Why/How did you make the transition from RN work through your advanced degree and into NP practice?
As an RN and entering into my advanced degree, I chose the NP stream to work directly with patients. I specifically focused on pediatrics as I wanted to work with the family unit. The otolaryngology NP role was open as I finished my studies. While it was more specific than I intended to focus on, the opportunity for a supported learning environment in a specialized tertiary care facility that families access throughout Western Canada was a huge draw. I was lucky to receive great support from other NP’s at the Stollery and the ENT surgeons as I made the transition. The surgeons were aware I was not coming into the role with expertise in otolaryngology and gave me the supports I needed to grow into the role. One of my mentor NP’s at the Stollery pointed out that residents take five years after their medical degree to be proficient in their specialty, so having a learning curve entering such a specific role was expected.
Describe one significant learning about the role of the NP within your current practice environment.
There is so much to learn! I have learned to ask many questions and make time to read each week to keep up to date in the field. There is little that is black and white when dealing with unique people and cases. Staying up to date on advances and changes is vital, no matter what specialty or path you choose.
What is one thing you wished you knew before starting in your current position?
There will be many days you feel like you don’t know anything, and that is ok. Reading, asking questions and time in the role will change that feeling — until there is a new research to consider, and then the learning begins again!
Can you tell us a bit about your clinical environment (e.g., where you work, with whom you collaborate, etc).
My environment is varied. I work with post-operative short-stay patients – most commonly head and neck abscesses, adenotonsillectomies and ear surgeries. I also work in an outpatient clinic where we most commonly see sleep-disordered breathing, recurrent ear infections (and their complications), new babies with breathing concerns and swallowing dysfunctions. Most of my collaborations involve kids with tracheostomies. We follow these patients in the hospital weekly. There are anywhere from 10 to 20 children admitted at any given time, and about 80 we follow in the province. These kids are medically very complex and live at the hospital anywhere from three months up to a year or more. We work with other teams – respirology, general pediatrics, rehab, respiratory therapy, infectious disease and ICUs. Once discharged, we organize a trach clinic where all patients in Northern Alberta and Saskatchewan are followed through the trach clinic at the Stollery and seen by a multidisciplinary team to limit the number of hospital visits needed as an outpatient.
What does your typical day look like?
I start early – usually 630 and round on the inpatients with the residents and ENT staff. I spend about half my days in the clinic seeing new consults or post-op follow-up patients. I also spend a lot of time teaching and addressing the needs of trach inpatients. I go back and forth to the wards to help facilitate prompt discharges for ENT admissions or follow up on diagnostics or acuity changes. I often finish my day meeting the post-operative patients and their families on the ward and do teaching and ensure all the orders are completed.
Describe the challenges you face in your position.
Otolaryngology can be so specialized, and because we are such a big referral centre, there are often conditions or diagnoses I have not seen before. It’s a challenge to support patients and families when a new situation presents that I do not have first-hand experience dealing with. The patient care aspect, often due to age and distance, can be challenging due to the complexity of some cases. For example, planning a discharge with an infant that is going home to a location hundreds of kilometres away and having to address the education and support for the parents in managing a tracheostomy. Another challenge is balancing the needs of various stakeholders in each case. From the surgeons to families to administration, I need to ensure that everyone’s voice is heard and that their position and interests are considered. I also always need to be prepared for both long-term cases such as ear tubes and acute situations such as an airway obstruction that requires immediate medical interventions.
What research or teaching are involved in your current role? (non-clinical work)
For research, currently, the focus has been on qualitative data, connecting with families on their navigation of the systems and processes in their tracheostomy journey. Our research is specific to their experience at the Stollery Children’s Hospital.. I also take on NP students.
What is something that all NPs can learn from the work you are doing in your current environment?
Like many specialties, wait times are long to get into the ENT clinic. We get many referrals that can often be initially managed by primary care in the community alleviating long wait times for families. There are guidelines available for managing recurrent otitis media, epistaxis and sleep-disordered breathing. If these guidelines were accessed and followed closely by primary care practitioners, patients may have a medical workup started while waiting to be seen by a specialist.
How can the NPAA support NPs working in your practice area?
I think continuing to expand the public and other healthcare providers’ knowledge on the utility of NP’s. I don’t think people realize that the NP scope of practice can be vast and their capabilities quite in-depth. Of course, if the NPAA could wave a magic wand and get the government to approve a funding model that allowed family’s access to NP’s in a clinical setting, that would be beneficial! NP’s are a viable opportunity for excellent and affordable health care in the community.
What do you feel is the biggest impact of the role of the NP in your practice setting?
I am typically the first point of contact for pediatric trach patients on the ward and in the community. My role allows families’ needs to be addressed quicker and more efficiently versus waiting for our busy ENT surgeons. ENT surgeons often do not have enough time to spend with complex medical patients due to their caseload to minimize wait times.
Advice for NP students who want to work in your field?
Be adaptable and focus on how you can improve patient experiences and outcomes. Keep your eye on patient care, and avoid getting wrapped up in politics you have no control over.