Traveling NP

I have been fortunate to have family and friends visit me in Seattle. It has been so much fun exploring the town with them. My favorite food is definitely sushi; I can eat it practically every day. I must admit that the best sushi I have ever eaten in my life is in Seattle. They have great combinations of rolls and the raw fish is super fresh. Some of my favorite places are Bluefin Sushi and Shiro’s Sushi.

I really enjoyed visiting the Chihuly Glass Museum when my mom came to visit. My friend at home had mentioned his exhibit to me in Miami once, and I was surprised to see how amazing his art truly is. If you have been to the Bellagio Hotel in Las Vegas, you will recognize his work on the ceiling of the lobby. I would have loved to purchase one of his glass sculptures for sale….except the cost started at $4,000.00

Of course we went up to the Space Needle, which was an organized process. It is worth the cost to see a spectacular view, and you can get a discount when you purchase your ticket with entrance to the Chihuly Glass Museum as well. I had always wanted to eat at the restaurant up there, but my sister and I had previously done that at the CNN Tower in Toronto. So I did not find it necessary, especially because they have a café by the observatory deck.

The cost of parking in Seattle is pretty steep – and this is someone coming from Miami. What was neat is that when I was looking for parking, a nice man came up to me offering valet services. There is a company called Luxe, that when you download the app, you can request valet parking for a low price. Normally parking in Seattle for 2-3 hours, costs $15-$20. Parking with Luxe would cost $30 maximum for the entire day. So you can drive to different places in Seattle and someone will pick up your car and bring it back to you when you are ready to leave. Luckily, I got the first time user promotional rate which was free for the day. It was pretty nice having someone drop me off and pick me up at each site. I contacted Luxe and told them to come to Miami ASAP!

The great thing about being a locum tenens Nurse Practitioner is being able to travel! I may not currently be in the largest town ever, but it’s ok since I find myself working for the majority of the time on weekdays. I do have the weekends off, so I take advantage of my free time to explore nearby towns.

My first weekend here, I went to Spokane, Washington. Before moving to Washington, I went on Pinterest and searched for ideas of places to visit. I immediately saw a beautiful picture of a waterfall in Spokane. Everyone that travels has different interests. Some people I know love trying new food; others enjoy going to museums or natural parks. Although I definitely cannot pinpoint one exact thing I travel for, I do love waterfalls (maybe I get it from my grandmother).

As soon as I had the chance, I drove the 1.5 hours to Spokane Riverside Park. I walked along the river and saw several incredible views of the waterfalls. It was so relaxing listening to the movement of the water. The weather was in the perfect high 60’s/low 70’s.

One of the pins I posted from Pinterest was of this gondola that goes over the waterfall. I thought it was super cool to get so close to the falls. When my sister and I had visited the Niagara Falls a couple of years ago, we took a boat ride close to the falls. So seeing a waterfall from a different angle really appealed to me. The gondola was a little frightening at times because it would shake with the wind, but it was certainly worth the view.

 

Last week I wrote about my experiences working at the new community health center and the workflow of the facility. However, I did not discuss my patient population.

I automatically assumed that the majority of my patients would be of low socioeconomic status since the facility is a community health center. That is not necessarily the case. Only a quarter of the patients are self-pay or sliding scale fee patients. The majority use private insurances or Medicare/Medicaid.

Before coming here, I was informed that a lot of the patients would be migrant farm workers. I thought this would be interesting since I did some research on them while I was in nursing school at Florida State University. I have always enjoyed helping underserved populations.

So half of my patients are Mexican migrant workers and the other half are white Americans. This is different compared to my patient population in Miami, which were majority Cuban. Most of my patients here are young, ranging from 2 weeks – 25 years old, or middle-aged 35-50 years old. I do have a handful of elderly patients, but nowhere near as many as I did in Miami. Most of my patients in Miami were elderly, whereas here there is a large pediatric population.

My first week working, I immediately learned the dynamic of my patients. For example, I prescribed a muscle relaxant for a patient with back pain. I saw he was self-paying so I told him that he could get it for $4 at Walmart. He told me Walmart is too far for him (20 min away) due to the cost of gas. Luckily the clinic and pharmacy have a program allowing him to purchase the medicine from them for only $8.

I have a lot of children coming for well child exams before they start school. At first I was worried about being competent in this age group but as with anything else, the more children I saw, the easier it got.

For instance, whenever someone says they have a sore throat, they always think it is strep throat. Treating an older patient population in Miami, I have never seen a positive rapid strep test (since strep is more prevalent in children). Strep throat is a more severe type of sore throat because if untreated with specific antibiotics, it may cause other organ complications later in life. Treating a lot of children here, I am more alert to strep throat symptoms.

One day I had 3 positive strep throats within 6 hours. Another day, a child came in for a wellness exam, but I noticed on his vital signs he had a fever. Through my examination his throat appeared red and his tonsils were severely enlarged. I asked the child and his mom if he was sick, they said no. I asked if he has a sore throat and he said a little starting that day. Although my shift had already ended, I decided to go with my gut and order the rapid strep test, since he had no other symptoms except sore throat and fever (classic strep). His results were positive and I treated the patient accordingly. I am glad I provided the care that he deserved.

I am so accustomed to knowing my patient population so well. So that whenever they come it is for a brief visit, as I already know everything about them, and they are just following up with their chronic illnesses. Here I mostly see acute visits and obviously all of the patients are new to me.

I have never enjoyed maternity or women’s health. I cannot exactly pinpoint what about it has always kept me away, but it started since I learned nursing in high school. I guess I always just thought it was gross (so mature I know). Anyways, here I find myself doing a lot of pap smears and even offering them to patients that are overdue. It turns out that it really isn’t a big deal. However, I think I will stay away from maternity 😉

I think having previous experience is helpful working here because I am competent in various diseases management. For example, in Florida, fungal skin infections are common due to the humidity and people are always sweating. Here they are not as common so they are often misdiagnosed as an allergic reaction or eczema. So I admit that it is a great feeling to tell patients that it is a fungal rash and when the treatment I ordered improves their rash, they become confident in me (especially as a new provider they are not accustomed to).

At the same time, I do enjoy being able to see different things I did not commonly see in Florida. But due to my overall background and experience, I am still able to identify and treat accordingly. For instance, gallstones are more common in white women in their 40’s. As I mentioned previously, my patients in Miami were way older than that, so gallstones wasn’t that common with them (a lot of them had their gallbladder removed decades ago). One day I had a patient here with severe right upper abdominal pain. She did not have any other symptoms (nausea, vomiting, diarrhea, constipation, fever) as a lot of the other patients do when they have the stomach virus/gastroenteritis. In my physical exam, she had a positive murphy’s sign which indicated potential gallstones. I ordered her a stat ultrasound and it confirmed my suspicions. I referred her to general surgery and she was scheduled for surgery the following day.

I think one of the reasons I am enjoying my time so much working at this facility is because it challenges me. Working at the same site for a few years, you obviously become an expert in your field. Yet there is no progress without being challenged.

My first week working with a community health center in Washington was amazing!  The facility had so many different departments including medical, dental, maternity, WIC, laboratory, imaging, and pharmacy. There are groups of people who are assigned different tasks to facilitate the medical process for both patients and providers. For example, there is a unit that works with referrals. So they establish appointments for patients with the specialty provider depending on their insurance and availability. In addition, after the appointment they follow-up to make sure the patient went to the consultation, and to obtain records from the visit. Then there is a unit that uploads all supplemental documents to the patients file on the electronic health record. They contact hospitals and other medical centers to obtain previous records, so when a patient comes in for a follow-up ER visit, you can know what was done in the ER.

Each provider has two medical assistants and one nurse assigned to them. The medical assistants bring the patients to the room, take their vital signs, and ask for the chief compliant. For well child exams, they do the hearing and vision tests as well. The nurse administers medications, does wound care, and will assess which vaccines are needed per visit and administer as necessary. This saves me time and energy from having to review which vaccines each child needs. Moreover, the medical assistants have established protocols in which they can do lab work if warranted. For instance, if a patient comes with a fever and sore throat, they can go ahead and perform the rapid strep test before I even see the patient. The same applies for urinary tract infections and possible pregnancies.

The facility is large and accommodates all of these departments. The best part would have to be all of my co-workers. They are all supportive, friendly, and encouraging. They always check in with me to see how I am doing. It is a good feeling to have a good relationship with other nurse practitioners, physicians, and physician assistants. Sometimes others in the medical field can be antagonizing, as I am sure many have experienced. It is a good feeling knowing I can ask any of them for help or a second opinion, as medicine is a constant learning process.

I feel spoiled with all of the support I have here because I can focus on my patient and their health. In places I have worked in Miami, I was often the sole provider. In addition, a lot of the assistive personnel were computer illiterate, so I had to input vital signs in the computer myself. A lot of them were not properly trained, so they could not help with assistive tasks such as notifying patients of their lab results. Nor did I ever have a nurse to administer medications, call in prescriptions for me, or provide patient teaching on insulin use. I was pretty much a jack of all trades. I definitely will not take for granted my experience with this community health center!

They are always looking for locums and permanent providers. So if you are interested in working in Washington with a community health center, I would love to refer you to them!

I have wanted to go to Seattle since I was in high school. Maybe the fact that it was on the opposite side of the continental U.S. from Miami, is what appealed to me. I never had the chance to go, probably because the flights from Miami were just as long as going to Europe (non-direct flights).

I finally made my dream come true when I accepted my first traveling Nurse Practitioner job in Washington State. I had been looking forward to getting out of Miami, that I didn’t realize what I would be leaving behind until the day of my departure.

As I was packing up my last items, it dawned upon me that I wouldn’t be seeing my family practically every day as I had grown accustomed to. I was leaving behind close friends, patients and staff I had known well, and my favorite spots around town. I couldn’t help myself from crying almost that entire day. I thought to myself that you do not know what you have until it’s gone. However, I knew this was my chance to pursue a career in traveling and I couldn’t give it up.

Luckily, upon arriving in Seattle I was instantly impressed by its scenery and diverse population. It was different from anywhere else I had been before. The tall “Christmas trees” were amazing and of course they reminded me of the movie Twilight. There were multiple waterfront sites, such as the ocean and various lakes. Coming from Florida, I love being close to the water.

Everyone was extremely friendly! Wherever I went people were talking to me and asking me questions. At first I was confused to why they were talking to me. I was in culture shock! I travel frequently and I was perfectly aware of how unfriendly people in Miami could be, but I had no idea to what capacity.

My first stop was to the space needle. It was spectacular seeing it for the first time – something I used to see on a poster in my room during college. It didn’t appear to be as tall as I thought. The previous year my sister and I had visited the CNN tower in Toronto and that seemed to be much taller. I decided to wait to go up to the observatory until my family visited.

I then strolled around town and ended up at Pike’s Place Market. It was an incredible fresh market with the most beautiful flowers I have ever seen, for such a cheap price. They also had all kinds of meat, fish, grains, and fruits at your disposal.

A short walk from there was the original Starbucks. There was a long line to get inside, so I settled for the café down the road. I love how Seattle has an abundance of cafe’s and bookstores!