Don’t Let the Rat Race Affect Your Practice

I might as well declare myself a pediatric fever specialist. I have been treating kid after kid after parent after parent for fevers, coughs, colds and the flu. I’m pretty sure my clunky nursing clogs have left skid marks on the hospital’s laminate floor. After the first few hours of my shift a few evenings ago I felt like I was in the movie groundhog day with each patient all too similar to the last. The flu is everywhere. Whenever I find myself feeling like a hamster on a wheel at work, once I get past the initial exhaustion of running around like a chicken with my head cut off, I get nervous- for a few reasons.

First, busyness can cloud clinical judgement. When we as nurse practitioners focus too much on meeting metrics and churning patients through the doors of the clinic or hospital, we’re more prone to make mistakes. During flu season we see case after case of influenza and as winter wears on we approach the diagnosis less and less seriously. We are in a hurry and we may miss subtle signs that a patient is ill with something more acute. Maybe this particular patient really has a life-threatening PE? Or, perhaps they have a compounding case of pneumonia or asthma exacerbation that we may mistakenly send back out the door without treating appropriately.

A similar situation happened during my last ER shift. It was a hamster on a wheel kind of day. My last patient arrived around 1:30am. A child with vomiting. No big deal, right? So, with it being very near the end of my shift (why do the sickest patients always arrive at the end of a shift?!), I gave him a Zofran and attempted so give some oral fluids. Then, vomit. Everywhere. So, I tried again. Same story. Ultimately I was taken out of my this is just routine gastroenteritis mode and gave some fluids and IV nausea meds etc. and he eventually perked up. Had I sent him home without staying late to treat him appropriately he would have been back, sicker, and required possible hospital admission. Don’t let the rat race pull you in so far that it affects your clinical judgement.

Second, when the emergency department gets crazy busy and I find myself treating the same diagnosis over and over and over again, I forget to connect with my patients. For me as a medical provider influenza isn’t a big deal. For the mom trying to pay for Christmas gifts on a limited budget forced to stay home from work with a sick child, the flu can rock her world. Too often I rush through discharge instructions because I’ve said them time and time again, not to mention the waiting room is packed. I let the rat race affect my level of care and concern.

As nurse practitioners, potentially life-changing circumstances become routine. For those working in oncology, treating cancer is just another day at work. For those of us working in the emergency department, a diagnosis of appendicitis isn’t such a big deal- it could have been something worse, right? A diabetes diagnosis, while an easy call for an FNP, can instill fear and worry on part of the recipient. It can be hard to remember to address and acknowledge that for our patients who don’t encounter medical situations on a regular basis this is their life, not just a job.

Working in the rat race that is healthcare it’s easy to get sucked in and lose sight of the vision you once had for your career. Don’t let it cloud your clinical judgement. Don’t get to busy to connect. If you do, eventually you’ll find yourself stuck in a rat trap.

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