Pre-Nurse Practitioner Certification Exam Anxiety

In less than a month I will take the national certification exam for family nurse practitioners. Similar to law school grads who experience a certain discontent at graduation with the summer Bar exam looming over their heads, my own graduation was a bit marred with the anxiety of my upcoming exam.

Basically, until I pass that exam and am licensed to practice, my nurse practitioner degree is meaningless. While excited that I was nearly done with school, I started studying for this exam while in the midst of finals.

Today, I also ran into a really cool blog written by a family nurse practitioner in New York, while looking for ways to assuage my pre-exam anxiety. It is a relevant, interesting blog, and one that I plan on keeping up with while beginning my own career as a family nurse practitioner.

I would like to detail my own experience while studying for the NP certification exam. Hopefully in months or years to come, other soon-to-be NPs will stumble upon this and find some solace that they are not alone in what they are going through.

Oh, and hopefully I pass.

1. I, many times a day, alternate between being convinced I am way too stupid and not prepared and am going to fail the exam, and being convinced I am a genius who probably doesn't really need to be studying at all.

Until I get to questions like:

"Actinic keratosis can be described as:

A. a slightly rough, pink or flesh-colored lesion in a sun-exposed area.
B. a well-defined, slightly raised, red scaly plaque in a skin-fold.
C. a blistering lesion along a dermatome.
D. a crusting lesion along flexor aspects of the fingers."

(The correct answer is A.)

2. Along that same vein, I am also convinced that when I start practicing, I will either be the best nurse practitioner ever and all my patients will love me, or I will kill my first several patients and be sued and lose my license within the first couple weeks.

Let's hope it's the former.

3. Within a couple months, I will be unleashed into the real world and expected to be able to accurately diagnose, manage, and treat lots of weird diseases out there.
People will walk into my office one day soon and expect me to know what things like neurofibromatosis, thalassemia, and hand, foot, and mouth disease are.

While I may or may not always have an MD or more experienced NP around to help guide me through my first year or two in my new career, the thought of all of this is overwhelming and scary. Am I ready?

Well, I better be soon.

4. I really, really hope my test is full of questions about STDs, HIV, and upper respiratory symptoms.


5. I have an unabashed admiration, bordering on a crush, on Margaret Fitzgerald, her review book, her courses, and her mnemonics. I will never forget the cranial nerves again.

6. Until I take this test, I have free reign to drink as much as I want. And afterwards, of course, in celebration. Or sorrow.

That's all. I guess I should study now.

Stolen Lines #2

"Tell me... have you ever thought...of
changing your life?"


I asked the Vietnam veteran corner store clerk as I
picked up the daily newspaper on my lunch break one overcast
November day. It was a day just like 100 previous
days: I woke up at 7 o'clock, drove the 45 minutes to
Bloomington after lugging myself out of my dad's
pull-out couch in the basement, parked in the drab, concrete
parking garage, and walked up the hill to the tiny law firm
where I was a secretary for a lone practicing
attorney.

It was a day just like the 100 previous work days that
I sat transcribing my perverted boss' lawyerly notes
into his beaten-down Mac computer, answered ridiculous,
angry phone calls from bitter divorcees for the upstairs
attorney, got bitched at for not bring their faxes upstairs
quickly enough, and wasted a perfectly good college
education and year of law school on a pointless $10 an hour
job with no chance of upward mobility.

It was a day, like every other day that would come for
the next year, in which I desperately wanted something more
yet could only muster up the ambitiousness to look forward
to each Friday's happy hour at the corner bar, finding
solace in the next round of Blue Moons and pretending I was
okay with where and how I had ended up for the rest of my
life.

"I hate to be the bearer of bad news, but
your entire left cheek is showing."

Said the Vietnam vet. I don't even know if
he had been in Vietnam or was even a veteran,
but he smoked cigarettes in his shop, had a limp and a plethora of
American flag t-shirts, and wore his black-gray
hair in a ponytail. We chatted amicably like this
every day for the past 100 days. I really enjoyed our
shared apathy and friendliness, we bonded nearly every day over cokes
and central Illinois' most "pressing" news of the
day. Then I would walk to lunch and pore over the
classified's, hoping to find that one
lucrative career for an English major/law-school
drop-out within 30 miles of my hometown.

"Wait, what?!"

"Your entire left cheek. It's
showing. You have a rip in the back of your pants. I
thought I should tell you."

I turned around and there it was, in plain sight for
all of downtown Bloomington to see. What had
happened?

I froze, I panicked. I did the only
thing I could think of and asked the Vietnam veteran, with his
years of hard-core military experience and living a hard
life. He would know what to do.

"Well? What the hell do I do?! And of all the days to wear a thong!"

He's been through war. This is nothing to him.

Calmly, he answered.

"There's a seamstress next door.
She may be able to help you. Good
luck."

Though the sign said, "By appointment only,"
I walked into the drab building directly across from the law
firm at which I worked, and pleaded my case to The
Seamstress.

Suddenly, everything in my life depended on
the whim of this all-powerful Seamstress, and her needle and
thread. My fate was in her hands for the next 30
minutes.

"I live 45 minutes away. I've got an hour for lunch, please fix my pants."

I sat pantless in the dressing room on that gray
November day that wasn't like the 100 previous days,
reading an oversized book of horoscopes for the next 30
minutes while The Seamstress sewed my pants back together:
"The Sun, ruler of our inner nature, is somewhat
dimmed in Cancer, the home of the Moon. Creative and
romantic, with a strong love of home, family and tradition,
you are a good communicator and a strong provider. Your deep
sensitivity presents you with valuable and illuminating
intuitions, especially regarding those you care
for."

Well, I never felt as if I was reading something more
inaccurate about my life at the very moment.

I left The Seamstress after repeated failed attempts
to pay her for mending my pants and grabbed a quick goulash
at the Pub down the street, silently reading my newspaper
picked up from the Vietnam vet's corner store.


I trudged back to work, transcribed more lawyerly notes
from my perverted boss, answered ridiculous, angry
phone calls from bitter divorcees, got bitched at for not
bringing the faxes upstairs quickly enough, checked my email
and make plans for happy hour on Friday. At 5
o'clock, I walked down the hill into the drab, concrete
parking garage and made the 45 minute drive home.

I parked my little car behind my dad's over-sized Man Truck and walk inside, weighing my desire to make people laugh against my embarrassment
at the day's events, when something caught my eye.

On the kitchen table in my dad's green one-bedroom
house, next to the Hamburger Helper (three-cheese special)
and slices of white bread with butter, my dad's favorite
meal that year, was a large white envelope addressed to
me.

"We are pleased to inform you that you have
been accepted into the Nursing Program for the Fall 2004
Quarter."

I signed the letter, informing the school I would be
attending classes in the Fall, and put the envelope back in
the mailbox. I went downstairs, pulled my bed from the
couch, had another meaningless conversation over
the phone with my girlfriend in a relationship that was
headed nowhere fast, and fell asleep to the tv. I
woke up at 7 o'clock, drove to work, parked in the gray,
drab parking garage and walked up the hill to the tiny
lawyer's office where I worked for the next 200
days.

My last day on the job, I walk into the Vietnam
Vet's corner store, and inform him I am leaving
town. We laugh at the pair of mended pants I am
wearing, and we say our good-byes. He gives me a
newspaper for free, and this time I read it without
searching the classifieds as I eat my goulash at the the Pub
further up the hill.

I walk to The Seamstress' store and leave a small
check on her desk, thanking her for helping me out The Day
My Left Cheek Was Showing. I grudgingly have a beer
after work with my perverted boss and drive home as soon as
I can politely get away, to enjoy one last happy hour with
my friends.

I buy the next round of Miller Lites at our favorite
bar, laughing and hugging my friends. Newly
single, I scan the crowd unsuccessfully for traces of
another lesbian. The band is loud, but the music is
good. We are drunk and happy to be together, next
Monday is miles away. They want to know why I am
leaving our town, our bar, our beer, and our fun.


In my mind I don't hesitate. I think
of my stagnant, dead-end relationship,
transcribing lawyerly messages for my perverted boss, the
rip in my pants, the Vietnam Vet, The Seamstress, the
angry messages from bitter divorcees, the plain gray parking
garage, the hill, and getting bitched at for
not bringing the faxes upstairs quickly
enough.

I take a swig of my beer, not wanting to seem eager to leave them behind, and
answer.

"Tell me... have you ever thought...of changing your life?"


(The first line was stolen from the play, Betrayal, by
Harold Pinter. This is also part of Grace's Stolen Lines series.)

Lesbians and HIV

Rachel Rabkin Pechman's June 2009 article in Poz, entitled, "The L+ Word" gives a nice synopsis into an often unnamed, unheard-of, and un-epidemiologized segment of the population: that of the HIV positive lesbian.

Given my recent accidental occupational needlestick, I became hyperaware of this issue as I was waiting for my own HIV results.

Sadly, even I in the LGBT healthcare field had not really thought about lesbians who are living with HIV. While the percentage of lesbians living with HIV is likely much lower than that of gay males and much of the heterosexual population, they do exist. Lesbians, like any other group of people, cross and re-cross the pre-determined boundaries and categories set by epidemiologists. As with everyone else, lesbians can be infected through IV drug use, sex with men, and even sex with other women (though a definite documented case is yet to exist).

What I think is most important from a health-care provider perspective is knowing what to ask patients, and what to tell them in regards to safer sex. Mainly, never assume someone's sexuality without first asking them who their sexual partners are. After that, it becomes easier to tailor education to the patient, based on those sexual practices, and what is safest and most relevant to them.

Which brings me to the next point, if you are NOT being asked by your health-care provider who your sexual partners are, it's time for a further discussion with her, or to switch to someone you do feel more comfortable with. Health-care, as we all know, is very costly right now, even to those lucky enough to have insurance. And, most importantly, you're stuck with your body your entire life. We all deserve to be treated safely, and with dignity and respect by our health-care providers.