Clinical Experience is Golden. Or is it just what you make of it?
21 May 2012 4 Comments
in Spirituality & Positive Thinking, Student Resources Tags: clinical experience, clinicals, Family Nurse Practitioner, intern, motivation, NP student, Nurse Practitioner, nurse practitioners, nursing student, residency
I had the opportunity to meet a very humble and clinically astounding physician yesterday. He was talking about the clinical experience he gained during his training in Punjab, India during the 70′s. He discussed how he would sometimes perform over 15 appendectomies a day! He also described the patient population treated in Punjab as “people just desperate for any kind of care”. I suppose it makes sense when you are in a country where the population exceeds its resources. Speaking with this physician made me reflect on what my own upcoming clinical experience could potentially be like.
The physician discussed how he practiced during a time where there was no easy access to MRI’s, CT SCANS, Blood studies, or X-ray imaging. Diagnosis, implementation, and patient management was clearly based on the building of previous clinical experience, hands-on physical assessment, and basic anatomy and physiology knowledge.
He and I joked for a moment as I described to him how my physical assessment class felt like a joke and that I still didn’t understand the first thing about “percussion”. What did it matter anyway? Couldn’t I just order an “X-ray” if I suspected something clinically crazy and/or wild?
His knowledge about the presentation of appendicitis was so great that he even explained the nature of the symptoms to be related to how LONG, LARGE, and WIDE a person’s appendix is. (WOW). For example, if the appendix touches the person’s cecum a little more than someone else’s.. that person might present appendicitis with a great deal of diarrhea.
After chatting with him, I did feel a little overwhelmed and highly incompetent about my skills thus far in my academic and clinical career. However, I told myself to snap out of it. How could I ever compare my level of competence to a practitioner with over numerous years of clinical training and experience? It was at that moment I remembered something my physical assessment and pharmacology professor shared with me last semester:
“No primary care clinic cares about how good your skills are as a new Nurse Practitioner. They just want you to have an EAGERNESS to learn”.
Well, that’s what re-charged me. I reframed my paradigm of thinking and told myself that it’s all about what I make of it. I start my clinical residency in just 2 months or so. I have no idea what kind of clinical experience I will get and HOW MUCH of it I will get. What I do know is that I need to have an OPEN attitude, a willingness to practice, and an EAGERNESS to learn. At the end of the day, some other student may be getting double the clinical experience that I might be getting. HOWEVER, if they don’t come home everyday and diligently EVALUATE exactly what they learned…. (like I will)… their experience won’t have any upper hand on mine.
Patient Tailored Insulin Therapy
14 May 2012 Leave a Comment
in Patients, Student Resources Tags: diabetes, insulin, pharmacology, prescribing
Apparently HCP’s are not prescribing enough insulin therapy in those T2DM patients where oral therapy fails. I can see why and how it would be intimidating–especially for new practitioners. Came across this table which might come useful to me or you in the future.
The most important pieces of information to learn before an interview
01 May 2012 Leave a Comment
in Current News in NP Practice, Student Resources Tags: career, interview, jobs, new grads, new graduates, nurse, Nurse Practitioner
I just saw this in the ADVANCE magazine for Health Care Professionals this morning. This will come in handy for you new graduates and for those (like myself) currently looking for preceptors.
Here is the link: http://www.advanceweb.com/web/emailimages/_eblastimages/ADVANCEPLANNER/201205/MayArticle.html
By Linda Jones
In today’s competitive job market, knowledge is king. The more you learn about a prospective employer before stepping foot in the building for an interview, the better your chances of walking away with a job offer. But with so much information at our fingertips, which details deserve the most attention?
Job Description
Keep your focus on the reason for the interview—you. Don’t become so caught up in learning every detail of company history that you forget to examine the job description and find ways to best emphasize how you fit the role.
Job descriptions can be very detailed, or extremely vague. So use your intuition. Look for certain words and phrases; what are they telling you? Experts claim that job duties typically are listed in order of relevance. Sometimes the company will make it easy—for example leading off with “experience with a geriatric population is preferred.” That’s your cue to build your presentation around your experiences in this area.
Company Knowledge
With that said, you need to do enough background research on the company to portray a genuine interest in the people and organization you are hoping to join. No one expects you to remember the name and title of every employee, but here are some areas where your research will pay off:
• Product and Service Offerings—Get a feel for how the company views itself and the services it offers. Some companies will make their annual report available on their website. Try to remember some of the high points and establish a rough idea of what’s currently happening in the organization.
• Company News—In the Google age, staying up on current events is easy, particularly for larger, public companies. Get an idea of recent happenings—awards the facility may have received; new technologies that have been implemented; or relevant hires at high levels.
• Miscellaneous—Most websites contain a few interesting—if somewhat irrelevant—tidbits about the company’s history. If you have the time and ability to memorize one or two of them, all the better. Odds are the opportunity may never present itself to showcase this knowledge during an interview, but if it does, your research and preparation will be evident.
Your Own Compatibility
Lastly, combine the above elements—your understanding of the job you’re trying to attain and the research you’ve completed on the organization—and tie them into why you are the best fit for this particular position. You can know every fact about the company’s history and management style, but if you can’t use that information to show how it relates to the role you’ll play, it loses all value.
Mission statements are probably the most obvious place to start. Chances are some employees, and even a few managers, don’t know their company’s mission statement by heart, but if you’re able to take even a few of its basic points and work them into normal conversation, you can impress a hiring manager.
Pay close attention to promotional opportunities and be ready to use them in your answer to the common “where do you see yourself in 5 years?” question. An understanding of the organization’s internal promotions process will help you to answer this question appropriately.
Finally, keep your eyes on your ultimate goal. One often-overlooked benefit of completing research before an interview is it can provide a snapshot of what a career in that particular setting might entail. You might find that the position isn’t exactly what you’re looking for. But hopefully, you’ll find you’re interviewing for something that resembles your dream job.
Dyspepsia Diagnostic Tree
30 Apr 2012 Leave a Comment
in Student Resources Tags: abdominal mass, anemia, antibody test, biopsy urease test, dyspepsia, dysphagia, GI bleeding, Helicobacter Pylori, lymphadenopathy, stool antigen test, urea breath test, vomiting, weight loss
Looking for a preceptor… I feel like a beggar next to the Ganges River
30 Apr 2012 Leave a Comment
in Spirituality & Positive Thinking, Student Resources Tags: clinical rotations, clinicals, FNP, nurse practitioners, Nursing School, preceptors, primary care, searching for preceptors, university
Beggars
My earliest memory of traveling to India is walking along the Ganges River with my mom and uncle..scared shitless of the thousands of beggars lined up next to the banks. I saw armless, legless, dark, yellow, green, dirty, crying beggars–just asking for any alms they could get.
That is exactly how I feel right now as I tread on my quest searching for a preceptor in primary care. I may be exaggerating a bit (but in my head and in my heart this is exactly how I feel).
My university has left me with the option that I can either search for a preceptor by myself OR I can have them match me up. They added a disclaimer, “we won’t match you with your best match”.
Well, that is just comforting.
I am finding it difficult to understand why it would be so painful to locate a preceptor. Everyone I have contacted so far has said, “we already have many students lined up from other universities”. One of the main reasons for entering this profession was so I could feel appreciated and so there would be an abundance of work. All this competition makes me wanna vomit x 3 green small amount.
Guess I will keep searching for a bit. After putting in 98% of my effort, I shall do what I do best: Leave it to the stars.
The beggars seem pretty happy anyway. They may be sleeping on empty stomachs at night. However, they are not taking Ambien nor are they sleep deprived over issues of liability or pending lawsuits.
I Didn’t Know that was a Fungal Thing
23 Apr 2012 Leave a Comment
in A Day in Clinical Rotation, Student Resources Tags: dermatophytosis, fungal, fungal infections, integumentary, noncandidal, skin, skin disorders, tinea, tinea versicolor
I had my first skin disorder case just a few days ago. Here is the SOAP for it.
Chief Complaint: “I have these weird spots on my forearm, abdomen, and upper thigh, and groin that are nonitchy”
Subjective: Non-itchy, nonpainful spots that appeared 3 weeks ago which have persisted since. Denies any recent viral illness or fever/nausea/vomiting/diarrhea .. Denies any recent travels. Pt stated that she started a new job at an eyebrow threading salon around the same time spots appeared. However, denies recent exposure to drugs, environmental or occupational toxins or chemicals. Patient has been taking OTC anti-fungal topical treatment, applying it 2x a day. Denies any improvement in response to treatment.
Objective: Spots are darker (brownish) than rest of skin tone, spots are size smaller than a dime, dry, flat, odorless, configuration is diffused, Localized to the forearm, abdomen, and upper thigh. No exudate or bleeding noted. An erythematous border surrounds lighter skin.
Assessment: A bit of the skin must be gently scraped off to be observed under a microscope. The skin must be looked at under a wood’s lamp, by holding it about 4 or 5 inches from the affected skin. If the patient has tinea versicolor, the affected skin appears yellowish-green in color when looked at with this lamp
Diagnosis: Tinea Versicolor
Selenium Sulfide: Apply 2.5% lot qd x7 days
Info: Do not apply to inflamed or broken skin; apply x10 mins, then rinse.
Treatment: There are anti-fungal shampoos, soaps, creams, and lotions that can keep the yeast under control. The active ingredient in these medicines is often selenium sulfide, ketoconazole, or pyrithione zinc. Tinea versicolor often returns, especially when a person lives in a place that is warm and humid. Using a medicated cleanser once or twice a month, especially during warm and humid periods, can prevent the yeast from overgrowing again. A dermatologist may prescribe these pills if the tinea versicolor covers a large area of the body, is thick, or often returns after it is treated. These pills are taken for a short time. But anti-fungal pills can cause unwanted side effects. They can interfere with other medicine that you take. A dermatologist will monitor a patient who takes this medicine.
Follow-up: If improvement is not seen in 4 weeks, make an appointment with the dermatologist.
Tinea Versicolor
Monitoring:
With treatment, the yeast is easy to kill. IT IS NOT CONTAGIOUS. The skin, however, may stay lighter (or darker) for weeks or months. The skin will eventually return to its normal color. To help even out your skin tone, you should protect your skin from the sun and not tan.
Tinea versicolor can return. When the air outdoors is warm and humid, the yeast can quickly grow out of control. Some people who live in a tropical climate may need to use a medicated cleanser to prevent the yeast from overgrowing. People who live in an area that becomes warm and moist each spring may see tinea versicolor return every year.
A website I found to be very helpful in deciphering the information above was the “American Academy of Dermatology”
E-Medcape Treatment and Management
How much caffeine is too much caffeine?
26 Mar 2012 Leave a Comment
Great questionairre on the consumption of caffeine by Dr. John Preston.
Take it and find out where you stand. Is it causing your sleep problems?
—–> Click here for the caffeine questionairre
What is “Mindfulness” ?
21 Mar 2012 Leave a Comment
Here is an EXCELLENT blog written by Brain Hines on “mindfulness” and how to practice it.
C’mon, Get Happy
21 Mar 2012 Leave a Comment
in Eastern Medicine, Spirituality & Positive Thinking, Student Resources Tags: wholistic holistic
14 ways to fight DEPRESSION naturally (by Lisa Turner)
I found this article in a wellness magazine and became pretty interested since my thesis topic is related to research in depression. Not sure what Lisa Turner’s credentials are, but based on previous knowledge that I have gained on natural health.. all this makes sense!
*Note: Please consult with your healthcare provider before beginning any herbal treatments or supplements especially if you are taking any other medications because there might be possible interactions. 
1. St. John’s Wort- herb found to be as effective as antidepressants. Improvements were seen in their symptoms after 12 weeks. 900 mg per day has been recommended.
2. Skip the Diet soda. Aspartame is a excitotoxin used as a sweetener. Drink iced Jasmine green tea or sparkling water instead.
3. Curb your sweet tooth. Sugary treats lead to blood sugar fluctuations that can cause mood swings, fatigue, and symptoms of depression.
4. Cut the alcohol. It is a nervous system depressant. More than 2 drinks a day can disrupt REM stage of sleep.
5. Nosh on Brazil nuts.They have a lot of selenium which is linked to decreased depression rate due to the powerful antioxidants.
6. Sam-e. Known to be involved in neurotransmitter function.
7. Move it. EXERCISE! The endorphins increase mood positively. In a study, it was found that women who exercised to their own regimen (rather than a prescribed one) were more likely to stick to it.
8. Use saffron a spice traditionally used in the Middle East to uplift spirits. Some studies claim that this spice can have the same effect as Prozac? (hmmm)
9. Turn on the lights. Light therapy has been used for many years to treat SAD (seasonal affective disorder). Invest in a light box…better get GO OUTSIDE and get natural sunlight!
10. Bake with buckwheat gluten-free and rich in magnesium–necessary for synthesis of serotonin (needed for proper balance of mood).
11. Boost your B’s– B vitamins are critical for converting amino acids into neurotransmitters.
12. Say ommmm. Yoga, deep breathing, and meditation all relieve stress.
13. Zone in on Zinc- Low levels of zinc have been found in people who have depression.
14. Feast on Fish – Omega 3 fats are the safest treatment for mood disorders and depression. Some studies show that the production of serotonin, norepinephrine, and dopamine is slowed in cases of inadequate omega-3 intake.
