When Are You Going To Be A Doctor?

It's hard to believe I have been a nurse practitioner for seven year already. It seems like yesterday I was studying for boards and trying to find a job. Very few weeks go by where I am not explaining to a patient what a nurse practitioner is. This drives me crazy because this is not a new field-nurse practitioners have been around since the 1960's!

Unfortunately, nursing is a complicated career because their are multiple paths to becoming a nurse. You can get your Associates Degree (which is being fazed out because they are really encouraging nurses to get their 4 year degree), or Bachelor's Degree to become an RN. There are still LPNs which can confuse people. Some nurses go on to get their Master's Degree, but that doesn't necessarily mean they are nurse practitioners. Yet all nurse practitioners have a master's degree. See what I mean about confusion? Plus, every state has a different term for nurse practitioners: In Iowa, we are known as Advanced Registered Nurse Practitioners. In other states I may be known as an Advanced Practice Nurse, Advanced Practice Registered Nurse, or simply Nurse Practitioner. To make it even more confusing, a nurse practitioner's scope of practice varies from state to state. Iowa has one of the most "flexible" scopes of practice. There are no restrictions with regards to my prescriptive ability and I can open my own clinic and practice independently. Many other states are more restrictive with regards to what an NP can do.

Probably the two most common questions I get from patients are: When are you going back to school to become a doctor and what is the difference between a nurse practitioner and a physician's assistant. I always laugh at the first one and explain that I don't ever want to become a doctor and that I'm done with school. Being an NP is the best of both worlds-less schooling, thus less school debt, no call/weekends, but still being able to see, diagnose and treat patients. Now if only our salaries were the same...The second question is also easy to answer-we pretty much do the exact same thing.

After 4 years of working in a busy internal medicine office and 3 years working in nephrology, I have gained a ton of experience. There have been moments I will never forget. Like when I have to tell someone they have HIV, hepatitis, an STD, or cancer. There are also patients I will never forget. I will never forget my "dumpster diving" patient who resumed his hobby just 1 week after having open heart surgery and developed a horrible infection in his incision. Nor will I forget his wife of whom I was doing a pap and pelvic on and had an abscess on her abdomen. She proceeded to squeeze the lesion and drainage shot across the room-thank God I had my PPE (personal protective equipment) on. I've been practitioner, nurse, counselor, therapist, and friend for many patients. I've lost many patients. I've shared pictures of my children with patients and met many of my patients own children. I've rejoiced with patients when their CAT scan showed their tumor had shrunk, their diabetes was under better control or their blood pressure was within range. I truly enjoy what I do.

My job as a nephrology nurse practitioner is very unique. On the days I am in town and not seeing patients in the clinic, I round at the six dialysis centers in Des Moines. When seeing patients on dialysis, I evaluate their treatments and make adjustments if needed, monitor labs (specifically their hemoglobin, phosphorus, potassium, and calcium levels, and ensure they are getting good dialysis). I evaluate their blood pressures before, during, and after treatments and make changes in medications if needed. I also adjust their treatment medications pending on what their labs are. Besides addressing dialysis things, many patients believe I am their primary health care provider so I sometimes manage other health conditions too. This means I see the same patients every week on dialysis. I've become close to many of these patients. We talk about our weekends, they ask about my children, and we chit chat about Iowa Football.

During clinic days I see patients who have kidney disease, but are not on dialysis and may never be on dialysis. Some are kidney transplant patients. I do a lot of educating during my clinic, to prepare patients for dialysis if it is in the foreseeable future. I make sure patients are aware of the two different types of dialysis, along with their option for transplant if they are a candidate. I also spend two days a month at the VA hospital seeing Veterans with renal disease. I have a special place in my heart for Veterans. While going to nursing school at the University of Iowa, I worked as a CNA at the VA hospital on the post-surgical floor. I really enjoyed it and the Veterans I met. I especially love the WWII vets! For the most part, they are grateful for their health care and adhere to their treatment regimens.

I also travel out of town 4 days a month (soon to be 3). In two of these towns I only see dialysis patients and the days are usually short. The other two towns I see dialysis patients and do a clinic there. I also have one day a month where I see our home dialysis patients in clinic (home hemodialysis and peritoneal dialysis). I enjoy this day each month because I love that patients have the ability to do dialysis treatments in their own home. Our home dialysis patient census is the largest in the state of Iowa.

You can't beat the flexibility of my current job and I will never find another NP job that is this flexible. On the days I'm not in clinic, I basically make my own schedule. If a child has a doctor's appointment I don't have to have my clinic scheduled cleared to I can take him/her. I often work hard in the beginning of the month, which allows more free time at the end of the month. There is no way I could run a household, take care of three kids, and work full time without this flexibility. In the future as my kids are in sports (hopefully!), it will be easy for me to be done working by 4 to go watch their games. I love not being in the office from 8-5 seeing patients every 15 minutes like my old job. This is the perfect "mom of twins + 1" full time job.