As in most things, getting off to a good start as a nurse can help ensure a long, successful, and satisfying career. With nursing shortages and nurse burnout still taking a tremendous toll on the profession, hospitals must do all they can to ensure new nurses have the tools to succeed.
Organizations help ensure success for new nurses through nurse residency programs, also called transition to practice or new grad programs. These structured learning experiences can be of great benefit.
readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the study organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed notable improvement.
In this article, we’ll offer specific suggestions on what to look for in a nurse residency program so that you can find a good fit. But first, let’s look at when you should start investigating those programs.
Start Early
To discover if a nurse residency program is right for you, don’t wait until you pass your licensure exam. “Waiting until they pass their NCLEX many times is too late,” says Sheri Cosme DNP, RN, NPD-BC, director, Practice Transition Accreditation Program (PTAP), Advanced Practice Provider Fellowship Accreditation, American Nurses Credentialing Center (ANCC).
Nursing students should “use the time that they’re in school to start identifying those organizations that they want to work at sooner rather than later,” notes Cosme. Many programs start only two to three cohorts a year, so they have very specific recruitment timelines for when they accept applications from new graduate nurses, she says. “My biggest piece of advice to a new graduate nurse is not to miss that window.”
Cosme says to take advantage of your time at your clinical rotations and interview the facility. “That’s going to give them a good sense of what the organization is all about.”
In addition, Cosme suggests checking social media to learn what nurses say about the organization. Also, reach out to employees. You might also ask to speak to a nurse who has recently completed the program to find out how they balanced class time with working off-shifts, suggests Sara R. Grieshop, MHI, BSN, RN, practice excellence supervisor, American Association of Critical-Care Nurses. “Don’t hesitate to interview the programs as much as they are interviewing you,” notes Grieshop.
Make sure, says Cosme, that the organization has a specific plan in place for the program. For instance, the organization should tell you how much time you will spend with a preceptor or the milestones you need to hit to reach full competence.
What to Look for in a Nurse Residency Program
As you research nurse residency programs, consider the following areas:
Accreditation. Find out if the nurse residency program carries accreditation. As of mid-November 2023, some 250 programs in 831 healthcare sites were part of the ANCC Practice Transition Accreditation Program.
Accreditation helps ensure that programs provide a rich educational experience. “Accreditation validates that the programs are consistently following evidence-based standards that support nurses in their transition to nursing practice,” according to Christine Young, MSN, MBA, RN, NEA-BC, DNP, chief of hospital-based services and chief nursing officer, Akron Children’s Hospital.
Length of time. Cosme says a nurse residency program will run between 6 and 12 months. “A majority of the time, the programming is front-loaded,” she notes so that during the first part of the program, the nurse gets more concentrated professional development and support.
Seek programs that provide at least 6 to 12 months of program support and a preceptorship, which will help you acclimate to your intended specialty with a structured orientation and clinical training at the bedside, suggests Laura Douglas, MSN-Ed, RN, NPD-BC, CCRN-K, manager of the transition to practice programs (nurse residency, fellowship, and respiratory residency) at Memorial Hermann Health System.
While clinical orientation may last only 3 to 6 months, depending on specialty, a residency program supports the new graduate first through orientation, then through the initial phases of independent practice for up to a year, according to Young. Support into the second year is also ideal, she notes.
The nurse residency program should provide opportunities for participant feedback and evaluation, including regularly scheduled formal meetings to examine strengths and areas for growth, as well as provisions for individual self-assessment/self-reflection, according to Karen T. Pardue, PhD, RN, CNE, FNAP, ANEF, associate provost for strategic initiatives and professor, School of Nursing and Population Health, University of New England. Also, the program should dedicate attention to activities and interactions that build a sense of community and provide peer support, heightening the new employee’s sense of connection and belonging, she suggests.
Preceptorship. It would help if you were working with a preceptor, and ideally, one or two preceptors through the orientation phase of your residency program, notes Cosme. You should also check if you will have a mentor. While those two roles intersect, they provide different support, notes Young. The mentor, Young notes, could be a previous nurse resident who remembers what it was like to be a new grad in the specialty area they are working in and is willing to connect with the new nurse regularly to offer support, identify resources, and so on. The preceptor must evaluate the new nurse’s ability to demonstrate competency in practice and provide feedback during orientation.
Specialty experience. Determine if the nurse residency program will provide education in your specialty area, notes Cosme. If you’re unsure which unit is best for you, look for a residency program that allows you to work in various units, notes Grieshop. “This will allow you to broaden your horizons beyond what your clinical hours achieved,” she notes.
Never-Ending Learning
Nurses in a residency program, notes Cosme, should “be a sponge, soak it all up, wring themselves out, and soak up even more because they will be learning in nursing every day. I think the biggest blessing in healthcare is that things are constantly changing. We’re always learning.”
Read the January issue of Minority Nurse focusing on RN-to-BSN and Nurse Residency Programs here.
Nurses gain clinical and academic experience throughout their careers, all of which combine to form a foundation of essential skills. As the nursing industry continues its drive to have most of its workforce prepared with a baccalaureate degree or higher, many RNs are looking to RN-to-BSN programs.
Whether a nurse has been in the field for 5 or 35 years, or is a nursing student considering the best path, baccalaureate degree programs offer additional training in areas that develop critical thinking skills and are proven to bring better patient outcomes with further gains in leadership, research, and community health.
When nurses have the RN-based clinical experience to be excellent nurses, they gain the additional BS/BSN broad-scope perspective of nursing care’s impact on community health or national nursing policies, for example, their nursing changes, says McClenny. “You learn more about how to apply what you are learning to what you are doing in practice,” she says.
“Most hospitals and health departments prefer and only hire BS/BSN nurses,” says Bray. “Advancing your knowledge and skills leads to job satisfaction and career and earnings advancement.”
Attaining a BSN also aligns nurses with the industry standards that are increasingly focused on nurses who are trained with a BS/BSN or higher. However, nurses with an RN might find the thought of returning to school daunting. When they have family, work, and outside interests to juggle, applying for an RN-to-BSN program might need more support. Looking for the right program for your needs is key.
Find the Right Program
Compare programs to find one that will fit your lifestyle and financial abilities while offering a rigorous curriculum that will equip you for the nursing roles and opportunities you want to pursue, says McClenny. Work with your employer to see if educational reimbursement is offered and ask a school about potential financial aid.
Sometimes, the most challenging barrier is making time for an RN-to-BSN program, but it is possible. Many schools offer asynchronous programs in which courses are completed to fit the student’s schedule instead of being held on a specific day and time, says Bray. That helps make an RN-to-BSN program more attainable for nurses with multiple priorities, says McClenny, but online courses are no less rigorous than in-person courses. When considering the schedule that will work best for their time constraints, setting aside sufficient time for coursework is critical to success.
What should you look for in a program? Bray and McClenny say taking the time to compare programs will pay off in the end. Nurses will seek “a curriculum focused on advancing your skills and knowledge to shape you into a well-rounded, culturally competent, critically compassionate nurse, a thoughtful, skilled communicator, and enhances your leadership skills,” says Bray.
McClenny says to look for the program’s flexibility and see if a program overview or introduction is available. Look at program requirements to see if you need to take any courses and what the curriculum offers. Are there opportunities for interprofessional communication and development or real-world experiences to combine your academic knowledge with your clinical skills? McClenny, whose students complete a capstone-like project, says those real-world projects are often when nursing work and educational training help guide students to their passion.
An RN-to-BSN program is more than just what happens in a clinical experience or the classroom. Any academic program should offer nurses opportunities for personal and professional growth for building their network. Whether technical, career-based, or educational, support should be easily accessible to nursing students in the RN-to-BSN program.
Many students returning to school for a BSN are already working and have other responsibilities, so they are balancing assignments with other commitments in tight schedules. Access to someone who can help with a middle-of-the-night technical glitch could be critical to success.
Those tools are necessary because students are more likely to complete a program with support. And no matter how a degree program is delivered, establishing relationships with program advisors and faculty members will also smooth the path. These folks offer support by navigating your educational journey alongside you, says Bray, so they can guide and advise if you need to reduce or increase your course load, shift classes, or find academic support for a particularly challenging subject.
Becoming Part of National Nursing
Many nurses look to an RN-to-BSN program to advance their careers but find an unexpected benefit in promoting and improving the nursing industry. Nurses with additional education are positioned to gain advanced degrees like the MSN or DNP. These nurses represent the industry in a broader stage, can help fill the primary care provider gap, and can help alleviate the nursing faculty shortage. Because nursing makes constant progress in developing evidence-based practices, McClenny says BSN coursework often reflects real-time industry needs. “I ask students, ‘What are your managers, your administrators, your educators looking for from you?’”
With many hospitals and organizations now requiring a BS/BSN, career options expand significantly with the degree. “The AACN and healthcare organizations with Magnet hospital status fundamentally view nurses with BS/BSN as leading to a better quality of care for patients and improved outcomes,” says Bray. “The nurse with a BS/BSN in nursing has greater opportunities to select a position from various nursing settings.”
Read the January issue of Minority Nurse focusing on RN-to-BSN and Nurse Residency Programs here.
Earning an advanced degree offers nurses immediate career benefits, including skills and knowledge they’ll apply to their work long before graduation. But advanced degrees, including the designation as a nurse practitioner (NP), also offer study nuances that propel careers forward and present opportunities that weren’t available before.
Nurses who pursue an NP with a master’s of nursing degree find, in particular, that the additional credential offers a level of autonomy leading to career paths that could include direct patient care, nurse leadership roles, research, business, academia, or the diverse potential in entrepreneurship.
As nurse practitioners branch out to explore entrepreneurial pursuits, new roles that blend bedside and leadership, or new research models, the beneficial impacts on public health and approaches to healthcare are widely visible.
“The NP workforce is in a constant state of growth
to keep up with the rising demands of the healthcare system,” says Paula Tucker, DNP, FNP-BC, ENP-C, FAANP Clinical Associate Professor and Interim Director of the Emergency Nurse Practitioner Program Nell Hodgson Woodruff School of Nursing, Emory University. “NPs frequently operate in regions where access to healthcare services is limited and providing care to vulnerable populations. This experience equips NPs with invaluable skills for providing care to diverse patient groups and addressing healthcare disparities.”
The COVID pandemic brought significant changes to the nursing practice and workforce and, in many ways, paved the way for NPs to expand their career paths. And because their experience and expertise were crucial to in-the-moment patient care scenarios, public awareness about nurse practitioners increased. “NPs have demonstrated their leadership capabilities by pioneering innovative care models that adapt to these changes,” says Tucker, who also holds a volunteer leadership position for the American Association of Nurse Practitioners. “This experience in healthcare innovation is an asset for nurses contemplating diverse career avenues.”
Miranda High MSN, APRN, FNP-C, works as a Certified Mobile Research Nurse/CMRN and a nurse practitioner for PCM Trials. When she started on a nursing path, High says becoming a nurse practitioner was her goal because it would allow her to work as a provider. Working as a mobile research nurse wasn’t a path she was initially aware of. “I thought this was a role where I could potentially help people have access to treatment options that they may not otherwise have due to several factors, including traveling restrictions and financial obstacles preventing people from making follow-up visits at the site,” says High. “I felt like being able to take ‘the site’ to them allowed them the ability to be a participant in a clinical trial to not only help themselves but to be part of something bigger than just themselves. Being part of something that could potentially help so many other people in the future was what led me to discover the excitement of this role.”
Tucker says that identifying goals, developing a passion for a specialty, and gaining new skills are all effectively leveraged in diverse roles. “The key is to find one’s passion in caring for patients and allowing that passion to drive creativity, giving back to the community, and fostering innovation as a change agent in healthcare,” she says.
Alita-Geri Carter, MSN, RN, CPNP-PC CEO and founder of The Commission for Health, LLC, says she decided to become an NP when she was 14, a path that began when her younger sister spent weeks in NICU. Carter’s entrepreneurial approach allows her to provide various nursing services rooted in her passion. “Nursing is a significant part of who I am, and my nursing perspective also plays a critical role in each decision I make,” she says. As a nurse entrepreneur, you must be able to pivot and meet the needs of your consumers to remain relevant.” Carter has shaped a career that lets her use her nursing skills to provide patient advocacy and resource coordination education, healthcare provider and school-based provider training, curriculum development, public speaking, communications and public relations consultant services, and legislative advocacy for children and youth with special healthcare needs.
For High, a mobile research nursing role brings her into the homes of subjects participating in a clinical trial, and needs follow-up data obtained as required in-home visits. “On these follow-up visits, any number of nursing tasks can be performed, including labs, EKG, obtaining information, reviewing logs, etc.,” she says. In High’s other role, as an NP with PCM, she is part of the clinical interview team conducting clinical interviews with potential NPs to discuss clinical competencies since the initial recruiters are not clinically trained. “We discuss their skills and abilities as they relate to the nurse practitioner’s scope of practice,” she says. “After the candidate interview, I help to determine if they are eligible for hire based on their clinical competencies.”
According to Tucker, the NP credential means nurses have experience with using advanced clinical skills, making complex medical decisions, and, particularly, developing effective communication with patients, which fosters teamwork and interprofessional collaboration. Both High and Carter say the NP expanded their career options. Because the NP background gave her an understanding of how to interpret the patient findings she was reporting to physicians as a registered nurse, High says being an NP has helped her expand on how she helps people and the number of kinds of people she can serve. “It gave me the opportunity to potentially be a provider to people to the underserved community who may not have access to care in any other way,” she says. “As an NP, I can help them with preventative and chronic health needs in a way that many MDs do not practice. I firmly believe that having my NP allows me to bridge the gap in healthcare disparities.”
Carter’s entrepreneurial approach relies on the NP’s experience as a provider with prescribing, diagnosing, and authorization responsibilities. “I can understand the healthcare system more intimately,” she says. “There is something to be said about the firsthand experience. I have the unique experience of working as a nursing assistant, registered nurse, nursing administrator, and nurse practitioner. It creates a well-rounded perspective of patient care, outcomes, provider scope, and access.”
Nurse practitioners can open doors they never knew existed, and that’s often a starting point to a meaningful career. “The NP path offers a gateway to a world of opportunities,” says Tucker. “Being part of a community of NPs who serve as catalysts for change within the healthcare system facilitates personal and professional growth, positively impacting the lives of patients, families, and communities. For nurses considering this path, being part of a trusted profession, the ability to adapt to various healthcare settings, experience in serving diverse populations, and contributing to innovative healthcare interventions makes it an immensely promising and fulfilling career choice.”
Burnout can steal the enthusiasm, satisfaction, and joy that prompted you to become an NP. It can rob you of the joy of caring and potentially deprive your patients of the care they need.
As a nation, the U.S. can ill afford to have NPs burn out. A national survey of U.S. adults conducted by the American Association of Nurse Practitioners (AANP) in April 2023 found that more than 40% of respondents have experienced a “longer than reasonable” wait for healthcare. In a press release, 26% of those surveyed reported waiting more than two months to gain access to a healthcare provider. NPs, notes the AANP, can help fill that void.
delivered by NPs and physician assistants (PAs) increased from 14.0% to 25.6%.
We’ll look at some factors that cause burnout and ways to prevent it from diminishing your enthusiasm or leaving practice entirely.
First, let’s take a brief look at the signs of burnout.
Signs of Strain
Burnout is characterized by emotional, physical, and mental exhaustion, notes April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, immediate past president of the AANP. A practitioner can feel less valued and lose interest in their work.
You may have trouble sleeping, experience tension and stress, and potentially have prolonged feelings of depression, according to Sunny G. Hallowell, PhD, APRN, PPCNP-BC, associate professor, pediatric nurse practitioner, M. Louise Fitzpatrick College of Nursing, Villanova University.
COVID Makes it Worse
While blaming the pandemic for NP burnout would be easy, burnout was a phenomenon before COVID. “What happened during the pandemic is the phenomenon of burnout, which has been consistently well documented in the healthcare literature for decades before COVID. Those events were exacerbated by the pandemic,” according to Hallowell. “It was already there. It just got so much worse.”
One data point of burnout before the pandemic comes from a study conducted in early 2018, which examined advanced practice registered nurses, including NPs and PAs. It found that 59% of respondents experienced or formerly experienced burnout. The pandemic “really blew everything up,” says Kapu, the study’s lead author, published in the Journal of the American Association of Nurse Practitioners.
Forces of Stress
Besides the pandemic, unhealthy work environments can lead to burnout. In those environments, notes Kapu, staff shortages continue to take a toll, overtime may be needed, and there needs to be more opportunity for professional growth, development, or change.
Furthermore, the back-and-forth involving full practice authority for NPs may also cause stress. During the pandemic, various states provided temporary waivers allowing full practice authority for NPs. Since then, some states have reverted to reduced or restricted practice laws. This sends a “mixed message,” notes Hallowell, breeding mistrust, uncertainty, and confusion.
“In states that have moved to full practice authority, we’ve seen an increase in the workforce; NPs enjoy working there,” says Kapu. “We’ve seen those states move up in terms of overall healthcare outcomes. The top five states in the U.S. in terms of healthcare outcomes are all states where nurse practitioners can practice to what they’ve been educated and trained to do.”
NPs might also suffer from stress in dealing with inexperienced healthcare colleagues. “The distribution of healthcare delivery has shifted in such a way that we have a lot of inexperienced folks at the frontline now,” Hallowell notes.
“We need to create a structure to onboard and train and bring these new workers into the work environment, help them develop confidence in their skills, make sure that they’re competent in what they’re doing,” notes Kapu .” We’ve done this as nurse practitioners for years. We have onboarding, orientation, and training programs, and we support them through that so that they feel competent and integrated into the team. They have a supportive environment where they can reach out and ask questions as needed.”
Self-care is Key
When it comes to preventing burnout, tactics involve self-care, notes Hallowell. They include:
Rest.
Asking for help. Hopefully, you can call on experienced colleagues who can provide emotional support to offset the stress, demands, and mental load of patient care.
Requesting training. If you are doing something unfamiliar, ask for education.
Exercise.
Good nutrition.
Having interests outside the profession.
Socializing with friends and family
Mindfulness.
“We need to make sure that we recognize the signs and symptoms and then determine what will be our change,” says Kapu. “Do we need to work in a better environment? Can we help contribute to making our work environment better? What are we doing in terms of self-care?”
Addressing the exhaustion that can lead to burnout is similar to exercising a muscle, notes Kapu. “You work a muscle to a critical mass and then recover. That’s how it gets stronger. It’s the same thing with stress,” she notes, where some stress is good, but it may get to a point where you have to take time away.
“We have to give ourselves time to recover, to refuel, to constantly check in and say, Am I taking care of myself so I can bring my very best self to my patients?”
Nurse practitioners have been valuable members of the healthcare ecosystem for decades. As providers with increasing practice autonomy, NPs fill significant healthcare delivery gaps.
With a growing shortage of primary care physicians, the need for NPs could not be more dire. When NPs approach patient care innovatively, everyone benefits from their creativity.
NP Innovation is Here
Coming from a background steeped in nursing’s more holistic view of patient care
, nurse practitioners’ outlook can differ significantly from physicians’ perspectives.
“Nurse Practitioners do what nurses do best — educate and listen to their patients,” states Dr. Mykale Elbe, DNP, APRN, FNP-BC, Assistant Dean of Nursing and Associate Professor at the Catherine McAuley School of Nursing of Maryville University. “Patients report that nurse practitioners listen well and educate them more on their disease and treatment plan.”
She affirms that nurses are responding to the needs they perceive.
“Nurses are returning to obtain their NP degree to serve their communities due to the need for more providers. Most nurses write about the need for primary care or mental health services in admissions essays. With nurses being on the front lines and seeing the needs of their patients, they are being motivated to advance their education and make a difference.”
Claire Afua Ellerbrock, DNP, APRN, PMHNP-BC, is a psychiatric mental health nurse practitioner who supports other PMHNPs in managing their well-being. She sees the NP’s point of view as key to creating effective provider-patient collaboration.
“Nurse practitioners’ approach to the provider-patient relationship is unique, with its foundation rooted in compassion, collaboration, and trust,” states Dr. Ellerbrock. “As nurses first, NPs excel in building trust with patients, and this trust significantly enhances healthcare delivery.”
Dr. Ellerbrock elaborates on how NPs can provide quality care that matches or exceeds that of physicians. “A 2015 systematic review of ten randomized controlled trials found that NPs ‘demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction, and cost.’ Our ability to foster trust is the cornerstone of these positive outcomes.”
And in terms of innovation, Dr. Ellerbrock is enthused by what she sees.
I’m witnessing exciting innovations in NP entrepreneurship. Nurse practitioners are identifying unmet needs and creatively addressing them, whether it’s through innovative delivery models or educational initiatives for NPs. For example, Justin Allen from The Elite NP has developed a business that assists other NPs in establishing their practices and ensuring high-quality patient care.”
Dr. Ellerbrock continues, “Additionally, my online course business, Stress Free Psych NP, is dedicated to empowering psychiatric and family practice NPs to diagnose and treat mental health patients with greater confidence. I firmly believe that entrepreneurship is the driving force behind advancing healthcare.”
Other NP innovators dot the country with their unique practice models.
Dr. Joanne Patterson, DNP, PMHNP-BC, CIMHP of Atlanta, has created the first-ever tiny house psychiatric clinic on wheels. She can deliver on-site mental health care for businesses, corporations, and schools and reach patients who might otherwise lack the ability to get a fixed office location. Dr. Patterson’s innovation extends to being licensed to treat patients virtually in Maryland, Nevada, Florida, and Washington, D.C., which increases the number of patients who can benefit from her holistic orientation and broadens the market for her business.
Josie Tate, MSN, CRNP, FNP-C, is a nurse practitioner who provides career guidance for other NPs. She feels that NPs are thinking innovatively and creating careers that work for them.
“NPs are leveraging their skills to become intrapreneurs and entrepreneurs within the healthcare industry,” shares Ms. Tate.
“Healthcare organizations benefit from NPs being highly experienced personally and professionally, “adds Ms. Tate. “We’ve created blended and flexible schedules and salary structures that challenge the norms. Whether having two PRN roles, taking locum tenens assignments, or 1099 contract positions, we provide optimal care while living our vision of a liberated life.”
Turning the Tide for a Bright Future
When it comes to the future, many NPs see a limitless horizon. Nurse practitioners can focus on adult gerontology (AGNP), the entire lifespan (FNP), mental health (PMHNP), pediatrics (PNP), midwifery (CNM), and other specialties, and certain roles can be pursued through educational pathways focused on either acute care or primary care. NPs can also earn post-master certificates in other disciplines.
Additionally, full practice authority is slowly growing despite resistance by medical groups who may feel threatened by NPs’ success and growing market share.
Ms. Tate states, “I envision the future for nurse practitioners as the powerhouse of healthcare, especially with an increased number of states gaining full practice authority. Primary care for underserved populations will be accessible thanks largely in part to nurse practitioners.”
Dr. Ellerbrock concurs. “I see the future of the NP role expanding to encompass full practice authority in all states, effectively bridging gaps in primary care and reaching underserved populations.”
She continues, “These gaps in care are not only persisting but also expanding, both in the United States and globally. By 2030, the demand for healthcare workers worldwide is projected to rise to 80 million, while the supply of healthcare workers is expected to reach only 65 million over the same period. Granting NPs the authority to practice to their fullest extent across the country positions us well to meet these growing needs.”
When it comes to embracing this rising tide, Ms. Tate adds, “Nurse practitioners need an empowering mindset to guide and direct their career paths. This mindset will build on their strengths and open opportunities throughout healthcare.”
Dr. Elbe is encouraged by how today’s NPs are being educated. “We’re ensuring that we’re preparing NP students around access to care, understanding social determinants of health, and the role NPs can play in improving outcomes, promoting health, and preventing disease cost-effectively.”
There’s no denying that nurse practitioners are reaping the rewards of decades of hard work, advocacy, and professional advancement. From entrepreneurship and a business mindset to innovative patient care models, NPs will continue to be an essential cornerstone of keeping the American healthcare system serving patients with increased access to care and the compassionate, skilled providers to treat them.
The American Association of Nurse Practitioners (AANP) welcomed Stephen A. Ferrara, DNP, FNP-BC, FAANP, FAAN, as the organization’s new president, taking the reigns from former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN in late-June.
Ferrara is a busy man, wearing many hats.
He’s an actively practicing NP in New York and a member of the senior leadership team at Columbia University’s School of Nursing, serving as the associate dean of clinical affairs and assistant professor responsible for overseeing the NP primary care faculty practice located in New York City and teaches health policy in the DNP program.
Ferrara is passionate about health information technology and integrating evidence-based practice into daily nursing practice. His doctoral work examined the impact of
group medical visits for patients with Type 2 diabetes and whether this intervention led to better health outcomes. He’s been honored with the AANP New York State Award for Clinical Excellence and inducted as a Fellow of AANP, as well as into the American Academy of Nursing and the New York Academy of Medicine.
Meet Stephen Ferrara, the president of the AANP.
Congratulations on becoming the new president of AANP. What do you look forward to most at the helm of one of nursing’s most influential organizations?
It’s just great to be leading the largest NP organization that represents over 355,000 nurse practitioners across the U.S. I’m excited to continue to have nurse practitioners partner, care, and grow so we can build the NP workforce for the future. We do that through speaking with our policymakers and modernizing state and federal laws that will allow our patients greater access to NPs.
Talk about your early years in nursing and what inspired you to become a nurse.
I’ll start with what inspired me to become a nurse. I knew early on I wanted to be in a profession that helped people. I was unsure what that profession would be, but I always gravitated towards the help professions. I credit my aunt, a nurse, who all the while was saying consider nursing, and I did it. It took me a while to come to that decision on my own. Once I understood the role of nurses and patient advocacy, the ability to share health information and care for people and promote health and wellness, that was my epiphany.
Once that all came together, I said okay, this is what I want to do. So, I credit my aunt for putting me on the path to my career as a nurse practitioner. I knew I wanted to work as a nurse practitioner early on. I worked on a med-surg floor, which was a heavy orthopedic floor. And I give kudos to my colleagues who are on units in hospitals. But I knew that helped solidify that I did not want to be in that environment. I wanted to see patients on an ambulatory basis. And that’s where nurse practitioners became the natural fit for me. I’ve worked in some prior healthcare settings. I was associate director of student health services at Fordham University and loved working with college students. I also worked in retail health for a bit with MinuteClinic. Before joining the Columbia School of Nursing, I worked in occupational health. So, I was always connected to primary care. That’s where I wanted to be. That’s where I thought I could influence my patients and partner with them to reach our shared goals.
I’ve been incredibly fortunate to have these roles and fulfill what I wanted to do. Other than my presidency of AANP, I am the Associate Dean of Clinical Affairs at Columbia University School of Nursing. I oversee our primary care nurse practitioner practice as my everyday work, so I still do similar types of work, but more on a system scale than an individual patient basis. And I feel like I’m still contributing to the healthcare system through that NP lens.
When you were the executive director of the Nurse Practitioner Association of New York State (NPA), you were frustrated by “arbitrary limitations” in your practicer and successfully advocated for full practice authority (FPA). Can you talk about that?
I enjoyed my time at the Nurse Practitioner Association of New York State as a member of that organization and then ultimately as executive director. I was frustrated by things such as not being able to sign most medical orders of life-sustaining treatment forms or not being able to sign, believe it or not, a barber who needs a physical to be cleared to get their barber license in New York State. As a nurse practitioner, the law at the time prohibited NPs from signing this form. I’ve been performing physicals for hundreds of patients across the spectrum, and organizations accept my signature, except for this barber form. Some of those examples drove me to get involved at the policy level. And I thought that all we need to do is change these laws, and then you could do it, but it’s not an easy task. It’s certainly empowering to feel part of it, and my frustrations were not just mine. Once you speak to colleagues, they have the same frustrations. So, working with people who want the same things, ultimately taking care of the patients in front of us without those barriers, was very empowering.
In those ten years, nurse practitioners can now sign most forms in New York State, and we can sign the barber physicals. In April of 2022, New York Governor Kathy Hochul signed legislation that nurse practitioners with more than 3600 hours of clinical experience have full practice authority and are no longer mandated to have any contract with physicians to practice. So, what this means is increased access for patients. It means a more equitable healthcare system. We are improving those dynamics around us. I advocate for everyone to get involved in health policy because it affects us all personally or professionally. So, NPs have a crucial role in advocating. Nurses are the most trusted profession in the Gallup poll every year. And we need to continue using our voices outside patient rooms with our policymakers and lawmakers. So they need to hear the stories of the challenges we face that impact patients in their constituents and districts and then work together to solve them. I want to leave this profession better than when I found it. And it requires not just nurses and nurse practitioners to talk about these things, but collectively, we need to use our voices to escalate these issues. And we know as nurses, we’re leaders, we have no problem advocating for our patients. I would love to see us continue that advocacy beyond and to our lawmakers and policymakers.
You’ve worked with several national organizations. Can you talk about who they are, what motivated you to join them, and how nurses can become more involved?
I’ll use AANP as the first national organization. People need to join their membership organizations. They don’t necessarily consider joining an organization because information is out there, but our national organizations advocate for the profession. And they are looking out for us in ways we cannot do alone. So, join your national organization and your state organization. Sometimes, they’re not the same organization. And that’s somewhat confusing. So you have to be a member first and foremost. I recognize, and I’ve been through the ups and downs of a career, and sometimes you want to reach out to your organization and say, “I’m a volunteer, and I want to help you. I want to lend my talent.” And sometimes you are so busy with your work and personal life that you can’t possibly volunteer any more time, and that’s okay. But we want you to be a member. We want you to lend your time and talent and be part of the membership. That’s how we can band together and use our collective voices. Hopefully, that’s a loud voice with more people supporting the cause.
The other organization I’ve been involved with for two years is Jonas Nursing and Veterans Healthcare. I led that organization as executive director, and that was a fantastic opportunity to support nurses returning to school for their doctoral education in the form of scholarships. So, it was empowering to hear the stories of the applicants and what they wanted to do with their advanced education and plans. In every instance, it was about bringing increased access to care to their communities or studying underserved communities historically passed over. It was inspiring to me. It gives me hope for the profession’s future, knowing that such passionate people are in the pipeline and looking to finish their education to do the work they feel most impactful for their patients and their communities. So it’s been great.
You’ve worked in several nursing leadership positions. What advice do you have for nurses seeking leadership positions?
First, you need some experience. People should volunteer, whether volunteering their time or being a mentee, reaching out to individuals who might be out there who could help them. I support and endorse the idea of a mentor-and-mentee relationship. Finding the right mentor takes time. Sometimes, that mentor may not be available to you based on what’s going on in their lives. So there needs to be a plan, and you need to have a few people on your list that you identify that you can say, hey, I’m going reach out to them to see if they’ll give me some words of advice. I think that’s quite powerful.
The other thing to say to people is that once you have some experience, go ahead and apply for the job. You may not get that role, but going through the steps of submitting an application for interviews is always good. And it allows you to interview that organization as much as they’re interviewing you. That’s a key. As people mature in their careers and roles, I remember being in love with a job before it was offered. I’m like, “Oh, this would be the perfect job for me.” And then you go on the interviews, speak with people, and do your diligence. You’ve concluded that maybe that role is not the best for me. And I think that takes just having some experience, speaking with people, and making the best decision for yourself. Sometimes, we forget about that when we go on job interviews. We see a job description on paper, and it looks perfect. But the reality is no job is perfect. You have to look at the full pros and cons of any situation. Certainly, there are lots of opportunities for people to get involved. Nurses make great leaders, and I encourage people to seek those leadership positions.
Speaking of leadership, what was your motivation to run for president of the AANP?
I wanted to give back to my profession. I wanted to support the profession in ways I felt supported in the 20-plus years I’ve been a nurse practitioner. So I like working with people. I like making changes at the system level. And being the AANP President would allow me to continue doing those things at a national level. And so far, I am just still a few months into this. I officially became president at the end of June, but it’s been fun. It’s been so rewarding to me. Hearing and speaking with our members invigorates me and gives me the passion to continue creating positive change.
You are particularly interested in health information technology and integrating evidence-based practice into daily practice. How do you plan to make that a focus of nursing?
From a healthcare technology perspective, I think there’s a huge potential to allow us to care for patients better. The example I like to use is the electronic health record, which is sometimes challenging because it’s very structured and takes more time. But what we have accessible to us that we didn’t have before is just reams and reams of data. And it’s a lot of data points, and no human can look at all these data points and make sense out of them. And this is where I see the potential of artificial intelligence to look at information and summarize it. We have wearable technology like the Fitbit and Apple watches and things like that. We can get EKG readings every hour that can go to anyone. But that information isn’t helpful if it’s just recorded as a point in time. And that’s where technology can help us make better sense of the information and determine if this information that we’re getting is good and if it’s actionable. And that’s where a clinician’s expertise comes in to say yes; this is good information that I can make an educated decision for my patients. So that’s critically important.
My doctoral work focused on evidence-based practice to critically appraise data and ensure we’re doing things in healthcare because they are based on evidence and not just how we always did that. It’s vital for credibility; it’s essential to new treatments, and as we learn more about disease processes, it’s critical to keep incorporating these aspects into our daily practice. And then there’s the research piece. There are so many opportunities for research for nurse practitioners. At Columbia University, we’re working with our researchers on nurse practitioner and patient outcomes, but not just that. We’re also looking at nurse practitioner-led interventions and different studies aimed at taking better care of patients.
What is your vision for AANP under your tenure?
It will be working with our stakeholders and lawmakers at the federal and state levels. We want to remove barriers to practice that impede nurse practitioners from delivering healthcare to our patients. There are many outdated laws or policies, particularly Medicare and Medicaid. Medicaid is also legislated at the federal level, and there’s an opportunity there for us to make historic changes within those programs that will increase access to care. One of the items in the current bill in Congress, both in the House and in the Senate, is the ICAN Act, which aims to improve care and access to nurse practitioners. This bill will make many improvements and modernizations to laws, including a nurse practitioner’s ability to prescribe diabetic shoes for patients with Medicare insurance for cardiac rehab, inpatient cardiac rehab, and medical nutrition therapy. There’s a whole host of priorities that are included in this legislation. I was looking this up, and we only have 14 co-sponsors in the House right now for the ICAN legislation out of a possible 435 districts. On the Senate side, there is just one Senate co-sponsor. So, we have a lot of work to bring awareness to this bill and not have it lost in our society’s political discourse today. This means patients are prohibited from getting the care and access they need. The other thing we need to do is on the state level. We have 27 states that are full practice authority. We need to work with those 23 states that are not full practice authority. And we know that full practice authority leads to better outcomes. Most of the healthiest states in the nation are full practice authority states for nurse practitioners.
And conversely, the ones that are not healthy restrict NP practice. So there’s a lot of work to do. And it’s no one person’s responsibility to do all that work. But it’s truly working together and getting our lawmakers to listen to some of these challenges and hear the stories that everybody’s encountering on a daily basis.
You have a lot on your plate. What do you enjoy doing when you’re not working hard to elevate the role of NPs?
I put my family first and foremost. I enjoy being a father to my three children and a husband to my wife. My kids are involved in various sports and activities, so you’ll find me at the soccer or the football fields. I listen to music and exercise and try to have some sense of balance in my life. I also love things like sports and cars. I try to find a good mix of balancing everything, but sometimes it’s easier said than done.
