Monday, February 3, 2014

What Is A Nurse Practitioner, And How Is It Different Than A Registered Nurse?

If I had a nickel for every time someone asked me this question, I wouldn't have to pick up nearly as many overtime shifts.... (Also, if I had a nickel for every time someone asked me "You're so smart, why aren't you a doctor?" I'd have the beginnings of my endowment for a nursing theory based medical school, but that's a different/future post and rant...)  There is room for a lot of nuance in this explanation that I'm not going to touch on in this post.  I'm going to do my best to give a solid, simple overview.

To begin, all nurse practitioners (NPs) are registered nurses (RNs), but not all registered nurses are nurse practitioners.  There is a hierarchy of training involved in both jobs.  A nurse practitioner requires more eduction, either a master's degree or a doctorate of nurse practitioner (side note: the level of education required is becoming an increasingly controversial area in nursing and may also result in a future post).  Registered nurses require only a minimum of a 2 year degree in nursing to sit for their licensure, but there is a large movement in nursing for all RNs to have a 4 year degree in nursing.  At the end of their education, both RNs and NPs must sit for their respective standardized exams in order to obtain a state issued license that will allow the RN or NP to practice medicine.

The next big and most important difference is scope of practice i.e. what are RNs and NPs allowed to actually do.  The scope of practice for each is designated by the particular state that the RN/NP is practicing in and it can vary widely from state to state.  But the main difference is the level of authority each has in their medical practice.  A nurse practitioner can actually prescribe medications, perform some procedures, order medical tests and give you a diagnosis, similar to a doctor, though more limited in scope.  A registered nurse cannot do any of these things.  The line can feel convoluted at times because RNs are good at their job.  They might be able to listen to someone's lungs and know that they probably have asthma, but RNs cannot officially tell someone they have asthma, order their inhaler, or send a patient out for further testing.

So there you have it.  Those are the big differences.  Both NPs and RNs share the same theory base and approach to care.  Each role has its pros and cons.  But together, RNs and NPs help to make up the necessary team for ensuring that patients get the kind of holistic care they deserve.

Sunday, January 26, 2014

Coming Out in the Workplace

As most of us know, a job in the healthcare field is unlike any other with its own set of very unique challenges.  Today, I'd like to discuss a particular challenge of being a queer nurse.

One of the fundamental tasks of being a nurse, or any healthcare worker, is to create a therapeutic relationship with your patients.  Establishing this connection is important in being able to effectively communicate with your patients to help empower their health choices.  And often times, it is the simplest gestures that helps to establish this bond; sitting down with your patient, therapeutic touch, and listening.  It is very difficult to maintain a one-way direction for this relationship and many times patients will want to get to know you too.  Do you have any kids? Are you married? If you're not married, anyone special? These are often the introductory questions that patients will ask you.  But these can be loaded questions for the queer identified nurse.  The nurse may have to choose between keeping private about their life (a valid option for queer and non-queer folks alike) and possibly make the patient feel shut out or answer them and out themselves to their patient.  And if your patient is homophobic and you answer honestly, you may run the risk of destroying that therapeutic relationship you've been working so hard to build.

Much research attention has been focused towards the interaction of the healthcare worker with the LGBT population.  However, based on PubMed perusing, very little, if any focus, has been placed on examining the other direction i.e. how patients interact with LGBT healthcare workers.  In fact, only one study, reported perceived discrimination by LGBT physicians, though numbers were not reported on perceptions of discrimination by patients towards LGBT docs.  And though it was noted that the burden of dealing with a discriminatory patient is far worse for the nurse, who must spend more time with such a patient, the research so far has been only physician focused.

The quandary about caring for patients who may hate you has been discussed elsewhere, but its primary focus has been race based.  There's been little exploration about how queer healthcare workers deal with the constant question of outing themselves to their patients.  There are many strategies and I would never fault another nurse for not being out to their patients (or even their co-workers) because every person has a right to their privacy.  But this is honestly not something I've ever discussed with other queer healthcare providers.  I am very curious to know how others deal with this and what their rationale is.  I, personally, have adopted the notion to answer the previous questions honestly (No I don't have children.  No I'm not married, but I do have a special partner.  What does he do?  She's a grad student...)  because I believe in normalizing the queer experience to everyday people.  As of yet, it's gone pretty well and no one has "fired" me from being their nurse, though I've had people become intensely more awkward and quiet.  But generally, people are still receptive and appreciative of the quality care that I work hard to provide.  I've actually had some amazing dialogue with patients about what it's like to be a queer nurse/person and it has even facilitated a better therapeutic relationship.

What I'd like to know is: how do other queer identified healthcare workers deal with this situation?  What have been your experiences, positive and negative?  And can we get some research done on this, especially looking at nursing?

Citations (non-APA style because hey, I'm not a student and this isn't a paper for class):
LGBT docs experiences:
When the patient is racist (original article):
When the patient is racist NY Times editorial:
Editorial on the role of nursing in LGBT care:

Wednesday, January 15, 2014

Greetings to you all,

I'd like to take this time to introduce myself and talk a little bit about why I started this blog.  We'll start with the introduction piece.  I am currently working as a registered nurse (R.N) in the women's health field and I recently graduated to become a certified women's health nurse practitioner (WHNP).  I consider myself a strong feminist with a penchant for fighting for social justice.  The self-identifications that I would choose to describe myself and that compelled me to even begin this blog would include: queer, atheist, sex positive, feminist, nurse.

This blog is meant to give a voice to concerns that I have and that I feel are lacking in the dialogue about healthcare and social justice.  It's also a place where I hope to engage other minds so that they can learn, and more importantly, that I can learn from others.  I'd also like to take a moment to note that this blog will frequently reference women and "women's health."  This is the official title of the work that I do and therefore this blog will have a tendency to sometimes skew to cis and heteronormative definitions/ideas/etc.  I apologize for this and it is definitely something that I plan to address in future posts.  However, GYNs are able to take care of people across the entire gender and sexual identity spectrum, and my greatest hope is that this blog helps to illuminate that.

Additionally, as I am new to the WHNP role, I intend to use this blog as a tool to discuss the transition from R.N. to N.P.  It will be a place to discuss the many ups and downs, challenges, frustrations, and rewards of being a nurse.

I hope that you all take the time to read this and enjoy this journey with me.