Working as a Certified Pediatric Emergency Nurse

Working as a Certified Pediatric Emergency Nurse

The nursing field is filled with various specialties. And that’s a good thing, as while working in emergency would be too stressful for one nurse, it is the perfect fit for another.

Cara J. Szeglin, BSN, RN, CPEN, a Clinical Ladder III Staff Nurse at NewYork-Presbyterian Morgan Stanley Children’s Hospital, is one of these nurses who thrives working with emergency patients. She took time from her schedule to answer our questions about what it’s like to work as a Certified Pediatric Emergency Nurse (CPEN).

How long have you been a CPEN? What drew you to get that certification?

Cara with BCEN Board of Directors Chairperson-Elect Kyle Madigan, MSN, RN, CEN, CFRN, CTRN, CCRN, CMTE right after she received BCEN’s 2019 Distinguished CPEN Award
(Photo courtesy of Brian McCarthy)

I became CPEN-certified in November 2014. By this point, I had been an emergency nurse for about seven years. The first year was with only adult patients, the next two years with adult and pediatric patients, and the last four years were solely pediatric emergency patients. 

When I applied to sit for the CPEN, I had reached a point in my career where I felt like my education and pediatric emergency experience were enough for me to be ready. The Board of Certification for Emergency Nursing (BCEN) recommends nurses have two years of practice in their specialty. Passing BCEN’s Certified Pediatric Emergency Nurse (CPEN) examination proved to myself, my place of employment, and to my patients that I was indeed an expert in my field.     

Why do you enjoy working as a CPEN?

I absolutely love working in pediatric emergency care as a CPEN. I still cannot believe I get to do my job because it is just so much fun. The pediatric patients are great, the parents and guardians are grateful, and my co-workers are amazing. 

Some of the greatest moments I have as a Certified Pediatric Emergency Nurse are when a patient comes in sick or injured, and their guardians and the patient can be confused, worried, upset, and experiencing a host of other emotions, and as a CPEN, I’m able to anticipate what the plan of care should be and I know how to tell them what’s happening and what to expect in a way they will understand. You know by their questions if they understand or if they need you try to explain it another way. I always tell them it is all right to ask questions — as many as they like — and as a CPEN, I feel confident I know the answers or know how to get them and explain them.

The biggest thing about being a CPEN is that you have gained their trust because you are an expert professional who is going to give their loved one the very best care.

What are some of the biggest challenges to being a CPEN?

I have known some extraordinary pediatric emergency nurses who just needed a motivating nudge to get their nerve up to take the exam and get board certified. When I first started nursing and heard about the CPEN, I thought “Those are the elite people. I want to be them one day.” And then when I passed the exam, I said “What took me so long?”

What are some of the greatest rewards?

As a CPEN, I’m part of the care plan for my patients. Before I became a CPEN, fully understanding the rationale of why providers were requesting what they were ordering and engaging with the whole team had really been a challenge for me. Earning the CPEN has helped me find my voice and offer suggestions instead of just accepting all orders as they are. I love being able to constructively question the providers and asking for rationales.

Being a CPEN has boosted my confidence — I am a valued member of the care team who needs to know what is going on and why and whose voice needs to be considered when the care plan is being discussed. This also means I’m better able to ensure that my patients and their families know what the plan is and understand why. 

If nurses reading this are interested in becoming CPENs, what would you say to them?

The CPEN is for nurses who want to demonstrate their expertise in treating infants and children in emergency settings. The exam covers the most common pediatric illnesses and clinical issues of all kinds, including trauma, respiratory and cardiac issues, plus less common things that you still need to know because you never know what might come through your doors. The BCEN website contains all the information you need to apply for the exam, how to schedule a test date (which you can do all over the country throughout the year), plus a lot of helpful resources. 

I studied for the CPEN exam just as hard or probably even harder than I had for the nursing boards. A key part was scheduling a test date along with a pediatric emergency nursing friend of mine — so there was no backing out. We studied together, supported each other, and passed on the same day together! Each of us study and learn in different ways.

What else is important for readers to know?

There are so many good things, rewarding things about being a nurse, especially pediatric emergency care. There are days when everything seemed to go so smoothly and you excelled at everything you did. And then there are the days when something came through the doors totally unexpected, and you only hope you can hold it together until the end of your long shift so you can cry about it on the way home. The same can be said for all specialties of nursing. But you pull it together and show up for work the next shift, with the same level of care, dedication, and enthusiasm because being a nurse is the best career

I love being a CPEN, and I hope that readers can feel my passion and get motivated to become certified themselves, and if they are already certified, I hope that this inspires them to seek out other nurses and start being a mentor for them!

Nursing Side Gigs: Boxing Coach

Nursing Side Gigs: Boxing Coach

This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a boxing coach.

By day, Cindy Bohmont, RN, SEN, Med, CCRN, CSD, works as a staff nurse in the Cardiovascular Surgical Intensive Care Unit at Mercy Hospital in Springfield, Missouri. She’s worked at Mercy for 48 years, and during that time, she’s worked PRN in Coronary ICU, Pediatric ICU, Medical ICU, Neurotrauma ICU, and Mercy Home Health Care. For five years, she even taught at St. John’s School of Nursing.

In her free time, though, Bohmont does something that you might never expect from a nurse: she officiates amateur boxing matches and is moving into the professional field to work as an official for professional fights.

Boxing coach Cindy Bohmont

About 25 years ago, Bohmont developed her interest in boxing after two of her sons got into a fight on their ranch. When he was in the Marines, her husband boxed, and he suggested that they find a gym for the boys to learn boxing.

“We found a boxing program at the Boys and Girls Club in Springfield, Missouri,” says Bohmont. “And I was hooked!”

Bohmont says that all five of her sons as well as her youngest daughter became involved in boxing, although none of them ever went pro.

While Bohmont began as a supportive mom, attending her kids’ matches, she soon learned enough to become an amateur official and began judging boxing tournaments all across the state. She also began coaching at the club. “I discovered that the sport of boxing is not just a legal fight. It’s a very complicated sport—[boxers are] trying to land scoring punches while at the same time protecting themselves,” explains Bohmont. “The most important things I taught were integrity, fair play, good nutrition, good sleeping habits, believing in yourself, generally taking care of your body and mind, and no drugs, smoking, or alcohol.”

Because, Bohmont says, boxing is an individual sport, whatever athletes put into it—in terms of training and the like—that’s what they get out of it.

Although some may think that it’s counteractive for a nurse to coach a sport where athletes get injured, Bohmont says that “If you listen to the news, you will rarely hear of a boxing injury. Everyone knows someone with a tennis-elbow, football knee, etc. Most boxers are in tremendous shape and are very skilled at defensive maneuvers.”

Boxing Coach Cindy Bohmont

Over the years, Bohmont has won a number of awards, including the Outstanding Official of the National Junior Golden Gloves Tournament in Mesquite, Nevada as well as the Greater Kansas City Golden Gloves Coach of the Year. “Those are major accomplishments when you consider this is generally a male domain that I’ve jumped into,” Bohmont says.

Considering that coaching boxing can be tough on the coach’s joints (Bohmont would hold practice pads and mitts for up to 30 kids to hit each night for four nights a week over 20 years), she has decided to focus on moving into the professional field of boxing and aspires to be an official for pro fights.

That’s just one reason why Bohmont has begun working one week a month in the ICU at St. Rose Hospital in Las Vegas, Nevada, as the area holds tons of professional boxing matches.

“It has been difficult stepping back a little from coaching. Then I get an email or see a Facebook posting from one of my former boxers with a new aspect of their lives that I had a hand in guiding them toward,” says Bohmont. “It’s so good for my soul to be able to work with healthy, thriving young men and women after caring for the sickest of the sick in the intensive care unit. It keeps me emotionally healthy and balanced.”

What’s the Difference Between Employer Provided Malpractice Insurance and Individual Professional Liability Insurance?

What’s the Difference Between Employer Provided Malpractice Insurance and Individual Professional Liability Insurance?

While working on the job, have you ever been concerned that a mistake or an accident could cause you to be sued? Even if that happened, you would be covered by your employer’s malpractice insurance, right?

Well, maybe and maybe not.

We interviewed David Griffiths, Senior Vice President for the Healthcare division of Aon Affinity. Griffiths has overall responsibility for the malpractice insurance program for the Nurses Service Organization. We asked him to explain how and when nurses are covered. (Note: because individual experiences are different, always seek professional advice regarding your own situation.)

Why should nurses considering having individual liability insurance?

Employer insurance is designed to protect the hospital or health care facility first and foremost. A hospital or health care facility’s coverage may extend to health care staff; however, there are key differences in how the coverage activates, and there could be gaps that would be detrimental to a nurse. Getting your own professional liability policy is a key way to make sure you are in control of the protection of your own career at all times. 

What is the overall difference between the two types of policies?

  • Employer Provided Malpractice Insurance: 

A hospital or health care facility’s attorneys are required to place the best interests of those organizations first. However, this may or may not be in your best interests depending on the situation. Your career is far too important to place in the hands of your employer, its attorneys, and your employer’s insurance company. An individual professional liability insurance policy ensures you have a team in your corner that has your best interests in mind.

  • Individual Professional Liability Insurance:

There are two key things an individual professional liability insurance policy does that an employer’s policy may not:

  1. An individual professional liability insurance policy like those NSO provides covers you as a nurse 24/7–an employer’s policy only covers you when you’re on the clock.
  2. In addition to professional liability insurance, your individual policy provides license protection — most employer provided coverage does not offer defense of license to the board because it may be the employer who submits the complaint. Your license is your means of practicing as a nurse, and if it is threatened or taken away your livelihood is at stake.   

Should only nurses in certain fields look into it? Why or why not?

All nurses should consider an individual professional liability insurance plan. There may be differences in coverage for nurses in certain fields, but overall this type of insurance is an effective source of protection for all nurses.

Are there any kind of specific experiences in nurses’ careers that should make them obtain professional liability insurance?

A board complaint can be made against your license for any reason by anyone.

An analysis of license complaints from NSO insureds show the location of most incidents are actually in the hospital.

The complaint could arise from a patient, family member, the hospital, or even a colleague.

Most employer provided coverage does not offer defense of license to the board because it may be the employer who submits the complaint.

Your license is your ability to practice as a nurse, it represents a huge investment of your life, it defines who you are (as well as helps pay the bills).  

What other factors should be considered when to purchase this kind of insurance?

Nurses help individuals when they are most at risk. Today, nurses are more at risk for legal action than ever before. An individual professional liability insurance policy helps them manage that risk and protect their careers and livelihoods. Many nurses may think an individual policy is complicated and expensive to get, and that’s simply not the case. In most cases, coverage can begin as soon as a completed application is approved and payment is received — online in a few minutes. Every nurse can afford malpractice insurance — the premium is in most cases about $100 a year, and the alternative is potential liability for upwards of millions of dollars on legal fees and payouts.  

Is there anything else about the differences between employer provided insurance versus individual professional liability insurance that is important for readers to know?

Depending on the scenario, a lawsuit could be brought forth years after the incident occurred. Many times, the nurse may have left the facility. Depending on the type of insurance the employer carries, coverage may end on the last day of employment. Nurses need to be aware of this very real scenario. One of the values of having individual coverage is that it goes with you.

Working as a Nurse Psychotherapist

Working as a Nurse Psychotherapist

Pursuing jobs in the field of psychotherapy isn’t just for doctors; nurses can do it too. Benjamin Evans, DD, DNP, RN, APN, past president of the New Jersey State Nurses Association, has his own practice as a nurse psychotherapist in addition to consulting. He made the change in the 1980’s after he had completed his nurse practitioner training. Based on his work with people living with chronic and catastrophic illnesses, he decided to earn a master’s degree in counseling because it would be a good fit.

Evans talked with us about what a nurse psychotherapist does and what nurses who are thinking of entering this area of the field should keep in mind.

What exactly does a nurse psychotherapist do?

A nurse psychotherapist does the same work as any other educated psychotherapist — using psychological and counseling methods to assist in behavior and mental health changes. Usually the state board of nursing incorporates some form of health counseling within the definition of nursing practice. Psychotherapy can be done with individuals, families, and groups.

What should nurses keep in mind if they are thinking of becoming a nurse psychotherapist?

Nurses need to understand their reasons for wanting to become psychotherapists. Psychotherapy is not about “fixing” others who have similar issues to the therapist.

It is not solely health counseling for issues like nutrition, stress, or weight control.  It is not nurse coaching. Psychotherapy is undergirded with theoretical frameworks that are used by the psychotherapist to help in the change.

Nurses who wish to become psychotherapists will be integrating nursing theories with theoretical frameworks from psychology, psychiatry, social work, and other disciplines.

Psychotherapy education is usually done at the graduate level. For this reason, the nurse wishing to do psychotherapy needs to determine if she or he will pursue psychotherapy education through a graduate nursing program like a psychiatric mental health nurse practitioner/clinical nurse specialist role or through another discipline like psychology, educational counseling, or social work.

What kind of certification or other education would they need?

Certification can be obtained by credentialing organizations like the American Nurses Credentialing Center or through various certifying bodies outside of nursing. Some types of psychotherapy have non-degree supplemental experiential training and then “certify” the practitioner in a particular modality — for example, training in cognitive behavioral therapy.

What else should they do?

A nurse wishing to become a psychotherapist should meet with and shadow a nurse psychotherapist to really learn all that the specialty initials. She or he should become familiar with modalities of psychotherapy and vet programs for training. 

What are the greatest challenges to being a nurse psychotherapist?

Challenges include training (time and cost), building a practice, obtaining referrals, and ongoing maintenance of competency. 

Additionally, reimbursement issues play into the challenges of practice as many insurers do not cover nurses for psychotherapy.

What are the greatest rewards?

There are many rewards to being a nurse psychotherapist, including watching as behavior changes and mental health improvements are accomplished by the patients. 

Is there anything else important for our nurse readers to know?

The practice of psychotherapy as a nurse is quite rewarding. The nurse who chooses to go into psychotherapy practice must want to help others to make behavioral or mental health changes. The nurse must have clear boundaries — being able to be empathic and not take on the issues of the client. Nurse psychotherapists must be mindful of self-care and to develop a sound network for referrals when the issues presented are outside of the psychotherapist’s area of expertise.

The DNP Project: What Is It Exactly and Why Is It Necessary?

The DNP Project: What Is It Exactly and Why Is It Necessary?

Anyone who is in a DNP program already knows about the final DNP project. But if you’re thinking about pursuing a DNP, you need to know more about it.

Stephen Ferrara, DNP, FNP, FAANP, FNAP, Associate Dean, Clinical Affairs & Associate Professor, Columbia University School of Nursing; Editor in Chief, Journal of Doctoral Nursing Practice; and Executive Director, The Nurse Practitioner Association New York State, took time to answer our questions about the final DNP project (also known as the capstone project—please note that these terms will be used interchangeable in this story). What follows is an edited version of our interview.

For those who don’t have a DNP and may not know what the DNP project is, please explain what it is and why it’s necessary.

Completion of a final DNP project or capstone in doctoral programs is intended to demonstrate the students’ synthesis of knowledge gained during the program. DNP students should be familiar with AACN’s Essentials of Doctoral Education for Advanced Nursing Practice since most, if not all, DNP programs are expected to adhere to this document.

In essence, the faculty utilize the final project as means of evaluating whether the student has developed mastery of the concepts within the students’ course of doctoral study. The final project must show an improve to clinical practice and/or patient outcomes.

How long do nursing students usually spend on their projects? What are they expected to accomplish?

Projects vary in length but are generally 1-1 1/2 years. Some examples of final DNP projects include a quality improvement initiative or other clinical practice change such as a pilot study, implementation and evaluation of a new practice model with scholarly dissemination in the forms of manuscripts for peer-review submission. 

When they embark on these projects, what should DNP nursing students keep in mind to help things go smoothly?

One of my mentors would remind me that the final project was not meant to be my “life’s work.” In other words, the application of the final project needed to be transferrable. The education and skills we learned could be applied to different clinical issues, populations, and settings. The project needed to stay on a reasonable timeline so that it could be completed. This concept differs somewhat from PhD studies, where students typically focus on a specialty and continue throughout their career. Also, PhD dissertations can last through many semesters. Finally, strong organizational skills are essential since there are many inter-related parts that need to be coordinated to ensure success.

What are the biggest challenges for nursing students in completing their projects?

I would say that there are two main challenges: 1. Having too broad or too ambitious of a project and 2. Not adhering to timelines. This can jeopardize the entire project.

If a student is having issues with his/her project, what should they do?

DNP students need to regularly meet and communicate with their faculty advisors. Advisors should help students navigate through unanticipated challenges, bureaucratic delays, and unexpected results. Other DNP graduates or mentors can also students with some issues they may encounter. “Crowd sourcing” through social media may also help students with general issues they may encounter.

What else should nursing students—and nurses who don’t have and aren’t yet pursuing a DNP, but might in the future—know about the DNP final project?

Doctoral work in any discipline is synthesizing information. Final DNP projects tend to take existing high-level evidence and implement or apply to different practice setting rather than creating new evidence as is done with the PhD.

In addition, DNP work should not end with the final project. The expectation is for DNP graduates to continue contributing to the scholarly application and dissemination on their work throughout their careers. I encourage anyone wanting to see examples of this scholarly work to visit the Journal of Doctoral Nursing Practice (JDNP) website or check with their institutions’ library.

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