Entering into the new role of a Nurse Practitioner is difficult. We’ve taken all the course work, fulfilled all the requirements and successfully passed our national certification exam. We now have to learn how to actually ‘do’ the job.
It parallels the same phenomenon we experienced when we graduated basic Nursing school. There’s what they teach and show you in school… and then there’s what happens in real life.
One of the things they don’t ‘teach’ you is how to walk across that imaginary line. The line drawn in the professional sand that separates the RN from the NP (APRN, CRNP, ACNP, etc.) The ‘advanced practice’ line.
This may only apply to the role of an NP caring for the inpatient population, but there comes a moment when you have to actually piss off the bedside nurse. You have to be the bad guy. You have to be the provider that causes a tad bit of nurse-misery.
The nurse-misery I’m talking about is making the job of the bedside nurse worse than it already could be. You write an order that is going to tax their physical and emotional tolerance as well as test their patience.
Here’s an example:
Or ordering Go-Lytely, Kayexalate or serial enemas…
You get the point.
As a Nurse Practitioner you have the medical rationale to support why you place such an order, but as a former bedside nurse, you know how bad it will sting……
so you feel guilty and horrible.
Regardless of how bad you feel for the bedside nurse, you know the order needs to be placed and the intervention needs to be carried out to provide the care needed for your patient. Whether you’re treating a lethal electrolyte level, prepping for a procedure, or addressing constipation it’s a needed therapy for your patient.
Aaand whether the bedside nurse wants to hear it or not, a patient can become severely septic and (or) develop a medical emergency (colon perforation) if the constipation is left untreated.
But, let’s be serious here. When I was the bedside nurse, all I heard from any of those orders was the amount of clean-up I had to endure or how uncomfortable it was going to make my patient (or me).
This is when you have to brush up on your communication skills because the way you deliver this sort of message matters greatly.
The last thing you want to do as an NP is to be perceived as demeaning, condescending or dictator-like when placing these types of orders.
Because you know better than anyone…..
You do not to piss off the nurses.
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