Code Bell
Boston, MA
Female, 34
I have been in the nursing field for 12 years. I have worked as a RN in an adult medical-surgical unit, Neonatal Intensive Care Unit (NICU), and Pediatric Cardiac Intensive Care Unit (CICU). I went back to school to obtain my masters and now work as a nurse practitioner in a Pediatric CICU. These kids are sick. The issues can be straightforward or extremely complex. No patient is the same and no day is routine. I am lucky- I love my job (most of the time).
You usually don't drop dead from a hole in your heart but I wonder if you are referring to the hole called a patent foramen ovale (PFO)? It is the type of hole that Tedy Bruschi (patriots football player) had in his heart that lead him to have a stroke..... 20% of all people have this type of hole in the heart. It is a hole that is part of fetal circulation (in utero). In 80%of cases it closes and in 20% of cases it does not. Most people have no idea that they have an open PFO because there is no clinical significance UNLESS you have a clot that passes through the hole and goes to the brain therefore causing a stroke. Yes- you can screen for this as babies but there really isn't anything to be done for it and you would be hard pressed to find a clinician to close the hole for you- because the act of closing it would be more risky then actually having the hole. However- if you have had a stroke, etc then yes- a physician would close the hole. With kids just dropping down playing sports, etc- it is usually related to a rhythm disturbance not necessarily a hole in the heart. I hope that this answers this question...
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In general where I work - most practitioners (MDs, NPs, RNs,etc) are both. It is a difficult balancing act but you can always be caring regardless of the circumstances. The best clinicians provide great care and have great relationships with the families. It is about being truthful and EVERYTHING is how you say it- never what you say. You can give the most devastating news in a careful/caring manner and the information is delivered and the family knows you care. The balance is only difficult when the caring outweighs the clinical- ie becoming TOO close to a family. It is impossible to make good clinical decisions if you are clouded by a personal relationship. Burning out is common. I protect myself by keeping patients/families at arms length- it is difficult but important.
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I would absolutely speak up. Communication is key in healthcare as in any profession. We look at the healthcare team as a sum of its parts with no person having more significance than the others. Everyone brings a different perspective and their voice is important. We are required to take classes in communication so that important information doesn't get overlooked because someone is afraid to speak up. The classes involve role play, etc and it has helped those that are less confidant or newer staff speak up to interject when they should.
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Yes and no. Nurse Practitioners are GREAT but they do not have the breadth of knowledge that a physician has. So for everyday illness and common things- great but for something more serious- a physician has the more in-depth training to go on.
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Male nurses are on the rise especially in higher acuity care (Intensive care units). It is still predominantly female but there is a rise in male nurses. AND contrary to popular belief- they are not all gay. Alot are military or second career.
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A nurse practitioner is considered a mid-level practitioner or physician extendor. You can think of a nurse practitioner as a hybrid between a RN and a physician. A nurse practitioner can diagnose an illness, order tests/laboratories, and prescribe medications. In some states a nurse practitioner can practice independent of a physician and in others a nurse practitioner needs to work collaboratively with a physician. In my unit my role is most similar to that of a fellow (a physician in training). I have my own patients that I am in charge of for the day- I examine the patients, order appropriate tests, and make a plan of care. I present all the data on morning rounds to the attending that modifies the plan as they see fit. A registered nurse provides direct patient care. They are truly the workhorses of the hospital. They carry out the plan of care and obtain the tests ordered by the nurse practitioner, physician, or physician assistant.
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I no longer work in the NICU but when I did we attended all of the high risk deliveries (those with known prenatal diagnoses that require immediate care, any with perinatal complications, preterm deliveries, multiplies and all cesarean sections). Even though we attended all of those deliveries not all of those infants were admitted to the NICU. I would have no idea what the percentage would be but it is very low.
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