WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

Gift Guide for the Medical Professional

11/23/16


Those in the medical field know we don't do our work for the "thank yous", but it's always nice to receive a token of appreciation in the form of a gift. Below are some fun and creative gifts from Etsy, that also support small businesses, which are a fun way to show your favorite dentist, doctor, nurse, nurse practitioner, physical therapist, respiratory therapist, medical assistant, or caregiver  appreciation this holiday season.

1.Heartbeat necklace  -A fashionable gift for the cardiac nurse or others that work in the cardiac field.
2.Coffee Mug-A fun gift for those working long hours,on-call hours, and overnight shifts, fueled by caffeine.
 3.Lab Coat Hanger-This personalized hanger is the perfect gift to keep a lab coat crisp in the office or a locker.
4.Stethoscope Tag - This makes a great gift for anyone who works in a hospital where it is easy it is to misplace your stethoscope (and reminds those who"borrow" your stethoscope to give it back).
5.Anatomy Wall Art Prints-These human anatomy prints on vintage dictionary pages, make great decorative pieces to display in an office. A variety of anatomical sketches are available.
6.Anatomy Cookie Cutter-These human anatomy cookie cutters make great gifts for those in the medical field who also love to bake. These would be perfect for my former charge nurse, who would religiously bake cookies for all the ER staff to have as our "afternoon snack".


For more creative and personalized holiday gift ideas that will allow you to avoid the stress of department stores, check out the editors picks on Etsy.


Winter Book Review: Fates and Furies

11/21/16

Fates and Furies: A Novel was another pick from my husband about marriage and deceit, so I don't know what message he is trying to send me. This novel was however, on the New York Times best-seller list, and the synopsis on the back sounded intriguing and suspenseful, so I thought I'd give it a shot. I still have mixed feelings on this novel, and it was by no means a page-turner, taking me a good two months to get through it. Midway, I almost tossed it aside because I felt it was going no where and the two main characters were less than likable, but I manage to stick it out because I'm not a quitter dammit! The novel is a look at the layers of the marriage between couple Lotto and Mathilde. The first part of the novel the "Fates" starts with Lotto's story, and the second part the "Furies" ends with Mathilde's. Lotto is a of a piece of work, a self-indulgent heir to a bottled-water fortune, who is loved and adored by everyone. When he meets the aloof, mysterious, and gorgeous Mathilde in his senior year of college, they start a whirlwind romance marrying within quick two weeks of dating, resulting in Lotto being cut off from his family fortune. He and Mathilde, who is also estranged from her family, start a life in New York together, as Lotto attempts to make it as an actor. In the first half of the novel we know nothing of Mathilde, other than she has an undying devotion to Lotto. Lotto is as devoted to Mathilde as she is to him, but seems to be somewhat clueless or not in tune with who his wife truly is. This becomes more apparent in the second half of the novel from Mathilde's perspective. Mathilde's side of the story was more interesting, and gave more depth to her character than in the first half of the book, but still left me with lukewarm feelings towards her character. I imagine the author intended readers to question how much intimacy and transparency are actually needed in a marriage. Mathilde and Lotto's love was without question deep and committed to one another, but lacked in the area of transparency, which lea me to question how sincere their devotion actually was. Although Mathilde was not exactly forthcoming about her past life, and some of current life with Lotto, Lotto did not ever bother to ask her some general questions you should ask a spouse, such as, " Why don't you talk to your family? , Do you want children and why? What was your childhood like? Is Mathilde even your real name?" (spoiler alert, it's not). It made no sense to me at all why Lotto never had any interest in knowing his wife more. Their marriage spans over 20 years in this novel, so it's not as though Lotto never had the opportunity to get to know his wife a little better. Furthermore, this story did leave me asking, how much of their devotion to each other was out of codependency rather than love? The author is a gifted writer (although her style was a bit much for me to wade through at times) but the plot was stagnant with some gaping holes, and I just never felt a connection to either of the characters. If you've read this novel leave your comments below. I am also looking to get some good reads to put on the kindle for after the baby is born, since that was a great way to pass the time while breast feeding in the wee hours of the night last time. If you have any good light reading suggestions please leave them below also.

Life of a Family Nurse Practitioner

11/14/16
Happy Nurse Practitioner Week to the current 220,000 licensed NPs in the U.S.! I often get the question from family and friends, "what do you do?" I have written several posts about my decision to pursue this career path, and the training and certifications required, but I will now write about what it is I actually "do. As a family nurse practitioner or FNP, I work in an outpatient internal medicine clinic with an urgent care. This means I see patients over 16 years of age and treat many chronic conditions as well as acute conditions that can be managed in an outpatient setting. I prescribe medications, treatments, order and interpret diagnostic tests, and refer to specialist care when needed. What types of illnesses do I treat? I see literally everything. In a typical day I treat and manage an elderly diabetic patient, a young twenty year old female with irregular menstrual cycle, a middle aged man with severe depression,  a 20 year old male with cerebral palsy who has been confined to a wheelchair his whole life, and routine physical exams to ensure all preventative care is taken on all types of patients based on age and risk factors. My main role is to keep people healthy and out of the hospital. I often refer to specialists, however with insurance roadblocks (more on that later) referrals often take time, so I  manage care of these patients until they can see a specialist.

What I love about my job
Continuity of care. Working in the ER I rarely knew the outcome of a patient, and it was hard to follow up on any prescribed treatment. Here I see most patients frequently and I can modify plans of care based on my assessment and the unique needs of each patient.

Variety. Although I feel sometimes as I am a "master of none" having to have such a broad knowledge of every medical condition, I love having such a variety in what I see on a daily basis. It keeps me sharp and forces me to keep learning.

Preventative Medicine. An ounce of prevention is worth an.. I don't know the whole saying, but it makes me feel so rewarded when  I have a role in preventing a bad outcome with a disease, and that is what primary care is for.

Challenges of my Job

Insurance roadblocks. HMO insurances are the bane of my existence. I see many patients with HMOs, and they all require authorization for most treatments, whether it be as simple as an ear lavage or pap smear. I've had to refer to ENT specialists for an ear lavage, which is a simple procedure that can be done in any primary care office, simply because the HMO will  not reimburse for this. This also goes for routine immunizations and some medications that can be given in the office, which is also counter intuitive. Finding specialists for mental health conditions and pain management is especially difficult and require long periods of waiting, which brings me to my second biggest challenge.

Prescription drug abuse. I have a whole other post on this. It's such a problem that spans across all genders, ages, races, and socioeconomic levels. It's so exhausting dealing with this on a daily basis, and there are very few resources for patients that need help withdrawing or dealing with addiction from these drugs.

Time Management-In primary care new patients, and existing patients will often bombard me with a laundry list of complaints, from toenail fungus, to tingling in the feet, and blood in the stool, all during one visit. Most days I have patients scheduled every fifteen to twenty minutes so it's completely unrealistic to thoroughly address more than one complaint per visit. It's difficult for me to cut someone off, or tell them to reschedule to address another concern, but in order to give quality care this is often necessary. It's also my job to prioritize the most pressing concern, even if it's not what is concerning to the patient. For example, many times a patient comes in for a visit related to a minor cold or refill of medications, and his or her blood pressure will be sky-rocket high. I need to address this before other needs of the patient. Because increased blood pressure often produces no physical symptoms to the patient, the patient sometimes will not agree with my decisions to address this concern first.

What can't I do. I'm not very limited to what I can do by my training. I do everything in the office that the MDs I work with can do. I can do minor procedures, such as drainage of abscesses, wound care and suturing, splinting, although I rarely do these procedures. Most of the time these patients are treated in an ER setting or I cannot get reimbursement through insurance for some of these minor procedures. There are some strange laws prohibiting NPs from ordering certain medical equipment and supplies, such as diabetic shoes, which is counter-intuitive since I can order diabetic medications, including insulin. I also do not do hospital admissions. This is not to say that NPs cannot do hospital admissions, but I do not have admitting privileges to any local hospitals. This means if I have a patient that requires a hospital admission I have to refer them through the ER for evaluation rather than do a direct admission, and I do not round or see my patients if they are hospitalized. Although there are drawbacks to this lack of continuity of care once my patients are admitted to the hospital, I like that I have regular hours and do not have to be on call with my current job.

How does my job compare to a Registered Nurse As a nurse practitioner I have to keep my registered nurse license active, and thus I am still licensed to do all tasks under the scope of a RN. At my current practice, I sometimes start IVs and monitor IV infusions in our clinic, for example. However, as a nurse practitioner I can prescribe medications and medical treatments, unlike a registered nurse. I did work as a registered nurse for four years before a nurse practitioner, and the jobs are very different. I enjoyed working as a registered nurse, and I was challenged mentally, physically and emotionally daily. My work now in an outpatient setting is much less physical, and less of an adrenaline rush than when I worked ER, but still very mentally and emotionally taxing at times. Overall the stress level I feel currently at work is much less than my previous work as a RN, although this is not to say that I am not challenged or stressed at my current job.

If you have more questions about the role nurse practitioners play in our health care system, please visit the American Association of Nurse Practitioner website here.

The morning after

11/9/16
I really, really, did not want to write about the election. I refrained all election season about posting much on social media or the blog that was connected to the presidential campaigns. I was as sick as everyone else was of election coverage. I was sick of the late-night Trump impersonations, I was sick of the attack ads, I was sick of non-stop coverage and analysis of the polls, and sick of scandal after scandal. But, here we are, and I feel that I can't keep quiet and move on and write a lifestyle post, or pretend that everything is okay. I, like many, had my reservations about Hillary, but her ideology and experience made my decision to vote for her easy. I really felt the country would eventually rally behind her. We really couldn't be that angry at the last 8 years? We insured millions, unemployment rates are at record lows, and people are back on their feet after losing everything in the recession. I personally remember how I struggled during the recession during the G.W. Bush administration after just graduating college. I remember watching family members and friends get laid off, and I remember two hospitals I worked for going through rounds of lay-offs and cut backs, and the nursing staff being bare-boned. Flash-forward 4 years from when the hospital I worked for was offering severance for staff"voluntary separation" as they called it, to now where they are offering nurses $10,000 sign-on bonuses. Before Obamacare if you had a diagnosis of cancer or another "pre-existing" condition, good luck getting affordable insurance. We now stand to lose all of that progress. For what? There's talk of how gender and race influenced this race, and that many Americans weren't ready for that change. I don't think we can deny the influence of racial and gender bias in the many Americans decision to vote for Donald Trump, and that of disturbs me most of all. It saddens me that Americans are okay with blatant bigotry and sexism. But that being said, I am not going to Canada. I am not going to feel that this is the end, or our country is entering an Apocalypse. There will be major changes in many people's lives, and I living within the insulation of a culturally diverse and tolerate region of the country, not from a family of immigrants,young and healthy, and with a recession-proof job will probably not be the first to feel these changes, but unfortunately many others will. Taking a stand and having a voice matters more now than ever, so I encourage you to share yours.

Medical Social Media Favorites

11/4/16

My use of social media has drastically shifted over the past few years, and I have found so many intriguing social media personalities, if you will, that I find inspiring. I have found there is such a large presence of medical professionals, sites, and apps on social media, that I find both educational and inspirational. I have listed a few social media favorites of mine below that fall into the medical realm.

Figure 1.-
This is an app that is available to anyone within the medical field (techs, medical students, PAs, dentists, etc.) that can share interesting case studies (compliant with HIPPA of course). I really like testing myself and reading the comments and others professionals plans of care on these cases. I have yet to upload any cases myself, but I plan on doing this in the future


Snapchat-
I resisted joining snapchat forever, simply because I was trying to limit my social media use and it seems so ridiculous with all the filters. I still think snapchat is a bit ridiculous and rarely post to snapchat, but I've found a few accounts I like to follow. One in particular is medtakovers. On this account a different health professional or student "takes over" the account and fields questions regarding their career and career path. I really enjoy these takeovers and the exposure to all sorts of medical careers.


Instagram-
@mrs_angemi -This account features all sorts of interesting pathology cases. The pictures are often very gruesome, so not for the faint of heart.
@dr.majestik_md-This is the account of an Orange County ER physician that posts on a lot of interesting ER topics, as well as general health and wellness posts.
@drlindseyfitzharris-This account are posts all about medical history and photos of  historic medical equipment and surgical illustrations. I find this a fascinating look at medicine.


Podcasts-
Ask Dr. Angela-This is a podcast from a Ob/Gyn Dr. Angela that answers women's health questions. She's very upbeat and has a wealth of information on various women's health topics.
The Nurse Practitioner Show-Another podcast (available in app form) run by a nurse practitioenr with guest speakers on variety of medical topics.

Twitter-
Kevin Pho-@kevinmd- A prominent social media influencer whose site (kevinmd.com) has so many articles on relevant health care policy issues.
STAT news-I follow this medical health news site for links to articles on current healthcare issues.

There are plenty more, and a bunch of vloggers and youtube accounts that I have been meaning to check out. If you have any suggestions on accounts in the medical or healthcare field that interest you, leave them in the comments below.

Daycare Dilema

11/3/16




Daycare has been both a blessing and a curse in my life. As my husband and I have prepared for our second child, we have tried to figure out how to balance work, our budget, and needs of our children into our decisions for childcare. My greatest anxiety while pregnant for the first time was around childcare. Unfortunately my husband and I both drew the short stick when it came to family help, and although it sometimes seems like we are the only ones that are in this boat, it's not the case. We happened to find a preschool and infant center close to where we lived when I was about 8 months pregnant, and put our son on the list after touring and talking with the staff. I had sent out a few inquiries at other day care centers, and signed up for care.com, as well as sent out an ad for a babysitter to nursing students at my school. I ended up opting for the daycare option because of affordability and the socialization for my son. My husband and I are both the only ones with kids on both sides of our families, and thus my son's interaction with other kids has mostly been at daycare.

What I like about daycare:
 He has had interaction with a diverse teacher and student body from infancy.
His language skills have developed in leaps and bounds (he knows the whole alphabet, and has been learning to count in Spanish).
 He has learned about "taking turns" and waiting in lines.
They do fun crafts at school daily, and other cultural activities, such as learning about Day of the Dead or Chinese New Year.
It's tax deductible (Hey, I'm married to an accountant).
It's media free, meaning there are no TVs, ipads, etc. in the classrooms.
All teachers and aides are CPR certified.
I don't have to worry about having someone come to my home and the concerns with that (keeping the house in order, caring for our dogs, safety, etc,)

The hard parts of daycare:
It was hard to leave him at first and I felt guilty
My son became sick often during the first year.
We have to miss work if my son is ill or has a fever.
There is not flexibility on scheduled days and times (when I did not have a consistent work schedule, I had to constantly trade days at work, my husband would have to occasionally take a sick day to cover, or I would have to beg daycare to let us swap a day. If you are late you are charged an additional fee for every fifteen minutes late).
It's expensive
Not a lot of individualized 1:1 care.

I put my son in daycare at two months so I could complete my clinical hours for grad school. For the first few months he was only at daycare  two days a week, and when went back to work full time when he was five months he started three days a week. Now that he is two, he goes four days a week. By now he is well adjusted to the routine of daycare. I feel he is safe and well taken care of, and that the curriculum  helps with his cognitive and social development. That being said, I really do not want to put my daughter in day care as early as I did for my son. We already had to put her on a waiting list to start at the infant center, but I still have reservations. I anticipate her starting at about 5 or six months, but ideally I would wait a year. I would like to wait longer this time so I can have more time to breastfeed, establish a sleep schedule, and for her immune system to develop.  I will not have the flexibility in my schedule as I did with my son to start part-time daycare, which also gives me pause. The daycare option still seems to be preferential with the second child due to affordability, convenience, socialization, and educational components.
With a household with two full-time working parents without any family assistance, there is no easy solution to childcare. Our monthly expense on daycare exceeds all other bills besides our mortgage. We have been stretched to our max making ends meet with our first child, and I don't anticipate things getting easier with number two. I often feel frustrated that there is such little help for parents. If you are not living below the poverty level, have a special needs child, or have family to help you out, society pretty much tells you "you made the decision to have children, now figure it out." I often feel angry about the lack of support, from family and our current government. I'm definitely not in the worst situation as a parent, and I remind myself of this when I find myself getting angry. However it does take a village to raise a child, and most days I feel like I'm on an island as a parent. I will stop my rant for now, but I would be interested how other working parents have found solutions to their childcare needs.