Life of a Family Nurse Practitioner

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.

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