Let Them Teach
I spent many years in Emergency Departments across Middle Tennessee as a nurse and then as a Family Nurse Practitioner. I had the privilege of working alongside some of the most talented nurses and providers in the area. As a Family Nurse Practitioner, I worked in an Emergency Department on Friday, Saturday, and Sunday night. We would always be slammed when we came in at seven PM, with an eventual slowing down around two AM, just in time for the bars to close and the gun and knife club to break out their usual heated debates that inevitably landed someone in the Emergency Department for a broken bone or a laceration repair. Just as we would get those folks taken care of, the chronically ill folks would awaken with an exacerbation of their Congestive Heart Failure or Chronic Obstructive Pulmonary Disease. This would be the rush of patients which would push us all over the seven AM stopping point.
It was truly an honor to have been entrusted with the care of my fellow citizen. As a person who had grown up poor, with essentially no access to medical care because it was cost prohibitive (I once had a piece of plastic in my eye for a week before my mother gave in and took me to the doctor), I understood the importance of not spending someone else’s hard earned dollar on unneeded tests. If I ordered a test, I could tell the patient exactly why I was ordering it, and what I would do if the test was abnormal, and what I would do if it was normal. I tried to be a good steward of each patient’s healthcare dollar.
Occasionally, I would encounter a patient who had nothing acutely wrong with them. They were simply looking for a prescription for a controlled substance, usually an opiate. These patients were the most challenging. It is easy to tell people yes. It is very difficult to tell people no. Prescribing someone opiates who had no medical reason for them was a hard no for me. I remember one night, a patient presented with the complaint of severe lower back pain. This pain was chronic, was unbearable, despite the patient sitting with their legs crossed in the bed eating the fast food they had gotten on the way to the Emergency Department. As I am required to do by Tennessee prescribing requirements, as well as my ethical requirement, I looked this patient’s prescription history up in the Tennessee Controlled Substance Monitoring Database. The patient had told me they did not take any home meds for their chronic back pain. Regretfully, the patient had been less than truthful. The results of my search revealed a mere two days before this Emergency Department visit, the patient had received 240 Oxycodone 10 mg tablets. When I brought this to the patient’s attention, I was cursed at and hit with a bag of French fries, as they threw them at me as they departed the Emergency Department. Suddenly the back pain was relieved, and the previously limping gait was normal. I had done the right thing clinically and ethically. I did not contribute to the opiate crisis and may have saved this patient from an unintentional overdose. I did suffer the slings and arrows of a tuber toss, but I pushed through.
A few weeks later, I received a letter from the peer review investigator, for lack of a better term. The patient had complained; and now the peer review investigator wanted my explanation for why I did not write this person more oxycodone. My charting was complete. It contained the thorough explanation of my exam as well as the Controlled Substance Monitoring Database. However, the peer review investigator was alleging I had not treated the patient appropriately. Interestingly, the “peer” who was reviewing and investigating this complaint, was, in fact, not a professional peer at all. They were not a physician, a nurse practitioner or a nurse. The “peer” was a marine biologist. That is correct. The person who was judging my care decisions was a marine biologist. The patient was not an octopus, walrus or starfish. They were a human being with a pretty good arm for throwing fried potatoes. I was insulted, demeaned, and defeated. I had practiced ethically and likely kept opiates out of the hands of someone who could have died from them. Yet, I was being accused of subpar practice by someone who wasn’t even an actual peer. The person was very nice and was simply doing their job. However, they were in no way my peer.
Remember how I mentioned I was insulted, demeaned and defeated? Teachers often feel the same way when people who have never spent a day teaching attempt to speak with authority as to how education should be provided. Teachers are not so different than Nurse Practitioners. They provide a vital service to a diverse group of people, all of whom have unique needs. Imagine if I prescribed the same blood pressure medication at the same dose to every patient and expected it to work. People would think I was insane. However, many people have that cookie cutter expectation for teachers. They forget each child is unique. A classroom of thirty children present thirty different needs, at a minimum, that must be met. A teacher has to come up with just the right manner of presenting information so that each of those thirty children understand it and retain it. That is a daunting task.
Teachers have specialized training, just as I did to become a Nurse Practitioner. They are taught specialized skills, just as I was. They understand the educational plan for child A is likely to be dramatically different than the plan for child B. This is no different than the treatment of patient A’s hypertension requiring a different approach than patient B’s. However, for some reason, teachers are expected to follow guidelines set by people who aren’t their peers. How is that any better than my medical care being evaluated by a marine biologist? The answer is simple. It is not. We must allow teachers to practice their art, just as I am allowed to treat patients as I see best, under a set of guidelines agreed upon by my supervising physician. Teachers have supervision, just as I do. I am required to meet benchmarks for quality care, just as teachers are required to meet benchmarks. However, they need to be reasonable benchmarks developed by actual peers.
I fully believe teachers are underappreciated and undervalued in our society. They have an immensely difficult job. In addition to teaching, they often are the person who makes sure a child eats each day. They often are the person who helps make sure a child has school clothing that is not torn or damaged. They often are the only person a child has they can rely on in this chaotic world we live in. As your school board member for the Fourth District, I will represent teachers. I will fight to promote their independent practice. I will fight to ensure we retain the best and brightest stars in our county, rather than lose them to Williamson and surrounding counties. We must invest in our teachers because the kids they are teaching today will be our peers tomorrow.
Posted on 11 Jan 2024, 11:31 - Category: News