Who taught you THAT!?

We all have skills. Some are more interpersonal, some physical. Some will happily read a room and make sales pitches and win and others will get the door slammed in their face. Some people like me will crash their bike just getting it out of the rack, and others can go for Tour de France-level hills with ease.

Some would say they have a sixth sense about patient care and when they are going to crash or when they are stable. Others will tell you there is no innate talent, but only repetition to affirm the basic tenets of the procedure, skill, movement, what have you. Any way you look at it, we can all agree some people are better at certain skills than others and it’s not always fair or whom you might expect that’s your local expert.

When it comes to being a new grad NP, I will speak from firsthand experience that many times you simply need to get your feet wet before you jump in (learning how to perform a thoracentesis or a chest tube), and other times you just have to jump in and get it over with (starting an IV or doing a pelvic exam). The point is we ALL have our own versions of the hard skills and the easy skills, and they are not always the same list. Yes, experience plays into it but no two nurses are the same in their experience caring for patients even if they work the same shifts for years in the same hospital. We are all beautifully and wonderfully made and with that uniqueness comes perspective.

How did I learn to do what I do in my role as a cardiothoracic surgery nurse practitioner?

I thought you’d never ask. First, let me say that my path getting to that job was not straightforward, but rather very indirect, time-intensive, and much like many late-bloomers in life, a path wrought with many mini-steps forward when others took bigger steps for the same goal. Therein lies the perspective that is mine. Having had many roles in healthcare along the way (EMT-Basic, EMT-Intermediate, EMT-Paramedic, RN, BSN, MSN, and DNP respectively) I can tell you how each role in the chain does a vital piece of the education I now have.

For example, I learned first how to do an IV while in an ambulance and after doing that, it’s all downhill easier from there. I first learned how to interpret EKGs and run a code well as a paramedic working in a rural EMS service. I learned pharmacology of patients’ med lists as a paramedic, more so than even as a new nurse. I learned more random things at random times not knowing fully how it would impact the next steps of my career. But again, that’s my perspective and it’s not always when we want to learn things that we are forced to do just that.

How did I learn to suture? When I was in NP school, I was scared to death of not being able to do something so simple and rudimentary (or so I thought). Turns out, suturing is actually rather involved and complex if you want to work in surgery (not so bad if you plan to only do simple interrupted stitches). I chose to go to a course that seemed to be a well-rounded conference which included suturing as well as some basic office procedures and outpatient skills. I LOVED IT. But I learned on crappy instruments and had an unrealistic simulation skin, and quite honestly it was subpar. This is not an uncommon experience for many new-grads who spent a king’s ransom to learn the skills to be prepared in their NP programs just to find out they forgot a few. key. things. not cool.

When I was hired for the role of cardiothoracic surgery nurse practitioner, I had zero experience in the operating room. I had never been an OR scrub or circulating nurse or worked as an orderly, anesthesia tech, or any of the possible jobs in the hospital setting which would have given me that “leg up” on the competition. Or at least taught me how to SPEAK the language.

Fortunately, I was able to take a formalized nurse first assisting program, and in doing research to prepare for this, found the National Institute of First Assistants, INC, or NIFA (sounds like knife-uh, not neef-uh). Their program is designed to take any Joe Blow off the street with an APRN license (or any RN in the OR with 2 years of experience) and get them behind the wheel and drive as a first assistant (second set of hands working with the surgeon plus the scrub techs). After doing the online portion, I went to their 6-day SutureStar course and was blown away. First, I thought it was going to be a slave-labor camp. It was hard, don’t get me wrong, but I was prepared and the lead instructor Dean Parsons was so good at identifying my weaknesses and strengths that I left the course feeling ready to take on the world.

Nothing’s immediate in this process, and suturing is no exception. I was left handed and still am, but when it comes to suturing, I forced myself to be right-handed. In fact, the surgeon who hired me told me I would not be allowed to be in the OR if I wasn’t a righty since our hands would bump and get in each other’s way. Talk about trial by fire. But I was fortunate to get a great immersion with NIFA and took those six days to learn how to suture right-handed.

Fast forward. I actually am an instructor for NIFA and help APRNs much like myself get over the hump. If you ever thought it was out of your reach to be an APRN in the OR, it’s not. The Skills On Point, LLC Comprehensive Suture Training Workshop was co-created in consultation with Dean Parsons as a precursor for the NIFA SutureStar Workshop so anyone who desired to get a upper hand in preparation would have all tools I wish I had to succeed.

Eventually all these skills become something you look back and say “I remember when I learned that the first time”. And just like me, you will have reasons why you prefer certain courses over others. There is something to be learned from everyone. No matter what their title is. Paramedics know some things better than nurses and CNAs know something paramedics don’t. We are all in this together and fortunately at the end of the day, our patients get to benefit from what we bring to the table.

If you’re interested in learning more about NIFA and their RNFA and APRNFA programs, I’m always happy to add my perspective, and so are they if you go to www.RNFA.org.

Coming up in February 23-24, 2019, at the Skills On Point Comprehensive Suture Training Workshop in Chicago, NIFA will be sponsoring the Saturday lunch for all the course participants and in that time, there will be a presentation where you can ask real-live questions about what the program entails and have access to DISCOUNTED REGISTRATION RATES. That’s right, I said it. Who doesn’t like a coupon, right? Hope to see you there!

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