From RN to APRN - How Much Experience Do I Need?

“How much experience do I need before becoming an Advanced Practice Registered Nurse (APRN)?”

If you ask 10 different APRNs you will likely get 10 different answers.

As a nursing instructor and Family Nurse Practitioner (FNP) student myself, this is probably the most frequently asked question I get.

Unlike the MD or PA route, nursing has no standardized way for continuing education. There is no data. No scientifically proven route that supports better patient outcomes. So, that means most of us have to rely on the advice, experiences and personal opinions of others. Oh, and random blog posts like this one.

Let me tell you.

People get fired up about this discussion.

REAL fired up!

alphabet soup

Before we jump in, let’s do a quick refresh on what exactly Advanced Practice Registered Nurses (APRNs) and Nurse Practitioners (NPs) actually are.

• APRNs need at least a master’s degree and include certified nurse-midwives (CNM), certified registered nurse anesthetists (CRNA), clinical nurse specialists (CNS) and nurse practitioners.

• Nurse Practitioners (NPs) specialize in a population focus (pediatrics, family, acute care, psych, adult/gerontology, etc) and work to diagnose and treat health conditions. They emphasis disease prevention, health promotion and health management.

• In other words, every NP is an APRN but not every APRN is an NP.

the great debate

Still with me? If so great! You are probably thinking, “yep, still want to be an APRN over here. Sooo how much experience do I need? Get to the point already!”

I wish I could make this easy for you, but unfortunately there is no one right answer.

Seasoned RNs/APRNs/NPs will tell you at least three to five years at the bedside are needed before you go back. That experience is crucial, necessary and should never ever be overlooked.

New grads rushing back to school without experience has actually left many bedside nurses feeling threatened and/or devalued, to the point where they may bully you into questioning your path. Why hospitals (and our society) fails to value the bedside nurse and why does every young RN want to leave and become an APRN is a whole other post…so let’s stay focused. 

On the other side you have direct-entry APRN programs that push no experience necessary. Nursing students heading into their last semester already applying for APRN specialty programs before they take the NCLEX. If you know you want to be a NP, why wait? The role of the APRN is completely different from the RN anyways, so get in and get out. 

While both sides have reasonable points, a valid question is raised here. How can you be an “advanced practice” nurse without really having “practice”?

My Path to NP

Here’s a quick recap of my healthcare experiences that led me to purse a career as a FNP.

• BS in Physiology and Neurobiology from the University of Connecticut. During these years I volunteered in an ER and worked in research over the summer.

• 2 years of clinical research at the Shirley Ryan Ability Lab (previously the Rehabilitation Institute of Chicago). This is where I was first exposed to NPs and found my passion for community health & primary care.

• Started a 2.5 year grad-entry MSN Nursing program. Continued to work in clinical research through most of it.

• Worked almost 2 years at the bedside on neuro and cardiology inpatient units.

• Started my Doctorate of Nursing Practice (DNP), FNP program.

Right now I have two more years left of the program. I teach as a clinical nursing instructor and work as a community health RN. So, counting my years of clinical research before and during my nursing training, it will be over a decade in healthcare by the time I see patients as a provider.

to learn more on why I decided on the FNP / DNP track, visit my post here.

As someone who heavily considered a direct NP program myself, looking back I am exceptionally grateful for the two years I had to train at the bedside before going back. Truly, those years were invaluable. Which leads me to my general answer to this question.

My advice? Give Yourself Time 

Whether you decide on two years like I did or want more - I really advise you to take at least a year or two off. Give yourself time to build the confidence and critical thinking skills you will need as an APRN. You will learn how to educate, advocate and care for your patients on levels you probably did not know existed.

being a new grad sucks

This is my next reason you should take at least a year before going back.

95% of what you will learn as a nurse does not happen in school, but on your first job as a new grad. That first year of being a new RN is incredibly demanding, stressful and exhausting. For me, it was far more demanding than nursing school. I cannot imagine how I would have handled starting another program on top of that adjustment.

Choosing a population specialty 

Next, even though you may think you know your population focus (pediatric NP, CRNA, FNP, Acute Care NP, midwife, etc)...you also may not really know for sure.

My gut instinct of going the FNP route was spot-on, BUT this isn’t always the case. I know plenty of nurses that thought acute care was their path but after experiencing it at the bedside realized it was too emotionally taxing for them. Or vice versa, some nurses think primary care is their calling but fall in love with the intensity of the hospital and end up finding primary care boring AF. Some are dead-set on midwifery, but later find out they can serve women on a larger scale in community health or general women’s health. And so on, you get the idea.

Maybe you are like me and your gut feeling is right. Maybe it’s not and you change your mind. Either way is OKAY! We should evolve with our experiences. Just be sure to give yourself time so you don’t waste your time, money or sanity pursuing a speciality that is not true to you.

enjoy some time off

Adjusting from being a student to joining the work force is an adjacent that has it’s perks. Make some money and for the love of god, give yourself a break. See your friends. Travel. Have a freaking life! Your career and advanced education will be waiting for you, even if it’s just a year later.

exceptions to every rule

With all this being said, I do believe direct admission programs and going straight from RN to NP can work for some. It really depends on you, the life experience you bring to the field, the program you apply to and of course your motivation, personal readiness and dedication. I am sure there are some brilliant, world changing providers that had little to no RN experience and some nurses that worked at the beside for a decade that aren’t quite as sharp in the APRN role. But, in general I do think there are major benefits to taking your time and getting experience.

I’ll leave you with this: think about how long you have left in your career. Maybe it’s fifteen years or maybe it’s fifty! Why not wait at least a year or two to regroup, hone your skills and be sure you are choosing the right path.

Regardless of when you go back to school, continuing education is ALWAYS an admirable thing to do for yourself and the nursing profession. Props to you for being invested enough in this question to get through this post.

If you are thinking about pursuing a career in nursing, as an NP or FNP I hope this helps! Please reach out with any questions, thoughts, or ideas. Drop me a line in the comments or find me on social media. I’d love to hear from you!

The Toll of Lateral Violence & How to Handle It

“Nurses Eat Their Young”,

An unfortunate, yet well understood statement that every new grad nurse and nursing student is familiar with.

I remember as a nursing student wanting to be invisible during my clinical rotations.

As a new grad nurse I would sneak off and cry in the bathroom, and pray no one would hear me.

Even as a more seasoned nurse there were many days I wondered if I made the wrong decision going into this field. 

It wasn’t the 14 hour shifts, the exhaustion from working overnight or the disappointment of working on Christmas and Christmas Eve. It wasn’t the compiling emotional toll or compassion fatigue from seeing constant illness and sadness either.

It was other nurses.

The dirty look after you give report.

A demeaning comment after you ask a question.

Gossip in the breakroom.

An eye roll from a senior nurse.

Giving you an unfair assignment and refusing to help.

Unit cliques, scapegoating, intimidation, shaming, blaming, withholding information, hostility, sabotage, passive aggressive, rude, judgmental, sarcastic or disrespectful actions or comments. 

It can leave you feeling anything from undermined, belittled or inadequate to straight-up humiliated.

This is not just nurses eating their young, it’s lateral violence (LV). 

Lateral Violence 

That’s right, there is an actual term for the bullying experienced in nursing culture, and it is well-documented in the literature in America and around the world. Lateral violence, AKA workplace aggression, bullying or peer incivility is a systemic, complex and pervasive problem . 

• 93% of nurses report witnessing lateral violence in the workplace.

• 85% of nurses had experienced it, but 90% had difficulty confronting the perpetrator.

•  40% of nurses reported definite intent to leave their current position, or were considering leaving because of it.

• Over a 6-month period, 88% of nursing students experienced bullying in the clinical setting.

So how is it that the most trusted profession, the most honest and ethical, has this devastating, hidden culture of bullying? 

Explained

Theorists since the 1970s have believed that members of oppressed groups (nurses) feel powerless, inferior and devalued in a culture where power resides in a more dominant group (providers). Unable to take frustrations out on the dominant group, they develop disdain for members of their own group. This powerlessness is the foundation in a cycle that is perpetuated by aggression and anger towards each other. Over generations, it has affected nearly every specialty, academic setting and organizational level of nursing (ANA, 2015).

On top of that, nurses struggle with incredible physical, emotional and mentally exhaustive work conditions. There is a nursing shortage, hight patient-to-nurse ratios and unfair pay. Plus personal lives, relationships and families at home to balance…it’s not an excuse, but this stress definitely doesn’t help the situation.

So what?

Unless you have experienced it yourself, you may think this sounds a little dramatic. An eye roll here and there...really? It can’t be that bad...right? 

Wrong.

LV has serious implications on the mental and emotional health of nurses and at the very worst, threatens patient’s safety. LV has been associated with:

• nurse burnout

• psychosomatic symptoms such as headaches, frequent illness, depression, PTSD & anxiety

• poor quality of life

• impaired relationships

• fear of going to work/ absenteeism

• decreased quality of care & collaboration

• reduced productivity

• dissatisfied patients

(ciocco, 2017)

This has become such an issue that in 2015 the American Nurses Association (ANA) convened a Professional Issues Panel on Incivility, Bullying, and Workplace Violence. In their released statement, they affirmed a zero tolerance policy for any kind of this violence.

The Joint Commission also issued a statement that bullying has no place in healthcare in 2016, and implemented a standard requiring accredited hospitals to define and address all forms of disruptive behavior in the workplace. 

On a bigger scale, nurse’s disruptive and inappropriate behaviors towards our own keeps us from developing a sense of unity and gaining power in the ever so hierarchical structure of the healthcare system.

So WHAT TO DO??

Confront It.

As much as you don’t want to, you have to confront the perpetrator. Address it as soon as you can, in a firm but not accusatory manner. Here’s what I mean:

• First, take a moment. Do not dismiss your feelings or blame yourself for what happened. Pause and take a deep breath, ten minutes or whatever you need to compose yourself. As hurt as you may feel, responding emotionally will only make you look unprofessional and make things worse.

• Be the Bigger Person. When you have calmed down and have your thoughts together, I want you to come from a place of compassion. Why may they be acting like this? Are they overwhelmed with patients? Maybe they had an argument with their spouse this morning or their child is sick at home. Perhaps they were a victim of LV earlier that shift and now they are just taking it out on you. By starting from a place of empathy, you are setting the tone for a more constructive conversation. 

• Communicate your boundaries. You need to be clear about what behavior is and is not acceptable, and that you will not tolerate it. 

• Set goals. Be specific about your needs and expectations with this co-worker moving forward. Tell them how you would like to be treated in the future, and what you hope for the rest of the staff moving forward. 

short, sweet(Ish) and to the point

Stand up Against It  

If you witness LV, keep in mind that silence is complicity. All nurses must stand up against this behavior and advocate for a culture of respect, compassion and unity. If you see LV in any shape or form, diffuse the situation and appropriately stand-up for the nurse that needs your voice. Let the person know that their actions do not reflect the values of the unit culture or our profession.

Talk to Your Manager

Per recommendations from the ANA, your managers need to adopt a zero-tolerance policy in the workplace. Express your concerns and experiences. They should also be responsible for cultivating an environment where nurses feel safe and comfortable reporting acts LV and bullying. They should take these reports seriously and respond timely. 

Keep Record 

Gather all details of these incidences with dates, times, witnesses and specifics. Bringing bullying to HR may seem dramatic but it’s not. That is what HR is there for, so include them  early and often.

For Nursing Student:

You especially will feel hesitant to speak up but I absolutely encourage you to practice doing so now. At the very least, tell your clinical instructor, preceptor or take it up the faculty chain.

For New Grads:

Look for hospitals with New Grad Nurse Residency Programs that may teach you further skills necessary to deal with LV and prepare you to confront these issues.

If your Manager Doesn’t Listen

Direct them to the ANA’s zero tolerance policy and remind them they are expected to hold nurses accountable to the ANA’s Code of Ethics for Nurses. You can also direct them to the resources at the end of this post.

Know Your Limits

If you feel like you have exhausted all options, consider if this position is worth it. I have known plenty of nurses that have left their jobs for more positive work environments. There is no room for this behavior in nursing, and if it’s not being addressed, chances are that won’t change any time soon. Empower yourself by finding a new job that respects your boundaries and provides the kindness, dignity and respect you deserve.

If Needed,

seek behavioral health services or therapy. Workplace bullying is not a joke. It can seriously impact your long term mental, physical and emotional health.

Educate Yourself & Take Collective Action

While managers can create and enforce policies, real change can start with you. You can educate yourself and create a culture that is safe and supportive for nurses. Use this as an opportunity to join a unit committee or start a quality project to address bullying.

More than anything, remember that lateral violence is not a right of passage. It is not normal. For any nursing student, new grad or seasoned nurse, it is 100% unacceptable and it needs to stop.

I hope this gives you the confidence to step up for yourself in the workplace, but more so I hope this reminds you that you are not alone. Your mental, emotional and physical health is just at important as the patients you care for. Continue to advocate for yourself, and reach out if you have any specific questions, thoughts or ideas. 

Drop me a line in the comments or find me on social media, I would love to hear from you! 

Resources 

Nurses Eat Their Young: Inside The Nurse Bullying Crisis by Olivia Thompson 

ANA Podcast Series on Bullying

Combating Bulling, Incivility and Workplace Violence:  What Nurses Need to Know in a Nutshell by Maggie Ciocco MS RN BC  

Nurses Inspire Nurses who provide bimonthly classes teaching you all the things you didn’t learn in nursing school-confidence, handling emotions and the workplace environment. They also have the cutests NIN Apparel!

ANA on Violence, Incivility and Bullying

Joint Commission Workplace Violence Resources

Mental Health Resources  

SAMHSA Treatment Referral Helpline: 1-877-SAMHSA7 (1-877-726-4727). Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST.

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

References 

Bartholomew, K. (2006). Ending Nurse to Nurse Hostility: Why Nurses eat their young and each other. Marblehead, MA: CiHCPro, Inc.

Budin, W.C., Brewer, C.S., Chao, Y., & Kovner, C. (2013). Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship, 45(3), 308-316. 

Clarke CM, Kane DJ, Rajacich DL, Lafreniere KD. Bullying in undergraduate clinical nursingeducation. J Nurs Educ. 2018;51(5):269–276.

Ciocco, Maggie MS RN BC. (2017). Combating Bulling, Incivility and Workplace Violence:  What Nurses Need to Know in a Nutshell

Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An Intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257- 262.ed

Jacobs, D., & Kyzer, S. (2010). Upstate AHEC lateral violence among nurses project. South Carolina Nurse, 17(1), 1.

McKenna, B., Smith, N., Poole, S., & Coverdale, J. (2003). Horizontal violence: Experiences of Registered Nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96. 

Laschinger HK, Wong CA, Cummings GG, Grau AL. Resonant leadership and workplace empowerment: the value of positive organizational cultures in reducing workplace incivility. Nurs Econ. 2014;32(1):5–18.

Read, E., & Laschinger, H. K. S. (2013). Correlates of new gradu- ate nurses’ experiences of workplace maltreatment. Journal of Nursing Administration, 43(4), 221-228.

Rowell P. Being a ‘‘target’’ at work: or William Tell and how the apple felt. JONA. 2005;35(9):377-379. 1995;4:5-9. 

Stanley, K., Martin, M., Michel, Y., Welton, M., & Nemeth, S. (2007). Examining lateral violence in the Nursing workplace. Issues in Mental Health Nursing, 28(11), 1247-1265.

Thomas S. Horizontal hostility nurses against themselves: how to resolve this threat to retention. Adv J Nurs. 2003; 103(10): 87-88,90-91.

Wilson, B.L., Diedrich, A., Phelps, C.L, & Choi, M. (2011). Bullies at work: The impact of horizontal hostility in the hospital setting and

10 Tips for Studying at Home

Studying at Home

can definitely present some challenges.

If you are a student in 2020, especially a nursing student, I feel for you. Distraction, procrastination and focusing through long lectures and study sessions were hard enough before. Since the pandemic, most students have no other choice but to make studying from home work.

Fortunately, as a FNP doctoral student I am right there with you. I know it can seem harder than ever to stay motivated, but I hope with these tips you can make the most of learning from home.

Grab your laptop, books, witty coffee mug, gel pens and the rest of your study supplies. Let’s jump in!

1. CREATE A SACRED STUDY SPACE

Whether you are studying in your home office or at the corner of your kitchen table, try to dedicate a learning area separate from your sleeping/relaxing area. Make this special space your own by having your favorite coffee mug, candle and maybe little plant, piece of art or motivational quote. It should be cozy and comfortable, but still clean and organized.

If you can, take your online exams here too! Studies show you recall information better information where you learned it.

2. DO NOT DISTURB

Saying “no” to family or friends when you don’t physically have to go to class can be tough, but the time has come to set up some major boundaries. Let your family or roomies know when you need to study. Whether this is a set time each day, a block of hours on the weekends, or all day before an exam, LET THEM KNOW. Put a reminder for them on the fridge or even a little sign up in your study area. Hopefully this can promote an uninterrupted environment for you, while avoiding unnecessary arguments and frustrations.

3. QUIET ZONE

Even with family/roommates respecting your do not disturb boundaries, studying at home still presents noise challenges. Siblings watching TV, fur babies barking, real babies crying, construction outside, the list goes on. To cancel out any unwanted noise invest in a pair of noise canceling headphones if you can, (AirPods Pro are pricey but worth it in my opinion), try earplugs, or whatever headphones you have. I tend to get too distracted when my music has lyrics, so experiment with what works for you- classical, jazz, or binaural beats which are an emerging form of sound wave therapy! Spotify also has white noise playlist if any sort of music is too distracting.

4. GET ORGANIZED  

The first thing I do when my semester syllabi get posted is pull out my Life Planner from Erin Condren and go to town. Every paper deadline, test dates, discussion board due dates and everything in between. This way you can look at your weeks and months in advance and be on the lookout for those weeks where you have multiple assignments and tasks. From there I like to keep sticky notes for my individual day to-do lists. Pandemic or not, staying organized, planning ahead and staying on schedule is a nursing school essential.

If you don’t have a solid desk area or need to switch it up, try out a lap desk!

5. ROUTINE, ROUTINE, ROUTINE

As much as quarantining has allowed us to embrace sweatpants all day, structure is key. Get dressed, fix your hair, make your morning coffee and incorporate all parts of your usual morning ritual as if you were heading to the library or cafe. 

If your lectures are posted online to view at your own speed, create a routine around them as if you had to go to physical class. If you fall behind on your material it will be extremely stressful to catch up, so designate your class time and “show up”, to help get some normalcy of routine.

6. STAY FOCUSED

First off, put your phone away. Like, in the other room. Or in the drawer. On airplane mode. If that’s too much at least turn off the notifications.

I also like to get everything in order- snacks, water bottle and study supplies before I actually sit down for a study sesh so I avoid having to get up besides scheduled breaks. If you have a hard time with distractions, try the be focused app for your computer/phone which allows you to adjust settings for amount of work and breaks.

7. SCHEDULE BREAKS

Did you know studies show that taking breaks actually improves your attention? Stretch, clean up, cook a meal/make a snack or latte, get outside, go for a walk and podcast, call a loved one, meditate, or get in a quick workout. I find with my study breaks, scrolling on my phone or watching a Netflix show makes it exponentially harder to get back in the zone, so I generally prefer breaks to be away from screens. Find out what works for you, take your breaks and come back with some fresh motivation.

8. LOOK OUTSIDE YOUR ASSIGNED MATERIALS 

Since we are moving a lot of our nursing education online, we might as well embrace all the world wide web has to offer! Search youtube videos like the ones from Khan Academy NCLEX-RN, collaborate on Quizlet (search nursing or the specific topic), and download the NCSBNS NCLEX RX App for memorizing drugs. Pinterest (yes, Pinterest) also has witty mnemonics, funny diagrams and helpful tips for studying nursing content.

For extra back-up, Osmosis has tons of videos for A&P review, practice questions and resources dedicated for specific healthcare student programs. 

9. ZOOM STUDY GROUPS

I know you might feel zoomed-out, but research shows that students who study with peers retain 90% of the material, versus 60% of what they hear in class. For you hard classes, schedule a weekly meeting with a few classmates to stay on track with material. I personally like to have gone through the material myself to feel as prepared as possible before heading into a group.

10. ASK FOR HELP

Learning from home is hard. Remember your instructors and faculty are also having to figure this out as they go, so chances are they will be very understanding of your needs and concerns. Don’t hesitate to reach out with questions and utilize additional support, TA office hours, tutors & resources found on your (e)campus. If you are heading back to clinical, check out my post answering all your Clinical and COVID FAQs.

I hope we will be back in our cozy coffee shops or posted up at the library soon, but for now I hope this helps as we are all studying from home. Stay safe and please do not hesitate to reach out if you have any specific questions, thoughts or ideas. Drop me a line in the comments or find me on social media, I’d love to hear from you!

Nursing Clinical During COVID: Your FAQs Answered

We are in a pandemic,

and if you are a nursing student right now, things are less than ideal.

The clinical hours spent at the bedside in a nurse’s education are vital. It’s where you practice those hands-on skills and develop comfort of patient interactions- things you simply cannot teach over zoom or on a mannequin. However since the pandemic, academic institutions and hospitals have had the unprecedented ethical consideration of valuing hands-on clinical education against the risk of COVID-19 exposure for staff and students. COVID is changing the future of nursing education and if you are currently in school, you are the guinea pigs. Awesome...

First, let me tell you that I am so sorry. I’m sorry on top of everything you need to deal with as a nursing student that this is happening. With that being said, you also are getting to learn from the true heroes of this pandemic. You are witnessing the strength of our field and nurses coming together. You are seeing healthcare workers step up, advocate for themselves and their communities. For the first time, healthcare workers are being celebrated for their undeniable dedication for the wellbeing of others and I hope you find inspiration in that.

While questions undoubtedly circle your mind, I hope as a clinical nursing instructor I can provide some insight and advice to your very well justified concerns. These opinions are my own. Always follow the guidance of your own institution or University that is taking your specific community transmission, local and state regulations into consideration. 

FAQs

I’M WORRIED I FORGOT ALL OF MY CLINICAL SKILLS

Don’t fret, you are not alone here. Your clinical instructors are well aware of the pandemic putting the last few months of clinical experiences on hold. Refresh on the most important skills before heading back: checking vitals, PPE, infection control, hand hygiene, safety and the physical assessment. Don’t put too much pressure on yourself to pick up exactly where you left off, and never hesitate to let your instructor know your concerns or ask for help.

IF WE MOVE BACK ONLINE SOON, HOW CAN I MAKE THE MOST OF MY CLINICALS NOW?

Completing complex clinical skills will come over time. As I like to tell my students, you can teach a monkey to start an IV. Right now, stick to the basics I described above, focus on your patient interactions and thinking critically about their disease processes and plans of care. Come prepared and don’t be afraid to ask questions.

For the last few months, patients have been limited with the amount of visitors allowed and probably still are! Use this as an opportunity to be a source of emotional and educational support for your patients that are most likely feeling lonely and isolated. I am sure they will love your extra company and attention. 

WHAT IF ALL OF MY CLINICAL GOES VIRTUAL?

Unfortunately, we on the academic side are preparing for another COVID wave and yes, there is a strong chance we will shut back down and go to remote learning (if your institution hasn’t done so already). Take comfort knowing your faculty is keeping the health and safety of you and your loved ones a top priority. Nursing education is changing and this will most definitely be reflected in training new nurses coming out of the pandemic (hello NCLEX already adapting!). It’s your job to get through nursing school, not figure out how to get clinical hours. Save that problem for your faculty and the nursing board of licensing to figure out.

If and when virtual clinical comes, make the most of it. Come prepared, ask questions and consider a zoom study group.

check out my post here if you are learning remotely

I’M MISSING MY DREAM ROTATION. HOW WILL I KNOW MY SPECIALTY?

One of the most exciting parts about going through nursing school is experiencing the different specialties- peds, L&D, psych, community health, etc. Having an entire specialty rotation cut out of the mix can leave you with a lot of question and uncertainty. My personal advice: chances are if you just have a feeling peds is for you, or you just know L&D is your calling, then you are probably right.

Missing your dream NICU rotation? don’t give up!

BE PROACTIVE. Try to find outside volunteer experiences on these units now if you can or when the pandemic calms down (who knows when that will be). Reach out to those specialty clinical directors at your institution to see if they have any connections with hospitals allowing volunteers or nursing students just to shadow, even for one or two shifts. That may be enough to confirm that specialty is right for you. You can also reach out to find nurse mentors that work in that field. Pick their brains - ask what drew them to that speciality, pros/cons of that work, what a typical day is like, what recommendations they have for volunteer or work opportunities during the pandemic to get more experience.

SHOULD I GET A JOB AS A TECH/CNA TO GET HANDS ON EXPERIENCE?

This may not be a popular opinion but unless you are truly called to start working as a tech or CNA, I would proceed with major caution. Training and working as a tech/CNA is extremely demanding and the pandemic has made it even more challenging. Starting a new job, plus COVID, on top of your nursing course load is probably not a good idea right now.

However, if you are called to this work and want to help fight the good fight against COVID-19, major pat on the back to you. Do not let my opinion stop you. Nursing students that have CNA experience really have a leg-up getting comfortable with patient care and it will definitely help get you a job coming out of this potentially tricky market for new grads. If you are interested, start looking for a job now and maybe train over one of your breaks from school. 

I AM ANXIOUS, STRESSED & WORRIED I MADE THE WRONG DECISION BEING A NURSE

Another thought that is extremely common for nursing students, pandemic or not. Take care of yourself by approaching your immune system holistically- prioritizing nutritious foods, hydration, exercise, sleep and self care. Whether that’s an online yoga class, journaling in the morning, downloading a meditation app like Calm or calling a loved one, find those practices now and stick to them.

However, as the months continue through the COVID-19 pandemic, increasing anxiety and depression is common for many people, especially those in healthcare with higher exposure. Know your limits, give yourself some grace and reach out to your faculty, other students and campus organizations for extra support. Most universities are offering remote counseling and support groups. See the resources at the bottom of this post for more.

I’M ABOUT TO GRADUATE AND FEEL TOTALLY UNPREPARED

Let me let you in on a little secret….Ready?

All nursing students feel completely unprepared heading into their first jobs, pandemic or not. Believe me, 99% of what you learn as a nurse will happen during the first year on the job. While clinical is a great experience to get you ready for that, the amount of learning that will happen in that first month of you working will probably be more than all of our clinicals in nursing school combined. 

When applying for jobs, look for nurse residency programs that support new grads. Discuss your concerns with managers while applying because again, you are not alone. Seek mentors on your unit when you get hired and give yourself some time & patience. Your managers, preceptors and fellow nurses will know you trained during the pandemic and hopefully will give you that extra support and time that you deserve.

I’M WORRIED I WON’T BE ABLE TO FIND A JOB

That’s right, we are in a global pandemic and some nurses are having a hard time finding work. With hiring freezes and stressful work conditions, unfortunately hiring and training new grads is not at the top of many hospital’s to-do lists.

If you have a stable job already and are not itching to start your RN career, my advice is to take a break while you job search. It can take some new grads anywhere from 6-10 months before finding a job anyways (that’s why I say NETWORK, NETWORK, NETWORK when you are in school).

If you are dead set on starting a nursing job right away, try to make as many connections as possible before graduation. Reach out to old clinical instructors, instructors, faculty members about hospitals hiring new-grads. Attend virtual job fairs. If you can’t land your dream job during or after the pandemic, keep your head up. You have lots to learn in the nursing world and there are always opportunities to change units, hospitals or specialties.

I AM WORRIED ABOUT GETTING COVID ON MY CLINICAL SITE/BRINGING IT HOME TO MY FAMILY

If you are going on-site to clinical, you are not alone in your fears or stress. To get you up to speed and make sure you feel as safe as possible, check out my Tips for Staying Safe in Clinical During COVID-19. However, know that your safety is the most important and continue to advocate for yourself and your family. Express any concerns about exposure in clinical you have to faculty members and administrators.

I hope this gives you the support and comfort you need heading into clinicals. Stay safe and please do not hesitate to reach out if you have any specific questions, thoughts or ideas. Feel free to drop me a line in the comments or find me on social media, I’d love to hear from you!

 XOXO,

Jac

RESOURCES

Well-Being Initiative from the American Nurses Association (ANA).

Nurses’ Guide to Mental Health Support Services

The Guide to Sleeping Better and Restoring Energy

Download the Happy App, a nurse-specific platform that gives you access to 24/7 support.

If you feel overwhelmed beyond your limits by sadness, depression, or anxiety, or if you have thought of hurting or killing yourself, call 911. You can also call or text one of these crisis hotlines for immediate response:

Crisis Text Line: Text HOME to 741741 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or Live Online Chat . If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Lifeline. Trained crisis workers are available to talk 24 hours a day, 7 days a week. 

SAMHSA Treatment Referral Helpline: 1-877-SAMHSA7 (1-877-726-4727). Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST.

Nursing Clinical During COVID: Tips for Staying Safe

Tips for Managing Clinical During COVID

From juggling multiple courses, keeping grades up, learning complex skills, studying for boards and trying to curate a competitive resume, pursuing a nursing degree is beyond stressful. Amongst all of this, what do nursing students find the most stressful of all? Clinical (Dunh Dunh Dunhhhh!).

Like many students, this may be the first time you have been in a hospital or clinic setting working with real people, real patients. You are learning to take vitals, start IVs, chart, use complex thinking, respond to real emergencies. It’s normal to feel an immense weight of pressure, responsibility, and…fear.

It’s 2020, so let’s throw a pandemic on top of all of this. I would be worried if you as a student didn’t feel overwhelmed or uncertain right now. Learning to care for patients is hard enough, and the pandemic has brought additional challenges we could have never anticipated.

If you are a student going on-site to clinical, I’m here to tell you that you are not alone in your fears or stress. To make sure you feel as safe as possible heading into clinical, let’s get you up to speed with the tips & tricks healthcare workers have been utilizing for months throughout this pandemic to decrease their exposure to COVID-19.

After working in a clinic swabbing for COVID all summer, I have lots of insight!

BEFORE HEADING IN

• Make sure you are up to date with your University’s and/or clinical site’s compliance. To ensure safety, most sites are requiring additional COVID screens and temperature logs. Put a reminder in your phone and keep your thermometer in a place you will see it. For my students, anything over 100.0F is now considered a troublesome temp.

• Ask about your sites’ COVID protocols & precautions ahead of time, as well as the PPE available. Your clinical instructor should let you know what your institution is/is not providing. They should also reassure you that as a pre-licensure student, you will not be going anywhere near a COVID patient or COVID floor.

• If you feel more comfortable bringing additional PPE from home (N95 mask, goggles, scrub cap, etc) ask your clinical instructor. This should be fine but some units are more strict than others when it comes to BYO PPE.

• If you are considered high-risk, pregnant, have at-risk children at home, take care of at-risk family members, or have other specific COVID-safety concerns, take them to course instructors and up the administration ladder. Your safety is most important!

• In pre-COVID days, menstrual cramps and a little headache were not excuses to miss clinical. That’s now thrown out the window. If you develop any COVID symptoms defined by the CDC, stay home and let your instructor know ASAP. Do not second guess your symptoms. Do not feel bad. Do not worry if your think your peers will judge you. Prioritize your health and the health of your fellow classmates and patients. Follow up with protocols on monitoring symptoms, self-quarantine and getting tested. 

AT YOUR SITE

Even though you should not be working with COVID patients, you must be aware of potential exposure from other employees, students or patients that could be carriers or pre-symptomatic of COVID. Why not be as safe as possible!

• General hand hygiene practices and knowing the correct sequence of putting PPE on/off matter now more than ever. If you haven’t already done so, become an expert at washing our hands and being mindful of not touching your face.

ALWAYS practice hand hygiene before removing your mask!

• Remember soap and water should be used over hand sanitizer when hands are visibly soiled, after using the restroom and before eating.

• Nursing students are usually required to keep hair tied back and nails short anyways, so don’t expect any exceptions to this now.

• Social distancing with your patient obviously is not possible, however try to distance yourself from fellow students and staff members when you can and limit the amount of people/patients you are getting in close contact with.

• Avoid crowded elevators and take the stairs instead if you can.

• Eat alone, away from others.

• Disinfect work stations and computer keyboards for charting often.

• Leave all nonessentials at home and bring only what you need into clinical. Less stuff means less surfaces for contamination and less things to disinfect.

• If using a personal stethoscope, disinfect before and after use with every patient.

• Keep phones far, far away from patient care areas. If you need to hop on your phone, make sure you disinfect it. Get in the habit of doing this frequently, and definitely wipe it down if you are taking a break to eat. Consider storing it in a clear, sealable bag.

POST-SHIFT DECONTAMINATION ROUTINE

Although the research is not clear on COVID being transferred on your scrubs, healthcare professionals have been practicing religious post-shift decontamination routines to avoid bringing anything into their house or to their loved ones.

• Bring a change of clothes (clean scrubs, sweats or a t-shirt, whatever is comfy) and shoes to clinical if you can, and change before leaving or entering your home.

• When it’s time to change, throw your “dirty” and possibly contaminated scrubs into a pillowcase. Wash everything in hot water (as hot as your scrubs allow) with detergent separately from other laundry items. The pillowcase makes it easier to throw it all in the wash when you get home instead of using a bag and having to take it out.

• Change your shoes before you get into the car and put them in a bag in the trunk or garage (or other designated place no one will touch them). Throw them in the wash or clean them weekly with a strong disinfectant.

• Disinfect everything that comes on the unit with you or things that you touch: phone, keys, debit cards, ID, watch, pens, clip boards, etc.

• Disinfect your car after your drive home. Masks are not needed in the car if you are alone, but yes if you are carpooling. I keep a bottle of hand sanitizer in the cup holder so I remember to practice hand hygiene the second I get in the car!

make sure you are properly disinfecting and using an effective EPA-registered disinfectant

when you get home, wipe down everything you may have come in contact with: seat, steering wheel, cup holders, door handles, radio knobs.

• When you get home, strip everything off and hop in the shower. Find a spot in your garage or entryway you can keep seperate from the rest of your household to do this.

• Hold the hugs with family members and fur children until you have completed all of the above. Be sure to talk to your loved ones at home or roomates about COVID-19  transmission and let them know about your routine. See if they can help out by opening the laundry machine, setting out a clean towel by the shower, and keeping kids/pets away until your are all clean.

Learn more here on how to keep yourself and your family safe.

FOLLOW THE EXPERTS

As a future nurse it’s important to remember the  Centers for Disease Control and Prevention (CDC) is our gold standard for evidence-based information in the U.S. Stay up to date on guidelines and protocols in this evolving pandemic.

STAY FLEXIBLE

If you are back at clinical sites, there is a strong chance that we will have to shut back down and go to all virtual and remote learning again. Stay flexible with your faculty as they also navigate the pandemic and keep your safety as a top priority.

TAKE CARE OF YOURSELF

Approach your immune system holistically by prioritizing nutritious foods, hydration, exercise, sleep and self-care. Whether that’s an online yoga class, journaling in the morning, downloading a meditation app like Calm or calling a loved one, find those practices now and stick to them.

For more ideas check out my post on Self Care.

Utilize resources like the Well-Being Initiaive from the American Nurses Association (ANA). Their Nurses’ Guide to Mental Health Support Services is a great starting point, as well as The Guide to Sleeping Better and Restoring Energy. You can also download the Happy App, a nurse-specific platform that gives you access to 24/7 support.

ASK FOR HELP

As the months continue through the COVID-19 pandemic, increasing anxiety and depression is common for many people, especially those in healthcare with higher exposure. Know your limits, give yourself some grace and reach out to your faculty, other students and campus organizations for extra support. Most universities are offering remote counseling and support groups (for UIC students check out these resources)!

Check out my post before heading back to clinical!

I hope this gives you the support and comfort you need heading into clinicals. There are few career choices as selfless, honorable, and rewarding as becoming a nurse. However, know that your safety is the most important and continue to advocate for yourself and your family. Stay safe and please do not hesitate to reach out if you have any specific questions, thoughts or ideas. Feel free to drop me a line in the comments or find me on social media, I’d love to hear from you!

 XOXO,

Jac

RESOURCES

Keep in mind the high-stake decisions and moral duress healthcare professionals currently face will undoubtedly take a toll on our field. If you feel overwhelmed beyond your limits by sadness, depression, or anxiety, if you have had hurting or killing yourself, call 911. You can also call or text one of these crisis hotlines for immediate response:

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Crisis Text Line: Text HOME to 741741 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or Live Online Chat . If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Lifeline. Trained crisis workers are available to talk 24 hours a day, 7 days a week. 

SAMHSA Treatment Referral Helpline: 1-877-SAMHSA7 (1-877-726-4727). Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST.

REFERENCES

American Nurses Association Well-Being Initiative - Free Tools to Support the Mental Health and Resilience of All Nurses

 Centers for Disease Control and Prevention (CDC) - Get the Facts About Coronavirus

 Centers for Disease Control and Prevention (CDC) -How to Protect Yourself

Joint Commission - Preventing Coronavirus Transmission in the Hospital Setting

OSHA - COVID-19 Precautions for Healthcare Workers

Reflections from the Frontlines

Reflections from the Frontlines

of the COVID-19 Pandemic

Hand sanitizer for 15 seconds.

Gown.

Booties.

Hand sanitizer again.

N95 mask and seal check.

Surgical mask, secured with bobby pins to keep it tight.

Hair net over my slicked back military bun.

Face shield.

First pair of gloves.

Second pair of gloves.

Ready.

This is the order I ritually put on my personal protective gear or PPE, the household term we are now all familiar with in 2020. Lack of supplies has not hit my institution as hard as others, however I have been asked to reuse my N95 mask over the course of multiple shifts. Sometimes I look down at my one N95 mask and remember how frequently we used to discard them. Before the COVID-19 pandemic and PPE shortage, discarding your N95 mask after every single use was considered best-practice. As I head in to see my first patient of the day, I pause. “Wait, did I forget my second hand sanitizer before touching my mask? No, I did it...I think...right? Well, here we go. Let’s do this”. 

As you may know I am a clinical nursing instructor, family nurse practitioner doctoral student, and now a nurse working on the front-lines of the COVID-19 pandemic in Chicago. I am also IGrow Chicago’s resident nurse, “Nurse Jackie” as neighbors of our community call me. Right now the pandemic has brought me to an employee health COVID clinic where I perform the notorious nasopharyngeal swab for healthcare professionals. Described as anywhere from chlorinated pool water up your nose, to feeling like a stick is penetrating your brain, the coronavirus swab is anything but comfortable. I am testing employees, doctors and nurses who have performed the test on dozens of patients themselves. 

In efforts to decrease transmission, patients are advised not to talk, though this guideline is rarely maintained. They are scared, uncertain and understandably in need of kind and compassionate words. Some patients shake, they cry or nervously ramble. Some are so anxious they uncontrollably laugh, in the way some displace emotions in a subconscious attempt to reduce anxiety. Many patients are healthcare workers I know. They are nurses that taught me how to start IVs. Nursing techs that have helped me monitor patients over 16 hour long shifts. Doctors I have rounded hospital halls with and have paged at 2AM about an unstable patient.

They are the health care professionals you now see in the newspaper, on TV and gracing billboards off the highway. They have been celebrated for their bravery and commitment to serving our community. They are mothers, fathers, sisters and brothers. They are friends. And they are now the patients. I am reminded every day how easily I too, can be the patient. Knowing my eyes are all they can see under my PPE, I look each person directly in the eye with my deepest empathy and compassion. I hope they can tell I am smiling, sending my love and trying my best to be there for them during this somewhat traumatic moment.

As the coronavirus pandemic sweeps the world, all eyes are on healthcare professionals and first responders in a way that could never have been anticipated. We are praised by loved ones and the media, but we are also uncertain. We are also scared. I have had my fair share of sleepless nights, panic attacks and have shed many, many tears. I wonder if today is the day my mask fails me and I am exposed. I wonder if today is the day I bring this disease home to my fiance who has stood by my side this entire time. Headlines of nurses dying of COVID in their own ICUs, doctors seeing devastating scenes of the coronavirus who took their own lives. I think about my twin sister working in an ICU, who is watching patients dying without a chance to say goodbye to loved ones. I pray she is given a clean mask today. The high-stake decisions and moral duress healthcare professionals currently face will undoubtedly take a toll on our field.

There are thousands out of work and unable to put dinner on the table. We are all facing unprecedented loneliness and lack of physical connection. This pandemic has hit Chicago’s vulnerable populations including the IGrow community in Englewood especially hard. They face barriers including food insecurity, lack of internet (meaning lack of updated information), jobs and/or housing where social distancing is not an option. This population in which trauma is no stranger, must rise against an inadequate healthcare system and decades worth of injustice, oppression, systemic racism and health disparities. 

I feel my chest tightening, a lump in my throat and tears welling up in my eyes. I am frustrated, angry and scared. When my anxiety and fear seem to be taking over, I pause. Breathe. I look at the quote on my office table from Florence Nightingale, “The Lady with the Lamp,”. A social reformer, advocate and the founder of modern nursing,

“How very little can be done under the spirit of fear.”

Lithograph by Robert Riggs ca. 1930 with modern watercolor via The Independent

I refocus my energy and count my blessings. I have my health, a safe place to shelter, clean water, nourishing food, safe streets to walk down. I have my purpose: to serve my community and care for those most vulnerable. Succumbing to fear will not address the deep-rooted flaws in our healthcare systems or the disparities that are quite literally determining life and death in this pandemic. It will not change the 30-year difference in life expectancy that already exists between the Streeterville and Englewood neighborhoods of Chicago. 

“How very little can be done under the spirit of fear”

During this time of crisis, we all see the way we can contribute, adapt, and take the lead. Whether you are on the frontlines, making masks, checking in on loved ones, supporting local or just staying home, you are part of something bigger than yourself.  IGrow Chicago has donated thousands of meals, dozens of bars of soap, bottles of hand sanitizer and toilet paper. We are supporting children in remote learning, providing tutoring, legal benefits and financial support. Our medical volunteer team has expanded to four volunteer medical students and a fellow nurse. Together we make calls to over one hundred families to check on potential symptoms, mental health needs and share latest updates from the CDC regarding protection and safety. All families have my personal phone number to call or text with any questions or concerns. 

At the end of my shift, I remove all PPE items in another specific order. I carefully take off my N95 mask, seeing it’s rough outlines on my skin as I place it in a safe and secure bag. I drive home from the clinic and begin my strict post-shift routine. Nothing with me or on me at the clinic enters the house. Work clothes and shoes are tossed into a pillowcase to be washed on the highest heat possible. After I disinfect the car and my essentials, I run to the shower. As the water streams down my face, my fears and anxieties also wash away. I have hope. I dream of the day I can once again hug neighbors at the most special place on 64th and Honore. The Peace House at IGrow Chicago, where love lives in public, where no life is expendable and where we always choose love.

My RN Report Sheet

Nursing Handoff:

an essential yet terrifying part of your job as a new nurse.

If you have ever felt overwhelmed, unprepared, or straight up shoook during handoff, you are not alone.

Giving a thorough and accurate report during change-of-shift is critical for patients, but it can give any new/student nurse anxiety beyond belief. In my early nursing days there were times I:

• Cried after giving report because my oncoming nurse called me out for not knowing details

• Had eyes rolled at me for taking too long giving report

• Forgot essential bits about my patient while rushing through report for so-called eye rolling

• Been peer pressured to not do it at the bedside

• Stayed an extra hour(+) into the next shift to sort out whatever my oncoming nurse thought was incomplete

Sounds fun, right? After a long 12 hour shift overnight working your tail off, having your report torn into shreds makes your feel like garbage. Handoff can truly feel like the most daunting part of your day as a fresh nurse.

Cue Report Sheets AKA your “brain”. They are common in nursing, especially when you are just starting off, to organize your thoughts and tasks throughout the shift. Yes, it’s called a brain sheet because literally, this becomes your BRAIN.

Print it out, attach it to your care plans and use it as your guide throughout your shift. When change-of-shift comes you have everything you need to know about your patient in an organized fashion. It gets you through your shift- from the moment you get report to the moment you give it.

So here it is, my sacred report sheet. It’s the method I have used for years with patients and what I offer to my student nurses when they are starting clinical.

If you are a little confused, keep scrolling for clarification on abbreviations and formatting.

Basically, I organize my template into sections starting at the top with the most important safety information. I then go down in the way report is typically given/received: chief complaint, history of present illness (HPI) and past medical history (PMH). That then takes you to the head to toe with reminders in each system of things to cover & look out for.

On the right side I keep shift organizing topics: the patient’s plan, test/procedures, anticipated discharge, goals and med passes. At the bottom I always leave space for notes, because at some point you will need to keep track of new orders, critical values, changes in patient status, reminders for charting, education, or hey, even a reminder for you to go drink some water.

Receiving and giving report is an art that will only be mastered with time, organization and practice so do not get discouraged! I hope this template can help organize your thoughts for each patient and remind you what is necessary to ease the handoff process.

If you are a student or new nurse, please reach out with any questions, thoughts, or ideas. I have said it before and I will say it again: there are few career choices as selfless, honorable, and rewarding as becoming a nurse. Keep it up and just know there are millions of nurses that started exactly where you are right now.

Drop me a line in the comments or find me on social media, I’d love to hear from you!

XOXO,

Jac

FNP - Why I am Going Back to School

From RN to FNP + DNP Student

what this all means and why I’m going back to school

As you may have read in my Why I Became a Nurse post, I have wanted to go into healthcare for as long as I can remember. Although my journey to nursing was somewhat unconventional, I entered the field with early intentions of continuing my education to become a Family Nurse Practitioner (FNP).

Now starting my second semester of the Doctorate of Nursing Practice (DNP) program at the University of Illinois at Chicago (UIC) to become a FNP (terrifying but exciting), I wanted to clarify what this all means and answer a few questions on why I decided to go back to school. Because really, after 19 years of education, who wouldn’t want a few more…right?

Before we dive into the hows and whys I chose the FNP route, let’s clarify a few confusing points about nursing careers & continuing nursing education.

WHAT’S THE DIFFERENCE BETWEEN A NURSE (RN) AND NURSE PRACTITIONER (NP)?

What nurses (RNs) do is nothing short of extraordinary and this really deserves a post of its own, but for the sake of simplicity, RNs work in patient-centered roles carrying out procedures, treatments, and medications ordered by a provider (physician, physician assistant, or nurse practitioner). They work hand-in-hand with patients- assessing, observing, monitoring, educating and advocating for them, while ensuring their care is safe, competent and thorough.

Nurse Practitioners (NPs) are Advanced Practice Registered Nurses, nurses that have continued school to be able to examine, diagnose, order and prescribe medications. Specific rules and regulations however, depend on the state in which the NP is licensed in and determines their scope of practice. NPs bring a comprehensive and holistic approach to health care, with an emphasis on disease prevention and health promotion. There are several options for NP students to specialize in a chosen patient population: acute care, adult/gerontology, pediatrics, neonatal, emergency, psych, women’s health, midwifery and my chosen focus- family practice.

WHAT IS A FAMILY NURSE PRACTITIONER (FNP)?

Of the population focuses just listed, family is the most common specialty for nurse practitioners to advance in. FNPs provide a wide range of family-focused health care services to patients of all ages including infants, adolescents, adults and seniors. You can think of an FNP as your Primary Care Provider. 

Focusing on disease prevention and health promotion, FNPs see and examine patients, maintain records, order tests, prescribe medications (again, rules and restrictions depend on licensing state), develop treatment plans, educate patients and manage acute and chronic illness for patients across the lifespan. They practice in a variety of settings including community health centers/clinics, private practices, urgent care facilities, health care systems, schools, universities and beyond.

WHY DID YOU DECIDE FNP?

Working at the bedside on a hospital inpatient unit can be a struggle for any nurse- the exhausting hours, being on your feet, working overnight and on holidays, the demanding patient load (I could go on)...but working at the bedside was extra hard for me. I constantly questioned what lifestyle modifications could have prevented my patients from being admitted in the first place. Every discharge frustrated me beyond belief, knowing how many community, social, economic and systemic barriers existed for my patients once they got out. Yes, I was keeping patients alive, comforting them and educating them (with the little time I had), but I felt like I wasn’t even scratching the surface. Our healthcare system was failing these patients and missing a huge part of the picture…maybe even missing the whole point.

This line of thinking was nothing new for me. As I said in the beginning of this post, I had an inkling to become an FNP before even becoming a nurse. Growing up on the near-west side of Chicago, I was exposed to the harsh realities of health disparities early on. Before nursing school, I then worked in clinical research seeing the same problems among my patients, the undeniable healthcare disparities and our terribly broken system. Later on, my public health rotation in nursing school further pushed me in this direction and confirmed my FNP calling.

I felt at home in community clinics, lived for health promotion projects and idolized my instructors and the badass nurse practitioners. They were out in the community providing care for those who needed it most.

photo by Madi Hebner

On a lighter note, by the likes of this blog I’m sure you can tell I have a LOT of interests. I love travel, beauty, wellness, sustainability, gardening, cooking, music…and everything in between. The same is true in healthcare. I crave variety and honestly, I get bored pretty easily. With family practice, I will have the opportunity to see patients of all ages, backgrounds and medical histories, with a range of healthcare needs. 

WHY ARE FNPs IMPORTANT TO HEALTHCARE?

Our country is facing increasing rates of chronic disease, cancer, stress, anxiety, and depression, in addition to more pollutants and toxins than ever in our food, air and water. By providing long-term care for patients, managing disease, and providing preventative education, I truly believe FNPs can aid in lessening our country’s primary care crisis. Overall, this is my #1 reason for choosing this path.

WHY THE DNP? IS IT NECESSARY?

All NPs must complete at least a master's degree and have advanced clinical training beyond their initial RN preparation. The doctorate, or DNP is the furthest step in clinical education. It is the ultimate practice-focused degree awarded to nurses who want to achieve the highest level of proficiency in delivering complex care. With additional preparation in research, social determinants of health and healthcare systems, DNPs can also embrace roles that don’t involve direct patient care such as working as administrators, executive leaders, informaticists, health policy specialists, public health advocates, nurse educators and more.

For now, the DNP is not required but it establishes the highest level of credibility for clinical nurses, something I knew eventually I would want in my career. Better to do it now than later in my opinion!

WHY UIC?

Again, I grew up on the near west side of Chicago, a few blocks away from UIC’s medical campus. My preschool is actually a rocks-throw away from the College of Nursing so yes, I will admit there is a hint of nostalgia and an inexplicable desire to learn and practice in the community that shaped me.

The DNP Program here is one of the top ten programs in the country, and since I completed the Generalists Master’s Program at UIC I had a few doctoral credits already under my belt…so this was a no-brainer. Their faculty is beyond impressive, and during my masters I grew to admire some of my professors on many levels. To give you my application answer (which is genuinely accurate), “I believe the environment, education, and faculty here will best prepare me to be a culturally sensitive and competent provider”.

In addition, I recently transitioned into a faculty role at the college as a clinical instructor. Apparently I cannot get enough of this place!

WHERE DO YOU SEE YOUR CAREER IN 5 YEARS?

I am a Chicago girl through and through, so I envision myself working in urban community clinics or health centers in any of the medically underserved areas close by. There is so much I hope to accomplish in my career- from primary practice to research and teaching, to addressing social justice issues including food security and gun violence in relation to health. I hope with the DNP I can advocate for patients in the primary care settings and legislative arena. I am also a certified yoga instructor and have a huge interest in childhood obesity and the advancement of urban farms to meet community nutritional needs. Remember when I said I have many interests?? We will see how all of that can fit in!

Overall, although my time at the bedside has provided an excellent foundation for nursing practice, as an FNP I know I can truly find ways to close the gap and work towards equal primary healthcare needs. In five years I hope I can say I am truly making a difference.

Nurses are an incredible breed. I have said it before and I will say it again: there are few career choices as selfless, honorable, and rewarding as becoming a nurse. I will always be grateful for a set of skills that can truly help others, and the endless opportunities to affect individuals, communities and the world.

If you are thinking about pursuing a career in nursing, as an NP or FNP please reach out with any questions, thoughts, or ideas. Drop me a line in the comments or find me on social media, I’d love to hear from you!

XOXO,

Jac

Why I Became a Nurse

Every path to the medical field is different…

but yes, I am one of those people who always knew I would go into healthcare.

When I was seven years old, my mom got pregnant with my baby sister Julia. For months my twin sister Nicole and I awaited her arrival, ready to be the best older sisters on the planet. On New Years Eve of 1996 Julia joined the family, but unexpectedly was unable to come home from the hospital. Julia was born with a heart complication known as patent ductus arteriosus (PDA), an unclosed hole in the aorta that is supposed to simultaneously close at birth. In other words, she was born with a hole in her heart. After a few weeks, Julia’s heart healed and she was finally able to come home without any further surgeries or medications. My parents said the doctors and nurses saved her life.

From that moment on, I knew I wanted to spend my life doing exactly that for other people and their families. 

baby sis Julia in the middle with a fully healthy and happy heart!

Now, Julia is on the way to becoming a nurse herself! Go Jules!

As I got older I was your typical overachiever- constantly going after the best grades and being the MVP of every sports team. I only cared about two things: becoming a doctor and playing Division I Ice Hockey. During high school I said no to any form of social life, put my nose down, and worked my butt off. My ambition and perfectionist tendencies got me recruited to the University of Connecticut (UCONN, #gohuskies) where I studied on the “pre-med” track. After college I had every plan of going to medical school, but my 3.5GPA and mediocre MCAT score were not enough to get in- crushing my dreams and sense of self worth. 

Getting denied from medical school was the best and worst thing that has ever happened to me. For the first time in my life I was faced with the pure feelings of rejection and failure. I felt like I was letting everyone down (mostly myself) and constantly thought I just wasn’t good enough. This, paired with an ending hockey career and cheating boyfriend, offered the lowest sense of self worth and shame I have ever experienced. At the age of 22 my borderline identity crisis manifested into years of distorted eating and exercise habits (I will be touching more on this on the blog later). It took a few more years of getting help, growing, but mostly un-growing to shift my perspective and step back into my worth.

Since my “Plan A” didn’t work out, I scrambled and decided to take some time off to work in a clinical research lab at The Rehabilitation Institute of Chicago (aka RIC, now the Shirely Ryan AbilityLab). Although I didn’t know it at the time, this was the first step that changed my perspective on myself, the world, and my career…leading me to my true authentic path.

insert inspirational quote about “no wrong turns” and finding your own path

At RIC I worked with patients from all facets of life- every race, background, socio-economic status, you name it, I saw it all. Our lab did not require patients to have insurance, so we attracted many who had no other option for therapy, or healthcare at all. In one hour, I could work with a veteran, an immigrant without documentation, and a PhD college professor. The health disparities- unequal access to quality healthcare, education, and resources I was seeing could not be more apparent. Being from Chicago’s near west side, I had a sense of what social determinants of health looked like, but now the reality was right in my face. Slowly, my curiosity and perspective shifted from the “sick” diagnosis/treatment model, to preventative measures, public health, education, and the systems and policies reinforcing these health disparities.

always in my favorite scrubs FIGS!

During my time in the lab, I also started working alongside nurses and nurse practitioners. I admired the knowledge of the physicians, but the nurses…they were at the bedside really making a difference. Nurses were on the front lines dealing with life-saving stress, but also served as the caretaker, confidant, teacher, and number one advocate. Patients and their families trusted and relied on the nurses during their most vulnerable moments. 

After two years of working at RIC and lots of self reflection, I knew the nursing path spoke much truer to my soul.  I admired nursing’s holistic approach of taking the whole person into account by meeting the physical, emotional, social, and spiritual needs of every patient.  So, instead of reapplying to medical school I put all my eggs in the nursing basket and applied to the University of Illinois Chicago College of Nursing's accelerated Master’s Program. I got in and have not questioned my path since. 

At UIC I was led by a few professors that I will idolize forever. My education was extremely progressive, and besides getting me ready for the bedside, it touched on community health, social justice issues, and social determinants of health- topics I grew a real passion for. Since graduating this program, I have spent two years working at the bedside on a neuro and telemetry (heart monitoring) unit and am now a clinical nursing instructor for bachelors nursing students. I am also in my second semester of the Doctorate of Nursing Practice program at UIC to become a Family Nurse Practitioner. 

Nursing is an incredible career path for many reasons. A steady paycheck, benefits, flexibility, job security, as well as ample opportunities for growth, continuing education, and of course helping people! However, before I keep going, let me make this very clear: nursing is not always glamorous. In fact it is usually anything but glamorous. Working as an RN is incredibly difficult. Nurses work crazy hours, holidays, often overnight, and back to back. It is physically, emotionally, and mentally taxing. Patients, families, and physicians aren’t always nice to nurses. A lot of times, nurses aren’t even nice to nurses. I still get nervous delivering report to a more experienced nurse, and have cried after a shift more times than I can count. Let’s face it, there aren’t many jobs as stressful as watching over the lives of other human beings.

I mean, who doesn’t like working on Christmas?

But, that’s exactly why nursing is so much more than a job. Nursing is a way of life, and being a nurse is like forever being part of a tribe. Unlike other paths in healthcare, nursing is equally an art and a science. It gives you a deep understanding of the body and disease, but more importantly the human condition. There are few career choices as selfless, honorable, and rewarding as becoming a nurse. I will always be grateful for a set of skills that can truly help others, and the endless opportunities to affect individuals, communities and the world.

What I do know for sure is- nursing has allowed me to heal my patients, but it has also given me the space to heal myself. My path to nursing was not a straight line, but let's be real, who’s journey is?

If you are thinking about pursing a career in nursing, you can relate to my story, or if you are also a nurse please reach out with any questions, thoughts, or ideas. Feel free to drop me a line in the comments or find me on social media, I’d love to hear from you!

XOXO,

Jac