How repetitive is your job?

VivaRN · Mar 9, 2009

Although I work in the specialty of HIV it encompasses primary care. I am new and wish it would start to be repetitive already... there is so much that can be wrong with a person, medically and everything else besides. Patients don't talk like the textbook. It's a constant discovery, building relationships, trust, and diagnostic acumen - an art in and of itself.

It's not easy or repetitive, it's a huge responsibility and every day I learn how much I don't know. It may be primary care... but is that 20lb weight loss anorexia, cancer, hyperthyroid, diarrhea, esophageal thrush, dental pain, substance abuse, and what if I forgot something and that's what it was? How do I prepare the patient for the possibility of a serious illness without scaring her out of her mind?

Needless to say, I have yet to be bored. My colleagues and I have dx'd everything from breast cancer to acute renal failure to neurosyphilis. I hardly consider those things minor ailments.

Do you have a chance to try primary care vs. acute care before you commit?

Joe NightingMale, MSN, RN · Mar 9, 2009

Don't know how many opportunities I'll get to see primary care, but I'll get lots of opportunities to see acute care over the next few years.

Trauma Columnist · Mar 9, 2009

I work in nephrology and like Viva, though I work with a narrow focus, my patients have a multitude of problems and since they see me weekly, I'm their primary care provider as well.

Advanced Practice Columnist / Guide · Mar 10, 2009

In my opinion, one should never view the role of a healthcare provider as being repetitive regardless of what setting the provider is in. Patients may come in with the typical complaints for the most part, but it is the responsibility of the healthcare provider to still sort out the symptoms, analyze the exam findings, and look through the diagnostic tests to make sure every possibility has been ruled out in terms of arriving at an exact diagnosis. That is not an easy task. Add to that is the fact that the culture of healthcare in the US is definitely one where we as providers are easily scrutinized for our competence and that the risk for litigations are driving us towards defensive healthcare practices.

I work in the Cardiothoracic Surgery ICU where many of the sickest patients are probably admitted to. On the other end of that equation, patients who had the typical CABG or valve replacement come and go day in and day out and many are quite straightforward cases. However, I always approach each patient with vigilance because something awry can happen. True enough we've had extreme things happen in a straightforward patient ending up being coded and eventually being placed on ECMO! Another thing I try not to develop a habit of is practicing a recipe approach in my patient management. Protocols are great and many say a trained monkey can follow protocols but one needs to also use judgement when following those as patients don't always come with textbook-precise problems.

Another thing I realized now as an APN is that it's easy to judge and criticize a healthcare provider for being slow in their patient management until you are caught in the same pedicament as they are. I was a staff nurse for a long time and in the past, I've made comments about why a specific resident wouldn't just order the Lasix I wanted to give my patient or intubate the one I think needed to be on the vent realizing now as an APN that there are a multitude of things you consider before you make decisions on therapy or intervention. For one, the NP is the responsible for the ultimate outcome of that treatment and if that turns south, he's the one explaining that to patients and families and in worse case scenarios, explaining it to an irate attending or being crucified in the Morbidity and Mortality meeting.

cruisin_woodward · Mar 10, 2009

I am still a grad student, but as an RN, in a busy inner city CTICU, I would never say it is repetitive or boring!! So many comorbidities!! Pts get septic, cardiogenic shock, etc!! I could go on and on!! I know as a nurse, I'm constantly looking things up, and trying to figure out what's going on!! I am excited to learn something new every day!

Joe NightingMale, MSN, RN · Mar 10, 2009

In my opinion, one should never view the role of a healthcare provider as being repetitive regardless of what setting the provider is in. ... I always approach each patient with vigilance because something awry can happen.

I know that, I'm not asking if it's OK to be less than vigilant, I was asking how much variety you see in a given position. To see if my assumptions about various positions are correct or mistaken

mom and nurse · Mar 14, 2009

As an inpatient NP working with a mostly elderly population in a hospital, ... never a dull moment... :)

JDCitizen · Mar 15, 2009

There is a possibility that in any practice day in day out events that happen may seem like the same old thing. Size of hospital, size/type of unit, size/type of practice.

Now my average day I know the patients I am going to see. I look at the list of their complaints. Sometimes I even can do a brief review of their charts.

Sometimes though:

1) The lab result on the chart with no ones signature needs addressing more than the patient complaint for that visit.

2) When the patient states "by the way" and those little shivers go up your spine.

3) The 4th physical of the day and the palpation of the abdomen doesn't feel right so you start asking questions (see #2)

4) Routine lab work comes back not so routine.

5) Lab / test work ordered to rule out something rules in something else.

6) Patient in front of you in the office should be in the hospital or just got out of the hospital and because of whatever circumstances they are in your office.

Hospital rounds:

Same list except...

1) These lab results came in and we knew you would be rounding first thing this morning.

2) Going over D/C instructions with patient and family and patient codes.

3) That little bit of shortness of breath turns out to be a PE

4) That IV antibiotic add that to the allergy list.

5) Mr. 5E should be in ICU but ICU is full.

6) The monitor is not telling the truth.

7) That INT that is needed to push that emergency drug is not well in...

Even in the smallest of hospitals as an RN and now as an NP the most mundane, routine day can change to nightmare reality at the push of a call light or with the next patient.

VivaRN · Mar 15, 2009

Even in the smallest of hospitals as an RN and now as an NP the most mundane, routine day can change to nightmare reality at the push of a call light or with the next patient.

Well said!