Tightly Scripted: One NP’s Experience with Retail Clinics

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Retail health clinics (walk-in clinics that are in a retail setting such as a drugstore or discount department store)KarenRoush have become an effective mode of providing increased access to care for many people and a growing source of employment for nurse practitioners (NPs). Their place in the health care arena may take on even more significance as the Affordable Care Act (ACA) increases access to care for previously uninsured people.

I worked as an NP in a retail clinic for about six months while working on my PhD. I left because of concerns I had about the model of practice. It didn’t have to do with the fact that I had to mop the floor at closing time or collect the fees and cash out the “drawer” every night. Nor because I spent eight hours alone in a small windowless room tucked away in the back of a drugstore. Those aspects were not great, but they weren’t deal breakers.

What was a deal breaker was the rigid programming of my practice. The computer was in control. From the moment the patient checked in at the kiosk outside my door, every action was determined by the computer.

The organization I worked for prided itself on following evidence-based […]

2016-11-21T13:06:09-05:00November 1st, 2013|career, nursing perspective|2 Comments

Guess Who’s Wearing Housekeeping Garb Now? Surprise! It’s Your Nurse

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Catch-all: noun [usu. as modifier]

a term or category that includes a variety of different possibilities: ex. the stigmatizing catch-all term “schizophrenia”

American Hospital/by J. Paradisi American Hospital/by J. Paradisi

The first thought that came to mind after I heard that Vanderbilt University Medical Center had laid off its housekeeping staff and assigned cleaning patient rooms to nursing was this: Has anyone from the hospital’s administration ever looked inside the nursing staff’s refrigerators, microwaves, or sinks?

Universally, nurses’ staff lounge kitchens nearly rank biohazard status. In every unit a single nurse, but often it’s the unit secretary, martyrs herself (or himself) by emptying these refrigerators of forgotten food. She washes the moldy containers and places them on a nearby countertop, with this message scrawled in Sharpie:

CONTAINERS NOT TAKEN HOME BY WEDNESDAY WILL BE THROWN OUT! (Caps intended)

Another sign commonly posted above the staff lounge sink or microwave by this same nurse or unit secretary reads:

CLEAN UP AFTER YOURSELF! YOUR MOTHER DOESN’T LIVE HERE!

Fact: Nurses know a lot about infection control, but this does not automatically make us good housekeepers. Besides, nurses already have a job: keeping hospitalized patients safe while assessing their needs and administering their care.

While Vanderbilt’s decision to lay off its housekeeping staff and assign […]

Taking Flight: A Nurse Recharges Her Batteries

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

interior, BK 117 medical helicopter interior, BK 117 medical helicopter

You’re part of a fixed-wing flight transport team called to pick up a 32-year-old male who’s been involved in a paragliding accident in Puerto Rico. Upon landing, you see an ambulance at the end of the tarmac. As you exit your plane, the ambulance pulls up and the crew opens the back door of the rig. They pull the patient out on a stretcher and hand you a folder of X-rays, saying, “He’s all yours.”

After four days of intensive training in the Air Medical Crew Core Curriculum course, my team was given that scenario as a group assignment on the last day of class. We were given a folder of radiology films and briefed on our patient’s vital signs and our assessment findings. We conducted a quick “field interpretation” of his X-rays and presented our interventions, along with our concerns and specific accommodations for transporting this unstable patient to Florida in a Learjet.

This was no ordinary class. Offered to nurses and other […]

Differentiating Nurse Burnout From Boredom

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

BarriersToAccussParadisi

Nurses frequently discuss burnout. Sometimes it’s called compassion fatigue. Regardless of which term, nurses are at risk because our work requires complex technical skills, an expanding knowledge base, physical endurance, and critical thinking, since a patient’s symptoms often do not present in a manner described in the textbooks studied in nursing school.

Above and beyond this, nurses are expected to display warmth and caring towards their patients, even ones who are rude and argumentative. This alone requires character and self-discipline. Add inadequate staffing ratios to the mix, and it’s easy to understand that at some point, a nurse may become susceptible to burnout or compassion fatigue.

Nursing school graduation and passing NCLEX don’t make you a nurse. These milestones earn you a place at the starting gate. It’s up to the individual nurse to navigate her or his career towards growth and longevity. I clearly remember, several years into my practice, recognizing that I’d reached a point of expertise in which I might not know exactly what to do in any emergency, but whatever intervention I chose would be safe and maintain a patient until the doctor or code team arrived. This was around the same time I stopped feeling nauseous every time I pulled […]

The Heart of a Nurse

By Diane Stonecipher, BSN, RN. The author lives in Texas. Her forthcoming Viewpoint essay in the October issue of AJN, “The Old Becomes New,” will consider aspects of nursing that may be obscured or lost due to overreliance on technology.

Heartstudy by James P. Wells, via Flickr Heartstudy by James P. Wells, via Flickr

I am somewhat embarrassed to admit that my initial interest in nursing came as a 10-year-old Yankees baseball fan. I could not get enough of The Mick, Elston Howard, or Mel Stottlemyre on my transistor radio, during televised games, or in my baseball card collection. I decided that I could be the team nurse—take their vital signs, set their broken bones, assess their injuries, and best of all, travel with the team.

This rather irrational desire was solidified when my aunt had a face lift. I was 14 at the time, and she recovered at our house, specifically in my room. She was swollen like a prize fighter, with bloody bandages that needed changing, pain medication to be dispensed, meals to be fed—I was hooked. I am not sure I even knew what a nurse really did, but my heart was stirred.

I sailed through high school, graduated with honors, and left for one of the three […]

2018-03-28T10:30:20-04:00August 14th, 2013|career, nursing perspective|17 Comments
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