NAINA Celebrates Advanced Practice Nurses

NAINA Celebrates Advanced Practice Nurses

The 2017 clinical excellence conference organized by the National Association of Indian Nurses of America (NAINA) concluded on December 2nd at Houston, Texas. It was for the first time that NAINA as a minority organization ventured to engage in a clinical excellence conference titled “Advancing Health through Excellence in Clinical Practice.”  This conference, hosted by the Indian Nurses Association of Greater Houston, Texas (INAGH), was attended by over 200 participants and nurses were provided with 8.91 CEUs by the Southwestern University Hospital, Texas. Participants applauded the organizers for providing an opportunity to network and immerse in a day full of activities that provided thought provoking information to bring back to their own clinical practice.

The APN committee chairperson, Dr. Lydia Albuquerque, set the tone of the conference by welcoming the Houston chapter President Accamma Kallel, MSN, APRN, APN-C, CCRN, president of INAGH and local chapter APN local planning committee chair, to deliver her welcome address. The key note speaker, Melissa Herpel, MSN, APRN, FNP-BC, challenged the participants to embark on pathways to excellence in independent practice as nurse practitioners. As an entrepreneur, she shared success stories of her own business model, how she overcame the challenges that she faced during the process and dared to challenge the participants to go out and start clinics that would provide primary care to the communities. All other speakers delivered their topics of interest and expertise with recent practice guidelines to the participants.

Poster presentations were coordinated by Dr. Letha Joseph, Dr. Solymole Kuruvilla, and Dr. Simi Jesto.  Bindu Jacob, BSN, RN (New Jersey) was awarded the first prize, Jessie Kurian, MSN, RN (Dallas) was awarded the second prize, and  Dr. Lisa Thomas (Houston) was awarded the third prize. Dr. Rachel Koshy, committee chair of the NAINA Journal, motivated the participants to submit scholarly articles for publication. The NAINA Journal was released by NAINA President, Dr. Jackie Michael. This Journal has been published for the second time with a goal to continue publications at least twice a year.

At this conference, NAINA presented a donation towards the Hurricane Harvey Relief Fund which was accepted by Mr. Zafar Tahir, Houston planning commission representative on behalf of the mayor of Houston. NAINA received a grant from Boston scientific and generous sponsorship from educational and pharmaceutical companies. Our grand sponsor, “APRN world,” an independent educational organization started by Dr. Harila Nair, a nurse practitioner and entrepreneur of Indian origin based in California, needs a special mention for his generous support.

Conference hosting chapter, INAGH, facilitated the Gala night celebration with Bollywood dancing, a grand finale of the Texan dance choreographed by the nurses of Houston chapter, and other entertainment programs. The plenary committee members along with the planning committee were given a standing ovation for conducting an excellent conference which was inspiring, energizing, and remarkable.

Nola the Nurse – Showing Kids What Nurse Practitioners Do

Nola the Nurse – Showing Kids What Nurse Practitioners Do

When Dr. Scharmaine Baker started the Nola the Nurse book series, she knew kids needed information about advanced practice nurses and a role model to show them all about it. What Baker, DNP, didn’t expect was the impact the character and the Nola books would have on kids or the people who would help her get the word out.

On October 27, Baker told her story on The Harry Show, in which New Orleans-native, show host, and entertainer Harry Connick, Jr. gave her a chance to talk about Nola the Nurse on a show devoted to nursing. While the experience was thrilling (and included a vacation to Punta Cana that Connick gave to her family), Baker was especially excited at the thought of having more information about nursing and advanced practice nursing reach a national audience so quickly. “He said, ‘I really believe in Nola the Nurse and I hope this show helps you go far,’” recalls Baker of Connick’s support.

Nola has really taken off,” says Baker. She started the books when she couldn’t find any books that featured African American NPs or even many that talked about nursing as a career. Baker’s books take her Nola character into people’s homes, each of which exposes her to different cultures.

Over the summer, Baker said she thought a mascot would help the kids connect nursing to real life, so she added a life-size Nola doll to bring with her when she makes presentations and reads her books to groups. “She’s a tremendous hit,” says Baker about the Nola doll.

Kids get engaged with the story and it’s an opportunity for them to listen to her heart and to check her pulse,” says Baker.

As Baker continues to develop the Nola series (three more books are set to be published starting next year), she is developing a specific structure to help kids understand what NPs do. Using the Nola mascot, stickers, activity books, and the stories themselves, Baker connects with elementary school kids in schools, camps, and groups.

As the program is taken to teens in high school, Baker finds it just easy to talk to them about nursing as a career. “It’s engaging the next generation into the world of advanced practice nursing,” says Baker.

Add an NP to improve ER patient QT

Crowded, busy emergency rooms may find their patient loads alleviated by the addition of just one nurse practitioner to general hospital staff, according to a new study by the Loyola University Health System. The NP can curb unnecessary ER visits by serving as a first line of defense, providing preventative treatments, “improving the continuity in care, and troubleshooting problems for patients,” says a Loyola University Health System release.

Published in a recent issue of Surgery, the journal of the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons, the research analyzed the results of adding an NP to a department with three surgeons. The study recounted an individual experience in one hospital, following nurse practitioner Mary Kay Larson, B.S., M.S.N., C.N.N., A.P.R.N.-B.C.

Researchers examined patient records from one year before and one year after Larson joined the hospital’s staff. Both sets of patients (415 before Larson, 411 after) were statistically similar, including length of stay and readmissions. From these groups of patients, researchers monitored which ones returned unnecessarily to the ER, i.e., those visits that did not lead to an inpatient admission.

Larson credits the decrease in ER visits to her communication with patients, saying she “routinely checked on their progress and responded to their concerns by ordering lab tests, calling in prescriptions, and arranging to care for them in the outpatient setting to maintain continuity in treatment.” She was also responsible for their discharge plans. Patient phone calls increased by 64% after Larson joined the hospital team, as did other outpatient services (visiting nurse, physical therapy, or occupational therapy). Researchers say this combination contributed to unnecessary ER visits dropping from 25% to 13%.

Though further research is necessary to corroborate these results, the addition of RNs to hospital staff may be the key to measurable improvements in patient care and operations.

Healing from the Bitter Pill of Incivility

Not long ago, I was facilitating a workshop on fostering civility in nursing education when a faculty member approached me during the break. The soft-spoken professor related her thoughts in a quiet voice, her eyes reflecting a certain sadness as she spoke. She said, “Please think about us—the clinical faculty, I mean—when you are speaking about incivility in nursing education. I am a member of the clinical faculty, and I can tell you, unequivocally, that we are a marginalized group. We are not considered part of the ‘real faculty’ and are often referred to as ‘minions and underlings.’ We are frequently told that we have no clout nor can we provide input into the theoretical courses or exams.” I asked the faculty member how she responded to these incivilities. She said, “I just take it—it’s like swallowing a very bitter pill.”

What I call the in-group and the out-group of nursing faculty teams—and I use the word “team” lightly—is further illustrated by a story described in a study I recently conducted to examine faculty-to-faculty incivility and ways to effectively address the problem. Approximately 13% of the respondents reported experiencing racial, ethnic, sexual, gender, or religious slurs within the past 12 months. One respondent wrote, “During a faculty workshop, faculty members were asked to work in small groups. One group contained four minority faculty members. A non-minority faculty member asked, ‘Do I have to paint my face black to be in this group?’”

Another faculty member related the incivility of perceived ageism that exists in her nursing program. She explained that when she met with her dean to seek advice about returning to graduate school to complete her doctoral degree, the dean laughed and said, “Are you kidding, at your age? You can’t be serious. By the time you finish your degree, you’ll be ready to retire. We prefer to invest in younger faculty.” Other forms of discrimination are also apparent: a student recently commented on faculty bias in the classroom, saying, “Students are often subjected to religious, racial, and anti-gay/lesbian content. We [students] feel vulnerable and do not know how faculty and administrators will react if they complain. It’s appalling and inexcusable.”

Regardless of their origin, uncivil encounters are an affront to human dignity and an assault on a person’s intrinsic sense of self-worth. The effects can be devastating and longlasting. Incivility may come from myriad sources; it is complex, disordered, and multidimensional. Taking time to engage, communicate, and listen with intention has a profound effect on preventing and healing the effects of incivility.

I often refer to incivility as a dance, an expression of feeling and social interaction that gets articulated through a variety of movements, gestures, and actions.1 Each observer and participant interprets the dance within the context of his or her personal experiences, through the lens of his or her own world-view. Because of this individual perception and interpretation, it becomes essential to actively listen, consider the intent of the action, and engage in meaningful and solutionbased conversation.

More than two decades ago, Ernest Boyer asserted that institutions of higher education play a vital role in helping students develop a sense of civic and social responsibility, and become productive citizens of the academy and the community.2 The promotion of civility and good citizenry is especially important in nursing and other health-related disciplines where the risk assumed by not addressing uncivil behavior reaches well beyond the college campus and can negatively impact patient safety, recruitment and retention, and commitment to the nursing profession. Because nursing programs are places where students and faculty provide direct care to patients through clinical experiences, uncivil and disruptive acts must be addressed so that such behaviors do not spiral into aggression and jeopardize the learning and practice environment.

While promoting civility is one of the primary functions of higher education, in some respects the system is failing. This failure may be related to a lack of understanding about the topic in general, and ways to prevent and address incivility in particular. I define incivility as rude or disruptive behaviors that often result in psychological or physiological distress for people involved, and if left unaddressed, may progress into threatening situations.3 Exposure to uncivil behaviors can result in physical symptoms such as headaches, interrupted sleep, and intestinal problems and can cause psychological conditions like stress, anxiety, irritability, and depressive symptoms. Thus, it is important to foster civility—an authentic respect for others requiring time, presence, a willingness to engage in genuine discourse, and an intention to seek common ground.4

Similarly, it is important to raise awareness about the importance of fostering a civil and healthy academic work environment. According to researchers, a healthy academic environment consists of a number of factors, including a clear mission with shared values and norms; high morale, job satisfaction, and an esprit de corps; competitive salaries and benefits; reasonable workloads; positive employee recruitment and retention; policies to eliminate incivility; respectful communication, teamwork, and shared decision making; organizational support and collegial relationships; and competent, honest leaders who collaborate with faculty to share decision making.5,6,7

Awareness may be raised by describing specific rationale for establishing and sustaining healthy academic work environments. First, the costs of incivility are vast. Uncivil behavior adds to employees’ stress level, erodes self-esteem, damages relationships, and threatens workplace safety and quality of life.8 Incivility also lowers morale, causes illness, and leaves workers feeling stressed, vulnerable, and devalued. The human and financial costs of these behaviors may be disastrous.9 Second, the recent Institute of Medicine Report10 includes several recommendations that call for nurses and other health care workers, such as physicians, to collaborate to advance the nation’s health. To fulfill these recommendations, we must establish civil and respectful relationships and interactions. Third, the American Nurses Association Code of Ethics for Nurses with Interpretive Statements Provision 1.5 promotes a civil, healthy work environment by requiring nurses to treat colleagues, students, and patients with dignity and respect, and states that any form of harassment, disrespect, or threatening action will not be tolerated.11 Similarly, the American Nurses Association Standards of Practice reinforce the need for objective standards such as collaboration, ethical conduct, and communication for nurses to be accountable for their actions, their patients, and their peers.12 These rationales and fostering a healthy academic work environment are difficult, if not impossible to achieve in the absence of skilled, ethical leadership. Successful change requires both formal and informal leadership—leaders who hold formal positions as well as individuals without a formal title or authority, but who have significant influence with members throughout the organization.

Once awareness is raised and leaders agree that changes are needed to foster a civil workplace, it is highly desirable to use empirical measures to determine levels, types, and frequency of civil and uncivil factors, and to reveal strategies for fostering a healthy workplace. Some examples of empirical measures include the Organizational Civility Scale (OCS)13 and the Culture/Climate Assessment Scale (CCAS).14 Other data sources are also helpful, such as formal and informal reports, evaluations, satisfaction surveys, performance evaluation information, regulatory reports, and information from focus groups and open forums. Once a comprehensive organizational assessment has been conducted, strategies can be implemented to improve areas of concern and to reinforce efforts already in place to enhance areas of strength and excellence.

Specific strategies include aligning the organizational mission and values with a focus on civility and respect. Successful organizations intentionally focus their vision for the future so that employees are able to meet organizational objectives as well as achieve personal satisfaction in their work. Organizational values undergird the formulation and implementation of norms of decorum. Without functional norms, desired behavior is ill defined and thus, members of the campus community are left to “make things up as they go along.”

Healthy academic work environments do not occur by accident—creating them requires intentional and purposeful focus. Unfortunately, many faculty, students, and administrators are unaware of how their behaviors affect others, and many are ill equipped to deal with incivility. Thus, strategies to prevent and address incivility must be taught, practiced, reinforced, and supported. We must make civility a priority. Faculty and staff meetings are excellent venues to raise awareness, discuss acceptable and unacceptable behaviors, establish norms of behavior, and practice and role-play civil interactions. When faculty and staff collectively co-create norms for behavior, they are more likely to approve of and conform to these behaviors. Once the norms are agreed upon, they become the standard for faculty and staff interactions. It is also important to establish, implement, and widely disseminate confidential, non-punitive policies and procedures for addressing incivility. This includes enforcing sanctions if indicated, and perhaps more importantly, to reward civility and collegiality. Although positive motivators are preferred, the consequences for violating the agreed-upon norms must be clearly stated and enforced. Ignoring or failing to address the uncivil behavior damages the organization as much, if not more, than the incivility itself.

Acting civilly and respectfully isn’t always easy, especially in a high-stress learning environment where constant change is the norm, and where faculty and students experience complex and demanding workloads. Yet, we must make civility a priority for our students, colleagues, practice partners, and ourselves. Incivility takes a tremendous toll on everyone throughout the campus and practice community. In a fast-paced work environment, patience is often in short supply, yet it remains a virtue we should value and uphold. Each individual must set a positive example to lead the transformation for cultivating civility in nursing education.


  1. C.M. Clark, “The Dance of Incivility in Nursing Education as Described by Nursing Faculty and Students,” Advances in Nursing Science (2008), 31(4), E37–E54.
  2. E. Boyer, Campus Life: In Search of Community. Princeton: The Carnegie Foundation for the Advancement of Teaching, 2009.
  3. C.M. Clark, “Faculty Field Guide for Promoting Student Civility,” Nurse Educator, 34(5),194–197.
  4. C.M. Clark and J. Carnosso, “Civility: A Concept Analysis,” Journal of Theory Construction and Testing, 12(1), 11–15.
  5. C.M. Clark (in progress), “Pathway for Fostering Organizational Civility.”
  6. M. Brady, “Healthy Nursing Academic Work Environments,” OJIN: The Online Journal of Issues in Nursing (2010), 15(1),Manuscript 6.
  7. National League for Nursing. “Healthful work environments for nursing faculty.” Retrieved February 26, 2012,
  8. P.M. Forni, The Civility Solution, New York, NY: St. Martin’s Press, 2008.
  9. C. Pearson and C. Porath, The Cost of Bad Behavior: How Incivility is Damaging Your Business and What to do About it. New York, NY: Penguin Group, Inc, 2009.
  10. Institute of Medicine Report (2010). “The future of nursing: Leading change, advancing health,” Robert Wood Johnson Foundation Publisher.
  11. American Nurses Association. (2001). Code of Ethics for Nurses With Interpretive Statements. Washington, D.C.: American Nurses Association.
  12. American Nurses Association. (2010). Nursing Scope and Standards of Practice. (2nd ed). Silver Spring, MD: American Nurses Association.
  13. C.M. Clark and R.E. Landrum, “Organizational Civility Scale.” Retrieved February 26, 2012,
  14. C.M. Clark, M. Belcheir, P. Strohfus, and P.J. Springer, “Development and Description of the Culture and Climate Assessment Scale, Journal of Nursing Education (2012), 51(2), 75-80.
From Minority Nurse to Nurse Practitioner

From Minority Nurse to Nurse Practitioner

Amen Eguakun, MSN, RN, FNP, considers himself blessed. Working at a church-sponsored clinic in Nashville, he provides primary care to minority and disadvantaged patients battling HIV and AIDS. He works independently and can devote as much time as he needs to each of his patients.

Eguakun credits it all to three coveted initials: FNP (family nurse practitioner). “If I were still a registered nurse, I could not be doing this,” he says. “Becoming a nurse practitioner gave me [advanced] training and expanded my knowledge of medical treatment. Now, I can combine that with the skills I had as a nurse.”

Today, many other nurses are choosing to become nurse practitioners. According to the American Academy of Nurse Practitioners (AANP), there are more than 106,000 NPs in the United States. This represents a threefold increase since 1990. Even with this growth in numbers, NPs are in demand in virtually every part of the country.

Nurse practitioners perform many functions usually associated with physicians. They diagnose illnesses by performing physical exams and by ordering needed lab tests or other diagnostic tools. They also prescribe treatment. This often includes writing prescriptions for medicine as well as ordering treatments like physical or occupational therapy. Because NPs are able to provide basic primary care, some minority health experts believe that increasing the number of minority nurse practitioners could make a major difference in the war against racial and ethnic health disparities.

What nurse practitioners do is regulated by state laws, so their responsibilities can vary depending on their geographic location. Health care facilities further define what nurse practitioners do within their organizations, which means the functions NPs perform can also vary from one hospital, physician’s office or other practice setting to another. While nurse practitioners typically hold a graduate degree, a few states allow them to practice without one, but only after completing one or two years of intensive training.

Why Become a Nurse Practitioner?

Many nurses who decide to continue their education and pursue a nurse practitioner license cite such benefits as higher salaries, expanded job opportunities and increased job security. Those are certainly very valid reasons for becoming an NP, but many practitioners say the real benefits are intangible.

“My job as a nurse practitioner is rewarding financially,” says Eguakun. “But spiritually, I’m a millionaire because I have the opportunity to make a real difference.”

Eguakun, a native of Nigeria who is now a U.S. citizen, began to dream about becoming a nurse practitioner while working in a hospital as an RN. “Most of the ailments we were dealing with were expensive to treat,” he recalls. “I realized that I could do more if I was involved in primary care and could prevent people from going to the hospital. If more people were involved in preventive care, maybe we would not have to spend so much time and money on hospital care.”

He also realized that minorities, particularly those with HIV and AIDS, often have a very difficult time getting primary care. “In the hospital, I saw many African Americans with HIV and AIDS. They were dying. I learned that everything has to do with prevention,” he says.

Now, as an FNP, Eguakun has the time and the authority to treat the entire patient. Many of his patients like to refer to him as a doctor, but he quickly corrects them. He is proud to be a nurse practitioner and declares, “I want my profession to get the credit.”

Of his work at the First Response Clinic, he says: “We take care of patients with HIV and AIDS, but we also provide primary care. This population is very hard to reach. We want to give them all the treatment they need in one location. That relieves some of the patients’ problems in accessing care, like getting from one clinic to another.” He has even visited patients at home when they couldn’t make it to the clinic.

First Response Clinic, operated by the Metropolitan Interdenominational Church, receives federal funding but is operated solely by the church. Eguakun believes that gives him a better chance of reaching many patients, providing treatment for those afflicted with HIV/AIDS and helping those who are still healthy avoid the deadly disease.

“In the Southeast, religion and the church are big factors in people’s lives,” he explains. “The religious community has also been seen as a problem in reducing the occurrence of HIV in minorities, because the issue is not discussed in churches. [The church that runs our clinic] is actually in the forefront of disseminating information about preventing the disease.”

That close relationship with patients is what drives many nurse practitioners, according to Kenneth Miller, PhD, RN, CFNP, FAAN, president-elect of the American College of Nurse Practitioners (ACNP) and professor and associate dean for research and clinical scholarship at the University of New Mexico Health Sciences Center, College of Nursing.

“The biggest reward is having the time to do what we were educated to do: talk to patients about disease prevention and health maintenance,” he says. “Most physicians don’t have the time to do that. [Compared to doctors], we do a lot more education and discussion with patients.”

Welcoming Diversity

Here are a few quick facts about nurse practitioners from the AANP: The average annual salary of full-time practitioners is $73,620. Nearly half of the country’s NPs (41%) specialize in family medical care, 19.5% specialize in adult care, 11% in women’s health and another 11% in pediatrics.

Miller also expects rapid growth in two other specialty areas: acute care and gerontology. “The hottest specialty right now is acute care. Residents have a limited number of hours to work in the hospital and someone has to pick up that slack. There’s a demand for acute care nurse practitioners all over the country.

“The group we really need to start focusing on for the future is geriatric patients,” he continues. “Nurse practitioners can provide the type of care that senior citizens are going to need.”

Over 95% of nurse practitioners are female, although high-profile male NPs like Miller hope to draw more men to the field. The NP profession is also very open to racial and ethnic minorities. According to the most recent National Sample Survey of Registered Nurses, published by the Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing, approximately 11% of nurse practitioners are nurses of color–and that figure is expected to increase.

“All of the programs [that train practitioners] are trying to recruit more minorities,” Miller comments. “Here [at the University of New Mexico], we are trying to make sure that the composition of our class meets the cultural diversity of the state where we live. [NP] programs want to make sure there is equity in terms of the composition of classes that are admitted so that our practitioners can better serve the minority populations.”

Eguakun says he’s never felt that his race or gender were obstacles in becoming or practicing as a nurse practitioner. “I actually saw it as a plus,” he maintains. “I was working as the sole nurse practitioner at a clinic in a housing development. Some people argued that we might lose women coming in for Pap tests because I was a man, but the number actually increased.”


An Innovative Approach to Developing Minority Nurse Practitioners

While many nurse practitioner training programs around the country are working hard to increase the racial and ethnic diversity of their student populations, one innovative program in Southern California already has an unusually high success rate when it comes to recruitment and retention of minority students. More than 50% of the students in the Women’s Health Care Nurse Practitioner Program (WHCNPP) at the Harbor-UCLA Medical Center in Torrance, Calif., are students of color.

“Out of the 12 people in the class that’s enrolled now, two are African American and four are Hispanic. The previous class had three Hispanic students, two Asian and Pacific Islander students and one Native American student,” says Susan Stemmler, MSN, MPH, FNP, CNM, the program’s acting director of education. According to Stemmler, the program doesn’t have a magic recipe for attracting students of color, although the diversity of its faculty could be a contributing factor. Stemmler is Native American; the faculty also includes African American and Filipino instructors.

Another unusual feature of the WHCNPP is that it is a certificate program for RNs, not a degree-granting program. The program has affiliations with several local universities that enable the NP students to earn academic credit toward their next degree, and many do go on to pursue a BSN or MSN after earning their certificates. The program is accredited by the National Association of Nurse Practitioners in Women’s Health and is approved by the California Board of Registered Nursing as a provider of advanced practice nursing education.

WHCNPP is one of only a handful of certificate programs still operating in the United States. When it began in 1970, it was the first women’s health care nurse practitioner training program, with a focus on training mid-level providers to work in rural areas, Latin American countries and other medically underserved places where there was little or no health care available.

Five classes a year complete the intense nine-month program, which is offered through the Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center. Until 2006, graduates of the program can take the state’s NP licensure exam. After 2006, however, California law will require nurse practitioners to have a graduate degree.

But that won’t mean the end of the Women’s Health Care Nurse Practitioner Program. The program has developed articulation agreements with its university partners that will enable students to bridge into master’s degree programs. Also, says Stemmler, some of the nurses in the WHCNPP are international students who go back to their home countries to practice after receiving their certificates.

“What we offer is a depth of knowledge in women’s health care,” she adds. “This program is a good step for our students, but this isn’t the end for them. It’s only part of the journey. Education keeps going and it’s never done.” More information about this program is available at



For More Information

He has also found that being an African American male gives him the opportunity to build relationships and trust with other black men. “The majority of women are wonderful about seeking health care, but men do not seek it,” he says. “I can reach out to young males and talk to them about getting medical care.” He spends one day a month walking around housing projects, passing out condoms and business cards and connecting to young men in the community.

Choosing an NP Program

So you’ve decided that an advanced practice career as a nurse practitioner is right for you. Where do you go from here? If you’re already an RN, your first step will most likely be to go back to school and earn a graduate degree.

Some experts estimate that at least 50 new nurse practitioner training programs have opened since 1995. They range from intensive, on-site full-time programs to accelerated “fast-track” programs to those offered entirely online through distance education. Before you decide which program to apply to, first think about your passions and then imagine what you want your life to be like after your training.

“It’s always good to work as an RN for a few years,” Eguakun advises. “That will guide you to what you like and don’t like and can help you decide on a specialty. In my case, I knew I wanted to work with disadvantaged populations and HIV/AIDS. My training, everything I did, was geared toward that. The preceptorships that I did were designed to reflect my needs and my goals.”

Once Eguakun was in graduate school, faculty members looked at his goals and introduced him to people who still serve as mentors, providing advice and information on new developments in his field. “Those relationships become very important,” he emphasizes. “The individuals you’ll meet have been in the field. They’ll continue to guide you and expose you to new resources. Plus, you’ll learn how to be a mentor to the next generation of minority nurse practitioners, and that’s very important.”

Miller recommends that nurses who are considering becoming practitioners first spend a couple of days shadowing a working NP. “You have to understand the role nurse practitioners play,” he explains. “The best way to do that is to spend two or three days with a nurse practitioner, just to get a feel for whether this is something you want to do.”

He also reminds would-be NPs that graduate school will be very different from their undergraduate nursing education. “The most difficult thing in terms of becoming a family nurse practitioner is having to think outside the box,” he says. “Many nurses have been educated in a disease mode. They learn about a disease and then they look for signs and symptoms. Nurse practitioners look at the total picture, using the patient’s history and physical condition.”

While all nurses are involved to some extent in diagnosis, NPs are able to diagnose and prescribe treatment independently because of their advanced education, Miller explains. “Graduate programs that train nurse practitioners are two years in length and have 600 to 1,000 more clinical hours beyond the bachelor’s degree,” he says. “Nurse practitioners have advanced skills. They function at a level that allows them to practice independently and they’re able to make more decisions about what is best for the patient.”

Finding the Right Practice Setting

Once you’ve completed your educational and clinical practice requirements and become licensed as a nurse practitioner, your next decision is choosing where you want to practice. NPs can work in a wide variety of practice settings, including hospitals, clinics, physician’s offices, public health departments, HMOs, home health care agencies, hospices, private practice and more. Once again, it’s important to think about what your needs and goals are in order to choose the setting that’s the right fit for you.

“In some offices, nurse practitioners see patients every 10 minutes. You need more time than that to do a good job of diagnosing and treating a patient,” Miller says.

On the other hand, some NPs are able to find workable solutions for providing effective care despite these tight time constraints. Miller says he knows a nurse practitioner who walks into a patient’s room with two assistants. As she’s examining the patient, one assistant is writing down her notes. The other follows through on her treatment plan. “When she leaves the room, she’s finished with that patient,” Miller explains.

But if spending only 10 minutes with a patient isn’t your style, be careful in selecting your first job after adding “NP” to your signature. “When you get out of school, don’t just settle for any job,” Eguakun cautions. “Find a practice group where you really want to work.”

He warns future NPs to do their homework about a practice or health care facility before accepting a position there. “How a nurse practitioner practices depends on the philosophy of the organization,” he says. “If you are in a private practice as an NP, your paycheck may be based on how many patients you see. There’s pressure to get patients in and out quickly.”

Organizational policies can also influence the amount of independence an NP has, Eguakun adds. “I worked in a hospital setting after I graduated. I was a nurse practitioner, but the physician had to see everything [I did] and sign off on every prescription. It wasn’t productive and I knew it wouldn’t work for me. I wanted to have a physician who saw me as a collaborator. I wanted to have some independence and control over what I did.

“Now, the physician I work with is a collaborator. We are a team and we act as a team. He’s accessible to me 24 hours a day.”