Many current nurses are unsure about the decision to enroll in an LPN to RN bridge program, BSN program, or other advanced nursing degree program. Education can be quite expensive, so concerns about the value of a nursing education for one’s career is certainly justified. Learning from someone who has experience in the field can help assuage any fears one might have about continuing nursing education. We were fortunate to interview Jan Daniel, MSN, FNP-BC who owns and operates Stokesdale Family Care. She has worked as an RN, obtaining a BSN from UNC-Greensboro and an MSN from Duke University . Her knowledge and experience is valuable to anyone interested in a nursing career.
- When you were deciding on schools for your BSN and MSN degrees respectively, what factors did you consider to be most important?
- Currently there are many nurses in the field who may only have an associate’s level degree; what are some advantages for those who have obtained a Bachelor of Science degree in nursing?
- Looking back on your studies, what college course has helped you the most in your current profession?
- What are some of the most common challenges a nurse faces day-to-day on the job?
- How did you decide to become a family nurse practitioner specifically?
- What skills do you consider to be essential in order to have a successful career in nursing?
- Technology has had a significant impact on health care; how do you think it has affected the nursing profession specifically?
- Many nursing students are concerned about the job climate upon graduation; what steps should BSN candidates take to improve their employment opportunities?
- What is one piece of advice you’d give to someone deciding to further his/her nursing career through either a bridge program or advanced degree in nursing?
- Do you feel demand for skilled nurses is rising? Where do you see the industry in ten years?
1. When you were deciding on schools for your BSN and MSN degrees respectively, what factors did you consider to be most important?
Distance was really the only factor. In 1980, I was not aware that there was an associate degree in nursing. Had I gone that route, I would not be where I am today. When I returned to school in 1997, I had three options of schools within 1 ½ hours of my home. All three had excellent reputations, and all offered the Family NP track. One of my (then) co-workers was in the program at Duke and another one of my co-workers applied when I did. We were both accepted and spent the next 2 years carpooling together.
2. Currently there are many nurses in the field who may only have an associate’s level degree; what are some advantages for those who have obtained a Bachelor of Science degree in nursing?
The BSN program will graduate a nurse who is not only competent in the science of nursing, but is also competent in critical thinking, leadership and communication. When I think of the role of a nurse in any setting, I think of a person who is able to think through situations clearly, lead the patient back to health and communicate effectively with other members of the healthcare team, as well as with their patient and the patient’s family. The basic science of nursing and the memorization of such will essentially remain the same. It is the nursing theory and critical thinking processes that set the nurse with the BSN degree ahead and apart.
3. Looking back on your studies, what college course has helped you the most in your current profession?
Managing Acute and Chronic Illness I & II N354 & N355. These courses focused on the majority of common illnesses seen in primary care. We had to write papers called ACR’s or Advanced Clinical Reasoning. While these papers drew groans from all of us (they were grueling to write), they were by far the most beneficial. We had to take a SOAP note from a patient we saw in clinical and pick the note apart bit by bit, explaining, defending and rationalizing our care, our exam and our plan, all the while utilizing evidenced based references. A three paragraph SOAP note would end up being the focus of a 14 page paper! The thought that went into each paper helped me in countless ways. I not only learned how best to perform examinations, I understood the rationale behind each step of the entire process.
Non-compliance is now my greatest challenge in primary care. Non-compliance can come from a background of ignorance as well as from an attitude of carelessness. The latter is usually unintentional and the former from informed choice. It takes me just as long to figure out now whether someone is not taking their medications as prescribed because they don’t understand how, or because they chose to not take them. The outcome is the same, the medications are not taken as prescribed, but my approach regarding educating these people is completely different.
When my children were young I decided to take a job as a telephone triage RN. I learned a great deal during my short triage career. The MD’s I took call for were so appreciative of what I was doing for them that they were more than happy to answer all my questions I would ask such as, “Why are you prescribing that?”, and “What will you do when you see them?”. I had several standing orders to prescribe certain medications and or treatment for common ailments. I finally decided since I was already doing a lot of assessing, diagnosing and treating, I might as well go get a degree to support this and learn more.
Some synonyms of nurse are: encouragement, keeping an eye on, preserving, promoting, watch out for, take care of, take charge of and treat. These are all essential aspects of nursing. Just as important are: the ability to systematically coordinate, organize and catalogue. Of course all must be done with diligence, patience, persistence and guts! A skilled nurse must be empathetic and nonjudgmental, be intellectual with strong math and science background, an effective communicator with substantial observational skills (knowing when something is just not quite right), an aggressive patient advocate and also have the physical capacity to handle manual labor.
7. Technology has had a significant impact on health care; how do you think it has affected the nursing profession specifically?
The advent of computers and EMR’s has definitely changed my daily routine. Some aspects of electronic charting are cumbersome, but the benefit of being able to share information with other providers is great. For example, if I have to send a patient to the ER for further care and work-up, it is relatively easy for me to finish the note, send it and any prior notes along with labs to the ER provider, all electronically. There are significant cost savings too. No expense for transcription or for paper. In my practice I have also begun to offer patients a USB flash drive with their complete medical history on it. Of course, a HIPAA agreement is signed by the patient and placed on the drive. I am able to do this in minutes. The patients are then able to carry this with them.
8. Many nursing students are concerned about the job climate upon graduation; what steps should BSN candidates take to improve their employment opportunities?
Be open to several different opportunities. I never imagined that a job answering after hour’s calls would lead to what I am doing now, but it did. As a nurse you will be able to move around and do several different types of work. Some may think this hopping around is not good, but I look at it as opportunity for continued learning. As an RN I pretty much stayed in one place, but once I was an FNP I moved around a lot. My dream was to open my own practice someday and I knew when I graduated from Duke that I needed to get a lot of experience in several different areas in order to be a well-rounded NP. As such, I have worked in Pediatrics, Family Practice, College Health, Urgent Care, and Occupational Health. The occupational health job was a very independent position and it led me to believe I was “ready”. I opened my office in June of 2008 and have drawn on all my past experiences in one way or another.
9. What is one piece of advice you’d give to someone deciding to further his/her nursing career through either a bridge program or advanced degree in nursing?
Do it! The benefits you will reap will be amazing. Unless you are really convinced and set on one narrow field (such as nurse anesthetist or neonatal nurse practitioner), get a broader degree. For example, a pediatric or womens health NP can only see pediatrics or women. I can see the entire family and it didn’t take that much longer in school.
Yes. Nurses are taking on so much more responsibility. They are the backbone of healthcare and there will always be a high demand for nurses. In ten years I see more advanced practice nurses in hospitals taking an even greater role in the care of patients from both a medical and nursing standpoint. Nurses should take an even greater role in the education of resident physicians in the hospital and be given credit for that education. I see nurses and physicians working side by side, collaborating as peers, both respecting each other’s career choice. Family NP’s have a golden opportunity to take on the task of providing primary care to all. I am proud of the fact that we have stepped up to fill a need and are doing it well.
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