How new career path changed five nurses’ lives

Many nurses want to carve new career paths for themselves while aiming to keep quality, accessibility, and compassion at the forefront of their health care efforts. Both the federal health care reform law and the Institute of Medicine’s The Future of Nursing report currently present opportunities for nurses to accomplish those dual goals.

These five nurses ventured and gained by expanding their role and career trajectory to make a difference.  Their careers are still evolving.

Jane Young: A health care pioneer in Idaho

Jane Young, ND, PNP, NP-BC, became a nurse practitioner (NP) when the role was fairly new and largely a mystery to many in her home state of Idaho, whose population of 1.5 million residents stretches over roughly 82,600 mostly rural miles.

“Scarcely anybody knew what a nurse practitioner was — not patients, not physicians, not even the majority of nurses,” said Young, an Idaho Nurses Association member. “But the need was evident for providers who looked at the whole patient and took the time to listen and establish trusting relationships with their patients.

“The first steps were to define the role of the nurse practitioner, and emphasize to the state attorney general and area physicians that nurse practitioners met the corporate and health care provider definitions of a professional.”

This paved the way for NPs’ independent practice in Idaho and allowed Young to found her Boise practice, Family Health Care, in 1983. Family Health Care offers comprehensive health care to patients from birth to 105 (her oldest patient.)

Jane Young

“With each patient, we focus on wellness,” Young said. “We look at the whole person in the context of their family and environment, as well as consider variations in their health through their lifespan. And we view patients as equal partners in their care.”

Over 28 years, the practice has grown, necessitating four moves to larger offices and increasing the number of providers to four (Young, another NP, a family physician, and a physician’s assistant). They now take care of four generations of families. And Young sees patients at the office and in their homes, and has privileges at an area hospital. (For more about how ANA is working to expand advanced practice registered nurse (APRN) privileges, see the APRN Focus column on page 10.)

Young initiated an NP-interest group to promote the role early on, and currently about 300 NPs participate. She also co-authored the book, Managing Your Practice: A Guide for Advanced Practice Nurses, which provides information on starting an NP practice, including the business side.

Young’s decision to pursue a health care career was strongly influenced by her father, who was responsible for initiating the education and placement of NPs in the western states to improve patients’ access to quality care. Shortly after earning her bachelor’s degree in nursing, she accepted a job in northwest Montana. However, Young soon realized that she needed greater expertise to meet the communities’ needs. She decided to become a pediatric nurse practitioner and graduated from the second class of NPs at the University of Washington School of Nursing in 1976.

Over the years, Young determined that “trust” was at the center of both her education and career.

“If we expect our patients to change behaviors to decrease illness, they need to trust our expertise and direction,” Young said. “If we expect our colleagues to change their view of nursing, they need to trust that we offer a different aspect of care that can complement theirs to improve patient care.

“If we expect change in our health care system, we need to trust ourselves — that we are capable, insightful, intelligent leaders who can improve individual and system-wide health care in our country.”

Carol Timmons: It’s all about the people

Carol Timmons, FNP-BC, GNP-BC, started her nursing career some 30 years ago as a general nurse on the night shift at a small, rural hospital.  After two years, she split her time between working on the floor and as the house supervisor — wherever the need was, be it med-surg, the ER, or the skilled care unit.

That expertise-building and a return to school for her bachelor’s degree served her well when her facility, Samaritan Hospital, began to consider opening a rural health clinic.

As it turns out, locating the clinic site — an old downtown building — was the easy part. Finding a nurse practitioner (NP) to run it was not so easy. Initially hospital administrators hired an NP who was willing to drive an hour and a half to work the clinic. Meanwhile, Timmons, one of six RNs with a bachelor’s degree at the hospital, agreed to earn a master’s degree to become an NP.

The downtown clinic opened in 1996, Timmons began working there in 1998 after the first NP left, and in 2001, it closed. Timmons quickly found another job, but after eight years, she was ready for a change.

Carol Timmons

“At the time, I was 56 and at a crisis point,” said Timmons, a Missouri Nurses Association member. “I realized I did like what I was doing. So I decided to start my own business.” She contacted NPs affiliated with the University of Missouri School of Nursing to determine what she needed to do to successfully run a business and interact with insurers. She also had the strong support and business knowledge of her husband.

After remodeling a building in 30 days, borrowing $5,000 in seed money, and getting some medical equipment from her former hospital employer and more through eBay, she opened Carol Timmons’ Clinic, in Clarence, MO. She provides primary care services to patients, many of whom followed her to her new practice.

“I think about health care more holistically,” Timmons said. “I really try to keep costs down for working people, who don’t qualify for assistance and who might have high deductibles or co-pays.” She also tries to prescribe generic drugs when appropriate and doesn’t “over-follow up.”

On her website, Timmons describes her practice as being somewhat akin to a small town family doctor, but coupled with the latest technology and evidence-based practice. She also states that she will help her patients understand and navigate the ever-changing health care system.

Timmons  would like to see more NPs run their own practices.  Said Timmons, “Nurse practitioners need to see their own worth — that they are trained from day one to take care of the [multidimensional] needs of people, not just the illness.”

Leigh Wood: Affecting life at the beginning

Shortly after Leigh Wood, CNM, graduated from a diploma program in 1970 and took a job in a busy ICU, she was off to Germany with her husband who was stationed at a military base there.

“I worked at the army hospital in their tiny special care unit and helped out on the OB and pediatric units,” said Wood, a South Carolina Nurses Association member.  She preferred the pace of the latter. “I also liked my autonomy there,” she said. “You didn’t have to call a doctor to give a Tylenol.”

Those early experiences in labor and delivery abroad and later back in the States led Wood to become a certified nurse-midwife. “What I liked about nurse-midwifery is that you don’t wait for a problem — you stop it from happening in the first place.”

Becoming a nurse-midwife also fit her personal take on life.

Leigh Wood

“I call myself an old hippie, because I really wanted to make the world a better place,” Wood said. “And what better way than to start at the beginning, when you can affect the health of a mother and child?”

On Dec. 21, 1982, Wood delivered her first baby as a nurse-midwife at the once thriving, 56-bed Bamberg Hospital in rural South Carolina. And for the next 29 years, she attended to the births of more than 2,000 babies.

“There is a lot of poverty in the area,” Wood said. “I’ve seen women who had no prenatal care or preventive care, who had no means of [routine] transportation, and who lived in homes with no running water and just a wood stove for heat.”

Nurse-midwives had run the hospital’s birthing unit since the mid-1970s; the hospital’s former director, Michael Watson, MD, saw them as an ideal solution to meeting the needs of women and lessening the patient-load of the handful of family physicians in the area. Wood knows from experience that some women initially view being seen by as midwife as suboptimal to being seen by an obstetrician. But also from experience, she finds women return to her and other nurse-midwives for their subsequent deliveries because they want the care, the time, and the attention they received the first time around.

There has been a very strong need here for women’s services,” Wood said. Despite that need, Bamberg Hospital recently closed all but its emergency room to cut costs. Now Wood works with three other nurse-midwives in the free-standing, midwifery owned and operated birth center in Charleston, SC. She provides a range of women’s health care services, including prenatal, intrapartum and postpartum care, well-woman care, and interventions for gynecological problems.

Wood believes that nurses who may be considering becoming a nurse-midwife should shadow a practicing nurse-midwife for at least a week to see what it’s really like and whether it fits their lifestyle.  Midwifery is a strenuous profession physically, mentally and emotionally, and the hours can be horrible, she said.

She also suggested that nurses who are pondering new roles also look to boards of nursing and other resources to see where the needs lie, as well as examine their own motivations for taking on a new nursing role.

David Pederson: Ensuring timely access to care

If it weren’t for certified registered nurse anesthetists (CRNAs), patients in some parts of the country would have to travel far and wait longer for needed procedures and surgeries.

That is certainly the case in many Western and Midwestern states, including Iowa, where David Pederson, CRNA, who is a member of the American Association of Nurse Anesthetists (AANA) — an organizational affiliate of the American Nurses Association (ANA) — has been providing anesthesia services for more than 20 years.

Like many other APRNs, Pederson started his nursing career as a staff nurse, first on an orthopedics unit and then in the OR as a circulating nurse.

David Pederson

“I was working days, rarely worked weekends, did some call, and was reimbursed well for it,” Pederson said. “But it wasn’t all I needed in my life. My uncle was — and still is — a CRNA. He suggested that I take a look at what he does and how he works. I did just that and was inspired.

“I remember being nervous about the training,” said Pederson, who started a CRNA program in 1978. “I had no idea of the complexity of what I was getting into.”

Since graduation, his practice has been primarily in rural settings. For the past 23 years, he has worked at St. Anthony Regional Hospital in Carroll, IA, a 99-bed facility that only utilizes CRNAs. The staff has doubled in size from three in the early 1990s to the present staff of six.

“I provide whatever anesthesia services are required in the house,” Pederson said. “There is nothing as rewarding for me as seeing a patient safely through an anesthetic and having a good outcome in the end.”

He recalled a case from his first year of practice, in which he was called in at 8 pm for an emergency C-section.

“The education and clinical training makes you better prepared than you realize,” Pederson said. “It turned out great. The baby was healthy. The mom was healthy. It wasn’t until I was a block away from the hospital that I started trembling. It was the first time I had done a Caesarean on my own.”

CRNAs practice in every setting in which anesthesia is delivered, and are the predominant providers of anesthesia care in rural communities (sometimes the sole providers) and other medically underserved areas of the United States, affording health care facilities to offer obstetrical, surgical, and trauma stabilization services.

In 1991 the Centers for Medicare and Medicaid Services published an important rule allowing states to opt out of requiring CRNAs to be supervised by physicians. So far, Iowa and 15 other states have opted out of this burdensome requirement that affects patient access to necessary anesthesia care.

Still, practice barriers remain for CRNAs. AANA continues to work with federal and state policymakers to ensure CRNAs have the ability to provide patient care to the full scope of their practice rights.

Pederson noted that nurses who are considering a career as a nurse anesthetist should shadow a practicing CRNA for a period of time.

“I get an incredible amount of satisfaction from it [his role of a CRNA],” Pederson said. “But it is not for everyone. It is a lot of responsibility and, at times, pressure. And there can be a big difference if you are practicing in an urban setting versus a rural practice.”

Janice Putnam: Look at opportunities

Back in the 1980s, Janice Putnam was working as a phlebotomist and trying to figure out her next career step: lab tech or nurse?

“I chose nursing, because it seemed like there would be more opportunities in the future,” said Putnam, a Missouri Nurses Association member. Following the death of close family member from a heart attack, Putnam decided to focus on cardiovascular nursing. She initially worked on a telemetry unit, and then switched to a cardiac rehabilitation unit.

Over the years when faced with change — be it the birth of her daughter, a family move, or a new policy within the larger health care environment — Putnam looked for opportunities.

Janice Putnam

“And usually education is the key to taking advantage of those opportunities,” said Putnam, who earned a master’s degree in health promotion and eventually a doctoral degree.

On faculty at the University of Central Missouri since 1998, Putnam uses her passion for health promotion, particularly tobacco-use cessation, in her evidence-based practice research, teaching, and community service activities.

Through her research and counseling, Putnam learned that many college students are socialized to become smokers, and many use smoking as a way to control their weight.

Again looking at opportunities, she determined that a provision in the new health care reform law can help nurses nationwide address the problem of tobacco use.

Under that provision, a tremendous number of young adults will be staying on their parents’ insurance until they are 26 years old, making them eligible for smoking cessation programs, Putnam said.

“As nurses, we’re going to have greater access to populations, like college students, that we are not used to having,” she said. “We need to understand those [health reform] changes and be able to explain them [to patients], and expand our programming and services based on those changes.”

Putnam also has embarked on a project with colleagues from the nursing and exercise physiology departments, and the local Agency on Aging to evaluate the fitness and wellness programs being delivered at 24 senior centers. They specifically want to determine if those programs are indeed improving the health of older adult participants.

Looking at nursing and its place in the future, Putnam still sees a world of opportunities — although perhaps different from when she started her career.

“When a student tells me they want to go into pediatric nursing, I say, ‘Do you want to work with sick children or well children?’” Putnam said. “You don’t need to just nurse the sick anymore. With the health care reform law, there are many opportunities opening up to do wellness and prevention.”

That said, she believes nurses must continue to advocate strongly for both illness and wellness care, be flexible in their career decisions, and work toward ensuring laws, regulations, and policies acknowledging — and funding — nursing practices meet the needs of patients now and into the future.

How you can change your direction

Nurses considering a change in professional direction can use a number of tools to facilitate their journey, including the following:

•  Learn as much as possible about an RN specialty or advanced practice registered nurse (APRN) role from nurses who are practicing in that area — either in your workplace or through your nurses association colleagues.

•  Shadow a nurse in that specialty or advanced role for a day or ideally longer.

•  Explore what is motivating you to choose another path in nursing, and determine what it takes to make it happen, such as certification, retraining, or advanced academic preparation.

•  Research the demand for a specific specialty or advanced role.

•  Do your homework before choosing a graduate program, checking its accreditation and flexibility in terms of your schedule.

•  Accept the support of nurse colleagues, friends, and family all along the way.

•  Check out online resources that specifically address the role, have financial information on returning to school, and other important factors.

Additionally, the American Nurses Association (ANA) has several resources to help, including the following:

•  The Nurse’s Career Center (www.nursingworld.org/careercenter) is an online resource designed to connect qualified nursing professionals with leading health care employers. Employers can post a job, view candidates or create a resume alert. Job seekers can search for a job, post a resume or create a search agent. Additionally, there are career-related resources for new nursing grads and experienced RNs available on the Web. The career center also offers access to the National Healthcare Career Network (NHCN), a comprehensive source of career opportunities for job seekers and employers. NHCN is a network of more than 200 top health care associations and professional organizations.

•  Tools to learn more about APRNs, financial resources, and online degree programs, at www.nursingworld.org/EspeciallyForYou/What-is-Nursing.

•  Access to a list of ANA organizational affiliates that can offer nurses information on their specialty or advanced roles at http://nursingworld.org/AffiliatedOrganizations.

•  American Nurses Credentialing Center (ANCC) certification can open new doors when advancing in a career path. Learn more about becoming certified at www.nursecredentialing.org.

— Susan Trossman is the senior reporter for The American Nurse.