Checking out the "real" NP world

I have to admit, as a military FNP, I am a little sheltered from the “real world” of NPs. In our community, FNPs usually work in primary care and, occasionally, pediatrics. We don’t typically specialize in areas such as surgery or dermatology. There are programs in the military for our PA counterparts to branch into specialty practice—most common is surgery or orthopedics—but they are not available to us. Why this is, I cannot answer. I would think it has much to do with the current shortage of primary care providers, but if that is the case, why do PAs occasionally specialize?

Over the last few months, I have met more and more civilian FNPs and am frequently surprised by their ability to specialize. One works in general surgery at the Veterans Administration (VA) facility in town, and prefers to specialize in breast surgery. I was thrilled to hear this because, historically, the VA has been a “man’s world” where there were few services tailored to the female veteran. Another friend works in oncology, both inpatient and outpatient. She talks about how removed she feels from “regular” medicine, and my head spins thinking of all the complicated medication regimens she prescribes.

The one that surprised me the most? A friend who is a women’s health NP recently interviewed for a job in pain management. My first question was, “Can you really do that? Take care of men, too?” And, apparently, she can!

As my time to leave the military slowly approaches—I have just three years left!—it is a little overwhelming to think I will have to go looking for a “real job” and that there are more options than family medicine. I still don’t know that I would choose something else. I enjoy the variety of what I do. But, you never know what door might open when the time comes!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

A REAL doctor!

I had one of those experiences last week that I know is not specific to military medicine. I am sure it happens to our civilian counterparts, to other NPs and PAs. And I know it happens on a near daily basis at military treatment facilities worldwide. As I walked into the exam room and introduced myself as a nurse practitioner, the patient announced she was “forced” to come to our clinic and “wasn't allowed to see a real doctor” downtown. I was slightly taken aback. Here I was, running on time, in a pretty good mood and ready to assess and treat to the best of my abilities, and then WHAM. I took a deep breath and realized she wasn’t slamming NPs; she had a grudge against military providers, regardless of education background.

Some people think we are on active duty because we can’t cut it in the “real world,” that we are somehow subpar when compared to our civilian peers. And, people do sense a lack of control, since they have to enroll with a provider at a military clinic, requirements put in place by TRICARE (basically, our military HMO/PPO/insurance provider, depending on current terminology). In reality, we are all credentialed and/or certified in our specialty and really have two specialties to maintain, our civilian requirements and our military ones. I honestly believe military medicine should be it’s own specialty, since we have to know how various military-specific careers affect disease processes. And don’t even get me started on deployment medicine—who needs malaria prophylaxis, who is more resilient and able to tolerate the stress of deployment, etc. I could go on and on!

So, what did I say to that patient that day? Basically, a toned-down version of the above. That she is actually lucky, that we are a unified practice of providers all credentialed in our fields, who “get” the difficulties of being a military family. Then I asked, “What can I do for you today?” and we progressed on with the visit. I hope it was a positive experience for her and she won’t be so opposed to military providers in the future. Time will tell.

As NPs, that is all we can do; try to show the world—a patient at a time—what we bring to the table and what we have to offer. And, to hope that, over time, the response won’t be, “I wasn’t able to see a real doctor” but that patients become more accepting and some will even prefer to see us for what we have to offer!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.