“Treat the person, not the disease.” An interview with nurse practitioner Phyllis Zimmer

Family Nurse Practitioner Phyllis Zimmer has a Master’s degree in Nursing and is a Fellow at both the American Academy of Nursing and the American Association of Nurse Practitioners. It sounds like Phyllis always knew she wanted to be a nurse, but truth be told, Phyllis wasn’t sure what her career path would be until she decided where to apply to college. Then it all came together.

Read on as she describes her passion for nursing, her own experiences as a patient, and some of the important questions patients should ask their doctors and nurses.

You seem passionate about nursing. Why did you become a nurse in the first place?

The short answer? I don’t know. Maybe it has something to do with my years as a Girl Scout, and always wanting to make a difference in my life.

When I was in high school, trying to decide on a college, I told my parents that I wanted to be a nurse, but I had no idea where that came from. Years later, I found out that my paternal grandmother, great aunt and her sister were all nurses. My family has a wonderful photo of the three nurses wearing long, floor-length pinafores, watches around their necks, and winged nursing caps.

Then when I was an undergrad, I saw nurses in action and thought, “I want to do that!” So I became a nurse, then a nurse practitioner and have practiced as a nurse practitioner ever since.

Tell us about what it means to be a nurse practitioner.

As a nurse practitioner, you have a huge responsibility to provide quality care, but also an amazing entrée to patients’ personal lives. People trust you. They’ll tell you things about themselves that you’d never dream you would learn about another person.

I feel so honored when people are comfortable enough to share both the joys of their lives – the births, the experience of being a new parent, as well as the difficult parts of their lives – something they’re afraid of, a new symptom or disease they are coping with, a sexual problem. People talk about intimate personal issues: domestic violence, concerns about alcohol use or fears about death or dying. They trust me to listen and to help.

The nurse practitioner role blends what I love best about nursing – the advocacy for people, patient teaching, and patient-centeredness of my profession – and what I love about medicine: making the diagnosis (solving the puzzle of what the symptom or problem is), the clinical decision-making, providing treatment that is medicine.

I also like the level of autonomy nurse practitioners enjoy. I’m accountable and responsible for my own practice.

Do nurse practitioners specialize?

Yes. Nurse practitioner programs are offered in specific specialty areas – family medicine, pediatrics, adult/geriatrics, acute care, psych/mental health, and so on. The broadest scope of practice is the Family Nurse Practitioner, who sees patients for health and illness concerns across the age span. The Pediatric Nurse Practitioner, in contrast, sees only children.

Your specialty determines the scope of your practice. Nurses choose their nurse practitioner specialty based on where they are most comfortable and have the most interest. The data says that nurse practitioners do a great job, and offer high quality care regardless of specialty.

I began as an adult nurse practitioner, and when the masters program became available I went back for my master’s degree and chose family medicine because I enjoyed seeing both adults and children, and wanted the broadest scope of practice possible.

Can you tell us about an experience that really affected you?

Definitely. One of the most impactful experiences I’ve had was as a brand new grad. I’d only been practicing for a short time, and I was given a referral to see a woman who had been diagnosed with lung cancer.

After she was sent home from the hospital, I was assigned to do her discharge and follow-up care. The family decided that she was not to be told she was terminally ill. She’d been doing well, and she was able to care for herself and get around for a while. I visited about once a month to check on her.

As she got sicker, I did home visits more often. From monthly visits, I moved to every three weeks, then every two weeks, every week, then every day, and finally several times a day. We became close. The family wanted to provide her care themselves, so we moved a hospital bed into her home, she went on oxygen, and I worked with the family to support them in caring for her.

It was a slow, gradual, downhill course. I still remember the day when she and I were in her bedroom, talking. She asked me why her family wouldn’t talk to her.

I asked what she meant, and she said, “I know I’m dying.”

As a nurse, I was treading on delicate ground. I had specific instructions from the family—I couldn’t confirm or deny anything. So I tried to listen, and tried to be a coach for her and help her feel comfortable raising the question to her family directly.

It was hard for her to talk with her family. There were a lot of tears. But then, it got so much easier. Feelings of fear, sadness, anxiety, all were shared. They had opened the door to communication, and each family member had an opportunity to share their thoughts with my patient. These were important final conversations. I realized then that this is how end-of-life care should be.

I understand you had surgery. Why? What happened?

I found a mass. It turned out to be benign, but it was big and needed to come out.

Actually, I found it in the middle of the night, and I was shocked. My husband’s a doctor, but I waited until morning to tell him and then went in for tests to find out what it was.

I was just like some of my patients – I didn’t want to deal with it!

School was restarting. I had a million things to do, with teaching and practicing. I thought maybe I could manage the problem medically for a while. That lasted a few months, and then I had a period of time where I had more pain than I’ve ever had in my life. So, two days after school got out, I had surgery.

I was scared to death.

I imagined not waking up from anesthesia. So I talked with the surgeon and the anesthesiologist and asked if there was any way to avoid being intubated and having general anesthesia. They said they might agree to do just an epidural instead of general anesthesia.

For me, that was the lesser of two evils. The choice was being intubed and having a longer recovery versus having an epidural (an injection into the spinal area), with a shorter recovery but being awake during surgery. I got the anesthesiologist and the surgeon to agree to the epidural. The biggest advantage of the epidural was that I had an incredibly speedy recovery, and I felt more in control. I also conned my hubby to be in surgery with me – and we talked during the procedure, which I found very comforting.

But there were definitely moments when I felt I had no control- and I was afraid. And the entire procedure of having surgery is tough. You feel a loss of privacy, you feel embarrassed. The gown is open at the back, and so you feel exposed, even though everyone tries hard to keep your modesty intact. You may need an IV or a catheter, or some other procedure to “prep” for the surgery, and you have to deal with it. In my case, everyone tried hard to be respectful and explain things, which taught me how much we, as patients, need that kind of support.

The only really negative part was that they asked me in admitting if I wanted to be an organ donor. I don’t think you should ask someone that on the day they’re having surgery!

Do you think your nursing background helped prepare you to be a patient?

All of my nursing experience is in outpatient care, and the hospital environment is very different. But, yes – it made the difference in helping all the parts come together. I knew a lot of what to expect from admission, to the surgery, and after. When you’re the patient and you have monitors beeping and IVs in your arm and you feel very vulnerable. But being in nursing helps you feel a little more in control. For example, I knew my discharge plan. I felt ok and not weak and dizzy, and I could do some things on my own. I knew what I couldn’t do when I got home. I had clear written instructions and knew who to call if I had a problem. I went home in 24 hours instead of in several days. My nurses made sure I could go to the bathroom, could walk and not fall over, and was able to eat and drink.

What were your nurses like?

I had three different nurses caring for me, and each had a distinct style. One was an older, really experienced nurse with a very “cut and dried” approach, and she was great. She got things done. One was younger, newer to the profession, sweet, very kind and caring. The third was a wonderful Irish nurse with a darling brogue. She was a blend of the other two, and she had a great sense of humor. Each of my nurses brought something different to my care. They all were competent and inspired trust.

And, my Mom came and sat in the room with me and read a book or knitted or whatever. She wasn’t talking with me much, but as a patient, it was hugely reassuring to have my Mom there. It made me think: As a nurse, do I welcome a family member, help them know what they can and can’t do?

How did your own experience change your practice, if at all?

My nursing career began as a public health nurse, and that background makes you think about care in the broadest sense- public health nurses look at community and family variables as well as the issues for the individual patient. I’ve always had that “holistic” mindset. But being the patient yourself, experiencing the fears, the questions, the difficulties of doing what you are supposed to do when you don’t feel well, makes you practice differently. I think it makes you more understanding, more empathic.

When I think about all the things I’ve learned as a nurse, and my experience as a patient, the most important lesson for me is to treat the person, not the disease. And remember that each person has people in their lives, family, friends, partners, etc., who are concerned about them. The patient needs care, but so do those who love that patient. They need attention as much as the patient does. My experience made me even more aware of how valuable nursing can be – the truly important role that nurses play in patients’ lives each and every day.

What advice would you give patients, from a nurse’s point of view?

I’d tell them, “Ask questions and make sure you understand all your options.”

If you’re given only one option, it’s not enough. Ask what the full range of possibilities are, and what are the pros and cons of each approach.

Personally, I’d ask: What is your best advice for me as a person, and why do you say that?  In other words, the best for me, not someone else. If I were your sister or mother or wife or friend, what would you advise?

The more you know, the better. Don’t be afraid to ask questions. If they use a word or name a med you don’t recognize, you absolutely have a right to know. It’s your body, your life, and these are your decisions, not our decisions.

My job is to support your choice. I don’t always have to agree with my patients, but I think I do owe them information about why I don’t agree. As a patient, you trust your health and well being to our care. It’s my goal to always be worthy of that trust.

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