On one of my first days on the job as a new NP the internist I was working with told me, “You’ve got to take the word “nurse” out of your title. It does not reflect what you will be doing.”
The hairs on the back of my neck stood on end. A sure sign I was getting angry. “He is so wrong.” I thought. I wanted to argue with him. Before I reacted, I decided to ask him to clarify his statement, “What do you mean?”
“When I received my undergraduate degree in chemistry, I called myself a chemist. When I got my doctorate in medicine, I became a doctor. I was no longer a chemist.” He explained. “You got your undergraduate degree in nursing so you could call yourself a registered nurse. Now that you will be diagnosing and treating in a primary care practice, you need to call yourself something different. The word, “nurse” has a negative connotation.”
I could see his point of view from his personal experience, but the problem was he just did not understand nursing. So I explained it to him. “Because my graduate degree was in nursing, I am still a registered nurse. After going to school, I have advanced skills, but I plan to apply those nursing skills in the primary care setting.” Today I could have added, “And the word “nurse” is not seen as negative to the public. According to a Gallup poll nurses are the most trusted professionals for the 12th year in a row.”
He wasn’t convinced, and my behavior over the next year was not going to help my argument. I was one of the first NPs employed by this health care system. I convinced this internist to hire me right out of NP school to fill what had previously been a LPN position. I knew I had to prove myself. My graduate program taught me to perform advanced physical exams, but I was not as strong on the diagnosis and treatment of illness. As I worked alongside this young internist, I soaked up everything he had to teach me. What I didn’t expect as a result was to slowly turn my back on my nursing skills.
Unconsciously, I began modeling myself after my contracting physician. I thought like he did. I dictated my notes like he did. Despite all my years of writing nursing care plans using a nursing model, it became much too easy to adapt to his medical model. I am grateful that a patient opened my eyes that first year that would shape my NP practice for the rest of my career. She suffered with debilitating migraines for years. She had seen multiple physicians but still was not getting any relief. Using my nursing skills, I was able to help her decrease the severity and frequency of her headaches so that she could function again. (You can read the details in my article, “Rational-emotive therapy in the Management of Migraine Headache in the May, 1994 issue of the J Am Acad Nurse Pract.) As the years went by, there would be many other patients who I helped using my nursing skills.
I share this story with all the NPs or would be NPs so that you will not make the same mistake I made. Here are three tips to keep nursing in your nurse practitioner practice:
1. Think like a nurse
Focusing only on the diagnosis and treatment of illness is easy to do when you are making the transition from registered nurse to nurse practitioner. Don’t forget to look at the patient as a whole. Do a psychosocial assessment. What is happening with him emotionally? What is going on in his life that may influence his symptoms? What are the stressors in his life?
One of my patients came into the office every month. Her complaints seemed silly: A sore toe, a sore throat, an ache in her abdomen. I could never find anything physically wrong with her. When I discussed her case with my contracting physician, he labeled her as a “nut” case and wrote her off. But she was still asking to see me. I decided to delve a bit into her psychosocial status on her next visit. When she came in the next month with an ailment and no physical findings, I asked her respectfully and in several different ways if something else beside her present complaint was going on. Suddenly, she burst into tears. Her father had died six months before. During her teenage years he had raped her, but she never talked with him about it. Now she would never have the opportunity to. I think she had used the multiple visits to see if she could trust me with this secret. I counseled her and referred her to the rape crisis center for help. Had I listened to the internist, I would have missed the opportunity to help her. Making a difference like this in peoples’ lives is one of the biggest reasons I became a nurse.
2. Educate your peers and patients about how a nurse practitioner practices.
This is what I like to say when people ask what NPs do: “We are registered nurses who went back to school to learn to diagnose and treat illness similar to what a physician does. In addition, we apply our nursing skills in the primary care setting. Nurses use their clinical skills and knowledge to give care to people of all ages to improve, maintain, or recover health, to cope with health problems and to achieve the best possible quality of life, whatever their disease or disability. Some of the skills nurses possess are listening and communicating with patients, teaching, coordinating care, counseling and advocating for the patient.”
3. Use your nursing skills
Take every opportunity to utilize your nursing skills. If time is an issue, talk with your practice manager and ask for the time you need. Tell him/her the advantages of having the time to practice as you desire. People may come to see you because you practice a bit differently from everyone else. I can’t tell you how many times I’ve heard people say, “I would rather see the NP than the physician. No one listens like she does. I feel comfortable telling her anything. She teaches me how to stay healthy and prevent getting sick again. She solves my problems and if she does not have the answer, she won’t hesitate to refer me to someone else. She never gives up on me.” (There are definitely other primary care practitioners who practice this way. NPs have not cornered the market, but if we practice this way as a group, then this is what the public knows to expect.)
So if you are a NP or planning on becoming a NP, don’t make the mistake I did. Keep the “nurse” in your nurse practitioner practice. Focus on the whole patient not just on diagnosing and treating the illness. Use the nursing knowledge and skills you know so well to be a great primary care provider. If you are surrounded by physicians in your practice, don’t adapt to your environment so well that you are thinking like them. You may offer a different kind of practitioner for the public. It is up to us to educate both the public and our coworkers what nurses and nurse practitioners do. (The day will come and has, I hope in many practices around the country, where all primary care practitioners will practice in the same way: Listening to the patient and focusing on the whole patient not just his illness.)
Please comment below.
I’d like to know if you are a nurse practitioner, how you tell your patients what you do.
If you have been a patient of a nurse practitioner, what has been your experience?