-Feels like I’m aging a little bit
Another Year!
It’s been 3 years since becoming a Psych NP and yes it feels longer so it’s time to rant. I promise to try to write a yearly reflection post about what’s been helpful, not good and to give insight to others. I also encourage others to think about their own mistakes, flaws, and victories because it’s also a form of coping. Also note that I know the year is almost over, so 2021 tips may seem old but I passed my boards in the fall and at least you have tips for the new upcoming year :)) so without further ado, here are some lessons I’ve learned. Brace yourself.
The Elephant in the Room
Community Mental Health (CMH) is hell on earth but if you work there, you can truly work anywhere. I actually wanted to work CMH after school because I knew how valuable the experience would be but it is BRUTAL. I only recommend this for Psych NP’s if they have a critical care background (because nothing is crazier than ER) or have past experiences in CMH/substance abuse to not get horribly burnt out.
I have much more to say but the lesson here for new providers and in general is to try to work in your comfort zone. If you’re not sure about diving into CMH or trying something different just ask if you can shadow and look at job reviews online. I had 3 other jobs so I proudly caused my own issues but in general, do not put yourself in a situation that will make you feel more uncomfortable as a provider. However, it taught me some valuable lessons and I started off with this major point because it will frame the rest of this post….
- Lesson 1. Continue to Advocate for Independent Practice: One of the reasons why I was having difficulties in CMH is how there’s only ONE doctor, so if he was sick, on vacation, I had to deal with my load and his plus I specialized in populations that he didn’t see… I stay in a collaborative state so what’s the only thing I can do?? I get surveys and I write them up to the sky heavens! Don’t shun the surveys. Be bold and honest to get your voice heard. I write in recommendations, how providers are moving away, the lack of doctors, access to care…etc. and if you live in an independent state, continue to express your concerns.
- Lesson 2. Be a Mentor: To piggyback on the previous point on how to advocate for independence and mental health, help the next class of providers. In addition to working multiple jobs, I was also precepting multiple times. I usually can handle high stress but it’s not for everyone. I never thought to get compensated but I love to teach and would never charge. Long story short, don’t just be a mentor to your patients, also be a mentor for the profession. If you can’t precept, offer to do guest lectures, mentor at your past schools…etc. I understand NPs that feel like they don’t have enough experience but it’s truly about dedication.
- Lesson 3. This is sort of winded but here we go, Improve Your Writing Format: A functional EMR system is the most productive and valuable thing to have for your practice: I’ve written dissertations about charting but the fact of the matter is with an awesome EMR, life can get better. You don’t have to grab a bottle. I work CMH so our EMR is on life support and I had to free text just about everything. The best EMR is one that has the standard things checked off/generated i.e. ICANnotes, eclinical works are a few good ones I can think of but they all have pros/cons. The main issue is not to rely on the computer and focus on improving your writing format. I don’t mind writing/typing but I was struggling with >20 patients but mainly due to the EMR. Therefore…
—I couldn’t use my charts, tables, or any resources anymore. This was not intentional, things got so crazy that I actually lost my stuff, which is why I’m glad I have them on the website. I guess on the plus side, I just about memorized everything but I still plan on using them for seminars and think they’re helpful for school or to use in an office so this will lead to the next lesson…
—Don’t get resource overload. Don’t think just because you don’t have the Stahl 88th edition or couldn’t attend the NEI $60000 seminar you’re losing out. First of all, these conferences are expensive, NPs are usually underpaid, and barely have free time to deal with life. Even this website is bloated but it mainly serves to offer free resources, which is RARE in general. So unlike my post from last year, I’m not mentioning additional resources/materials but will do so or add as needed. Use what you can and tailor whatever you have to your own specific needs because it’s the most realistic and convenient method.
- Lesson 4: Don’t box yourself in. I originally planned on just treating adults but by default, it turned into kids, OB, elderly, green people, and anything with a pulse. It’s nothing wrong with specializing but the need is so great that I’m being careful not to corner myself or feel like I should just see ONE particular group. If you plan to specialize, great but continue to learn and stay updated with the general population.
- Lesson 5: Less is More. I’ve been learning to say less, fight/argue less, and try to neutralize/lessen bad thoughts. I truly just respond when it’s life/death and I have little tolerance for drama. For instance, the pandemic means different things to different people so we have to respect people’s beliefs while staying objective. I get how difficult it can be but many people were not greatly affected or had to deal with other significant issues. So I even tell my patients to be careful not to put all your eggs in the “COVID” basket. How can you get Xanax for dealing with the same issue that millions of other people are also dealing with?? But overall It’s just another form of deescalating a situation and coping in healthier ways.
- Lesson 6: I couldn’t do telehealth anymore. This doesn’t apply to everyone, but when I’m home, I want to be HOME and NOT work on other people’s issues. The number of traumatic stories in CMH can easily be overwhelming and I needed to power down. I had to quickly prioritize a refuge (my bed) and build better coping skills to have some kind of peace. However, with telehealth, you can work for yourself and have patients that are usually not high acuity. This lesson was last because it’s the most important… don’t forget to manage your own mental health EVERYDAY.
Any Regrets?
I personally don’t live with regrets because I believe everything happens for a reason. Nevertheless, I do have a few things that I may have handled differently or could be helpful for others:
- Don’t avoid Rx reps. When I was new to the profession, many colleagues told me to avoid reps and I just assume they were evil but agreed to go to something for school. So at my first rx dinner, I was asking people, what are we doing here like it was taboo. However, the majority of the attendees were doctors and one of them told me how the rx dinners are mainly educational and informative. That completely changed my outlook and yes they are very informative. The speaker is usually an experienced doctor/provider and you can exchange ideas and concerns with others without judgment. The reps also have great connections to get coverage or discounted prices. Almost all my patients have state insurance so see how an rx rep can help, build those connections, and continue to learn and grow with your peers.
- It’s okay to not be okay. Like I mentioned previously, I struggled with hearing the traumatic stories and needed some support. I went to my collaborative physician and he recommended going to a therapist but he didn’t get it, I wanted to QUIT the job! And how dare he thinks I’m the one with the problem so clearly I wasn’t handling it well. I didn’t get how you can hear about parents trafficking their own child for example and NOT explode. So I’m saying all this to help others who may deal with the same dilemma: (1) having anger or sadness is normal whereas having NO reaction will be problematic. (2) it is normal and healthy to express your feelings because not doing so can make the anger and pain build up/countertransference. (3) neutralize bad thoughts and prevent normalizing the trauma. Once you hear something profoundly concerning, don’t picture it in your head/counter it with something that is normal and proper. For example, one of my patients said when they were younger, the family groomed her by using a pet but instead I pictured kids playing on the beach to not picture the inappropriate behavior. (4) Remember most patients have been living with traumatic issues since childhood so their demeanor may seem off or nonchalant but it doesn’t mean the patient is not just as outraged and continue to remain objective/supportive. (5) Another thing that helped was charting the patients with the most traumatic experiences at work or a location other than at home… keep your refuge/home calm, safe, and peaceful. If I couldn’t calm myself down then yes I would’ve considered therapy.
- The last issue is to NOT be afraid to admit your weaknesses. I let my patients know, I don’t do hormone therapy, birth ctrl, fertility treatments, or puberty blockers but usually refer them to a specialist or the PCP. I usually have no issues if it’s simple but definitely seek help if it’s out of your scope or not a medical necessity. Professionally, I know I can’t do forensics or corrections. I also don’t have time to write letters for someone to get weight loss surgery, disability, a revoked driver’s license, schools, food stamps, animal support… but again it’s okay. Being honest about the things you like/dislike or don’t know is more important than trying to please everyone.
Ok, I think I covered most of my main points and probably put someone to sleep lol but overall I’m doing great! I have a huge break and had to buy a new computer so I can finally upgrade the website. We have to endure like the great Lord. Thank you for understanding and reading!
