Interview with Allyson Cole, Nurse Practitioner Student

How did you decide to become a Nurse Practitioner?

While pursuing my nursing degree, I worked at an urgent care that utilized lots of mid-level providers (NP’s and PA’s). While working herein that facility, I was fortunate to get to shadow the NP’s and really started to see myself in the role of an advance practice nurse. I loved the interaction with patients, the level of care they provided, and the satisfaction they all seem to have for their job. As a nurse, I felt that being an NP was the avenue that would allow me to make the greatest impact in the health of my community. Also, what drove me to become and NP, was that even as a nurse, I never wanted to work in a hospital. I do not like acute care. I am much more interested in preventative health care which is underutilized by the general public due to financial burden and access. An NP, makes healthcare more attainable by making it more affordable. So, I wanted to become an NP to give more people access to healthcare and to hopefully avoid hospital stays with good health maintenance in the outpatient setting.
Reflection: As Ms. Cole explained how she decided why she wanted to become a nurse practitioner, it surprised me how she said she started off working to become a nurse.  

I loved how she expressed how she looked at both of the positions of the doctor and a nurse practitioner, and how she then chose to become a nurse practitioner. Due to how doctor seemed to be rushed with his/ her patients, and how a nurse practitioner seems to care about spending more time with the patient to find out how to get them better.

Why did you decide to become a Nurse Practitioner, rather than a doctor?

​I decided to become an NP rather than a doctor mainly because I wanted to be a nurse. I grew up with a mother, step-father, and step-mother who were all nurses, so when I went to college I knew that was what I wanted to be too. I wanted to have a good paying job with the ability to care for people all at the same time. I did entertain the idea of going to medical school. What ultimately made me not want to become a doctor was actually working in the hospital and watching the doctorsinteract with their patients. The doctors were so over worked and so rushed when they talked to their patients they usually left the room without addressing the patient’s needs or even laying hands on the patient.  Doctors look at patients like they are science, because that’s how they are trained. Nurses and nurse practitioners looks at patients as a person and address the needs of the patient on a personal level before addressing the needs on a scientific level. (This is a big generalization—there are wonderful doctors out there that care for the patient first before the medical issue, but for the most part doctors are over worked and over stressed and I want to have a life outside of my job).
     Reflection: I like how she said she wanted to become a nurse, because of her close relatives that already were. Then how she then learned the role of the doctor and how they interacted with the patient. I liked how she also addressed how doctor only look at patients as science and nurses and nurse practitioners look as them as real people and working to get them better. 

What are the differences between a Nurse Practitioner and a Doctor?

 ​Main difference between the two is scope of practice, which indicates what a medical professional is and isn’t allowed to do. Each state determines the scope of practice of the Advanced Practice Nurses practicing in that particular state. Scope of practice for the NP is categorized into full practice authority, restricted practice authority, or reduced practice authority. In states with full practice authority (most notably Oregon) there is essentially no differences in the scope of practice between an MD/DO and an NP. Here in Georgia, a restricted practice state, as an NP you can manage your own patients (including diagnosing, medication prescriptions, lab diagnostic ordering and interpretations, and certain procedures-suturing, punch biopsies) with minimal physician oversight. The “restricted” part of Georgia nurse practice act, prohibits NP from prescribing schedule II medications and necessitates 10% of NP charts be signed off by a physician. The NP scope of practice can be expanded with onsite training—for example the NP who is working primarily in a Derm clinic could be trained in melanoma excisions and can perform them, even though for most NP’s this would be out of scope.  

Scope of practice is further differentiated between different types of NP’s, fiimilar to how it is with doctors. In NP school you pick a specialty- Family practice, geriatric primary or acute care, pediatric primary or acute care, neonatal acute care, psychiatric, intensivist, midwifery, or woman health. This further designates what an NP is able to do in their scope. (if you are a primary care NP you generally can no practice in acute care). This is similar to the residency specialization of a doctor, where they receive advanced training in a particular area of medicine and this narrows their scope to that particular area—the primary care doctor is not specially trained in preforming surgery therefore they do not perform surgery. 

Scope of practice is also different between NP’s and PA’s, although most think the rolls are synonymous. The PA scope of practice in all states is limited more than NP’s. The scope of a PA is to preform delegated tasks of an MD. Whereas a NP can work for the most part autonomously, the PA has more physician oversight.   
Reflection: Wow! This is eye opening to the many differences between a nurse practitioner and a doctor, because I have always heard that a nurse practitioner is basically the same as a doctor just a lower degree. It gives a wide perspective of all the differences between them, and some of these really suprised me.

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It has been said that NP’s and PA’s will soon dominate Primary Care, do you see this happening?

YES! & sooner rather than later! Students getting out of medical school are no longer going into primary care but rather are going either into specialty practice, emergency medicine, or surgery; leaving a huge gap in primary care. Although I do see mid-level providers dominating primary care in the near future, there is much to be done to make this feasible for NP’s. Nurse practice acts have become stricter and narrowed NP’s scope of practice in many states in the last few years. These regulations have to more lax, to allow NP’s to work to the full extent of their education and training before NP’s will be able to totally dominate. 

     Reflection: This really helps to authenticate my essential question, because it shows a medical student who has considered and experienced shadowing doctors and nurse practitioners and how they feel towards why so many people are becoming nurse practitioners rather than doctors.

What do you plan to specialize in as an NP? With your specialty could I work in another department?

I am getting an FNP, which a Family Nurse Practitioner. This is the broadest in terms scope of any specialty education for an NP. With an FNP my scope includes pediatrics, adolescents, adults, geriatrics, women’s health, and psychiatric. Essentially I can work in any specialty (cardiology, pulmonology, urology, ect). I do plan to work to the full extent of my scope by working in a family care practice upon graduation. But, I have a large interest in dermatology and at some point in my career would love to work in a dermatology clinic. 

     Reflection: I like this question and how Ms. Allyson answers it, because many people nurse practitioners can only go into limited practices. When in reality Ms. Cole says they can work in many specialties. 

Explain the education you have and are receiving to become an NP?

To become an NP you must first be a Registered Nurse with a Bachelors of Science in Nursing (4 year degree). Then to be able to sit for certification exams to become an Advanced Practice Nurse or NP, currently you must complete a Master’s of Science in Nursing degree. There is talk of changing the rule to become an advance practice nurse to a doctoral degree rather than a masters but this has not been changed yet!

The education I am currently receiving is both in the classroom and in clinic. I take a full class load, 16 hours of didactic work that is supplemented by 360 hours’ worth of clinic work with a preceptor per semester. Most NP schools take 2 years to complete but the program I am attending is an accelerated master’s program and only takes one year to finish!

     Reflection: I thought it was really cool how Ms. Cole has received her education, because it shows that you can take many paths that can get you where you want to eventually be. 

Where did you go to College?

I took the roundabout way to my BSN—I went to a school that still had an Associate Degree of nursing, so I received my ASN from University of North Georgia(3year program), then my BSN from Georgia College (one year program), and I am currently pursuing master’s degree from Vanderbilt University which in total will take one year. I hope to continue my education to receive a doctorate through Vanderbilt after graduation with my masters. The Doctoral program will take another 4 semesters to complete. 

     Reflection: I thought it was really Cool how she went to many different colleges, and by doing this even though it might of worried her at the time for doing that it really worked and helped her finish school earlier. 

If you could do it again would you change anything?

​No, at least I don’t feel like that now. I always thought I would regret going through an ASN program and then a BSN program. But, the way I did it got me out into practice sooner where I really was able to learn and master the art of nursing. I do feel like at the end of this year in NP school I will have wished it would not have gone by so fast (at least that’s what all my professors say). So in a year my answer to this would probably be: I wish I would have taken advantage of having a preceptor following up on all of my patients. 

     Reflection: It really encourages me to hear that she wouldn't do anything over or differently. This happened because she was so self-motivated and worked her hardest. It also makes me excited to keep on my journey to becoming a nurse practitioner. 

Do have advice for future NP’s?

​Go into every experience with an open mind! This is for nurses or just anyone wanting to go into any aspect of the medical field as well. You may think going into nursing school or NP school that you absolutely want to work with one population and one population only, but once you get into other areas of nursing you may find yourself loving something you never in a million years thought you would love. And if your mind is so closed off to other areas you won’t ever get to that realization! 

​Also, work in the medical field as soon as possible. Get a job at the front desk of an office, work as a tech on the floor of a hospital, anything to get exposure to real life medical problems. This real world experience is better than anything you get in the classroom! And the connections you make will usually come to your benefit later down the road!

     Reflection: I like how she encourages anyone who wants to work in the medical field to get in as soon as possible as working in the front desk and really diving I to show that you are serious and hardworking!