Fellowshipping: Month 7

Saturday, August 1, 2020

I'm now done with my 7th month of fellowship -- the solid inpatient floor block with rotations in the OR. It's really a bittersweet feeling being done with this block. 


On the one hand, I really enjoyed my time working the wards and working alongside all the different preceptors/mentors I've had throughout my fellowship program so far. It's a great reflection of how much I have grown as a provider since my initial days rotating with them and learning the ins and outs of the attending they work with and their subspecialty. 


On the other hand, I'm curious/excited/nervous to see how this upcoming month goes as I complete my off service rotation in the ED/trauma service and move on to neurocritical care. I'm excited and curious to learn, yet nervous about leaving this comfort zone and working closely with familiar faces from my fellowship journey thus far. 




On the floor side, I've learned how to better manage patients for several days in a row and to handle a larger patient load on my own.

Similar to when I was a floor nurse (med-surg/tele & stroke/tele), the first day "on" is always the toughest because I'm getting to know the patient and pick up from where the provider who was "on" the previous day left off and figure out what happened overnight, if anything. This is where the morning team huddles have been helpful. But day one is still tough. 


By day three or four, if the patient is still there, it's a little easier. It's like picking up the baton from where you left off. The rapport with the patient has been built, and the basic trajectory of the disposition plan has been more or less figured out. There are changes that occur overnight for some patients. For those, other departments are consulted (if needed), tests and studies are ordered, and a new plan is made. 

Throughout the program, I have been increasing/building on the number of patients I care for (although the count would restart when I worked with a different attending on the outpatient side). 

Now, being a little more than half way done, it's apparent how much I have grown as a new NP. I am still learning something new every day and still asking a lot of questions for more complex cases, but it's really all a part of the learning process and it's something I've learned to embrace.


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For the OR, I've learned to better understand and appreciate the different neurological surgeries (elective and traumatic) performed.

Rotating through the OR gave me a better appreciation for what neurosurgeons do and what technique/approach they use to achieve their goal/target. It's been a great learning experience seeing the anatomy and watching the residents in action. 


I admit. It has been a while since I've been in the OR, although the last time I was there was for observational purposes as well. The last time I was in the OR was back when I was in nursing school for my BSN/RN. Having rotated through the OR again, this time with more years of healthcare experience, I appreciate moreso the role of the nurses, scrub technicians, anesthesiologists, and radiology technicians who work in this foreign (to me) realm. It never ceases to amaze me too how they have built up the thick skin to make it through the chilliness of the OR!


OR cases I've learned about and observed this month:

  • Hemispherectomy
  • Cavernoma resection
  • Cranial nerve decompression
  • Tumor resection, glioblastoma 
  • Cerebellar hemorrhage evacuation
  • Minimally invasive spine surgery decompression
  • Anterior cervical discectomy and fusion (ACDF)
  • Cervical total disc arthroplasty


I don't expect that any of the attendings would see this little old blog post out in my little corner of the internet, but I am thankful for them, their impact on my journey as a new nurse practitioner, and their openness to having me in the OR and teaching. 


As I've said earlier, I'm a mix of curiosity, nervousness, and excitedness for the month ahead. It'll really put my flexibility into play as I leave my new comfort zone and venture forward to the trauma/ED then the neuro ICU! I predict it will be a busy but fun month ahead! 


Nicole G.

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