Introducing the OB/GYN Nurse Practitioner
Monday October 2, 2000
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By 10 AM I have begun my individual rounds on the gynecological service. After checking patients' lab work obtained that morning, I order additional tests and consults as necessary. Next, I evaluate each patient, answer questions, and discuss discharge plans. When my gynecology (GYN) patient rounds are completed, it's off to L&D again to evaluate any new patients who may have arrived. Through-
out the day, I respond to pages for the obstetrics (OB)/GYN service.
On any particular day, I might have a staff inservice scheduled because staff education is another of my roles. I might be lecturing to newly hired RNs, presenting a fetal monitor tracing review, or holding OB nursing grand rounds. The day usually ends around 5 PM, but just when I think I am close to being finished, the pager starts to beep, and I am off and running for another hour or two.
A Day in the Life of...
My greatest reward is following the everyday care of my patients, who include women in labor, high-risk antepartum patients, pre- and postoperative GYN patients, and gynecological oncology patients. On this particular day, L&D is unusually busy, and I evaluate Jean,* who presented in early labor at 35 weeks' gestation. After taking her history and reviewing the fetal heart rate pattern, I order an IV for hydration and glucose administration. The fetal tracing has a normal baseline, minimal variability, and no accelerations. After approximately two hours of monitoring and no change in the fetal heart rate, I perform an internal exam, which reveals a cervix that is long, closed, and posterior. Completing my assessment, I collaborate with the attending physician by phone and discuss my recommended interventions. Jean is sent to the ultrasound unit for a biophysical profile that turns out to be normal. Together the attending physician and I decide that Jean can be safely discharged with instructions about fetal movement counts and scheduled for a nonstress test in the morning.
In the early afternoon, I receive a page from the ED. Sally, a 50-year-old with acute abdominal pain, needs a GYN consult. On examination, I palpate a large adnexal mass, and Sally complains of severe tenderness. My diagnosis: ovarian torsion. Sally, who is stable, is immediately sent for a pelvic sonogram. The sonogram reveals a 10 cm adnexal cyst with possible intermittent torsion. Surgery is required, and I alert the OR and discuss the surgery with Sally and her family.
Toward the end of the day, I receive a page from one of our GYN oncologists informing me of a pathology report on Nancy, the patient on whom he operated that week. The pathology report reveals a leiomyoma sarcoma. Although he called Nancy to inform her of the findings, I have to meet with her to discuss the need for further tests. I sit with her as she works through her feelings about her diagnosis of cancer.
A Source of Continued Support
Along with being a support for patients, I am also a resource for both the nursing and medical staff. They know that when my pager goes off, I will immediately respond. The attending physicians see my role as crucial because of the consistency I bring to the OB/GYN service. The residents rotate every six weeks, whereas I am routinely there and involved in all aspects of patient care. This allows me to get to know patients and their families. When patients are readmitted for chemotherapy or complications, they have the reassurance of seeing a familiar face.
What's unique about my role is the different patients with whom I have contact every day. In the morning, I may be assisting a new mom in early labor and, in the afternoon, supporting a patient newly diagnosed with cancer. Because the two areas are so diverse, I may experience the joy of new life and the pain of death in the same day. Those are the days that become the most challenging and reinforce the importance of my role.
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