Pregnancy After Loss: 8 Things to Consider.
It took five years for us to get to the point of deciding to have another baby after the stillbirth of our first son Walter. For a while, I questioned whether or not I was meant to be a mother. I felt inadequate. I was mad at God because I could not understand why he would allow us to become pregnant only for our baby not to live. We were not even trying to get pregnant but we were excited and full of anticipation. So after losing Walter, I decided motherhood was not for me, at least not any time soon. Seeing pregnant ladies initially was a painful reminder of what we lost. This got better as time passed and the wall that resided around my heart slowly began to crumble. But I was still scared for us to try. Birth control was my constant companion. The questions and doubt were endless it seemed. What if it happened again? How could I go through another 36-37 weeks long pregnancy and risk the chance of not having a baby go home with me? What if something was wrong with me that caused my baby to die? I now had high blood pressure, how would that affect the pregnancy and my body? What if the baby stopped moving? What if anxiety got the best of me? What if? What if? What if? Nevertheless, there was still a longing deep down to try again. Many had tried again and succeeded, right? My grandmother and three of my aunts had shown me that success was a possibility. My OB/GYN had also started asking when my husband and I were going to try and get pregnant again. He would ask each year that I would see him for follow-up. I found this encouraging yet scary at the same time. Finally, one day we decided that we were going to rely on faith and medicine and pray for a favorable outcome. March is Pregnancy After Loss Awareness Month. A range of emotions ebb and flow as you are experiencing pregnancy after loss. You are hopeful and happy yet fearful and nervous. It is quite a precarious position to endure. However, it is also a good teacher. Here are 8 things to keep in mind during a pregnancy after loss: 5. Have a good support system and/or a good therapist. Even just one person with whom you can be totally open and transparent is healthy and promotes healing. You want to know that you have support. A pregnancy loss experience can make you feel like you are on an island and can make you want to isolate yourself. I recall feeling lonely and like no one could completely relate to what I felt because I was the first (and hopefully the last) to experience this within my close friendship circle and it had been many years since my aunts had had their loss experiences (though they were very helpful and supportive). Additionally, organizations like PALS (Pregnancy After Loss Support) offer a ton of resources including support groups. PALS was not around during our first and second pregnancies after a loss but I am so thankful to have learned about it now as I have been able to share information about them with others. 6. Journal or participate in some other self-care or stress-relieving activity. I was never a big journaler though I fancy myself a writer. However, during periods of profound grief or in tumultuous situations writing is my superpower. It is what eases tension and soothes my soul. Figure out what that is for you and do it. Use it to your advantage. It may be knitting, cooking, or reading. Whatever it is, allow it to help usher healing and restoration for you. 7. Do not isolate your partner. Marriages and relationships have been destroyed by grief and pregnancy loss. Pregnancy after loss can also cause strain because of varying opinions. My husband and I worked together and dealt with emotions and concerns throughout the pregnancy. If he felt like I was doing too much, he would tell me nicely and I would be openly receptive (mostly, ha) and vice versa. He also went to most of my appointments with me and there were A LOT of those. Supporting and loving each other is how we worked through our loss and how we got through our pregnancy after loss. 8. Focus on enjoying the pregnancy more than on losing the pregnancy. I admit this is hard but a stressed pregnancy is not good for you, the baby, or those around you. I recall that I was full of nerves when I was pregnant with my oldest living son however, I found comfort in crossing weekly (sometimes daily) hurdles and in his movements. I started feeling him move pretty early and that was so reassuring. My husband and I took a lot of pictures and tried to have mostly fruitful conversations regarding our future with our baby. Pregnant Again! Happy Birthday, Eron! Pregnancy after loss can be a beautifully scary process but the only way to get to the rainbow is to have weathered the storm. If you decide to keep going after the rainbow baby you may reach a pot of gold! Can you think of any other tips to add? Do any of these tips resonate with you?
1 Year of Confessions: New Year, New Goals!
It has been one year of Confessions of a Nurse Practitioner and it has been a fantastic journey. It’s been successful and amazing mainly because of your support and feedback. I have learned so much along this journey and plan to continue to serve in this capacity. Over the course of this first year, I have published 45 blog posts including this one! That is nearly double the anticipated goal of 26 posts as my goal was to post every two weeks. I am happy to have exceeded that goal tremendously! Let’s take a look at the top 12 posts of the past 12 months of Confessions of a Nurse Practitioner. These are the posts that were read and shared the most. Which post was your favorite? If your favorite did not make the top 12 list please share in the comments! What I have learned from looking at this list is that you like content that applies to you in the moment. You like content that is personal. You like content that is not only fun but also thought-provoking. The special bonus of having started the blog was the birth of the Confessions Chat on Facebook Live. This has happened monthly since the blog launched in February 2020 and has covered an array of topics including deeper discussions of the blog posts. These chats have been a hit for many of you! As Confessions of a Nurse Practitioner has evolved, I have a confession for you. I have decided to do some pivoting. I initially created the platform to shed light on various general health topics with the goal of helping EVERYBODY. The longer that I have done this, the more I am learning that I can not be everything to everybody. I am also learning that for growth and sustainability, my target audience can’t be EVERYBODY. “EVERYBODY” is entirely too general. I have come to the realization that I need to have a niche. In my case, it will be two niches as I am multi-passionate about these two groups of people particularly. Now, this is not to say that I will not continue to provide content that everybody can use, at least sometimes, but my primary focus will be on two groups. These two groups couldn’t be more different from each other if I tried. In fact, you would have to work or think really hard to connect the two. Yet I have been heavily and dynamically impacted by both. Take a guess. Ok, ok, I’ll just tell you. Niche one is persons with cancer and their families. Niche two is families of early infant and pregnancy loss. I plan to provide content specific to the needs of these populations. I hope you will continue with me along this journey and share information with your family and friends. It has been 12 wonderful months of Confessions of a Nurse Practitioner. Happy Anniversary to the blog and thank you for the support! Join me in the Confessions Challenge on Facebook and Instagram! Don’t worry, you don’t have to post a confession for 12 days in a row but I will present a question or challenge daily on Facebook and Instagram that I would love for you to answer or complete! By participating daily, you will qualify to win a prize at the end of the 12 days! It’s simple right! Answer the question within my post and or post on your social media and tag me!
Happy 2021! 6 Things You Should Do.
If you are reading this then you have the biggest blessing imaginable to be thankful for considering all that happened in 2020. You did not die in a helicopter or plane crash. You were not another black man or woman who lost your life due to racism or police brutality. You survived the “murder hornets”. You did not die from colon cancer or any other cancer. And most obviously, you did not succumb to the homicidal viral maniac that is COVID-19. That biggest blessing is life. If you are reading this, you have crossed over to 2021 and you are no doubt in at least some way hoping that this year will be better than 2020. I don’t blame you because I am too. But having survived and in many ways thrived in 2020, there are a few lessons that should prove helpful in 2021. 4. Improve and or maintain your health. The healthier you are the better you will feel and the better you can fight off infections. Eat nutritious meals and be physically active. If this is an area of struggle for you then take baby steps and try one thing at a time. Make time and be proactive in getting routine check-ups including preventative health screenings as indicated such as a mammogram or colonoscopy. 5. Be as clean as you can be. If you have not learned anything else from 2020, hopefully, you really do know the power of good hand hygiene. Whatever you do in 2021, do not stop washing your hands and your high contact surfaces. Do not stop wearing your mask properly over your nose and mouth. Respect each other’s space and maintain social distancing when appropriate. 6. Live your life to the fullest. You never know when or if certain opportunities will arise again and you do not want a life of shoulda, coulda, woulda. If 2021 allows, take the trip, change jobs, start the new hobby, visit the new church, join the new organization, go on the interview, start school, launch a business, retire, write the book, relocate, build the house, pay off debt, volunteer or whatever it is that you want to do. Probably more than any year before, 2020 has taught us that tomorrow is not promised. I hope that you are entering 2021 with thanksgiving and expectations. I am excited for what is to come and thankful to be around to see it. I hope that 2021 brings renewing and refreshing to all and that we see a sliver of light at the end of the dark tunnel that is COVID-19. Happy New Year!! What lessons did you learn in 2020? How will you apply them in 2021?
Christmas, Santa or No Santa?
Spoiler alert: You may not want to read this in front of your children. I never believed in Santa Claus. Even as a young child, I was an old soul with an ability to reason beyond my age level and something about Santa Claus just didn’t make sense to me. I could not understand how one man could make it all over the world in one night delivering presents to all children. I was a child who had a map of the United States on the wall in her room as decor and whose dad had purchased a globe that sat on my dresser. So I had a sense early on that the world was just too big for this to be true. Additionally, my parents never fully taught us to “believe in” Santa. Now of course we knew about Santa and who he was. We loved Santa. He was a Christmas figure who we acknowledged as part of the traditions of Christmas. But we also knew he was not responsible for our joy on Christmas morning as we rushed around the Christmas tree. Now don’t get me wrong, my parents didn’t bash Santa. And yes we even took pictures with him a time or two. My mom was a Kindergarten teacher for most of her career as an educator so Santa was definitely prominent. Yet, I do not recall seeing a single gift labeled as being from Santa. Now of course there were big gifts like bicycles that were not wrapped or labeled at all. I guess these could be inferred as being from Santa if I chose to believe. My parents did not say one way or another. However, other gifts specifically said “love, Mom and Dad”. On the other hand, my husband, Floyd grew up believing in Santa and all of his glory. From writing a list to leaving milk and cookies. He knew wholeheartedly that the “big” gifts like ping pong tables and bicycles came from Santa. They were not left unwrapped because they were too big, they were left unwrapped because Santa brought them. He recalls trying to “catch” Santa making his deliveries but says that he was told that he would get ashes if he did such a thing! He says that he was in the 4th grade when he learned that Santa was really his parents. Though he initially found it disappointing he was still thankful for the experience and counts it as a magical part of childhood. It was not until after our son was born that we as parents had to have the conversation about what to do about Santa. I was content to raise our kids as my parents raised me. This meant allowing them to enjoy and experience Santa but not by wholly involving Santa as the one who delivered presents or to whom a list should be sent. This also meant active engagement in the fact that Jesus is the reason for the season. My husband, on the other hand, though completely on board with our Jesus-centric household was not on board with Santa being a sideshow. Santa was going to shine! Our differing views meant that a compromise or a concession had to be made. Hearing his wonderful tales that included a vivid imagination, I decided to go along with him regarding Santa. I did not want to be a stooge or to be known as the Grinch who stole Christmas, lol. So we are embracing Santa as my husband did and I am doing my best not to spoil it. Therefore, I direct all Santa questions to him, lol. Coming up with lies to answer the children’s questions is stressful and I have never been good at lying, even for a good cause, lol. Not to mention that my oldest son who is in the 4th grade thinks more like me and has asked particularly insightful questions like “What does Santa do for homes that don’t have a chimney?” and “Does Santa really take time to eat cookies and drink milk at everyone’s house?” He has asked these kinds of questions for a few years now. Using a team approach, Floyd and I work together to be sure the Christmas season is magical and joyful. It is so cute seeing my 2nd grader and my 4-year-old sing Santa’s praises and to see them so full of excitement. My 2nd grader’s letter to Santa was sure to say that he should be on the nice list because of how awesome he is. He also let Santa know that he was great too, lol! We know that one day the realization of Santa will pass away but the revelation of Jesus will always stay. We are still careful to be sure the message of Jesus is not lost during the season but like many homes on Christmas Eve, we’ll leave out the cookies and milk for Santa. You know what they say, “parenting teamwork, makes the dream work”. Ok, maybe I remixed it, but it’s true. Merry Christmas!! How have you and your spouse or partner had to work together or compromise regarding holiday traditions? What was Christmas like when you were going up? Do you incorporate Santa during Christmas? What are some of your favorite memories of Christmas?
40 Years, 40 Songs! A Musical 40th Birthday!
I love music and I have been known to break out in a song during a conversation when someone says something that reminds me of song lyrics or if the conversation reminds me of a song period. At work, one of the nurses always jokes about me making a “CCTHENP playlist” and I have been known to get a little carried away with my singing when I think no one is listening. Ha! Whoever came up with the saying of “I love Jesus and trap music” must have been reading my mind because that pretty much sums up my music tastes! Maybe not “trap” but definitely “rap”. My friend says that I am righteous and ratchet (in a good way, lol). I guess she’s right! Music is a big part of who I am. It inspires and motivates me. It also changes my mood or attitude, good or bad. I love lyrics but I really love beats and music. I admit that sometimes I can ignore terrible lyrics for a cold beat. It has been that way for 40 years now! When pondering how I wanted to write about my 40th birthday, I decided, why not musically! Though 40 songs may seem like a lot, it was hard narrowing this list down as it could have easily been more. So here is my 40 for 40. 40 songs that have impacted me over these 40 years on earth! The Early Years (1980-1989) 1. Supercalifragilisticexpialidocious. For as long as I can remember I have been a fan of Mary Poppins. Who else do you know who is practically perfect in every way? After all these years, she is still my favorite character. I am still trying to figure out why snapping my fingers doesn’t work for my children. Ha! 2. Balm in Gilead. Waaaaayyyy before I knew what a balm in Gilead was, I loved the song and to this day I love the Clark Sisters!! My mom and I listened to their (clears throat) cassette tapes on repeat! They are the greatest female group ever. 3. No Charge. In gospel music, it is not uncommon to tell a story within the song and nobody does that better than the legend herself, Shirley Caesar. The song tells the story of a mother and a son. The mother wants the son to help out around the house and the son agrees but he wants to be paid for the chores. Well, there came a time when I decided that I wanted to be compensated for my chores or whatever it was, and upon saying this to my mom, she began to sing the words of this song to me. Now that I think about it, I believe my tendency to break out in song during conversations comes from her. Ha! 4. You’re All I Need to Get By. Since I am doing this by songs, I was forced to pick one but, to be honest, I find it impossible to pick just one song by this musical genius. I owe my appreciation for Marvin Gaye to my dad. This duet with Tammie Terrell was my first dance song at my wedding. 5. Smooth Criminal. Frankly, there are too many songs to choose just one from the greatest entertainer of all time, the late great Michael Jackson. As a lifelong Michael Jackson fan, his movie, Michael Jackson Moonwalker was a favorite in our household! The video of Smooth Criminal had me practicing unrealistic dance moves and I really wanted to know if Annie was ok! 6. My Prerogative. I must have been 9 or 10 and I remember thinking, “now this is a big word” and I loved it! After looking it up, I happily added the new word to my vocabulary and let anyone who wanted to listen know. It is still my favorite Bobby Brown song and that whole album was full of hits! 7. Dial My Heart. The Boys, a group that I would have loved to see more from and with so much potential. Their debut album was nothing but hits and for a while, they were my favorite boy group. I may have even pretended to be Hakeem’s Lucky Charm. Ha! 8. A Change is Gonna Come. I recall hearing this Sam Cooke song at a very young age courtesy of my dad and I am still not sure why it resonates so much with me. I find myself singing it when I feel heavy or when dealing with some difficult situations. When I start belting out that “I was born by the river” my husband will interject, “no you weren’t” and it immediately lightens the mood. 9. Parents Just Don’t Understand. Before my favorite male entertainer became an actor in one of my all-time favorite TV sitcoms or an actor in any of my favorite movies he was a rapper and I was here for it. Will Smith. I don’t remember what I didn’t think my parents understood at 9 or 10 but it must have been something. Ha! The Adolescent Years (1990-1999) 10. Tootsie Roll. You could go ahead and throw in Da Dip and Scrub the Ground in there too. Coming of age in the 90s means you love “booty music”! In my room with my “boom box,” it would be on with The 69 Boyz and more. 11. Swing My Way. It was late high school I believe, that I truly knew that I could pursue a rap career if I wanted, LOL! That was when a hip hop duo named K.P & Envyi released Swing My Way and to this day, if this song comes on, get ready because I am going to rap every word. 12. He’s Able. Most people probably fell in love with Kirk Franklin through Why We Sing. Though I like this song too, it was He’s Able that solidified Kirk Franklin’s place in my tape player, CD player, and Amazon Music playlist to this very day. If
Be Thankful Anyway
Dumpster fire. Toilet bowl. The worst ever. Crap pot. The end of the world. The wrath of God. The disaster. The year that went to you know where. These sentiments and more I have heard to describe the year that is 2020. Just when you think things cannot get any worse, 2020 manages to prove you wrong, right? Well, if you feel this way, I would like to challenge this thought. Although 2020 has been wrought with more challenges than I could have ever imagined, there have been some personal victories in 2020. I will share some of my highlights. I encourage you to keep an open mind and try to find some good among the not so good of this year and be thankful anyway. Before 2020 started, I created a vision board with 12 major things that I hoped to accomplish this year. For a year that I had no idea would be so tumultuous, 9 out of 12 isn’t bad! Even in the midst of a pandemic, racial turmoil, and a divided nation here are a few things that I am thankful for in 2020. 1. I launched Confessions of a Nurse Practitioner and have successfully published blog posts, articles, and had speaking opportunities. I am thankful for your support of this endeavor. I am also thankful for a platform that educates and inspires. 2. Debt elimination. Thanks to being able to defer some payments and to having some plans canceled, we were able to pay off more debt! This time has also given us a chance to reevaluate our financial goals. 3. Increased quality time with family. I know many people have complained about the increased time at home but I have cherished it and would actually appreciate more of it. Now please take into account that while most of the world was shifting into work from home life or modified work schedules, mine never skipped a beat. So the extra minutes that I can get, I am thankful. 4. Exercise. This year, I vowed to exercise more and I have. My exercise has been mostly in the form of walking. I even had a stretch where I managed to walk for 3 months in a row without missing a single day! I am proud of myself for that but in general, I aim for at least 3 days a week. 5. Family members with COVID who recovered. COVID-19 has impacted all of us in some way or another. I have seen the tragedies and triumphs of the disease. I am overwhelmed with gratitude for families and friends who have survived and persevered. 6. Being able to connect via technology. I know many are tired of Zoom, Google Meet, and the like but think about how much more difficult things could have been without these modalities. Thanks to video technology, I have been able to have girls’ night with my aunts and cousins, attend birthday parties and showers, continue with book club meetings, connect with my writing group, attend conferences, and more. And for many of you, work was still possible thanks to technology. Not that I want to see my friends and family via Zoom the rest of my life but I am thankful for it nonetheless. 7. Writing. It has been so invigorating, rewarding, fun, and therapeutic getting back to writing this year. I do not plan to stop again and I am so thankful for the feedback and encouragement of others. What hobby or passion have you allowed to become dormant that needs to be revived? 8. Health. My health is something that I do not take for granted. In my profession, I witness fading or challenged health daily and it encourages me to work hard to maintain the health that I have. As far as diagnoses go, I have high blood pressure. Though I lament this, it pales in comparison to what some endure. It is up to me to be sure I stay on track managing it through my lifestyle and medication. It is not lost on me that things could be worse so I try not to complain. 9. Family and friends. This could be an entire post by itself but I’ll keep it short. I am so thankful for my family and friends. They come through for me like no other. And not just my dad and brothers (who are exceptional) but I also mean aunts, uncles, cousins, and in-laws too. As far as friends go, I feel beyond blessed. People talk about how blessed and rare it is to have one true friend but my experience is different. I can truly say that I have a few close friends who I know have my back at any time and who can be trusted. As for my children, well they help me keep things in perspective. If I want the unfiltered truth about things, I know that is what I will get from them even when I don’t ask. Ha! I am thankful to be their mother and for their unconditional love. I cannot have a gratitude list that does not include my husband. He is the real MVP for sure. A lot of who I am and what I have been able to do is because of him. He is the epitome of a family man and his love for us is always apparent. Even when he thinks that I am doing the most (LOL), he is supportive and I am thankful. 10. Faith. “If it had not been for the Lord on my side, tell me where would I be, where would I be?” Honestly, I have no idea how people who don’t have faith maintain peace of mind or continue to navigate in such a world of turmoil. There are many times I have to remember that I know who holds the future despite what everything around me looks like. I find comfort in the midst of storms because I know who has the final
Nurse Practitioner, Your Burning Questions Answers!
Is an apple the same as an orange? That is what it sounds like when I am asked if a nurse practitioner is a physician or the same as a physician? Though the apple and the orange are both fruits, the paths to becoming a particular fruit are different. The same goes for nurse practitioners and physicians. The paths are different as one is achieved via a nursing continuum, usually a continuation of the nursing continuum. The other a medical continuum. It is important to note that most nurse practitioners worked as a registered nurse prior to pursuing additional education. Most physicians do not initially have any medical experience but get extensive training once accepted into medical school. They obtain a bachelor’s degree first and then go to medical school upon doing well on an admission exam. This is followed by a 3-year residency. Can a nurse practitioner do many of the things a physician can do? Yes, a lot of the scope of practice overlaps especially when it comes to diagnosing, treating, and managing chronic illnesses in primary care. It varies more within subspecialties. For example, in my practice, I diagnose and treat symptoms of cancer and blood conditions and side effects of cancer treatment. I also treat acute and chronic health conditions aside from cancer or blood diseases such as high blood pressure and depression. The physicians I work with are hematologists/oncologists. They also do all of the aforementioned but in addition, they are the ultimate experts in hematology and oncology. They determine the cancer treatment (chemotherapy/immunotherapy etc.) for the patient. To become a hematologist/oncologist they completed medical school (4 years) followed by an internal medicine residency (3 years). After this, they then completed a hematology and oncology fellowship (2-4 years) and certification exams. Can a nurse practitioner perform surgery? No, only surgeons (physicians with surgical training and expertise) perform surgery. However, nurse practitioners may assist the surgeon in surgery depending on their training. There are other non-surgical procedures that nurse practitioners can be trained to do. For example, I can perform bone marrow biopsies and aspirations. There are other nurse practitioners who can perform everything from Botox injections to intrauterine device placement (IUD). Nurse practitioners do not deliver babies. Nurse practitioners can provide prenatal care but the advanced practice nurse that can deliver babies is the Certified Nurse Midwife. Otherwise, delivering babies is done by a physician specialist called an obstetrician. Nurse practitioners do not provide anesthesia for surgical procedures or epidurals for the birth of a baby. However, Certified Registered Nurse Anesthetists do this and of course the physician specialist, anesthesiologists. Nurse practitioners are advanced practice nurses who have been changing the face of healthcare. There are more than 290,000 of us in the United States. We are filling in the gap in primary care, especially with the shortage of primary care physicians, and adding to specialty care. Nurse practitioners also provide cost-effective care which overall reduces health care costs which have been a burgeoning problem. Furthermore, physicians and institutions such as hospitals that employ nurse practitioners do so because of the benefit to their practices and the added value they provide. Finally, if you are wondering if the care you receive from a nurse practitioner is as quality as the care provided by a physician? The simple answer is yes. Studies have shown that not only is the quality of care provided by nurse practitioners superb but also patient satisfaction rates are higher. It is no doubt that nurse practitioners are a major asset to the healthcare team. So salute your favorite nurse practitioner! Happy Nurse Practitioner Week 2020! This is post number four, the final post in the Nurse Practitioner Week series. Be sure to catch up on the three prior, Nurse Practitioner Who?, Nurse Practitioner, What An Adventure! and Nurse Practitioner, Which Way Will You Go? Let me know how you liked the series and or which was your favorite post!
Nurse Practitioner, Which Way Will You Go?
I didn’t grow up saying, I want to be a nurse practitioner. To be honest, I had no idea that there was such a career. What I did know is that I wanted to be in healthcare. I wanted to help people. I loved science. I loved medical stuff. I thought that I wanted to be a doctor until I decided that I wanted to be a nurse. (Why I Became a Nurse) Then I was determined to be a nurse practitioner. See Why I Became a Nurse Practitioner. In order to become a nurse practitioner, the registered nurse must attend graduate school. I completed my Bachelor of Science in Nursing at the University of Alabama in Huntsville. For nurse practitioner school, I chose to go to the University of Alabama at Birmingham. I also had to choose a concentration. I chose the Family Nurse Practitioner concentration because I was fascinated with care across the lifespan and I liked the idea of having the option to work with different age groups. My certification allows me to care for patients throughout the life span from infants to the elderly. However, I work in the subspecialty of hematology (blood disease) and oncology (cancer) with adult patients only. Read Mom Had Cancer and Mom Died From Cancer for details about how I landed on this specialty. Other specialties include Women’s Health Nurse Practitioner, Pediatric Nurse Practitioner, and Psychiatric-Mental Health Nurse Practitioner to name a few. To obtain one of these degrees, an additional 2-4 years of study is completed that includes robust course work, clinical rotations/preceptorships, and a residency. Upon graduating, a national board certification exam must be taken and then a license must be obtained from the board of nursing of the state of practice. I was giddy with excitement and anticipation as I prepared for my national board certification exam. I was also nervous. I hate standardized tests though I had become used to them to some degree. By the time I took my exam, I had been a graduate for 4 months. If you recall from Nurse Practitioner, What An Adventure, that I gave birth to my youngest son just before graduation. Therefore, I was taking care of a newborn and studying at the same time! Hard is an understatement, but I’m nothing if not determined. Thank God for my father in law who generously and graciously helped watch my baby to allow me study time. I stayed at a hotel the night before my test. My husband took care of our boys and I was able to get my mind right for the task ahead. That may have been the longest test in the world and even though you find out right after if you pass or fail, those 10 minutes or so felt like 100 minutes. I had a good feeling about my performance, but you don’t know for sure until you know for sure. The guy who handed me my results gave no indication of whether I had passed or failed. His poker face was solid! I guess that is a part of the training. Relief does not even begin to explain what I felt when I saw that I had passed. Another milestone behind me! Being officially board certified, I could now work as a nurse practitioner once the Alabama Board of Nursing granted me my license. As you know I chose to work in the subspecialty of hematology and oncology. Other subspecialties include neurology, gastroenterology, and rheumatology to name a few. Though there are additional certifications that can be obtained in many of the subspecialty areas, much of the additional training comes through the physician who is the specialist. In my case, this is the hematologist/oncologist. Additionally, specialty and subspecialty specific organizations and nurse practitioner organizations provide additional education including continuing education units. My favorite conference for my subspecialty is through an organization called APSHO (Advanced Practice Society of Hematology and Oncology). For several years my NP bestie/colleague, Rachel, and I go to this jammed packed conference together to invest in ourselves through continuing education. So what can I do as a nurse practitioner? With my advanced clinical training, I am able to assess patients by reviewing medical histories, performing physical examinations, and ordering or performing various diagnostic tests. I am also able to diagnose and treat various conditions and illnesses. The treatment prescribed may include prescription medication, therapy, or referral to a specialist. Additionally, I provide health and disease prevention education and disease state education. Nurse practitioners are able to practice independently or in collaboration with other health care professionals including physicians. The type of practice depends on the state in which the NP practices and the specialty. As an NP in hematology and oncology, I work in collaboration with the hematologist/oncologist. As a team, we manage our patients along with the other clinical staff. It’s National Nurse Practitioner Week and I am striving to educate and empower you regarding health cares best secret weapon…the nurse practitioner. This is post number three in the Nurse Practitioner Week series. Stay tuned as it comes to a
Nurse Practitioner, What an Adventure!
I was pregnant during my final year of nurse practitioner school and set to deliver after graduation. I waddled along completing my residency during my final semester. The finish line was in reach and my hard work was paying off. Interestingly enough, my OB/GYN was gracious enough to let me precept with her during my pregnancy. In case you are wondering, yes, I was pregnant taking care of other pregnant ladies. This made for great conversations and interactions during patient visits. Anyway, I had it all planned out. I was looking forward to graduation on Saturday, December 15th. I had just gotten my cap and gown and I made sure to get the gown large enough to accommodate my gigantic belly. The Thursday before graduation, I had my whole day planned. I had an OB appointment that morning after which I was to go get my hair done. From there I was planning to squeeze in a pedicure. Not that I was planning to wear open-toe shoes for graduation but my feet were in need. Plus, with delivery expected to happen right around Christmas, I did not want to deliver with crusty feet. For a reason that I can not recall now, I was running a little behind getting to my appointment. I was so behind that I didn’t have time to stop by the Hardee’s drive-thru for the omelet biscuit that I was craving. I didn’t sweat it too much because I would head straight back there once I was done with my appointment. Needless to say that I felt like I was starving by the time I completed the appointment. Actually, the appointment never quite ended. Not on that day at least. I was only supposed to be having my weekly non-stress test. This was done because I was in the high-risk pregnancy category. I was over thirty, had high blood pressure, and had experienced a prior pregnancy loss. The non-stress tests could monitor fetal movement as well as uterine contractions. As it turns out my uterus was contracting regularly and with more force than I knew. My spunky nurse asked, “you don’t feel that?” I was like, “feel what?” I felt my baby moving which he did especially when we were hungry because otherwise, he was pretty laid back. I was trying to hurry up and get to my biscuit! She told me that I was going to have to wait right there until I saw my doctor. For a moment I was nervous because I wasn’t scheduled to see her that day and I was hoping and praying nothing was wrong. My doctor came in soon. Nothing was wrong, except that I was in labor! To my surprise and dismay, I would be going from her office down to labor and delivery. Starving with dirty hair, dusty feet, and no hospital bag, I was headed to deliver my nearly 10 pounds bundle of joy. There would be no in-person graduation for me. I thought to myself, “how did I end up here?” So to get to what it means to be a nurse practitioner, let’s first look at what it means to be a registered nurse. With a bit of an unconventional path, I went to nursing school after having already obtained a Bachelor of Science. Upon graduation from nursing school, I received a second bachelor’s. Instead of this taking me another 4 years, it took me 2 because I already had a bachelor’s. Now with a Bachelor of Science in Nursing, I was set to take the licensure exam to become a registered nurse. For most registered nurses (RN), a career in nursing looks something like this. They have attended nursing school, either a 2-year program or a 4-year program. A 2-year program grants you an associate’s degree and a 4-year program grants you a bachelor’s degree. Now back to me. Upon graduating from the nursing program with my degree I could not start nursing right away. I had to take a national exam called the National Council Licensure Examination (NCLEX-RN) and pass to be granted a nursing license. Once I successfully passed the NCLEX, I was able to obtain my Alabama state license through the board of nursing (each state has one) and practice as a registered nurse. Thankfully, I already had a job in the hospital where I worked my way through nursing school as a patient care technician. I, like many nurses, practiced as a registered nurse for some years, gaining valuable experience along the way. Some nurses even become experts in certain areas of nursing. I decided that I wanted to further my education and broaden my scope of practice. Of the advanced degrees available to nurses, I knew the nurse practitioner degree was the way for me. Other options include Nurse Educator, Clinical Nurse Specialist (CNS), Clinical Nurse Leader (CNL), Certified Registered Nurse Anesthetist (CRNA) and Certified Nurse Midwife (CNM) The graduation that I missed was from the University of Alabama at Birmingham where I obtained my Masters of Nursing (MSN) degree as a Family Nurse Practitioner. One of my classmates was nice enough to save a program for me and somewhere there is a picture of me in my cap and gown that was later returned to the store for someone else to use. Good thing being present at graduation was not mandatory huh? This is the second post in the Nurse Practitioner Week series. Here’s the first one, Nurse Practitioner Who?.
Nurse Practitioner Who?
Few things make my heart beam with pride more than a satisfied patient. As a nurse practitioner, I am faced with patients who sometimes feel out of sorts when it comes to understanding my role. The extremes go from “Oh great, I saw a nurse practitioner at my family doctor’s office before! She was so nice and spent so much time with me. She is the only one I want to see now when I go to the office!” to “Uh oh, the nurse practitioner, I don’t want to see the nurse practitioner. Where’s the doctor?” The confusion seems to lie in the fact that many patients are not familiar with nurse practitioners or have had very limited interaction. Many patients also do not understand the role and are not sure that a nurse practitioner can meet their needs. This is understandable. Since the early days of health care, you had the doctor and the nurse. That is what most people have understood all of their lives. After all, it wasn’t until 1965 when Dr. Loretta Ford (a nurse) and Dr. Henry Silver (a pediatrician) developed the first nurse practitioner program at the University of Colorado. The program was developed after both recognized the deficit in care available in certain communities, especially rural communities. The role of nurse practitioner integrated the traditional role of the nurse with advanced medical training and increased autonomy. Since 1965, the profession has grown tremendously, especially with the physician shortage. As a result, nurse practitioners have become more recognized and in increased demand. With education and awareness, I am hoping to help patients feel more at ease when the opportunity to see the nurse practitioner presents. I also hope that patients will feel empowered in their decision or option to see a nurse practitioner. Early in my nurse practitioner career, it was not uncommon for patients to ask what I do or to stare at me in confusion when I introduced myself. I knew that as the first nurse practitioner in my practice that I had my work cut out for me. This would mainly include the patients but even the physicians and staff that I worked with had to adjust and learn. I learned early on that the best way to tell people who I am, what I am, and what I do is to show them. I had to say it with my actions. As a nurse at heart, this was not hard because of my compassionate yet driven nature. So when, Ms. Jackson (made up name), came in with a chip on her shoulder because she had to see me for her visit that day, I was sure to kill her with kindness, answer all her questions, provide a thorough exam and create the appropriate treatment plan. By the time she left the chip was in the trash and she was asking to be on my schedule for her next visit. And that’s my goal every time, to take such good care of the patient that they know nurse practitioners are more than capable, qualified, and able to meet their needs too. It often happens with a hefty dose of compassion and a bonus of more patient interaction. Who doesn’t want that? It is National Nurse Practitioner Week so salute your favorite NPs! Happy Nurse Practitioner to all the wonderful NPs out there making a difference!