It's time to vent!!!

[MegRyanGirl]

I was looking for a place to release some work tension but didn't find the right topic. So here is a place for every NP out there to vent your frustrations that you come across as an NP :-) Advice, encouragement and support is what we are looking for! Share and sympathize

Here goes mine.

I've had a typical week at a primary care office. Saw about 40 patients with some form of URI. I'm very diligent about not prescribing antibiotics when it's clearly a viral case. With the new CDC recommendations and the antibiotic resistance epidemic, every one has to take a part. But I'm getting really frustrated with providers out there that have no problem prescribing abts to pts that had some cold for a few days. It really undermines providers like myself that diligently educate the patients on viral v.s. bacterial infections, not to mention bad medicine that goes against the most up to date evidence based practice. Patients can be quite frustrating as well. They all fall into one of 3 categories. 1) Those that I educate about the viral infection, understand it and follow instructions, 2) Those that seemed to have understood it but then second guess and start calling and asking for antibiotics when it's not necessary, 3) those that get annoyed that I didn't give them an antibiotic and just go to another place or urgent care and get what they want. ARRRRRRRRRRGGGGGGHHHHH

What am I to do???

Another issue. I don't know how many people on this forum are from the U.S. or another country, but I was raised outside of the U.S. and the mind set is very different for that of the U.S. where I practice. I don't want to be judgmental or anything but American born patients seem to have a very low tolerance for anything that's a little uncomfortable. They can't deal with a little sore throat or a little cough here and there. I mean I have pts that come running to see me for some medicine after some sniffles or some sore throat or a little cough for even less than a day! Most common is someone with cold symptoms for 3-4 days. Where I come from, you just suck it up for a week or so. Back when I was younger I didn't know much about viral versus bacterial infections but now I understand that most of those sniffles were just viral anyway and went away on it's own. Here in the U.S., people take and demand so much antibiotics that they get sick much faster! It's really frustrating. Sometimes I just want to tell them to stop their whining!!!! Or have some cheese with it

[CrunchRN, ADN, RN]

I so get that. People these days run to the doctor for every little cold. I constantly tell them to just let it run its course to no avail. And I am an American nurse lol.

[TakeTwoAspirin, MSN, RN, APRN]

My favorite is the rash that was there yesterday, gone today, but pt wants something just in case it comes back!? Rule of thumb: If I can't see it I can't fix it!

[BostonFNP, APRN]

Are you new to an established practice?

Just like you, I (and we all) have this problem. Over the years I have made a huge dent in the inappropriate scripts. My colleagues before me were very lax and it takes time to establish trust with patients then change their view of the topic.

I started with delayed scripts. I would post-date a script and tell them if they still felt horrible in 3-5 days to fill the script, but next time I wouldn't do the same. I went over the evidence and directed them to patient resources to confirm.

Now that most of the "frequent fliers" in my practice have been through the routine, I get very few problems. Did a few people get abx when they should have? Yes. But far fewer now than they get over at our local ED that I swear has a bowel of Zpacks available for self-serve.

[BCgradnurse, MSN, RN, NP]

I work with a doc who will not stand up to patients. If they want an abx for 2 days of sniffles, he writes the script and calls it a sinus infection. Sometimes he'll write a script for an antibiotic with a refill. Not only is this harmful, he sets the expectation that every provider in the practice will do that. I hate to see his patients. I'm leaving this practice in another month and I hope no one at my new job practices like that.

I refuse to practice like that. I'm pretty stingy with antibiotics, but big on helping patients manage their symptoms.

My other pet peeve are patients who won't use their controller inhalers, cause they "don't want to get dependent on them". Oy vey...

[sauce]

America is the land of entitled wimps. We've grown soft

[sailornurse]

I work urgent care and this is a constant battle. I recently saw a lady that wanted a zpack since she was going on vacation. No fever, just sniffles. Denied with explanation about antibiotic resistance and appropriate prescribing. She was upset responding with "what happens if I get sick on my trip?" Duh you find an urgent care "back east" where you are going to be. I countered with "so by your reasoning, everyone getting on an airplane should have a zpacK?" Sometimes you have to shame people into being reasonable.

[WIBound]

We are taught not to prescribe abx for colds and viral infections, but in the clinical setting time and time again it is done. I had one provider tell me that if they do not provide the abx the patient will just go next door where someone will and the practice loses the business. Plus with these urgent care clinics every 10 feet the competition is getting much tougher for providers - I man not saying that makes the practice right, but I can understand the reasoning for handing out Zpac like candy.

Also, when you talk about people coming to a provider for everything. Those on medicaid and medicare come much more often for the silliest things. I guess if you don't have a job and don't have to pay there is no incentive to stay home and wait it out. People with jobs and insurance only seek treatment if really necessary.

I remember doing triage in the ED and would ask so many times, "you came to the ED for that?" It always amazed me what some people considered an emergency. A split toenail, a runny nose, hangover or whatever stupid reason they have to waste our time.

[NurseSpeedy, ADN, LPN, RN]

I totally get the overuse of antibiotics issue and patient's having a strange view that if they have a cold then they have to get medication to get rid of it because in today's world, "There's a pill for that!"...no, it's a virus and it will take a week or two to go away. I've worked in offices and would ask the patient how long they've had symptoms for, "I woke up like this"....yeah, it's probably viral, let's go through what the doctor would recommend you take to manage those symptoms.

Unfortunately, because so many people have gone to the doctor in search of an antibiotic for the sniffles, it has become very hard as a parent to get a doctor to prescribe something for the child who had started out with what was a cold but over the course of the past couple of months it has turned into something more. My daughter's pediatrician was out on vacation so a covering physician in the group decided that she didn't think that she required anything and sent us home over the Christmas holiday with a children's Nettipot....that went over well for a 5 year old...over Christmas, my daughter then developed a low grade fever (100 F). After the holiday, brought her back into the same covering doctor who got quite snotty with me. Arguing what constituted as a fever as my daughter sat coughing and miserable for over 2 months now. Finally, covering doc stated, "It's not a fever until 100.5. Maybe she has asthma and should be checked out?" Me, "or maybe her primary care physician can see her when he returns but in the mean time I have a sick kid who doesn't get colds for more than a few weeks at a time and has only gotten worse". "What would make you happy?" she asked condescendingly. I told her, "She's 5. She's relatively healthy. She's been dealing with this for over two months...the fever will probably go up to your 100.5 in a little bit more time (and it did). It will take weeks before a pulmonologist could see her to look into 'asthma'. She is miserable and the doctor who knows her history is not available. Her liver and kidneys are fine. Humor me. Give her a round of antibiotic treatment. If I'm right, my child feels better in a few days. If I'm wrong, then I will look into the other options you think may be causing this. But one treatment for symptoms that have been present for over 2 months isn't overkill in my mind. I've tried OTC allergy meds and nothing has helped".....She gave me the script to get me out of her office. About 36 hours later my daughter started hacking up and blowing out all kinds of green/yellow/brownish colored mucus and was clear by the time the antibiotic was completed....It's been three months since and has not had a return of any symptoms.

[gonzalezs]

I have had a similar situation. I had a bad virus infection (as I thought) for more than a week. Progressively, it became worst and I went to see my PCP. Paid $20 co-pay by a check. My PCP was on vacation and the covering bit$& (a female) refused to prescribe any antibiotics. She did not even suggest that I do any lab tests! Frustrated, I stormed out, and went to the walk-in clinic affiliated with CVS, and walked out with my meds. Two days later my infection went away. But, I stopped the payment on my check to my PCP's office. They sent me a bill plus $25 for the stopped payment they had to pay. I responded with a copy of my bill from the walk-in clinic and a copy of prescription bottle, with two questions next to the balance due of $45 - for medical mal-practice? Failure to diagnose? Never heard again from my PCP again.

I guess there is two sides to the request and denial of antibiotics!

[BSN-to-MSN, ADN, BSN, RN]

Yes, definitely see the American "poor little sick me" with a sore throat. My patients get a cough, and a sore throat, demand their cough syrup, and then go looking for the nurse after each little cough they have. After 1 hour: "I STILL have a sore throat!" Well, guess what, you will probably have it for the next 2 days. I swear, it's like they never had it in their life!

[applewhitern, BSN, RN]

I am an RN, not an NP, but I simply can't pay a $40 co-pay just to see someone for something that trivial! I guess that forty bucks means more to me than a couple days of viral sniffles.