While the average person probably thinks that nurses working via telehealth is something new that came about during COVID, that couldn’t be further from the truth.
“I have personally been practicing in telehealth for the past eight years,” says Mariea Snell, DNP, APRN, FNP-C, an associate professor of nursing and the director of the Doctor of Nursing Practice Programs at Maryville University. “I think the pandemic changes how people access care in large numbers, but it is not new. Many people with access issues due to physical disabilities or needs have used these systems. Others did not fully understand what it could do until put to the test.”
Georgia Reiner, MS CPHRM, a Risk Analyst at the Nurses Service Organization (NSO), agrees that telehealth has been around for a while. She adds, though, that its use has dramatically increased.
“Some nursing professionals, mainly advanced practice registered nurses (APRNs), including nurse practitioners (NPs), worked in telehealth before the beginning of the pandemic. However, there has been a dramatic increase in the utilization and availability of telehealth services due to policy changes implemented in response to the COVID pandemic,” says Reiner. “For example, an analysis by McKinsey & Co found that telehealth accounted for less than 1% of Medicare services before the onset of the pandemic, but by July of 2021, telehealth services accounted for about 13-17% of claims submitted to Medicare. Additionally, licensing requirements were relaxed in many states, which helped enable nursing professionals to practice across state lines via telehealth, as were requirements that patients have an established relationship with a provider before they could receive telehealth services. However, many of those policy changes are set to expire at the end of the public health emergency, leaving the future of telehealth services somewhat in question.”
Additional Training
If you’ve never worked in telehealth before, you may wonder if it’s necessary to receive additional training before working in it. The answer is yes and no.
“All nurses can participate in telehealth,” says Snell. “They would provide the level of care that each are currently licensed to provide. In the case of a DNP/NP, they would treat patients the same way they would in an office setting.”
However, the training that nurses would and could receive will depend on several factors.
“Nurses and advanced practice registered nurses may receive training through their educational programs on the use of telehealth. If nurses do not receive this training in their educational preparation, they may receive it through their employment or workshops and educational programs. There are certification courses that are available for healthcare providers to take as well,” explains Robin Arends, DNP, CNP, FNP-BC, PMHNP-CE, CNE, FAAN, FAANP, the APRN Program Director at South Dakota State University as well as a nurse practitioner at Avel eCare. She’s published and presented both workshops and talks about all aspects of telehealth—regionally, nationally, and internationally.
Nurses have worked in a variety of settings in telehealth—such as school nursing, critical care, emergency care, specialty care, and geriatrics, Arends says. Be sure to check if the state you’re practicing in mandates training or taking a test before providing telehealth services.
She continues: “Nurses should be trained to use the telehealth equipment to complete the assessment and how to help others at a remote location use the equipment. They should understand how to appear on camera and communicate with patients through technology. Nurses should be aware of the background that the patient sees on camera and any sounds occurring in their environment. Nurses must know and comply with HIPAA, information security, and confidentiality. Nurses should also be aware of licensing requirements as they need to be licensed in the state where the patient is located.”
Because she works as a risk analyst, Reiner takes a deeper dive when explaining the training nurses need and why.
“Nursing professionals working in telehealth need to verify with relevant state professional licensing boards the practitioners — known as “qualified providers” — who can legally provide telehealth services. Nurses must be appropriately credentialed to practice in the state(s) where their patients or clients are located and work under that state’s scope of practice for nursing professionals,” Reiner says.
“Prior to beginning any telehealth work, nurses need to be prepared and have a backup plan in place in case of an emergency or technology breakdown. In addition to obtaining their patient’s/client’s consent before participating in telehealth services, nurses must also clearly convey to their patients/clients the inherent technical and operational hazards that may impede communication, such as:
System compromise or hardware failure, which could lead to an incomplete or failed transmissions.
File corruption or other data transmission issues, resulting in less than complete, unclear, or inaccurate reception of information or images.
Unauthorized third-party access, which may lead to data integrity or information security problems.
Natural disasters, such as hurricanes, tornadoes, and floods, which can potentially interrupt operations and compromise computer networks.
Whether a nurse can or should provide telehealth services from their residence depends on factors including state regulations, their employer’s policies, and procedures, their home environment and infrastructure, their ability to comply with technical, security, and confidentiality considerations from their home, as well as the nurse’s comfort level with engaging in telehealth practice from their home.”
Challenges
Working in telehealth may seem much easier because it can be done from nearly anywhere. However, there are some challenges to working in it.
“The biggest challenge is that providing services via telehealth is so different from traditional, in-person care, where a patient is physically present in front of the nurse. When providing telehealth services, the nurse relies entirely on technology for the patient encounter. In addition to adhering to traditional clinical standards of care and practicing within the scope of practice authorized by law, there are also technical considerations,” says Reiner. “Equipment and software must be routinely tested, maintained, and updated for quality assurance. Nursing professionals and their employers must also track how well a telehealth program functions carefully. Indicators should capture clinical, efficiency, and satisfaction outcomes, including:
Patient/client complication and morbidity rates
Compliance with provider performance criteria
Diagnostic accuracy
Adherence to clinical protocols
Referral rates
Patient/client satisfaction levels
Cost per case
Delays in accessing consultations, referrals, or specialty practitioners
Arends says that another challenge is that nurses must remember to maintain licenses in the states where their patients are located—and follow that state’s practice rules and regulations.
Remember Documentation
Just as you would if seeing a patient in person, nurses need to do documentation.
“Telehealth sessions should be as thoroughly documented as all other patient/client encounters. Just because some information may be automatically captured by software doesn’t negate the nurse’s professional responsibilities around documentation,” Reiner states. “Documentation in the patient’s medical record should be in accordance with the same documentation standards of in-person visits—including documentation of all communications with the patient or other providers (whether verbal, audiovisual, or written), clinical observations, orders, test results, and patient education and follow-up instructions.”
Telehealth Helps Nurses Become a Key Player
According to our sources, if you haven’t decided whether to look into providing telehealth, you should.
“Nurses should consider getting into telehealth because this is the direction that healthcare is going in. Incorporating technology in care will continue to develop and will never go back,” says Snell. “It is important to stay current with this trend. You won’t necessarily make more money, but you will be more marketable and have a better work-life balance.”
Arends agrees. “Nurses should consider working in telehealth because there are increasing opportunities in this area of healthcare. Patients saw the benefit of telehealth during COVID and want to continue to receive healthcare through this modality. Telehealth has shown high patient and provider satisfaction. I predict that telehealth will only continue to grow and expand.”
In addition, Arends believes that nurses will become key players in telehealth. “Nurses are the core of healthcare. In traditional settings such as hospitals, they are the first to alert providers to changes in the patient’s condition and are truly the front lines of healthcare. This will continue to be seen in telehealth,” she says. “Many studies have shown that nurses utilizing telehealth for remote monitoring as well as real-time audio video telehealth formats have reduced complications and readmissions and increased access to care.”
The benefits to patients are seemingly endless. “Nurses work where the patients are. Some patients cannot travel to clinics because of weather, physical condition, or other factors. Nurses who work in telehealth can care for patients when the patients are not able to seek care from traditional locations. Like home visits, nurses can visit the patients in their home environment. They can assess how the patient moves and works in their environment. They can assess for safety hazards in the home environment as well.”
Finally, working as a nurse with patients in telehealth can also be immensely rewarding. “The greatest award of working in telehealth is helping the patient achieve the best health outcomes while minimizing barriers to accessing healthcare,” says Arends. “Helping a patient who may not be able to access healthcare for various reasons achieve control of chronic diseases or feel healthier is a huge reward for telehealth. In addition, helping patients meet their personal care goals in their preferred environment is also optimal.”
Rachel Ellis, RN, works in the ICU and, for the past five years, has primarily worked in the critical care setting, but on the side, though, she provides postpartum care to new moms.
Here’s her story. We edited the interview for length and clarity.
Why did you decide to start your postpartum side gig? When did you start it, and how did you go about it?
The decision to start a side gig in postpartum care stems back to 2009, after the birth of my first child. At that time, I didn’t have the language for the postpartum experience I found myself in. Sadly, this is a common theme for most new mothers in modern-day America.
I had spent nine months planning for a beautiful water birth but had completely neglected to prepare for the postpartum time. In hindsight, I noticed how providers offered little-to-no education or care about the postpartum period. Because of my wonderful birth experience, I initially chose to go into the nursing field to become a midwife but ended up in bedside nursing instead.
In 2020 while in my second pregnancy and during the height of the COVID-19 pandemic, I realized that I wasn’t doing what I felt most passionate about. Although nursing is rewarding, I felt burnt out and began to remember my “why.” Why did I get into nursing in the first place?
Throughout my second pregnancy, I began researching and prepping for my postpartum time instead of planning for my birth. While exploring, I found a podcast episode featuring Rachelle Garcia Seliga, a New Mexico midwife speaking about postpartum care.
After listening to a particular episode, I suddenly had the language missing from my previous postpartum experience. With intentional preparation, I went on to heal my story by having the most wonderful postpartum experience after the birth of my second child. I wanted everyone to know they could have the same experiences after birth. In 2022, I became a certified postpartum care practitioner through Innate Traditions and created a business called Nourished Beginnings. I had never worked in a postpartum care setting before this.
What need did you see in the community—so that you knew or at least thought this would work? What type of women uses your services? Why do they need assistance postpartum? Is this covered by insurance or a cash-based business?
Innate Traditions was created by Rachelle Garcia Seliga, a midwife in New Mexico, to teach people traditional postpartum care. This model of care is unique in our modern-day society as her teachings weave together the common threads of postpartum care from cultures around the world.
For millennia, communities have been utilizing specific modalities to tend to postpartum mothers’ physiologic design resulting in optimal health. Today–especially in America–most people associate postpartum with depression when in reality, the postpartum time is when a woman heals and should come out on the other side thriving. Luckily, in most intact cultures (China, India, New Mexico, Somalia), these traditions are still carried on and passed down from generation to generation. We are looking to the wisdom of these cultures to relearn and remember how to take care of new mothers.
This is important work for the collective of humanity because “Mothers are the soil from which humanity grows,” to quote my teacher Rachelle. I often notice how negatively women speak about their postpartum bodies, experiences, etc. The need for this work is so dire, in my opinion, as I’ve seen new mothers in the darkest moments of their lives after having a baby.
The type of women and families who seek out my services are typically not first-time mothers. They have already been through the trenches and realize the importance of having help outside their partners.
Most women seeking my services also live a holistic lifestyle and typically experience more natural ways of birthing, such as unmedicated or home birth. My type of service is not covered by insurance; however, I am connected to a large doula agency working in the tri-state area, which can match families looking to utilize health insurance or working on a sliding scale based on income.
Approximately how many patients do you serve? You can make it on a weekly/monthly basis. Is it challenging to balance your side gig and your full-time job?
In terms of service, I typically take on 1-2 clients a month. I will work with a new mother for the first month after her baby is born. My offering emphasizes nourishment, as I am passionate about food as medicine and utilizing a lot of bodywork in my care with a new mother.
It can be challenging to balance my life as a bedside nurse, running my business, and being a full-time mother. Still, I am choosing to go per diem as a bedside nurse shortly to allow room for my business to blossom, as this work will change how our society cares for mothers.
Did you have previous entrepreneurial experience? Or did you learn on the go? Did it take a lot of time or money to establish your business?
As someone with no previous entrepreneurial experience before this, navigating details such as website design, marketing, and social media, has been interesting. The program I took through Innate Traditions was an investment and a nine-month commitment. However, beyond that, it hasn’t taken much financially to start going out there and working within my community. It has been more of a time commitment than anything else.
What did you enjoy most about your side- gig?
What I enjoy most about my side gig is the freedom to create hours that work for my lifestyle and family.
I also love teaching the education series “Innate Traditions Planning for the fourth trimester” with clients and their partners/friends/families because it genuinely brings that piece of the community into the postpartum time before a woman even arrives there. So many families appreciate this education series and have told me they feel way more prepared to care for their loved ones than ever.
What are some of the challenges?
Some challenges I face are finding time to bulk cook for clients throughout the week with a toddler and infant at my side and learning certain things on the go since I am new at running my own business. Luckily, I have a great community that I’m a part of where I can ask questions when more support is needed.
What are the most significant rewards of having your side gig?
This work is gratifying because I witness new mothers come out of their postpartum cocoons feeling rejuvenated and wanting to do it all over again. It truly doesn’t feel like “work” at all. \
What would you say to someone considering starting a side gig like yours—with postpartum care?
Something I recommend to anyone looking to start a business like this is to remember your boundaries. It can be easy to become a babysitter to older children and occasionally perform some light household chores for new families. Remember to center the new mother and inform everyone in the new mother’s postpartum space what your role is. Education is so essential beforehand as this will help all parties recognize what you will be doing during that time.
Also, make sure you’re taking time to prioritize your needs. Remember that you can’t pour from an empty cup as you serve others.
You Make a Difference: such simple words to write but a challenge to put into practice. So I’m thrilled to introduce you to a nurse living up to the mantra. Meet Alice Benjamin, or Nurse Alice, as she’s known to many and how she’s making a difference in her patient’s lives, the surrounding community, and the nursing profession every day.
Nurse Alice’s personal experience of her father dying in the ER from cardiac arrest while awaiting care inspired her to become the best cardiac nurse in the world and a community health leader to help create programs and empower and educate communities of color to take control of their health and get the most out of their healthcare.
But that is only part of her incredible journey.
After starting as a volunteer with the American Heart Association educating people about basic heart health, she advanced her nursing education. She learned more about research, health policy, and public health and advanced her clinical expertise within cardiology as a CNS and NP. Nurse Alice’s education and personal experiences helped her become a well-respected and credible community health leader.
She eventually landed opportunities on national platforms and in the news media to become a TV medical correspondent. Each stop of her nursing journey provided her with unique, colorful, resourceful, well-rounded, and practical, real-life experiences that have molded Nurse Alice into the nurse leader she is today.
Minority Nurse chatted with Alice Benjamin, APRN, MSN, ACNS-BC, FNP-B, CCRN, CEN, CV-BC, Chief Nursing Officer and correspondent for Nurse.org, clinical nurse specialist and family nurse practitioner, and critical-care and emergency medicine nurse at the Community Hospital of Huntington Park, California, with over 23 years of experience about the need for community education, how to make a difference in nursing, being a health advocate, her poignant story about her connection to the ER, the endless possibilities for creating a job in nursing, why nursing needs all of the brightest minds and kind-hearted people, and more.
Learn Nurse Alice’s Secret Sauce for Being a Happy Nurse and Loving Your Nursing Career
The ANA’s theme for National Nurses Week this year is “You Make a Difference.” You’re making a difference in nursing as the Chief Nursing Officer and correspondent for Nurse.org and host of the podcast “Ask Nurse Alice,” a medical correspondent for NBC LA, a family nurse practitioner, clinical nurse, and a mom, author, and health advocate. What is your secret for juggling it all?
The secret sauce is I love what I do in different ways. They’re the same. But there’s a common thread of education and community service, which is something that fills my bucket. I enjoy community education and talking to other people. And my mantra is that I love to talk to people before they become my patients, just because I’ve seen so much of the devastation as a daughter and mother. It’s different when I’m on one side of the bed rails taking care of a patient, but when I’m on the other side, and it’s my loved one in the bed, it’s a vulnerable place to be in. So I like to talk to people to prevent their issues as much as possible so they can have a quality of life. So I love doing what I do as an extension. It’s patient education, using different platforms, like on television with NBC, on a podcast, through Nurse.org, or blogs. I feel so lucky, so blessed to love what I do. Now, some parts of nursing are challenging, but overall, I love what I get to do. I’m like, wow, this is so cool.
Your work makes a difference in the lives of so many every day. What are some ways that nurses can make a difference?
There are numerous ways in which nurses can make a difference. There are nearly 4.4 million of us now, and if we could all divide and conquer. And I would like to empower nurses to think about their passion. What are you good at? What’s your lane? There are so many different ways that we can approach this. But one of the things I think nurses need to do is take care of the patient inside of those hospital walls or those clinics. We must cover so much groundwork, strategizing, and working with other groups and disciplines outside hospital walls. Yes, people come to the hospital for care, but that’s already after something happened. We don’t want to work ourselves out of a job, but we want to care for people so well that they don’t need to come here. And to do that, we need to swing the pendulum and focus on preventative care, health promotion, disease identification, and early intervention because we want to keep people outside the hospital. Nurses need to get out in the communities to educate and become patient advocates in whatever area they wish. Advocate for their patient’s best interests—advocating for what will be better for their care, a more efficient and effective work system, and better work conditions. Because when you have happy nurses, you have happy patients.
You talk about happy nurses. However, nurses must cultivate and maintain optimal mental and physical health to affect change in their patients. What are some things that nurses should be doing to ensure they’re healthy to provide the best patient care possible?
Nurses and healthcare providers know exactly what to do because we tell our patients what to do. But yet, we don’t always do those things for ourselves. We’re so focused on caring for others that we don’t fill our cups. So nurses need to allow themselves to embrace and recognize we are consumers of healthcare too. So when we’re talking about our patients, we’re taking care of our patients too. And I think somewhere along the line, nurses and doctors over here, their patients over there. Nurses and doctors are patients, too, right? So we must ensure we’re doing our annual physical and getting our mental health checks. That’s something that even the whole general public misses altogether. The pandemic highlighted many things, but nurses were going through the mud. It’s such a place of being happy to help people but simultaneously feeling devastated because we are asked to do more with less in a situation where we were fighting the Invisible Man before we understood what COVID is. It’s a profession that’s predominantly women.Many of us are mothers, so we’re also taking care of children and always heard stories about the woman being the rock of the home and making sure everyone else is cared for. So we must allow ourselves some grace and recognize that we are also patients. We need just as much physical wellness, mental wellness, respite care, relaxation, and de-stressing as the next person, and if we don’t do that, we will find ourselves being someone’s patient.
Nurses were the heroes throughout COVID. So what can nursing do to honor nurses who are leading, excelling, and innovating our healthcare systems and the communities they’re practicing in?
Something that we as nurses can do is celebrate each other to support one another. The American Nurses Association is so powerful. They’re able to move legislation and lobby and get things done. There are fewer physicians than nurses, yet nurses have been so fragmented. We have the AMA, but not everyone’s a member. But if we were more unified and took our collective voice to support different initiatives, we could be more powerful in moving important legislation and changing practices for the better, not just for the nursing profession, but for the patient.
To lead and excel in nursing, we have to support one another. That’s one part of it. The other part is that we must also learn to play well in different sandboxes. Because a lot of what we do as nurses are inward driven, nursing school and nursing education, you have this whole larger healthcare conversation happening adjacent to us. And we can’t just be side to side. We must jump into that sandbox, join the conversation, and collaborate. Historically, nurses haven’t been invited. So it’s essential that as we move forward, and we move our profession forward, we need to be more politically savvy and more strategic in how we work with other agencies and groups. Because overall, many groups outside of nursing all have the same goal of improving patient outcomes, improving healthcare, and decreasing chronic illnesses. So working nurses need to unify our voices and learn how to strategize and work with other groups to move the needle on important health initiatives.
To move the needle on important healthcare initiatives, nurses must leverage every opportunity for professional development. So what are the best ways for nurses to access resources and insights to guide their professional development?
This starts in nursing school, but I know nursing school is jam-packed. But early on, as soon as we enter nursing, we need to learn the importance and significance of finance, budgeting, and strategy working with other groups. Because when I went to nursing school, we were taught to care for the patient. It doesn’t matter how much this costs, or don’t worry about anyone else. You focus on the patient. This practice has blinded many of us, not realizing that we can work smarter instead of harder if we collaborate and network with other groups, agencies, and disciplines to share some of our resources. There’s no point in nursing establishing a committee to do all this work independently while another group is doing it. And we’re both doing work but not making as much progress. If we worked together, we could move that needle further. But in nursing school, that’s not necessarily one of the priorities and teachings. But as we grow in our career ladder, we need to foster experiences and learning opportunities that teach us how to do that networking and the collaboration that happens in an interdisciplinary setting. And also in the back of our mind being business and finance savvy to understand that. This is in the patient’s best interest, and B and C might be good considerations considering finances and resources.
What do you recommend nurses do to excel and lead in their nursing careers or inspire others in their nursing journey?
I’m joining a professional organization, and there’s AMA, but then there’s also your specialty nurse organization. I’ve always been a part of my professional organizations and participated in events remotely and in person. I’ve always been a part of my professional organizations, and I’ve participated in events remotely and in person. The synergy happening in that room when you have a nurse or an ER nurse from California, an ER nurse in New York, and you’re discussing situations and can hear like, oh, wow, that’s how you handled that situation. Now that’s the process. Oh, let me bring that practice back to my facility. And it’s an opportunity to share evidence-based practice and talk about the latest research. Iron sharpens iron to build our community and engage with one another.
I did something beneficial for me, and I hope it’ll help someone else. As someone who was very cardiovascular health-focused, my love, my number one love and passion, I was a volunteer for the American Heart Association first and still am for several years. I take my expertise as a nurse and my knowledge about cardiovascular health and work with the American Heart Association to help identify programs and processes that specific communities need to improve patient outcomes to get people to check their blood pressure, eat better diets, and things like that. I was often the only nurse in the room, but work with people of different interests. These are all community folks convening together for the sake of wanting to improve cardiovascular health. But it opened my eyes to what happens in our communities. I know hospital stuff, and I know some clinical things, and I know those healthcare organizations. Still, when a grocery store owner is so interested in cardiovascular health and wants to put on events at their store and do a cooking demo, it opened my eyes to creative ways to do patient education and empower the community to take charge of their health. We have many opportunities to expand and grow our skills and knowledge outside our nursing organizations.
You mention engaging with the community. What are some ways for nurses to better engage with the community besides joining nursing organizations?
For example, I did community service with the American Heart Association. I also served as the health chair for my local NAACP and Urban League. I also volunteered at my son’s schools. Wherever there are people, there will be some health issues. Someone might fall and break their knee, and as nurses, even if you’re a NICU nurse, or labor and delivery nurse, if someone slips and hurts their knee, you will know some basic fundamental things to stabilize that patient. When COVID hit, all know how to stop the transmission of infection. Every nurse was a great resource during the COVID pandemic, teaching different communities about preventing transmission and things you should do to protect yourself. So it’s essential for nurses first to identify their passion. What places are you going to, and what groups are you already part of? Maybe it’s something that’s happening at your church, perhaps it’s your daughter’s Girl Scout troop, and you can participate there. So there are just so many different opportunities. That’s one of the great things about nurses too. We’re so creative and innovative. I’m sure once you identify my passion and what groups I am a part of, you can probably list 100 ways you could help communities.
Talk about the importance of what nurses do beyond the bedside: advocacy, shaping public policy, serving on an organization’s board, and having a seat at the table.
It’s critical that nurses, while we are at the bedside, do as much as possible to share with the public, the community, and our politicians what we do and how we can contribute. Yes, I can start an IV, but then I can also help you strategize an effective plan or bill to improve the quality of school lunches so our children aren’t becoming obese with the foods they’re eating at school. So beyond the bedside, we can advocate.
During the President Obama administration, I had the pleasure of volunteering with AARP. I went through this extensive AARP Volunteer Leadership Program and learned the Affordable Care Act inside and out. So when I came back from training in Washington, DC, I participated in different congresswoman’s town halls, talking about the ACA and seeing changes opening up. Here I am talking about health’s significance and its importance. Health is universal, and it impacts everyone, regardless of what side you sit on politically. But advocacy, I was able to do that, working with state politicians. That’s something that you can do to shape public policy. I live in Los Angeles. I would go to Sacramento, be there to talk to the general public as well, and go knocking on doors to talk about the significance of a particular bill, like the tobacco tax, to decrease the number of people smoking. So I participated in shaping public policy. You do that because the public makes up the voters. They’re the constituents that the politician needs to listen to, but also knocking on those doors and speaking directly to those politicians, and serving on executive boards. This is something I don’t necessarily like, but again, this is where you lean on what your passion is. And it might not be now, but many years from now. It’s so important that we have nurses sit on hospital boards and boards of insurance companies.
There’s a nursing process called ADPIE. And that’s short for assessment, diagnosis, planning, implementation, and evaluation. It’s like a Six Sigma. We go through a thought process whenever we provide patient care, and the ADPIE strategy can be applied anywhere. And if we can get nurses on these boards, especially decision-making boards, that will be key in helping to guide and shift and change policy, procedure, and practice not just in the hospital but outside in the community and how things are done. We know what patients need because we care for them 24/7 and listen to stories that physicians don’t hear because patients trust us. So that experience and thought process will be instrumental in helping to move and make changes outside of hospital walls.
You are a health advocate for your patients. How do you empower them to take control of their health, wellness, and lifestyle?
Whenever I get in front of people, to take their guard down so they don’t think I’m talking at them, I’ll start the conversation by reminding them I’m a patient too. I’ve been in the hospital too. This has happened to me. I’m a nurse, but I’m also a regular person just like you, so I’m not immune to sickness or illness or any of these things, just like I’m telling you about the significance of getting mental health checks and talking to a therapist, I need that too. We’re equal. We are all human beings. We are all subject to the same things. So I do that first to establish trust. Then, I take the time to understand the audience I’m speaking to because, in nursing, we’re taught to talk to the 80%. But there’s also going to be a 20%. Maybe this doesn’t apply or needs to be individualized to the patient. So I constantly individualize the information I’m presenting or talking about.
For example, suppose I’m at an event and speaking to a roomful of Asian people. When it comes to talking about diet, I’m making sure that while I’m talking about traditional foods, I’m also going to speak to those cultural and ethnic foods that are common. Doing that helps the people who are listening to me to feel seen. Many times, especially small, minority, and vulnerable groups feel like they’re talking over my head. They’re not talking to me because that doesn’t apply. My culture doesn’t do that. But when I can individualize it, they feel heard and seen, fostering trust. And when we can foster trust, people are more inclined to follow up with the care plan. So when you have that distrust or mistrust, patients will say, they said that, but I’m not doing that because there’s no trust. So I try my best to continue to support them. Sometimes there’s that one-time interaction with someone. And it’s like, here today, gone tomorrow. But we can still help one another through social media and other ways. And I think that’s why Facebook groups are so big. You can have a community of supporters even long past the initial interaction.
What do you like best about being a family nurse practitioner?
I didn’t plan to be a nurse practitioner, especially not in the emergency room. I wanted to be an accountant. When I was going to school, my dad fell sick. When he was in the military, he began smoking cigarettes because they would say to smoke them if you got him. So he picked up smoking, which led to high blood pressure, a heart attack, a stroke, and congestive heart failure. And ultimately, my dad died in the emergency room from a massive heart attack and went into sudden cardiac arrest. Now being the eldest, I would help my mom care for my dad and things like that. I’d always question why this didn’t make sense. And it was because, at the time, providers weren’t communicating effectively or in a way that my dad understood or that my family understood because we weren’t healthcare professionals. We didn’t know that particular hospital had many patients and was under-resourced. And unfortunately, it’s one thing we don’t necessarily like about healthcare, but we’ve all heard the stories about ERs being so busy, and then someone dies in the hallway while waiting to be seen because they’re so understaffed. And so that was my situation with my dad.
I said I would be the best cardiac nurse in the world. And that’s when I set out to work with American Heart Association, anything and everything cardiovascular. I’m doing it as volunteer work. I don’t care. I want to learn it all. So I can teach and empower the community so this doesn’t happen to them. I worked in ICU critical care, telemetry, and all these places, and I’ve worked in home health everywhere. I never wanted to work in the emergency room because it was too painful. So fast forward. I got frustrated with not having prescriptive authority, and in my journey, I ultimately went back to become a nurse practitioner and landed in the ER. And it was a place I never wanted to work because it was too painful. But now I can redeem things for my father because I’m now that provider and will be so attentive. I’m not going to let you die in the hallway. We know that sometimes people come in the ER and feel their symptoms are dismissed –medical gaslighting–and we’re not doing any of that. So I get to be the provider and care for someone like my dad. Hopefully, in my attentiveness, and because I care so much because of being a patient advocate, I can do as much as possible not to have those outcomes. I can’t control it all the time, but I can do my best to prevent those things from happening.
Do you think education level and specialties play a role in a nurse’s job satisfaction and navigating your career?
More education puts you in a position for opportunities you may not have as an associate degree nurse versus a doctoral-prepared nurse. And then also along the lines, it’s not just the letters behind your name but the quality of education. That’s what you’re learning in the program. As someone who’s gone back for more, I started with the LPN certificate and then ADN, and I initially thought a nurse was a nurse. So along that journey, I learned more about evidence-based practice research leadership, performance improvements, how to be more politically savvy, strategize, negotiate, work with and have crucial conversations with stakeholders, and learn more about budgeting, finance, and cost avoidance. So those are important elements of nursing education that you learn along the way. You’ll still get frustrated with some things, but you’re better equipped with tools and how to navigate those rough waters. So I think education and specialty training, like getting your certification if you work in critical care, having your CCRN or if you’re an emergency room nurse and having your CEN because, in that certification, you’re tested on a series of clinical situations, medication scenarios with how you would manage certain conditions. And when you work in one hospital, you might not have exposure to something. If you go back for your certification, you will have been exposed to multiple relevant things within your specialty. So if a high-risk, low-volume case comes into your hospital, you’ll know how to manage it. So education certification plays a role in job satisfaction and career navigation.
Nursing is an admired and honorable profession, and nurses have been ranked as the most honest profession 21 times, yet nurses need help to persist in their field. So what can nursing do to save itself and progress forward?
We must maintain the integrity of our nursing education. There have been many discussions about compact states and nursing schools, some not so good, some great as of late, but we mustn’t have a nursing shortage. Yes, we need more bodies, but how will we get there? We won’t get there by lowering the entry standards to nursing programs because it’s still critical and life dependent. We’re taking care of people’s lives, so we don’t want to water down the requirements for nursing school. That’s not how we’re going to solve the nursing shortage. While you may get more people to care for patients, how does that affect the quality of patient care? In the end, if you’re pushing nurses through just trying to get them through, we need to focus on investing in our nurse educators and getting more of them. Then attract the best of the best and the brightest because if you want students to learn about critical care, you need the practicing critical care nurse, not the retired 20-year retired critical-care nurse teaching it. But you’re only going to attract them with competitive salaries. Working at the bedside, for the most part, does pay more than working as an educator. So we must look at how we will improve nursing in that sense. And see what else as far as saving itself. That will be a key and foundational thing we must take care of. And then the other pieces.
As nurses, we need to move beyond the bedside. And I don’t mean abandoning patient care. We need people in patient care, but there may be creative opportunities. For example, some larger academic organizations allow their nurses to work at the bedside. Then for their community service for a certain amount of hours, they are compensated or given other points or a reward system to do things in the community. So to move the needle forward, we need one foot at the bedside and one foot beyond the bedside. So we’re straddling the fence. But I know it sounds like a daunting task, but we can do it. We have to look at our resources. And it’s not a game of checkers. This is the game of chess we’re playing. But if there’s anyone that can pull this off, nurses can. We’re the largest segment of healthcare workers; when we talk, people should listen.
What are your words of wisdom for nurses currently in the profession and others considering becoming a nurse?
First, I want to say we need you. We need anyone and everyone passionate about taking care of patients. That is the primary charge. I know it’s a reliable profession. But, most importantly, you have to want to care for patients. And that caring is going to look a little bit different for everyone. Some people say I can’t stand the sight of blood or I can’t do this. I want people to understand that, yes, there are some fundamental things that you will have to learn. But we have nurses in government. We have nurses in politics. We have nurses in education. We have them in public health. We have them in schools.
Take your pick. There are so many options. Nursing is one of the few professions you can enter where everyone has a standard education, and we all pass a standardized test, the NCLEX. But once you do, that sky’s the limit. And I had a mentor tell me, Alice, wherever there is pain and wherever there are people, there will be problems, so you can create your job. During the pandemic, we’ve seen many nurses leave the bedside, some are still at the bedside, but they’ve created their jobs. Some are still in patient care, but it looks slightly different. There are so many problems and plenty of work to go around. We need all the best and the brightest minds and kind-hearted people. We need you.
U.S. News and World Report ranked the NP role first on its 2022 Best Health Care Jobs list, so we chatted with April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, and the president of the American Association of Nurse Practitioners® (AANP), about where she sees the role of nurse practitioners going in 2023.
You’re the President of The American Association of Nurse Practitioners® (AANP). What does it mean to you to hold this role?
I’m an acute care nurse practitioner, so I have education and training in acute care. My practice was in critical care. Before stepping into this role as president, I was the associate chief nursing officer for advanced practice at Vanderbilt University Medical Center. I oversaw all of the advanced practice professional models of care across the health system. Then I moved into this role, and it is a full-time role. I also moved to our Vanderbilt School of Nursing, where I’m an associate dean for clinical community partnerships. I have supported nurse practitioners and NP practices throughout my career, so moving into the president’s role allowed me to do that more on a national level. I have thoroughly enjoyed every moment of meeting nurse practitioners everywhere, not just in the U.S. but across the globe, seeing more about what they do and hearing more about their concerns and needs. I’ve been humbled by how much impact they have made in increasing access to care.
U.S. News and World Report ranked the NP role as the best job in healthcare for 2023. With over 350k + licensed NPs in the U.S., what draws nurses to this career?
This is the second year in a row the U.S. News and World Report ranked the NP role as the best job in healthcare, and according to the ranking of healthcare positions, the growth is up to 355,000 NPs across the U.S. We’re expected to grow between 2021 and 2031 by 46%. So there are a lot of factors that go into it.
It’s rewarding to be a nurse practitioner and provide that much-needed care across all settings. But it’s also consumer demand. Over 1.6 billion patients saw nurse practitioners and 2022 alone. And we continue to see increased demand. I constantly hear from patients and consumers of care how much they appreciate their NP care and how much their NP listens to provide comprehensive healthcare and high-quality care.
The patients say that, but also it’s our evidence. And our data has demonstrated our continued patient care outcomes impact, high-quality care, and access to care. So yes, nurse practitioners and nurses in all categories are in high demand, nurse educators and all types of nurses, but many nurses go in and become nurse practitioners because they want to meet that need. They often want advanced education and training to provide much-needed care in their community. So that’s why you see nurse practitioners in urban and rural areas, community centers, community health, and telehealth. I see them in skilled nursing facilities in schools. They are committed to ensuring everybody has access to health and healthcare.
What specific characteristics set apart a nurse who wants to take that step to become a nurse practitioner?
The majority of nurse practitioners set out to be nurse practitioners. So everybody seeks different occupations and jobs for various reasons. And so we all think it’s a question about why you became an NP over an MD. That was never even a thought for me. I wanted to be a nurse practitioner because of the nursing philosophy, and we provide comprehensive, holistic care. We’re very focused on social determinants of health, ensuring that the patient is engaged in their care and actively engaged and that the patient has ownership over their healthcare plan. We’re very good at coordinating care. So if you need to see a specialist, we’ll help coordinate that care.
Most nurses had it in their long-term career plan to be nurse practitioners. However, during the last several years, nursing has continued to be very challenging as a role. And many nurses may have worked at the bedside or in the clinic and may have said, I need to change in my career. And so, they chose to go down a different path because nursing offers lots of opportunities in terms of career paths. Some have said, I want to do something different, I’m going to go back to school, and I’m going to pursue my advanced education and training to be a nurse practitioner with a particular patient population.
You’re quoted as saying, “The nurse practitioner role is more than a job — it’s a calling, and it is an honor.” Can you expand on this?
I knew I wanted to be a nurse practitioner. I worked with nurse practitioners, saw what they did, and was compelled to do that type of care. When I say the honor part, that comes with a lot of emotion because I have been honored to meet so many amazing nurse practitioners providing care that otherwise would not have been provided in that community. They’re connecting the dots. People are getting access to care like never before in our country, where nearly 100 million Americans lack access to primary care. Seeing so many nurses stepping up to meet that need is humbling.
Where do you see the role of nurse practitioners going in 2023?
We have workforce challenges overall in healthcare. We need more nurses overall. So a lot of effort is going towards educating students coming up through elementary, middle, and high schools about the different career paths in nursing. And nurse practitioners are definitely one of those pathways.
We continue to seek to diversify our workforce. We want to make sure people interested in being nurse practitioners can do that. What I love about the AANP is that we offer many resources and support to nurse practitioners. But we also provide grants, scholarships, and information for potential future students on what it means to be a nurse practitioner, just introducing them to the career.
I know that the U.S. News and World Report have a lot of things that go into the ranking. But nurse practitioners, just like healthcare, have been challenged over the last two or three years as we’ve gone through the pandemic because there have been a lot of other needs. Nurse practitioners have stepped up to meet those needs by providing a lot of community clinics to increase access to COVID-19 care, expanding ICUs to see patients in the home, and expanding telehealth. So there’s still challenges work with challenges, and they’re still challenges with burnout. So we need to work hard as an organization to focus on the health and well-being of the nurse practitioner so that they do see the work-life balance and know how important it is that they take care of themselves so that they can bring their very best selves to their patients to do what they love.
Do you see nurse practitioners as the solution to the nursing and doctor shortage?
We need everyone working in healthcare to the top of their education and training. Nurse practitioners have done a lot. They have really stepped up. Over the years, the profession has evolved. We have national education as national standards for accredited education training and national board certification for the patient population, and we have done a lot we’ve set up to meet the demand. You see the increase, working in all settings now, certainly over the pandemic, but we could do more. But unfortunately, 24 states still have outdated laws where nurse practitioners cannot practice to the full extent of their education and what they’ve been trained to do. And these are unnecessary barriers to care that limit NPs from providing much-needed access that is needed out there.
As full practice authority is gaining ground in many states, do you expect to see a rise in the number of NP-led practices?
Absolutely. And we’re going to see more states move to full practice authority as they continue to see the evidence of what happens when nurse practitioners can practice. We’ve seen a tremendous impact in the workforce and states that have moved to FPA, an immense effect on NPs working across all settings, including rural areas, and improving patient care outcomes. The healthiest states in the U.S. are also practice authority states. We’re now in 26 states and DC with full practice authority.
During the last two years, they updated their laws. They needed to make sure they could increase access to care, we saw what was happening in the pandemic, and Massachusetts, Delaware, and New York all moved into full practice authority just in the last few years. So the momentum is there. States need the workforce, the solution to the workforce, the answer to access to high-quality care, and solutions to healthier lives. And nurse practitioners are absolutely doing that.
Can full practice authority help communities of color address healthcare access disparities?
Yes, absolutely. This is part of this. In my own journey, I’ve met many nurse practitioners working in many different communities, whether taking a mobile clinic out to the community, setting up in a community center or church, or ensuring that healthcare access is affordable and accessible. They are establishing trust with the community so that people actually reach out for health care.
A recently published study shows NPs in full practice authority can increase care to all communities, particularly communities of color and historically underserved communities. Our focus and the mission of our organization is to provide high-quality, accessible equitable care, so we’re focused on the reduction of healthcare disparities.
Talk about becoming a nurse practitioner (MSN vs. DNP) and the specialties a nurse can explore.
A nurse practitioner is part of a category called advanced practice registered nurse. There are four different categories of APRN. Nurse practitioners are one of those. The others are certified nurses, nurse anesthetists, clinical nurse specialists, and midwives. NPs are one type of APRN.
So we are registered nurses who pursue advanced education at the master’s and, often, a doctorate level for the nurse practitioner, advanced clinical training. And we select the patient population that we will focus on.
My background is in acute care, but about 90% of the NPs today have their education and training in primary care, which is where we see our most significant needs. But we’re seeing nurse practitioners going into other specialties, acute care, women’s health, mental health care, and pediatric care. So we’re finally seeing nurse practitioners in all settings.
Many nurses know the type of patient population they want to work with. And so that might help them in determining their pathway as a nurse practitioner and the patient population feels cared for. However, some may not know, so I encourage nurses to shadow a nurse practitioner to ask questions. Learn more just standing there side by side, and learn more about what an NP does. We have a website called We Choose NPs, with videos to learn more about what it’s like to be a nurse practitioner and the type of care we provide. Nurse practitioners all have graduate degrees, and many pursue a doctorate. I certainly did that. Several years ago, I pursued my doctorate because I wanted additional skills at the doctoral level in leadership and understanding finances and macro systems management. And really, to better understand how what I did as a nurse practitioner, clinical care could be expanded more on a leadership level.
Is there anything else you’d like to share about the AANP and the nursing profession in 2023?
I think the horizon is so bright. I think if we continue the momentum to stay focused on access to high-quality care and watch the evidence and follow that data follow the evidence, there are excellent studies with hundreds of 1000s of participants in those studies that show that we continue to provide high-quality, accessible care. So I would continue to follow the evidence to meet the demand for access to care. The American Association of nurse practitioners is the largest NP Association, and are a member-driven association. So we’re committed to ongoing education. We’re committed to providing practice tools for NPs, and we’re committed to advocacy. So we spend a lot of time on the state and federal level to update laws focused on patient care, and NCAA working to the fullest extent of their educational training. We are also very engaged in research and continually growing that body of evidence in terms of diagnosis and disease management, and treatment. So the future is very bright. And I hope that we as a country will continue the momentum to solve some of those critical needs that we have in healthcare.
Medicine and technology have continuously operated hand-in-glove, and never has that been more true than today — and this is all the more reason for nurses to prioritize tech literacy if they want to be the best nurse they can be.
Nursing is the ultimate caring profession, but nursing is also a science. Making it through the rigors of nursing school proves you’ve got what it takes to manage the challenging academics and the more tender side of the profession.
If you are a nurse looking for an opportunity to boost the quality of care you provide your patients, then enhancing your tech literacy should be job one.
Tech Literacy Expands Patient Access to Quality Care
There’s no question that the COVID-19 pandemic and the rapid ascendancy of telehealth have transformed nursing practice. It’s estimated, for example, that as much as 25% of patients had used telehealth services in 2022, with a significant proportion of those patients deriving from demographic groups historically marginalized within the national health system, including minorities and patients on Medicare and Medicaid.
You’re not just a caregiver and comforter when you are a nurse. Every nurse knows that patient education is one of the most critical aspects of the job. As the patient’s primary advocate and point of contact, nurses are uniquely positioned to help educate patients on critical issues, such as disease prevention and management.
And technology is often one of a nurse’s most essential tools for increasing health literacy. For example, nurses may engage with patients one-on-one through email or private video conferencing, create digital documents on a clinic’s website to address common patient health concerns, or conduct remote seminars and online patient education events to help disseminate health and wellness information to the community at large.
This means that nurses, as educators, need to cultivate their expertise in an array of productivity and communication technologies, from secure video conferencing platforms to the creation of documents, images, videos, and infographics for online consumption.
In addition, tech literacy in nurses is also critical for supporting the digital health literacy of patients. Patients, for instance, may need to learn how to use telehealth services securely and effectively. They may also need help locating reliable health information online or may be subject to health misinformation due to their relative inexperience in assessing the credibility of online information.
However, a highly tech-literate nurse can play an invaluable role in helping patients learn to use telehealth and navigate the confusing sea of online medical information — the good, the bad, and the unproven.
Researchers have found, for instance, that 89% of health consumers look up medical information online before consulting with their doctors. However, without the aid of a technically proficient nurse to show them how to separate the wheat from the chaff when it comes to health claims found online, the consequences of a health-related online search may be dire.
Tech Literacy as a Conduit for Nursing Leadership
Nurses are caregivers and educators, but they’re also leaders, and the mastery of technology can be an important vehicle for ascending through the ranks of your profession. For instance, cultivating a broad leadership and technical skill set ensures your versatility within the field, enabling you to deliver the same superior level of care in the telehealth domain as you do in a physical clinical setting.
In addition, developing robust technical skills also helps you engage in advanced research that is valuable for nurse leaders. This might include, for example, the ability to use technology to compile and analyze massive quantities of Big Health Data and then transform this analysis into evidence-based nursing care practices that can significantly improve patient outcomes and experiences.
The Takeaway
Tech literacy isn’t tangential to the practice of nursing. More than ever, technical skills are critical to quality patient care. Tech literacy helps nurses increase access to and care for the most vulnerable patient populations. It supports the nurse’s efforts to bolster patient health literacy, including their digital health literacy, which can, in turn, protect them against potentially dangerous online health misinformation. Tech literacy is also a central component of nursing leadership, enabling aspiring nurses to rise to the top of their profession as skilled, versatile, and knowledgeable practitioners.
