It's time to vent!!!

Specialties NP

Published

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 :up:

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 :D

Specializes in EMT since 92, Paramedic since 97, RN and PHRN 2021.
America is the land of entitled wimps. We've grown soft

I don't know if I would say that, but I believe that with the pressures of everyday life people don't want anything that will slow them down. Between family, work, and other demands of life people just don't want anything that will slow them down and disrupt their life. Yes, this is the wrong mindset to have as everyone gets sick once in a while.

As many have said , it is lack of antibiotic education.

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There's definitely some truth to the American thing haha. My husband is Filipino and the second anyone gets a cold I (the American born one) is trying to force cold medicine down everyone's throats, while he has more of a "wait it out" attitude. He refuses to take any medicine or see a doctor unless it's really bad.

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Specializes in clinic, ortho/neuro, trauma, college.

I'm not an NP, so forgive the intrusion here, but I had a student the other say who walked in with a Dunkin Donuts iced coffee and said that she thought she had strep because her throat had been hurting for two days. I asked her if it hurt to swallow her own saliva, the whole while I'm looking at her sipping her coffee without so much as a pained look on her face. "No, it doesn't hurt to swallow."

THEN YOU DON'T HAVE STREP! Of course, I did assess her properly, but come on!

I'm trying to acclimate my own children to the notion that we will be uncomfortable at times in our lives. Colds suck, and can make it challenging to go to school/work/whatever, but with a little self-care and some knowledge about what really needs a physician, we can make the world a better, less whiny place. ;)

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Specializes in Adult/Geriatric.

I think canceling a check for service provided is wrong. Just because you don't like the diagnosis you got doesn't mean you shouldn't pay for the work that was done. And no, no lawyer is going to call such an episode "malpractice."

Lab test is not necessary for a URI unless strep throat is suspected. Obviously this is all theoretical since I didn't see you personally, but in general if the cold went away within 2 weeks (with or without antibiotics) it is safe to say it was a viral infection. That's what evidences show. So you can't attribute the fact that you got better when you took the antibiotics to the good work of antibiotics. You were on your way to getting better and you happened to take an antibiotic so you think that's what made it better. Again, that's if the whole thing lasted 2 weeks or less and all in theory.

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Man im glad i never think about what happened at work when i get home. Internal control makes life easy. No need to vent just move on. Suck it up and who cares.

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Specializes in Reproductive & Public Health.

My favorite are the patients who come in "just wanting to make sure everything is okay." No presenting complaint, and they wait till after I do my nice thorough well woman history and targeted physical to tell me that actually they have been having so and so concerning symptom. Like I am magically going to discover their dysuria during an exam. Or they want me to "just run all the tests."

I don't blame patients for having these unrealistic expectations, but it is frustrating when people don't realize that I can't figure out their problem without their input! I can't magically know you you are having weird bleeding and you didn't take those pills for the chlamdyia infection you had last fall. That's important information, sigh.

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Specializes in Adult/Geriatric.
Internal control makes life easy. No need to vent just move on. Suck it up and who cares.

I wish I were better at that! :-) Have been working on it. Any tips on how to just let things go?

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Specializes in clinic, ortho/neuro, trauma, college.
Man im glad i never think about what happened at work when i get home. Internal control makes life easy. No need to vent just move on. Suck it up and who cares.

She has a valid vent here. Antibiotic overuse is a thing. And providers can address that problem by not acquiescing every time someone demands z-pak for what are probably viral symptoms.

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Specializes in Nursing Professional Development.
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.

It sounds like you saw my sister. She is one of those patients.

Dad was a country doctor concerned about abx resistance -- and who taught us kids about it at an early age. But somehow, my sister was resistant to the message. She runs to her doc for a Zpack for every little thing -- and won't travel without one. She insists that her colds are always sinus infections and that she always gets a bacterial bronchitis if a cold goes to her chest, etc. etc.

I just want to slap her.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
America is the land of entitled wimps. We've grown soft

Forgive the jump-in, as not an NP either-- do have years of family practice/nurse/clinic time though, so I can attest that we were soft as of the 80s, with our on-call (walk-in) system people who get the "talk" (non-rx comfort measures, no abx) become incensed, sign back in and wait as long as it took to see the doc who always gave them the script. They were all employed and insured at the place where this occurred most often.

At the clinic with mostly medicare/medicaid patients we had a hell of a time getting them to come in for follow-ups-- which many sorely needed in order to forestall the worse problems that usually resulted.

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"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."

To me this displays something that is all too common these days, a very low distress tolerance, and this attitude of entitlement, that if they pay to be EVALUATED and assessed by a professional, that it entitles them to be prescribed whatever they want. I actually had a patient who wanted her money back after an 1.5 hour Psych Eval because I wouldn't recommend a stimulant. "But why won't you give me Adderall, I paid for this appointment". Ugh....

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Specializes in Family Practice.

I know the first thing she should have listened to you if your symptoms were not improving by the allotted time then it may bacterial. Jeez! Every patient is different can't assume all the time.

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