My First 47 days working as a PNP

My FNP colleague once compared the first weeks of working as an NP to standing in front of a fire-hose. And indeed, I have to agree with her.

I am feeling the full weight of caring for a large number of children who are at high risk for poor outcomes.

I previously worked at this clinic as a nurse, so I was given very little transition time. My schedule quickly filled to the same degree as my physician colleagues. While the original plan was to find a replacement for a physician that moved away in June, we have yet to find a pediatrician willing to work under high stress in a poor neighborhood for very little pay. So I have inherited his panel of 900 patients. Before he left, he handed off his most complicated patients to other physicians, but since their schedules are over-booked I end up seeing those patients as well, and have to consult and research quickly in order to give them the care they need.
This is complicated by the many barriers to care including insurance complications (are they assigned to us? can this really be covered by FPACT?), transportation issues (I have no car, I work 2 jobs), and communications issues (illiteracy, different perspectives of health and wellbeing).

It is an extremely frustrating, demanding, and mentally challenging job. My brain seriously feels like it’s going to explode at the end of every day. Each day I survive an onslaught of patient complaints and new issues I’ve never encountered before. I am constantly feeling unorganized, stupid, and subpar. Of course I understand this is how all new providers feel. That doesn’t change the level of stress and anxiety I am dealing with on a daily basis.

On the other hand, I am also feeling proud of my accomplishments. I have established myself as a full time provider with my own rooms (with bios and business cards), my patients seem to love me (I am the only native-Spanish-speaking provider), and I am getting better at my job every day.

In these first 47 days I have diagnosed a patient with Chikungunya, told a 13-year-old she’s pregnant, treated lichen sclerosis, tinea capitis, asthma exacerbations, acute otits media, eczema, UTIs, migraines, and constipation. I’ve made around 10 referrals to specialiests in development, audiology, optometry, neurology, urology, nephrology, and ortho. I’ve ordered a handful of diagnostics including ultrasound, xray, and MRI. I also cared for children with complicated social and medical histories including previous incarceration, drug abuse, foster children, a kid with diabetes insipidus, and a couple children with epilepsy, a girl with severe burn scars poorly treated in mexico, a kid with a neonatal stroke, a boy on two meds for ADHD, along with the multiple children with obesity, speech delay, and asthma.

I don’t think that fire-hose is going to get turned off any time soon, I’m just hoping I can get more efficient with my charting (staying up till 2 am charting at home is not sustainable), and be more comfortable prescribing medication. I thank God for my supportive colleagues, great training, and two wonderful inventions called Lexicomp and Uptodate.

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