Being a Nurse Practitioner Is Your Path
I love to tell this story. I was actually born at the hospital where my grandmother worked as a nurse. After she completed her master's degree in Nursing Administration at UCSF, she became the chief nurse executive. My grandmother has been my personal and professional inspiration, mentor, support, companion, editor, and guide. I followed in her footsteps and have worked at the same hospital she did.
A few years ago, we were at an Association of California Nurse Leaders (ACNL) conference, and she encouraged me to visit the attending schools to learn about their graduate nursing programs. We were both impressed with the USF DNP program and how they sought to improve patient care and the nursing process.
When I told my grandmother I was accepted at USF, of course, it made her very happy. She supported me all the way through it, editing my papers and giving her professional input. I kept telling her that by the time I finished the program, she should have earned an honorary doctorate alongside of me.
Early in the program, my advisor Dr. Alexa Colgrove Curtis, connected with me to work on my doctorate project. With her, I learned about treatment options for opioid use disorder, such as medication-assisted treatment (MAT). Her classes grabbed me, mainly because, at that time, I was working in the ER, and we nurses struggled to manage patients with opioid use disorders confidently.
In my rural community, our resources are limited for patients needing help with opioid use disorder. Our patients are often blue-collar workers that suffer from a physical injury from their work, which may necessitate pain control. With narcotic pain prescriptions being scaled back recently, some people turned to illicit drugs, such as heroin or fentanyl. MAT offers them a safer option for pain management. Where I live we have one county health clinic that offers MAT with complementary counseling. It would be wonderful to bring this education to other clinics because so many people here need help.
As I was starting my capstone project, our community hospital was starting to offer initiation of MAT in the Emergency Department, but we didn’t yet have a good implementation process. Nurses expressed frustration and didn't understand how to best care for our patients suffering from opioid use disorder. There's always some stigma surrounding these patients, so we needed to work on having a welcoming environment to accept patients as they come.
My capstone project focused on introducing medication-assisted treatment to the ER nurses and with an education process for treating patients. Part of the education was to address biases surrounding opioid use disorder. Stigma continues to be a challenge since there are many different reasons that lead to it, whether it's people's backgrounds or past experiences, that breaking stigmas becomes a complex barrier to overcome. We learned to avoid stigmatizing patients by avoidance of language or behaviors that might discourage patients from seeking or continuing their treatment. Clients who feel they're not welcome may turn around and leave. Every person who has contact with the patient, from the admissions person to the physician, can affect the client relationship via their words or body language. Everyone can make a difference in encouraging the patient to stay and access treatment. The last thing we want to do is turn away people when they are finally ready to accept help.
Most likely, patients have experienced stigma before, whether from a healthcare provider or other people in the community. They are also feeling physically ill from the effects of the withdrawal. Even some patients, as I learned from Dr. Curtis, will self-stigmatize, and they will call themselves names like “druggie.” We have to help change that narrative to focus on the person, not the behavior. We are not just treating a patient, but we are treating their spirits and souls.
Currently, I have the privilege to work as an educator at the hospital. I don't work in the emergency department anymore, but I hope to bring this education to other parts of the hospital and others in the community. I would love to bring this education to the inpatient nurses. They also have the same need for knowledge and the same need to learn about stigma and its impact.
The Jesuit values of the University of San Francisco that emphasize caring for others align with the mission and values of where I work at Dignity Health. However, at USF I gained a different perspective for implementing those values. Learning about patients suffering from opioid use disorders was essential, and then, I gained the tools and the education about how to minister to those patients.
The best part of the Doctorate of Nursing Practice-Family Nurse Practitioner program was the strong focus on serving rural and underserved populations, which was my intention. Drs. Alexa Colgrove Curtis and Trinette Radasa introduced us to the Nurse Practitioners and Communities Together (NPCT) HRSA grant to support students who are committed to improve health outcomes among rural and medically underserved communities. The timing of meeting Dr. Curtis and the timing of the grant were amazing. It just felt like it was meant to be.
USF will give you a more well-rounded education and better tools to evaluate the information needed to do the right thing for your patients. Advocacy for the underserved was one of the things the faculty encouraged students to consider. I do think USF encourages advocacy for the nursing profession as well. They emphasized that nurse practitioners should work at the top of their scope of practice. We have such a need to provide increased access to healthcare and nurse practitioners practicing at the level of their scope could be one way to increase the number of people who have access to healthcare.
I got my diploma the other day. It brought my grandmother to tears. She gave me a big hug and said how proud she was of me. She's still my mentor. A long time ago she said, “You're not supposed to take the same path I took (as a nursing administrator). You're supposed to take the path you're supposed to take. Being a nurse practitioner is your path.”
At work I tell students and new nurses, “You'll never regret being a nurse. You might change your mind about what kind of nurse you want to be, but in the end, you will never regret being a nurse.” For me, it will always be who I am.