| Friday, September 10, 2010 | |||
| NEWSRoom | |||
| 07/01/2010 | |||
Q&A with Melissa Garrison, ARNP Specializing in Family Practice and Geriatrics at Marquez Medical Clinic |
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Rate It! Q: How did you become interested in nursing? A: I was pregnant at an early age and delivered my first child at 34-weeks-gestation. He was premature and had to be in the neonatal intensive care unit for nearly 30 days. I gained a great deal of respect for the nursing staff that had been taking care of my tiny tot. I liked the autonomy exhibited by the neonatal nurse practitioner, as she was able to provide and direct during critical moments. At the time, I was working as a manager at a local fast food restaurant and had never been so unhappy. I began to examine my goals and what direction I was headed. I went to a local community college and took a career assessment test. Multiple choices came up. I literally played Russian Roulette and picked the career where the spinner landed…nursing. I quit my management position. I started at a local nursing home with a Certified Nursing Assistant class. I also began taking general courses at the community college towards nursing. I could not believe that I could actually like my job. From that day on, I have continued to work in the nursing field and have never regretted that decision. Q: What made you go for the nurse practitioner track? A: After being a registered nurse for about 10 years, I began to feel restricted within my career. I decided that I needed to be able to help patients more than what my RN license would allow. Doctors tended not to be sensitive to patient issues that seemed to impact their wellbeing and the healing process. I was able to identify ways to help patients, but rarely were ideas welcomed by physicians. I knew that I had more to offer to the nursing profession and to my patients. I pursued the nurse practitioner track at a local private university and was pleasantly surprised of the overwhelming opportunities that I gained by furthering my education. Q: What kind of facility is Marquez Medical Clinic? A: I work in a relatively small facility. There is only one physician and I to cover the practice. The major focus of our facility is family practice with a large emphasis on geriatrics. The facility is a solo medical practice in a retirement community. We do cater to this population due to our location. The physician and I continue to do hospital rounds daily, although most other physicians in town use hospitalists. We also follow our patients to skilled nursing facilities, assisted living facilities, and rehab facilities. We follow the patient through their continuum of care. We recently moved into our new facility that has special accommodations for our elderly patients. During the progress of the building being built, patients have watched the structure emerge and transform into "our clinic." They are just as thrilled to have new accommodations as we are. Q: What's it like working in a retirement community? A: Being in a retirement community has definitely been a wake-up call for me. The average age of our patients is mid-80s range. They are active in the community with sports, recreation, family activities, couples activities, and remain as physically fit as possible. The majority of our patients are very compliant with their healthcare. They follow direction well and look for opportunities to improve their health as they wish to stay well. The doctor has two medical assistants and I have one. We all work together as a team to accommodate our patients. Our patient population tends to come early to appointments, forget appointments, change the times of their appointments, etc. We try to keep a schedule the best we can, but each day has surprise agendas that we accommodate. Unlike any other family practice position that I have been in, I have not come across any other that has to assimilate and coordinate care with other PCPs across the US. We have multiple patients that are "snow birds" in Florida for several months of the year and in their "home state" the remaining months. We encourage the "snow birds" to be more proactive and maintain relationships with both sets of PCPs as it promotes better overall care when both care providers are abreast of the patient's conditions. Interestingly, patients stop in for a visit before they leave town to bring us up to speed on any issues that they will be addressing after they leave Florida. Upon their return, patients make our office one of the first stops to "fill us in" on what has happened during their travels. Q: When and how did you start at Marquez? A: I began working with Marquez Medical Clinic in 2008. I had been searching for "the perfect" place to work. My husband and I had been planning to move to Florida to be closer to family. We had decided that when the opportunity came up, I would know it was right and we would relocate at that time. An opportunity presented itself in Sun City Center, Florida, for a family practice clinic that was seeking a nurse practitioner. After interviewing and negotiating with Dr. Marquez and his office manager, I was offered a position as their first nurse practitioner. I was very impressed with Dr. Marquez during our interview. He had done his homework. He knew that he wanted a nurse practitioner (over a physician assistant). He already was aware of the nurse practitioner capabilities and educational background. He also knew the restrictions. From the first day when I walked in the door of the clinic, I was made welcome and made to feel like a valuable part of their team. Q: What types of patients/diagnoses do you encounter most frequently? A: The majority of patients that I see are same day, acute ill visits. I do have about half of my schedule that is filled each day with patients that are for routine lab follow-ups, routine three month visits. Both the doctor and I see multiple disease states, co-morbid conditions that require evaluation and management. Preventative visits are key to maintaining the health and wellbeing of these clients in particular as their chronic conditions put them at risk for illness and worsening symptoms if they are not managed closely. Q: Is there anything that you are extremely passionate about when it comes to your position? A: Because I work in a family practice clinic, I see multiple patients who present with vague symptoms that are affecting their quality of life. The importance of determining the root cause of their symptoms is imperative to shortening their anxiety, pain, and the uncertainty of what is causing their symptoms. On a personal note, my son was diagnosed with lupus at the age of 12. Because lupus was not including in the differential for his sex and his age, there was a prolonged time frame before he was actually diagnosed with this autoimmune disease. I am very passionate about this topic. I believe that other NPs should be aware of the typical findings, so that they, as well, will see the importance of diagnosis and referral for specialty consultation. When something is near and dear to your heart, you can be especially motivating as a writer or a speaker. I have been fortunate enough to give two lectures on systemic lupus erythematosus: early assessment, diagnosis, and treatment related to pediatric patients. Q: What are the greatest challenges you face as a nurse practitioner in a geriatric setting? A: Insurance and reimbursement restrictions make it difficult to provide healthcare without having to adjust your plan of care. Also, non-compliant or forgetful patients tend to make providing healthcare frustrating. Q: What do you like most about your job? A: I absolutely love the social aspect of my job, like getting to know patients—they are a wealth of information when it comes to travel plans, where to go and what to see; old home remedies; old war stories; old family traditions, etc. The rapport gained and friendships that are entered while developing a patient-provider relationship make being an NP well worth the effort. Q: Is there anything you dislike about working with older patients? A: I dislike having to make end-of-life decisions for patients, unless I have been able to work with the patient long enough to know their wishes before end-of-life becomes a real issue. It is very difficult to have family members or significant others step in and take over when you know what the patient would have wanted. It is an honor to be able to carry out their wishes and to be able to provide care through all stages of their life. Q: Do you think the NP profession is becoming more popular? A: I have been a nurse practitioner for about eight years. I believe that the pioneer NPs had a much more restrictive role. Over time, it appears that NPs are gaining more popularity as they are proving that they are able to provide excellent care, patient education, and follow-up "just as good as a doctor." Q: What should nurse practitioners be concerned about today? A: The insurance companies have put so many restrictions on medicine that providers are not able to provide reasonable, prudent care for our patients. Unfortunately, patient care is being compromised due to the many restrictions that are being placed and the guidelines that have been developed. We are forced to lose sight of the main focus, which is the health of our patients. Q: What is the most rewarding part about working with patients? A: I have found that sometimes the smallest things in my job have to be the most rewarding. I find the most reward is seeing patients smile when labs improve, when they are feeling better, when they are seeing improvement in their medical condition, or when they finally able to figure out how to prevent "becoming ill." Q: What surprises you about this job? A: I never know enough. I can never learn too much. There are always new things being developed every day. I need to keep open-minded. You really can learn a new lesson every day. Q: Would you recommend your career choice to others? A: Absolutely, I would recommend the role of the nurse practitioner to anyone serious about the nursing profession. The opportunities are endless. I believe that the nurse practitioner role will only expand in the future. |
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