The Worst Parts Of Being An NP
My number one most viewed youtube video is about the downsides to practicing as a nurse practitioner. I guess I shouldn’t be surprised by that. You want to know what the cons are before diving head first into uncharted waters. It’s a great illustration about how life mimics art. My craft is working as a critical care nurse practitioner and informed decision making is a huge piece of making life and death decisions. As long as the patient and family is aware of the risk/benefit and I do my job well in explaining it to them, we can all go forward with realistic expectations. Same should be true about making a big life decision like going back to school. Since very little in life is all good, anticipating the challenges/cons to this career tract is everything. In this blog post I’ll discuss the biggest bummers to daily life as a nurse practitioner. If you are in a season of deciding on nurse practitioner school, this one is for you.
The Perfect NP Student
If you are a student reading this, you are already in the top 5% my friend. How am I so omniscient you ask? Well, after serving as a preceptor for the last five years or so I’ve seen all sorts of students. We all are unique and bring different skills, backgrounds, and personalities to the learning space. This should be celebrated, the world would be awfully boring if we all were the same. Having said that, there are trends I see amongst nurse practitioner students, and some of them are not so great. I’m going to tell you what IMO I believe makes for a fabulous student in clinical rotations; one we want to hire. Arguably one of the best qualities is beginning with the end in mind. Those who prepare in advance are not amongst the majority, so congratulations for being an elite! Clinicals are your #1 source for job acquisition, so you want to show up with your A game!
Clinical Pearls:What’s up with the lactate?
In 2001 a research article was published expounding early goal directed therapy as a treatment strategy for sepsis. Key points in the article suggest that physical exam findings are subpar for directing resuscitation and that measures such as lactate, SCVO2, base deficit, and pH are more accurate measures of adequate treatment. There were certainly other factors, and the take home message was to find the source and start antibiotics early, but volume resuscitate until tissue hypoxia improves was the practical application of this research. As a result lactic acidosis has become a bad omen to be feared by all. Several guideline updates have since been published, the most recent in 2021 with weak evidence to suggest using lactate as an end-point measurement. Practically speaking though, the word is out that a high lactate = bad bad badness. I’m not saying it isn’t bad, but there are plenty of reasons why an elevated lactate alone is not the end of the world. In this post we’ll discuss causes for lactate elevation, what should be cause for alarm and what shouldn’t, and how to manage it.
Clinical Pearls: Weird COPD Labs
I recall sitting in my ninth grade biology class and feeling awed at how perfectly our bodies are designed. It is infinitely complex at baseline - just keeping the status quo. True magic happens when badness ensues and the body begins to change it’s patterns to compensate. Must. Keep. Things. Going. It’s amazing to me. That’s the moment I knew I would go into the healthcare field.
To this day I remind myself that just because modern medicine offers the capability to tweak things, sometimes the best thing we can do is just stay out of the way. First, do no harm. It’s tough though, because when things are hitting the fan, the instinct is to look at a set of patient problems and try to optimize them. If you fail to recognize when an abnormal finding is actual a new normal in a chronically abnormal person you may jump to fix things, unintentionally worsening things. That’s a heavy use of the noun things, but you get what I’m putting down right?
COPD is a perfect example of this phenomenon so in this post I will discuss the normally abnormal derangement’s that can occur in a patient with COPD. Why they occur, how to interpret them, when to intervene, and when to leave them alone.
Nurse Practitioner Boards Preparation
After one has achieved the degree, put in the herculean effort to study, stressed beyond reason, hyper-fixated on all the possible outcomes, and then stood in this place of last minute test anxiety, bargaining with one’s maker is where you may find yourself. Based on the conversations I have with NP students I precept and online / via my mentoring business, I can confidently say only a tiny fraction of new grads are immune to this fear. There are some things out of our control as a neophyte, but boards preparation is not one of them. Taking control of how you ready yourself for this exam definitely impacts anxiety level as well as success rate. In this post I will discuss the best way to prepare for your nurse practitioner board certification exam
Clinical Pearls: Liver Failure
Oh the ways the liver can fail. As a new nurse practitioner this one was hard to get down. Cardiology is generally seen as the bee all end all when it comes to keeping our bodies running, but I’d like to talk about the under appreciated liver. Hepatology is fascinating because the normal function of the liver is supremely multi-faceted. Throw in a little pathology and any number of pathways can be deranged and within those any degree of severity can be seen. From acute to chronic to acute-on-chronic, severity can run the gamut. Decompensated cirrhosis is a common killer in most ICU’s. Given how poorly understood this disease state is, I’d like to talk about the complexity, progression, prognosis, and management of liver failure in the intensive care unit.
Mistakes To Avoid On Your Resume
I’ve seen a fair number of nurse practitioner resumes in my day. Seems like my large group is always cycling through new hires. In addition to that I look at all the resumes that come through for my consultation/interview prep business. It’s interesting to me the variety of what folks are doing across the nation. When I wrote my first NP resume I assumed we all heard the same HR lecture and wrote them the same. Most people have professional looking resumes but there are some industry specific issues that I find am repeatedly addressing with clients. In this post I’ll discuss the most common mistakes I see on the nurse practitioner resume.
Clinical Pearls: Evaluating For Intubation
When is it time to say it’s time? I think back on the really bad days of the pandemic when I walked from room to room asking myself this question repeatedly. Honestly, for intensive care unit level covid that’s what it felt like - a few random meds that typically didn’t help, supportive care, and careful vigilance for when it was time to go on the dreaded vent. Our patients feared it, our families feared it; it was the elephant in the room every time you walked in. Outside of covid pneumonia, there are a million reasons why a patient needs mechanical vent support and failing lungs are just one component. This is a very common question I get asked when I am training a nurse practitioner student Here’s how I approach evaluating a patient for intubation need.
NP vs RN: Differences in employment structure
This topic comes from a question I received from a client asking to explain how nurse practitioners fit into a physician run group. She expressed her surprise to learn that many APPs and physicians who work in a hospital are not employed by the hospital and asked for feedback about how this works and how nurse practitioners fit into this model. I definitely understand this confusion. As nurses, we are used to standard hospital or health system employment with clear hierarchical management. In this post I’ll talk about my experience with this and the main differences between NPs and RNs in regards to:
Who employs you.
Who manages/directs you.
How you get paid.
Who your colleagues are.
Toxic Workplaces And What to Do About Them
I talk to a fair amount of nurse practitioners who are in a space of indecision. My goal is to help them sort out what will best serve their {whole} life goals. It’s always about balancing work-life factors with career goals. Some of them are considering leaving the profession and going back to the bedside or doing something else altogether. Some are coming to me seeking interview/job acquisition help and what we discover is that their confidence has been wrecked by a unhealthy work environment. I’d be willing to bet many of you have experienced this in the past or are stuck in this situation currently. It’s truly a sad state of affairs these days particularly for nurse practitioners. In this article I wanted to talk about this phenomenon and what some options may be for you.
Nurse Practitioner Fellowships
When I say fellowship, I’m really referring to two types of post-graduate training: nurse practitioner residency and nurse practitioner fellowship. What’s the difference? A residency is more general and encompasses a broader scope of practice. It may be a longer time frame as well, most range between 6-12 months. It is ideal for someone who had little bedside experience or sub-par education in school (be it academic or clinical). A fellowship on the other hand is specialized and has a particular focus of interest. It is ideal for someone who has a strong sense of what they want to do and/or lack the opportunity to find a way into the niche.