Introducing the OB/GYN NP
Monday March 19, 2001
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By 10 AM I have begun my individual rounds on the gynecological service. After checking the 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. Throughout the day I respond to pages for the OB/GYN service.
On any particular day, I might have a staff inservice scheduled because staff education is another one 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. After 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 we decide that Jean can be safely discharged with instructions about fetal movement counts and then scheduled for a nonstress test in the morning.
In the early afternoon I receive a page from the emergency department. Sally*, a 50-year-old with acute abdominal pain, needs a GYN consult. On examination I palpate a large adnexal mass and the patient complains of severe tenderness. My diagnosis - ovarian torsion. Sally, who is stable, is immediately sent for a pelvic sonogram. The sonogram reveals a 10cm adnexal cyst with possible intermittent torsion. Surgery is required and I alert the operating room 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 he operated on 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 staffs. 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 I have contact with every day. In the morning I may be assisting a new mom in early labor and supporting the newly diagnosed cancer patient in the afternoon. 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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