How Your Nurse Practitioner Can Help You

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Topics include: Living Well

The role of the nurse practitioner is a critical part of your healthcare team.  How can he or she help you? What questions should you ask?  Tiffany Richards, an advanced practice nurse at MD Anderson Cancer Center, joined Patient Power to share important information on how patients and caregivers can communicate well with their nurse practitioner and make your doctor visits productive.

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Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power. I’m Andrew Schorr.  Well, any of us blood cancer patients who to go to the clinic with some regularity, we know that, of course, you want to see the doctor, the expert. But there are other members of the healthcare team that are so critical to us living well. And one member of that team is the nurse practitioner. And there’s a great one that we know of at MD Anderson, she’s been with us before. That’s Tiffany Richards. Tiffany. Welcome back to Patient Power. Tell us about the role of the nurse practitioner.

Tiffany Richards:

I'm a nurse practitioner, and so part of my responsibility is to go over side effects with patients and provide them patient information that they'll need, either to make their treatment decisions or once they've made a treatment decision on how to manage those side effects.  I'm also responsible for helping the physician with returning phone calls to patients and triaging phone calls that the nurses get during the course of their day. 

I am also responsible for managing prescriptions without—with the exception of chemotherapy drugs.  We can't prescribe those here.  And so that's really my role is to really be kind of a second hand to the physician in clinic. 

Andrew Schorr:

So often you’re there before the doctor. Tell us the kind of questions that patients ask you.

Tiffany Richards:

I think it really depends on where they are in their diagnosis.  Obviously somebody who is newly diagnosed is going to have a different set of questions as opposed to somebody who has been diagnosed for six years and is coming in to our clinic for a second opinion. 

I'd say for the newly diagnosed patients, they don't really at that point know what questions to ask yet.  A lot of times, they're just still struggling to try and understand what the disease is and what all these numbers mean.  So I try and go over what we're explaining to them, what an immunoglobulin is, what their light chains are, what their monoclonal protein is so that when they come for subsequent appointments they are able to understand what we're talking about. 

Somebody who is later on in their diagnosis and they're well versed in myeloma, that's a little bit of a different conversation.  Sometimes it's how is this treatment going to affect my quality of life?  Sometimes the biggest question on their mind is do you have treatments that—that I can get here that maybe the local oncologist has said that there's nothing else for them to get.  So it really depends upon the stage of their disease. 

Andrew Schorr:

I think we’d all agree that it is helpful for a caregiver to accompany the patient to appointments. Often in the first few appointments so much is said. What would you say are important questions that caregivers can ask in those first few appointments?

Tiffany Richards:

That's a great question.  I think a lot of times you forget about the caregivers in the course of an appointment.  I think the caregivers need to understand the side effects and how to manage it because if a patient is having a lot of diarrhea or is starting to have some signs and symptoms of peripheral neuropathy, they may not want to talk about it because they want to keep on going with treatment. And oftentimes I find that the caregivers are the ones that report the symptoms as opposed to the patients.  And so I think the caregivers are almost like our eyes and ears when the patient is not in clinic with us. 

I think the other important question is how can they best support the patient, both emotionally and physically.  And I also think it's important to remind the caregivers also during that time to not forget to take care of themselves, because I find that caregivers sometimes forget to take care of themselves. And that's not healthy for them, it's not healthy for the patient.  And so I think it's really important that we look to the caregivers, and we also want to make sure how they're doing. 

I also make sure that when I'm talking about steroid side effects with the caregivers that they're aware of the moodiness and irritability that can occur, and that they know that they're not alone in that and that they don't have to be afraid to mention it.  And so oftentimes I find when I'm talking about the moodiness and irritability, particularly on the subsequent visits, how the patient is perceiving their moodiness and irritability is a little bit different than the caregiver.  So I think it's really, really important that we talk about that with the caregiver so that they don't feel like they're alone in this. 

We have had patients who are the nicest patients when they first get diagnosed.  They're nice, they're sweet, you'd never, ever think that they would have bad moodiness and irritability, and they can get it.  There's no way to predict how bad the moodiness and irritability is going to be, so it's really important that the caregivers, that we educate them. 

Andrew Schorr:

So would you send your patients to a pain specialist or mental health professionals to help them deal with the side effects of treatment or the burden, if you will, of the diagnosis?

Tiffany Richards:

Yeah, definitely.  So almost all of our patients that come in with like compression fractures or a lot of pain, we'll send up to see our pain management folks just because they know how to manage pain better than we do.  We can get them started on something, but we—you know, if they need kyphoplasty or vertebroplasty, they're the ones that do that.  Sometimes they can give nerve blocks or steroid shots, so they're much better at managing pain. 

They're also—with a patient has painful neuropathy, they'll do things with their medications that we wouldn't have any idea to do, so we definitely send a lot of patients to pain. 

For psychiatry, it really depends on the patient.  Sometimes I find that patients don't want to because we have a stigma in this country.  We have stigmatized mental health and any kind of depression.  And so what I always try and tell patients is just as if I was to give you steroids and you would get diabetes and your blood sugars would go up and you needed insulin because your pancreas wasn't producing enough, same thing can happen when you take steroids and that it can mess up what's going on in your brain.  On top of that, they're dealing with a new diagnosis, and so that in and of itself is a lot to deal with. 

And so we'll try and start them on an antidepressant if they're interested.  Sometimes they're interested in seeing psychiatry, sometimes they're not.  We're fortunate that within our integrative medicine department here that we—they have a psychologist there, they have a physical therapist, they have a dietician that can work with patients. 

I really try to send more patients into integrative medicine so that they can get education about their diet.  They can get education on what kind of physical activity they can do, because I think that's all really important for the patient when we're looking at long?term survival in our patients. 

Andrew Schorr:

Tiffany, having been with you, I know how passionate you are about your work as a nurse practitioner. What’s your favorite part of your job?

Tiffany Richards:

I would say probably the education piece, educating patients, but also the relationships that I've built.  A lot of people sometimes think, oh, my gosh you work with cancer, and you work with an incurable cancer. It's got to be so depressing.  But I don't find my job depressing.  I find that I get a lot of rewards.  Patients—my patients teach me something new every day. 

They have taught me how to live and how to make every moment count—how to appreciate my friends and my family and to make sure that I'm putting that as a priority rather than everything else.   

Andrew Schorr:

Tiffany Richards, Nurse Practitioner at MD Anderson Cancer Center in Houston. Thanks so much for being with us on Patient Power once again. And, Tiffany, thanks for all you do day after day for patients.

Tiffany Richards:

Thank you. 

Andrew Schorr: 

I’m Andrew Schorr. Be sure to be signed up for alerts on our website, so you’ll know whenever we post something new. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on March 27, 2015