Week one as a CNM (office)

Well, I survived week one in the office as a new CNM!  To sum up my week: I have learned so much, and still have much, much more to learn!

Days 1 and 2 - saw a handful of patients independently.  Observed/assisted other CNMs with their annuals/problem visits.

Days 3, 4, and 5 - had my own patients on my schedule!  Not a whole lot of them, but had a few also added on.  I felt much better about independently seeing and managing my "easy" to low risk clients.

I would say that the majority of the clients I saw in the office were for annual well woman exams.  That was about 80-90% of the clients I saw.  There were just a few prenatal clients that I saw this week.  Which is quite ironic, because I am weak in GYN areas, but strong in OB areas.  Practice makes perfect, right?

Since my schedule is so light right now, I don't feel that pressure to keep moving, and rush through exams and documentation.  Which is super nice, because it gives me time to get used to being a brand new CNM, learning the ropes of the office, and also gives me lots of face to face chat time with the clients!  Which the clients, of course, love.  No one likes to feel rushed when they go in for a check up.

I have so much to refresh/re-learn about GYN care.  I did some birth control pill prescribing (new starts, changing methods from one to another), some general contraceptive education (options, how they work), STD testing and education (treatment, prevention, screening).  I also saw several peri/post-menopausal women in for annual exams.  Hormone replacement therapy is a big area that I need to refresh/re-new my knowledge.  Luckily, there is one midwife in the practice who "specializes" in menopausal women --- so I know who my "go to" person is for menopause!

Finding the elusive cervix -- an ongoing issue with me.  Some cervixes are easy to find on a speculum exam, while others are playing "hide and seek".  I know that this is a skill that will come more and more with time and experience.

I had a little bit of exposure to abnormal uterine bleeding this week.  It's great to know that there is always an MD in the office that I can go to him/her to run possible diagnosis/management plans by for clients.

Documentation and billing is another area that I am finding has a steep learning curve.  There are checks and balances for the billing and coding, but I am gradually working on making sure my documentation is good/adequate.  We do not have an EMR yet, so all documentation is on paper.  Thankfully, there are pre-written forms that we document on.  The medical assistants/LPNs are fabulous about filling in some of the info ahead of time, but it's still up to the CNM to verify that all info is correct.  Billing and coding is a pain in the butt.  Check this for Medicare, this for any of the Blue Cross/Shield, this for Medical Assistance, and this for all other 3rd party or self-pay clients.  So many different codes........ok, now I'm a believer in a universal health care system.  One code for all annual exams (billing code) please!  One code for the annual well woman exam diagnosis please!  I think I'm going to see if I can find a good billing and coding seminar/online class/intro to take, specifically for OB/GYN offices.  But then again, we are using ICD-9 codes, and will be changing to ICD-10 codes next year I believe.  Learn it, then re-learn it.

All in all........a good first week as a CNM!

I won't be taking hospital call time until my temporary hospital privileges are granted.  Hopefully by October 21st!