geriatrics, Nurse Practitioner

Dermatology Nurse Practitioner?

Geriatric Nurse Practitioner – May 2009

I have worked at the nursing home for nearly five years giving primary care to the elderly residents. There is no dermatologist that holds a clinic on site so the patients must wait for months to see a dermatologist in his office when we refer them for a skin problem. The patients did not use sunscreen when they were young and many have developed suspicious looking moles that need to be biopsied. Others have slow healing wounds. During my monthly meeting with my boss, I asked Dr. S. what he thought about me receiving special training so I could open a dermatology clinic at the nursing home? He asked me to explore it so I registered to attend a conference in Dallas, Texas designed specifically for Nurse Practitioners (NP’s) and Physician Assistants (PA’s). Since I have never been to Texas, I decided to take a few vacation days and visit friends in Dallas prior to the conference.

Dallas, Texas

My plane was diverted because of thunderstorms, but we landed just before lightning struck, closing the airport. I waited an hour with others until the storm passed and they could safely unload our luggage. I smiled as I drove by a sign that read, “Don’t mess with Texas!” I met my friend and we enjoyed touring the beautiful Dallas Arboretum, all freshly washed from the rain. We took a tram ride around the nearly deserted colorful grounds. One of the men on the tram said he worked in aviation design. He informed us that planes are often struck by lightning, so I thank God for His protection.

The colorful Dallas Arboretum was stunning.

Over the next few days, my friends gave me a tour of Dallas Theological Seminary, founded by Lewis Sperry Chafer. Dr. Chafer’s books, Major Bible Themes, and Systematic Theology were foundational for me as a new Christian. We also toured the Sixth Floor Museum where Lee Harvey Oswald hid as he shot and killed President Kennedy. I still remember as an eight-year-old child when my school principal announced over the loudspeaker that the President had been killed and sent us all home early. Then we went to the Holocaust Museum built by a number of Holocaust survivors who lived in the Dallas area. We sadly gazed at the cattle car where the Jews were brutally herded like animals and taken to the concentration camps. This was such a tragic time for the Jewish people during World War 2.

On my third day, I bid goodbye to my friends and drove north to the state of Oklahoma, my 41st state to visit in the USA. Lake Texoma is a huge manmade lake on the border, stretching for miles. It was at flood stage because of all the recent rain, hot, and very windy. Acres of green knee-high corn surrounded the huge ranches. I gazed with delight at the white puffy clouds in the clear blue sky. I drove back to Dallas and could barely stand in the ferocious wind as I wheeled my suitcase into the hotel. I turned on the television and looked with amazement at tornadoes in northern Oklahoma. I thanked the Lord again for keeping me safe from my second weather event.

I checked in to the dermatology conference the next day at the hotel and picked up my heavy ten-pound notebook. The excellent speakers were excellent showed us photo after photo of hundreds of skin conditions and described how to treat each one. I had no idea there so many diseases of the skin, the largest organ in one’s body. At times, it almost sounded like they were speaking a foreign language. I have never heard so many new medical terms in that short of time in my thirty-two years of nursing. I definitely learned how little I know about dermatology.

I learned all about skin diseases at the dermatology conference.

During the breaks and lunchtime, I enjoyed talking with NP’s and PA’s, many of whom work fulltime in dermatology. Most were trained by working and observing fulltime for six months with a dermatologist in his office. One said that after working fulltime for five years in dermatology, he was still constantly learning about new skin conditions. Some had worked in primary care prior to dermatology but said they liked specializing in dermatology better. They all put in long hours and saw 30-40 patients daily. The medications they prescribe have many potential interactions with other medications, so this increases their liability significantly. They also learned how to do local biopsies and assist in surgery. Some specialized in the cosmetic area and gave botox injections, etc.

I thank the Lord for letting me attend this conference, but I realize that it is not feasible for me to learn this new huge specialty at my age. But I learned so many useful things that will help me better care for my patients’ skin conditions while they wait to see a dermatologist. I have already worked in twelve different specialty areas and recall how much energy it takes to learn a new area and become proficient. I am very content to continue to give high-quality primary care to my geriatric patients.

I will instruct you and teach you in the way you should go; I will guide you with My eye. Psalm 32:8 (NKJV)


Little did I know that the nursing home would have severe financial difficulties a few months later, but God knew. In the next posts, I will share how God wonderfully provided for me once again. I am so thankful I can trust in Him and rest in Him to open and close doors as He sees fit. He sees the big picture whereas I can only see my little corner of the world.

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