Prescription for success: advancing the education of nurses
The role of nurses is rapidly evolving along with changes in healthcare. This week’s nursing immersion at the Irvine campus brought more than 90 nurses ready to advance their careers by becoming doctors of nursing practice (DNP), specializing in acute or primary care of adult-gerontology patients; family or “across the lifespan” care; acute pediatric care; or psychiatric and mental health care. Also attending were students in the RN to BSN program (registered nurses working toward their bachelor degrees).
To help the group adjust to the changing world of nursing, a panel of experts from the Marybelle and S. Paul Musco School of Nursing and Health Professions discussed everything from what’s expected of the group as students to how an advanced degree is likely to change their roles.
Faculty members Dr. Donald Beissel, Dr. Vanessa Kalis, Dr. Ruth Milstein, Dr. Patric Schine and Dr.Christine Williamitis offered examples from their own transitions from “nurse” to nurse practitioner and DNP.
“I think the role transition is different for everybody,” said Kalis, who specializes in intensive care, cardiology, congenital heart disease and cardiac electrophysiology and who continues her work as an acute care nurse practitioner in addition to teaching. “It’s a bigger step than you think going from RN (registered nurse) to DNP.”
“I remember when I was a bedside nurse and I thought I knew exactly what orders I needed for patient X in the CCU (critical care unit) and I was going to call the resident and let him know what I thought the patient needed,” said Kalis, whose comment drew sympathetic laughs from the students. But once she was a nurse practitioner, she said it wasn’t quite so clear-cut and that lots of other things came into play.
Kalis also said it was difficult for her not do the hands-on work. “I was usually one of the people in the chaos and I had to learn to take a step back … I cannot be the one at the bedside doing resuscitation. I have to be the one at the head of the bed, giving directions, making sure things are happening the way they should … and thinking about what needs to be done next.”
Schine said the biggest issue for him was knowing the scope of practice. When he first got his advanced degree, he was working in a clinic doing triage as a pediatric nurse. But while he was earning praise from the physicians he was working with, he realized that he was beginning to overstep his role.
“I had to be careful about diagnosing because I was getting to the point where I understood it better,” he said. He realized he was creating a problem when his triages went from a normal 5 to 10 minutes to 20 minutes, because he was diagnosing instead of deciding the order of treatment and degree of urgency.
“In a hospital, you’re being watched and you will be called out on it,” he said.
Sometimes the bigger problem is getting the people you work with to understand how your role has changed, said Schine. “They’re going to have you come over and do shots, and they’re going to ask you to do things you did as a nurse when you’re trying to manage a complicated diabetic patient who takes an hour visit. They want you to do this other stuff because that was your role before.”
The benefit of a DNP degree, he said, is the greater understanding about what advanced practice means and what it means to be a leader and educator and model for other nurses.
Williamitis, who has had a number of roles in critical care and mental health care, said although she was excited about all the new things she was able to do as a DNP, especially as an acute care nurse practitioner, it was also a major adjustment. “I was trying to combine the nurse role with the nurse practitioner role,” she said.
“I wouldn’t trust people because I thought everything was my responsibility. So I was getting to the hospital at 6 in the morning and not leaving until 7 at night. After three months of that, I realized there was a problem. But I just had to work with myself.”
Milstein, who owns a private practice in Florida, said her adjustments were a little different because she didn’t work in a hospital after earning her DNP. “So one of the biggest adjustments was I didn’t have a paycheck anymore and I had to wait to do billing.”
Figuring out billing and other business aspects of running her own practice eventually led to creating a billing and payroll company with seven other people. “We discovered we didn’t like the concept of someone else billing for us.”
Like Kalis, she said she was unnerved at first at having to make major decisions on her own. “I think the first time I made rounds in the hospital and realized my preceptor wasn’t in the next room and I had to make these decisions myself, was like ‘Whoa! These people’s lives are in my hands.’” She also called seeing patients alone in her officer for the first time “scary” and urged the students to build a really good support system.
“I had all my preceptors on speed dial. They answered my messages right away. The doctors and nurse practitioners I had as preceptors were wonderful about that,” she said, adding it’s also important to be honest with your patients about what you don’t know but are willing to research.
“I think the take-home lesson is you have to acquire this whole new level of maturity and thoughtfulness and leadership to get the big picture,” said Beissel, a nurse anesthetist who earned his DNP from Brandman. “When things start to go bad, as an advanced practice nurse, all of a sudden people are looking to you for the answer. So basically you have to learn to lead.”
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