I am a relatively new FNP (worked as a surgery NP for first 1.5 yr, just switched to primary care 2 months ago).
The family practice I work has a physician who prescribes diet meds like phentermine for patients, and these patients are scheduled with me for either continuation or re-initiation of these meds. I am personally against the use of appetite stimulants. Is it right for me to refuse to prescribe these meds? Some providers don't do chronic pain management, but they could. Isn't this a similar situation? What type of specialist can I refer the pt to if they insist on using these meds? I am just not comfortable, but feel badly disappointing these patients.
Mar 2, '13
If you fall for something, then you'll fall for anything. The beauty of your position is your autonomy to practice. Continue being a patient advocate and stand up for your beliefs. It shouldn't be an ethical dilemma because your APRN position allows you to have a choice. Let the physician know how you feel. Perhaps, he'll compromise with you or maybe he'll change his view. Patient education on nutrition and exercise is key instead of diet drugs for someone with undiagnosed cardiac issues. If patients are insistent, then they will get it somewhere else. Unless you continue to enable them. Depending on the situations, drugs for weight loss is not always the solution. i agree with you on that one. Good luck!
Mar 2, '13
Was that mentioned when you interviewed? If it was mentioned in the interview as being expected as a part of your job, I don't think you'll have much choice but to either go against your personal beliefs or find another job. Medical weight loss is a big money maker, and I don't see your sponsoring physician being okay with your decision to refer out for it. Good luck with the new job whatever you decide.
By the way, if you don't mind me asking, why did you leave your surgical position? I'm a surgical NP and I'm trying to work through whether I want to spend the rest of my life "on call".
Mar 3, '13
I actually switched to primary care more for career reasons. I liked surgery, but I kept hearing that FNPs wouldn't be allowed to work in hospitals eventually, and that some hospitals already require ACNP. So first I looked into acute care post-masters certificates but didn't look like I could work full time while doing it. Also, my company was not willing to pay for the program because I would be "grandfathered in" at my hospital. But I didn't plan on being at that hospital forever, so that assurance was not enough. I decided to get primary care experience for job security. There also seems to be more primary care jobs out there than surgery.
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