Monday, August 07, 2006

Moonlightin' Nurse

Now that my teaching days at the community college are done, I'm stepping up my moonlighting at two other per diem gigs. This nurse and his blushing bride don't seem able to earn quite enough from 9 to 5, so some evening shifts are de rigeur in terms of financial survival and debt relief, at least for now.

This evening was four home visits for a local visiting nurse agency which had woo'ed me for more than a year to take a full time position. I've refused their offers time and again---including a managerial position---but have taken on the mantle of "Evening Per Diem Nurse" simply to increase deposits to my checking account.

Interestingly, both of my per diem gigs reflect the nature of two previously held jobs during my early career as a nurse. My current work as a per diem visiting nurse harkens back to my previous employment at a locally-owned visiting nurse association which afforded me the opportunity to work somewhat autonomously, visiting 8 homebound patients per day, but bound and gagged by the specific orders signed by the supervising physician. I found that role stifling and clinically limited and lasted only a few years before being swept off my feet to the job which I now hold.

My second per diem position is within the community health center where my full-time care management program is housed as a contracting agency. I primarily chose to work per diem at the clinic so that I could gain access to various employee benefits at the hospital of which the clinic is a part, namely the employee gym where I work out several times per week for $20 per month. Aside from that, it gives me an insider's view of the health center and some measure of an edge when it comes to facilitating care for the 80 patients on my roster during my day job.

Wearing several different hats as a nurse can be confusing at times if one loses sight of what the particular scope of practice is for the position of the moment. While I may occasionally experience "role confusion" (ie: wanting to make an autonomous decision in my clinic role as Pod Nurse before realizing that this autonomy belongs to my full-time job), I'm relatively capable of maintaining my differentiation depending upon the role in which I am presently embodied.

Examining my three distinct clinical roles and their defined scopes of practice, I am immeasurably grateful for the breadth and depth of the autonomy which is the cornerstone of my full-time job, a reason why I remain in such a stressful and demanding professional position. Overseeing and managing the care of 80 people whose clinical disposition, comorbidities and occasionally chaotic lives can be an enormous challenge, but the freedom of practice which is the central aspect of my role more than makes up for the frustrations and vicissitudes of the job.

As much as it's difficult to work in two other positions which place me in a more, shall we say, "subservient" nursing role (ie: simply carrying out doctor's orders with relatively little room for personal initiative), spending time in those other "hats" gives me time to pause and reflect on the singular nature of what I do from 9 to 5, the authority and trust placed in me by my bosses and the doctors with whom I co-manage patients, and the ability which I regularly exercise of making clinical judgments and enacting plans of action vis-a-vis those judgments.

All this is to simply say that my "other jobs" can often serve to reinvigorate my 9 to 5 experience rather than just exhaust me due to the extra hours of labor after the 5 o'clock whistle blows. Would I rather not feel the need to work more than just my full-time job? Sure. But when push comes to shove, the Man Who Would be Nurse does what he must do, and then comes home to reap the rewards of a day's work well done.
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