“Since I was in, I think, about 4th or 5th grade I knew I wanted to be a nurse,” says Brittany Wilborn, RN. It took the mother of five nearly a decade, but Wilborn, our Nurse of the Week, knows how to persevere and how to pace herself. She has cleared the many obstacles in her path, developed an arsenal of leadership skills, and is steadily amassing a collection of nursing credentials. Over the past 10 years, she progressed from a CNA to an LPN, then an ADN RN. Before the ink had dried on her RN, she had gone on to enroll in a BSN program. And after that? She plans to become an FNP.
Wilborn’s nursing aspirations were born early in life. As a child in Galesburg, Illinois, when Brittany went to see her pediatrician, it was not the doctor, but the nurse who attracted the little girl’s rapt admiration. The APRN-to-be recalls, “I thought she was so pretty, and she was professional. The way she approached me and treated me, made me feel better about myself and the situation. That’s when I knew that I wanted to be a nurse.”
But she had a lot of living to experience first. After Wilborn graduated from high school in 2010, she enrolled at Carl Sandberg College to begin her studies and earn her CNA credentials. However, life had other plans for her. Brittany became pregnant and soon dropped out to give birth to twin boys. (Twin boys have a talent for stopping all sorts of things). For the next few years, she focused on mothering the boys through their Terrible Twos and had two more children. Looking back, Wilborn thinks she needed to do some growing up herself first. “Now I feel like it [dropping out of college] was an excuse that I was making,” she said, and added, “And I think it’s one that a lot of us, as parents, make. ‘Oh, the kids, oh the kids!” After giving birth to child number four, though, she decided it was time to move fully into independent adulthood and pursue that nursing career: “2014 is when my journey really began to take off. I became a CNA, started working, got an apartment, and moved out of my mom’s house….”
After earning her CNA, Brittany went on to complete Sandburg’s Licensed Practical Nursing program in 2018. However, as a woman of color she had been subject to so many non-criminal law enforcement encounters that the NCLEX-PN criminal background check was deeply intimidating. Anxious and overwhelmed, she went no further until Covid and an insightful instructor pushed her forward. While Wilborn was working as a CNA at the height of the pandemic, the nurse she was assisting told her, “I don’t know why you won’t be a nurse. Why won’t you take your boards?’ Then, Stacy Bainter, MSN, a Sandburg nursing faculty member, also urged her to go ahead. “I realized that [your history] doesn’t define who you are and what you’re capable of,” Wilborn says. And, with a conscientiousness typical of good nurses, she thought, “If (Bainter) believed in me and Sandburg believed in me to give me this degree, I owe it to them to at least apply for my nursing license and put it to use.” She also began to flex her leadership skills (valuable not only for nurses but to any mother of twin boys). Brittany joined Sandburg’s Black Student Association, became a student trustee for Sandburg’s Board of Trustees, and was selected as chairperson for the Illinois Community College Board’s Student Advisory Committee.
Today, Wilborn has five kids and a growing collection of degrees and certifications. She is now an RN with an associate’s degree (ADN), but that is just the beginning. Wilborn is pursuing her BSN now at a joint Sandburg/Chamberlain College program, and after that plans to enroll in the FNP program at Chamberlain College. If there are more obstacles ahead, Wilborn will find her way around them: “It’s necessary for me to keep going because I know that I can. It’s necessary because I feel like I shouldn’t limit myself. For some people, the ceiling, that’s their limit. And for others, the ceiling is your bottom.”
For more on Brittany Wilborn, RN, see her interview with local TV station KWQC.
Missouri faces a shortage of primary care physicians, particularly in rural and underserved communities, making it challenging for residents in some parts of the state to access health care services.
Advanced Practice Registered Nurses (APRNs) can provide an alternative because they are trained to assess, diagnose, treat and prescribe for medical conditions in much the same way optometrists are trained to assess, diagnose, treat and prescribe for eye-related conditions.
But rules in Missouri restrict APRNs to practicing within 75 miles of their collaborating physician and require an initial one-month direct observation of practice between an APRN and an MD or DO and regular medical record reviews of the APRN from the MD or DO. What’s more, MDs and DOs cannot have collaborative practice with more than six full-time APRNs or physician’s assistants, and APRNs cannot conduct video visits or write for home health orders.
“I think it is very important to hear from nurses on the frontline,” said Pamela Talley, an MSN-DNP student in the College of Nursing who practices at CHIPs Health and Wellness Center on North Grand Ave. in the city of St. Louis. “We see the issues daily. We became nurses to take care of people, in response to seeing people suffer. Nurses have an ethical responsibility to advocate on behalf of those underserved populations. I believe it is a social justice issue and we must advocate for access to health care for all people.”
The students and faculty spent Tuesday morning talking to legislatures such as Sen. Steven Roberts and Sen. Brian Williams about access to health care, including for Talley’s clientele at CHIPS, a nurse-founded, free medical care clinic where most providers are volunteers in what is considered a medical-provider shortage area.
“I’ve been practicing as a pediatric nurse practitioner for over 30 years, mostly in the emergency department,” Kuensting said. “Children are a vulnerable population, often without health insurance, leaving the emergency department as their only source of health care. Organizations such as CHIPs and other nurse-led clinics in medical provider shortage areas can facilitate health maintenance and avoid episodic care visits for individuals and their healthcare needs, but the barriers APRNs face in Missouri make providing care extremely difficult.”
Talley had the opportunity to describe how restrictions impact her ability to care for patients in her community.
“It was great meeting with state legislators to discuss the need to reduce practice restrictions,” Talley said. “These restrictions are a barrier to vulnerable populations in both rural and urban areas. The current collaborative agreement creates restrictions to fundamental access to health care for people to manage their health and to live a quality life.”
She added: “If nurse practitioners could have greater independence and a less restrictive practice they would be able to provide much needed care in those areas where there are the greatest needs.”
There is precedent. Missouri temporarily lifted these restrictions for nearly two years during the COVID-19 pandemic with no adverse events, though that temporary lift expired on Dec. 31.
More and more states have also taken to permanently grants APRNs full-practice authority. On April 10, New York became the 25th state to take such action, and the Veterans Administration issue full practice authority to APRNs, regardless of the state they practice in, about two years ago.
“This course, and particularly this experience, is important for our APRN students to understand why being aware of the issues affecting our practice matter,” Kuensting said, “and more importantly, how to advocate for change.”
Photo at top includes U Missouri St Louis College of Nursing faculty members and students (from left): Laura Kuensting, Pam Talley, Marina Fischer, Marie Turner, Brooke Shahriary, Louise Miller, Kate Skrade, Carla Beckerle, Taylor Nealy, Ann Mwangi-Amann, Paige Bernau, Lucy Kokoi and Tammy Vandermolen at the Missouri Capitol last Tuesday to take part in the Association of Missouri Nurse Practitioners Advocacy Day. (Photo courtesy of Laura Kuensting)
Evidence-based practice is at the heart of nursing—and most of that evidence is based on quantitative research. For nurses who are merely competent in math, though, interpreting the numbers can be a challenge. And if your own facility with statistics is middling, trying to mentor semi-numerate DNP students may leave you feeling helpless at times.
Help is on the way. On May 19, data analysis expert James Lani, Ph.D., MS is hosting a free webinar specifically aimed at faculty members who mentor graduate students for dissertation, thesis, or scholarly projects and are seeking to take their command of statistics to the next level to better guide those students.
Dr. Lani, the CEO of Intellectus Statistics, has been helping faculty and graduate students with their quantitative research for over two decades.
In his upcoming webinar session, Dr. Lani will use mock data to work through faculty and students’ research questions, prepare and graph data, select and conduct the correct statistical analyses, and demonstrate how to appropriately present results. He will also cover sample size and power analysis, data management, and visualization techniques, and at the end of the presentation, he can even provide faculty with project-specific help.
James Lani holds a Ph.D. in Clinical Psychology from Miami University in Oxford, Ohio, an MS in Psychology with an emphasis in Experimental Methods from California State University Long Beach, a Bachelor of Science in Electrical Engineering, and minors in Mathematics and Human Services from California State University, Fullerton.
Who can attend: Faculty members in nursing, social work, counseling, public health, psychology, and health administration at any stage of their research or faculty who mentor students’ research as they pursue their degree (i.e., Dissertations, DNP Project for Nurses, Fieldwork and Supervision for Behavior Analysts, etc.)
Governor Spencer Cox signed the APRN Compact into law in the state of Utah on March 24, 2022. When implemented, the compact will allow an APRN to hold one multistate license with a privilege to practice in other compact states.
Through the APRN Compact, APRNs will have the ability to travel from state-to-state to deliver care or provide telehealth services across state borders in other compact states. This will increase patient access to high-quality care with the assurance that their practitioner has met rigorous uniform standards no matter where that care is provided.
Bill sponsor Sen. Curtis Bramble, commented, “It was my privilege to support APRNs in Utah and the important role they play in providing excellent care to our community. The passage of SB151 is significant because it will allow nurses from other states to practice in Utah without a lot of unnecessary bureaucratic red tape. We need these highly qualified health care professionals to live and work in Utah in order to address our growing population’s needs. This bill balances the urgent need for more health care workers while upholding high standards for training and safety.”
Utah is the third jurisdiction to have enacted the APRN Compact. North Dakota and Delaware enacted the compact in 2021. The APRN Compact will be implemented when seven states have enacted the legislation.
For more information about the APRN Compact visit aprncompact.com.
”Three decades of evidence have shown that nurse practitioners with full practice authority play a vital role in improving health outcomes, especially in underserved communities, Ramos observed in his remarks. Focusing on the connections between FPA, access to care, and health outcomes, the Dean presented his case to the state’s Joint Legislative Committee on Access to Healthcare and Medicaid Expansion at the North Carolina General Assembly and urged them to pass the SAVE Act to grant full practice authority for NPs providing primary care. Ramos, who is also the vice-chancellor of nursing affairs for Duke, was among eight experts presenting varied views on full practice authority.
“Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs.”
In speaking to the joint committee presided over by Sen. Joyce Krawiec, Ramos addressed the role that nurse practitioners have in transforming health care access and outcomes in North Carolina, including the opportunity to expand care in rural areas that face health care shortages. The joint committee is hearing from experts as they consider passing the SAVE Act, which was first introduced in 2021 to expand full practice authority for primary care NPs in North Carolina. A similar version of the SAVE Act has been introduced in previous legislative sessions, but no action was taken on the legislation.
Role of FPA in Access to Care and Health Outcomes
“Nurse practitioners should be able to practice at the highest level of their competencies, education, and licensing,” Ramos said. “Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs. This improves health outcomes and expands health care to underserved populations and will benefit the people of North Carolina.”
Across the state, 97 of 100 counties face a health professional shortage.
Ramos reflected on his role as dean of the top school of nursing in the state and the second-ranked school in the U.S., and the intense pride he has seeing Duke graduates strengthen their career opportunities with the education they gain at Duke. “The nurse practitioner workforce growth is faster in states with full practice laws than in states with restricted practice,” said Ramos, who is interested in attracting NPs to practice in the state.
Ramos observed that the first states to authorize full NP practice authority began doing so in 1994 — nearly three decades ago — and that, once passed, full NP practice authority has never been repealed. “Full practice authority for primary care NPs improves care access, improves care outcomes, and improves workforce supply,” said Ramos, who also addressed a systematic review of 33 studies that showed no evidence for better NP care outcomes in states with more practice restrictions.
NPs with FPA Increase Efficacy of a State’s Health Workforce
In addressing the critical nursing workforce shortages across the U.S., Ramos notes that NP workforce growth is faster in states with full practice laws compared to states with restricted practice. Across the U.S., during the COVID-19 pandemic, states issued temporary waivers of NP practice restrictions. “This enabled more time-responsive NP practice and care provision as well as a streamlined process for NP orders in the absence of physician signature requirements and an increased capacity of the health care workforce to respond to COVID-19,” Ramos said.
Ramos observes that the reliance of nurses in this manner during a pandemic and health care crisis demonstrates the clinical, scientific, and relational expertise that support nurse influence in improving health outcomes, and it demonstrates the confidence that the health care systems and public have in nurses, who have been considered the most trusted and most ethical profession for more than 20 years.
In conclusion, Ramos pointed out to the committee that:
NP practice restrictions contribute to inadequate care access and primary care workforce shortages, particularly in rural areas.
NP practice restrictions can be a barrier to improving health outcomes and reducing health outcomes and reducing health-related economic costs.
NP practice restrictions requirements can lead to an unsafe and fragile care model, including risks such as the possibility of immediate NP loss of ability to care for patients if a physician can no longer provide supervision for any reason, including moving, retiring, and so on.
NP practice restrictions weaken health workforce responsiveness to emergencies.
Physician supervision agreements can contribute to unnecessary and excessive costs.
The SAVE Act (House Bill 277/Senate Bill 249) did not receive a committee hearing during the 2021 legislative long session. However, following the conclusion of the committee’s work later this spring, the bill could move forward when the legislature returns for the 2022 short session on May 18, 2022.
The scrub wardrobe of Philadelphia nurse and elite marathoner Samantha Roecker, RN is undergoing an unprecedented stress test this month. One might even say that her scrubs are moonlighting, but it’s for a good cause.
Our Nurse of the Week is running through the Philadelphia streets in her scrubs as she prepares to achieve the “fastest marathon run in a nurse’s uniform” at the Boston Marathon on April 18, 2022.
While some fellow distance runners cheerfully concern-troll her about potential chafing, Roecker’s unusual athletic apparel has been fine so far, and at the marathon will be worn in honor of her profession – and of the sponsors behind her fundraising run to support the American Nurses Foundation’s mental health and wellness programs. (The American Nurses Foundation and Moxie Scrubs are backing her effort).
“I was trying to think of what I could do to make running not a selfish thing, but a meaningful thing.”
Her inspiration for the fund-raiser was her fellow nurses – and her own experience. Roecker observed, “It seems like every day there’s a new story about nurse burnout or health-care workers struggling.” And, when she picked up first-hand frontline experience earlier this year, she became keenly aware of nurses’ urgent need for more robust mental/emotional support systems.
“On top of really tough diagnoses like cancer or brain fluid leaks or whatever we deal with on a ‘normal’ daily basis,” Roecker said, “Pandemic worries about who’s going to accompany somebody to the hospital during their chemotherapy treatment or how they would get a test prior to treatment — all of those unknown stressors and barriers added up.”
Apparently, the inspiration struck while she was showering one day: “I was trying to think of what I could do to make running not a selfish thing, but a meaningful thing,” she told Runner’s World.
Like many nurses, the Philly RN always has a lot going on. Roecker is currently working 25 hours a week as an RN at an otolaryngology clinic while pursuing an FNP degree at Penn Nursing at the University of Pennsylvania and puts in 20 clinical hours a week at Cooper University Hospital. On top of that, she manages to run 90 to 100 miles every week.
Nurses supporting nurses
She is a passionate and competitive runner, and her marathon project combines her love of the sport with her dedication to nursing and helping others. As Roecker puts it on her American Nurse’s Foundation fundraising page, “Over the last two years, I have witnessed and personally experienced the effect that the COVID pandemic has had on healthcare workers’ mental health and wellbeing. This April, I am combining my two passions and attempting to break the World Record for ‘fastest marathon run in a nurse’s uniform’ at the Boston Marathon.”
The funds that Sam will raise will go towards the American Nurses Foundation’s Well-Being Initiative programs supporting the mental health and wellness of RNs. The initiative offers RNs access to free therapy resources, expressive writing programs, financial consulting, podcasts and mobile apps dedicated to mental health and well-being, and content dedicated to grief and bereavement.
Help is on the way. On May 19, data analysis expert James Lani, Ph.D., MS is hosting a 
aprncompact.com
Her inspiration for the fund-raiser was her fellow nurses – and her own experience. Roecker observed, “It seems like every day there’s a new story about nurse burnout or health-care workers struggling.” And, when she picked up first-hand frontline experience earlier this year, she became keenly aware of nurses’ urgent need for more robust mental/emotional support systems.