Nurse Sara, NP

Welcome to my blog! I am a Board-Certified Nurse Practitioner specializing in Palliative Medicine. Here you'll find a bit of everything -- my journey through nursing school, life as an NP, dreams for the future, and bits of my day to day sprinkled in between. I hope you stay a while! All views are my own.

[nursesaranp]

House Tour Sneak Peek #1 -- Eclectic Boho Modern Living Room

I wanted to give ya’ll a sneak peek of our living room. 

We’ve been slowly working on our living room since we moved in early summer. We’re now living in a beautiful townhome in the perfect neighborhood. Although still renting, we see ourselves settling here for a little while. We’re considering buying in a few years, but when that time comes we’re sadly going to be moving further out of the city as there are more important things to consider, like school districts over proximity to bars.  We want to make the most of our last few years in the city, and that starts with making our little house the perfect space for relaxing days, entertaining, and hosting overnight guests.

I LOVE entertaining but haven’t had much of the opportunity to do that in recent years --  we’re a few hours flight away from most of our friends and family, and we did not have the space for overnight guests. More space was super important to us when house hunting, and we’re excited to now have nearly 1900 sq feet (which is A LOT for city living).

The decorating process was initially very rushed -- we had many friends planning short weekends to visit, and were planning to host our families for thanksgiving. Then, COVID hit. While I am so so disappointed that we aren’t getting to see our loved ones, it’s allowed us to take our time getting things together.

It has especially allowed time for bargain hunting -- because this is not our forever home we did not want to spend a fortune decorating it. Most of our decor is from Homegoods, with a few things from World Market, At Home, Target, and Nebraska Furniture Mart. I go to these stores almost every weekend to browse new inventory.

I’ve been able to identify specific stores in certain neighborhoods that have what I’m looking for -- if I am searching for high quality art, there a specific Homegoods I’d go to (where I scored the art behind our couch ). I stopped by the Homegoods near my hair salon and was taken aback by how many eclectic modern finds they had -- that’s where I scored the pillows and most of the table decor. There are a few global treats mixed in as well -- I have beautiful coasters that I purchased in Barcelona, as well as black rocks I picked up from a beach along the Mediterranean sea. These memorable pieces go perfectly with our living room style.

Honestly It’s taken a long time to find a blend of our two styles -- outside of a mutual love for the color gray, my husband skews towards eclectic modern and my style is more mid century modern boho. But I love the final product. There are a few more tweaks, and then our living room will be complete.

[nursesaranp]

Undecided about NP vs. Physician? And what about the drama? 😰

 A friend halfway through NP school called me in a frenzy this weekend. The first question they expressed was, “When do I get to the good stuff? Learning about diseases and illness and medicine? I am halfway through the program, and theres so much more I need to know.  Am I making the right choice? Should I get a post-bacc and go into medicine instead?”. 

As I listened, they continued on about their desire for more intense sciences, a deeper understanding of pathophysiology, more exposure to an array of illness. My answer to them? 

Stop the program. Start the prerequisites. Apply to medical school. Medicine was the dream. Being a Nurse Practitioner may not satisfy that.

Their next question, “Do you love your job? You seem happy. Are you happy?” My answer?

Yes, of course I am happy. I wanted to be a Palliative Care Nurse Practitioner, and here I am.

I know this is a controversial topic. This is based on my experience having trained at the #1 nursing program in my speciality.

One of my NP professors said to me, “Physicians are trained to practice medicine. Nurses are trained to practice nursing.” I liken the nurse practitioner experience to an intersection of social sciences and the medical model.

NP school trains you to assess patients with a holistic gaze, with intervention focusing on the person and their disease experience first while considering the disease itself.  This is a varied approach from the illness focused medical model. Which is better? The answer is — you can’t compare! These are two different forms of practice, and each meets a patient’s need in different ways. BOTH approaches are needed to provide adequate care to our patients in this era of healthcare.

I will be honest when I say that my first year as a palliative care NP, I felt like an internal medicine resident in terms of scientific understanding, but ahead of some of the attendings in terms of holistic understanding. There was so much I did not know scientifically, but the basic skills all nurses have (thinking critically & learning quickly!) helped my medical knowledge increase exponentially. The excellent attendings I work with were happy to help me learn, and I’ve gained so much insight into disease processes in the worlds of pulmonary critical care, hematology, cardiology, etc. etc. etc. seeing consults all over the hospital. Everyday I learn something new.

I work on a team equally divided between NPs and physicians. We each respect our skill sets and recognize the value one another brings to the team. There are consults I pull my physician colleague into where I believe a strong scientific approach is needed, and there are consults that they pull me into where they believe a strong holistic approach is needed. We help each other in the opposite ways as well, it’s all about a second set of eyes with a different perspective. We do not cut each other down, attack each other’s form of schooling, or critique each other’s practices. We practice independently together. No one is beneath another because we are in our own lanes.

If you want to be a nurse practitioner, be a nurse practitioner. You will learn to be a phenomenal clinician, and to provide enriching care to the lives of your patients. If your dream is to be a physician, being a nurse practitioner may not satisfy you. Do not go to NP school expecting to learn how to become a physician. And do not expect to have learned everything you need to know by the end of your training.

There is nothing worse than the grouchy NP spouting statistics about how NPs are better than physicians, or the bitter physician spouting the reverse. This is rooted in disrespect and an unwillingness to understand the strength another brings to the team, on both sides. Despite our differing backgrounds, if you put my treatment plans side by side with one of our physicians, it will likely say the same thing. We come to the same conclusions, it’s just a difference in approach. It’s all about mutual respect, and all about the patient.

[nursesaranp]

Rediscovering Intention and Healing through Lists ☀️

I have a lot of mixed feelings working in a hospital that is in the heart of the second wave (or, the true first wave). There is an article about my hospital making its way around social media. It’s a strange feeling seeing the faces of my my friends and colleagues — photos from this article — being shared on the timelines of those from various stages of my life, high School, college, prior jobs, etc. My two worlds are meshing in an uncomfortable way, and I’m not sure if I should acknowledge it, or look away.

As a black woman, I’ve often responded to pressures to be everything to everyone, and try my hardest not to let anyone down. I’ve relied on routine lists to make that happen. In quarantine, I’ve subconsciously put even firmer systems in place that would keep me from allowing the stress of these uncertain times slow me down. For the first few weeks I found myself trying to stick with my same routines —  Giving 100% each and every moment at work, exercising daily at home or going for long runs, coordinating regular zoom sessions with friends, staying up to date with the news so I could inform my family, and of course squeezing in time to be a wife.

This is borderline unmanageable on the day to day, and I quickly realized in quarantine it was just unsustainable. Work has been DIFFERENT, the volume has increased and the needs are so much more. It does not help that many of those getting seriously ill are brown and black folk like me.  Add that to all of the planning, coordinating, organizing trying to maintain the perfect schedule — I could not maintain this added load even though it brought me so much joy. The schedule slipped away from me, I became more of a recluse as a result. I felt guilty for not keeping up my level of enthusiasm from the first few weeks, and beat myself up for it.

Gradually, I slept more, snacked too much, and plopped on the couch for an hours long nap after work as the days bled together. Soon, I began having more aches and pains to the point it was painful in my hips and back to even sit upright. I was so fatigued that I stopped walking Duke. I was either missing most of my meals, or eating until I was about to burst. My husband snapped me out the spiral— not only was I being a human lump, I was seriously losing wife points.

My spark to change was inspired by revising my New Years resolution: To be more intentional with my time, and to rediscover my hobbies. I’ve decided change perspective on my New Years resolution, and focus on using it towards healing. 

Here’s my healing list:

I’ve stopped working out — I KNOW, that’s a big step for me as someone who was religious in Orangetheory twice a week and lifting weights 2-3 other days. I’ve focused on regular visits to the chiropractor. My first adjustment was crazy, I had no idea my body was so out of wack! I know there is conflicting research about chiropractic care, but I love mine because he is also a nurse practitioner, so he is able to navigate the medical side as well. The TENS (transcutaneous electrical nerve stimulation) treatments are the best. I nearly have my full range of motion back. 

I’ve started watching trash TV — I’ve realized I need more time to detach. I generally try to watch intellectually stimulating shows or documentaries, and listening to podcasts about current events or analyzing life situations. I realized that all this was doing was giving me more mental work. Curling up to a show like ‘Love Is Blind’ was a guaranteed way to take my mind off of things for a few hours. 

I’ve allowed myself to snack — I’ve struggled with food for most of my life, and I’ve also given myself permission to accept that this tendency is going to resurface in times of stress.  At first I would beat myself up for not adhering to my general healthy diet. By giving myself permission to cheat, I’ve been able to normalize snacking. I don’t feel the need to rush through snack before the guilt hits, and because of this have had an easier time stopping when satisfied. 

I’ve cancelled my zoom happy hours— To be honest, I really miss my girlfriends’ weekly zoom happy hours from early quarantine (friends, if you’re reading this, call me!). But as work has picked up and the days have become very long, making time for these happy hours took away the time and attention I could give to my mini-family. My marriage was FEELING it. I realized that the energy I was putting into these hangouts really needed to be diverted to my husband, and this was a difficult conclusion to come to. Of course, I still need to be there for my girls. I’ve started scheduling texting times, usually in the mornings or weekend afternoons, where I can check in. I’ve also started calling friends while doing other tasks, usually driving home or putting away laundry. It’s not the perfect solution, but it allows me to still be there and nurture these friendships in an era where my time is very limited.

I’ve started leaving work early — and by early, I mean on time. Y’all know the feeling. Early in quarantine, my manager gave us the ability to work from home up to 3 times a week. Since then, I’ve worked from home a whopping 5 days. I’ve always found a way to convince myself for come in. But as restrictions have mounted (we are now required to wear full face shield in addition to masking), I’ve realized that my safety needs to come first. I am working on modifying my schedule to come in early and round on my patients, going home to complete my charts in an effort to minimize hospital exposure. I have also been better about working from home at least once a week.

I’ve stopped watching the news — this one speaks for itself. I am exposed to enough trauma, no need to let it into my home as well.

I’ve started writing again — this one also speaks for itself! I realized that my dream of being a writer can flourish during quarantine. I am committing to writing something — anything —  daily. Now that I have secured a career I love, I am working on chasing the dream I’ve always desired! 

I’ve stopped trying to do it all —  At work and in my personal life, I am always the first to volunteer, whether it be my thoughts to the conversation, my time to creating a project or program, or my dissent on behalf of others. My mama will tell you I am VERY opinionated. As a black woman, it takes a lot of energy not to look angry and black, annoyed and black, loud and black, especially when voicing opposition in the workplace. I don’t always do it right, but I definitely always expend a lot of energy trying to. Lately, I’ve just stopped. I’ve started sitting silently, ignoring the calls for volunteers even though I can feel the eyes on me. I’ve stopped going out of my way to be super helpful. I’ve redirected the energy I use to go above and beyond with others inward. Of course, I’m being cordial, cooperative, and a team player as always. I just can’t be anymore than that right now, and I’ve given myself permission to be okay with that. I’ve also given myself permission to keep my opinions to myself (which I’m sure many in my life are happy about LOL). Taking this step back has had a monumental impact on my happiness at work in these times where there is very little I can control. One day I’ll have my hands back in all of those pots, but for now I’m riding in the back seat.

What is your healing list? Comment below!

Xo, Sara

[nursesaranp]

My Journey to NP Part 2: An Uneven Path

Welcome to part two of my series about my journey to becoming a Nurse Practitioner. See Part 1before reading. Like all good stories, my journey has many twists and turns. I’m hoping by sharing I can help some of you realize that you are in fact capable, and can make it to goals you’ve never even imagined.

I want to preface this by saying that the beauty of nursing is in its many forms. The content of this post is not to disparage any nursing role. It serves to provide insight into what nursing means to me, and to help other nurses out there who do not fit at the bedside. The opportunities are endless for us, we just have to discover our space.

I often found myself going through the motions in college. Science classes were just as blah as they were in high school, and I did not love learning about nursing theory. Care plans, skills testing, nursing diagnoses… after a while I could not stand it. While I did well in most of my classes, the passion was just not there.

I was drawn to humanities. Enthralled by courses on bioethics, sexuality, and socioeconomic influences in behavior, I found myself staying late debating topics in my elective courses, while running out of my nursing courses as soon as I could. I’d look longingly at the health and society majors, wishing I could be in their shoes. Here I was learning how to make a bed and wash my hands… I felt like I had a seat at the wrong table.

I considered changing majors freshman year. Thankfully, a friend helped me realize I could find what I was looking for in nursing, I just had to find my own space. And so I kept my head down and pushed through the years, waiting for my inspiration.

I studied abroad my junior year. In London I was given greater degree of autonomy without the hours of completing care plans or prep work. I grew accustomed to how things could look once I became a bedside nurse. While it was far from perfect, I could find joy in the work.

When I returned to Penn spring junior year, all of my classmates were talking about their planned externships. I didn’t even know what these were, THAT’S how checked out I was. I decided to dive into research instead. I earned a research grant and spent my summer during field work in Sierra Leone on maternal health. I loved it so much that I contemplated a career in research. I thought about becoming a midwife as well, and envisioned practicing/teaching midwifery while doing my research as a PhD. This was the first actual career I had imagined since starting college, and I was relatively excited about the prospect.

My senior year I sub-matriculated into the women’s health/midwifery program. I took my first women’s health masters course and guess what… BORING! I was so frustrated with myself and my lack of passion. I figured, maybe it was just another thing I was going to have to push through. I begrudgingly began looking for nursing jobs in labor and delivery. After a dismal search, I decided I would start in medical-surgical nursing and after a few years make my way into women’s health.

I found my rhythm as a bedside nurse quickly. But after two years at the bedside I knew I needed a change. I thought about making the plunge to women’s health or ICU, but soon realized I just didn’t like bedside nursing, at all. I do not want to go to deeply into what I disliked about my experience bedside nursing, but it largely boiled down to the value of documentation over patient care, poor treatment from patients that was overlooked by management for the sake of patient satisfaction, and not being given enough resources or personnel to do the job well. I found myself becoming angry, frustrated, and flippant about my work. I contemplated going back for my PhD at this point, but I still had no passion. What was I even going to research? I reflected on my experience at the bedside, I loved geriatric patients and caring for those at end of life, but I did not know how to put those two together at the time.

I decided to hold off on my doctorate until I found a true passion. The decision to become a nurse practitioner happened organically. I knew I could not stay at the bedside, and I knew midwifery was not for me. I had never thought about being a nurse practitioner before, and honestly I am not sure I completely understood what I was signing up for when I enrolled in the major. The more I looked into it, the more I realized that a nurse practitioner was the intersection of nursing and medicine that I was looking for (I should add here that I believe nurse practitioners practice medicine with a nursing gaze, and it is quite different from the way physicians practice medicine, will not go into further detail given that this is a point of contention on both sides).

As a part time student, I needed to take additional electives to fill my schedule. I saw a course in palliative care on the registrar; I did not know much about it but the time slot looked good so I enrolled. I think back to this decision and how it changed the course of my life. The moment I opened the syllabus I knew that this was what I was looking for. Palliative care was the intersection of humanities and medicine I was seeking. I thought back to my love of communication and educating patients, how much I enjoyed sitting and truly getting to know my patients without feeling like I was being stretched across five rooms. I thought about how I loved comforting patients in their final moments, and helping guide families through he difficult time. Everything I loved about nursing fit into this speciality.

I looked around to a room full of students who all felt the same. I was finally at the right table.

I have found myself in a space where I finally feel like I am doing what makes sense. I am savoring this moment. Of course, my PhD dreams are still here, but each day I find myself inching closer to something I could actually envision dedicating my career to. For once in my life I am not just pushing through. Not many people can say that they’ve found their place, and although my path was very uneven, I am getting there.

Thanks for reading, and stay tuned for part 3. Part 3 will detail my journey through NP school, studying for boards, and how I landed the perfect job by complete accident. Until then, ask me any questions you have down below! Stay safe everyone x

Sara

[nursesaranp]

My Journey to NP Part 1: Choosing Nursing

Welcome to part one of my series about my journey to becoming a Nurse Practitioner. Like all good stories, my journey has many twists and turns. I’m hoping by sharing I can help some of you realize that you are in fact capable, and can make it to goals you’ve never even imagined.

Why Nursing?

This is a question I get asked surprisingly often, and is the natural start for this series. At work, compliments from patients are often followed with questions as to why I chose nursing over medicine. Today, I am not going to focus on how much this question offends me (as if nurses can’t be intelligent and highly motivated…), but instead share some insight.

Nurses make up the largest healthcare force in the United States, and while they most often work in the hospital setting, their knowledge can be applied across industries. With nursing my opportunities are endless… but it was not my first choice.

The answer to this question goes back to my childhood. Growing up, I used to pretend I had a doctor’s office in my room. I would make my siblings come upstairs to get examined. I would use my belts to get blood pressure checks, the belt buckle to give injections, and administer gummies and vitamins as remedy. My parents were team players, and would force my siblings play along as well. I loved helping people feel better, even if it was only my imagination.

Years later, I fell in love with writing. I created a children’s anthology similar to The Boxcar Children and used to leave copies for my parents to read. I was a fairly good writer and always excelled in English class. From these experiences, my family assumed that I would end up in either writing or medicine.

I considered all of my options. But calculus gave me nightmares so engineering was out, law had too much reading, journalism was tedious, I was (am) a terrible artist, teaching seemed like a headache, and business just was not a fit (after all, I gave the lemonade at my stand away for free as a child)… so I came back to medicine or writing. However there were two big barriers for me.

I didn’t love chemistry, physics, OR biology. I was good at the subjects but I often had to force myself through assignments, and was all to happy to put my books down as soon as I could. I couldn’t fathom spending the best years of my life in labs. I LOVED writing — my heart would skip a beat when I found the right words (it actually still does). However, I only enjoyed reading young adult fiction, and the idea of spending days critiquing English literature was enough to have me question that path as well. After spending a weekend at a liberal arts college, I thought about studying anthropology or psychology and becoming a professor. As you can see, I was all over the place.

I turned to my brother, who at the time was a critical care nurse. He boiled it down to my strength that allowed me to love both medicine and writing — my ability to connect with and understand people, and my love for communicating stories and lived experiences. Nursing, he revealed, would allow me hone this strength.

Although I’d have to spend some time in dreaded labs, with nursing I would be able to work closely with people and help them feel better. I thought about my experience in healthcare settings where I would spend so much time with my nurse and only see my doctor for a few minutes. I wanted to be the one at the bedside, holding their hand, helping make sure they understood everything they needed to know to better take care of themselves. I realized I could write if I wanted to, either academic articles or fiction in my free time. I also realized I could eventually go into academia. Although I knew little else about nursing, I took the plunge and applied to seven nursing schools. I was accepted to every school I applied to, and ultimately chose the University of Pennsylvania.

But eventually I left the bedside…

By my first clinical freshman year, I knew the traditional nursing role wasn’t for me. I struggled a lot with this through college and thought hard about finding a new path. The next post will be about how I struggled with this realization and how I almost ended up in academia, how I found joy in bedside nursing, and when I knew it was my time to move on. The final post will be about how I was able to mold nursing to fit what I needed out of my career, and how I ended up in my dream position.

Until then, if you have any questions for me please ask below! I hope you all are staying safe!

xo, Sara

[nursesaranp]

January 1st, 2020

There is something about the new year. Midnight rinses away any lingering feelings of failure or inadequacy that nestled in our corners as recent as the hour prior, and that space is replaced with resolutions of betterment and hopes for the year to come. Or so they say.

I’ve always viewed “new year, new me” with a cautious lens. Each year I feel a sense of dread come over me as the reality of the celebration would set in. I would often focus on my failures; failed tests, failed work situations, failed relationships, whatever failure suited the season of life I was in. I’d set larger than life goals in that minute, hoping to wake up in a few hours as someone without the unique set of flaws that I felt prohibited my success. But instead I’d wake up the same person I was yesterday, the only difference being remnants of glitter and alcohol in my being. So yeah. Outside of the festivities, the new year was not something I loved celebrating.

Now that I come face to face with my mortality on a daily basis, I realize how fleeting life truly is. This was especially triggered by the loss of my sweet young patient (you may remember them from my previous post) who unfortunately passed days before January 1st, the date when their insurance would have kicked in making them eligible for a life saving transplant. In our visits we spoke of January 1st with such passion; THIS was the day they were going to have a chance to start a new life. But they didn’t make it. In their honor I’ve made efforts to be more intentional with my thoughts, as well as to express humble appreciation for the life I’m able to live.

Honestly, it’s taken me a while to come back and finish this post because I am still grieving this loss (there’s a lump in my throat as I write this). Instead of sharing the heartache of this story and focusing on how it exposes how broken our medical system is (after all, their death was due to an arbitrary insurance start date), I’ve decided to focus on how they’ve inspired me to start the year with the same hopeful energy that coursed through their existence. With that, I’ve come in with the following New Years list:

Be responsible for my own happiness

Strengthen my marriage and nurture my family

Strengthen my faith

Find time for hobbies (like this!) and hold myself accountable to them

Create more balance in my work; it’s okay to remain passionate but with boundaries

Make time for friends, family, and new personal relationships

Travel well, meet my goal of 4 trips this year

Be grateful, every day, for the life I’ve been given. I wanted for many years to be in the position I am in now. I hope to take time to reflect on this journey and congratulate myself for making it this far!

INVEST. (I really want to strengthen our retirement portfolio. I’ve been learning about the FIRE movement (financial independence, retire early) and want to modify it to suite our needs (we are going for a more relaxed approach). Let me know if you’d want me to share this journey on the blog!)

It’s been a week into the new year and I have been doing pretty well so far. It’s too soon to comment on the areas I’ve been working on, as I want to give it time and remain consistent first. I plan to do an update either here or on Instagram over the next few months. Stay tuned

Thanks for reading, and please comment your goals of the new year down below!

Sara

[nursesaranp]

Caring for your neighbors this winter

**From the old blog, but I love this post too much to delete. Enjoy! 

Yesterday was my father’s 69th birthday. I left his celebration glowing, rejuvenated from a lovely evening with family. I heard a voice as I fished my house keys from my jacket pocket.

“Hey baby, how are you doing?”

I turn to see an older black woman, eyes crinkled in the corner from a history of laughing, encased in a black down coat with a matching hat pulled low over her ears. 

“Im doing well Miss, how about you?” I replied, balancing my belongings with my right hand and holding my now found keys with the left. 

“Im doing well thanks for asking,” she started down the sidewalk, continuing the path that was drawn out for her without her consent, before pausing. “Hey baby, would you happen to have a few dollars so I could get something to eat?” 

My eyes danced from her hat to her shoes. The thought entered my mind before I realized, but she doesn't look hungry. 

What is looking hungry? We are taught to see homeless or food insecure neighbors a light unrelated to our own. While there are homeless neighbors and friends amongst us who are unable to afford basic necessities such as clothing, shoes, and warm weather gear and are hungry, the food insecure population is broad and diverse. There are neighbors who can afford basic necessities but are still hungry. There are neighbors who have a home but are still hungry. There are those who are financially stable on paper, but due to familial obligations and factors out of their control are still hungry. 

Twenty-two percent of Philadelphians are food insecure, which is defined as having access to enough food to live an active, healthy lifestyle. Our neighbors, our friends, our community members are suffering in silence, and those who are able need to set aside stigma and help where they can. I include myself in this need. I acknowledge my biases and challenge them, striving to see the good in all of God’s children. 

“Thank you so much baby. I haven't eaten since noon, and I’m starving,” The woman shared as I fumbled for my wallet. I gave all of the cash in my wallet, which admittedly was not much. It was midnight, and this woman who once laughed her skin into delicate creases had not eaten since noon. 

I’m thinking of her today as I watch the snow falling heavily through my window. With the winter bring freezing weather and snowfall, our neighbors need us the most. 

Admittedly, we have not been the most active over the past year. However, in 2017 I would like to make Neighbors and Friends for Multicultural Health into a movement. If we inspire just one person in Philadelphia to think of their neighbors, we will have succeeded. 

Please email  me at [email protected] if you would like to join in planning our year ahead. 

Best wishes and happy new year, 

Sara