In response many of the posts we find on here. What would be some of the biggest struggles that nurse practitioners, np students, new grads, vets, etc experience in this field? Does not have to be related to anything specific, but if you had one problem in regards to being a nurse practitioner, what would it be?
I guess to start mine would be something along the lines of attempting to understand what the future holds for nurse practitioners in this ever-changing world.
Let's face it, signing on the dotted line to be an NP is a challenge and we knew that out of the gate. I think it's worth it.
I agree 100% and was talking to someone the the other day who said in response to my comment that this was so much more exhausting than I ever imagined "did you think it was going to be easy working a job where you were making $200,000 a year?" True dat.
FWIW for the most part largely probably because I'm well known in my field but the physicians have been amazing. A rare few of the outside PCPs have made a futile attempt to minimize my role but it has never a problem from my inner circles. :)
On the NP professional level I worry about the present quality of NPs and the likelihood this will be more of a problem as time goes on with the current numbers of students that are being cranked out. Although I take it very personally when I get a patient with history of poor care from a NP, most often evident by their psych medication regimen, I try to keep it in perspective and remember that there are almost as many who come in with ridiculous meds from physicians also. It just hits too close to home when it is a NP because I really strive to have a great reputation among physicians in my community as a competent provider on par with a physicians care.
On a intrapeer level the lack of business acumen and willingness to pick up whatever scraps are thrown in our general direction drives me crazy. We have every right to be respected, make a good income and not take on every ailment even if it is out of our scope of practice because "If I don't help this poor patient who will?"-said with a whine, sigh and back of the hand positioned dramatically on our forehead.
On the patient level the lack of motivation for change, which I know is uncomfortable, frustrates me with regard to lifestyle such as drugs, alcohol, seeking disability and also the lack of medication adherence which of course can be both intentional and circumstantial.
Been away on vacation... But THIS.
I want to add a remark concerning NPs on a professional level. It burns me up when I hear either from NPs or docs about making calls or being called with problems particularly with the frequency which it happens.
Get your nose in a book or use your internet for something besides Pinterest and look up the darn solution. Much of it seems to arise from the absence of science in our training. I hear "my app says these two drugs shouldn't be used together but I think they'd really make my patient feel better." This is followed by "Oh, Dr. Soandso you just hung the moon. I cant ever imagine how you know that?"
Perception of the NP career field by other clinicians, providers and the public in lieu of the glut of programs that accept anyone and everyone.
What he said. I have not started my program yet, and once I have and then have graduated, I know more realistic and more difficult struggles will come my way, but for now, it's this. I have worked hard my entire education because this has been my ultimate goal. I wanted to get some experience under my belt before applying, and I feel now, that I will not be taken seriously, as anyone and everyone who wants to be an NP is entering a program, and many at no difficulty in doing so. I wouldn't feel quite this way if I didn't see so much in my own experience, a huge source of nurses who pretty much just up and decided one day they thought they wanted to do it. I see this so much. I work with a nurse who literally told me that she thought about it one day, called a (for profit) school and they told her "fill out this paperwork and you can start in a few weeks". And she is. It's all fine and well if it's what people really want to do, but it seems the majority of the people entering school around me are doing it for no reason other than "...because". It seems like a trivial problem, but it's frustrating and makes me worry I'm going to be grouped into "those" types of students.
I am in my 20s, am less than a week from completing my Master's and I have career aspirations to be a NP. Am I going to do it tomorrow? Nope. In a good few years with more experience and knowledge under my belt I will try. I will also be jumping on the 'psych wagon', or palliative care; certainly not because it is easy, or because it is seen as a cop out, but because mental health and palliative care are my two passions.
True, some people do the NP for the money or "prestige", or better hours, but then they're also the ones who make terrible practioners (particularly if they choose mental health and have no MH experience).
I suppose what I am saying is, from some of these posts, I would feel incredibly unsupported to stick my hand up and say "yes, my career aspiration is to be a NP", because of my age and where I want to end up practicing.
I have researched NP courses here in Australia, and there are not many to choose from. That says to me that it would be quite competitive, and (hopefully) make quality NPs.
I would hope that when the time comes, I find a community who is supportive and celebrates the fact that NPs are becoming more commonplace. Becoming an NP is no longer unattainable and more positions are being created which is fabulous; this is particularly important as the population continues to age and other options for receiving healthcare are needed.
In response many of the posts we find on here. What would be some of the biggest struggles that nurse practitioners, np students, new grads, vets, etc experience in this field? Does not have to be related to anything specific, but if you had one problem in regards to being a nurse practitioner, what would it be?
I guess to start mine would be something along the lines of attempting to understand what the future holds for nurse practitioners in this ever-changing world.
Any takers?
To bring this back to the original topic, my two cents:
I think the biggest struggle/frustration I have in practice is with a broken public using a broken healthcare system.
The irony of insurance companies "withholding" payments for quality measures that they themselves set (often not consistent with current guidelines) while at the same time refusing to pay for medications and diagnostics needed to meet those very quality measures really gets me.
Patients that refuse to make any changes in their lifestyle but rather are constantly looking for the "instant cure". Pills have become the solution to every problem. That frustrates me.
Providers and healthcare systems that place more emphasis on Press Ganey scores than good medicine, especially the EDs, that undermine good evidence -based providers gets me.
Speciality offices that use the "one-push" generated 8 page note and bill patients $1200 for their 5 minute visit complete with unnecessary procedure codes gets me.
Having little-to-no psychiatric/addiction providers in a 30 mile radius willing to accept Medicaid/Masshealth gets me.
The more I think about it, there are a lot of things...
Patient satisfaction is a pretty terrible addition to the world of medicine. As everybody else seems to imply, the hospital world is more like that of a hotel nowadays. I do not see this changing soon either. what patients want is usually not best for them unfortunately, especially in the lower-educated population.
Sometimes I think we should treat it like other businesses do, give the patients what they want. We could offer them our best advice and if they don't want it they sign a waiver saying they cant sue us and we give em what they want. Only thing is that this would cause many other problems such as more superinfections, spread of disease, more rampant drug problems. Hence why I wouldnt really do it....
but hey our satisfaction scores would go wayyyy up. Give everybody a "shot" of the best antibiotic, best pain medicine, and some random other colorful drug in a big phat syringe and pump it right in their AC. All while serving them top quality home made ice cream while they are on the insulin drip for DKA, and smoking a joint or three along with their whisky and cigar. Sounds like a good resort to me.
While I am still a newbie, my greatest struggle so far has surprisingly been establishing my "place" within a hospital that's unfamiliar to the practice of PAs and NPs. Dare I even say the culture is somewhat hostile? In it remains an unfortunate hierarchical structure of physicians versus underlings (sadly not even an exaggeration as I am constantly mistaken for a doctor, and the palpable look of fear from those who address me as such is truly devastating). This is a marked departure from the comparatively NP-friendly institutions I trained in as a student, where despite being a student, I was still considered an able "colleague" who was expected to pull my weight in intellectual contribution. And while I could not give a hoot about what people think of my career and qualifications, it DOES hinder my work and development as a NP to be left out of 98% of the physician to physician conversations about patient cases. Believe it or not, these patients are mine, and I absolutely do need to know what's going on! Furthermore, I seem to be practicing in the last standing hospital within a tech-saturated metropolitan area that's stuck in the stone age of paper documentation, effectively leaving me perpetually cross-eyed in order to barely interpret medical hieroglyphics. To top it all off, being a shorter than short female who looks like a child does not help my cause. END RANT:mad:
Nonetheless, despite the shortcomings and frustrations of being a NP, I absolutely love my job. While I would have loved to have the full and extensive 10+ year training of a physician, I simply could not afford the time or the money! Moreover, I am able to have a good work/life balance. I am not tied to my job, but still have the tremendous honor of assisting a sick person to health, or conversely, a dignified passing. And so to that I will push on, and continue to (un)pleasantly surprise physicians with questions about their (and MY) patients:)
In it remains an unfortunate hierarchical structure of physicians versus underlings (sadly not even an exaggeration as I am constantly mistaken for a doctor, and the palpable look of fear from those who address me as such is truly devastating).
One thing I have learned from being in practice a chunk of time is that it is a hierarchy for physicians too. Before I was in the field I always just assumed physicians wrote their own ticket, very few do: most get abused as much if not more than nurses by the administration and hierarchy.
There is always a bigger fish. Physicians and midlevels have more control in rural areas. I told off the ceo once for something worth being told off for and nothing came of it.
Of of course everybody in our group backed me also.
In the city I woulda probably had privileges revoked
There is always a bigger fish. Physicians and midlevels have more control in rural areas. I told off the ceo once for something worth being told off for and nothing came of it.
Of of course everybody in our group backed me also.
In the city I woulda probably had privileges revoked
There seems to be a bit of a specialty hierarchy in my experience also and in general some docs just don't get messed with. We all know who they are and the other docs as well as admin give them a wide berth. I was trained by one which in part might explain why I take no crapola, lol. Psych although generally low on the totem pole can also be in great demand for consults when a patient is in crisis which raises our stock value so the heavy hitters rule the roost both internally and externally. :)
The social lessons I learned in elementary school have been so valuable as I have negotiated my way through this entire nursing experience.
My personal struggle: Pressure to "see more patients an hour" at the same time dealing with many of the oldest, most complicated patients in the practice. Not to mention a huge percentage of the anxious and depressed patients. There is a reason I end up seeing them: I am thorough and I listen. I dig for answers. I follow-up. But that comes at a price. It takes time. Meanwhile, another NP in our practice sees lots of sore throats, sinus infections, UTIs, etc. Not that I never see those patients, but is it any wonder she sees more patients per hour? Ugh, I could vent more about this but I won't. I keep hoping my state will become an independent practice state!
My personal struggle: Pressure to "see more patients an hour" at the same time dealing with many of the oldest, most complicated patients in the practice. Not to mention a huge percentage of the anxious and depressed patients. There is a reason I end up seeing them: I am thorough and I listen. I dig for answers. I follow-up. But that comes at a price. It takes time. Meanwhile, another NP in our practice sees lots of sore throats, sinus infections, UTIs, etc. Not that I never see those patients, but is it any wonder she sees more patients per hour? Ugh, I could vent more about this but I won't. I keep hoping my state will become an independent practice state!
This is why outcomes studies are so important: saving one hospitalization covers the cost of months of sore throat visits.
Jules A, MSN
8,864 Posts
I agree 100% and was talking to someone the the other day who said in response to my comment that this was so much more exhausting than I ever imagined "did you think it was going to be easy working a job where you were making $200,000 a year?" True dat.
FWIW for the most part largely probably because I'm well known in my field but the physicians have been amazing. A rare few of the outside PCPs have made a futile attempt to minimize my role but it has never a problem from my inner circles. :)