Monday, May 30, 2011

Emma Hardeman....NP?!?

At home in California I am a licensed registered nurse. In the villages scattering the Kenyan countryside, I am a Nurse Practitioner. You may wonder the difference. An NP can assess further, diagnose, treat, and write prescriptions all based on their judgement. Pretty stinkin' cool, right? After the first day, yes. 

My previous trip to Kenya I worked mainly in the pharmacy but was able to triage a few times. I figured on this trip I would be in the triaging room taking vitals, writing down chief complaints, and so forth. Never did I imagine I would be doing what I ended up doing. The first day of clinic they put me in my own room and before I knew it I had patients waiting outside just to see me. Yikes! I still did their vitals, I still snuggled the kids, I still loved the elderly, but now I needed to make my own diagnosis on what was wrong. Oh man, I was nervous! I found myself just treating the minor issues like back pain, generalized body pain, healthy individuals who just needed vitamins, and mom's who were not sleeping well. I would still send every other case to the doctor because I wanted to make sure they received the help they needed. I didn't want to screw up.

Being a new graduate nurse I haven't done much. I'll be honest, you can only do so much in school and compared to the real world of working on your own in a hospital, it's nothing. My confidence as a nurse is pretty low because I have zippo experience. I was feeling silly running back and forth from the doctor's room to ask him questions or figure out a medication. That night, as I laid under my mosquito net and after I was finished praying that no bugs would attack me in my sleep, I prayed for confidence. I prayed that God would use me in great and mighty ways with the people in these villages. I prayed I would go with my gut in situations and that I wouldn't feel like I wasn't measuring up to people's expectations. I prayed I wouldn't feel intimidated working with Joel, a man who is so knowledgeable and confident it leaves me in awe. ( I guess that is a good thing for an ER doc!)

We have a funny God ad the next morning at clinic we were short a room and what did I have to do? Share with Joel. So every assessment I made, every treatment I did, every 'script I wrote, and each teaching I gave he was right there watching. Yikes! God has a good sense of humor, doesn't He?! It ended up being the best thing for me. I learned more that day than I did sitting in lectures at school. As he taught Brenton about each patient, I would tune in picking up snippets that will help me in my own practice. 

Because of Joel, because of being thrown in on my own to work in a position that is higher than my training, I am going to go into my first job with experience that most people won't have had. 

Here is some of what I did as an NP:

Labs: I drew blood more times than I can count. It is harder on African skin and I didn't have a tourniquet. I learned to go just by looking and feeling. After drawing blood I would put a few drops in the i-STAT and receive my patients lab work in a few minutes.

Injections: Well, you do tons of these as a nurse but I can't tell you how many I did on this trip. I could draw them up and give them with my eyes closed now.

Diagnosed: I can tell you the difference between ear infections just by looking in some one's ear now. I can look at a person and know exactly what tropical disease they have. I can see a child and know if it is viral or bacterial infection without needing to do anything further.

Exams: Joel would send me his patients after awhile and I learned to do vaginal exams, breast exams, and more. I learned what to feel for, what is abnormal, and how to treat different scenarios. 
STDs: We saw them all, many times, and unfortunately I can now take one look and tell ya what it is and what the treatment will be.
Meds: Because I was a given a list of medications in the names we are not familiar with ( it didn't say Tylenol but acetaminophen) I now know my drugs like the back of my hand. How they work, their classes, different things they can be used for, and....pediatric doses. 

Fungal infections: There was alot of them and many different kinds. Some look pretty similar and others distinctive. I'm glad I was able to learn how to assess, diagnose, and treat them!
Wounds: We saw quite a few as well. The last clinic day I did more wound dressings than I have even watched in school. I learned about different ways to treat them based on the cause and different ways to dress them. 

To think that is just a handful of responsibilities I had. I loved being able to hold my own exams. The first few days the kids would sit on my lap in the chair with me. The last day, my room had this huge table that we would put a mattress on when it was time for an exam but any other time there weren't enough chairs in the room so my patients and translators would sit in the chairs while I sat on the edge of the table. I usually always had a kid on my lap and their siblings next to me on each side. They loved holding my stethoscope or letting them take their siblings temperature when I was done. Those kids are just too much fun. 

I learned many things on this trip but one thing that surprised me is that I liked the role of an NP. Of course I want to work bedside for many years, but now I know that someday when our kids are older I want to pursue my NP license. 

What an experience for a little new graduate RN! 

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