To all my fellow nurse practitioners around the globe, I want to wish you all a week of celebration and appreciation for all you do for people in your respective settings. I understand the sacrifices each of you have made in order to reach your current role and the time it took to get where you are today. This post is to reflect on what being a nurse practitioner means to me and to discuss nurse practitioners in general.

First and foremost, let’s talk about what a nurse practitioner actually is, the road to get there, and what the role entails compared to other care team colleagues. A nurse practitioner is an advanced practice nurse. We can assess, diagnose, order tests, and treat patients. As an NP, we are able to assist in surgical procedures, be primary care providers, specialists, inpatient hospitalists, academic professors, administrative managers and directors, healthcare thought leaders, and the list goes on. To become an NP, we must first be registered nurses (RNs). So depending on the route of training, it can take three to six years of education to become an NP. To get your bachelors as an RN it takes four years and then typically two more years to get your masters degree in nursing as a nurse practitioner. There are programs for people who have bachelors degrees in other disciplines outside of nursing that provide an accelerated track. 18 months and you are trained as a bachelors prepared RN, and then another 18 months and you are train as a nurse practitioner. Having said that, most NPs come with many years of RN experience which is invaluable. I won’t get into how stressful, emotionally/physically draining, and challenging nursing school can be or the high standards to which they hold their students, but I will say that I have never had a more arduous academic path than when I entered nursing school.

During school you’re buried in research projects, papers, studying for ridiculously worded exams that are designed to make you pull your hair out, and then juggle clinical rotations. Then enter NP school where it is more of the same but more intense with a greater depth of detail and increased responsibility. While getting your masters as a nurse practitioner, you are juggling all the above as well as working as an RN, life responsibilities, and financial struggles. After your program has finished (and you’re swimming in debt), you are then left walking the line of nursing and medicine for the remainder of your career, choosing a path to travel which could land you in any number of possibilities. I couldn’t imagine doing anything else with my professional life. I had the choice of medical school and nursing school, and I strongly believe I made the right choice (for myself). Nursing spoke to me and while I could be biased having my mother being a nurse of 40+ years, I truly felt the profession called to me more than medical school. It was a profession rooted in history, compassion, pride, and respect. I took the best of both worlds and pursued a career as an NP.

So what can an NP do versus a physician versus a physician’s assistant (PA). Well first, a PA and NP are similar in many of their duties and responsibilities however the training and scope of practice does differ. First, PAs are trained in the medical model whereas NPs are educated in the nursing model. The actual educational paths are different. PAs do not require anything other than core pre-requisite classes and admission to their two year program with a previous bachelors degree. NPs require a bachelors in nursing (RN, BSN) which is four years (for most programs), nursing board exams (NCLEX), nursing experience, core pre-requisite classes, and admission to the respective program. Once in clinical practice not much differs in regards to duties and responsibilities. Both can assess, diagnose, order tests, treat, prescribe, and perform procedures. Scope of practice varies state by state. Both can be listed as PCPs in most states, however, across the U.S. PAs always require a collaborating physician. NPs have a scope of practice that varies throughout the country, however, many states offer nurse practitioners complete independence of practice. In other words, that means some NPs can own their own practices and work completely alone without the oversight or collaboration of a physician.

Now there is an argument about who is “better” or “more qualified.” PAs, NPs, DOs, MDs. In all this alphabet soup, the difference is training. If all were placed side by side at graduation day, MDs/DOs will be better prepared for their roles however, many NPs have decades of nursing experience which do put them at a clinical advantage in many ways. But to say one role is better than another, it just cannot be said affirmatively as many factors come into play. Depending on experience and years in practice, some NPs have a wider breadth of knowledge than some physicians and vice versa. When it comes to a care team, there is no hierarchy but varying roles and domains of knowledge. I like to think of treating a patient like building a house. There are many disciplines/trades that all work towards the same goal and offer certain skills and abilities that the other may not have. Nurses, physicians, PAs, and NPs are just like plumbers, masons, electricians, carpenters, architects, engineers, etc. Each role offers different training, expertise, and responsibilities but ultimately work towards the same initiative. Just like an electrician is no better than a plumber or mason, the same applies to nurses, NPs, PAs, and physicians. When I walk onto the hospital floor or into an exam room, I bring with me my experience, my skills, and my knowledge base. I have had physicians of many decades seek my opinion and expertise on cases and I ask the same of them when I know their experience and knowledge can fill a gap in my own. This is what it means to work in a collaborative care team; every role is important, one no more important than the other. I had patients of five years who never saw the physician in my practices and were more than satisfied with the care they received.

So what has my journey been like…? Oh boy… Since it’s Nurse Practitioners’ Week, let’s fast forward to post-graduation day with my masters in nursing as a family nurse practitioner. I am certified and licensed to treat patients of any age throughout the lifespan from newborns to end of life care. I am a pediatrician, obstetrician, adult medicine specialist, and geriatrician all roped into one (among others). My first job was a fast paced, high volume internal medicine, adult and geriatrics practice. I had my own large panel of patients who they listed as their primary care provider and I was solely responsible for their care. When they were sick, I would admit them from the emergency room (or sometimes my office) into the hospital and take care of them while they were there. Whether it was simply adjusting their medication and optimizing their health during an anticipated surgery or aggressively managing their entire well-being due to a life-threatening illness, I would be responsible for every aspect of their care. I was the one who decided on their tests, diagnosis, and treatment. I had the honor of building incredible relationships with many patients and taking care of entire families, something I still cherish to this day. I’ve made some of my best friends working in this role who have been like family to this day. While there, I assisted our hospital’s pulmonary rehabilitation program, held patient education sessions, contributed to textbooks, precepted about 50 NP/PA students, lectured NP courses, volunteered at community health events, and helped advocate for nurse practitioners within my practice and hospital. After seeing tens of thousands of patient visits over the course of five years, I made the decision to transition to a new role and start a fresh endeavor. I joined a national startup which specializes in serving underserved geriatric patients in the lowest socioeconomic areas of the country. It was something I had read and dreamt about as a healthcare provider but there was never an open position. Fortunately for me, a position opened up. From there, I became a team nurse practitioner for multiple high risk populations in the Boston area across three practices. Over time, I assumed the role of acting medical director while maintaining my own panel of patients. My time there once again provided me with an opportunity to get to know some incredible colleagues and patients. I had the added opportunity to continue training NP students as well as medical students. I was fortunate to have some patients follow me from my previous practice all the way to the Boston area, but, I transitioned into a more centralized role within my company to offer my previous experience in Medicare Risk Operations as well as training and onboarding new physicians to our practices in the Northeast. Since then I have been involved in multiple functions throughout the company, doing what I can to help further improve the way primary care is delivered to benefit both the patient and care teams. I am now fortunate to hold the position of medical director for our national patient safety team as well as the clinical lead for our Medicare risk operations team. In addition to that I am part of our national COVID-19 clinical response team, clinical advisory team, fill in when needed for clinical care, and onboard new providers as needed just to name a few roles I assume.

This may all sound like a braggadocios retelling of my story, but it is merely a reflection of what NPs can accomplish depending on one’s passion. It’s been a long 7+ years in clinical practice as an NP but I am grateful for every moment in this career. There is no greater feeling than helping someone in their most vulnerable moments in life and doing what you can to make their lives better. I have had to deliver devastating news like a terminal diagnosis and held the hand of dying patients I have known for years when they take their last breath, but, I have also celebrated the success of patients who lost weight and turned around their health, patients who beat their cancers, caught mystery diagnoses that had plagued patients for years, and helped those with mental health issues overcome the struggles of daily life or addiction. There is no profession where every day is different, you learn something new in any given moment, have to critically think while problem solving, and do all of this while helping someone else in need. In my heart of hearts, I feel I was born to be an NP. I love what I do and appreciate the gift of trust patients place in me.

During this pandemic, I have known many colleagues who have sacrificed so much and given their all to help battle COVID-19 as well as the misinformation which has been the second, not-so-hidden pandemic. Please, celebrate the NPs in your life for they have endured a lot to be doing what they are doing now. I’ve had the pleasure of training multiple classes of nurse practitioners over my career. It’s something I’m truly passionate about and have watched my students become respected members in their fields of practice. They are not only colleagues now but some are my closest of friends. I have watched colleagues advance their careers and follow their passions which they talked about during our training. In this profession, you learn to survive and rely on the comradery of your peers, making friends for life (any nurse will tell you this). This is true and I’m proud to be part of a profession who gives so much to the patients that they care for. We are nurses at heart with the skills similar to that of a doctor. So, Happy Nurse Practitioners’ Week to all my fellow NPs and do something for yourself for once (just once, lol)!