The following is Hara E. Oyedeji’s perspective and does not represent the perspective of all healthcare professionals. The information included is not a substitute for professional medical advice. Intended for US healthcare providers only.
As nurse practitioners (NPs), we work with patients in treating and managing chronic conditions. In behavioral and mental health conditions, such as schizophrenia, I believe only the patient really understands their lived experience and how they feel day to day.
This is why I like to think of adult patients as the “captains of their own ships” on their treatment journeys. This doesn’t mean they do it alone; rather, they help steer the ship while their crew (which could include physicians, nurses, pharmacists, psychologists, psychiatrists, family, and caregivers) offer critical and expert clinical experience, support, and guidance to help keep the ship on course, especially when navigating unexpected weather or rough waters.
I have treated many adults living with schizophrenia, a chronic, complex brain disorder with symptoms that may include, but are not limited to, delusions, hallucinations, disorganized speech, trouble with thinking, and lack of motivation.1 While schizophrenia is a lifelong disease, with an appropriate treatment plan, symptoms may improve.1
I believe the role NPs play on the “crew” is that of trusted medical advisor, using our professional clinical knowledge to help educate and inform patients about all their treatment options so the “captain” can make informed, shared decisions about their treatment journey.
Understanding Long-Acting Injectable Antipsychotics and Factors I’ve Considered for Treating My Patients
There are a range of treatment options for schizophrenia, including antipsychotic medications, which may be available in oral forms or as long-acting injectables, which are designed to release medication slowly over an extended period of time.2,3In addition, psychological and social treatments are also important treatment components.4
While LAI antipsychotics are FDA-approved for the treatment of adults with schizophrenia, they are commonly reserved for use in later or more severe cases of the condition.5
In my experience, I’ve found that if the clinical benefits and risks are explained clearly and appropriate patients take an active role with their treatment team in making treatment decisions, they are often open to trying LAIs. I believe NPs are in the position to help educate and guide patients when it comes to treatment plans. Choice and trust between the patient and treatment team, as well as ensuring that patients are educated on appropriate treatment options, can all have an impact on the patient’s experience.
Choice, Trust, and Ongoing Communication With HCPs Are Important for People Living With Schizophrenia
It’s important for patients to be informed about treatment options so they have input and choice when it comes to making treatment decisions alongside their healthcare providers. After discussing the benefits and risks with patients, I have found that LAIs can be an effective option for the treatment of schizophrenia in some of my patients living with schizophrenia. Certainly, individual results may vary, so it’s important to consider all of a patient’s needs and goals when making treatment decisions.
One LAI option I may consider for appropriate adult patients is ARISTADA® (aripiprazole lauroxil). ARISTADA is a prescription medicine used to treat schizophrenia in adults. ARISTADA is given by intramuscular injection by a healthcare professional following an initiation regimen. This medication is available in 5 dosing regimens, including monthly (441 mg, 662 mg, 882 mg), every 6 weeks (882 mg), and every 2 months (1064 mg). It is not known if ARISTADA is safe and effective in children under 18 years of age. Elderly people with dementia-related psychosis are at increased risk of death when treated with antipsychotic medicines including ARISTADA. ARISTADA is not for the treatment of people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). Patients should not receive ARISTADA if they are allergic to aripiprazole or any of the ingredients in ARISTADA.6,7
I’ve found that some patients appreciate the dosing options available with LAIs and work with their healthcare teams to select an appropriate dose. By talking to my patients, listening, and empathizing, I find that I can build collaborative, trusting relationships, and play an active clinical role as they steer the ship on their treatment journey.
Hara Oyedeji received compensation from Alkermes, Inc. for her contributions to this article. This article is sponsored by Alkermes, Inc.
Please continue reading for Important Safety Information, including Boxed Warning for ARISTADA INITIO® (aripiprazole lauroxil) and ARISTADA below.
INDICATION and IMPORTANT SAFETY INFORMATION for ARISTADA INITIO® (aripiprazole lauroxil) and ARISTADA® (aripiprazole lauroxil) extended-release injectable suspensions, for intramuscular use
INDICATION
ARISTADA INITIO, in combination with oral aripiprazole, is indicated for the initiation of ARISTADA when used for the treatment of schizophrenia in adults.
ARISTADA is indicated for the treatment of schizophrenia in adults.
IMPORTANT SAFETY INFORMATION
WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. ARISTADA INITIO and ARISTADA are not approved for the treatment of patients with dementia-related psychosis.
Contraindication: Known hypersensitivity reaction to aripiprazole. Reactions have ranged from pruritus/urticaria to anaphylaxis.
Cerebrovascular Adverse Reactions, Including Stroke: Increased incidence of cerebrovascular adverse reactions (e.g., stroke, transient ischemic attack), including fatalities, have been reported in placebo-controlled trials of elderly patients with dementia-related psychosis treated with risperidone, aripiprazole, and olanzapine. ARISTADA INITIO and ARISTADA are not approved for the treatment of patients with dementia-related psychosis.
Potential for Dosing and Medication Errors: Medication errors, including substitution and dispensing errors, between ARISTADA INITIO and ARISTADA could occur. ARISTADA INITIO is intended for single administration in contrast to ARISTADA which is administered monthly, every 6 weeks, or every 8 weeks. Do not substitute ARISTADA INITIO for ARISTADA because of differing pharmacokinetic profiles.
Neuroleptic Malignant Syndrome (NMS): A potentially fatal symptom complex may occur with administration of antipsychotic drugs, including ARISTADA INITIO and ARISTADA. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available.
Tardive Dyskinesia (TD): The risk of developing TD (a syndrome of abnormal, involuntary movements) and the potential for it to become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic increase. The syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses. Prescribing antipsychotics should be consistent with the need to minimize TD. Discontinue ARISTADA if clinically appropriate. TD may remit, partially or completely, if antipsychotic treatment is withdrawn.
Metabolic Changes: Atypical antipsychotic drugs have been associated with metabolic changes that include:
Hyperglycemia/Diabetes Mellitus: Hyperglycemia, in some cases extreme and associated with ketoacidosis, coma, or death, has been reported in patients treated with atypical antipsychotics. There have been reports of hyperglycemia in patients treated with oral aripiprazole. Patients with diabetes should be regularly monitored for worsening of glucose control; those with risk factors for diabetes should undergo baseline and periodic fasting blood glucose testing. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia, including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients require continuation of antidiabetic treatment despite discontinuation of the suspect drug.
Dyslipidemia: Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics.
Weight Gain: Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.
Pathological Gambling and Other Compulsive Behaviors: Compulsive or uncontrollable urges to gamble have been reported with use of aripiprazole. Other compulsive urges less frequently reported include sexual urges, shopping, binge eating and other impulsive or compulsive behaviors which may result in harm for the patient and others if not recognized. Closely monitor patients and consider dose reduction or stopping aripiprazole if a patient develops such urges.
Orthostatic Hypotension: Aripiprazole may cause orthostatic hypotension which can be associated with dizziness, lightheadedness, and tachycardia. Monitor heart rate and blood pressure, and warn patients with known cardiovascular or cerebrovascular disease and risk of dehydration and syncope.
Falls: Antipsychotics including ARISTADA INITIO and ARISTADA may cause somnolence, postural hypotension or motor and sensory instability which may lead to falls and subsequent injury. Upon initiating treatment and recurrently, complete fall risk assessments as appropriate.
Leukopenia, Neutropenia, and Agranulocytosis: Leukopenia, neutropenia and agranulocytosis have been reported with antipsychotics. Monitor complete blood count in patients with pre-existing low white blood cell count (WBC)/absolute neutrophil count or history of drug-induced leukopenia/neutropenia. Discontinue ARISTADA INITIO and/or ARISTADA at the first sign of a clinically significant decline in WBC and in severely neutropenic patients.
Seizures: Use with caution in patients with a history of seizures or with conditions that lower the seizure threshold.
Potential for Cognitive and Motor Impairment: ARISTADA INITIO and ARISTADA may impair judgment, thinking, or motor skills. Patients should be cautioned about operating hazardous machinery, including automobiles, until they are certain therapy with ARISTADA INITIO and/or ARISTADA does not affect them adversely.
Body Temperature Regulation: Disruption of the body’s ability to reduce core body temperature has been attributed to antipsychotic agents. Advise patients regarding appropriate care in avoiding overheating and dehydration. Appropriate care is advised for patients who may exercise strenuously, may be exposed to extreme heat, receive concomitant medication with anticholinergic activity, or are subject to dehydration.
Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotic drug use; use caution in patients at risk for aspiration pneumonia.
Concomitant Medication: ARISTADA INITIO is only available at a single strength as a single-dose pre-filled syringe, so dosage adjustments are not possible. Avoid use in patients who are known CYP2D6 poor metabolizers or taking strong CYP3A4 inhibitors, strong CYP2D6 inhibitors, or strong CYP3A4 inducers, antihypertensive drugs or benzodiazepines.
Depending on the ARISTADA dose, adjustments may be recommended if patients are 1) known as CYP2D6 poor metabolizers and/or 2) taking strong CYP3A4 inhibitors, strong CYP2D6 inhibitors, or strong CYP3A4 inducers for greater than 2 weeks. Avoid use of ARISTADA 662 mg, 882 mg, or 1064 mg for patients taking both strong CYP3A4 inhibitors and strong CYP2D6 inhibitors. (See Table 4 in the ARISTADA full Prescribing Information.)
Commonly Observed Adverse Reactions: In pharmacokinetic studies the safety profile of ARISTADA INITIO was generally consistent with that observed for ARISTADA. The most common adverse reaction (≥5% incidence and at least twice the rate of placebo reported by patients treated with ARISTADA 441 mg and 882 mg monthly) was akathisia.
Injection Site Reactions: In pharmacokinetic studies evaluating ARISTADA INITIO, the incidences of injection site reactions with ARISTADA INITIO were similar to the incidence observed with ARISTADA. Injection site reactions were reported by 4%, 5%, and 2% of patients treated with 441 mg ARISTADA (monthly), 882 mg ARISTADA (monthly), and placebo, respectively. Most of these were injection site pain and associated with the first injection and decreased with each subsequent injection. Other injection site reactions (induration, swelling, and redness) occurred at less than 1%.
Dystonia: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first days of treatment and at low doses.
Pregnancy/Nursing: May cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure. Advise patients to notify their healthcare provider of a known or suspected pregnancy. Inform patients that there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ARISTADA INITIO and/or ARISTADA during pregnancy. Aripiprazole is present in human breast milk. The benefits of breastfeeding should be considered along with the mother’s clinical need for ARISTADA INITIO and/or ARISTADA and any potential adverse effects on the infant from ARISTADA INITIO and/or ARISTADA or from the underlying maternal condition.
To report SUSPECTED ADVERSE REACTIONS, contact Alkermes at 1-888-238-8008 or FDA at 1-800-FDA-1088 or https://www.fda.gov/medwatch.
Please see full Prescribing Information, including Boxed Warning, for ARISTADA INITIO and ARISTADA.
Hara E. Oyedeji Bio: Hara E. Oyedeji, PMHNP-BC, CRNP, MSN, MSed, is a nurse practitioner with more than 10 years specializing in behavioral health. She serves as the medical director for an outpatient mental health clinic, Greater Chesapeake Health & Wellness, in addition to working in her own private practice, Fortitude Behavioral Health, both located in Baltimore, Maryland.
References:
1. What is schizophrenia? American Psychiatric Association. Accessed July 19, 2023. https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
2. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. American Psychiatric Association; 2020. doi 10.1176/appi.ajp.2020.177901
3. Depot medication. Royal College of Psychiatrists. Reviewed April 2018. Accessed December 21, 2023. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/depot-medication
4. Schizophrenia. Mayo Clinic. Accessed November 6, 2023. https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449
5. Schwartz S, Carilli C, Mian T, et al.Attitudes and perceptions about the use of long-acting injectable antipsychotics among behavioral health practitioners. Mental Health Clinician. 2022;12 (4): 232–240.
6. ARISTADA [prescribing information]. Waltham, MA: Alkermes, Inc.
7. ARISTADA Medication Guide. Alkermes, Inc.
Alkermes® is a registered trademark of Alkermes, Inc. ARISTADA® and ARISTADA INITIO® are registered trademarks of Alkermes Pharma Ireland Limited, used by Alkermes, Inc. under license.
Clinicians should approach their psychiatric care of adults with schizophrenia with a degree of cultural and intellectual humility, recognizing patients are the experts on their lived experience. It’s not feasible nor necessary for clinicians to become experts on each patient’s race, religion, culture, or beliefs. However, by practicing humility and curiosity, we can learn from patients’ experiences and continue to refine our clinical practice. In this way, we become better clinicians through our relationships with patients, deepening our understanding of their views and feelings on mental health and wellness and, in turn, improving the care we provide them.
Furthermore, the mental healthcare provider shortage is such that patients do not always have the luxury of finding a provider with shared beliefs, values, or aspects of identity. As such, we must help adults living with schizophrenia engage in self-advocacy and self-care to find ways to meet their needs beyond the clinical care encounter. Sometimes patients or families are searching for a “silver bullet,” but holistic recovery from schizophrenia often requires more than only medical treatment.
For example, adults with schizophrenia and their families must advocate to create meaningful employment opportunities and find a sense of community. These are critical components of the recovery journey, as people heal through not only medication but also through social connections and finding purpose in their experience. Unfortunately, adults living with schizophrenia are often met with marginalization and discrimination, further isolating them and making an already challenging experience even more difficult.
Nevertheless, clinicians can sometimes facilitate a therapeutic relationship by identifying similarities and shared experiences. For example, I often draw from my Hispanic culture and background when seeing Hispanic patients. I can connect through shared identities and values, such as being the children of immigrants or being first-generation Americans, and the work ethic, sense of opportunity, and ambition this instills. There may also be cultural references to certain Latin foods or music or humor that, when exchanged, can help us build rapport.
My dual identity as an adult living with schizophrenia and a psychiatric mental health nurse practitioner (PMHNP) also allows me to break down the hierarchy that may exist between patients and myself. Open communication with patients leads to better care—allowing a clinician to know the things that matter most to their patients and meet their needs. And for me, that may mean sometimes deciding to self-disclose my lived experience to establish trust and strengthen the therapeutic alliance.
Recognizing the Expertise Provided by Adult Patients
Patients are the experts on their lived experience, and recognizing this expertise is crucial to providing collaborative and supportive care. Clinicians often view schizophrenia in terms of clinical descriptors—hallucinations or delusions, disorganized thinking, and inability to concentrate or focus. Adults living with schizophrenia often describe the condition in human or functional terms—like trying to reduce the number of bad days, not feeling so overwhelmed, or having a desire to get better grades in school or live independently.
Treatment team members need to understand that our clinical descriptors, while important, may be insufficient for understanding the patient’s needs or goals. We should reframe management and care in terms of the outcomes or developmental milestones they wish to achieve. A way to think about our job is bridging the unmet need and the patient’s goals through our clinical care, for example, advising our patient this treatment plan may help them sleep better so they can get back to focusing on school.
To do this, I approach my clinical encounters with adult patients with a strengths-oriented framework, aiming to treat the whole person and not simply assess the patient’s disease or focus on deficits. Together, the patient and I identify goals and aspirations, highlighting what they can achieve by focusing on how we can move forward and recognizing the potential in the patient beyond the diagnosis.
Emphasizing Education and Empowerment
When I started working in mental health, the common assumption was that long-acting injectable (LAI) antipsychotics were for adults who had been in the mental health system for a long time, having failed multiple treatment modalities. However, evidence suggests this might not be the case, as recent guidelines and guidance have expanded the use of LAIs in appropriate patients.
As such, education on LAIs is a crucial component of schizophrenia management and care. Clinicians and adults with lived experience need the education to overcome the stigma or misperceptions frequently associated with LAI interventions. It’s essential to listen to adult patients, letting them ask questions about treatment options and working to answer and address those questions. I often draw parallels to other medical fields when discussing LAIs and find patients curious about administration, treatment duration, and how they might differ from oral medication. When seeing patients and determining who may be a good candidate for or benefit from an LAI, it is important to consider patient preference, caregiver preference, challenges with adherence, and whether it is viable for a patient to come into the office once a month or more often.
As a clinician, our practice setting sometimes dictates our prescribing habits. For example, as a PMHNP, nursing education has no residency infrastructure, so you often develop your practice preferences and norms on the job. If your first few jobs use LAIs, you will learn how to use them, but if they don’t, you will likely be less familiar with the formulations, administration, payment instructions, or fulfillment processes. Opportunities for continued education on all viable treatment options are crucial, especially for nurses, given the different training and education modalities. For clinicians like PMHNPs, and adults with lived experience, it often boils down to education to demystify treatment options, like LAIs, to empower the shared decision-making between patient and provider.
For adults with lived experience, medication adherence could increase the odds of managing symptoms and achieving success on the recovery journey. However, many adults living with schizophrenia, including myself, reach a period of temporary stability and stop taking their medication as prescribed. It sometimes takes a near-second episode to finally register that this illness is a lifelong condition requiring ongoing care. This makes it even more critical for adults with schizophrenia to understand that medication adherence is necessary to stay well.
I became a clinician not only to make sense of my experience and understand what I would need to do to cope with my illness but also to pay it forward and help others going through similar journeys. Schizophrenia is a chronic condition, and while we cannot yet prevent it from developing, we can mitigate its impact with early intervention and sustained treatment. This illness requires lifelong management, but helping patients achieve their goals is possible with knowledge, empowerment, and the right support system.
This article reflects my own experience and opinions and was developed in joint collaboration by Janssen Pharmaceuticals, Inc., and myself. I have been paid an honorarium for my time.
Nursing for me is about making a difference — and every day I’m making a difference in the lives of the people I care for. Take a Monday earlier this month. A patient of mine living with cerebral palsy was struggling to complete her therapeutic exercises. Her mother, clearly frustrated, feared her daughter wasn’t making sufficient progress. Dedicated and caring, the mother also worried that she wasn’t doing enough to help her daughter improve and succeed.
But this young woman was improving — slowly, surely, in ways imperceptible to the untrained eye. “Your daughter can now open both of her hands; all of our hard work is clearly paying off,” I explained, as the mother’s face transformed from hopeless to full of hope. “Your daughter just wants to be independent,” I continued, “and she obviously gets this spirit from you.”
Independence – as much as making a difference – is becoming a bigger focus for me in my career. The freedom to control my schedule. The freedom to control my income. The freedom to care for my three children. The freedom to care for me.
Until recently, I didn’t really have that choice.
For too long nurses have been treated like afterthoughts. We’re burned out and stressed out – from Covid, from our home lives, from feeling like our needs are always considered last. And this not only impacts our ability to perform, it threatens the effectiveness of the entire healthcare systems we’re so passionately committed to supporting. Yet, the working conditions and rigid schedules have not changed with the world around us.
Over my six-year career in nursing, I’ve witnessed both the indifference and abuse that has become too common in our industry. As a result, our community is suffering. Less than half of the 12,000 nurses recently polled by the American Nurses Association (ANA), for instance, believe that their employers care about them – a mere 19 percent for nurses 35 and under. More than 50 percent of all nurses are also thinking about leaving nursing; a figure that rises to 63 percent for nurses under 35. The latter numbers particularly worry me; with so many of my younger brothers and sisters ready to give up on nursing – and a national nursing shortage only expected to get worse – the future of the profession I love has never felt grimmer.
I know what it’s like to be undervalued in the workplace. I’ve been told by nursing agencies to wait in the cold if my patients are running late. Then when they finally do arrive, I’ve been expected to wash their clothes – even though I’m a nurse, not a housekeeper. I’ve been berated by patients for “moving too slowly” and battled with administrators for adequate PPE safety gear during the height of the pandemic. I’ve been made to feel like a number – a body – by nursing agencies just focused on profits and disrespected by patients and family members aggressively insistent I could just “do more.”
But more must be done to consider our needs, too – both by the nursing industry and the community of nurses to whom we all belong. What we seek is to be seen, valued, and supported in ways that matter. To be listened to if we are struggling during a hard shift. To hear “thank you” instead of being ignored. To give us tools and resources to take care of our mental health because after the past two years, we need it.
I experienced this kind of support unexpectedly when I found connectRN, a new platform that matches nurses with health care facilities that need our services. The ability to work when I want, where I want has given me the independence I was seeking, and an opportunity to step away if I need to recharge. As a mother, this flexibility is more important than ever. I can take on shifts that work with my child-care needs, eliminating the stress that usually occurs when making money and being a Mom collide. This should become an industry standard, rather than a perk from a digital start-up.
One of the things I value most about connectRN is that they are nurse-first and care as much about our community as the shifts they post. When I joined the platform, I was given access to The Beat, a private community of nurses who also work with connectRN. It is a safe space to chat with your peers about the things only nurses can truly understand – without the fear of reprisal or retribution. We share stories about hard shifts, give each other support to keep going, and often find “work buddies” in the places we work often. As debates rage around the role of nursing unions, hospitals and agencies must understand that a united nursing community is a better nursing community – better equipped, better prepared, and far better focused on the needs of our patients. With my life far more than just nursing – kids (both teens and a toddler), my extended family, a bit of me time – I feel lucky to be part of this community
For me, personally, The Beat proved particularly helpful when dealing with mental health concerns. At the height of Covid, the community offered telehealth therapy sessions through a partnership to use at our discretion. To be honest, I never considered I might need this kind of help — no one had ever asked me. But the death of a colleague — a young mother who passed away shortly after giving birth — hit me harder than I’d initially expected. I needed help to process how I was feeling and I took advantage of the offer. To have that support – for free – made me feel worthy and valued.
Over the past two years, I’ve been struck by a newfound respect for nurses as the Covid crisis continues unabated. Patients and families recognize our role at the frontlines of the pandemic and understand the risks taken daily to help their loved ones survive. What’s needed now is a parallel boost in understanding and appreciation from the hospitals and nursing agencies that power our profession. Because fairer pay, added flexibility, stress reduction, and self-care won’t just improve the lives of nurses, they’ll help ensure the positive patient outcomes we all desire. As nurses, we intuitively understand the necessity of these demands; it’s time for staffing agencies and health facilities to embrace this mindset with equally open hearts and minds.
Nurse practitioners are in demand. This is one fact that many healthcare workers agree on. The Bureau of Labor Statistics backs this up, stating that the demand for nurse practitioners is expected to grow by 28% between 2018 and 2028, and the growth is much faster than average for other job categories it tracks.
Nurse practitioners (NPs) diagnose, treat and manage acute and chronic illness. They focus on health promotion and education, disease prevention and health counseling to guide patients into making better health and lifestyle choices.
Christine Colella DNP, APRN-CNP, FAANP, with the University of Cincinnati’s College of Nursing, is a professor and the executive director of the college’s graduate programs. She’s also an Adult Nurse Practitioner who works in a federally qualified health center (FQHC). “Here at the University of Cincinnati, I work with students and my fellow faculty members. Then on Thursday and Friday mornings, I see clients in an FQHC facility that serves the uninsured and underinsured and other people who find it difficult to get access to care,” Dr. Colella says.
Need for Nurse Practitioners
Dr. Colella is keenly aware of the demand for advanced-practice nurses. “There’s a shortage of providers who can take care of the adult. Health professionals who are trained in and understand adult and geriatric patients’ needs will be highly sought after, particularly as the baby boomer generation continues to age.” These needed providers include those specialized in Adult-Gerontology NP and in Family NP, who are educated to take care of patients throughout their life span.
The NPs’ blend of clinical expertise in diagnosing and treating health conditions — coupled with an emphasis on disease prevention and health management — brings a comprehensive perspective to health care that’s highly valued today by providers and patients.
Master of Science in Nursing Degrees
Dr. Colella oversees the University of Cincinnati, College of Nursing (UC Online) Master of Science (MSN) in online programs. The MSN NP programs can be completed in two years, with students doing course work entirely online. The programs prepare advanced-practice nurses to diagnose and manage common and complex medical conditions across the lifespan — depending on their population focus and passion.
Our Master of Science in Nursing online programs include the following:
Family Nurse Practitioner – The MSN FNP prepares nursing students to diagnose and manage common and complex medical conditions across the lifespan, from children to the elderly.
Women’s Health Nurse Practitioner – This program prepares nurses to become primary care providers for female patients, promoting wellness and disease prevention throughout a woman’s life.
“A great aspect of our NP programs is that our faculty is actively practicing what they teach,” says Dr. Colella. “When we lecture and meet with students, we reference patients we worked with that very week — and this real-world aspect enriches the education we offer.”
Dr. Colella adds that the UC College of Nursing online programs have classes taught by the same faculty that teach onsite classes. “We make sure that the rigor and expectations of any student, whether they are in the seat on campus or working from across the country, are the same,” she says.
The high pass rates for the online and on-campus programs bear this out, with both sets of students achieving pass rates in the high 90s. “We have the same high standards for all students,” Dr. Colella says.
Degree Programs Appeal to a Variety of Students
Students who choose an online NP program already hold their Bachelor of Science in nursing (BSN) and at least a year of independent RN practice.
UC Online’s programs attract students who have been registered nurses for only a few years, as well as those who completed their BSN many years ago. “Our student body is diverse, and they each bring a unique perspective to our programs,” Dr. Colella says.
While many students come from the tri-state area in Ohio, our NP programs welcome nurses from many states across the US. Dr. Colella believes that this mix of backgrounds and geographical locations makes for an especially engaging learning environment.
Opportunities for NPs and Strong Patient Outcomes
Dr. Colella knows first-hand that NPs are well-positioned to make a difference in the lives of patients and their communities. “Our whole focus and philosophy is health promotion and risk reduction, and we do that through education and anticipatory guidance,” she says. “If you have a sore knee but you also tell me you smoke, I’m going to talk with you about smoking, too. That’s because I want people to look at their health more holistically and in a way that’s helpful for them over the long term.”
Studies show that NPs have excellent outcomes with patients, and this makes more people actively choose to work with an NP. According to the American Association of Nurse Practitioners® (AANP), since 1965 when the NP role was first created, more than 50 years of research has consistently demonstrated the excellent patient outcomes and high quality of care NPs provide.
For example, in one AANP analysis that compared 33 patient outcomes of NPs with those of physicians, the NP outcomes were equivalent to or greater than those of physicians. The patients under NP care had higher compliance levels, patient satisfaction and resolution of pathological condition resolution were greatest for patients cared for by NPs. The NP and physician outcomes were equal on all other outcomes. (Source: AANP.)
“NPs in primary care settings truly make a difference,” Dr. Colella says. “They’re a great asset to the health team. They can free up physicians who want specialty focus areas or complex patient cases. NPs are the patient advocate and educator, someone who can assess, diagnose and treat them, with the right diagnostic tools and medication — and then later, do the follow-up with the patient.”
Top-Tier Nurse Practitioner Programs
As the market presents online MSN programs from different universities and colleges, Dr. Colella alerts for the importance of understanding differences, sometimes subtle, among programs. She says that the University of Cincinnati has been a leader in online nursing education for years, helping students embrace the technology and implement self-discipline and receive the support required to succeed in our programs. “We started teaching this way long before COVID-19 changed the landscape of education. We’re highly ranked because of our long-standing and strong nursing programs. Our faculty actively practice in our communities, and we know how to deliver quality education from a distance. That’s why we have the reputation we do today, and I’m proud of the education we provide to all of our NP students.”
The University of Cincinnati’s online graduate nursing programs continue to be ranked among the BEST Online Programs by U.S. News & World Report and are in the #7 spot for 2020. For more information, view our program information and contact us to speak with an Enrollment Services Advisor.
As the COVID-19 pandemic swept through the country and universities shifted to online learning, nursing programs needed a new way of providing clinical experiences to students. Taking a cue from longtime online nursing programs like the RN to BSN, universities turned to technology for assistance.
What is a virtual simulation in nursing?
Throughout the years, traditional nursing programs have utilized in-person clinical simulations, which place students in a real-to-life learning experience using interactive mannequins or standardized patients (actors who portray patients), with many variations in between. However, the pandemic changed all of that and nursing programs came to rely on virtual reality simulations in place of their regular clinical simulations to provide meaningful educational opportunities.
Virtual simulations are valuable educational tools that not only provide nurses with practical experiences in a safe environment – they also allow students to effectively apply critical thinking skills and theoretical nursing care principles to better prepare them for a career in a real-world, acute care clinical setting.
Taking a cue from 100% Online RN to BSN programs
Online programs like Ohio University’s RN to BSN program have been using virtual patient platforms such as Shadow Health for years with great success. Shadow Health is included in two of the nine nursing classes required for the OHIO program.
These RN to BSN simulations allow online learners to participate in lifelike, conversational interactions with a wide variety of virtual patients. Learners advance their clinical and communication skills by interviewing, examining and treating virtual patients. According to Dr. Sherleena Buchman, assistant professor in OHIO’s College of Health Sciences and Professions School of Nursing, a variety of technologies can be used for virtual experiences.
VR simulations or vSim in nursing courses
Often universities have clinical simulation programs built directly into their nursing curriculum. Virtual simulations in nursing (vSim) is a platform that more universities embraced during the pandemic to helps to build clinical judgement skills through a realistic virtual environment, according to Dr. Buchman.
Cine-VR, a virtual reality 360 video simulation experience that uses the same principles of clinical simulation is a popular nursing tool. This way, students are able to see and hear a person in need, rather than using a mannequin.
“One example is the administration of NARCAN to a college student who has overdosed in a dorm setting,” said Dr. Buchman. “The learners are immersed in the virtual dorm room, which is viewed through virtual reality goggles, and are able to turn a full 360 degrees and see what is going on all around them. Additional Cine-VR simulations include two other opioid-related scenarios and a three-part experience related to providing care to a patient with Parkinson’s Disease.”
Why is simulation important in nursing?
Simulation is important to nursing because it provides the needed safe learning environment for students. “They are able to ask questions, make mistakes and learn from them without causing harm to a patient,” Dr. Buchman highlights.
“There are many opportunities for virtual and augmented realities to be utilized in nursing education. Our profession as a whole is just beginning to understand the potential for this type of learning,” Dr. Buchman explained. “vSim helps learners to develop confidence in their knowledge, skills and the attitudes of their profession, which is extremely important in the field of nursing.”
Nursing simulated electronic health records (EHR)
A critical part of simulations are electronic health records. Nursing students earning their BSN degree online or in-person can expect to not only learn about electronic health records, but to put that into practice. Nurses must document everything they do on a daily basis.
“There is a famous saying in nursing, ‘If it was not documented then it did not happen.’ As vSim and Cine-VR are realistic nursing scenarios, it is important that learners develop the skills of charting and understanding the electronic health record,” Buchman said.
What to expect from a BSN curriculum
Course requirements for BSN students, whether online or on-campus, are guided by the National Council of State Boards of Nursing, Quality Safety, Education in Nursing, and are built around the American Academy of Colleges of Nursing’s nine BSN Essentials. Ohio University’s RN to BSN degree is designed for working adults and offers 100% online coursework, 5-week sessions, and affordable tuition at less than $7,600 for the program’s nine required nursing courses.
Interested in learning more about an online RN to BSN degree? Visit ohio.edu/rn-to-bsn.
When patients present with a specific type of heart attack (non-ST elevation acute coronary syndrome) or chest pain related to coronary heart disease (unstable angina), they often undergo several tests—many being invasive—and then they may be sent to other facilities for even more procedures.
It’s time-consuming, it can be confusing to the patient, it can be stressful on the patient’s body, and when combined, can lead them to abandon care.
Sarah Slone, DNP, MSN, FNP-BC, CCRN began to address this problem from an implementation science standpoint in her Doctor of Nursing Practice (DNP) project. She aimed to streamline the process of existing care options from acute symptom presentation in the hospital to discharge.
But ultimately that raised a new question:
Can we determine best practices for when patients need catheterization (an invasive procedure) so that we can establish a standardized approach and identify barriers to care that may exist?
“Any invasive procedure carries risk,” Sarah says. “There are non-invasive options like stress tests, information that can be gleaned from a patient’s presentation and previous lab work, and newer options with CT scanners.”
Now she’s pursuing the question from a discovery science standpoint. Her Ph.D. research examines “care pathways” from acute symptom presentation to various methods of invasive and non-invasive testing, to establish best practices for when patients are most in need of these procedures.
From Implementation to Discovery
Sarah Slone graduated from the DNP Executive Track in May 2019, then started the Ph.D. in August 2020. She is in a new Johns Hopkins School of Nursing program that offers an alternative pathway to Ph.D. for nurses who have earned a DNP. Students can transfer credits and earn their Ph.D. in about three years compared to about five years.
The DNP Executive Track is online with on-site immersions, but Ph.D. students must live in Baltimore. So Sarah moved from South Carolina to Baltimore, alone, at the height of the COVID-19 pandemic.
She considered delaying her start but didn’t want to let the time go to waste. And even before the move, the family living situation was complicated.
“My husband is an interventional cardiologist who works in a hospital. At the beginning of the pandemic, we had to decide if we wanted to live together since he would be at risk of being exposed. Our son is in college, but he returned home because of COVID. He decided that he wanted to remain in the house as well,” Slone says.
Now in her second semester, Sarah reflects that the Ph.D. is not harder, but different than the DNP.
“The DNP enriched my perspective as a nurse scientist, but I learned that questions arise from evidence-based practice, and I needed a Ph.D. to explore that further.”
—SARAH SLONE, DNP, MSN, FNP-BC, CCRN
“I’ve already grown a lot in terms of research,” she continues. “I came in with a specific idea of what I wanted to do and was able to develop my research project with my mentors into something not just fundable, but something that can grow into a wider program of research.” Sarah’s DNP mentor was Dr. Deborah Baker, Senior Vice President for Nursing of Johns Hopkins Health System and her Ph.D. mentors are Dr. Cheryl Dennison Himmelfarb and Dr. Kelly Gleason.
Sarah recommends that, if you are considering a Ph.D. and have a DNP, define your research questions early. “The sooner you can do it, the better you can align assignments, so they build and benefit you throughout the program.”
A Passion for Research
Sarah always had a passion for research—from working as a research assistant in a plant pathology lab in high school to initially studying biochemistry in college. She took some time off from undergrad to have a family and later decided to pursue a BSN. Upon graduation, she worked as an ICU nurse for five years, then became a family nurse practitioner, followed by work in general and trauma surgery. She discovered a passion for cardiovascular care when the 36-hour shifts in trauma surgery became too much (especially with a young family!) and the cardiovascular service was hiring.
“It’s fascinating,” Sarah says. “Cardiovascular disease remains the number one cause of morbidity and mortality in the United States. There’s so much opportunity to improve the lives of patients.”
Often universities have clinical simulation programs built directly into their nursing curriculum. Virtual simulations in nursing (vSim) is a platform that more universities embraced during the pandemic to helps to build clinical judgement skills through a realistic virtual environment, according to Dr. Buchman.
