“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 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