Tell me the downsides.

[CardiacDork]

I like to be pragmatic.

So please NPs of allnurses. Tell me what sucks the most about being an NP?

I know that everything isn't filled with meadows and butterflies.

Anyone willing to just simply list some of your top complaints and perhaps things you wish could change about the NP industry?

Thank You in advance

CardiacDork, RN (BSN student)

Cardiac ICU Nurse

[GoodNP]

I think that's a little bit unfair. Yes theirs pt out their that do nothing and don't understand why this or that is happening. And generally don't care, and think everything you saying isn't true. But loosing weight or giving up smoking is much easier said than done. Their are people out there that do try and want to live healthier. Telling them to eat better and exercise isn't enough for most people. They need some one their to help them, show them what to do.

That's why in my country they started a thing called a green prescription. It's completey free course that consist of exercise classes, classes on healthy eating and what to eat and how to cook, plus support from a trained professional for 12 weeks for people who are over weight. It has proven to be very effective. Ofcourse it only works if people go to the classes. But is more helpful than just telling people to lose weight, join a gym, eat healthy ect.

I have lost weight myself. Losing weight is very, very hard. I would never state or suggest otherwise. It requires a lot of effort and near all-encompassing lifestyle modifications since most people's eating habits (at least in South Texas where I live) are atrocious. There are many difficult barriers to success, including time constraints, education, cultural and likely genetic factors as well.

I repeat, it is HARD.

Nonetheless, it is up to the individual. I do not put the food in anyone's mouth. I give very specific dietary recommendations, never just pat commands like "eat healthy" because "healthy" is the most useless and meaningless word in the English language. I also give referrals to a nutritionist, and even confirm how many visits a person's insurance will pay for. Many plans, I've learned, cover up to 10 visits per year! Free! Yet less than 10% of patients go.

I recently read results of a couple of studies about increasing access to parks and walking trails as well as building grocery stores in so called "food deserts". Bottom line - Build a walking trail, no one will use it. Build a grocery store in a "food desert", people will go there to purchase chips and sodas, not fruits and veggies. (I will try to find these studies).

Yes, people are busy, and we are overwhelmed by misinformation and conflicting information. But I have a preponderance of patients who consume ZERO vegetables. And feed their already insulin-resistant acanthosed kids ZERO vegetables. They claim they "can't" lose weight but are unwilling to keep a food diary. Or they consider anything that could be loosely called a "smoothie" to be a magic weight loss bullet.

In my humble opinion, the problem of obesity in the US is not the responsibility of the healthcare system. It is cultural. And by that I mean the culture of the developed west, with all of our misleading commercials and advertisements, food caricatures, false health claims, and so on, perpetuating our dependence on processed and convenience foods and our addiction to sugar. Like other social woes, I think it will improve slowly as our children will inevitably learn from our mistakes, but it will take decades. In the meantime, individuals have to make the difficult personal choice to eat more fresh vegetables and less processed foods, despite what everyone else around them is doing.

So, I will say it again: Losing weight is very, very hard. But it CAN be done. And I can't do it for you.

[ToFNPandBeyond]

Things I HATE:

#1. Charting. For every minute of face time with a patient there is at least 2+ minutes of pre/post charting.

#2. Charting/Meaningful Use. Even though the patient came in for XYZ complaint. I have to address: colon screening, Flu shot, PAP, check allergy button, check the PMH button, check the Medication button, and check the PMSH button (even though I'm doing this during each encounter).

#3. Charting/labs. Calling patients back getting their voice mail, playing phone tag with lab results, dealing with nurses playing phone tag with patients and then the patient asks a stupid off the wall question which then gets routed back to me to address

#4. Charting/Doc of the Day/covering for other providers on vacation/sick time

#5. Getting my mailbox stuffed with ASININE letters from insurance companies telling me they won't cover a medication OR the patient is not taking their medication correctly OR did I know the patient was on GASP!: aspirin and plavix at the same time....

#6. Fighting with pharmacies on drug coverage. Such as tablet was covered last week but now have to get a prior authorization to pay for tablet. 15 minutes on the phone with the pharmacy and MIRACULOUSLY they cover the medication in capsule form!!!!!!

#7. Peer to peer phone calls. I ordered an MRI. Insurance refused to pay. Spend an hour on hold, finally talk to a doctor and spend 30 seconds explaining case when they give me the approval number!

#8. Getting messages from local Home Health agency from local hospital ALL on the same EPIC charting system sending me HANDWRITTEN NOTES ON DRUG ALLERGIES that I ALREADY HAVE TO CLICK ON a button accepting drug allergies prior to the damn charting system letting me send in a refill...

#9. Charting/EPIC MyChart messages. Patients sending off the wall questions that take time away from seeing patients

#10. The inefficient bureaucracy of medicine. Im able to bill 50-60% of my time (face time encounters with patients scheduled that day). 40-50% of my time is spent on UN-billable time (inbox/refills/mailbox/phone calls/etc)

#11 filling all the patients meds, hit the send button, THEN they ask for it to be printed OR sent to another pharmacy OR asking for a 90 day supply

#12. I once filled out a prescription 5 TIMES for a walker. (1) Patient asked me for a walker. (2) They then asked me for a rollator walker. (3) The rollator walker has to specify 4 wheels and brakes. (4) The rollator walker has to specify 4 wheels, brakes, and a basket. (5) The rollator walker has to specify 4 wheels, brakes and a basket PLUS ensure the diagnosis was attached PLUS date it.

#13. Opioid Pain meds requests

#14. Disability requests

#15. FMLA paperwork requests

#16. Unrealistic patient expectations. For example, seeing a patient who has had 42 back operations over 20 years comes to me with back pain complaint (instead of going back to the surgeon) SMH!

#17. Never getting a lunch because of charting

#18. Never getting a bathroom break because every second of every day spent on being as efficient as possible. Everything NOT addressed during the day rolls over into personal time at home.

#19. Working 36-48 hours a week as a nurse and getting paid for every hour that I worked. Now as an NP, I'm supposedly a professional (salaried) and I put in at least 50-80 hours per week. AND the nursing/ancillary staff wonder why I don't look them in the face (instead of eyes glued to the screen charting)

#20 Dealing with soul-sappers. These are the vampires who will drain your soul dry. They are the non-compliant patients who promise the world but never make any changes. They don't have any money/finances/insurance/homeless and ask for more money/services/free stuff...

Things I love (which makes me go back to working da grind every day).

#1. Making a connection with a patient. I love walking into a room and the patient glances at me with a distrusting and hostile look (because they don't know me). 1/2 way through the encounter they start leaning forward, paying attention to everything I'm talking about. And at the end hearing them say "can I come see you again"

#2. Catching bad things others have missed (cancer/autoimmune/etc) (Again, not that I'm that good, most of the time its being in the right place at the right time to catch the diagnosis.)

#3. Doing the right thing for patients and earning their trust. For example, seeing the wife, husband (farm worker) walks in behind patient with an obvious basal cell cancer underneath eyelid. Whole encounter stops and I focus on him (MOHS surgeon got to him quick enough they were able to save his eyelid...)

#4. Making an impression on a patient THEN start seeing their spouse THEN start seeing their family THEN start seeing their church members (because of #3 above)

#5. Calling and checking up on sick patients.

#6. Hearing 3rd hand on how good the care you've been providing

#7. Bending over backwards for a patient (my usual care) who come to find out is the cousin/family member/church member of administration/employee's and word gets back to you on how they appreciate the care which was provided

#8. Learning new stuff every day

#9. Challenging patients

#10. I LOVE humble patients!!!!!

THIS right here is EVERYTHING!! Thank you so much for sharing such a detailed aspect of your experience. I am truly enjoying reading all of these experiences. It's a bit humorous if I'm to be honest, yet eye opening and humbling í ½í¸Š

[friendlylark]

Yes, I like your pragmatism! I would like to know as well, because I am starting an FNP program in about 2 weeks!!!