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  1. In this day of selivering bad news, I thought that this article that I saved from last year would be a great refresher. Food is food regardless of the source. The Rules for Delivering Bad News to Patients August 27, 2019 The Watercooler: Career Advice The Bookbag: Education The Rounds: Clinical Considerations General 0 Comments I've talked to some colleagues recently who've been a little down about their roles as nurse practitioners. Working in family practice, they have found themselves in the position of delivering bad or upsetting news to their patients. Cancer diagnoses were fortunately made rather than missed, but letting a patient know they've got a serious, life-altering illness or condition is tough, not to mention, this is not something most of us as NPs learn to do in school. Have you ever found yourself in the position of delivering difficult news to patients? How did you feel? Having such conversations as nurse practitioners can make us anxious or awkward. Some of us approach these discussions emotionally while others appear detached and robotic in their delivery of the news. Delivering bad news is an unavoidable part of our jobs as nurse practitioners but that doesn't mean we get used to it. Fortunately, however, conducting serious conversations is a skill that can be learned and there are many guidelines out there to help healthcare providers hone this skill set. Rule #1: Know what constitutes bad news Sometimes I share information with a patient that I perceive as not a big deal. Then, the patient starts to freak out. Or cry. Or to have some other sort of emotional reaction that I didn't anticipate. Bad news doesn't have to be a terminal diagnosis. It can be related to anything surrounding a diagnosis such as timing, personal or professional consequences. Breaking a metatarsal and wearing a boot, for example, may not be too bad in the grand scheme of things, but breaking your foot the day before your wedding is pretty disappointing. Rule #2: Full disclosure is best In the past, healthcare providers operated on a more guarded front. In the 1800's, for example, the American Medical Association even encouraged physicians to avoid sharing news that discouraged patients. Today, however, studies (not to mention ethics!) show that most patients prefer full disclosure. It's our duty as nurse practitioners to share up-front, honest information rather than sugar coat our delivery with excessive optimism, withhold details, or give false hope. Share news with the patient directly rather than directing it toward family members. Honest, trustworthy information is empowering! Rule #3: Prepare yourself Anticipate the conversation you're about to have with your patient. You may even wish to practice your delivery with a colleague. Prepare yourself to feely badly as you share the news. And, don't forget that silence is OK. Avoid the temptation to fill gaps in your conversation rather let the patient process and take the time to formulate questions. Rule #4: Frame the conversation Framing the news you're about to share is essential. Your patient may or may not be expecting to hear something difficult. And, the way you set up your conversation has an impact on the patient's reaction. Using the word "serious" (ex. "I have some serious news to share...") is better than using the word "bad". "Serious" creates a more constructive framework that inspires action and empowerment as opposed to the word "bad" which indicates the situation is helpless. Even if you're delivering a terminal diagnosis, your patient can choose how to react and what steps they wish to take in response. Rule #5: Think SPIKES There are a few well-known methods for delivering serious news to patients, my favorite of which is the SPIKES method. This algorithm lays out considerations for nurse practitioners and other healthcare providers in these situations. Here's the SPIKES protocol: Setup - Think through the conversation you're about to have, anticipating questions the patient might ask beforehand. Prepare for an emotional reaction. Gather any necessary resources that might be helpful for the patient. Perception - Gauge the patient's understanding and perspective on the news you have shared. This is best accomplished by asking questions like "What did you take away from what I just shared with you?" or "What are your expectations of treatment?". This way you know you are both on the same page as far as understanding the medical outlook, next steps and goals. Invitation - Encourage the patient to think further about their care going forward. Find out how much information the patient wants about his or her medical condition as well as who he/she would like to be included in decision making such as family members. Knowledge - This step has to do with how you as a provider deliver information. The best practice is to deliver the headline first, followed by the details. Communicate using language that matches the patient's level of education and medical knowledge. Be direct in your delivery, avoid skirting the main message. Empathy - Understandably, patients get emotional about serious news. Anticipate such a reaction and display empathy. Naming the patient's emotions can help. Asking "Can you tell me more about what you mean by that?" will also help you determine how the patient feels about the situation. Summarize and Strategize - Make a plan for the next steps in both treatment and communication with your patient. Express support and encourage the patient to tell friends and family the news to develop a personal support system. Talk about how the patient can act on this news to accomplish his or her treatment and lifestyle goals going forward. Have you ever delivered bad news to a patient? How did it go?
  2. Hi Everyone! New grad currently negotiating part-time PA position in Family Practice. I've done clinical rotations and scribed at a Family Practice office in NYC and will be working part-time until I start a Residency program in the fall. Trying to figure out what I should expect in a part-time contract if anything in terms of benefits, PTO, CME, etc. Also, trying to discern if it is in my best interest to be a part-time employee or 1099. Thanks in advance!
  3. Hello Everyone, My name is Olivia and I am currently a senior at USF. I am looking for shadowing opportunities to be able to start accruing my 2000 hours that I would need to accomplish by the time I graduate in order to be accepted into a PA program in 2021. If anyone has or know any opportunities that I may be able to apply to..I would greatly appreciate the referral. I can be contacted though this forum. Thank you Olivia N.
  4. I have 7 years experience as a PA (1 year General Surgery, 3 years IM private practice, and now 3 years at my current position in a family medicine outpatient clinic) in rural Kentucky. It is time for contract negotiations after 3 years of work here. I am outpatient only with no call, 4 days per week; averaging 18-20 patients per clinic day. My base salary is $93k, Encounter based bonuses ($16.59 per encounter over minimum 663 per quarter which does not prove profitable for me so basically my salary is less than $97k total), $2500 CME plus 40 hours PTO, 24 days PTO plus 12 sick days, Malpractice and license fees paid. Insurance and retirement are self funded. No 401k. I have continuously had superior provider ratings, increased clinic volume (with the highest in the local system for at least one year), diligent with completion of charts and never take days off. Recommendations on asking for raise?
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