Celebrating Ourselves. Nurse Practitioners Have a Week Too

This is one of the rare times that I'm going to do something that I don't enjoy all that much: I'm going to talk about myself. Let me begin by saying Happy Belated Nurse Practitioner Week to all NPs reading this. I wear the title of  NP proudly, although many people don't really understand who we are and what we do. Just a short list of some of the things I hear when introducing myself to patients or when I tell people that I'm an NP:

• "Nurse Practitioner. Does that mean you're in training (practicing) to get your license"?
• "So do I see the doctor after I talk to you"?
• "How much longer do you have to go to school to be a doctor"?

Here's a brief summary of the Nurse Practitioner profession. The first NP training program was started in 1965 as a collaboration between a nurse and a physician (working together, not as adversaries). The initial motivation was to address the primary care physician shortage. The first NPs were trained to manage the health of women and children. Over time the role has expanded to include specialized training in a variety of areas from psychiatry to oncology. NPs have a minimum of 6 years of education (Bachelors degree and Masters or Doctorate degree), which includes coursework on diagnosis and management of health conditions. Simply put, there's a lot of overlap with functions that a physician performs. And the answer to a question that many patients have: yes, we can write prescriptions. For a more detailed historical perspective click on this link, or google it. 

I decided that I wanted to be a nurse when I was 14 or 15 years old. When I was young I had a cousin and grandmother who spent significant amounts of time in hospitals and rehabilitation centers. During my visits with them, I noticed that nurses ensured that people felt cared for, and did whatever was necessary to stop their suffering. It was the nurse who stopped my cousin from crying when she had to get her blood drawn for the 20th time. The nurse was the one making sure family members understood what was going on. The nurses were there 24 hours a day providing treatments. Once I made up my mind I took classes in high school that would help me reach that goal (a lot of science and Spanish-I was close to fluent at one point- because it's a widely used language). There was only a brief moment in time that I considered becoming a physical therapist (I was an athlete).

Fast forward to 19 years ago, I started my first job as a registered nurse working the night shift. I was a vampire for 7 years. Nurses who work night shift exemplify the awesomeness of nursing. Contrary to popular belief, nurses don't just carry out doctors' orders. We actually have to know a lot about what is going on. How do you think the doctors know when something is wrong? Especially in the middle of the night. Nurses are walking around waking people up doing assessments and calling doctors to request specific orders. You better have an idea of what you are asking for when you page someone in the middle of the night waking them up out of their sleep.  The funny thing is, although I learned to love it I never wanted to do this type of nursing. I developed an interest in psychiatry during my undergraduate education but needed at least 1 year of experience in this type of setting (acute care/med-surg) for most psychiatric nursing positions. During my time in med-surg, I noticed the stigma directed towards patients with mental health and substance use issues. Some had the attitude that these patients didn't deserve to receive the same level of treatment because they weren't going to take care of themselves after discharge; we shouldn't give them pain medication because it's just feeding their addiction. Never mind that their roommate had the same diagnosis and the same orders. Sometimes their complaints were seen as not valid because of their mental health diagnosis, or people feared that they would become violent. The other thing that bothered me was the fact that I was often treating exacerbations of preventable or manageable conditions. I decided to go back to school to be an NP because I wanted to focus on keeping people out of the hospital, and I really wanted to work in psychiatry. As luck would have it, one of the best NP programs in the nation (UCSF) was nearby. I applied and was accepted.

I really just wanted to focus on psychiatry, but the program was designed to train me as an Adult Nurse Practitioner (ANP) in addition to providing specialized training in psychiatry (sort of a double major, yes I'm smart). The bonus was that I had the opportunity to work in a substance abuse treatment program for one of my clinical rotations. I graduated equipped to provide care for all aspects of health. I've been an NP for 13 years and enjoy it to the fullest. This career has provided me with the opportunity to work with some incredible physicians, social workers, psychologists, medical assistants, case managers, advocates, attorneys, health workers, and many others. And if you've read my book, you know I value the interactions with the patients that I've had the honor of caring for. Being an NP has also provided me with the opportunity to participate in practice-based research, participate in the drafting of policy recommendations, educate future health care professionals, write a textbook chapter, be featured in a documentary about nurses, and share information about different models of care at various conferences. Sometimes I'm asked a question that I can't stand: Is it better to be a doctor or a nurse practitioner? I can't stand it because it speaks to the tendency to view things as better or worse when making a comparison; some things are just different. It's like asking if chocolate is better than vanilla? How can I place value on a job that I don't do? And I won't get into a discussion about varying approaches to care, although nursing traditionally uses a different philosophy than medicine. In the big scheme of things, there isn't an us versus them controversy as portrayed by some articles (op-eds mostly) that are publicized. We are all in this together. There are simply not enough providers (physicians, nurse practitioners, and physicians assistants) to meet the needs of everyone who requires care. We are not trying to take their jobs. Furthermore, if everyone decided to be a doctor who would do the things that I talked about during my years of bedside nursing?; the things that inspired me to become a nurse. And some say that we've left nursing because our role differs. Not true, we just practice a different type of nursing. All I know is that I chose this profession for a reason, and I've been able to do everything that I wanted to do and then some. I LOVE being a nurse practitioner.