October 28, 2017

From Bedside Nurse ➡️ NP Student: The Differences

I started my nursing journey as a patient care technician while in nursing school. I got the nurses their coffees, checked the patients' blood sugars, picked up food trays, and assisted with baths. That position helped me to find my passion for critical care. Now, as an emergency department nurse-practitioner student, I'm using the Modified Wells' Score and Ottawa Subarachnoid Hemorrhage Rule to help rule out or rule in my differential diagnoses. What a difference a few years can make. I am currently in a Dual Role (Family NP/Adult-Gerontological Acute Care NP) BSN-DNP Program. I've completed family medicine, pediatrics, gynecology, obstetrics, and internal medicine clinical rotations. Currently, I'm in the emergency and intensive care rotations. With each rotation, I learn about different disease presentations and treatment guidelines, and the one that has touched my heart the deepest is the emergency department. It’s odd, because I'm an intensive care nurse and usually there is beef between the emergency department and intensive care nurses. Haha! It's really more our inability to understand each other's goals and environments.

As an intensive care nurse, I want the full story. I have the time (usually) to sift through documents (from outside establishments and other internal departments) and read the many diagnostic scans that have been completed. I can send a rainbow of labs and investigate what is going on within my patient. In critical care, you must know everything. The “why” is just as important as the “what.” Was the fever present upon admission? Does the patient take antihypertensive medications at home? My priority is to learn everything - all of it. This is unlike my role in the emergency department as a graduate student. When I'm in the emergency department, my goal is focused on the chief complaint. I'm no longer in the role of providing bedside nursing care. I'm now the creator of the medical plan. I initiate policies, I order diagnostics and necessary medical tasks, and I evaluate subsequent results and determine admission criteria (with collaboration, of course). My line was intensive care. I've been doing it for six years, and I know it pretty damn well (I hope).

Now, I'm in an entirely different world of differential diagnoses, medical plans, bedside procedures, and admission criteria. If I'm honest, there was a role strain initially. Bedside nursing prepared me for the art of physical assessment and standard treatment options, but I lacked proper critical thinking concerning disease manifestation. I know vasopressors and clinical presentations of sepsis (because I have extensive experience in these areas), but pediatric impetigo? Yeah, it took me a few patients to be able to eyeball that one (without preceptor input). As an emergency department nurse-practitioner student, I present cases to medical teams and emergency department residents in the hope that I'm on the right track and that my differentials are on target. I'm the new kid on the block all over again, making differential errors (during provider huddle) and not always knowing the next appropriate clinical move. It's tough to be uncomfortable and sometimes wrong in your new-found role. But as time passes, it occurs less, and I build my knowledge base. Changing roles is a scary process, but I love every minute of it. I hope this post motivates those nurses considering making a change from bedside to an advance provider role. It's so much fun and exciting. I love it (even if I am working for free), haha.

This is new series I'm starting as I approach graduation (hopefully I gradaute, haha)...

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