Updated: Mar 8
After eight years of bedside nursing in the hospital setting, I transitioned to the role of primary care nurse practitioner over three years ago. I had never felt fulfilled trying to stick a finger in the leaking dam that is our healthcare system. I heard a calling to help empower and educate patients to lead healthier lives and heal themselves. I naively thought knowledge was the answer, but the reality is most people I care for are not making real changes with my guidance as a primary care provider. Don't get me wrong, primary care is a great venue for education and prevention, but in the confines of our healthcare system I often feel very rote in my guidance. "You should eat a whole foods diet and exercise regularly to improve your health." "Smoking can give you cancer. You should quit." Did they not already know that?! Of course they did! They did not need me to tell them. Will me saying it make it happen? Probably not. I know my voice is not working miracles. So this has led me to continue to follow the calling to empower and educate people. How can I help people make real, lasting change?
I like to refer to this calling of mine as my dharma, and this word has always appealed to me although I do sometimes feel its a bit of a hokey word to use. Dharma has many meanings and explanations, but I prefer to explain it as the "right way of living" or being of service in life in a unique way that is quite possibly our reason for being.
I spent two of the last three years thinking I would maybe someday become a wellness coach, or come up with some similar business model as a nurse practitioner to focus on a population of patients that are motivated for change. I thought that was the answer to following my dharma. If I only take care of people who are ready for change, I'll be answering the call, right? I thought I'd learn more about weight loss, nutrition, and exercise, and incorporate this into my profession wholeheartedly. I found myself looking up continuing education and graduate programs that might encompass these subjects.
A few times I looked at nurse coaching programs, but never took the leap. Then about a year ago, I was attending a conference for continuing medical education, and I was so frustrated with the same band aid mentality I've grown so tired of in healthcare. "The most recent guidelines say this new medication is the fix for _____." (Insert every chronic health condition). I don't think this is public knowledge, so I'll share...
Guidelines for healthcare are made up by expert associations such as the American Heart Association, American Association of Clinical Endocrinologists, etc. These are well meaning organizations, no doubt. But they can only make recommendations using evidence based research. Do you know who pays for evidence based research? Drug companies. They are the only ones with enough money. So why are prescription drugs the number one treatment for almost every health condition? Because they are proven to work. Proven with lots and lots of money.
I had a patient, a young woman in her early 20s. She was overweight, had daily headaches, chronic pain including stomach pains. I'm not kidding her problem list in her chart was ten active problems. That's a lot for a young person! After multiple visits during which I recommended lifestyle modification and diet changes to no avail, I did not see her for a year. Recently, she returned for a wellness visit, and I went into the exam room expecting another discussion about ongoing problems and lack of self care. To my shock (and I say shock because ALMOST NO ONE EVERY DOES THIS), she had lost a ton of weight, was a very healthy size, but more so, EVERY SINGLE ONE OF HER CHRONIC HEALTH PROBLEMS HAD DISAPPEARED! No more body aches, abdominal pain, daily headaches, alternating diarrhea and constipation, bad sleep, depressed mood, anxiety, etc.
Now, I wish I could say I immediately knew how it happened because I had recommended the same course of action for two years, but I was honestly taken aback when she told me how she did it. After offering a well-deserved congratulations to her, she told me she went on a whole foods diet, eliminated suspected food allergens, and one by one her issues resolved. She felt fine! She had no complaints. She was cured with no medications, no tests, no labs, and no referrals. No expensive gimmick drinks. No supplements. She ate a healthy diet and stopped eating things her body didn't like. She started listening to her body.
I was thrilled for her, and I finally had some evidence that my "theory" was accurate. I say theory because as much as my job as a primary care provider is to preach what people should do, they rarely do what I think is best for them. People rarely take such advise, so I had no real evidence it worked. I had just read about it in books. Let's return to my medical conference and frustration surrounding more education in evidence based prescription medications for every problem.
While sitting in this room with probably a hundred other primary care providers, listening to the same tired solutions, I began searching online again for another way. Certainly I can go home and tell my patients something new, a better answer. I found myself back on INCA's (International Nurse Coach Association) nurse coaching website, reading about their program that leads to a board certification in nurse coaching. I noticed they had an upcoming conference in my area, and signed up.
To be honest, I didn't read too much about the curriculum. I think I assumed they would teach me about all those things I thought I wanted to learn- diet, exercise, weight loss tips, etc. I was dead wrong. Over the last year, I've been learning how to help people look deeper into themselves for personal answers to their problems. Nurse coaches help explore the barriers their clients encounter, and find ways to break them down.
Throughout the training, I've done a lot of thinking about my own dharma, and how I will use this training after my board certification exam is behind me this fall. Some books on coaching say that you should find your niche, specializing in something that is easy to market and that you feel good about. Each time I talk to friends about this or have to complete yet another self reflective assignment for my training, I go back to dharma, change, and happiness.
Yes, I derive plenty of happiness and fulfillment from helping people develop their own goals and celebrating their achievements. During my coaching training, I've helped people stay accountable to themselves writing a script, helped a mom incorporate painless, healthy lifestyle changes for her whole family that led to weight loss and more energy for everyone, helped someone with the first steps towards an (according to her) long overdue divorce, helped someone stand up to their difficult coworkers, and I've helped many people with chronic health conditions, their relationships, their happiness, their depression, their sleep, their career path, a tough personal decision. You name it.
So I realize I'm figuring out my dharma. I'm a change agent. I help people when they think they can't do it. My job isn't to preach solutions or medications to people. Its to listen and guide. To help people realize their own answers. All those little things I might help them address can gain momentum, and help them realize real change is possible. They can love themselves, be happier, have better relationships, and live their own dharma.