The healthcare system is ever changing and the need for advanced practice nurses will be in demand. I had an opportunity to interview two advanced practice nurses. Jolene and I met at her home in St. Charles, IL Jolene graduated from the University of Colorado at Denver in 2005 with a master’s degree in nursing and was granted the title: Family Nurse Practitioner (FNP). She got married and accepted a position as a Primary Care Provider at VNA Health Care in Aurora, Ill. VNA Health Care is a federally qualified health center serving the uninsured. In the year 2000, Jolene’s mother was diagnosed with breast cancer. As a loving daughter, she supported her mother through a cancer free journey today. From this experience, Jolene came in contact with all kinds of nurses and because she loves people of all ages, she became inspired to be a family nurse practitioner. I met Linda at her office at Women First in Aurora, Il. In 1974, Linda graduated from Northern Illinois University with her BSN in nursing. Linda worked many years as a nurse in woman health, especially in the OB Department at Provena Mercy Center in Aurora, Il. In 1980, after her daughter entered grade school, Linda decided she wanted pursue a master’s degree in nursing. In 1983 she graduated from the University of Illinois with a master’s degree in nursing and earned the title: Certified Nurse Midwife (CNM). Linda has worked in many in woman’s health practices with physicians and in 1997 established Woman First, Inc., which specializes in midwifery care and woman’s health from puberty to menopause.
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Linda entered nursing because with her mother being an RN she was exposed to nursing growing up. When she was working as a labor and delivery nurse at Provena Mercy Center and personally experienced midwifery care with her daughter’s birth, this inspired Linda to become a certified nurse midwife Jolene and Linda’s typical day in the clinic are similar because they see patients. In family practice, Jolene will see 40 patients a day, ranging from school physicals, to immunizations, to managing uncontrolled diabetic patients. At Woman First, their practice is different because of OB care. Along with providing routine health care to women, CNMs take an on-call schedule at the hospital to give labor support and help mothers deliver their babies. They also make hospital rounds with the practice’s inpatients and participate in committee meetings for woman health. Caring and Compassion ring through the practices of these two APNs. At the VNA Health Center, Jolene is happy with her practice and the support she receives from the VNA family. She feels if she can educate diabetic patients, manage their care and listen to them, evidence from her practice shows the patients are more compliant. Jolene practices with in her role as a FNP meaning she takes a holistic approach: (mind, body, and spirit).
Over 20 years Linda has pioneered midwifery care in the Aurora area. She was one of the first CNMs to deliver babies in the hospital setting using labor support and delivery of her patients. The hospital has supported midwifery are for more than 20 years. Linda loves being a CNM. She feels very fortunate to practice and give comprehensive healthcare to women and to empower them to make fully informed choices in their health care. Evidence has shown a decrease of cesarean sections and increases of healthy birth outcomes at Woman First. The APNs sit for certification exam based on knowledge and the need to practice safely in NP specialty area. Jolene obtained certification from the American Nurses Credentialing Service (ANCS), a national certifying body. She received the title of Family Nurse Practitioner (FNP). Linda became certified through the American College of Nurse Midwives Certification Council (ACNMCC), and granted the title of Certified Nurse Midwife (CNM). Recertification for the FNP is every 5 years and for the CNM is every 8 years. Jolene and Linda have full prescriptive authority and may prescribe schedule II-V but require some degree of physician involvement. The medication schedule II-V involves controlled substances and non- controlled substances.
Each practitioner has a DEA and NPI number. The DEA registration is required to prescribe controlled substances and NPI number is required on all non controlled substance prescriptions. Linda explained having full prescriptive authority gives her the freedom to practice midwifery care. Pregnant patients have the option to choose natural childbirth, a birth with some medication, or even epidural anesthesia. In order for APN’s to practice in certain situations in Illinois APNs need collaborative agreements. Jolene commented that she has a supervisory collaborative agreement with a family practice physician at the VNA health center.It is a legal document between the physician and FNP stating the relationship and similar unique practice skills of each individual. Linda has had a collaborative agreement with the same ob./gyn physician for the past 20 years. They have built a close professional and personal relationship to give woman excellent health care. The purpose of this agreement is having specific guides for CNM care, protocols and standing orders including prescriptive authority.
Both women described their credentialing and privilege process within the VNA health center and at Proverna Mercy Center. Jolene went through an interview process with the human resource department and the medical director of the health center. She supplied them with her application, licensure, education, and documentation of experience and clinical competency.
The process was different for Linda because clinical privileges at Provena Mercy Center involve a detailed processing. Credentialing is the first process; same as Jolene the credential and competency documents are supplied through the HR department. The difference in Linda’s process, she received a recommendation from her sponsored physician and extensively interview with the medical review board. The result of the interview and information supplied is used to make a decision to grant privileges Both Jolene and Linda had a 90-day period of time focused on professional practice under their collaborative physicians.
With ever-changing health care in APN practices active membership and participation is needed in professional’s organizations. Jolene expressed she is not a member of the American College of Nurse Practitioners (ACNP) because of personal financial problems. Linda is a member of the American College of Nurse-Midwives (ACNM). The example Linda gave was the ACNM is moving toward integrating certified midwives (CMs) with certified nurse midwives (CNMs). She is very interest in the legislation on this issue. Along that discussion I asked about furthering ones education to Doctor of Nursing Practice (DNP). Jolene commented in the future she would like to pursue her DNP along with her becoming a nurse midwife. The DNP is necessary because the APN scope of practice will widen and more education is needed. Linda received her DNP in 2012 at the University of Illinois. Linda took the clinician expert track in the DNP program because, later in her career, she may want to teach in the clinical setting.
Jolene and Linda are both passionate about their practices—and proud of their contributions to patient recovery. Jolene feels she has helped the underserved and enjoys the variety of disease management. She had a Hispanic man with uncontrolled diabetes. She expressed that patients with chronic diseases tend to have a fatalistic attitude. Jolene, through persistence, convinced him to seek nutritional consults and diabetic education, which caused the man to commit to be compliant and have healthy lifestyle. With Jolene’s help, the man realized he was going to die if he did not take care of himself.
Linda contribution to midwifery and woman care is many years of delivering babies, not all deliveries are happy. Some babies are stillborn or babies are born premature, and some with undiagnosed congenital anomalies. Part of Linda’s spiritual belief is that all babies are gifts from God and all life is precious. An example she related to me was about a Hispanic patient screaming in the labor room. The woman already received some medication for pain. The nurses were getting frustrated at this patient because of the constant yelling. This patient was not a typical midwife patient. Linda was on call when this woman came into the hospital through the emergency room with no prenatal care. Linda came to see the woman and sat down at the bedside and held her hand gently and stroked it her hand. The woman never cried out, Linda did labor support and delivered her baby. After the baby was born, the woman told Linda in broken English that when she touched her the fear lifted from her.
It was a pleasure to interview these 2 caring professional women from different APN career paths. Learning about their inspiration entering nursing, sharing day to day details, and the emotion expressed in their compassion for each area of practice. Gaining knowledge of the educational and credentialing process to insure competency in practice and patient safety. Lastly, hearing the personal accounts of their contributions and rewards for giving exceptional patient care.