First off, I so totally miss my job. I miss the patients, I miss my colleagues, I miss the physicians. I miss working with other physician's offices. I miss working with all the transplant centers. I miss calling insurance companies to get prior authorizations (go figure!). I miss being a resource for my former co-workers. I miss being a resource for the physicians. I miss trouble-shooting. I miss spending an hour on the phone talking to a patient and answering their questions about dialysis. I miss educating the patients on their medications and how to titrate their diuretics. I miss instructing them on the proper way to take a blood pressure and being sure they are using the right sized cuff. I miss seeing patients for blood pressure checks. I miss seeing patients for edema checks. I miss patients walking in the office unexpectedly asking to see me because they have a question. I miss coordinating patients' admissions. I miss the patients thanking me for helping them and telling me how much they appreciate me. I miss the physicians appreciating what I do for them. I miss screening patients for various studies that they might be eligible for. I miss explaining to the transplant patients that they need to take their anti-rejection drugs at the proper times and teaching them when they need to have their blood work drawn so their drug level results are accurate. I miss talking with Home Care nurses who call while they are with the patient to say that the patient is fluid overloaded, or that their blood pressures are too high. I miss educating patients about potential side effects of certain meds. I miss scheduling intravenous iron. I miss scheduling Cytoxan. I miss scheduling Rituxan. I miss being able to remind the physician that they need to test the patient for Hepatitis B before the patient receives their Rituxan, as the medication can re-activate Hepatitis B. I miss reminding them that if the patient is placed on more than 10 mg a day of Prednisone they should also start the patient on Bactrim to help prevent PCP. I miss scheduling phlebotomies. I miss scheduling blood transfusions. I miss getting the questions from the transplant patients asking if it is OK to take certain cold medications. I miss calling the pharmacy at the local hospital if there are any interactions between certain medications and the patient's transplant medications. I miss calling laboratories when we get skewed results that make no sense and arguing with them that they need to re-run the test as the result can't be right. I miss the patients who call and only want to talk to me. I miss the girls calling back to me saying, 'Nurse Michelly??' and knowing exactly which transplant patient is on the phone wanting to talk to me. I miss doing special projects for some of the physicians (OK, pretty much only one physician). I miss being able to teach the staff something that they never knew before. I miss teaching patients about Procrit and how it won't work effectively if they don't have adequate iron stores in their body. I miss telling them how taking oral iron is like 'pissing in the ocean' (LOL, yes, I've used that analogy at times!) and isn't near as effective as intravenous iron. I miss teaching patients about the bone disease of chronic kidney disease (yes, this has been the most confusing part of nephrology to me....it never failed, I always had to refresh myself before getting on the phone with the patient!). I miss getting to see patients finally get the kidney they'd been waiting for, which allowed them to come off dialysis. I miss calling the local pharmacy to say, yes, we know the patient is on both a potassium supplement and aldactone. I miss teaching the patient what to avoid on a low potassium diet. I miss trying to figure out what it is exactly they have been eating that may have elevated their potassium. I miss telling the patients that too high of a potassium level in the blood, without warning, can STOP the heart (I learned that from Dr. L., sometimes you need to scare the patient). I miss explaining to the patient that now they have to take a medication called Kayexalate, which will help to lower their potassium level, and yes, it is normal for them to get diarrhea since the medication is mixed with liquid sorbitol. I miss sending them for a repeat STAT potassium level the next day and keeping an eye out for it as I review the labs that come across the fax and in the mail. I miss calling the social workers at the dialysis clinic when I need help with a social issue that is beyond my expertise. I miss helping patients complete paperwork to see if they might be eligible for patient assistance from the drug companies because their medications cost too much. I miss hearing some of the physicians asking ME what I think and what I'd do in certain circumstances...clearly they respected me if they were asking my advice. I miss setting patients up for intravenous hydration, or intravenous magnesium, or intravenous pamidronate (given for high calciums). I miss explaining to patients what a goretex graft is and what an AV fistula is and why they don't really want to wait and end up then urgently needing a catheter instead. I miss calling the dialysis unit at LVH to confirm that some of the labs I just reviewed are from a patient who is receiving pheresis and they are addressing labs so I can just throw them away. I miss....I miss....I miss....I can just go on and on....
Now that I've gotten that off my chest, can I say how naive I am??? I was probably the ONLY one in the office when the merger was being discussed, and then actually happened, that thought my job was totally secure. I had co-workers come up to me and tell me likewise....they'll never get rid of you, you're too valuable. They'd say to me, 'Dr. K. will never let anything happen to you, you do so much for him.' I truly thought my job was the most secure in the office. Ha! I'm such an idiot. Looking back, I should have known this was coming and I never did. It hit me like a ton of bricks that day.
I think about the last couple of weeks I was there when the office manager knew that my position was being eliminated. He let me pack all my belongings and have them move FIVE boxes over to the new location. We were told that nobody would be getting their own computer with the move; I asked if there was some way I could still have mine. He promised to try and make that happen. There was an extra filing cabinet that was going to go over to the new location. I asked if I could put all my files in it to get them moved; he said yes. He strung me along. All along he knew what was happening.
The first and only day I was in the new location, my new desk was set up in a small corner with barely any space, certainly not enough to empty out my FIVE boxes of belongings. I had no shelves, I had no drawers. I had no telephone. Looking back on it, of course, the desk didn't need to have a phone set up; I wasn't going to be there after that day. If I pushed my chair out too far, I ran into cabinets behind me, which housed the stamp machine (where everyone came to add postage to their envelopes). If I didn't keep myself up against the desk, the staff couldn't get in to use the machine. Within minutes, the tears flowed, I couldn't believe this was happening. I proceeded to email the practice administrator saying I had no where to unpack all my things. She said we all needed to make adjustments and basically that I needed to deal with it. She was probably laughing; she knew what was coming later that day. No wonder they had me set up in a little corner; it was the only day I'd be there. I was so stupid. It makes me sick that I said anything at all....but how was I to know what was to come seven hours later? I (still) feel like such an asshole.
And, yes, I could have remained an employee, but would have been demoted to an LPN. That was my only option to remain as an employee. I have absolutely nothing against LPN's. I have known and worked with excellent LPN's over the years. I AM NOT AN LPN; I AM AN RN. I'VE BEEN AN RN FOR 33+ YEARS. I HAVE NO INTENTION OF WORKING AS AN LPN.
I had a wise friend recently suggest to me that it's time to get over this and move on. She said that by me holding on to the anger and hurt I have, I'm only giving them power over me. She recommended I ask myself two questions:
1. Do they care that I'm upset?
2. Is it going to change anything?
Clearly both those answers are NO and NO. She suggested that they don't deserve any more thought and it is time to move on.
I thanked her for the reality check and being so blunt with me. I think she's right. They don't care about me and how I feel. The physicians who care have already called me.
So. This. Is. It. My last post. I think I got it all off my chest. I'm going to try my best to move on. Nothing's going to change. What's done is done. I'm going to work real hard to not think about it any more and not talk about it any longer. Feel free to call me on it if I bring it up :)
The end. Really.
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