Reflection Blog

  • Do you feel prepared to practice as a Family Nurse Practitioner? Why or why not?
  • What skills and common diagnoses do you feel you need to research further for independent practice?
  • Reflect on the goals you set during Week 1 of the course. What goals have you met? What do you need to do to take what you have learned with you into practice?
  • What new goals do you have to prepare yourself as you transition into practice?

My time as a nurse practitioner student in Samuel Merritt University’s accelerated NP program did go as expected. I feel prepared to practice as a Family Nurse Practitioner who can work in the primary care setting with some guidance in the initial period. I’m not ready to work in urgent care setting as I have very less exposure to all the procedures that a provider in urgent care should know how to do it in the case of triage such as suturing. The medical field is a journey of lifetime learning in which you never stop learning different treatment approaches, diagnostics, prevention plans based on evidence- based guidelines and recommendations.  I learned a lot during my clinical hours.

New learning goals for N680L during Week 1

My learning goals for next semester includes working in the specialist clinic as Coumadin clinic, express care, ortho specialty, I want to be more confident in making treatment plans, be excellent in SOAP notes and seeing a different variety of patients.

I met my Coumadin clinic goal as well as express care but unfortunately, I’m not able to find preceptor who only deals with Ortho problems. I have seen patients in family practice with back pain, sports injuries, and muscle spasms. I’m confident with them but never get exposure to do knee injections. It took time, hard work, dedication, always eager to learn something new, the sacrifice of family and personal life to achieve these goals. Now I’m confident to make treatment plans for diseases I encounter. I’m able to see 15-18 patients in 10 hours of clinical practice.

New goals for transition into nurse practitioner

Transition phase of RN to NP is quite bit challenging, as a scope of practice of an RN is totally different to the NP. The organizational expectations to be clinically competent and able to meet the demands of a complex healthcare system can be overwhelming.

My new goals are to get my certification, finding a job in primary care where I can work for the underserved population. I want a mentor who helps to pass this phase smoothly. I will always follow the evidence-based practice, keep myself updated with new guidelines to work in primary care practice. I will join NP organizations to attend meetings and conferences to gain more confidence in practice.  

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Delivering Difficult News

Delivery difficult news to patients is sometimes very challenging to the providers as it involves emotions, stress, anxiety and fear. I’m going to the transition from RN to the provider so I have to face this type of situations very often. Empathy approach, a good listener, staying calm in stress situations as well as maintaining professional attitude are some of the qualities needed in provider during this task. All concerns of patient need to be cleared, the treatment plan should be discussed as well as follow up. SPIKES protocol is helpful for the provider to stay focused in this situation.

Case 1.

In this case, I will get her previous pregnancy history if she has any. I will start with some general discussion as a friendly approach in beginning will help patient to discuss all of her concerns. Based on the 2 consecutive HCG drops, I will initiate a difficult discussion with the patient that progressive decline in HCG as representing, a nonviable pregnancy. I will address the issues of guilt, blame, and grief associated with miscarriage. I will discuss with her need of further transvaginal ultrasound. I will discuss management options, including chemical induction, dilation and curettage, and watchful waiting. I will reassure her by letting her know that spontaneous abortions happen to many women, it will not affect her future fertility.

Case 2.

I will start the conversation with a patient based on her knowledge and by making her comfortable in the room, I will start the conversation by saying I get her biopsy results and then will interpret the results in a language she understands and based on how much she knows about breast cancer. I will reassure the patient that breast cancer is very common in the United States and the prognosis in stage 2 is very good. I will further discuss treatment options that include surgery, chemo, and radiation therapy. I will provide information about resources and support group. Emotional support with time spending with the patient is needed in this case to answer all the questions and concerns of the patient.

Case 6

In this case, I’m dealing with a teenager, so I need a patience because it may involve lots of anxiety, lack of knowledge and concern about confidentiality. I will reassure her it is a Herpes and it is one of most common STD’s but it is curable. I will explain to her causes of Herpes such as multiple sex partners, previous histories of STD’s, then I will explain her treatment plan which involves Acyclovir 400mg Po 3 times a day for 7-10 days. This will clear up the outbreak she is currently having. I will let her know she can have outbreaks again or may not have but if she again develops outbreak then suppressive therapy can be useful. I will give her instructions to not having sex until her symptoms clear, avoid unprotected sexual intercourse and her partner needs to be evaluated so that he can start treatment.