Geriatric Nurse Practitioner – July 2009
I was glad to have a day off to relax and catch up on my chores. The phone rang and the caller said, “Pam, this is Dr. S. (my boss). I’m sorry to call you at home, but I wanted to make sure that you knew about the announcement I made to the rest of the medical staff today. The nursing home here is struggling financially so we contracted with a physician and nurse practitioner from the community to manage one of our 60-bed long-term care units. It will become part of their private practice so they can bill Medicare directly. We are redistributing the rest of the patients among the medical staff so I need to decrease your patient load from 97 to 67 patients.” I replied, “Thank you for letting me know before I come to work tomorrow.” We chatted about the particulars a few more minutes before we hung up. I knew it would be difficult to meet my monthly visit goals with only 67 patients, and I would not qualify for any bonuses.
Dear Lord, Show me if I should start looking for another job. You are the only One who knows the future. Thank You that You have always provided for me in the past and I know You will again. Thank You for the peace that passes understanding. In Christ’s Name, Amen
I called my brother-in-law who is a banker and told him the bond rating of the nursing home had been decreased to BBB-. He said, “Pam, that is not a good sign. I would start looking for another job if I were you.”
“Wait on the Lord; be of good courage, and He shall strengthen your heart; wait, I say, on the Lord!” Psalm 27:14 (NKJV)
Two days after Dr. S. gave me the news, one of my office mates told me she heard there was a federal job opening at the Veteran’s clinic as a home care Nurse Practitioner (NP). I emailed my resume to the Vice President (VP) and after three weeks she called me to schedule an interview on August 3.
I took a deep breath as I entered the meeting room, praying silently for peace and wisdom. The VP, nurse practitioner, and a staff nurse introduced themselves. The VP described the job of visiting elderly complex homebound veterans who needed skilled services, case management and help with activities of daily living. The program was also for Veterans who were isolated or had a caregiver who was struggling. The goal was to keep them safe and comfortable at home for as long as possible and give support to the caregivers. I would drive a government car to visits and supervise with the physician the team of staff nurse, physical therapist, pharmacist, health psychologist, and dietician. I would help teach resident physicians enrolled in the local university program, lead several committees, and work one afternoon a week in the geriatric clinic.
Then the VP, NP, and RN took turns asking me a list of pre-set questions and rated each of my answers on their form. Using my background as a visiting nurse, the Lord helped me give examples of how I would treat the patients and handle the situations they described. I thanked them for their time as I shook hands with them. As soon as I arrived home, I emailed a thank you note to the VP. I asked the Lord to open or close the door to this job.
The next day, the VP sent me a return email and asked if I could have a second interview and make a home visit with the NP? We scheduled it for August 17. I needed two more weeks of patience.
I arrived at the local veteran’s clinic and Jackie, NP took me to her office and explained the computer system and the antiquated charting system. Each provider had to type a long detailed progress note on the computer after making a home visit. Unfortunately, there was no dictation available. I was amazed that they still used DOS as part of their email system. I have not worked with DOS for over twenty years.
Jackie picked up her heavy blue bag filled with her medical equipment and we got in her government car. As she drove, she told me about Ray, an elderly World War 2 veteran who lived alone and had recently had abdominal surgery. His daughter lived an hour away and checked on him weekly. Jackie suspected Ray still drove himself daily to a local restaurant for lunch even though he had not been cleared to resume driving.
Ray answered Jackie’s knock and asked us to come into his unkempt living room. Jackie asked him how he was doing, reviewed his pain level, medications, and then checked his heart, lungs, and blood pressure. She then requested him to lie down on his bed for the abdominal exam. She opened the bandages onto a sterile blue paper field, put on gloves, removed the old dressing, and placed it in a plastic bag along with the soiled gloves. She put on new gloves and gently cleaned around the stitches while examining his incision. She reported to him that it was intact and there was no drainage or redness and placed a new sterile bandage on the site.
His daughter, Sheila, arrived and Jackie reported her assessment. Sheila hated to leave her dad alone and desperately wanted him to move in with her, but he refused. We bid them goodbye and got back in the car. We discussed how most World War 2 veterans were fiercely independent and reluctant to accept help. As guests in their home, we do what we can to help them, but the veteran has the right to refuse.
After I returned to the office, the director and the physician in charge of the home care program interviewed me. They informed me of the excellent nurse benefits of 10 holidays, 26 days of vacation, and 13 sick days annually. The VA matches 5% on retirement funds contributed by the employee and gives a retirement pension after five years of employment. Human Resources will contact me within two weeks.
The job seems like the perfect fit for me. I hope I have the energy to work fulltime again. It would be a great privilege to help care for our veterans who have sacrificed so much for my freedom.
I received a call from Human Resources (HR) two weeks later offering me the job. The review board of nurses will meet on September 23 to determine my salary based on my experience and credentials. The salary range is excellent! I will need to go through an extensive background check and fingerprinting. HR strongly advised me not to give notice at the nursing home until I had a letter in writing with a starting date. They said it could take several months to get credentialed since they needed to verify every former employer listed on my resume and contact my undergraduate university, graduate school, and two state boards of nursing. The waiting continues…