The Advanced Practice Nurse (APN) I interviewed is FS; she is an Acute Care Nurse Practitioner (ACNP) with the department of Urology at Saint Louis University Hospital (SLUH) and has been licensed and board certified since 2010. FS graduated in 2005 from Goldfarb School of nursing in Saint Louis earning her bachelor of science (BSN) and then took an intensive care staff position with Missouri Baptist hospital for two years. With two years of experience she felt she needed to continue her education in nursing and enrolled in a Saint Louis University (SLU) ACNP program.
She realized after the first year that trying to work full time and take classes was too much for her, so she decided to quit her job to focus full time on her studies. Her first position as an ACNP was with the trauma department step down floor at SLUH in 2011. This position was advertised in newsprint and after sending in her resume she was contacted to for an interview in person. My first interaction with FS was last fall when I was teaching Advance Trauma Care for Nurses as she was one of the students that I recognized from the trauma department.
We struck up a conversation and I basically did a mini interview then and she since has given me contacts for preceptors this summer. Last week I notified her regarding this interview and she informed me to meet her at noon in her office where we discussed questions listed according to the description of assignment for a total of 30 minutes. Personal history including education FS received a Bachelor of Science degree from Georgetown University in Economics and International Business.
When working out a problem or learning a new skill she likes to get the general picture and start gradually focusing in on specifics similar to deductive theory. She knew she wanted to work in a hospital setting, from there to a surgical floor, and now she has focused in on Urology. She learned the Urology department at SLUH wanted to bring in two or three APN’s on service to round and be first assistants in the operating room through networking with other APN’s in the hospital. When she interviewed for the position she had a great working relationship with that service already.
They knew she was punctual along with having familiarity with documentation system. She basically had been marketing herself before she even knew it by having a proactive relationship with consults. Description of current practice FS does not currently have a formal job description since her position is new and she is the first APN to fill this newly developed role with this service. Other than being told she would round on patients in the hospital, write orders, discharge patients, and first assist in the operating room she has no formal written description.
When she applied for her position she was informed it would be a lateral move with no increase in pay or benefits. FS arrives to the hospital at 0600 similar to an intern or second year resident. Every morning she receives report from night float of any new patients or issues to existing patients who have been admitted. Information is gathered on labs and radiology films that have been completed and she uses this information when her first patient assessment is completed early that morning. The fellow or senior resident will round on each patient to discuss labs, radiology, and patient assessments.
From this a plan is developed what needs to be done that day to move forward before the attending rounds with the team to discuss the same items. From this point she may go to the operating room to first assist if it is her patient or write new orders on the other patients assigned to their service. If she happens to be first assistant she will follow the patient back to their room and write post operation orders. Her role is very similar to a second year surgery resident duties. Description of APN functions using the APN core competencies.
Working in an inner metropolitan city hospital that has many ethnicities has been challenging. She has had to learn certain customs, body posture, and position can have either a positive or negative impact in perception from the patient with regard to attitude of care they are receiving. She has learned from staff of the same ethnicity or watched family and friends interact with one another on proper cultural customs. The first of two main core competencies FS uses is clinical and professional leadership with fellow APN’s and physicians discussing assessments and plan of care.
The second of two core competencies is consultation with other services and the nursing staff in consideration to patient care and goals (Cooke, Gemmill, & Grant, 2008). APN’s have additional competencies but these are the two main descriptions FS uses daily. FS has worked through many challenges as an APN the last few years. Some of the minor issues have been the acceptance from other services that do not have APN’s. Over time other services have become accustomed to consults from APN’s by her demonstrating knowledge, professionalism, and kindness.
The biggest challenge she has faced is an overabundance additional patient work load since the department will no longer have residents this year. She has the attending’s blessing to hire more APN’s and they will take on more direct patient care. Issues confronting the APN in current practice FS reports there are no real issues she faces at present other than just continue to work on suturing skills in the operating room. She stays current in Urology by attending grand rounds along with reading and presenting journal articles.
She also has the luxury of having a fellow who has been a great source of knowledge. Perceived impact on APN role pursuant to current healthcare developments, changes, and national recommendations. It is my personal belief APN’s will be one of the fastest growing professions in the coming years when the Affordable Health Care Act takes place. It appears that many physicians will probably be in specialized services along with the APN. In addition, APN’s will be the majority of primary care in the future as more individuals will seek wellness physicals and the baby boom generation is nearing 70 years of age.