A day in the life of a nurse practitioner

I just had a funny thought as I sipped my coffee.  I wish I had read this article 19 years ago in my first few weeks of NP school.  I wonder if I would have kept going to class?  Probably... knowing me.  I'm always trying to prove somebody wrong.

Alright, alright, I'm about to let you all in on a BIG secret!   Those who love me, and especially those who live with me know all of these truths, but I bet many of you are about to lose all your enamor for your health care provider.  I am going to tell you about the daily life of a family nurse practitioner working in primary care.  In essence, my day can be broken down into a few "sessions" or time periods.

• Early morning
• Commute in
• Morning session
• Lunch
• Afternoon session
• Commute home
• Dinner / Kids / Chaos
• Winding Down
• Getting kids in bed
• Collapse

Now each of these sessions has its perks (well most of them do), but I don't think patients or friends or family of doctors, NPs, or PAs really know what our days are like.  I certainly didn't before I became one.  I envisioned fancy decision-making, collaborative care phone calls, and fun jokes in some break room.  I envisioned fancy clothes and cars and hefty retirement accounts.  I thought someone might bring me coffee, and someone might make some phone calls on my behalf.  I didn't think of those things as a power or control motive, more of "hey, I worked hard and went to school, maybe I can delegate more of the menial tasks and save my knowledge for the hard stuff."

Let me laugh with another sip of coffee real quick
​before I proceed.

• Early morning:  This is MY time.  I get up between 430 and 445 every workday before my kids wake up.  My husband is still at work (or asleep if he's off work).  The house is quiet.  Even Charlie the Dachshund is still snoozing.  The first smell that hits me is the freshly brewed coffee I assembled the night before (and set the timer - genius).  I read, pray, write, listen, and learn until about 530 when I drag myself into the bathroom.  I then smell the lemongrass essential oils I diffuse each morning and the fruity shampoo in the shower.  Both of these fresh scents get my blood pumping and help dissipate my tendency to overthink.  The next smell is the absolute best smell and that is bacon simmering in the oven waiting to be loved.
• Commute in:  I begin my hour drive no later than 7 am.  I have a beautiful commute on Georgia backroads into the small community where I practice.  As I'm tasting my fresh grapes, blueberries, blackberries, and pineapple, I get to see a gorgeous sunrise over rolling pastures of farmland.  Part of my drive is engulfed in beautiful pine and oak trees hugging my 2-lane highway.  I eat my one piece of bacon, one piece of multi-grain bread, and one egg over medium as I cruise through the country and listen to a book, podcast, or music.  I use this time to listen, learn, pray, and think.  This morning commute also calms my central nervous system and prepares my heart and mind for everything that is about to be asked of it.
• Morning session:  As soon as I open my office door around 745 am, I am usually greeted with new papers on my desk and patient messages in my computer inbox.  I work with some fantastic people, and while we ALL smiled more before March of 2020, I can usually find at least one smiling face in the crowd.  I have already been awake for 3 hours, but I'm feeling good.  I've usually already had 24 oz of water, learned at least one thing, and have mentally prepared myself for the day.  My patient appointments are usually 15-minute slots with 30-minute slots for paps, wellness exams, new patients, or hospital follow-ups,  I've worked at this practice since 2007, so I know my regular patients very well and that helps us really focus on the problems at hand.  Sometimes, my fantastic nurse will get our essential oils going and that definitely helps our focus and mood.  Sometimes, we can barely even speak between patients and the phones are ringing off the hook and we feel like we are on a treadmill that will never stop and keeps increasing its speed.  Each day is different, and I've learned to just try to do my best.  Our building is old and there are no windows ANYWHERE on our entire floor, so I don't get to see if it's raining or sunny or if there are signs of life.  (Pro Tip:  never take a job without windows that you can easily see or walk to and see... it will impact your life and your mental health).
• Lunch:  I pack my lunch from home for a few reasons:  cost, health, and time.  I have to get out of the office by 1215 or so, because nature is my homegirl and I don't want to be accessible for at least 30 minutes.  I drive out to the lake in our small town and eat my lunch in peace.  I use this time to return texts or phone calls, check on my children if school is out, glance at emails, and mainly just to BREATHE.  This small window of time allows me to ground myself with my 5 senses again and reset my body and mind.  You may have noticed, I didn't mention any of my senses in my morning session.  That's because I was too busy, and I know the afternoon is usually even busier.
• Afternoon session:  I try to get logged back into my computer no later than 115 so that I can answer a few messages from patients or glance at a few lab results before my first appointment at 130.  At this point, I am usually not really relaxed but I'm slightly refreshed from my lunch and lake view.  I finish out my afternoon appointments usually by 430 or 445 and am racing to finish my notes, respond to lab and radiology results, and answer patient messages so that nurses can return phone calls before 5 pm.  This is stressful, and I won't pretend to sugar-coat it.  I no longer enjoy the pressure or busy-ness of it all.  I love my patients, but I hate the pace of a fully loaded primary care practice, especially during a pandemic.  I haven't mentioned "the C word" in my writing, but it's taken a toll on all of us in healthcare.  We are exhausted, depleted, and defeated at this point in August 2021.  As for my 5 senses in my afternoon session, I don't have any.  I might feel tension in my neck and shoulders or a headache, but that's about it.
• Commute home:  My commute home is that same hour drive, BUT this time I'm trying to unclog the pipes instead of open them for compassion and wisdom.  It feels like everything that was just shoved into my body and mind over the last 8 hours needs somewhere to go, and sometimes I don't know how to do that.  I try to glance at my phone before I put my car in drive so that I can see what calls, texts, or emails need an urgent response.  I also use the Marco Polo video messaging app to touch base with my husband, parents, and friends.  Pre-pandemic, I might have used this time to listen or learn, but I am usually using this time to pray or think these days.  How did we get here?  When will it end?  How can I help it end?  Should I have tried harder?  Should I be more vocal- will I get fired if I am?  How can I teach a microbiology course in 2 minutes?  I will admit that lately my drives home aren't spent thinking about my kids or my own hopes or dreams.  Lately I'm just staring into space, none of my 5 senses in tow, completely detached and catatonic.  Is this trauma?  Regret?  Hopelessness?  Sorrow?  I don't know, but I don't think I can keep doing it much longer.
• Dinner / Kids / Chaos:  Once I pull into the garage, I usually sit a few minutes before walking into the battle zone called Evenings With Kids in Activities.  My husband is awake and either preparing for work or winding down from tackling his to-do list for the day.  Supper is planned and already ready thanks to my meal-planning skills.  I have a baseball player, a drama / band kid, and one in the Air Force now so even though I feed one less, the activities are picking up it seems.  My oldest wasn't into after-school activities and the youngest two have more commitments as they get older.  I love this part of my day in many ways because I am not responsible for any answers or solutions.  I'm usually just a spectator or chauffeur.  I love watching my boys have fun and grow into young men.  It's also exhausting, though... just the hours spent and mental bandwidth to be present.  I've given all day and continue to give more in the evenings.  In an ideal world, my boys and my husband would get my best energy.  More overthinking.
• Winding Down:  On the rare night we don't have activities or during the small timeframe after activities and before bed, I try to watch a little TV.  If husband is off, we pile on the couch with Charlie the Dachshund and watch something we can both agree on (that gets tricky, right?).  If husband is at work, I watch something with the boys while they wind down or if they're already headed to bed then my trash TV consoles me.  I wish I could tell you that this time is spent completely stress-free and relaxed but 99% of the time I have my laptop out.  If husband is home, I try NOT to do that, but if he's at work, I am working.  I am finishing notes, responding to labs / diagnostics, answering messages, glancing at tomorrow's patients so that I don't walk in every room blindly, and weeding through work emails.  The C word has created tons of work emails that are all important, and that takes a toll in and of itself.  Even pre-pandemic though, I work way too much at night and on weekends.  Part of that is because I truly care about my patients and I provide excellent care.  Part of that is just the nature of the beast that is primary care.  If you're reading this and you're considering work as an NP, go into a specialty!
• Getting kids in bed:  Just writing about this makes me tired.  They're so much better at 9 and 11, and I've always been a Mean Mommy when it comes to food and sleep, but... now they try to negotiate to stay up longer.  My 5 senses are long gone at this point.  The only thing I want to see, taste, smell, hear, or feel is my bed and my sound machine so I am an easy target.  I usually stick to my guns, but sometimes they win.  I'm strict on video game and YouTube time, but if they want to watch 5 more minutes of the family movie with me, the long eyelashes pointed my direction usually win.  This keeps ME up later, which is not good, but there you have it.
• Collapse:  Makeup remover pad (way too tired to actually wash face), teeth brush, sometimes floss pick (also a shortcut), coffee made for next day, doors locked, dog out and then kenneled, and 3 alarms set on phone, then climb into bed.  This should be by 930 but is often 1030 or later.  When I'm mentally healthy, I avoid all social media and go straight to sleep.  When the C word has won or life gets in the way via friendships, my own chronic illness, marriage, work stuff, or kid stuff, I do the worst thing ever and scroll social media which leads to more time awake and less peace.  I'm working on this.  I've set a 30-minute max daily intake of Facebook, IG, and TikTok combined (gasp!) and that helps but those lockouts can be dismissed (iPhone geniuses at work there), and sometimes I cave.  Anyway, this is a true story about a working mom in her 40s trying to figure life out.  I see no need to pretend it's fancy.

Going back to my original "dreams" of working as an NP, did any of it come true?

• fancy decisions?  not fancy, but important -yes
• collaborative care phone calls?  occasionally when we have time and they are good when they happen
• fun jokes in break room?  I don't even know the key code to our break room
• fancy clothes?  I wear scrubs and the same earrings every day now because I'm tired
• fancy car?  I drive a Honda Civic
• hefty retirement account?  it's okay I think- that part might have come true?
• does someone bring me coffee?  no, we are all too busy but they might if I asked?
• someone to do the menial tasks?  yes, I work with a fantastic team of nurses who make dozens of calls for me every day, but... I still do a lot of menial tasks and I try not to make them do something I could do in a few seconds' time
• was it worth it?  
  • yes
  • but I'm tired, and I want future NPs and patients alike to know that your health care provider is human, flawed, invested, interested, and also exhausted if they are doing a good job at all

Check out these posts from my fellow Hope*Writers for our monthly writing challenge.  This month's theme was "daily":

Oh, I Try by Jessica Weaver
www.rootedunrooted.com/blog/oh-i-try
Kids Sleep Meditation: 6 Daily Practice Dos and Don’ts by Ashley Olivine
louvaria.com/kids-sleep-meditation/
Lessons from Daily Bread by Dianne Vielhuber
simplewordsoffaith.com/2021/09/01/lessons-from-daily-bread/
Daily Conversations with God by Sharla Hallett
www.sharlahallett.com/daily-conversations-with-god/

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