David Thomas, NP, hams it up during a rare quiet moment at work.

I have been working in a newly developed position as a hospitalist for the past several months. Hospitalists manage the care for inpatients who either have no health care provider or whose health care provider chooses not to follow them in the hospital. Originally, hospitalists were physicians, but more and more, hospitals are hiring nurse practitioners to fill that role.

I have 12 years of cardiovascular nursing experience after graduating from the BSN program at Pittsburg State University, and I recently graduated from the University of Kansas' adult advanced nurse practitioner program. I now work as an NP hospitalist with Lawrence Memorial Hospital in Lawrence, Kan. The hospital is licensed for 173 beds, and it services the Lawrence area, which is a community of approximately 90,000 people. It pulls from many smaller communities in the surrounding area.

The hospitalist team consists of two NPs and seven physicians, all full-time positions. We supply 24/7 hospital coverage. At this time, there are fewer than five family/internal medicine physicians in the Lawrence communities that still admit patients to the hospital - all because the hospitalist service is available.

Since there are only two hospitalist NPs, our schedule is 7 days on and 7 days off, with our days typically starting between 7:00 and 7:30 a.m. and ending around 6:00 p.m. We start our 7-day work week on Monday and finish on Sunday night. The work day ends when the work is completed with all patients seen. I have left as early as 1:30 p.m. and stayed as late as 7:30, although 6:00 p.m. is probably the average.

We currently do not take call or work nights. We do not have vacation or paid time off, but use our weeks off for this time away. One of our professional responsibilities is to ensure that the hospitalist service always has an NP on duty during the day, so we work around family events and outside issues by changing our schedule as we need to with this in mind.

On a daily basis, the physicians rotate the "call" physician, who acts as the point practitioner for new admissions from the emergency department and surrounding medical communities. We typically work closely with the call MD triaging the areas of greatest need, but we also share patients with all of the physicians who are on service daily. We do not follow a physician around, but always have access to a physician if there is a question or new concern.

Once we see or admit a patient, we will see those patients on a daily basis until we discharge them. Our primary responsibility is seeing and planning for patients in the chest pain center, acute rehab/SNF, subsequent hospitalized patients, postoperative orthopedic patients, and new admissions. I enjoy many professional benefits and have a wide range of patient illnesses and disease states on my service. In addition, I enjoy learning and being creditentualed to do many procedures, including arterial lines, chest tubes, intubation, PEG tube and central line placement.

Here is a look at my typical day:

7-7:30 a.m.: Review overnight admissions and new patients and discuss who needs to be seen first. I will see patients in the chest pain area first to evaluate and develop a plan to rule out those patients with cardiac marker panels, stress testing or cardiology consultation. The NP coming off call on Sunday will send an e-mail note on a few patients from his or her list for the next NP to take over. I typically have anywhere from 12 to 16 patients on my list through the week and will turn over four or five who are having issues or pending discharges to the other NP. I would also let her know about any outpatient testing that I have pending while I am away.

7:30-9:30 a.m.: See new cardiac and chest pain patients.

9:30-12:00 noon: See ICU and step-down patients on my list; review labs, medications and new concerns; and write progress notes. I'll also see new ED admissions, write admission orders and dictate H&P. All new patients are seen in conjunction with a physician.

12:00-12:15 p.m.: Sign and review charts in chart completion room. I typically do this twice during a work week.

12:30 p.m.: Lunch!

1:00-6:00ish: Finish seeing all patients on other units on my list; write orders and progress notes. Assist in discharge planning and dictation of discharge summaries. Follow up on cardiac patient testing and, if ruled out, discharge with dictation to primary care provider. Also see new ED admissions and work those up with admission orders and H&P. I would also be available throughout the day for assistance with procedures.

David Thomas is an adult nurse practitioner who works as a hospitalist NP at Lawrence Memorial Hospital in Lawrence, Kan. Reach him at dknbthomas@yahoo.com.