate" as "I only want to hear from people who think like me". So I'm officially establishing that is NOT the case. All views welcome and Susie, the point about not being able to meet the needs of patients in family practice? That's the crux of it really.
    So does every provider in every family practice meet all of their patients needs equally? If so, what does that look like? If not what does that look like?
    I don't want patients ever feeling like they got the bait and switch with me, either.
  12. by   Susie2310
    Thanks for the clarification.

    I hope people come forward to answer your original question, and your questions in your post above.

    Best wishes to you, and I hope you are able to find a practice area that you will enjoy (if you are considering a new area).
    Last edit by Susie2310 on Sep 20
  13. by   UrbanHealthRN
    I've previously worked in very busy pediatric departments of community health centers, and GYN care and immunizations are both topics that I dealt with frequently in those settings.

    I'll start with immunizations. As nurses, we're driven to follow Evidence Based Practice as much as possible, and to present patients with credible, accurate health information so that they can make informed healthcare decisions. If your research into immunizations somehow results in an alternative schedule being your EBP, then so be it. There are certainly plenty of families out there who want a provider who is open to discussing when and how to vaccinate their children, and they will flock to providers who provide alternative scheduling. Keep in mind, though, that if you're working in a practice with other providers, some practices create uniform policies regarding immunizations, and your differing views may not be welcome in the practice.

    Regarding GYN care, plenty of providers who deal with women's health do not do every single GYN procedure. Many will refer women out to other providers for abnormal Pap smear follow-ups, IUD and other birth control placements, abortions, etc. Prescribing is a little different, especially with meds such as Plan B, which are very time-sensitive and should be taken ASAP. I think the important thing here is that, again, you present patients with accurate and complete information, so that they can make their own informed decisions about their health. Also, think about your own liability in those situations (ex. not counselling a patient about Plan B when it's a viable option for her unplanned sexual encounter, and then she winds up with an unwanted pregnancy and gets an abortion instead, which is a much more complex process on so many levels). Whether or not you want to do something for a patient, they still have the right to be told what their options are, and then you help them make a plan from that point (referral to other provider, etc.). Again, which practice you work in can make this a lot easier or harder for you- a religious institution will probably have more set protocols for you to follow in certain situations, and that may help guide your practice a lot better and make things easier for you. You could also try to gravitate to different populations of patients that may have less reproductive health needs, such as the elderly, though I'm not sure you'll ever completely avoid these issues.

    In keeping this as neutral as possible, I hope this provides some guidance.
  14. by   WestCoastSunRN
    Thanks UrbanHealthRN for such a thoughtful response. I agree patients absolutely deserve and need to be fully informed about their various choices. And almost all choices in healthcare come with upsides and downsides.

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