NP vs RN Job Satisfaction on Patient Care

Scenario: A Registered Nurse (RN) calls to my attention that a patient who has a permacath access for hemodialysis has fever and chills. I, the Nurse Practitioner (NP), tells the RN to draw blood cultures times two and to go ahead and give 1 gm of Vancomycin. In the mean time, the RN draws blood for cultures, places them in two blood culture bottles, packages them and sends them to the labs. While doing this, she also gets to assess the permacath access site for obvious signs of infection, like drainage, redness or tenderness, cleans the site and puts new fresh dressing. Then the RN gets to hang the Vancomycin IV bag and infuse it to the patient through his permacath. All this time, the RN also gets to talk to the patient, explains what she is doing, why she's doing it and tells him what to expect.

A day later or two later, I get paged and RN reports that there is growth on the patient's blood culture. I ask her for the organism, and ask her to read to me on the telephone the sensitivity report that determines which antibiotic is best for the infection. I, the NP, verbally order the antibiotic treatment. The RN gets to prepare the medication, hangs it for IV infusion, and starts the IV drip for the patient.

This is a common scenario in my job as a NP in nephrology doing rounds on hemodialysis patients.

I do feel grateful that I do not have to do bedside nursing anymore. I really don't miss checking vital signs, drawing blood, cleaning up patients, handling out medications, calling physicians and asking for orders, etc, etc. I have a very big task of my own as a Nurse Practitioner. While as a RN, I  have a handful of patients on the floor; as a NP, I have hundreds more.

However, sometimes I come home at the end of the day feeling like I didn't do anything for my patients. Yes, I saw patients, spoke to them, looked at their labs, might have even do simple physical exams like listening to their lungs and heart. If I'm not running out of time, I could have spent more time talking about things other than their health. I wrote my orders and that's it. I left and moved on to the next patient. This is SO different for what the RN does for the patient.

Did I do anything for my patients? I sure did. It just didn't feel that way if I compare it to what I would have felt if I was the RN.