The Psychiatric Hospital

December, 1998 – New England, USA

I have now completed my first six months as a Nurse Practitioner in a 120 bed psychiatric hospital. I thank God for my boss, Dr. T., who is a Family Practice Physician and an excellent teacher. The hospital has an adult unit for acute psychiatric problems, a second adult unit for detoxification of patients from alcohol and opioids (heroin and oxycontin mainly), a teen psychiatric unit, and a pediatric unit for ages 5-12. I thank the Lord that He closed the door four years ago to the Adult Nurse Practitioner (ANP) program and redirected me to a Family Nurse Practitioner (FNP) program. Otherwise,  I would not be qualified for this job since I need to treat the medical problems of the children and teens.

When patients are admitted here, Dr. T. or I must do their admission physical examination and record it in their chart within twelve hours. We have a full time MD who works all night and does the exams of patients who are admitted after we leave. I am becoming an expert at doing a neurological exam of the twelve cranial nerves. I am also improving in my examination of ears and eyes with the otoscope and opthalmoscope.

Image result for nurse using otoscope

I developed my skill in using an otoscope for ear, nose, and mouth exams.

In addition to being certified in cardiopulmonary resuscitation (CPR), I also had to be certified in handling violent patients without hurting them (Nonviolent Crisis Intervention). I learned how to break a strangle hold in case a patient tries to choke me. I never wear a necklace or scarf to work since a patient could use it to strangle me. If I feel uncomfortable about being alone with a patient in the exam room, I request one of the aides to be present with me for safety. I always keep myself between the patient and the door so I can escape the room if I feel threatened.

The hospital is under investigation from the state because a child died last year. The staff did a face down restraint when the child came violent, and he suffocated. Tragically, they were unable to revive the child. So the state investigators come every day and read each providers’ progress notes, including mine. How I ask God for wisdom in my job! It is sometimes difficult to work under such scrutiny.

“If any of you lacks wisdom, let him ask of God, who gives generously to all without reproach, and it will be given him.” James 1:5

Dr. T. and I write the admission orders for the patients going through alcohol and opioid detoxification. The nurses use a scale to measure the patient’s withdrawal symptoms which guides them to administer the correct amount of medications to prevent the patient from having a seizure or dying.

It is so sad to see patients’ lives wrecked by alcohol and drugs. Only the person who receives Jesus Christ as his Savior can truly be delivered from these deadly addictions.  I pray for each of them to look unto Jesus Christ and be saved. How I thank God that He has put a song in my heart and prevented me from ever using alcohol or drugs by His grace. By following Him, He has spared me so much heartache and grief.

“And be not drunk with wine, in which is excess, but be filled with the Spirit, Speaking to yourselves in psalms and hymns and spiritual songs, singing and making melody in your heart to the Lord.” Ephesians 5:18-19

Reflection

I thank the Lord for all I learned while working in psychiatry for those four years. It was sometimes difficult to see lives so broken. But my experience with psychiatric assessments was  extremely helpful in every other job I had the remainder of my nursing career. A person’s mental condition often strongly impacts his physical condition.

 

Which Nursing School????

“Trust in the Lord with all your heart, and lean not unto your own understanding. In all your ways acknowledge Him, and He shall direct your paths.”  Proverbs 3:5-6

March, 1973, Midwest, USA – High School Senior

Ever since last year when the Lord gave me peace about becoming a nurse, I have struggled in deciding which nursing school to attend. I visited two small Christian colleges here in the Midwest that I really liked, but neither has a nursing program. So I would have to earn a bachelor’s degree in some other major and then continue on to get a two year associate degree in nursing. Six years total sounds way too long to be in school! I wanted to attend a  Christian college in the south where I could major in missionary nursing, but my parents do not want me to go there, so they refused to sign the admission form. It was heartbreaking, but I know God closed the door for a reason.

Where Should I Go?

Where Should I Go?

I left the Protestant Church where I was raised because the Bible was not taught verse-by-verse and I wasn’t growing in knowing the Lord better. My sister also left, which broke our parents’ hearts, especially Mom. We became members of a Bible church led by the Pastor who Marsha met at the University her freshman year. A group of students from another University drive an hour every Sunday to attend. The pastor teaches a weekly Bible class on this University campus which is really growing!

They have a good nursing school at this University, so I decided to apply there as well as a three year hospital diploma nursing school in the same city. I have my interview tomorrow at the diploma school and will tour the University while I am in the city. The diploma students work many more clinical hours in the hospital than the University students, but it is more difficult for them to obtain nursing leadership positions after graduation.

The next day I nervously entered the office of the Director of Admissions at the diploma hospital school of nursing. Mrs. L. greeted me warmly and gave me a tour of the nursing skills lab, classrooms, and dormitory. Afterward we sat down in her office and she asked, “So tell me why you would like to become a nurse?”  I replied, “I like science and I would like to help sick people get better. I enjoy learning new things, and I think it would be fascinating to learn all about the human body and how it works.”  She asked if I had applied to other schools, and I told her I was also considering the State University in the city here.

She advised, “After reviewing your high grade point average and ACT/SAT scores, I think you should go to the University Bachelor of Science (BSN) program rather than our diploma program. Our program will probably be closing in the next few years, and I think you have real potential to go into management or research in nursing. You could then earn your master’s degree or even a doctorate degree in nursing!” I thought to myself, I am amazed that she thinks I have real potential to go so far in my nursing career! I would be satisfied to be a regular staff nurse, work a few years, marry a godly Christian man, quit work, have children, and be a stay-at-home Mom like my mother did. I thanked her for her time and drove across the city to tour the State University.

I joined the walking tour led by a student. This campus has 55,000 students, which is as many people as my entire city where I grew up! It has over ten libraries, 30 dormitories, and countless classroom buildings. The 1000 bed University Hospital is one block from the School of Nursing, so that would be convenient for clinical days. Despite all the buildings, it has green space and many beautiful trees, so it doesn’t appear to be a concrete jungle. After living in the country my entire life, I hope I can adjust to living in a huge city.

State University

State University

When I returned home, I asked the Lord to make it clear to me which school I should attend, and He gave me perfect peace that He wanted me to attend the University. I  was accepted, and am so excited to start in the fall! It will be so wonderful to have fellowship with the other Christian students in the Bible class, and give the gospel to American students as well as the the international students who attend from all over the world. In addition to the prerequisites for nursing, I’m looking forward to taking electives in a wide variety of areas since they offer so many majors.  The class catalog is fascinating to read.  I also hope to become very fit from walking all over the huge campus to my classes!

Reflection

The director of the diploma nursing program gave me excellent advice in steering me toward the BSN program at the University. As she predicted, the diploma school closed a few years later.When I was 39 years old, I returned to graduate school to become a nurse practitioner. I was thankful to receive my Master’s of Science in Nursing after four grueling years of working full time and going to school part time.

In God’s great sovereignty, He never gave me a husband or children. Little did I realize when I was in high school that I would have a 40 year full time nursing career, but God knew all along!

One of my favorite hymns is:
Tis’ so sweet to trust in Jesus, Just to take Him at His word,
Just to rest upon His promise, Just to know, “Thus saith the Lord.”
Jesus, Jesus, how I trust Him! How I’ve proved Him o’er and o’er!
Jesus, Jesus, precious Jesus! O for grace to trust Him more.
-by Louisa M.R. Stead

What is a Nurse Practitioner?

April, 1993

For some reason, I have been sick often this past winter with four colds, gastrointestinal virus, and bronchitis. I was only able to go skiing once in Vermont even though we had tons of snow. Things are going fairly well as a visiting nurse, although I have been assigned to three different districts, and had my office desk relocated five times in eight months. Finally, I’m the solo nurse in a beautiful rural area. I had to switch supervisors, which has been difficult because the two I have now complain constantly, but I’m trying to adjust.

I decided to take a music theory course at the local community college with three others from the church choir. I had fun writing four part harmony to a favorite poem called God of the Heights by Amy Carmichael, missionary to India, 1867-1951. Amy was an amazing single lady who the Lord used to rescue child prostitutes from the Hindu temples and start an orphanage for the rescued children. Even though she was disabled the last 20 years of her life, she wrote many books from her sick bed while in almost constant pain.

God of the heights, austere, inspiring, Thy Word hath come to me. Oh, let no selfish aims conspiring, Distract my soul from Thee. Loosen me from things of time; Strengthen me for steadfast climb.

The temporal would bind my spirit, Father be Thou my stay. Show me what flesh cannot inherit, Stored for another day, Be transparent things of time, Looking through you I would climb.

Now by Thy grace my spirit chooseth, Treasure that shall abide, The great Unseen I know endureth, My footsteps shall not slide, Not for me the things of time, God of mountains, I will climb!

May, 1994

During my annual evaluation with the director of the visiting nurses, she asked what career goal I had for the next year? I replied that I was considering getting a Master’s degree, but wasn’t sure what I should I get it in. I asked if she had any suggestions? She said, “I think you would make a wonderful Nurse Practitioner (NP).”  I never heard of a Nurse Practitioner, so I asked her to describe the role to me. She said a NP receives advanced training through a Master’s degree program and is taught how to diagnose and treat common conditions, much like a Family Practice physician does. NPs can also specialize in pediatrics, adults, geriatrics, critical care, psychiatry, gynecology, etc. She told me of several excellent NP programs in my state to investigate.

What is a Nurse Practitioner?

What is a Nurse Practitioner?

July, 1994

After much prayer, I have decided to go to graduate school for my Master’s of Science in Nursing (MSN) as an Adult Nurse Practitioner if I get accepted. I have spoken with several NPs who are currently employed and it sounds like a great career! My salary would also increase, so hopefully I won’t need to work two jobs to make ends meet. Many of them have private practices or work in MD offices. I can’t believe how motivated I feel about it!

I applied to the State University last week and received permission to take a 3 hour evening class in Nursing Issues this fall. I won’t learn if I am accepted into the program until April, 1995, but they will allow me to take 6 hours of credits prior to matriculating. The Visiting Nurse Association where I currently work will reimburse me the tuition up to two classes a semester as long as I get an A or B grade in the course. It will probably take me 4-5 years doing it this way part time while working full time during the day, so I’m trusting the Lord to give me strength.

For my spring semester course, I might be able to go to the Dominican Republic for two weeks in January and study trans-cultural nursing. The only holdup is that I am short three days of vacation time between Christmas and New Year’s. It is so good to leave it with the Lord and see if He opens the door or not.

Trust in the Lord with all thine heart; and lean not unto thine own understanding. In all thy ways acknowledge Him, and He shall direct thy paths. Proverbs 3:5-6

Reflection

And so I began to work on my MSN at the age of 39 after being out of school for 19 years! I was thankful there were others in my class who were older than me along with a few younger ones. It was a long hard pull over the next four years, and I nearly dropped out which I will tell more about in future posts. I am thankful I became a Family Nurse Practitioner (FNP) rather than an Adult NP as I originally planned. I was much more marketable as a FNP than ANP when I graduated since I could provide care for all ages of people from birth to death. I worked as a NP for the next 15 years. I recouped the cost of my graduate school education the first year out with my doubled salary, so it was a good decision financially also.

Here is an interesting time line about how Nurse Practitioners began in 1965. https://www.aanp.org/about-aanp/historical-timeline The reason I had never heard of NPs was that the physicians in the midwestern state where I received my BSN blocked NP programs  for many years, because they did not want them taking away physician jobs from them. Since then, most physicians specialize  and so they welcome NPs, expecially in the Family Practice role.

Which Nursing School????

“Trust in the Lord with all thine heart, and lean not unto thine own understanding. In all thy ways acknowledge Him, and He shall direct thy paths.”  Proverbs 3:5-6

March, 1973, Midwest, USA – High School Senior

Ever since last year when the Lord gave me peace about becoming a nurse, I have struggled in deciding which nursing school to attend. I visited two small Christian colleges here in the Midwest that I really liked, but neither has a nursing program. So I would have to earn a bachelor’s degree in some other major and then continue on to get a two year associate degree in nursing. Six years total sounds way too long to be in school! I wanted to attend a  Christian college in the south where I could major in missionary nursing, but my parents do not want me to go there, so they refused to sign the admission form. It was heartbreaking, but I know God closed the door for a reason.

Where Should I Go?

Where Should I Go?

I left the Protestant Church where I was raised because the Bible was not taught verse-by-verse and I wasn’t growing in knowing the Lord better. My sister also left, which broke our parents’ hearts, especially Mom. We became members of a Bible church led by the Pastor who Marsha met at the University her freshman year. A group of students from another University drive an hour every Sunday to attend. The pastor teaches a weekly Bible class on this University campus which is really growing!

They have a good nursing school at this University, so I decided to apply there as well as a three year hospital diploma nursing school in the same city. I have my interview tomorrow at the diploma school and will tour the University while I am in the city. The diploma students work many more clinical hours in the hospital than the University students, but it is more difficult for them to obtain nursing leadership positions after graduation.

The next day I nervously entered the office of the Director of Admissions at the diploma hospital school of nursing. Mrs. L. greeted me warmly and gave me a tour of the nursing skills lab, classrooms, and dormitory. Afterward we sat down in her office and she asked, “So tell me why you would like to become a nurse?”  I replied, “I like science and I would like to help sick people get better. I enjoy learning new things, and I think it would be fascinating to learn all about the human body and how it works.”  She asked if I had applied to other schools, and I told her I was also considering the State University in the city here.

She advised, “After reviewing your high grade point average and ACT/SAT scores, I think you should go to the University Bachelor of Science (BSN) program rather than our diploma program. Our program will probably be closing in the next few years, and I think you have real potential to go into management or research in nursing. You could then earn your master’s degree or even a doctorate degree in nursing!” I thought to myself, I am amazed that she thinks I have real potential to go so far in my nursing career! I would be satisfied to be a regular staff nurse, work a few years, marry a godly Christian man, quit work, have children, and be a stay-at-home Mom like my mother did. I thanked her for her time and drove across the city to tour the State University.

I joined the walking tour led by a student. This campus has 55,000 students, as many people as my entire city where I grew up! It has over ten libraries, 30 dormitories, and countless classroom buildings. The 1000 bed University Hospital is one block from the School of Nursing, so that would be convenient for clinical days. Despite all the buildings, it has green space and many beautiful trees, so it doesn’t appear to be a concrete jungle. I am so used to living in the country, I hope I can adjust to living in a huge city.

State University

State University

When I returned home, I asked the Lord to make it clear to me which school I should attend, and He gave me perfect peace that He wanted me to attend the University. I  was accepted, and am so excited to start in the fall! It will be so wonderful to have fellowship with the other Christian students in the Bible class, and give the gospel to American students as well as the the international students who attend from every country in the world. In addition to the prerequisites for nursing, I’m looking forward to taking electives in a wide variety of areas since they offer so many majors.  The class catalog is fascinating to read.  I should also become very fit from walking all over the huge campus to my classes!

Reflection

The director of the diploma nursing program gave me excellent advice in steering me toward the BSN program at the University. As she predicted, the diploma school closed a few years later.When I was 39 years old, I returned to graduate school to become a nurse practitioner. I was thankful to receive my Master’s of Science in Nursing after four grueling years of working full time and going to school part time.

In God’s great sovereignty, He never gave me a husband or children. Little did I realize when I was in high school that I would have a 40 year full time nursing career, but God knew all along!

One of my favorite hymns is:
Tis’ so sweet to trust in Jesus, Just to take Him at His word,
Just to rest upon His promise, Just to know, “Thus saith the Lord.”
Jesus, Jesus, how I trust Him! How I’ve proved Him o’er and o’er!
Jesus, Jesus, precious Jesus! O for grace to trust Him more.
-by Louisa M.R. Stead

Welcome to Pamela’s Nursing Reflections!

Dear Friends,

Welcome to my blog!  After receiving the Lord Jesus Christ as my personal Savior when I was in high school, God led My 1977 Nursing Cap!me to become a nurse.  I received my Bachelor’s of Science in Nursing degree in 1977 and began my nursing career.  I have worked in a variety of specialty areas including medical-surgical, diabetes, labor & delivery, staff development, dialysis, home care, geriatrics, and case management!

After a long break from school, I decided to return for my Master’s Degree in Nursing which I received in 1998 and began to work as a Family Nurse Practitioner.  I have also participated in several short-term medical mission trips in China, Honduras, and Belize.  I love to travel and have visited over 20 countries and 44 states in the USA.

Bible smThrough the years, God has been very gracious to me in encouraging me in my career.  I love to study the Bible that I might know my dear Savior better, walk closer to Him, and point others to Him!  As my nursing career draws to a close, I would like to share the wonderful life lessons God has taught me along the way that you may be encouraged to keep “Looking unto Jesus, the author and finisher of our faith!” Hebrews 12:2

Pamela, RN, APRN, Family Nurse Practitioner