Nurse not Doctor part 1
December 15, 2024
Welcome to my first blog post! Am starting at the beginning, the first question you ask a new client/patient/consumer of mental health services and that is, “what would you like to be called?” As you may have noticed, this website is called Nurse Shana, not Dr. Cantoni. Nurse practitioner training has changed since the early 2000’s when I attended graduate school. About 7 years ago the decision was made by some professional board of nursing bureaucrats that nurse practitioner education should result in a doctorate instead of a masters degree. This extra year of education seems primarily to be rooted in the completion of a ‘DNP’ project, which is a scholarly work. This extra year of education does not offer or provide any extra clinical experience, it does not translate into a near equivalency of a residency program. I have had options to attend a DNP program and have declined. I have noticed that graduates of said DNP programs refer to themselves as, “Dr. so and so.” It is how they identify themselves on zoom meetings, it is a part of their email signatures and although I have not heard this, my guess is that they introduce themselves to patients/clients as, “Dr. so and so.”
I have been a psychiatric nurse practitioner for the past 21 years, prior to that I was an RN for 4 years. There is nothing about my current practice that is not deeply rooted in nursing care and nursing principles. First off, and probably most important, nurses are awesome. In our fractured, divisive times they remain one of the most trusted professions. Let’s ask ourselves why that is? Nurses are the boots on the ground that are present when patients/clients have unmet medical and mental health needs. They are the ones to catch medication errors, assess wounds while doing wound care, use critical thinking skills to question why your blood pressure is too high or too low. In many ways the buck stops with the nurse taking care of you or your beloved family member. Did the doctor order the incorrect dose of medication? Are you having a side effect to a medication? Is that diabetic foot ulcer not healing despite regular wound care? This is to name a few ways in which nurses provide an essential safety net in your health care.
My work as a Registered Nurse was primarily on a neurology and neurosurgery floor at a level 1 trauma center, Harborview Medical Center. I started out there as a new nurse, I was 30 years-old at the time, had many life experiences before I started out on a nursing career and my mind was completely blown by what I had entered into as a nurse on that unit. To state the obvious, a level 1 trauma center means that you are going to have people who had been in car crashes, falls, assaults, gun shot wounds some of which were self-inflicted, spinal cord injuries and on and on. Nothing really could have prepared me for what it was like to have my hands in the care of the patients I had been assigned to. I was in awe of the position that my job had placed me in the lives of people going through a very difficult time in their lives.
It has been over 20 years and I can remember some patient interactions as if they were yesterday. One Christmas eve taking care of an older gentleman who had learned he had a terminal cancer diagnosis, he didn’t have any family and the weight of his situation was palpable. Walking with a young man who had serious facial disfigurement, he also could not see and was holding onto my arm as we walked around the hospital. The looks of astonishment from the passers by at his appearance, which he could not see. I could see them though, and I maintained eye-contact and felt not only unapologetic of this person but also exuding the dignity he deserved. So many calls to the doctor regarding a change in mental or physical status, armed with facts and numbers so that the overworked and tired resident wouldn’t blow off the concern. Discussions with family members regarding patient situations, many of which were not good, sitting on those moments of grief and loss.
On the other side of the proverbial bed rails, 21 years ago my child was born extremely premature at 25 weeks. This came as a big surprise to us, suddenly we were thrust into the world of the neonatal intensive care unit and our baby weighed 2 pounds and 1 ounce. She spent 113 days in that NICU. Yes, there were doctors who did miraculous things, but it was the nurses that cared for our child and for us day in and day out. Early in my daughter’s life she had a medical complication that resulted in emergency abdominal surgery quite early in the morning. The backstory was that the night nurse working a 12-hour shift had noticed that her vital signs were slowly dropping. Sometime around 5am they dropped to a point that warranted a call out to the surgeon and then within an hour or so she was whisked off to surgery. I have reflected back on this scenario many times on the past 21 years. What if the nurse wasn’t paying attention? What is she was done with her shift before it was over and passed it along to the next shift to take care of? That nurse saved my daughter’s life in the course of doing her job that is probably often difficult and thankless.
I am going to end this blog post right here with a to be continued and also the question, why are nurse practitioners not aligning themselves with the profession of nursing?