It's Foreign On This Side

And, it's been quite some time since I've posted. The last few months have been a whirlwind as I moved into my new role and to say it's been an adjustment would be an understatement. I've worked in oncology for my entire nursing career thus far, and up until I moved into the NP role, I have always been comfortable with talking about death and dying with my patients. I guess I was comfortable with it because I am comfortable with death; it's natural thing. We all have to do it and it begins as soon as we're born.

However, I have noticed one thing since becoming a NP and achieving "provider" status (scary someone thought I was bright enough for that): While I have talked with patients and their families about the end of life as a NP, I am not as comfortable with it as I was as a staff nurse. It's like someone has turned off the switch inside my brain that allowed me to to this. It would be easy to say that you get more attached to your patients in the outpatient setting because you see them more often, but not necessarily, for I have had many patients and families in the past who I was close with because, not only was I just assigned to them as a nurse, but they allowed me into their world and seeing people when they are at their most vulnerable state is something that is precious and shows the utmost level of trust.

So, why am I all of a sudden unable to deal with death and dying in the same specialty that I have always been in and love? Well, I think I have the answer, as my attending and I discussed this today after we admitted one of our newer patients who was recently diagnosed. We thought he was going to be a routine patient because of his presenting status, and then BAM...all Hell broke loose and his disease took off with aggresion rarely seen in his type of cancer. Afterwards, my doc and I talked about how quickly he had declined and how shocking it was to the both us.

My revelation (and I've had a few this week) is that in my new role as a NP, as a provider, I am essentially in charge of my patients. So ,when things do not go as planned, or as is too often in my specialty, cancer progresses, you feel this sense of guilt and failure to your patients and their families. Yes, I felt this as a staff nurse; you can't help it, but now it really hits. Unfortunately, lately the cycle of our group is that a lot of the patients are progressing and overall not doing well. Therefore, I feel not only the inadequacy of being a new NP, but of also feeling like somehow I've let my patients down and on some level I know it's not true, but it's still there.

"Knowing is better than wondering, that waking is better than sleeping, and even the biggest failure, even the worst, beats the hell out of never trying." -Grey's Anatomy