Saturday, February 18, 2017

Why a nurse practitioner and why full practice authority.

In May of 2000, yes almost 17 years ago, I finished a 4 year degree in nursing. By some reports this is one of the most difficult degrees to obtain.  I would agree. When I finished my BSN I had no desire to get a higher degree in nursing. I worked as a bedside RN for 5 years before I decided to get a Master's degree in nursing. During that time I spent 36-48 hours each week doing hands on patient care.

In October 2005 I made the decision to further my nursing  education. My husband and I had moved from Fort Worth, TX to a small town in southeast OK. I was back to working night shift and we wanted to start a family. Night shift is not the best shift for a new family. So, I did some reasearch and started the Family Nurse Practitioner program through the University of Alabama at Birmingham in the spring of 2006. I was responsible for finding my own clinical sites. I quickly found there were not many nurse practitioners in my area. When I finished my program in May 2008 I had completed over 700 hours of clinical time with a physician or NP.  I still had to pass my boards. I spent 2 months review for this test and passed in July 2008. By this time I had been a RN for 8 years.

I took my first, and only, job as a Family Nurse Practitioner in September 2008. I have been doing this for over 8 years now.  I can truly say I love my job. Depending on the day I will see 15-28 patients in a day. These patients range in age from just days old to their 90's. I see patients for well checks, sick visits and management of chronic diseases. In December 2015 I obtained an additional certification in Advanced Diabetes Management through the AADE. I am covered by malpractice insurance through my employer. I also have to obtain continuing education hours every 2 years when my license renews.

Many people don't know what sets apart Nurse Practitioners from other health care professionals. We are governed by the Board of Nursing and have a nursing background. Some states have different rules regarding NPs. In the state of Oklahoma I am required to have a physician (MD or DO) sign my prescriptive authority. This physician is not required to be in the office with me. He/she does not have to review my charts or sign off on anything I do. They are not required to see my patients. I have my own patient load -many of whom request to see me when they call to make an appointment. I assess my patient, order and interpret tests and order medication. There are a few medications I cannot order- like ADHD meds and hydrocodone.

In Oklahoma, physicians are only allowed "supervise" two full time NPs at one time. In rural Oklahoma this becomes a problem and limits access to care. It took the clinic group I work with 3 years to recruit a physician to work in one of our clinics. At times they have to pay physicians to sign the supervision paperwork even though that physician does not work for our clinic group. This is money that could be used to give more services to our patients. Some NPs pay $500-1000 a month for a supervising physician. That's $6000-120000 a year.

What does full practice authority mean? It means NPs do not have to have a physician sign that paper. It does not change what I do every day. I still see patients, order and interpret tests and order medication. But it makes it easier for NPs to get jobs and open clinics. Thus improving access to care. And in a state that ranks 49/50 for access to care this is a big deal. Research shows that nurse practitioners provide safe care for their patients. HB 1013 is up for a vote in the Oklahoma House of Representatives this next week. It would grant full practice authority to nurse practitioners in our state.

Please call your representative to support HB 1013 today.

Sunday, October 2, 2016

On my children's baptism

Thirty years ago, on a Wednesday night, I heard a teacher talk about Jesus and how He died for my sins. I went home that night and asked my mother and she told me what it was all about. That night, in my bedroom, she led both my twin sister and I in the prayer of salvation. The next day our pastor, Brother Gibson, came by to talk to us about it. It did not seem unusual to me at the time. Now, as a mother, I wonder what that conversation was like when she called him up. Did she wonder if she had done it right? Was it a matter of fact conversation? Here's what happened, will you come talk to them? I was baptized on a Sunday morning in August. I wore a red and white dress. I knew what I was doing was a big step but I had no idea how big. I had no idea how that moment would affect, shape, direct my entire life.

Last December I decided to do an Advent Box activity I found online. One of the nights we were talking about Jesus and how He came to die for us and how to we have to pray and accept His free gift. My, then 5 year old, son very matter of factly said "I'm going to do that tonight!" My husband and I just looked at him and said "ok". After more discussion that night, he did pray and ask forgiveness of his sins and asked Jesus to be his savior. He's always been a child that made up his mind about things pretty quickly and knows what he wants to do. We decided to give him some time to think about this and make sure he really understood.

Last month my daughter, who was 9, came to me to talk about salvation. I have been praying for this for several months and had talked to her about it on several occasions. She has to think about things for a while before she can make a decision. She needs to know she understands before she commits. That night she decided it was time to confess her belief in Jesus and accept Him as her Savior. When she told her brother the next day he said, "Yeah, I already did that."

Today, they were both baptized by my husband. Here's why this matters so very much. The water in the baptistery has no special powers. It cannot heal. It cannot save. It cannot make anything better. But it was a symbol. A symbol of dying. A symbol of living. A symbol of the washing away of sin..of things we should not have done or that we should have done but did not. A symbol of forgiveness. Knowing Jesus will change the way they live. It will change the way they view and interact with the world around them. They have no idea how this will change them and change their lives. I don't know either. But I know my story and I know how it changed me. Since they were born I have wanted more than anything for them to know my Jesus. I have looked forward to this moment. My daughter told me not to cry but it was difficult because my emotions often spill out through my eyes. I so look forward to watching these two grow in their relationship with Jesus.

Saturday, September 17, 2016

Disaster Relief Day 5: Church Camp for Adults

I've decided disaster relief is like camp for adults. The past 4 nights I slept on an air mattress in a church.  I shared a room with ladies from North Carolina and Virgina. My roomie from Virgina was a new college graduate who had all the entusiasm of a young adult ready to conquer the world.  She came in each day smiling and smelling of a combination of mold and a hard days work. Two of the ladies in my room looked to be in their seventies and spent all day doing laundry.  They were up before anyone else and came back to the room after everyone else. Th 5th lady in my room was probably I her 50's and was an Assessor. She spent all day driving from house to house looking at what needs to be done and reporting back to her crew.

A typical day started around 6 Am when we got up and got dressed and ready for the day. We had a morning meeting at 6:45 with brief instructions for the day followed by breakfast. (There was an entire other crew cooking for the volunteers.) Lunch options were spread out on the table and each person was in charge of packing his/her own brown bag lunch including snacks. We headed out around 7:45 AM. The rest of the day was spent working until around 4PM. There were coolers full of water and Gatorade available all the time. We took a break around 9:30 AM and then lunch was around 11:30

When we got back to the church it was a race to the shower.  This was one time I glad to be a girl because the female showers did not have as long a line as the male showers. The "shower trailer" was a hoarse trailer divided into 6-9 shower stalls each with their own changing area. 

We had dinner at 6 and devotion at 7. By 9:15 most nights we had the lights out. I got about 2 hours more sleep each night than I do at home.  I guess that's the way this was not like camp. Once the lights were out so were we.

One of the cool things about disaster relief is that they send you a state pin from whatever state you have worked in to put on your hat. So all the old guys that have been doing this for years sit around and talk about all the disasters they have worked and compare pins.  

So if you are nostalgic for church camp days but don't want to spend a week keeping up with teenagers volunteer for disaster relief.  It's a lot of work but a load of fun.

Friday, September 16, 2016

Disaster Relief Day 4: Life Lessons

It's been a month since the flooding hit Baton Rouge. Most homes have had some if not all the work done to them.  They may need to be sprayed to kill mold and prevent growth of mold but for the most part the work has been done. The homes that are left belong to people who cannot physically do the work,  the are dependent on other people.  The home we worked in today was a prime example.  We never met the homeowners but we had contact with their adult children. I'm pretty sure they'd had no idea what the home would look like when we were finished.  Our basic job is to clear the entire house so it is empty. Picture all the knick knacks, paper and furniture in your home. Now picture 20 strangers throwing it all into buckets and wheelbarrows and dumping it in a heap on the sidewalk. This was our job.  

I've always looked younger than I am. Which is a blessing when you reach the late 30's. But I've always felt the need to prove to people that I'm not a little girl. I guess some habits die hard.  With the exception of the 11 year old I was the smallest woman on our team.  And I wasn't bigger than her by much! But everybody on the team gave me a chance. I learned how to take about sheetrock and door frames. One big lesson I learned : if you don't know how to get it apart just hit it harder.  I so appreciated all the words of advice. 

One life lesson I have learned over and over is that if you work hard, don't complain and don't give up people will be more willing to help you out along the way.

Wednesday, September 14, 2016

Disaster Relief Day 3: Jesus loves you down to your studs

We moved to a different house today. The lady who lives there had some family that had emptied most of her house and pulled down half the sheetrock . So we thought there was not much to the beginning.  About 5 of us spent at least 2 hours just pulling nails.  That's 10 man hours just removing nails from studs.  Part of the group removed her crown molding so it can be reused.  So much of the time there's not much that can be saved but we try to help the homeowners when we can.  We spent a total of 8 hours working in this one house today. But now she's ready to rebuild. 

I have learned so much in just two days of working.  Like the best tool to remove a slew of nails is not always a hammer.  Mind blown.  I've learned how to remove sheetrock and feel a certain amount of success when it comes down in big sheets and not little clumps. I have never been very coordinated or strong but I try to take advice and be teachable. And that goes a long way.

The FEMA truck was working on the same street that we were on today.  It has one or two huge bins (depending on the truck) and a monster claw with an operator sitting on up by the bin so he can see what he is doing. We saw them fill 6 of these massive garbage trucks ( for lack of a better comparison) and they barely got 2 blocks done in 8 hours. So if you wonder why the cleanup effort lasts so long it's because the damage is so massive. Entire homes are on the side walk like junk. The claw picked up a couch in one load and dropped it right in. 

The last two days I have helped strip homes down to the studs. I have learned that if there is anything between the mold spray and the wood the spray won't work. The mold will continue to grow. We have found layers and layers of flooring in one house. When everything is stripped away we can see what a home is made of and the true extent of the damage. That's how God sees us.  He sees us down to the bare bones. He knows how deep the hurt and damage goes. He knows how many layers we have piled on top of the damage to try to cover it up. But He also knows that everything must be removed between Him and us. His love does that. His love puts all the damaged stuff on the sidewalk. Not so people can walk by and gawk but so it can be removed. Thrown as far as the east is from the west. If you have never experienced the saving power of Jesus please ask me about it. I will be glad to talk to you about my Jesus anytime. He wants to take all the broken, moldy, smelly things out of your life and build you up again, brand new. 

Tuesday, September 13, 2016

Disaster Relief Day 2: Sledgehammers and Divine Appointments

Today we finished gutting a house. To give you and idea of the amount of work required on this job it took 15-20 people 13 hours to clean out this house.  That's 260 man hours on one project. We were working on a parsonage. Being a youth minister's wife this hit close to home. There were a few momentos that were salvageable but most of it went to the curb. 

Yesterday I joked that I wanted to use the sledgehammer. The guys laughed. But today they gave me a chance. Of course they all stood and laughed because I'm the smallest adult on the team but I kept up. And it was fun.  In fact, I may have found a new calling: demolition. 

We took a break between house #1 and house #2 and stopped at DQ for some ice cream ( I had an ice cream/coffee mix because, well, why not ?). One of the couples with use brought their children along. The van they rode in left to go to another job without them so they rode with us. We were a little cramped. But at DQ we spotted a 4y/o boy waiting for his mom to get off work.  Our crew sat down and start d talking to him.  The kids immediately took up with this boy. One of the guys on our team bought him an ice cream. His mom thought he was bothering us and told him to move but I told her he was fine.  I sat as a bystander to see God allowing us to love on this little boy and as a consequence his mother. There wasn't much time to share Jesus with them but I know when we left that mother knew there was something different about those people in the yellow hats. Those parents followed the leading of the Holy Spirit when they brought their children. And it was no accident that they were left by the van they originally rode in.  God had what I can only describe as a Divine Appointment planned for us today. It was nothing we orchestrated. It was purely His guidance. 

The lesson I learned today: it's important to follow the leading of the Holy Spirit so you do not miss those Divine Appointments. But it's ok to have some fun and even tear stuff up in the process!

Monday, September 12, 2016

Why I'm doing disaster relief

A month ago I watched through social media as Louisiana was hit with terrible flooding.  A friend of mine from college and her family, including 3 children, were stranded on the interstate. When they finally got to safety and then home again to assess the damage it was a mess. I messaged her asking what she needed. Her reply "I just need bodies. We have everything else." My mind reeled.  I had no idea how I could help but I felt such a burning in my heart to do something.  Then our Pastor announced the Oklahoma Disaster Relief was being called out.  Our church would take a crew. And then the kicker. They were letting untrained volunteers go on this trip.  I could barely listen to the rest of the sermon because I knew I wanted to go (sorry Pastor!). As soon as the service was over I looked at Hubby and said "I want to go." Hubby looked at me and said "really?" 

You see I'm a youth pastor's wife. I'm a mom to three terrific kids. I work full time.  I have all these balls I'm juggling so I don't usually get to go on trips.  I stay home and juggle. It has been a decade since I have gone on a mission trip without children.  Which is ironic because it was on a mission trip that God spoke to my heart and called me into ministry. 

So this past weekend I did all the laundry and laid out clothes for the kids all week. Even picture day. Yes, you read that right. Picture Day at school is this week. I helped Hubby think about meals. And this morning at 6:30 AM I loaded into a truck and drove 9 hours to Baton Rouge, La.  

I'm hoping to blog throughout the week about the work here so stay tuned!