Family Nurse Practitioner Journey
Introduction
My name is Muzzamal. I have one year of ER experience and it has been a difficult journey transitioning from working as a new RN and attending school but I have learned tremendously from my coworkers, classmates and preceptors. I am very pleased that I made this transition.
My first Rotation
My first rotation was at an internal medicine office specializing in geriatric population. I was very overwhelmed because I felt like I knew nothing. There was enormous amount of information to learn in very short time. I lacked confident and was very nervous. I asked a lot of questions and clarified whenever I was confused. Also my preceptor asked me a lot of questions to gauge my thinking process. Now I feel a little more confident going into second semester practicum.
My goals
I would like to perform history, physical assessment, diagnostics and treatment plan with minimal assistance from the preceptor. Additionally, I would like to apply knowledge learned from theses classes to clinicals and come up with diagnosis as well as differential diagnosis. Lastly, my goal is improve my communication skills and get comfortable with educating patients and their families.
Resources
UptoDate
cdc.gov
https://www.uspreventiveservicestaskforce.org/
National guidelines
Clinical guidelines are a helpful tool that assists providers with recommendations based on evidence-based practice. There are many national guidelines that my preceptor utilizes daily. My preceptor for OB/GYN often uses the Centers for Disease Control and Prevention (CDC) and USPSTF (the United States Preventive Services Task Force) website on a daily basis for breast and cervical screening guidelines. Recently we were looking at CDC guidelines for influenza prevention and control in peri and postpartum settings. Also, at my primary clinic office we see many patients with Chronic Obstructive Pulmonary Disease (COPD) and the guidelines/recommendations are very helpful. Additionally, one of the apps that have facilitated my learning at the clinic is UptoDate, which provides great information and guidelines such as COPD, Diabetes, Hypertension, Asthma, Sleep apnea, etc. and is easily accessible. I do believe that national guidelines are being followed in both of my clinical settings.
Diagnostic Tests
PSA: pros: prostate specific antigen (PSA) is used for early detection of prostate cancer. It is simple and widely available. cons: PSA can be elevated even when the cancer is not present.
HgbA1c: Pros: HgbA1c measures the average blood glucose for 3 months and is a reliable measure of chronic hyperglycemia. Cons: certain diseases can cause falsely elevated hgbA1c levels.
Urinalysis: rapid results typically within few minutes of collection cons: not completely error free.
Paptest: pros: helps prevents cervical cancer by finding cervical cell changes in the body that can become cancerous if left untreated cons: can be uncomfortable
EKG: pros: checks for signs of heart disease or arrhythmia, cons: can provide with a false positive or negative result.
Patient centered care
Patient-centered care is defined as an “approach and philosophy to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among providers, patients, and families (Abraham & Moretz, 2012).” This partnership between the patients and the provider requires listening, and involving the patient in their plan of care. As a provider, we can collaborate on the plan of care by advising and informing the patient, but ultimately patient should be in complete control when it comes to making a decision about their health. We can help them set realistic health goals and plan of care. I always try to provide the patients with knowledge based on evidence-based practice and provide them with as much information as possible so that they can make informed decisions. I also try to encourage patients to become more engaged in their care. Lastly, while collaborating on the plan of care, we should be looking at patient and family preferences because both patients and their families play a huge role in a decision at every step of the way.
Abraham, M., & Moretz, J. G. (2012). Implementing patient- and family-centered care: Understanding the challenges. Pediatric Nursing, 38(2), 44-47.
Practice Inquiry
“Practice Inquiry (PI) is a set of methods that structure how clinicians could collaborate over time in learning from their patients’ case-based clinical uncertainties (Sommers, Morgan, Johnson, & Yatabe, 2007).” It entails the practice-based learning and improvement method (PBLI) to assist clinicians in managing their clinical uncertainty. The goal of PBLI is for providers to meet in small groups and discuss dilemma cases and share clinical experiences while integrating evidence-based research to improve practice and patients’ health outcomes.
At my clinical site, my preceptor is the only clinician in this private practice, and therefore it is difficult to discuss clinical cases. However, since this a primary care office, my preceptor does discuss clinical cases that are difficult with other specialists. For example, last week, we had a case with the patient with recurrent hypoglycemia episodes where my preceptor discussed the case with an endocrinologist, and a referral was made.
Sommers, L. S., Morgan, L., Johnson, L., & Yatabe, K. (2007). Practice inquiry: clinical uncertainty as a focus for small-group learning and practice improvement. Journal of general internal medicine, 22(2), 246-52. doi: 10.1007/s11606-006-0059-2
Continuing Education
Continuing education is imperative in providing evidence-based education, which assists nurse practitioners in attaining current up to date knowledge as a health professional. There are many routes of attaining continuing education, such as classes, live courses, conferences, workshops, webinars, and various forms of online learning provided by different organizations. One of the organizations is the American Association of Nurse Practitioners, which offers courses and presents articles, case studies, live conferences, and videos. I plan to join one of the organizations to gain more knowledge, stay informed, and stay up to date with health care issues. Currently, I obtain continuing education units through my employer as a registered nurse. I also plan to use different nurse associations such as the California Association of Nurse Practitioners to gain further continuing education. Additionally, I have used application such as UpToDate for school and clinical rotations, and they have not only assisted with enhancing knowledge but also facilitated in clinical decision making.
My Blog 