I should have gone to med school! (rant)

TreehuggerRN · Nov 18, 2009

I know how you feel. I was just talking about making a choice between family and career and that I just couldn't abandon my children. So, yes, I feel like I settled as far as a career goes but I'm trying to make the best of it.

zenman · Nov 18, 2009

Why are you choosing to let this bother you?

myelin · Nov 18, 2009

... as someone who recently decided to apply to RN/NP school this thread makes me nervous.

BmoreCRNP · Nov 18, 2009

Why are you choosing to let this bother you?

The real answer to that is probably long.....but the short answer is I have this need to feel competent, and for others to think that I am competent. In my opinion, if people don't think that you are competent, then they don't trust your decisions and do everything within their power to undermine you, go around you, sidestep you, etc.

maziemoo22 · Nov 18, 2009

... as someone who recently decided to apply to RN/NP school this thread makes me nervous.

I can't agree with you more

MERRYWIDOW46 · Nov 18, 2009

I think some of that goes with the area we live and practice in. SOME WORLD CLASS medicine in this area, and GIGUNDA EGOS as well.

Trust in yourslef and your abilities. KNOW that you are good, and hard as it may be look at it as their loss. Keep your head high and keep moving forward knowing WHO you are.

Rekkashinorei · Nov 18, 2009

BmoreCRNP,

Hey there, I'm sorry to hear that you are feeling down in the dumps about the nursing profession. I'm an RN aspiring to be a an NP someday and I am sad to read this message. I am not sad because of what you said, but rather how you bring attention to the reality of the challenges I know that we all face on a daily basis as healthcare providers. I am lucky so far in that I have had more positive experiences than negative ones as a critical care RN in a world-reknown teaching hospital that facilitates a culture of multidisciplinary teamwork and respect. When I was a new graduate RN, I made sure I worked for only institutions that respected and supported Nursing. However, nothing is perfect, and I too have had negative experiences and am occasionally haunted by the self-depreciative conundrums that seem to pervade many nurses. For the patient'sake, you must get yourself out of that conundrum. The pressures to validate oneself as an intelligent provider will always be there unfortunately, but the focus should be the patient. Stop thinking you should have gone to medical school as you may very well face the same disrespect and pressures as a doctor, too. (Shall I remind us all that there are also incompetent doctors?) Credentials only take you so far. The rest is how you respect and handle yourself.

First of all, may I make an assertion here that I feel that RNs in general are very self-critical. It seems to start in nursing school and then intensifies on the job as practice becomes a real-life issue between the patient and the healthcare team. The general public does not have a comprehensive understanding of the power of nursing and doctors are from an entirely different discipline that are also generally unaware of how powerful our contribution to a patient care is either. As I make it a point to tell all student nurses and nurses alike, that the life-saving and life-optimizing effect you provide to all patients under your care are often invisible and/or unacknowledged not so much because you are under-valued, but because they are acts of prevention and principle that are not easily detected or benchmarked. People recognize a doctor's skill because he/she fixes what is visibly broken. People don't recognize what nurses do because we keep them informed (aka worry-free) and comfortable and prevented potential harm done unto them. If you are successful in prevention, then there would be no need for attention from the patient that would illicit acknowledgement. Our impact to their care is counter-intuitive, I know. But, that's where the art of nursing lies.

We coordinate multiple orders thrown at us for the patient so that their tests, treatments, and medications are all given in a streamlined order. Doctors and patients do not know we do this, but we do this because it's safe for the patient. We cancel redundant and unnecessary laboratory orders for cost-effectiveness for the patient. We work around the unconducive hospital architecture just to reposition our patient or provide a bed cot for the family members. We catch sentinel events before they occur and prioritize our cares so that the patient is stable at all times. We hold their hands when they are afraid and in pain and we teach when they need to learn. RNs/NPs alike, this is what we do and know that our skills influence the totality of the patient experience. It just isn't always acknowledged, and that's okay because these are acts of principle. (Personally, this is where I see the beauty of what we do.) We do it because it is simply the appropriate and ethical thing to do not because we are in search of praise each time we accomplish a task for the patient. This is principle. I didn't become a nurse to be constantly thanked. I became a nurse to keep people safe and well and that's just what I do - what we do. Gosh, if it was not for us, can you imagine what patients would have to go through?

Can you think of a time that you caught an overlooked order and fixed it? Have you answered the pages from RNs who could not get the doctor's attention? (As an NP, you are the nurses' nurse, the nurses' advocate.) Have you been able to explain a test result or drug to a family member to alleviate their concerns and fears? Even if you say no, I am sure you have because you would not have made it this far into your career to say no. Remember that and make sure that you are not discrediting yourself for all the times you have made a difference in people's lives. Don't forget your patients and their family. They are thankful to have your care. The other half are your coworkers so don't let their criticism ruin your entire experience as an NP. Actually, they should be less than 50% of your experience as an NP. They should be 25%. The other quarter is you and those who love you for who you are.

Before you beat yourself up over things that are unfortunately out of your control, remember that you have gained a lot of experience as an RN as well as extensive training through NP school. If you just started out, give yourself a year to acclimate to the pressures of finally being in that autonomous role. If it is seriously problematic, consider working for a different employer that values NPs. Or, practice conflict resolution skills with those that are particularly problematic for you and do so in a professional and diplomatic manner. Prepare yourself to be logical rather than emotional by talking to trusted peers about your frustrations. (Hell, I'd even write them down!) As healthcare workers, we all work in an emotionally intensive environment. But, we are all here because we want to focus on the patient - not ourselves. Do not give into the pressures of their derogatory/antagonistic expressions and respond well to those who are willing to explain their disagreements with you. Choose your battles wisely. Learn from your mistakes and acknowledge that all healthcare providers are lifelong learners in the practice of healing. Time will give you the experience that you need to become a better practitioner. The fact may really be the institution and not so much you. There is a solution to this. Persevere and reflect on what drove you to become that smart NP. Remember this and take them with you to work everyday.

Thank you for being a nurse practitioner. Society needs NPs who can share the responsibilities with the doctors but provide care with the nursing touch. There are people out there that still appreciates you - such as I.

Chin up, keep going, and take it easy from time to time.

Trauma Columnist · Nov 18, 2009

This made me think of a recent credentialling meeting I had to go to. I work prn in a community hospital ER and had to actually go to the medical committee meeting where credentialling was approved or denied. It was all very cordial - everyone went around the room and introduced themselves, etc..

Then, came the questions! They asked me why I didn't become a doctor? I truly thought they were joking, so I answered, "Because there is very little need for 50 year old med students!" The docs I were with snickered but otherwise you could have heard a pin drop!

How archaic! I truly expected banjos in the background!

I did get credentialled but there are so many stipulations that I might as well work as a staff nurse...

tracelane, DNP, NP · Nov 18, 2009

Hi,

I know exactly how you feel. Some may think it is because you don't come off as confident but there are too many of us with the same problem. I've had nurses argue with me or refuse to complete orders I've written and have walked up to hear a nurse asking the doctor if what I've ordered is okay. I'd ordered the CDC recommended dose of Rocephin for an std. I've also walked up to hear an MD making fun of me for ordering Zofran IM to other providers and having to explain I'd looked it up and it was fine.

It is very frustrating. I think it is related to the state regulations. I plan to relocate to a state which allows for independent practice and open a cash clinic if I have to.

I think the credentialing issue is interesting. Just because your state allows you to work within certain parameters doesn't mean the hospital will. The doctors in the ER had to put there names on each chart we (np's) saw and they ever received credit for them toward their bonus.

I won't give in and go to medical school but I've had the same thoughts.

T

BmoreCRNP · Nov 19, 2009

Wow, I thank everyone for your responses. I will definately consider the advice. "Rekka" (had to cut it short, lol) I think your advice is very wise. I realize that resolving most of these problems really lies within me. I need to learn how to focus on the patients and families rather than allowing my interpersonal relationships with the staff to sour my experience. Of course I have to work with these people, but I don't need, and shouldn't seek approval from them. Tracelane, I am in a state that allows NPs to practice without having an MD present, but we must have a collaborative agreement with one. I am the only on-site provider in the facility that I work in. The MDs drop in every now and again. I have only seen and met one of the docs, and there are about 5 or 6 of them in all. So most of my issues are with the nurses and nurse managers. I think the real issue is these nurses don't want someone with less nursing experience who just went to school for an extra two years to tell them what to do! It's like some of them are actually angry that I dared to do that. Either that or they think you didn't learn squat in school that they didn't already know. I used to have the mindset that I knew nearly as much as the docs. However, after going through the program and learning some of the things that I did, I realize that there was quite a bit that I needed to learn....and STILL need to learn! It's important for me to always maintain the attitude that there is ALWAYS more to learn.

Lola89, LPN, LVN · Nov 19, 2009

Hey BemoreCRNP,

I have a question for you. So you went to a direct entry program, from BSN to MSN without prior nursing experience..correct? I'm just curious because I am planning on doing the same soon, and I always wondered how are these types of nurses received. I hate it when I hear stories like this of nurses hating on other nurses, we should stick together and help each other.

I'm sorry that you are going through that and I hope that it gets better.