A Day in the Life – Meet NP Debra Bishop
November 11th, 2015
“My role like many Nurse Practitioner’s is unique as my primary focus is prenatal health”
My role like many Nurse Practitioner’s is unique as my primary focus is prenatal health.
A typical day begins with checking labs and ultrasound reports. During this review there are two patients who have anemia or a low blood count, 2 have abnormal diabetes screens and there are four urinary tract infections (this is not unusual). My 18 year old first time mother’s hemoglobin is very anemic. An appointment is added for her at lunch time. Further blood work will be ordered and referral to a hematologist will be done. The women with bladder infections will be called in between patients throughout the day. A glance at my schedule shows that I have 12 people to see today, 3 initial visits and 9 follow ups. There are numerous voicemails from patients that will be checked later in the day.
Routine prenatal care visit consist of discussing client’s concerns, including aches and pain associated with pregnancy, determining what is expected or considered normal and what is not, listening to fetal heart rates, a blood pressures and monitoring the women’s pregnancy progression. Seemly straight forward my day begins. The first two initials are clients have no complex medical or social concerns. This quickly changes with my next client. She is 20 weeks and had not started prenatal care. There are many complex medical and social needs. She is Hepatitis C, and has been regularly using IV drugs, housing, and access to adequate nutrition is a concern. Further her partner is abusive and she does not want to go home. She states she needs to “get away from him”. Assuring her pregnancy itself is safe, and that there are no immediate fetal risks we begin to look at the different layers that are impacting her life. Managing the medical is only part of my job. Her nutritional needs are discussed, and she is seen by the dietitian. Supports are put in place and she is referred to a local methadone clinic. She is booked to see an obstetrician. . I am fortunate to have a social worker on staff so together we arrange for her to be transferred from our clinic to a women’s shelter. I have assured her that I am here to support her towards her ultimate goal a healthy baby that will hopefully go home with her.
Keeping appointments is a challenge for her, she knows that should she miss an appointment she can come in at any point and I will see her. Accessibility is one of the major benefits of being a nurse practitioner. The ability to meet this client at where she is currently in her life and help move her towards better health in all aspects, physically, emotionally, and socially reminds me why I am so passionate about my job. Despite two people waiting for their appointments, the extra time with this client is well worth it. She has taken steps in the right direction to ensuring a health pregnancy outcome. In addition to seeing clients at the prenatal clinic, twice a month I am on site at two local Ontario Addiction Treatment Centers, so she is booked to see me there. With regular prenatal care, addiction treatment and mental health counseling and improvement in her overall determinates of health, hopefully this story will end happily and her newborn will go home with her. For her as well and all my clients it is a privilege to be able to share in her journey to better health.
The next patient has no showed 3 times. This is a day to day reality. It is mid September and over the past 2 weeks, five women have presented with no prenatal care over the summer months. They are anywhere from 30 weeks to 37 weeks. She is the 6th woman who has had no prenatal care since first trimester. She is now nearing the end of her pregnancy. Her visit encompasses all that should have been done over the past 28 weeks. Her care is brought up to date. Like the other five her visit is no longer a 20 minute follow up. With each woman time is spent bringing her prenatal care up to date, including doing prenatal exams and assessing her psychological and emotional states, getting urgent ultrasounds, and re-linking them with a physician who will do their delivery. They should have already seen this physician and did not attend. The ability for me to see these women on short notice ensure that their gaps in prenatal care assessed, care is brought up to date and they are ready to see their delivery provider (an obstetrician or family doctor).
The afternoon goes smoothly. Like earlier today, meeting pregnant woman with complex lives is part of my typical day. It is also part of my day to review ultrasound that most often show a pregnancy that is progressing well, however that is not always the case. Each of us in our chosen specialty knows that every day is different and unpredictable. Each woman I meet is special in her own way and I am touched to be able to be part of their journey. I love my job, I see woman for their first pregnancies and am fortunate to see them for subsequent pregnancies as well. I have several patients that I have seen a 3rd and 4th time. These women are comfortable with me, they know I know their story. I am able to follow their babies until they are 8 weeks of age. For many I am able to continue doing well baby visits as I work casual one day per week at an aboriginal health access clinic. I am fortunate to meet women of many cultures who continuously amaze me in the challenges they have overcome, I learn as much from these woman as they do from me.
Every day I am thankful for my job, and I can’t think of anything else I would want to do.
Debra Bishop, NP-PHC, HBScN
Maternity Centre, Thunder Bay Regional Health Sciences Centre