Vanderbilt University School of Nursing recently received a $1.43 million award from the US Health Resources and Services Administration (HRSA) to develop and implement a Sexual Assault Nurse Examiner (SANE) education program for emergency nurse practitioner (ENP) students. The program is expected to increase the number of SANE-trained advanced practice registered nurses practicing in emergency departments and rural or underserved communities across the country.
Mavis Schorn, PhD, FACNM, the grant’s principal investigator, tells Nursing.Vanderbilt.edu, “Currently, there are just over 800 sites in the country that provide SANE services, yet nationally, one in six women and one in 33 men will experience an attempted or completed rape in their lifetime. Sexual assault nurse examiners have specialized education to conduct forensic examinations that have been shown to provide better physical and mental health care for assault survivors, deliver better evidence collection and support higher prosecution rates. Most important, SANEs treat patients holistically with compassionate and comprehensive care that takes into account the patient’s current acute care needs and the possible long-term effects of sexual assault.”
ENPs are positioned in emergency departments and are often the first to discover a patient who has been sexually assaulted. Their education and experience allows them to provide primary, episodic, and critical care of males and females of all ages.
Vanderbilt will offer SANE education to students in the Emergency Nurse Practitioner Post-Master’s Certificate program. Students in the program are current family nurse practitioners who want to become ENPs, and they will complete SANE training and their ENP education simultaneously with an option to select adult/adolescent and/or pediatric/adolescent SANE training.
The initiative is supported by Vanderbilt University Medical Center, Our Kids, Nashville’s Sexual Assault Center, and EmCare. To learn more about Vanderbilt Nursing’s $1.43 million HRSA grant to develop sexual assault nurse examiner education, visit here.
Registered nurses looking to advance their practice have several career paths they can take. One option is to become a nurse practitioner. Nurse practitioners are advanced practice providers who differ from registered nurses in several ways.
First, RNs either have a diploma, associate’s degree, or bachelor’s degree. The degree level corresponds with the type and length of time that was spent in school. Nurse practitioners are advanced degree nurses with either a master’s or doctorate in nursing. These degrees translate to an additional two to three years beyond a bachelor’s degree.
Another significant difference between RNs and nurse practitioners is the scope of practice. NPs have a greater scope of practice to include conducting physical exams, ordering and interpreting diagnostic tests, and prescribing medications. The board of nursing in each state sets forth the specifics of the NP scope of practice, and some states are more restrictive than others.
The highest degree a nurse can obtain is a doctorate of nursing degree. The length of time it takes to earn a DNP depends on the RN’s starting point:
- RN to BSN takes around two years
- BSN to MSN takes around two years
- BSN to DNP takes about three to four years
- MSN to DNP takes about one to two years
Additionally, some students opt to attend part-time. If so, the length of time to earn a DNP can take a little longer.
Many prospective students may wonder what they will learn in a DNP program. The curriculum can vary between schools, but some of the concepts students can expect to learn include evidenced-based practice, theoretical concepts for advanced-practice nurses, planning, evaluation, and leadership. Additionally, depending on the DNP track the nurse chooses as well as their starting point, they may need to take courses in advanced pharmacology, physiology, and health assessment. These three courses are typically required for BSN students enrolled in a DNP program and following a nurse practitioner track. MSN-prepared students have likely already completed them unless they are changing specialties (i.e., a nurse educator earning a DNP to become a nurse practitioner).
In addition to the core courses and specialty track courses, DNP students are required to complete a final DNP project. The project is to demonstrate that the nurse can identify issues or concerns in health care and provide evidence-based solutions to enhance patient care and improve outcomes.
Aside from it being a commendable academic achievement, earning a DNP can enrich the nurse in many ways. For example, nurses can expand their knowledge base. A bedside BSN nurse can earn a DNP and become a certified registered nurse anesthetist. An adult primary care NP can earn a DNP and become an educator. A clinical nurse specialist can earn a DNP and become a nurse executive. There are so many possibilities available to nurses with a DNP degree—which means a wider scope of career mobility.
Another way a DNP can improve a nurse’s career is that DNP nurses are trained to identify important issues in health care and have the knowledge, and sometimes power, to create change in their work environment. From the time one becomes a nurse, patient care remains the top priority. Nurses serve as advocates for patients on so many different levels, from the new grad bedside nurse to the executive-level DNP nurse. With each academic step, the nurse’s reach becomes longer, sometimes affording the ability to motivate and facilitate change within the highest level of an organization.
DNP nurses also have more of a critical thinking and holistic view of health care. Not only are they considered clinical experts, but they are also experts in leadership, management, and business. Being able to influence decision-making from a business standpoint with a patient-centered point of view is something unique and extremely valuable in health care. This exclusive approach allows patients to have a voice in health care, yet keep an organization sustainable.
In some organizations, DNP-prepared nurses have an edge when it comes to hiring. There is a push for the DNP becoming required for nurses looking to enter advanced practice, so those who earn one may currently have an advantage. Some employers offer higher compensation for DNP nurses as well. Nurses may want to consider earning either a PhD or DNP to become doctorate-level practitioners.
Each nurse has his or her own career and academic goals. One is not “better” than the other. However, for those looking to advance their practice and become clinical experts, the doctor of nursing practice is a great choice.
The Arizona State University (ASU) College of Nursing and Health Innovation has announced that it will be offering a new advanced practice nursing degree this coming fall with a focus on acute care for children. The Acute Care Pediatric Nurse Practitioner speciality program is an addition to ASU’s Doctor of Nursing Practice (DNP) program which aims to meet the needs of students and community partners.
Daniel Crawford, associate director of the DNP program and clinical assistant professor, believes the pediatric nursing program will prepare advanced practice nurses in the acute-care setting. He tells ASUNow.ASU.edu, “Those settings may include pediatric emergency rooms, pediatric intensive-care units, pediatric inpatient-care units and some pediatric specialties.”
Students who join the program can expect a hybrid format that requires in-person classes and online classes. The courses will focus on the development of a framework for developmentally supportive, family-centered, culturally appropriate advanced-practice nursing for infants and children with unstable chronic, complex acute, and life-threatening illnesses.
ASU’s Acute Care Pediatric Nurse Practitioner program is one of few in the country and will help prepare advanced practice nurses to treat a vulnerable population in need of specialized care. To learn more about ASU’s new pediatric nursing program, visit here.
Primary care is in short supply across the US, and nurse practitioners are increasingly stepping in to provide this much needed care. Studies show that NPs provide high-quality primary care, which improves access to care in underserved areas and reduces costs of care.
University of Pennsylvania researchers have called for modernization of the way Medicare pays for training nurses. A recent study highlighted a successful new model of cost-effectively training more advanced practice nurses to practice community-based primary care.
The findings come from a five-state demonstration of an innovative model of graduate nurse education (GNE) authorized by the Affordable Care Act. Each GNE site, managed by one teaching hospital hub, combined the training capacity of entire communities across health systems, hospitals, private medical practices, clinics, long-term care facilities, and universities.
The University of Pennsylvania School of Nursing’sCenter for Health Outcomes and Policy Research (CHOPR) and the Hospital of the University of Pennsylvania (HUP) led the largest demonstration site, which included nine universities, multiple health systems, and more than 600 community health care providers in the region.
Penn Nursing is calling for Medicare to adopt and fund the nurse training model nationally, shifting Medicare funding from diploma nursing programs that produce entry-level RNs to permanent, national funding of training for advanced practice registered nurses (APRNs).
To learn more about Penn Nursing’s call to action for Medicare to adopt a national nurse training model to help alleviate the national shortage of primary care providers, visit here.
I am privileged. I have been to the other side and experienced that the grass is greener. The majority of my career as a Neonatal Nurse Practitioner (NNP) has been in a Level 3 NICU with all the bells and whistles of high acuity, ECMO, high-risk deliveries, transport, and high patient volume. However, I then gained the privilege to also work as a NNP in a Level 2 Special Care Nursery (SCN). What a difference! But also, how similar!
The job tasks are identical … morning signout, collection of data from the medical record, physical exams, and writing notes. I touch base with the bedside nurse, case management, social worker as needed, and any ancillary staff. Consults are typically by phone. Sporadically, we may physically see an ophthalmologist, ENT, or cardiologist; but these occasions are not usual and customary. In addition, I can stand in one spot with full visual assess to all patients; as long as the census does not exceed 7 in the ‘main unit.’ The unit has evolved from a one room unit with one light switch, where either all lights were on, dimmed, or off equally. The SCN now is a state of the art unit of 7 individualized spaces to offer developmentally appropriate care, more patient privacy, and family-centered care. It is phenomenal!
Now, one may be thinking what a piece of cake. Well before we slice the cake, the grass really is not always greener. You see, regardless of the nursery level, the families are all experiencing a crisis. Acuity and level of nursery does not matter! The hopes, dreams, and vision these families had for their pregnancy, birth, and hospital experience are all shattered in the blink of an eye. The level of medical acuity has no direct correlation to the level of crisis for families. Due to lower medical acuity and lower patient volume, I am afforded the privilege of being able to take more time with families. I have the pleasure of sitting next to them, listening with my ears and eyes, to be in the moment with them. I can truly experience what the crisis or fears are. I feel a great sense of connection with the families. Regardless of the nursery level, these families become our family during their infant’s hospitalization. The communication, both active and passive, are vital for these families to emotionally survive this experience.
I have never experienced cross-trained nurses prior to working in a Level 2. This certainly is another privilege! This has positively enhanced my perceptions of the significance of the staff nurse presence in the delivery room, nursery, and postpartum area. In a Level 2, there is a staff of one NNP per 24-hour shift with attending back-up. The attending does rounds and meets with us daily, is present for all high-risk deliveries, and is always just a phone call away. This was a change coming to a Level 2. I realized how much I depend on my colleagues by just randomly shouting out to a fellow practitioner … ”What do you think?” Here, there is no one to just ‘bounce’ something off. However, it does afford me the opportunity to strengthen my knowledge by needing to know the answer ‘why’ and utilizing resources to confirm, learn, or discover answers. Because of the lack of colleague presence, the cross-trained nurses are a life-saver. They have a different level of competency, assessment, and confidence. It was awkward at first coming from a staff of 20 nurses per shift to having only 1 or 2 nurses. It truly reinforces the impact of communication and establishing rapport with others. Since there are fewer nurses, you work with people more infrequently, so communication, planning, and evaluating are essential—especially when those emergent situations do occur.
I still have the privilege of experiencing transport in a Level 2. The exception is that instead of going to receive the infant, I am sending them out. What an eye opener! This is where experience, confidence, and collaboration are vital. I remember my first meconium that clinically decompensated and overhearing, ‘I can’t remember a baby being this sick here.’ What a powerful lesson! This has afforded me another privilege of truly understanding the significant impact on providers and staff in managing these infants in an environment where resources may be more limited or staff may not be routinely used to managing these infants. I feel I have gained a level of inner strength, confidence, and resilience in handling distress in the clinical setting. It also reinforces the magic of nursing. Just like a Level 3, in a Level 2 the level of teamwork is there with everyone pulling together to do what is needed. Though a sick patient who requires transport is not usual and customary, the nurses are able to stabilize and do what is needed to optimize patient outcome. As a NNP, it is a humbling experience. Typically, as I stated previously, on transport I would pick up these infants to ‘give them what they needed.’ Recognizing you can’t fix this and need help is a character builder and essential professional trait.
In summary, I am privileged to experience the green grass on both sides of my world. I am so appreciative for my Level 2 experience because I am more proficient in looking outside of the box. I am not only a better practitioner, but a better listener, communicator, and mentor as well. I certainly have gained more than I can ever give back. And with that …I will go slice that piece of cake!
In honor of National Nurses Week (May 6-12, 2018), our Nurses of the Week are Ana Verzone and Jackie Baer, two nurse practitioners who have dedicated their careers to caring for the neglected and underserved populations in America’s rural regions.
According to The National Rural Health Association (NRHA), the US is facing a major rural health care crisis, with nearly one third of the country’s rural hospitals having closed or at serious risk of closure. This leaves rural populations at risk, often putting the lives of the poor, elderly, and chronically ill in jeopardy.
Both Verzone and Baer credit Jonas Philanthropies – an organization devoted to improving our nation’s healthcare through advancing the nursing profession – for the work they do today. As graduates of the Jonas Scholar program, they were awarded scholarships to achieve their Doctor of Nursing Practice (DNP) degrees. Over 1,000 nurses across all 50 states have received funding support from the Jonas Scholar program to further their doctoral education.
To shed light on the current rural health care crisis, we interviewed Verzone and Baer on their thoughts on the issue, and how they are both personally working to provide care to those most in need.
Q+A with Ana Verzone, FNP, CNM, and Jonas Scholar
Ana Verzone is a nursing educator and practitioner who has brought care to the most remote communities across the globe, from Alaskan villages to Nepal, where she conducted her doctoral research on improving communication between rural clinics and emergency rooms. Verzone now teaches future generations of nurses at Frontier Nursing University and the University of Alaska, helping to address the nationwide shortage of nursing faculty and rural primary care providers.
- Tell us about your background in nursing.
I love to travel, and before I became a nurse, I was a professional mountaineering guide in Nepal, amongst other places. While passing through a rural village I met two nurse practitioners conducting research on the impact of high altitude on health – they were incredibly inspiring. Knowing I wanted to serve others, I decided to follow their paths and become a nurse. I earned a Master’s in Nursing from the University of California, San Francisco and then worked at San Francisco General Hospital in the emergency department.
I knew continuing my education would empower me to help underserved communities, as well as eventually teach. Thanks to Jonas Philanthropies, an organization that supports doctoral nursing students through its Jonas Scholar program, I was able to pursue my doctorate as a way to give back to the profession I became so passionate about, and to address the shortage of nursing faculty in America. With support from this scholarship, I was able to improve care in remote regions of Nepal, continue my work in remote Alaskan villages, and teach the next generation of future nurses.
Today I work as adjunct faculty at Frontier Nursing University, where I received my Doctor of Nursing Practice (DNP) degree. I have also taught in the University of Alaska’s nursing program.
- How did you develop a passion for rural health care?
My mother was a first-generation immigrant, and my father was second-generation. I grew up in a poor environment that exposed me to the great need in underserved communities and inspired me to find ways that I could help improve nursing care in these areas with a sustainable impact. I have worked in private settings, but my heart was always in providing primary care to the less fortunate, because otherwise these communities would have no other options. Rural areas remain the most at risk; they continue to be neglected and there’s still much work to be done.
- How are you personally working to combat the rural health care crisis?
I am currently a member of the National Quality Forum’s (NQF) Measure Applications Partnership (MAP) Rural Healthcare Workgroup. This is a multi-stakeholder group that aims to identify appropriate quality measures and measurement gaps relevant to vulnerable individuals in rural areas, and provide recommendations regarding the alignment and coordination efforts of measurement in the rural population. This Workgroup will ensure the perspectives of rural residents and providers—those who are most affected and most knowledgeable about rural measurement challenges and solutions—have adequate representation on MAP.This group will provide recommendations to the federal government for Medicare/CMS’s measurement standards.
Of note: NQF is the only consensus-based healthcare organization in the nation as defined by the Office of Management and Budget. This status allows the federal government to rely on NQF-defined measures or healthcare practices as the best, evidence-based approaches to improving care. The federal government, states, and private sector organizations use NQF’s endorsed measures, which must meet rigorous criteria, to evaluate performance and share information with patients and their families.
My doctoral project focused on improving emergency transports from rural outreach clinics to large referral hospitals in Nepal and was very successful. The protocols I initiated during my project are continuing even though my project itself is complete. I remain committed to rural Alaskans, and continue to serve this population. I also make sure to volunteer in rural areas internationally, so I can keep my finger on the pulse of these issues on a global level. I travel with my family when I do this, since it’s important to me that my daughter also grows up exposed to these issues. My husband is a physician assistant, so he can also actively participate in these trips on the healthcare side as well.
I also hope to improve the quality of healthcare delivered in rural areas by committing to train the next generation of advanced-practice nurses to excel in rural settings. This is important to me especially as a Jonas Scholar, as Jonas Philanthropies empowers nurses to take leadership and faculty roles, to ultimately advance the nursing profession and improve care for our nation’s most vulnerable citizens. Frontier Nursing University, where I currently work, is committed to training advanced-practice nurses that want to serve rural populations, and my work at the University of Alaska supported training students in the specific needs of rural Alaskan regions. Rural areas often require a practitioner to have a wider breadth of skills (primary care practitioners in particular) and have fewer resources available. There are challenges such as geographic isolation or small practice size, limited time, staff, and infrastructure for internal quality improvement efforts. Advanced-practice nurses are a critical part of the solution for these issues.
Q+A with Jackie Baer, APRN, DNP, FNP-BC, and Jonas Scholar
Jackie Baer is a nurse practitioner who runs a free clinic in rural South Carolina, serving 3,000 uninsured patients per year. After witnessing the similarities in healthcare conditions for the poor in rural South Carolina compared to mission camps she served in Venezuela, Baer decided to leave her work in the privatized healthcare sector to serve the rural communities who need it most.
- Tell us about your background in nursing.
I began my nursing career in 1993, and after earning my Nurse Practitioner degree in 1998, I was still called to continue my higher education in nursing. With help from Jonas Philanthropies’ Jonas Scholar program, an organization that seeks to advance the nursing profession through the higher education of leaders in the field, I earned my Doctorate in Nursing Practice (DNP) degree at the University of South Carolina. The Jonas Scholar program took a big financial burden off my doctorate education, allowing me to grow as a nurse and connect with a network of nurse leaders that I wouldn’t have had otherwise.
Throughout my career, I’ve worked in many different arenas: ER, research nurse, home-health, rehab, and even a city jail. The different settings have helped me develop a passion for primary care and preventative medicine. In 2003 I started the first rural health clinic in Johns Island, South Carolina—a very destitute and underserved community. My clinic provides primary care to many in my community, keeping open late into the evening and providing weekend hours to accommodate the working poor.
- How did you develop a passion for rural health care?
In early 2000 I was a single mother and still relatively early in my nursing career. I took a mission trip to Venezuela and was so inspired by the patients who could maintain health and happiness even with a few resources. When I returned to the US, I stumbled upon Johns Island by accident; I got lost while traveling the Sea Islands of South Carolina and came upon the island and its federally qualified healthcare clinic serving the poor. I stopped by to ask for directions, but as fate would have it, I was inspired by the clinic’s work with the local community and began working there shortly after.When I moved to Johns Island and eventually opened the first rural health clinic in the county, I immediately recognized there were similarities to Venezuelan migrant camps and rural communities in South Carolina. Having spent part of my career working in private care, it was heartbreaking to see a great disconnect between how private patients and patients in poor, rural communities are treated. I believe each patient should be given the same care, which is what drives me to continue my work at my clinic today.
Being a nurse in rural healthcare is so much more than providing care—it’s about being an advocate for my patients. I’m helping people who are in great need, and recognizing not everyone has a roof over their heads. That’s why I chose to be a nurse, not a doctor. It’s not just about writing a prescription or providing an operation, it’s more about listening and providing care. Nurses are taught to care for the heart, mind, and the soul. I try to write few prescriptions and instead focus on life skills versus pills. Looking back, I feel that I have not only impacted my patients but improved the health care of families with early diagnosis and intervention. My doctorate thesis was on weight loss in obese African American women and it continues to be a great success for the community I serve.
- How are you personally working to combat the rural health care crisis?
At my clinic, we see around 3,000 patients a year who would otherwise not have primary care options. I feel a very strong connection to my community and am happy to provide a service to the poor. I am blessed to have a 73-year-old supervising physician at the clinic. But if she leaves or heaven forbid something happens to her, my clinic closes! In fact, one physician wanted to charge me $1,000 per month to supervise me in giving medically assisted treatment to patients. The red-tape and financial burden of these agreements continue to overwhelm me.
Health policy change is critical. In South Carolina, I continue to struggle with “agreements” due to outdated laws. Winston Churchill said, “History has a lot to teach and we are doomed if we fail to learn from it.” The National Council of the State Board of Nursing conducted a study in 2018 and found that states with “full practice” authority—the ability for advanced practice registered nurses (APRNs) to work to the full extent of their education—have better outcomes, save taxpayers money, and provide increased care access to rural communities. As doctors continue to leave our rural communities, the opportunity for APRNs is great, but the obstacles in the scope of practice limit success. As a nurse practitioner in rural South Carolina, I work day-by-day under these “agreements,” but could literally be gone tomorrow. Sadly, the injustice in healthcare continues for those that are poor and underserved.
As a highly trusted profession, nursing needs a mammoth legal presence in the state legislature to make sure laws are simple and clear. With fifty years of conclusive data, nursing will win but only if we have a team of lawyers advocating on our behalf. I believe that if “full practice” has improved outcomes for our Veterans, why not for rural America?