FNP | Special Issue April 2023

FOCUS: FAMILY NURSE PRACTITIONERS

APRIL 2023

Focus: Family Nurse Practitioners

PRESENTED BY:

4 Using an FNP Degree to Advance Nursing Leadership

By Julia Quinn-Szcesuil

6 Need for Family Nurse Practitioners in Community Health

By Reneé Hewitt

10 Family Nurse Practitioners: Caring for the Underserved By

Louis Pilla

14

Owning an FNP Private Practice

By Michele Wojciechowski

16

“There Hasn’t Been a Day That I Have Regretted Becoming an NP”

By Reneé Hewitt

Editor’s Notebook

The nurse practitioner (NP) workforce is expanding, delivering care to millions of patients nationwide and filling the many roles left vacant by a shortage of primary care physicians and registered nurses (RNs).

As more RNs opt for early retirement, resign due to burnout, or pursue careers outside of healthcare, hospitals and other healthcare facilities lean on nurse practitioners to fill in the gaps and mentor and develop registered nurses new to the field.

Becoming an NP offers many specialties, and the family nurse practitioner (FNP) role is among the most popular. According to the American Association of Nurse Practitioners® (AANP), nearly 70% of NPs are certified in family care. Because of their broad experience, FNPs make a difference in underserved communities and provide comprehensive medical care to patients of all ages.

Changing healthcare regulations, expanded health insurance options, increased focus on preventive care, and a greater demand for healthcare services by an aging population ensure that the need for FNPs won’t slow anytime soon.

FNPs are pivotal in delivering high-quality healthcare services, which means being the go-to resource for families for most preventive care services and treating acute and chronic conditions. And this is where the FNP holistic approach to patient care shines, concentrating on the patient as an individual and part of a family.

• This month, Minority Nurse focuses on Family Nurse Practitioners.

• The FNP background opens the potential for tremendous career growth in areas from healthcare policy to healthcare finance or academia. Julia Quinn-Szcesuil explores using an FNP degree to advance nursing leadership.

• The U.S. News & World Report ranks the NP role as the best job in healthcare for 2023. Reneé Hewitt profiles two FNPs, their essential role in community health, and their journey to becoming FNPs.

• Do you have a passion for caring for the underserved? Louis Pilla looks at how FNPs care for underserved communities on the East Coast and in the remote high desert of New Mexico.

• Have you ever wondered what it’s like to have a practice as an FNP? Michele Wojciechowski interviews a nurse that knew she wanted to go into private practice.

“Save one life, and you’re a hero. Save 100 lives, and you’re a nurse.” –Anonymous.

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Using an FNP Degree to Advance Nursing Leadership

By Julia Quinn-Szcesuil

Nurses pursuing a nurse practitioner (NP) degree often intend to improve patient care while gaining a broad nursing industry background. While building nursing proficiency, nurses explore challenging issues using critical thinking skills that have been sharpened with the challenges of the advanced degree.

Prospective nurse practitioners can choose several advanced degree paths, including the family nurse practitioner (FNP) degree. This popular option allows nurses to work with all ages and gain a lifespan approach to patient care. But the FNP degree, like most NP paths, also offers skills and knowledge that open up leadership roles in advocacy and at the bedside.

The FNP background opens the potential for excellent career growth in areas from healthcare policy to healthcare finance or academia.

“Traditionally, when family nurse practitioners enter the healthcare delivery system as advanced practice registered nurses, they seek initial employment opportunities to acclimate further and develop to their new role,” says Brian Higgerson, DNSc, RN, FNP-BC, CNE, a clinical associate professor in the College of Nursing & Professional Disciplines at the University of North Dakota. However, as they advance in their careers, FNPs have perspectives and experiences that inform their work beyond patient care. “Nurse practitioners can be an unwavering voice at the decision-making table,” he says. “The opportunities for nurse practitioner leaders are vast and limitless.”

As nurses gain additional on-the-job competence, they can explore different careeradvancing roles. “As nurse practitioners become more confident and experienced as direct patient care providers, they may explore other options to impact and improve healthcare outcomes within the context of a leadership role,” Higgerson says. “Nurse practitioners play an essential role as healthcare agents for change and advocates for both our patients and our profession.”

Gaining Autonomy

Carolina Jones, ARPN, FNP-C, and a certified nurse in obesity medicine, owns Vital Direct Primary Care, an NP-owned direct primary care clinic. Jones, a Colombian American, says the FNP path focuses on helping nurses gain the knowledge to become autonomous practitioners. “It changes a person,” she says. “Instead of following orders within guidance and protocols, you create them and make those decisions yourself. You don’t necessarily have to consult anybody, and that’s a big change.”

The FNP curriculum, which has courses in leadership roles, lets nurses pursue studies that will apply broadly. For example, the skills are useful and essential when a nurse advances as a leader to advocate for the wider nursing industry or if they choose to drive changes within their working environment as a bedside nurse.

The FNP, says Jones, lets nurses explore opportunities that arise from particular challenges. Frustrated by working within the traditional insurance-guided model of care, Jones wanted to offer more to her patients and says she launched Vital Direct because of her FNP background. “I would never have had the audacity to do something like that, on my own, without that FNP degree,” she says. “It empowered me to go out there and be the change.”

As more FNPs assume leadership roles, Higgerson says it causes a positive shift in the public perception of all nurse practitioners. “Throughout the years, I’ve watched the evolution of the growth and employment opportunities for FNPs as publicly we became more recognized and respected,” he says. “In my career, I worked in various healthcare settings, and through my experiences, I further refined my leadership skills from my days as an ICU nurse. I became more proficient in interprofessional communication, mentoring, cultural competence, and emotional intelligence. In addition, in a more autonomous role as an FNP, I developed a better appreciation for available community resources for my patients and the importance of patient education.”

A Nurse Advocate in Any Role

The leadership roles available to nurses are varied, cross industries, and appeal to many professional and personal interests. “Within healthcare organizations systems, nurse practitioners can assume clinical leadership roles, such as nurse practitioner care coordinators, nurse executives, directors of clinical operations, and may even aspire to be a chief executive officer,” Higgerson says.

Nurses can also use their influence to impact outside healthcare delivery organizations. Frequently, nurses find that one leadership position—for example, as a board member of a professional organization or as a conference presenter—will open doors to other opportunities they didn’t know about. For example, they may pursue work in academic institutions, state boards of nursing, health insurance organizations, research institutions, pharmaceutical companies, professional nursing organizations, and state or federal legislative bodies.

As more nurses pursue diverse leadership responsibilities, they will directly and meaningfully impact communities. “Real change through advocacy requires a dedication and passion for the best possible outcomes,” says Higgerson, “both patient and organizational.”

Carolina Jones, ARPN, FNP-C, and a certified nurse in obesity medicine, owns Vital Direct Primary Care, an NP-owned direct primary care clinic

Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

Need for Family Nurse Practitioners in Community Health

Q&A with Dr. Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, a certified family and pediatric nurse practitioner at the DePaul Community Health Center in New Orleans

by Reneé Hewitt

Family nurse practitioners (FNPs) are essential to the healthcare landscape, providing wellness guidance and necessary care to patients in need. FNPs help manage patient caseloads at hospitals, clinics, and medical practices, working alongside physicians and specialists to care for sick, injured, and healthy patients. As patients struggle to access care resources in some areas of the United States, the role of the FNP has become increasingly important to directly and meaningfully impact communities.

Minority Nurse chatted with Dr. Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, a certified family and pediatric nurse practitioner at the DePaul Community Health Center in New Orleans, about the critical role FNPs play in the community, what’s to come for the nursing profession in 2023, and her time as president of the AANP.

spectrum. We’re a multi-specialty clinic, but we care for the most vulnerable in the Greater New Orleans area. Our patient population is diverse. We have a lot of immigrants from various places around the world. We take patients with Medicare, Medicaid, and private insurance, as well as those uninsured.

How are you helping to make a difference in your community as an FNP?

As an FNP, I pride myself on the care I provide to my patients because they’re quite vulnerable when faced with multiple cultural challenges that impact their health status.

Dr. Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP

Talk about the DePaul Community Health Center and its patients?

DePaul Community Health Center is a federally qualified healthcare center with 11 locations in Greater New Orleans. We care for a diverse population of patients, from newborns to the very elderly, treating diseases and diagnoses that span the healthcare

So as I practice and take care of patients, I’m not just, “You know that you have diabetes, here’s a prescription.” I’m using that nurse practitioner holistic approach, and taking it a step further and making sure the patients can afford their medications, making necessary referrals for their social determinants of health, discuss food insecurities, help people who have housing problems or @ transportation issues, etc. In our practice, we have community health navigators that help patients. We assess their social determinants of health and have community health navigators that help me. They see social challenges and try to meet the needs of the community. So, as a nurse practitioner, looking at patients with that holistic approach is very important, especially when patients are so vulnerable.

Was there ever a thought about being an MD instead of an NP? Or did you always want to be a nurse practitioner? There was never a doubt. So I decided when I was 13 to become a nurse. And that

was after I had an emergency appendectomy in the hospital. So, unfortunately, I was very sick and hospitalized for a week, and the nurses at this county hospital in Warwick, Rhode Island, were so caring and compassionate. And then, as I was a nurse practicing in the intensive care unit, I saw patients who faced multiple health challenges. They were suffering from complications of diabetes and heart disease, and kidney failure. And then I realized we need more prevention for these patients. They would end up in the ICU there and were being treated for the things that could have been prevented. I focus on health promotion and disease prevention in the outpatient setting as a family and pediatric nurse practitioner. So that’s my journey as to how I evolved from wanting to be a nurse at a very young age to several years later and deciding that being a nurse practitioner was my goal.

What do you like best about being an FNP?

The connection with my patients is key. I’m certainly proud of the work that we do as nurse practitioners. It’s an honor to serve my community. What I love the most about being a nurse practitioner is impacting the lives of others and positively influencing their health, and looking at it with that holistic nursing approach that we do so well. Nurse practitioners start as nurses, so we have that four-year nursing background dedicated to our education before we even go to nurse practitioner school, which is very focused on the role we will practice. I went to FNP school to become a family nurse practitioner and got

my master’s and, ultimately, my doctorate. Others decide they want to work in mental health. So they focus their education solely on becoming mental health or start getting prepared for the medical modeling positions with a bachelor’s degree and in pre-med and then go to medical school and get exposed to many different areas of medicine before finally focusing on their residency. The educational model is different, but the outcomes are the same. And one of the things we’re very proud of as FNPs is that our healthcare outcomes are equivalent to those we see from our physician colleagues.

Full practice authority is gaining ground now in 26 states. Where do you see the role of the nurse practitioner going in 2023?

More states are instituting regulatory language that allows nurse practitioners to have full practice authority, which is the ability to practice to the full scope of our education and certification without any regulatory restrictions. And each year, we see more states moving this way. What’s important to note is that states that institute practice authority are growing the workforce. They’re creating an attractive place for nurse practitioners to practice. They’re going into rural areas and what we call healthcare deserts, where Americans lack access to care. For example, they used to institute a full practice authority in Arizona in 2001. Five years later, the nurse practitioner workforce doubled statewide, growing 70% in rural areas. And so when we have nurse practitioners practicing at the fullest extent of their education and training,

that’s a stable, permanent law. It allows nurse practitioners to decide to go into these areas where patients lack access to healthcare. It’s almost 100 million Americans lack current access to add primary care. It’s a 20% jump from a year ago. So with these healthcare shortages, we must have all healthcare providers practicing at the top of their education to meet those healthcare needs.

You’re a past president of AANP. What does it mean to you to hold this role? It was such an honor for me to be able to serve as president of the largest national professional association for nurse practitioners in the world. When you talk about 120,000 members, and just in the United States, over 355,000 nurse practitioners, providing care to millions of patients each year, it was

important for me to serve in this role, especially throughout COVID, when rapidly changing guidance seems to change constantly and the news was coming out very quickly. So I made it a point in my presidency to be sure that we were providing nurse practitioners access to all the latest information related to COVID-19, immunizations, and how the disease processes were going. But in addition, you know, at the same time, we saw that providers were becoming increasingly burned out. And so, we focus resources on our members related to provider burnout. So being responsive to our members’ needs was crucial as I served as president.

What are your words of wisdom for nurses who want to become FNPs? With almost 100 million people living in healthcare deserts,

this is a great time to become an FNP. Especially for those willing to move into those rural areas and ensure these patients have adequate access to healthcare. We have to prepare the next generation of nurse practitioners to meet the healthcare demands and prepare our healthcare workforce for the next pandemic. Whatever that means. And acting for practice authority to meet these patient outcomes is so essential. I encourage young nurse practitioners to get involved in health policy in their state, advocating for patients and patient services that can improve healthcare. The demand for nurse practitioners is growing along with other healthcare professionals. I was living in a small, rural community when I decided to become a nurse practitioner. I graduated, and I practiced in

that small rural community. Ten nurse practitioners and five physicians were in that community then. Now, 26 years later, there are five nurse practitioners and physicians. And that shows you our plight in predominantly rural areas, getting healthcare providers to care for those patients. And the tides are shifting, and nurse practitioners are there to meet the needs of those communities wherever they may be.

Reneé Hewitt is the editor and content strategist for Minority Nurse . When enjoying life unplugged from the digital world, you’ll find her on a trail taking wildlife photos or birdwatching.

Family Nurse Practitioners: Caring for the Underserved

By Louis Pilla

As a family nurse practitioner (NP), you may work in an underserved area, caring for a population desperately needing expert, sensitive healthcare. Yet, in rural and underserved communities, NPs provide a larger share of primary care to patients, according to a position paper from the American Association of Nurse Practitioners. It notes that NPs make up more than 25% of rural providers. It also indicates that for 2019-2020, some 65% of new NP graduates by certification exam were family NPs, much larger than adult gerontology primary care or psych mental health, for instance.

In this article, we’ll look at how FNPs care for underserved communities on the East Coast and in the remote high desert of New Mexico.

Offering Creative Care

At Total Health Care in Santa Teresa, New Mexico, family nurse practitioner Mayedel San Jose, DNP, APRN, FNP-C, cares for a rural population. She works with other NPs in a clinic not far from El Paso, Texas, and near the Mexican border.

under a supervising physician. At Total Health Care, San Jose works with two pediatric NPs and a women’s health NP. In addition, the clinic is planning to hire a mental health NP.

Most of her patients, she notes, have Medicaid or have no health insurance. “We have to be creative with the care because our patients don’t have commercialized insurance,” San Jose says. For instance, her clinic has partnered with a local pharmacy to help locate affordable medications for her patients.

Like most NPs, San Jose stresses preventive care and education. “We focus on health promotion and disease prevention. We do a lot of patient education,” San Jose notes.

One of those pediatric NPs, Tanya Marin, DNP, APRN, CPNP-AC/PC founded the clinic eight years ago—it opened on May 9, 2015. Marin echoes San Jose’s sentiments about the way NPs practice. “Nurse practitioners are very much focused on patient-centered and family-centered care, and we like to empower our patients to take care of themselves, to understand their illness. So we spend a lot of time teaching and helping them understand what is happening to them,” Marin says.

Marin says her patients are much sicker than those she cared for when she worked in El Paso. She says she never saw a case of hyperthyroidism during the 15 years she worked in Texas. However, at her clinic, she diagnoses it about every three months, she says.

Guiding Health

Some 2,000 miles east, NPs care for underserved populations at Luminis Health, a Marylandbased nonprofit health system. Luminis has roughly 17 sites staffed by about 70 providers in primary care, including 23 NPs, according to Roxanne Leiba Lawrence, MPH, MSA, vice president of primary care and community medicine at Luminis.

DNP, MSN, CRNP, advocates for her patients. She works at Luminis Health Primary Care Lanham, just outside Washington, DC. “There are underserved and highly impoverished areas,” Sanford says. “I like making things happen. I like when we can get samples to patients for medications they can’t typically afford.” For instance, she will find medication coupons online and print those for her patients.

<Insert Mayedel San Jose

Mayedel San Jose, DNP, APRN, FNPC, family nurse practitioner at Total Health Care

In New Mexico, NPs have full practice authority, while in nearby Texas, NPs have to work

“We’ve always used this team-based model for patient care,” Lawrence says. “Over the last few years, we have beefed up our advanced practice providers because we recognize a physician shortage. We understand that there are patients out there that specifically want to see a nurse practitioner, so they’re part of our model. They’re part of our care.” Maryland NPs have full practice authority.

Like her counterparts in the west, FNP Tormeika S. Sanford,

“I like that they trust me enough to follow my lead and to let me guide their health. I have patients who will see other specialists, and they will come back to me and ask, “So this is what they suggest. What do you think?” I like that they know I have their best interests at heart.”

“The most gratifying thing is my age,” says Sanford. “I’m young enough to connect with my younger patients who feel comfortable telling me things they wouldn’t necessarily tell their parents. I can relate to people my age, and we can deal with those issues from that perspective. And I like dealing with my elderly patients who are my parents’ and my

Tanya Marin, DNP, APRN, CPNP-AC/ PC, founder of Total Health Care

Roxanne Leiba Lawrence, MPH, MSA, vice president of primary care and community medicine at Luminis

Tormeika S. Sanford, DNP, MSN, CRNP, family nurse practitioner at Luminis Health Primary Care

grandparents’ age. So it’s the perfect position because I could connect with any age group.”

As an NP, Sanford says, she can call on a medical and nursing model of care. “I have that bedside nursing skill, but I also have that knowledge from the medical model that I can fit those two together and create a great care plan for my patient.”

Working to Full Capacity

Compared with other types of NPs, FNPs may have an advantage in caring for more patients, from birth to death, notes Paula A. Gray, DNP, CRNP, NP-C, clinical associate professor and director, FNP Program, Widener University, Chester, PA. “We are more

marketable than a person that just does adult or pediatrics or women’s health.”

San Jose notes that those interested in becoming an FNP should not pay attention to the misconception that the market is saturated and no jobs are available for NPs. The difference is that, unlike bedside nurses, NPs need to advocate for themselves.

“Once you become a nurse practitioner, the game changes, and now you need to be able to advocate and advertise for yourself,” San Jose says. “There is a need for family nurse practitioners because there’s a shortage in primary care providers.”

“We try to provide that patient-centered, familycentered care,” says Marin. “That’s how we can maintain

our patients healthier for longer, and it’s just so comfortable to work at the full capacity of your education and training. It’s very gratifying.”

Louis Pilla is a seasoned publishing expert with over 20 years of experience providing content and digital products to healthcare audiences.

Paula A. Gray, DNP, CRNP, NP-C, clinical associate professor and director, FNP Program, Widener University

Your care makes a difference

You flourish with connectedness, knowing that at the end of the day, we’re here to support one another—mind, body and spirit. At Providence, we wholeheartedly believe in the whole person. All are welcome—all are valued.

Together, our 120,000 caregivers serve in 52 hospitals, 1,085 clinics and a comprehensive range of health and social services across the western United States. With so many locations to choose from, it’s easy to find a role just for you.

rn.providence.jobs

Owning an FNP Private Practice

By Michele Wojciechowski

Ever wonder what it’s like to have a practice as an FNP? We reached out to one to give you the details.

Ever since she finished nursing school, Aliesha Mann, MSN, APRN, FNP-BC, IHP2, knew she wanted a private practice eventually.

Because she lives in Maryland—an independent practice state—Mann knew she could eventually open her practice whenever she decided to. So she returned to school to earn her FNP while working as a nurse on an Ortho/MedSurgical floor.

In 2018, she graduated from Chamberlain University and began, at that time, treating adults and children in a private orthopedic practice. But that wasn’t where she wanted to stay.

“I decided to open my practice at the end of 2021, and I truly wanted my practice to thrive off of a more holistic approach,” explains Mann. So in 2022, she became the founder and CEO of Zynda Integrated Health and Wellness.

In the meantime, she furthered her education to learn more about Adult and Pediatric Integrative Health, Functional Medicine, and Functional Blood Chemistry.

“I wanted my practice to solely be virtual starting, to be able to reach people nationwide through one-on-one health consulting/preventive care,” says Mann. But she has big plans for the future. “The intent is to grow and eventually open an in-person family wellness practice.”

Not One-Size-Fits-All

Mann’s practice offers highlevel, holistic health consulting one-on-one with virtual clients.

“I help high-performing women--primarily busy moms who are either stay-at-home or career-driven, and I help kids as well. I help them get to the root causes of digestive issues, low energy, and brain fog. I additionally support women on their fertility journeys, from preconception to pregnancy to postpartum care. I can relate to this population of people as a wife and a mother,” she says. “Fertility health is especially important after my ectopic pregnancy last year. My practice allows me to dedicate time, support, and accountability to those individuals who don’t receive that attention in a normal 15- to 20-minute appointment. It allows me the capacity to focus on lifestyle and nutrition in a more indepth way! I love it.”

Mann also says she loves her current practice because she can get to the root cause of symptoms. “I don’t use bandaid approaches or quick fixes. Instead, I incorporate mindset, nutrition, and lifestyle modifications and educate people to be the healthiest versions of themselves. I meet people where they are in life, and they get access to me any day and time of the week. They aren’t waiting weeks or months to follow up if symptoms pop up. They can contact me at the moment, and we will address it. I use state-of-theart functional medicine testing and blood work to help me provide answers and find

an individualized treatment approach. My practice isn’t one-size-fits-all,” explains Mann.

Encouragement

According to Mann, her FNP was a stepping stone to where she is now. “Having my FNP has opened many doors and also given me a great knowledge base,” she says.

If you’re thinking about earning an FNP or you already have one but have been thinking about opening your practice, Mann is encouraging. “I would say if you live in an independent practice state and have big dreams of opening your own practice, go for it! Don’t hesitate. So many opportunities open up as a nurse practitioner in any field of study that interests you. My path led me to Integrative and Functional Medicine,” says Mann. “The best reward is when a patient smiles and thanks you for the care you have given to them, and you can truly feel that deep appreciation. It makes any tough day better. In my business now, I love it when I hear, “No other physician has ever shown me the kind of attention and care that you do.”

By opening her practice, Mann says she has found exactly where she needs to be: “I think it is important to know that when you find your true calling and passion, work will never feel like work. I truly love what I do and how I can help people thrive and live joy-filled lives in a more holistic way!”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about nursing but comes close to fainting when she sees blood. She’s also the author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box

“There Hasn’t Been a Day That I Have Regretted Becoming an NP”

By Reneé Hewitt

Q&A with Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, the AANP Region 11 Director, and a family nurse practitioner providing primary and specialty diabetes care in Naples, Florida.

U.S. News & World Report , for the second year in a row, ranked the nurse practitioner (NP) role first on its “2023 Best Healthcare Jobs” list and second on its “100 Best Jobs of 2023” list. The annual rankings consider “the most important aspects of a job, including opportunities for growth, work-life balance, and salary.”

It’s estimated that nearly 100 million people live in primary care health professional shortage areas. According to the American Association of Nurse Practitioners® (AANP), NPs are leading the way in expanding access to care — everywhere.

Minority Nurse chatted with Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, the AANP Region 11 Director, and a family nurse practitioner (FNP) providing primary and specialty diabetes care in Naples, Florida, about her journey to becoming an FNP, how her training as an FNP helped her on the front lines of hurricane Ian, and what’s to come for NPs in the nursing profession in 2023.

U.S. News and World Report ranked the NP role as the best job in healthcare for 2023. With over 355,000+ licensed NPs in the United States, there must be something satisfying to draw so many nurses to this career. So why did you choose this career path?

Nurse practitioners (NPs) are trusted because they are highly trained and committed healthcare providers who work tirelessly and selflessly to improve the lives of their patients and communities.

I always knew that I wanted to be a nurse. There was just something in me that said, “I want to be a nurse.” Being a nurse practitioner is more than a job—it is a calling. I went to NP school because I wanted to be able to do more for my patients. Working in the hospital setting, I would see so many people there due to the consequences of chronic diseases. So many of these outcomes could be prevented. This is what NPs do. We focus on not just disease management, but health promotion and prevention as well. NPs blend the scientific process, current evidence, and national standards of care with a holistic approach to managing patient care.

The future of healthcare is bright with NPs.

Talk about your career path and how you ascended to that role. I am an NP in an internal medicine practice focusing on diabetes management. I see adults ages 18 and up. As I said, I have always wanted to be a nurse. I took a course while in 11th grade to become a nurse’s aide and worked in the pediatric department at my local hospital. At the urging of one of my supervisors, I earned an Associate of Science

in Nursing degree after graduating high school. With the NP role as my goal, several years later, I began working on my bachelor’s degree and subsequently completed my Master of Science in Nursing as an FNP. I had been a nurse for 16 years before becoming an NP. The Doctorate in Nurse Practice has become the terminal degree for NPs, so seeing that trend, I completed my DNP in 2013.

We’ve all heard the debate, why become an NP and not an MD? Did you ever consider becoming a physician? No, I never wanted to be a physician. However, the nursing profession, specifically the NP role, provides versatility, leadership opportunities, and flexibility in schedule, among other benefits. NPs are highly educated providers that assess, diagnose, and treat patients of all types. NPs are grounded in nursing, and then we blend the scientific process, current evidence, and national standards of care with a holistic approach to managing patient care. NPs are becoming the provider of choice for many Americans because of our role and model of care, which focuses on disease management, health promotion, and prevention.

The specific degree options are versatile, including family care, psychiatric care, acute care, pediatrics, and others. NPs can be found in hospitals, clinics, private practice, specialty offices, home care, etc. This versatility, in conjunction with the increase in demand for the role, allows NPs to make career changes throughout their lives.

What do you like best about being an FNP?

I like many things about being a family nurse practitioner, but I think what I like the best is getting to know my patients and their families and becoming a partner in their healthcare—helping them meet their healthcare goals.

What’s the difference between an FNP and NP?

An FNP is one type of NP. The NP role is consistent with the Advanced Practice Registered Nurse (APRN) Consensus Model. The Consensus Model for APRN Regulation is a model and document created by the National Council of State Boards of Nursing to create consensus on licensure, accreditation, certification, and education for APRNs. NPs are educated, then certified, and practice in one of the six population foci:

• Family/individual across the lifespan

• Adult-gerontology

• Pediatrics

• Neonatal

• Women’s health/genderrelated

• Psych/mental health

Beyond population foci, NPs can focus on and become certified in a specialty.

You’re the regional director of the American Association of Nurse Practitioners® (AANP) and former president of the Florida Nurse Practitioner Network (FNPN). What does it mean to you to hold these roles?

It has truly been an honor to serve in these leadership roles. I have strived to represent those who elected me to the best of my ability. I hope to have helped shape the NP role at both the state and national

Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM

levels by making decisions that have positively impacted the future.

Where do you see the role of nurse practitioners going in 2023?

The demand for NPs is growing. NPs are quickly becoming the health partner of choice for millions of Americans, with over 1 billion visits to NPs each year. We blend our clinical expertise in diagnosing and treating health conditions with an emphasis on disease prevention and health management, bringing a comprehensive perspective and personal touch to healthcare, which is desirable to healthcare consumers.

NPs top the list of professions expected to grow the fastest over the next decade, according to the most recent data from the U.S. Bureau of Labor Statistics. The profession is projected to grow by nearly 46% by 2031. So, despite some growing pains and the continued high levels of stress in the healthcare field, mainly because of the pandemic, experts see the role of the NP continuing to expand in the coming years. And I would agree.

For the second year in a row, U.S. News & World Report ranked the NP role first on its 2023 Best Healthcare Jobs list and second on its 100 Best Jobs of 2023 list. The annual rankings consider some important aspects of a job, like opportunities for growth, work-life balance, and salary.

According to the U.S. Department of Health and Human Services, there are nearly 100 million who lack adequate access to primary care. However, NPs are poised to address this challenge, with almost 90% of NPs educated

to deliver primary care. As a result, NPs are leading the way in expanding access to care.

More and more states are expanding access to primary care by eliminating outdated restrictions and giving patients full and direct access to NPs. This allows NPs to practice at the top of their education and clinical training, allowing patients to benefit more fully from the care NPs provide. For example, both New York and Kansas acted in 2022, and now 26 states, the District of Columbia, and two U.S. territories have full practice authority (FPA) laws in place. States that have adopted FPA are ranked among those achieving the best health system performance, access to care, and patient health outcomes in the nation. However, outdated licensure laws in the remaining states reduce or restrict patient access to NPs.

Mental health NPs are increasing access to mental health services. Today, 158 million people live in mental healthcare health professional shortage areas. NPs are stepping up to meet this demand for mental healthcare. Over the last ten years, almost 100 new psychiatric mental health NPs have been added. PMHNP programs have been added to schools of nursing in the United States. These programs have produced more than 13,000 new providers since 2012, according to the American Association of Colleges of Nursing Enrollment and Graduation Reports 2012-2022.

A study published last year found that the number of NPs treating Medicare beneficiaries for psychiatric and mental health conditions grew 162%

between 2011 and 2019, compared with a 6% decrease in the number of psychiatrists treating Medicare patients. This study also indicated that in 2019, these NPs provided 34% and 51% of mental health office visits for Medicare beneficiaries in urban and rural areas with the full scope of practice regulations. PMHNPs are a rapidly growing workforce instrumental in improving mental healthcare access.

Talk about the journey to becoming an FNP.

Becoming an NP is a rigorous educational process underpinned by evidence-based coursework and clinical rotations. To become an NP, one must be a registered nurse, hold a Bachelor of Science in Nursing (BSN), complete an NP-focused graduate master’s or doctoral nursing program, and pass a national NP board certification exam. In addition to core science and math coursework, such as a pre-health sciences core, graduate NP education builds upon the foundational knowledge obtained in undergraduate BSN-registered nursing education. During graduate school, NPs gain the advanced clinical knowledge and skills to diagnose, manage and prescribe medications and other treatments for patients. Before applying to an NP program, it is wise to research the program’s accreditation and graduate certification rate to find the right match.

NP students determine their patient populations at the time of entry into an NP program. While core courses in pathology, pharmacology, and physical assessment are included in all NP programs,

this population-focus-based education ensures that an NP student’s educational time is 100% concentrated on the clinical area where the NP clinician will ultimately be practicing. Identifying a population focus from the beginning of educational preparation allows NP education to match the knowledge and skills to the needs of patients and to concentrate the academic and clinical study program on the patients for whom the NP will be caring. For example, a primary care pediatric NP will spend the entire time in didactic and clinical education dedicated to issues related to the development and healthcare needs of the pediatric patient.

National board certification not only formally tests the knowledge of all that was learned along the journey to becoming an NP, but it is also a requirement for state licensure and credentialing with insurance companies. National certification boards are rigorous, psychometrically sound, evidence-based examinations verifying entry-level clinical practice. These exams test both general advanced practice knowledge and population-specific competencies and NPs are only eligible to sit for exams consistent with their graduate preparation. Once national certification is passed, the NP applies for licensure in the state where they practice.

You were on the front lines of hurricane Ian. How did your education and training prepare you for handling this type of emergency?

Nurses and NPs are resilient problem solvers, know how to work under pressure, and can think out of the box. Fortunately, my office did not

lose power with Ian as we did with Irma a few years ago. However, I know of NPs whose practices were destroyed by hurricane Ian. One particular practice is Samaritan Health and Wellness Clinic in Lee County. They are working out of a church until the physical space is back up and operationally sound. Recently the NPs of Lee County held a benefit to support healthcare workers in need following hurricane Ian, which included Samaritan. Another NP took a boat loaded with supplies day after day, before FEMA and other relief

teams arrived, to Pine Island to care for those stranded on the island. Unfortunately, the bridge was washed away by the storm.

What are your words of wisdom for nurses who want to become FNPs?

Don’t wait! Take that first step and apply to a program. Just do it. There hasn’t been a day that I have regretted becoming an NP.

Is there anything else you’d like to add?

Every NP must be active in their profession in whatever

form that takes. Join your professional associations at the local, state, and national levels. Run for a leadership role, volunteer to work on a committee.

AANP is the largest professional membership organization for NPs of all specialties and represents the interests of NPs as providers of highquality, cost-effective, comprehensive, patient-centered healthcare. In addition, AANP provides legislative leadership at the local, state, and national levels, advancing health policy; promoting excellence

in practice, education, and research; and establishing standards that best serve NPs’ patients and other healthcare consumers. To learn more about AANP and what membership has to offer, visit www. aanp.org

If you want to learn more about NPs, I invite you to visit www.WeChooseNPs.org

Reneé Hewitt is the editor and content strategist for Minority Nurse . When enjoying life unplugged from the digital world, you’ll find her on a trail taking wildlife photos or birdwatching.