Editor’s Note: We continue our NP Week celebration, with an article that shows the daily life of Kahlil Demonbreun, DNP, RNC-OB, WHNP-BC, ANP-BC, a nurse practitioner who has the challenge of balancing his faculty position at the Medical University of South Carolina and his clinical practice.
Morning
05:45. The alarm clock goes off. Realizing I have a very busy day today, there is no time to snooze, so I quickly start the day with the therapeutic energy offered by a hot shower. 06:30. I’m up, dressed, and ready for the day. First task is to feed our miniature schnauzer, Butterfingers, and let her out. I wait while she runs around the yard and check my personal and office emails, of which several need attention. Butterfingers returns to the front door. I let her in and rush upstairs to kiss my wife before darting out the door for a one hour and 15 minute commute to my office. Interestingly, just one month ago, my commute was limited to less than 20 minutes. But since I have recently taken a faculty position at the Medical University of South Carolina’s, School of Nursing, my time is now split between the role of a clinician and instructor. Today is faculty meeting day, which comes with the long commute. 07:30. I’m driving down the highway. I formulate a response to a student who has e-mailed several questions related to billing and coding. Hopefully, as soon as I get to my office, I can reply to her. 08:00. I arrive at my office. I spend the first 10 to 15 minutes in daily devotion, after which it’s time to work. I log on to my work laptop to check my schedule and note that I have several meetings, one within the hour. So I quickly write the response for the student about the billing and coding questions and send it off. 08:40. Usually around this time, if I were at the clinic, I would be well into seeing my second patient of the day, most likely a new OB patient or a walk-in with an acute Women’s Health complaint. Many of my patients utilize electronic media to contact me outside of office hours. For the most urgent issues, I usually tell them to walk in first thing in the morning. But since I’m not at the clinic today, it’s off to my first meeting. 8.55. During the meeting, the team discusses a group of second year Doctor of Nursing Practice (DNP) students’ performances on a recent quiz and strategies for improvement. The scores actually are quite good, but there is always room for growth. 09:08. I get a text from an outstate DNP student who I mentor concerning her Capstone Project. I reply that I am “In a meeting” and mentally place on her on a growing list of things to be done before the day is over. 10:30. So far the day has been a pretty routine Monday, also known as “Meeting Monday”. It’s actually the one day that most of the faculty gets to meet face-to-face since the program I teach is online. I actually welcome the meetings. They are a great change of pace from the online interaction in the Moodle virtual classroom platform. 10:35. Speaking of the virtual classroom, the break between meetings allows me to check the progress of an online discussion for one of my student groups. The discussion revolves around a mock patient encounter with a 20 year old patient who is scheduled for her first pelvic exam and Pap test two days before her 21st birthday . She is reportedly very apprehensive about the exam and not sure of the importance for cervical cancer screening. The discussion is focusing on whether it is more appropriate to perform the exam as scheduled or to hold off and have her return in several weeks. It is a very lively debate with many valid points presented ranging from patient comfort, cost, time, and strict adherence to the guidelines. Recognizing the educative benefits of this peer to peer dialogue, I decide to monitor the group’s interaction a little more and not post a faculty comment at this time. 11:11. On my way to my next meeting, one of the faculty who teaches in the undergrad program stops me to ask if I can present a live three-hour lecture on Women’s Health to her students. With welcome I accept her offer reminding her that “three hours may not be enough given my passion for the topic”.
Afternoon
12:15. Right on cue, my wife texts me to check in. The bad part is she also wants to let me know she will be late coming home. Translation: “Stop and get dinner.” 13:00. Lunch time, I head across the street to Bruegger’s Bagels, for my favorite: smoked salmon with plain cream cheese, tomatoes, red onions, and capers on a skinny plain bagel. Definitely one of the best treats of the day. 13.05. While I eat lunch, I catch up on Facebook and check the “Family Nurse Practitioner Networking Group.” It is a virtual gathering spot for some 5,400 nurse practitioners, registered nurses, and students. There are always some very interesting discussions occurring. One of the challenges is to try not engaging in too many at one time because they can become time consuming. 14:00. Well lunch was great, back to “Meeting Monday”. My next meeting is to discuss the DNP students who are currently in residency. I am assigned to ten students, and I monitor their progression in the final clinical aspects of the program. My group consists of all traditional post-bachelor students, none of which are currently nurse practitioners. Today, we are discussing and reviewing their first draft poster presentation submissions for their Capstone Practice Improvement Projects. I have looked over the submissions, and they look superb with only a few tweaks needed here and there. 15:02. With this meeting winding down, I quickly check in on the group that is discussing the 20-year-old patient. The discussion has narrowed down to the performance timing indicated in the guidelines. Is she too early for the Pap smear? It is interesting to see the level of critical thinking being presented. Such ambiguous challenges will no doubt occur often in the early careers of these novice practitioners. Again, I offer no comments at this time. 16:55. Man! What a day. Now for the commute home, I still have several things on my to-do list, which have been accumulating of the course of the day. Oops! I almost forgot. I also have to stop and pick up something for dinner.
Evening
18:43. Finally home, and what a day. I have a student to call, a group discussion to post to, billing and coding entries to check, all before preparing for the change-of-pace clinical day tomorrow. Guess I’ll start by feeding Butterfingers. 19:45. After checking the home mail, feeding the dog, checking in with the wife, and texting my two daughters to see how their days have gone, I once again sign into Moodle to check on the group discussing the 20-year-old patient. I submit several positive replies; compliment the depth of the discussion; and indicate there is no right or wrong answer in performing the test today or bringing the patient back. I conclude that the ultimate decision should be up to the patient. From there I check on my other class and review their coding and billing entries one by one. 10:15. Time to wrap up, I have checked with the student about her Capstone, so I am ready to put this day to rest. As a seasoned nurse practitioner and preceptor new to the faculty role, I am learning there are many challenges to educating clinicians who are not at the point of care. However, the virtual scenarios afford more time and greater reflection as opposed to live encounters, which are usually performed in haste to meet productivity. Still as a clinician I think the faculty/clinical role is one of the best career decisions I have made. I have the ability to impact positive health outcomes of the patients I see in the clinic while assuring the education of those who will eventually see patients as well. Hmmm, it’s pretty much like an extension of me. 00:10. It’s getting late. I better go to bed so I can do this all this over again tomorrow. Half asleep I ponder the blessed position that I am in and thank God for using me as an instrument to touch so many lives in so many ways.