In celebration of Certified Nurses Day, we asked certified nurses why they chose to earn extra skills in particular areas of nursing and what their favorite parts are of being a nurse. We heard from quite a number. Thanks to all for your responses!
“I’m certified in adult critical care. I always saw certified nurses as those who’ve gone above and beyond in their profession to distinguish themselves among other cohorts as those who are driven, have the utmost competence in their skillset, and are knowledge seekers, and that is what I wanted to be.
I love the diversity in the patient population. I work with anyone from the age of 17 and beyond. I describe the value of certification to my coworkers as a distinguished honor; it’s something one works very hard to achieve, and while the journey may not be easy, it’s worth it. I tell my patients who ask what a CCRN is that it’s certification which shows individuals I am more than competent and capable to provide the best evidence-based care possible.”
—CPT Laura Wyatt RN, BSN, CCRN, a clinical staff nurse in the United States Army currently working at Tripler Army Medical Center in Honolulu, Hawaii
“I’m certified in Critical Care, Progressive Care, Nursing Education, Healthcare Simulation. I enjoy working in critical care because I find it rewarding to see patients make rapid improvements in response to my interventions. I appreciate the autonomy that this area provides, and I enjoy the low nurse-patient ratio because it provides me with opportunities to provide holistic nursing care and make deep personal connections with each of my patients and families.”
—Jodi Berndt PhD, RN, CCRN, PCCN, CNE, CHSE, College of Saint Benedict/Saint John’s University and St. Cloud Hospital in St. Cloud, Minnesota
“My first certification was the Pediatric CCRN, and I took the exam almost as soon as I had enough hours to qualify because I was so excited at the opportunity to become certified. Once I entered the role of unit-based educator in the Pediatric ICU and had enough hours in nursing professional development, I also became certified in Nursing Professional Development. After completing my MSN, I became certified as a Family Nurse Practitioner. Now that I primarily do research, writing, and teaching, my CCRN has been modified to a CCRN-K, a relatively new credential for nursing professionals who influence the care delivered to acutely/critically ill patients. In this role, I no longer have enough direct patient care hours to qualify for the original CCRN, and I was beyond ecstatic when I learned that AACN offered an option for nurse managers, educators, and those researching or teaching with the same patient population.”
—Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC, Post-Doctoral Medical Informatics Fellow (U.S. Department of Veterans Affairs, Nashville, TN) & Education Consultant (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH)
“I wanted to get a certification in nephrology to show my dedication to it. My mom was a dialysis nurse, so I’ve been around it since I was born. I picked nephrology because of the opportunity to take care of patients and their families in a different way than any other outpatient or inpatient fields.
You have to have hard conversations in nephrology, at times, and I love being part of that process as a patient advocate. I also love helping patients during difficult times and making them smile.”
—Kristin Brickel, RN, MSN, MHA, CNN, Director of Clinical Services at DaVita Kidney Care
“I currently have two certifications in infusion therapy: Certified Registered Nurse Infusion (CRNI) and Vascular Access Board Certification (VA-BC). I have spent most of my nursing career specializing in infusion therapy and the sub-specialty of vascular access. I initially was interested in certification purely for the educational opportunity, studying for my certification taught me a broad base of clinical knowledge.
I find infusion therapy to be extremely rewarding. It offers a near perfect mix of technical procedural excellence, while retaining the individual patient care that I value. Outpatient infusion therapy allows you to create a unique personal 1:1 connection with patients. Some of my best memories as an infusion nurse are the conversations I’ve had with these inspiring patients. In my role today, I get to apply my experience connecting with patients to my passion for improving care through research, education, and product design innovation that can help enable continued progress in care quality.”
—Kristopher Hunter BSN, RN, CRNI, VA-BC, Senior Technical Service Engineer, 3M Critical & Chronic Care Solutions Division
“I am a certified oncology nurse. I got certified because I wanted to be able to offer my patients the best care possible by staying on top of the rapidly changing knowledge base in cancer care and research. I find that being certified gives you a wider base of resources and opportunities to network with other oncology professionals.”
—Alene Nitzky, PhD, RN, OCN, CEO & Founder, Cancer Harbors and Author, Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care
“I am now certified in hospice and palliative nursing. I knew the certification would enhance my professional skills. Earning the CPHN also gave me time to learn more about how hospice and palliative care has come to be seen globally, which is especially important because the patient population at MJHS Hospice and Palliative Care is as diverse as you’d imagine. I also appreciated the opportunity to better learn the ins and outs of the operations, insurance, and reimbursement processes.
I love my patients and my work. Contrary to what people think, being a hospice nurse isn’t depressing. Yes, it’s challenging and it’s hard to look into the face of a family member whose loved one is dying. However, it’s so rewarding to provide holistic care, help educate patients and families about what happens at the end of life, as well as to support people during a time when they really need it.”
—Neema Bandyopadhyay, RN, CHPN, RN Case Manager, MJHS Hospice and Palliative Care in New York City
“When I began my nursing career, I worked in OR and met the Chief of Surgical Oncology at Duke University. I transitioned to work on his surgical oncology team and felt that the additional Oncology Nurse Certification added credibility to my career. It also enabled me to move through administration into progressively more responsible positions, including Vice President.
As an OCN, I feel that effective national education in the U.S. is required to resolve the most difficult medical cases. Adult Oncology is a rewarding nursing genre. Patients need support in all aspects—mind, body, and spirit—in order to maximize benefit from their treatment regimens. Families also need support during this time which includes both medical education and emotional support.”
—Gail Trauco, RN, BSN-OCN, CEO, The PharmaKon LLC and CEO, Front Porch Therapy
Besides making sure that patients have everything they need to heal, nurses also have to ensure that their patients are safe. Sharon Roth Maguire, MS, RN, GNP-BC, Chief Clinical Quality Officer at BrightStar Care, has an extensive health care background with more than 15 years of experience in the health care field. Maguire works closely with nurses—in addition to having worked as one herself—and she knows how important patient safety is.
Maguire agreed to answer our questions on patient safety in honor of Patient Safety Awareness Week. What follows is an edited version of our interview.
What are some of the most important tips that nurses need to know regarding patient safety?
Nurses are uniquely poised to think of patient safety in a very broad way—emotionally, physically, socially, and environmentally—while simultaneously narrowing it down to the specific care situation. We need to think of our patients comprehensively, especially within in the home. We at BrightStar Care follow the national patient safety goals of the Joint Commission as accredited home care agencies.
Home safety evaluations are essential. What within their home environment could put the client at risk for falling? We need to evaluate adequate lighting, plumbing, furniture that is hazardous as a way of support, throw rugs, etc. Clients who are on oxygen in the home are at a significant risk for potential fire outbreaks. It’s important that the nurse educate clients and their family members on oxygen safety in the home.
Medication safety is a Joint Commission national patient safety goal. BrightStar Care nurses collect information about what medications clients are taking (prescribed and over-the-counter as well as home remedies) and are aware of potential hazards of the actual medication as well as how it interacts with other medications, diet, alcohol, etc. We advise clients and their family care partners about the risks we’ve identified. These interventions are critical to safe medication practices in the home setting.
What should nurses do if they make a mistake that results in possible patient harm/injury?
Nurses are skilled at following policies, process, and procedures, but despite their best efforts, a mistake can be made occasionally. Nurses are taught and held to a standard of high integrity including the importance of reporting any sort of mistake. The worst thing to do would be to hide a mistake. The quicker the mistake is reported and acted on, the quicker the potential negative outcome can be reduced.
What are the most common tips that new nurses should know so that they can keep their patients safe? What about keeping themselves safe?
When in doubt, ask questions. Even though nurses may have gone to school for many years, they might have never had the chance to practice a particular skill. Never hesitate to ask for help. If you’re unsure, don’t think you know something—instead just ask a more experienced nurse. Have a more experienced nurse mentor be your partner when you’re doing something for the first time.
Some patients tend to get scared in the hospital, rehab center, or any place they would be treated by nurses. What can nurses do to alleviate their fears?
Most patients really just want someone that they can trust and feel safe and confide in. Nurses should be reassuring and empathizing while explaining things simply to patients. It’s also important to listen to our patients and understand their concerns. Be kind and be patient.
Don’t let the schedule dictate your response. At the end of the day, your patient is your primary focus and although tasks need to be done, that shouldn’t be at the expense of your patient. Patient safety, comfort, and peace of mind are top priorities.
Is there any other important information regarding patient safety awareness that nurses should know?
Safety is so extremely important. Nurses should slow down, take time to understand what is required to be safe—whether that’s when performing a procedure, giving a medication, or reading physician orders. Safety is paramount in the world of a nurse especially in the nurse-patient relationship.
Keeping nurses committed and satisfied with their jobs can be challenging in the face of a nurse shortage. It’s up to the nurse leader to provide a work environment that fosters passion and positivity for registered nurses. As crucial as it is for nurse leaders to provide a positive work place, nurse engagement also relies heavily on appropriate staffing.
As the CEO of Avant Healthcare Professionals, I asked other nurse leaders how they would approach a nurse engagement program in 2018. Combining the expertise of a nurse staffing specialist and nurse leader, below are the predictions that will drive nurse engagement this year.
A Good Work/Life Balance
- Offer your nurse staff flexible shift options on holidays and days where you are short-staffed. Offering 4 – 6-hour shifts will increase the likelihood of a nurse coming in on their day off to help the facility.
- Allow your nurses to self-schedule their shifts. If they create their own schedule they feel involved and in control of their work/life.
- Establish a weekend-only program where nurses volunteer to work Saturday and Sunday shifts. On week days, those that volunteered can take time off. This way the same nurses won’t be stuck working every weekend.
- Create or offer a wellness program in your hospital that addresses self-care such as yoga/exercise classes, rest, and healthy eating. If you’re interested in this approach, be sure to tie it in to the facility’s culture.
A Recognition and Reward Program
- Create a compensation program that awards nurses for going above and beyond. Some hospitals have their own monetary system where workers give nurses “bucks” to cash out their rewards with free car washes or free Starbucks.
- Establish a patient/coworker recognition program to incentivize better patient care. When a patient commends your nurse, reward them. Including the DAISY awards in your recognition program is a great start.
- Encourage nurses to share exemplary stories of their peers in your hospital newsletters or internal communications.
A Shared Governance Policy
- The chief nurse officer, managers, and directors should drive and encourage participation among nurse staff. A robust shared governance program will only work if it has the backing of the facility leaders.
- Empower your employees to make change through shared governance – let them use this as an opportunity to participate in their practice by establishing a leadership council that reports up to unit chairs.
- Define unit chairs to increase responsibility for RN roles. If nurses are given liberty to influence change in your facility, they will be more committed to their job.
Nurse engagement is essential in providing quality patient care. Including a nurse engagement program in your facility in 2018 is highly encouraged. If your facility is using other engagement methods not listed in this article, please share with us in the comments.
Over the past 40 years, I have accumulated so many amazing anecdotes about working with and relying upon the pediatric and intensive care nurses in all of the hospitals I have worked in. The main message here for all physicians is to be able to trust, rely on and respect the nurses you work and will work with in the hospital or clinic setting. The fact that I feel this way has almost nothing to do with the fact that Sally, who is a former PICU, ER, clinic, consultant, quality improvement (QI), Daisy Award winning, mother of 3, unofficial Spanish translator and social worker, now infusion area nurse at the Ann and Robert H. Lurie Children’s Hospital of Chicago, for 40 years, and I have been married for 37 years. I think our greatest challenges have been after I had a sudden cardiac arrest and required 5 shocks 5 years ago…and when we worked together when I was a senior pediatric resident at what is now Lurie and Sally and I cared for some very critically ill children in the pediatric intensive care unit….
Pediatric and intensive care nurses are remarkably smart and well organized care providers and once you, as a physician, recognize that fact and begin to rely on them to provide the exemplary care of your patients and their families, you will be able to relax a little bit more. In my practice situation at NorthShore University HealthSystem, I was the attending, without residents or fellows, for these children in the intensive care unit with the nurses and respiratory therapists. When these infants and children presented to the Emergency Department (ED), I worked with the exceptional ED nurses and attending physicians to stabilize them before admission to the ICU and in some situations, the ICU nurse and I transported them to the children’ hospital for advanced care when the necessary resources were not available at Evanston Hospital.
My experience with neonatal intensive care (NICU) nurses during the 10 or so years I practiced neonatology in the NICU at Evanston Hospital, Children’s Memorial Hospital and Prentice Women’s Hospital was just as amazing. Once again, these nurses know their patients and their families so well when they were their primary nurse or, for that matter, whenever they had that patient, even for the day or night. One rule to keep in mind, is when the nurse who was caring for that patient called you to tell you they were concerned, it was best to respond and come to see that infant immediately. Wherever I have cared for infants and children, this rule is one to follow at all times. And wherever we were, whether it was in the NICU, the delivery room, on transport in the ambulance or at another hospital, or even in the ED at times, I always relied on the nurses I worked with to provide the best care of the infants and children I was responsible for.
Even now as the QI physician in the NICU at Comer Children’s Hospital, I continue to be amazed at the clinical judgement of the nurses. They are bright, insightful and continue to provide the best care of these very complex and critically ill babies. They also are sensitive to the parents who are most frequently from underprivileged areas of Chicago. Moreover, they have interest in improving the quality of care of the infants and their families and come up with new ideas for QI projects. I have also found the nursing managers to be outstanding in the ongoing management of the nursing staff of over 170 nurses in a NICU with a total over 60 beds.
The best way to summarize pediatric and intensive care (and ED nurses for that matter) is to say they are a joy to work with no matter how challenging the clinical, social, or for that matter QI or administrative situation is that you are facing.
Many physicians’ offices, hospitals, and urgent care clinics often have nurse practitioners (NPs) working in them. Although it’s usually the patients who aren’t sure what this kind of nurse does, we know that some of our readers may not know as well—at least not all the minutia involved with this kind of job and career path. Considering that more nurses are choosing to become NPs, knowing this information is important—especially in helping you decide if this is where you want to go next.
We interviewed Joyce Knestrick, PhD, APRN, C-FNP, FAANP, a family nurse practitioner and president of the American Association of Nurse Practitioners (AANP), to learn more about what exactly a nurse practitioner is and does. An edited version of our interview follows.
What is a nurse practitioner and what type of work does s/he do? What additional duties and responsibilities are they able to do because of their additional education?
The first thing to know is that NPs provide primary, acute, and specialty health care to patients of all ages and walks of life. We operate in all types of care settings from hospitals to home care, and urgent care clinics to the VA. NPs conducted over a billion patient visits in the last year alone. Many of your readers have probably seen an NP at some point, and we have developed a solid reputation of being close to our patients. The profession’s track record of patient-centered health care and outstanding outcomes have been well established over 50 years of research. NPs assess patients, order and interpret diagnostic tests, make diagnoses, and initiate and manage treatment plans—including prescribing medications.
NPs complete a master’s and/or a doctoral degree program, along with having completed advanced clinical training beyond their initial professional RN preparation. If an NP wants to go on to specialize in an area of care, it requires additional education and training.
With over 234,000 NPs across America, each having to undergo rigorous national certification, periodic peer reviews, clinical outcome evaluations, as well as adherence to a code for ethical practices, we’ve quickly become the primary care provider of choice for millions of Americans from rural areas to dense urban ones. About 16% of the profession works in communities of less than 10,000 and over 36% work in communities with a population less than 50,000.
Are there currently any barriers to practicing as a nurse practitioner? If so, what are they?
Yes, there are several barriers to practice for NPs all across the country. Currently, 22 states, plus the District of Columbia, allow NPs to practice to the full extent of their education, training, and licensure. While that may be over 40% of the country, AANP believes every state should enact laws enabling what we call “full practice authority.”
Every state is unique with its own set of public policy and political challenges, but we are committed to removing the barriers between NPs and their patients by drawing on the expertise of NPs who serve at the intersection of health care policy and patient care with the goal of achieving better health and improved access to care, at a lower cost.
We’ve identified several states as priorities this year. Any of you readers who are interested in helping to reduce barriers to practice for NPs should visit AANP.org and look for our state policy guide.
To make it easier for people to understand many of the nuances surrounding the FPA issue, we’ve assigned each state a color (see our map here).
Green states, which we’ve already mentioned, allow NPs to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications and controlled substances—under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and National Council of State Boards of Nursing.
Yellow states are called “reduced practice states,” and they reduce the ability of an NP to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care or limits the setting of one or more elements of NP practice.
Red states are called “restricted practice states,” and they restrict the ability of an NP to engage in at least one element of NP practice. State law requires career-long supervision, delegation, or team-management by another health provider in order for the NP to provide patient care.
There are many reasons why states fail to modernize regulations to enable NPs to practice to the full scope of their education and clinical training, not the least of which is pressure from organized medicine. That’s not to say that there aren’t similarities between yellow and red states’ barriers, but each state requires its own approach, and we actively identify legislation, support state-level NP organizations’ policy initiatives, and develop policy resources that cultivate strong NP leaders and sound health policy in every state.
What states are the best to work in as a nurse practitioner? Why?
Of course, any state colored green on our map will be more favorable to NPs than ones colored yellow or red. As the map demonstrates, western and northeastern states have chosen to enable NPs to practice to the fullest extent of their clinical training and licensure.
Why is it important for NPs to be able to practice fully? What do they bring to the health care table, so to speak, that benefits the health care system as a whole?
As clinicians, NPs blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. We bring a comprehensive perspective to health care.
You can have it all. Decrease the stress in your life. Stop to smell the roses. Be in the moment. Great words of advice, but how does that happen? I don’t know about you, but I have found it almost impossible to accomplish! Almost.
I am the manager of a group of neonatal nurse practitioners in a level 3+ NICU of a large, urban Midwestern university hospital that provides care to an underserved population. Yikes! Talk about stressors.
There are 18 women all ages, experiences, and personalities in our group. The question is: How do you create a cohesive, compassionate, supportive, and clinically excellent group of practitioners? Well, it took years of trial and error, strong faculty support, and the unexpected loss of our previous beloved manager—and then to find our feet again over the next three years. I hate it when people say “it’s a process.” Really? Of course it is, but it’s hard to see it in the beginning. We all want instant gratification, whether it’s from new sources, TV, retail, or work. I want it NOW! Yeah, well, that’s not going to happen.
First, you must have individuals of amazing talent, drive, personality, and intelligence. No short order for anyone. I’m not sure how we achieved this dynamic, but we did. Every person in our group is unique in their interests and skills. We foster and encourage the differences. We celebrate the differences. Thank goodness there are NNPs that are the ultimate in PICC insertion skills—not me! I will do anything for you if you get my line in—I will see all the other babies! (Just a note, my other procedural skills are awesome.) Thank goodness we have some young energetic women that love to go on transport. I am getting too old for climbing in and out of ambulances.
Second, you must have the unwavering support of the faculty of neonatologists. Without the clear dedication of the physicians it’s like fighting upstream in the spring run off. I’m not talking about money or time off or even the gift at Christmas. I’m talking about standing for you and beside you to the bureaucracy of administration. We all face shortages of staff, long hours, and extremely difficult patient care situations, but when you know that the medical staff is with you—and you with them—it means everything.
Third, and most important, you need to see the problems that cause discord, anxiety, and anger within the group. In my first ten years here, the NNP group was growing in numbers and responsibilities, especially when we moved into our new, larger NICU. Often when a need arose in the unit the response was ”the practitioners can do it.” Sound familiar? Five years ago we unexpectedly lost our manager. This was a stunning blow to our group and unit. The next two and half years were a struggle as the section and department leadership changed, thus leaving the NNPs in limbo for their own leadership. In many ways the group was rudderless. We had no goal or focus. We reacted to the needs of the unit without any professional growth for any of us.
Last, you must have a manager/leader who believes. Believes in themselves, the members of the group, the faculty, the staff nurses, and staff support members. I know it sounds hokey, but it is absolutely essential. When I became the manager, I held a dinner at my home so we could come together as individuals to talk, laugh, cry, and plan. I met with every practitioner to discuss their goals, aspirations, and what they wanted from me as the manager. Since we cover the unit 24/7/365, the NNPs are never all together at an event. I insisted that the NNP group have an annual retreat so that we could all be together to continue the discussion for our group. With a facilitator, we identified several issues that had been troubling us for many months. We designed a plan to address these issues. We also affirmed our commitment to each other as colleagues and friends.
We continue the “process” to grow and change. But it is not all the big stuff, the retreats and meetings. It is the seemingly small things, like making our collective office a little more cozy, posting funny and inspiring quotes, putting a seasonal wreath on the office door for all to enjoy, and remembering that this is our job, not our life. We are not always perfect, but we strive to be. You can have it all — just not all the time.