Category: nursing

it is what it is, right?

I wish I were more of an “it is what it is” kinda guy, I really do. Perhaps then when patients really try my patience, and upset me, I could tell myself, “self, it is what it is”, and just let it go. But I don’t.

This week has really been trying my patience, because of my patients.

See, I am the nurse practitioner, and they are the patients. When they come to me with problems, I listen to their symptoms (self-reported), assess the situation (make my own observation of symptoms if they are present), and based on my education, guidelines, and any other information that I need to access in order to come up with a plan of care, I make a diagnosis, and come up with said plan of care. At that time, it is the time where the patient either likes what I have to say, and agrees to do it, or it can go another way entirely.

Lately, it’s been a little more of the latter, and it’s wearing me down.

See, I am invested in this job. I actually care what happens to the patients, and I want to make sure that I am always operating under the healthcare tenets of beneficence and non-maleficence; which simply means that you do no harm, and you always seek to do the best for the patient that you can. Hence, again, why I use my education, knowledge, and guidelines to guide my practice; whether the patient agrees or not.

Now I get it, you can google anything. ANYTHING. And you can find a ton of information out about just about anything as well. BUT, I challenge anyone that questions why I decided to go one way versus another in my decision to treat (or not); where did you find that info? How did you know how to sift between accurate and often times, mostly wild conjecture? How did you know and when did you learn how to interpret labs, symptoms, multiple medical conditions (not to mention how they interact with all of the other intricacies of other bodily systems), and how to pick and choose between hundreds of different solutions, medications, and remedies to come up with the best solution for yourself? Unless you’ve gone through school for it, you are probably operating under the assumption of what someone else has said, and there is no factual evidence behind it; that is, unless you know where to find the correct remedies and solutions.

This is where the frustrating part starts.

I say, based on what you have told me, and my assessment, we are going to do X.

They say, “well I read online that you need to do X”.

I disagree, because this is not the truth. I assure them that I am using factual, evidence-based practice to guide my decisions, which I even offer to get a second of, by asking my colleagues.

Still, I am often met with eye rolling, and being told that they “know their body”, and demanding certain treatments, which can actually do more harm than good. Worse still are those that have series health conditions and don’t seem to heed my warnings about medication compliance, and put themselves at risk for further harm daily.

It really wears you out when you are not an “it is what it is” kinda guy like me; and because of that, I need to rant sometimes, and that is what this is. Maybe I’ll get better at letting it roll off with years of practice; I certainly hope that I do. I wish I could be a little less stressed about the minutiae of it all, and realize that, yes, when it comes to many patients, it truly is what it is, and I have to just let go, and realize that all I can do is attempt to lead them in the right direction; despite the fact that they have the car in reverse and are slamming on the gas at the same time. I just need to focus on the realization that I am not in the car, and whatever happens really is, ultimately up to them.

it’s the little things that kill


On Bush’s Little Things, which hails from their debut album Sixteen Stone (which came out when I was in high school… many mooons ago!), Gavin Rossdale sings, “it’s the little things that kill, tearing at my brain[s] again”. Sometimes, I feel like that song lyric really applies to me, because I do just that more often than I would like; I tend to let the little things get to me, and tear at my brain, bringing me down.

I think I am a pretty easy-going person for the most part, but there are a lot of times when it’s the little things that kill, and get me worked up, and it’s hard to come back down. This occus in more aspects of my life than I would like, but I’ve always been like this, for as long as I can recall.

Today, on my mind, I specifically refer to work for instance; when I am seeing a patient who has (from my perspective) a lack of a discernible stake in their own health care, it really bothers me. It always did when I was a nurse, and it continues to do so now that I am a nurse practitioner. It frustrates me when patients with serious medical conditions have a seemingly lackadaisical attitude about compliance and management of their illness. Sure, I get it, life happens, and I get that you are “busy and cannot come in so often”, but you have a serious chronic condition that if left unchecked, can literally be the death of you. Surely that responsibility is impressed upon most, right? I like to think that it is, but there are many patients that don’t seem bothered by the fact that they ran out of medication weeks ago, and never thought to call the office and see if we could help them in any way. Perhaps it is, in some part, a coping mechanism, fear, or simply ignorance, but when it is a patient that I have seen multiple times, it really tears at my brain how they just don’t seem to have a care in the world, and this “little thing” doesn’t seem like anything important to them. Then, when I am seeing them for their appointment, I get frustrated, and start lecturing them about possible side effects, complications, and all of that, and they just look at me like I’m being mean to them. Then, I get more frustrated. I get that old adage of you can lead a horse to water, but you can’t make him drink; but that means being really angry at the horse sometimes.

I know it is my job to educate, and I have learned in the past year of providing care for multiple patients daily, that I will, and continue to, encounter tons of patients that have real medical issues that they don’t want to, or refuse to take ownership of, and deal with, but it really bugs me, because I sincerely want the best for every patient I care for, and their lack of ownership and action on their own behalf stands in the way of that many, many times.

It continues to frustrate me, and while these are little things, and should be more of slight annoyances and things I should just let go, sometimes, I really brings me down, and can make my day less than a happy one. I hope that through my career I learn how to better walk the line between over-caring and complete ambivalence, because the gray area between the two can make even the most compassionate and patient person very frustrated to say the least. Anyone else work in health care feel this same way? I’d be surprised if I’m the only one, because this job can be very trying at times.

Here’s to going forward and trying to not let the little things kill; and hopefully not ruin my day, either.

So… I’m a family nurse practitioner.

I posted recently about finally graduating from grad school, again, and then I passed the boards. YAY! Today makes two weeks into my new job as a family nurse practitioner, and I can certainly say, that while it is challenging, and I have a LOT to learn, I kind of love it! I know, going from a job that I really never wanted to do again to one that I kind of love? Crazy. It makes me think that this whole journey may have ACTUALLY been worth it. I know I have a lot of growth ahead of me, and I have a lot to learn, but I am going to keep doing what I am doing, and try to enjoy the journey; if this beginning taste is an indicator of what is to come, I may have finally found the right career fit for me… and before I turned 40! HAHA!

graduate school completed… again.

So today marks another milestone in my nursing journey; I am officially done with graduate school, the second go-round. It has been two and a half years of non-stop, class, clinical, and continuous stress, but here we are, and I made it. Believe it or not. (I am still a bit in disbelief at this very moment).

Now, waiting to get grades posted, get everything finalized, and sit for the board exam, I see that my stressors are not over, and are intensifying for a short time. Hopefully, this too will be out of the way soon. Thanks for everyone that put up with my ranting, raving, angry, “negativity” during this process (especially James!!!), as I know I was not the best to be around at times… stress will do that to you, and as someone who carries around a lot of stress normally, the extra helping certainly had that effect on me. Here’s to my next few weeks of trying to process things and get in some relaxation as best as I can, finishing the rest of the process, and becoming a fully licensed nurse practitioner. Duane Moody, NP-C (pending!!!) doesn’t sound that bad to me, not at all. Onward towards a new career, full steam ahead!!

year end… again

So again, I find myself at the end of another year, and I am sitting here asking myself, what has happened with this year? It has flown by. Since I started nursing school, and since being a nurse full time, I find that I need to have way more down time, and time that I spend recovering from the job, mostly because it is so tough. That being said, I am definitely still here, and things are good; in fact, much better right now than before, and I feel that it will keep getting better. Here’s a few things that have happened recently that I probably should have blogged about, but didn’t.


In September, James and I got married in DC. Here’s a lot of photos, and I realize that I need to upload so many more… in time. It was an amazing experience. We have been together for a little over 11 years, and we got married with friends and family, and it was honestly, the best I could have imagined. My parents were there, James’ parents were there, and everything went over without any issues. The wedding itself was short and sweet, which I liked, the reception was amazing, and is something that we can always cherish. There were many great memories, lots of fun, and I couldn’t have asked for anything better.

A little over a month ago, I decided to take a big chance, and switch jobs (and hospitals). So far, going from the Emergency Department to the ICU has been a bit of a change (unorganized chaos to timely structure), but I can already tell that I am a lot less stressed, and a lot less upset all of the time. I think the pressure of the ungrateful, not-sick-give-me-a-sandwich patients in the ED finally wore me out, and the universe gave me a huge sign that it was time for a change. I am excited about this new opportunity, and I cannot wait until I get more accustomed to my new environment, and feel as comfortable here as I did in the ED. I have already learned a lot, and I know that this was a good move, and I am excited for the new experience.

Lastly, I started grad school for my MSN, which will propel me from RN to FNP. I am getting more into the process, and I am sure that this is going to be a great thing in the long run, but it’s definitely another major undertaking, that I have decided to take on. It seems that I either love school, or love student loan debt, because here I go again… although the outcome will be a major reward, and I know that it will be difficult, but is ultimately a great choice.

All in all, it’s been a busy year, and many changes have taken place; and I expect great things as a result. Here’s to a great (and hopefully even better than 2014) 2015!

a little reflection

A little over 3 months ago, I switched from working at an LTAC, long term acute care, hospital to working in the emergency department. The LTAC was my first job after nursing school, and it was grueling, exhausting, and often very trying. It was no stretch to say that I was kind of miserable a lot of the time. When my contract was up, I was hopeful that I would be able to move to a new area of nursing specialty at the hospital, because I really liked working for this hospital, and I was delighted when I interviewed and was hired to work in the ED. While I was excited, I was also terrified; I had been told by a lot of nursing instructors that I would love the ED, but I was still pretty nervous (especially given my experience in nursing so far), because if this was a bust, what the hell was I going to do?

With that being said, I started on nights, and I really started to enjoy my job. I liked the people working on nights, and actually found that I was getting a lot more satisfaction out of my job; more so than I ever had before. Additionally, I found that I was less unhappy when I wasn’t at work, and I didn’t dread going to work anymore. I think it really hit home, when James mentioned that he noticed I didn’t really complain about work anymore; which is something I was really happy to hear.

As I was hired with the intention of going to day shift, the time came recently for me to go to days, and again, I found myself very nervous. When I switched over to days a couple weeks ago, I was really nervous not only because I had gotten to like working with the night time crew, but also, because I was worried that I was going to dislike anything about days. This had a lot to do with the fact that I had finally found a place I felt like I fit in within nursing. Well, I can certainly say, that while I miss my night time comrades, I find that I have been enjoying working days as well; and a bonus is I don’t have to deal with the fucked up sleeping schedule.

I am pleased that I have found a place in nursing that I actually love, and even more so, that I can actually say that I love being a nurse (most of the time… after all, there are parts none of us nurses like!). That just makes me really, really happy. Things are kinda good, and I am okay with that!