Geriatric Nurse Practitioner

April 25, 2005

I thank God for carrying me through the first three weeks of working as a geriatric Nurse Practitioner at the 500 bed nursing home. The insurance company assigned me to provide medical care for 32 residents who have enrolled in their program as an alternative to Medicare. Judy has worked for the company for awhile and is my excellent preceptor. After she orients me, they will move her to another facility in the state. I need to do an complete physical examination on each of my patients, type it into the insurance computer in their format, and then call the family member to introduce myself. I only have nine more physicals to finish by the end of the month. In May, I will do a shorter assessment on each patient and call the family with a quick update. If the patient has a new problem, the nursing staff calls me to assess the resident that day and treat the problem as quickly as possible.

So far, the only downside is that there is no air conditioning because the home was built in 1935. I feel sorry for the patients in the heat, especially on the top floors which are the hottest. My office doesn’t have any windows or air conditioning, so the medical director said I could do my charting in the doctor’s night shift room which is empty during the day and has a window air conditioner. I have enjoyed working with Dr. R. who is a board certified geriatrician and likes to teach me about geriatrics. My biggest adjustment is assessing the patients with advanced dementia (memory loss) who are unable to communicate their needs. I have to depend on the nurse’s assessment and input from family in addition to my physical assessment. The staff is wonderful in giving the residents activities to stimulate their memory.

May 3, 2005

“I press on toward the goal for the prize of the upward call of God in Christ Jesus.” Philippians 3:14

I have a bad head cold after being at the nursing home for just one month and have already used up my sick time. We are not permitted to work with a respiratory infection because the elderly are susceptible to catch it resulting in serious complications. I’m just not sure I can work full-time anymore. God comforted me with I Peter 5:7, “Casting all your care upon Him, for He cares for you.”

Dear Lord, Thank You that this cold is a very little thing in light of eternity. Help me keep the big picture. If You want me to work today, put Your healing hand upon me. If not, I rest in You and trust in You. Thank You that You do all things well. Amen.

May 27, 2005

“For He shall deliver the needy when he cries; the poor also, and him that has no helper.” Psalm 72:12

God has so graciously been carrying me along at work and things are going more smoothly. I finished all 13 of the new patient’s physical examinations and 52 monthly visits plus all the sick visits for the month of May. I have now completed eight weeks of work at the nursing home.

My biggest concern right now is my vision which has become more blurry from all the long hours of charting on the computer. I saw an optometrist and she could not correct my left eye beyond 20/60 and said my left optic nerve doesn’t look right. I thank God that I don’t have a retinal detachment. My uncle went blind when he was about my age from retinal detachments.

June 1, 2005

After three hours of very uncomfortable eye tests with bright lights, the ophthalmologist said he couldn’t find any retinal or macular tears. He is referring me to a retinal specialist who can’t see me until August. Trudy, my dear friend who has battled glaucoma for many years, said that her eyes are in God’s hands. If she loses her sight, God will be her vision.

July 4, 2005

Two weeks ago a Nurse Practitioner (NP) at the insurance company resigned, so they assigned me to cover his patients in another nursing home as well as my own. So now I am responsible for 96 patients. When I interviewed for the position, they assured me that I would only have 70-80 patients. My new supervisor said this is their goal, but I’m the only one who is credentialed at the hospital which owns the second nursing home. I am so exhausted that I feel like I’m at the breaking point.

July 11, 2005

Mary, a NP at the main nursing home, told me there is a 32 hour position open that is not associated with the insurance company, and they want to recruit me for it! She also said the nursing home is losing money with the insurance company and will probably soon terminate their relationship. I like the administration at the nursing home, but have not had much support from the supervisors at the insurance company.

I interviewed with Dr R., and he offered me the position of 32 hours weekly with every Friday off, and full time benefits. He said they would bring me in at the top of the pay scale for Nurse Practitioners. This is such a gift from God!

Dear Lord, Thank You once again for Your wonderful deliverance and that You won’t test me above what I can bear.” Amen.

July 18, 2005

“Leaning on Jesus’ bosom.” John 13:23

God carried me through some grueling eye tests from the retinal specialist doctor. He strapped my head in a machine, put a magnifying glass straight on my eyeball, and then told me to look at a very bright light without moving. The tears were streaming down my face because it was so uncomfortable. Then I started silently thanking Jesus that He is the light of the world. I remembered the verse above and the wonderful hymn “Leaning on the Everlasting Arms”.

The doctor said part of my vitreous (like jelly in my eye) is covering the retina like wrinkled plastic wrap. There is nothing he can do about it, so we’ll just “watch it”. My new glasses arrived this week and I am seeing so much better. Thank You, dear Lord, for my vision today!

I told Bee, one of my coworkers, that I know the Lord Jesus Christ will be my eyes if I go blind. She came up to me a few days later and said, “I wish I had your faith. I feel so guilty about not teaching my adopted son anything about religion.” I shared with her the good news about Jesus Christ and how much He loved her that He died on the cross for all our sins and rose again. He wants her to receive Him as her personal Savior. I also gave her some literature and a children’s Bible study for her son.

August 10, 2005

I thank the Lord for a refreshing vacation with two ladies from church at beautiful Lake Tahoe in California. What stunning mountain scenery! We even caught some fish in the sparkling deep lake. The nursing home becomes my new employer tomorrow!

The Lord gave me a refreshing vacation at beautiful Lake Tahoe in California.

Reflection

I enjoyed my next five years of working in geriatrics at the nursing home. Every day was a new experience and challenge as I progressed in my knowledge of assessing and treating older adults. I also learned that I needed to communicate clearly with the family members since the resident often couldn’t remember the information I gave them. Even though I didn’t stay with the insurance company very long, God used that to get me in the door at the nursing home and guided me to a much more manageable job with less stress.

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Honduras Medical Mission – Part 3

Camasca – Thursday, October 29, 1988

Today I woke up at 3 a.m. with a stomach ache. I have been doing well with the food until now. The village dogs howl until 1 a.m. and the chickens start crowing about 3:30 a.m. so I keep waking up early. I never knew a village could be so noisy at night! After the clinic started, I had to run through the crowds to the only toilet a block away. So thankful I made it in time. I thought I would be crushed in the mob waiting to see the doctors outside the village school. It’s a good thing I’m a head taller than most people here. I just kept saying, “Permiso” (excuse me), and the crowd parted for me.

This afternoon, the mission director came up to me in clinic and told me they found my suitcase and he put it in the women’s house! During a break, I went to the house to bring back some more gospels of John to hand out. I gave the rest of them to one of the helpers to hand out tomorrow and next week at another village they are serving.

My lost suitcase amazingly showed up in after one week! It contained 400 gospels of John for the patients.

My lost suitcase amazingly showed up in after one week! It contained 400 gospels of John for the patients.

I am so sad that this is my last day to work with the group who is going to another village Saturday and staying a second week. There is no telephone or telegram to communicate with Dr Pete in the next village. Judy and I don’t even know how we’re getting to the capital city, Tegucigalpa, tomorrow. Short wave radio contact is difficult. The mission director said we will be taken to the next town at 4:30 a.m. where the local doctor will take us with him to Teguc (short version for the capital).

I feel like I have a fever so one of the doctors gave me a new antibiotic to take called Ciprofloxacin to kill the stomach bug I have. I taught Harold, one of the general helpers, how to take a blood pressure. It’s challenging to hear in this noisy crowd, but he was a quick learner.

I gave the devotional tonight after dinner on “Christ, the solid Rock” from 1 Corinthians 10:1-6 and 2 Samuel 22:1-3. I might tremble on the Rock, but the Rock never trembles under me! How wonderful it is to trust and rest in my faithful Savior.

The Lord is MY ROCK, and MY fortress, and MY deliverer. 2 Samuel 22:2

Afterwards, one of the school teachers gave us a brief history of the town of Camasca which was founded in 1746. Currently it has a population of 6000. The average annual salary is 50 Limperas ($25).

Friday – Camasca to Tegucigalpa

Judy and I arose at 3:30 a.m., but the pickup truck arrived at 4 a.m. – 30 minutes early! We were hurrying in the dark and my flashlight batteries were almost out, so I forgot my camera and suitcase wheels. The head lady flagged down our truck and took us to the pharmacy where she had two cups of hot tea and cornbread ready for us. What a treat! We both gave her a big hug of appreciation. The driver took us to the next town, Concepcion, and dropped us off at Dr C’s house at 5 a.m. and then sped off. Dr. C came out and was rather upset with us. He had waited up for us until 10 p.m. and then finally went to bed. Our ride to Teguc came at 2 a.m. so we missed it. I guess there was a communication breakdown somewhere. His car clutch is broken, so he is concerned about driving that far, but finally decided to try it with a friend. We made good time to the next town, La Esperanza, in 3 hours.

Kathy, the wife of the mission director, lives here, but she didn’t know how to get us to Teguc. Someone heard of a school teacher going to Teguc, so she took us out to the bus stop. The “bus” was a little Toyota pickup truck. We threw our stuff in the back and climbed in with 11 locals – 10 men and 1 woman. I sat on my big red suitcase with my other bag at my back and bounced along for 5 hours. The scenery was beautiful and the sun was shining, but my back ached as my skin burned. At the end, a lady climbed in with her little boy and a big bag of oranges she was selling in town. She smiled and asked, “Christiana?” (Christian?) We said “Si” with a big smile. She pointed to herself and smiled and pulled her Bible out of her bag! It was so wonderful how the Lord took care of us.

We stopped for lunch at a small restaurant. Judy and I had a Coke and cookies because that is all we could safely eat with no guarantee of a bathroom. I am so thankful the fever and stomach ache are gone today.

Then the pickup truck dropped us off by the roadside and we waited with the teacher. Behold, a large modern air conditioned bus stopped and picked us up! The soft reclining seat felt like a little taste of heaven! It only took 2 hours on a smooth road to go the rest of the way to Teguc. Then the teacher called us a taxi which took us right to the hotel where Dr Pete was waiting for us. He arrived at 11 a.m. by small plane in 30 minutes from his village. He tried to contact us by shortwave radio to tell us we could also fly out, but couldn’t get through. I’m rather glad though that we came safely in 14 hours by 5 different vehicles, because the Lord showed Judy and me how much He truly cared about us.

Casting all your care upon Him, for He careth for you. I Peter 5:7

Camasca is near El Salvador. It took us 14 hours to get to Tegucigalpa in 5 different vehicles!

Camasca is near El Salvador. It took us 14 hours to get to Tegucigalpa in 5 different vehicles!

Judy and I walked into our hotel room and were excited to see two real beds and a real shower! I couldn’t find a light in the bathroom, so I took a hot shower by flashlight which was totally refreshing after a week of sponge baths. After we ate dinner, we strolled around the city park. It is hard to witness the poverty everywhere. I am thankful we were out in the country most of the time. When I came back to the hotel, I noticed the light over the bathroom sink, but it took me 5 whole minutes to find the light switch. Judy and I had a good laugh over that one! After a week of sponge baths in the dark, I had forgotten what a light switch looked like. I thanked the Lord for journey mercies, and fell into bed at 8 p.m. totally exhausted.

Tegucigalpa, capitol of Honduras

Tegucigalpa, capitol of Honduras

October 31 – Home

We flew to Miami where I said goodbye to Pete and Judy, and then spent 2 days visiting friends before flying home. The greatest blessings of the trip were becoming friends with Judy and praying and reading the Bible together every day, seeing God answer prayer daily, sharing John 3:16 with over 400 people, seeing the beautiful countryside, having my faith in God increased, and meeting so many godly doctors and nurses.

Reflection

This first medical mission trip certainly expanded my world view in a different way from my previous journeys to Europe, Chile, and China. It is so wonderful to know that God loves each person in this world He created and desires each one to receive Him as Savior so they can enjoy Him for all eternity. How thankful I am for this opportunity God gave me to sow the seed of the gospel in Honduras. I hope I meet some believers from Camasca in heaven who read the gospels of John and received Christ!

Nurse Burnout Prevention

Labor and Delivery- April, 1982-11:30 p.m.

We only had one lady in labor tonight, so we all pulled out our various needle crafts and Theresa went and made a huge pan of popcorn for everyone.

popcorn

POPCORN! Favorite labor & delivery snack.

The resident doctors and med student pulled up a chair also to chat for awhile. Anne and Susie like to do counted cross stitch and taught me how to do it, so I am working on a strawberry clock. I find it quite tedious on my eyes to count all the tiny stitches and use the right color thread according to the pattern, but I’m determined to finish it! Bonnie likes to crochet and volunteered to teach me how to do it after I finish my clock. It’s fun to feel creative in between patients and on breaks!

My 1983 Strawberry clock still hangs in my kitchen!

My 1983 Strawberry clock still hangs in my kitchen!

No matter how busy we get, Mary Lou, our assistant head nurse always makes sure everyone takes 30 minutes for lunch. She knows how essential it is to fuel our bodies and to take a break from the intense speed at which we sometimes have to work. I thank God that I can work with such a pleasant group of hard working nurses. Since I started last summer, they have been so kind to mentor and teach me. Most of them have many years of experience and absolutely love labor and delivery!

Reflection – 2015

I think job satisfaction was the highest among the labor and delivery nurses than any other group I ever worked with over the years. They all loved helping to bring babies into the world and found their needle crafts to be a good stress breaker and use of their time when we were slower.

Nursing is a high burnout profession since it tends to be very stressful mentally, emotionally, and physically. I searched online to see what other nurses were writing about preventing burnout, but none of them approached it from a Christian perspective, nor had they worked very long as nurses. It is purely by God’s strength and mercy that I have been able to work for 38 years as a nurse. So I decided to make my own list of how God has led me to cope with the stress of nursing.

1. I start my day with Bible study and prayer before I go to work. I ask God to teach me from His word and commit the day to Him, ask for His wisdom, and that I would be a good testimony for Him. I write down a Bible verse from my quiet time and put it in my lunch box to think about later on. Today my verse was Psalm 94:19 “In the multitude of my thoughts within me, Thy comforts delight my soul.”

2. I always eat breakfast before I go to work and pack my lunch. I try to eat whole unprocessed foods, lots of fruits and vegetables, and drink lots of water to stay hydrated. The main cause of headaches at work is from dehydration.

3. Exercise. I do some stretches in the morning and ride the stationary bike and lift weights in the employee gym at work. It really helps to get rid of the kinks from sitting at the desk and boosts my energy. On weekends I walk outside or do an exercise DVD inside.

4. I love to learn new things totally unrelated to nursing. Art, music, and travel are my favorite ways to unwind. Last year I went to a weekend fiber arts retreat for Christian women. As we knitted and crocheted all weekend, I discovered that over half the women were nurses!

Knitting and crocheting are favorite stress breakers!

Knitting and crocheting are favorite stress breakers!

Over the years, I have taken oil painting, glass painting, cake decorating classes, mountain dulcimer, and violin lessons.

Monochromatic winter oil painting I did in class.

Monochromatic winter oil painting I did in class.

Painting on glass is fun!

Painting on glass is fun!

Cake decorating class.

Cake decorating class.

Last year, I began hosting a group of guitar, violin, and dulcimer players from church for a monthly night of playing hymns together which is great fun!

My mountain dulcimer is great fun!

Mountain dulcimer

Playing my violin and dulcimer are great stress busters.

Playing my violin and dulcimer are great stress busters.

Over the years, I’ve learned German, Chinese, Spanish, and a little Hebrew. I’m far from fluent, but it feels good to stretch my mind and comes in handy when I travel. Many times I have trouble finding someone to travel with me, so I was happy to discover Road Scholar a few years ago (www.roadscholar.org). This is not a Christian organization, but they have interesting educational trips all over the world. Often the single supplement is not too exorbitant, so I get a private room, and enjoy meeting many new interesting people at mealtimes and during the educational activities. Usually, there are quite a few who are traveling alone like me.

4. I find it interesting and thought provoking to read biographies and about history. I discovered I can check out free books from my public library on my Kindle through the Overdrive app!

5. I buy myself fresh flowers a couple times a month, especially during the dreary New England winter.

Cheery primrose in the winter!

Cheery primrose in the winter!

6. To change it up, I drive home by a different route  and notice everything along the way. When the weather is nice, I stop at a park and take a walk before arriving home.

7. I LAUGH, SMILE, and SING praises to God as much as possible, because it always lifts my spirits. “Then was our mouth filled with laughter, and our tongue with singing.” Psalm 126:29.

8. I do deep breathing exercises with visualization of my favorite scene. I tend to hold my breath unconsciously when I become tense, so I put a little sign on the wall above my phone, “TAKE A DEEP BREATH, PAM!” It helps when a patient starts yelling at me for something over which I have no control.

9. Whenever I have been in a very stressful job situation, I ask the Lord to deliver me in His time and His way. Sometimes He does it by changing my attitude or the people around me, or He moves me to a different job. It is so wonderful to trust Him! “Casting all your care upon Him, for He careth for you.” I Peter 5:7

10. I do something spur of the moment for the sheer fun of it!

11. I avoid negative people and gossipers.

12. When asked to do something extra, I ask God if He wants me to do it before I answer. I need to guard against spreading myself too thin and getting overly exhausted. “Redeeming the time, because the days are evil.” Ephesians 5:16

I would love to hear about your stress breaker tips and how you prevent burnout. Email me at pamela.aprn@gmail.com

Sleeping in Statistics Class

College Freshman – May, 1974

“He giveth power to the faint; and to them that have no might He increaseth strength. Even the youths shall faint and be weary…” Isaiah 40:29-30

“Pam, Can you please see me after class?” announced my statistics professor. I nervously approached Professor L. who had shared at the beginning of the quarter with the class that he was a Christian. (He was the only professor in my four years of college who claimed to be a Christian.) He said, “I noticed you have been falling asleep in class. Do you have a job where you work at night?”

Sleeping in Statistics Class

Sleeping in Statistics Class

stat class

I explained that I worked ten hours weekly at the main library. The statistics class was from 4-5 pm Monday-Friday when I was most weary. I had also just missed a week of class because I was sick with the flu. We reviewed my midterm grades of 96% (A) on the first one and 6% (F) on the second one. I had never failed a test before and was horrified when I saw the F! I had reviewed my classmate’s notes for the week I missed, but I guess I didn’t understand the material. He kindly said, “Pam, get a tutor to review the material before the final exam. If you do well on the final exam and remaining quizzes, I will drop your F on the midterm now that I understand your circumstances. I thanked him profusely for his consideration and advice.

In addition to working and taking classes, I was teaching the women’s Bible class weekly and children’s Bible Club every other week. It was no surprise that I became ill, because I was simply doing too much! I found someone else to teach the Bible clubs, found a tutor, and did my best on the statistics final exam. In June, I apprehensively opened my grades when they arrived in the mail.  B in statistics!!! Thank You, Lord, for your grace and strength! My courses this quarter were: statistics – 5 hours, chemistry- 5 hours, violin lessons – 1 hour, logic – 5 hours, tennis – 1 hour.

Reflection – 2014

So ended my freshman year of college. It still remains a constant balancing act between worshiping and serving the Lord, working, maintaining my home, and getting enough rest and relaxation. I ask the Lord daily to help me put Him first and do all things for His glory and honor while resting and delighting in Him. When people ask me to do something, I pray about it first and ask the Lord what He wants me to do. As nurses, we are used to always helping people and our automatic response is “yes”. But I have slowly learned over the years to say “No” if God does not give me peace about going forward.

Many times in my nursing career when I have been totally exhausted, I have cried out to God to strengthen me and ask Him to do my job through Me, while leaning hard on Him. A favorite poem of mine is “Lean Hard“.

Child of My love, Lean Hard, and let Me feel the pressure of thy care;

I know thy burden, child, I shaped it; Poised it in Mine own hand, made no proportion

In its weight to thine unaided strength. For even as I laid it on, I said,

I shall be near, and while he leans on Me, This burden shall be Mine, not his;

So shall I keep My child within the circling arms of My own love.

Here lay it down, nor fear to impose it on a shoulder

Which upholds the government of worlds.

Yet closer come; Thou are not near enough; I would embrace thy care

So I might feel My child reposing on My breast. Thou lovest Me? I knew it.

Doubt not then; but loving Me, Lean Hard.

(unknown author)

“Cast thy burden upon the Lord and He shall sustain thee.” Psalm 55:22

“Casting all your care upon Him; for He careth for you.” I Peter 5:7

Rest in the Lord