What gets my goat is having to justify the discrepancy to my preceptors and advisors. On top of everything else I’m responsible for with this program, having to keep walking this fine line between school and clinical practice so that everyone is happy and satisfied is one of the toughest.
One night, I took the opportunity to ask a provider I was working with about his decision making process for prescribing antibiotics for a likely viral illness. His response was classic and expected. He acknowledged that the guidelines probably recommended against antibiotics, but he said, in his experience, a prescription for antibiotics now would satisfy the patients, prevent them from coming back in a few days with worsening symptoms and that the short course of treatment would ensure compliance.
I know what you’re thinking, “that goes against everything we are being taught in school.” You’re right, it does. I get it. It’s not just antibiotics either. I’ve seen similar situations with the use of blood pressure meds or diabetic treatment. As a student, this dichotomy makes it hard to know what to do; it’s frustrating because we are faced with the fact that there are no easy answers in this field.
What I’ve got to accept and acknowledge is that sometime soon, I’m going to have to rely not only what I’ve been taught and trained, but on my own clinical judgment to be able to do the right thing. That’s a scary fact.
I have to be ready to realize when following my gut is the way to go and when the guidelines are the path to righteous prescribing practice. As a professor once said, “having a prescription pad is a scary thing.” I want to believe that I will know how to use it wisely when the time comes.
Sean P. L’Huillier, BSN, RN, CEN, is an emergency department nurse currently enrolled in Georgetown University’s School of Nursing and Health Sciences Family Nurse Practitioner Program.