About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Saturday, June 23, 2012

Army Medicine Experience 2012

When the American Psychiatric Nurses Association asked me to represent them for the Army Medicine Experience Tour (AME12), I was both honored and thrilled. There have been three distinct times in my life when I considered joining the military. Once in high school when West Point invited me for a visit, second for ROTC during pre-med undergrad, and third for active duty Air Force after working as a PMH RN.  The options for learning were intriguing and the benefits tempting, however military service was not right for me at those times and I chose different paths. While I like who I am and where I am in life, I must admit this trip carried the"what if" factor for me.  The following reflections are just a few nurse-empowering highlights from AME12, an educational and rewarding experience not just from my perspective as a health provider, but as an American.

"Not everyone is meant to be a soldier" - Major General David L. Mann
The purpose of this trip was made clear early on - "Learn about your Army. . . get the word out so you are armed with the facts . . . this is not Mash 4007." We were recruited not to raise our own right hand, but to inform our spheres of influence about the benefits of working as a member of the Army healthcare team. Beyond the frequently advertised scholarships and loan repayment that come with service, Army healthcare providers described the deep sense of personal satisfaction and unique opportunities for professional development. While all providers may serve the public, those that serve soldiers exhibit an extra layer of pride and honor not replicated in the civilian world.

"We owe them the quality of medicine consummate with their service." - Herbert A. Coley

"We want people who are devoted to duty and high ideals" - Major General Robert J. Kasulke
Contrary to the idea that the Army will take anyone, only the most qualified providers and future providers are being recruited to care for our soldiers. There are over 9,000 health care providers serving in the Army, and the level of qualification is at a two year high. Competition for the Health Professions Scholarship Program is stiff and only the best are chosen to serve.

"We take care of America's sons and daughters." - Major General Jimmie O. Keenan
Rather than advancing her career as a Piggly Wiggly checker out of high school, Major General Keenan was one of the 1% of US citizens who raised her right hand. On choosing and chose to pursue a career in Army nursing, "it's about knowing what options are out there. I figured I would stay in as long as it was interesting. Its now 26 years later and I still bleed green" This 2-star general is chief of the Army Nurse Corp and Commanding General of the U.S. Army Public Health Command.  She presented all of us with her official coin during the farewell dinner which she assured us was not just so she could call out for it when in need of a free cocktail. She is one of the few people I have met who can say that they have it all.  A truly inspiring, authentic spirit!

"We rehab you for reality" - Brooke Army Medical Center
The nurse manager of the burn unit took us on a tour of the newly opened wing, and I re-learned a number of facts about vital signs, environmental protocols, caloric needs, and risk statistics. Nurses undergo a 6 month 1:1 preceptorship on the 40-bed unit (16 ICU/24 Step-Down) and are not considered experts for at least 2 years. The therapeutic alliances are much more personal than in other specialties, and professional boundary norms do not always apply. Due to the highly specialized nature of burns, many of the healthcare staff have been at this one post for a decade or more.  Stem cell skin regeneration is just one of the innovative therapies they are using to increase survival rate and functionality for burn victims.

"We have 3 missions: Patient care, training, and research. Not necessarily all in this building." - Center for the Intrepid
This facility has treated over 725 wounded warriors in the past five years using a number of high-tech modalities including Intrepid Dynamic Exoskeletal Orthosis (IDEO), FireArms Training Simulator (FATS), a made-from-scratch gait lab, and the largest Computer Assisted Rehabilitation Environment (CAREN) in the world.

"It's unfortunate it took 9 years of war to get here, but it is exceptional what they have done." - Specialist Christopher Powell
Our guest speaker from the Wounded Warrior project lost his legs to an IED while working as a medic in the field. This hero spoke to us the day before he was to get his first set of computerized knees. As a Psych nurse, I was particularly impressed that he engages in proactive, preventative counseling -  "I don't have PTSD or  TBI, but that doesn't mean I won't." Best of success in PA school!

"It's kind of dangerous, but don't worry about that. Look good, have fun, and safety third." - Golden Knights
Major lesson: DO NOT WISH AWAY EXPERIENCES! I initially prayed for bad weather and a broken plane. Well, both happened right before it was my group's turn to go up. By karmic reprieve I was able to get on the manifest for the following day and had the experience of a lifetime! Check out the photos and videos for an external look at this incredible opportunity to jump with the Army's professional parachuting team, and my stab at a haiku to poetically describe the indescribable:

Wind rushing. Quiet
Falling. Abruptly floating.
Dream oblivion.

Thursday, June 14, 2012

Flying Providers!

This weekend I am off to attend the 2-day Army Medicine Experience Tour in San Antonio! Check out the list of the scheduled events with links to the highlights. For the latest updates, follow me on Twitter @OneDNP #AME12

Day One: Monday June 18th
0700: Welcome Breakfast with Major General David L. Mann
0900: Tour Brooke Army Medical Center and Center for the Intrepid at Fort Sam Houston
1245: Lunch at Fort Sam Houston Golf Course Club House with Major General Robert J. Kasulke
followed by Wounded Warrior presentation
1430: Army Medical Department Museum Tour and Army Medicine Q&A panel
1700: Experience San Antonio at will

Day Two: Tuesday June 19th
0600: Breakfast at will
0700: Depart for Stinson Airfield, Camp Bullis
0800: Tandem Jumps with the Golden Knights
1500: (if we survive) Health Professional Scholarship Program presentation, participant written reviews, film testimonials, and ravel claims
1930: Farewell dinner with Major General Jimmie O. Keenan

Friday, June 8, 2012

What Now?

The post-graduation elation has given way to the reality that I now have to use the education I have taken a couple of decades to acquire.  So, where does a DNP go from here?

For starters, I have to take the ANCC certification exam. Application was sent, the card was charged, and I am anxiously awaiting my approval to test. I will be provided a 90-day test window, and if all goes according to plan, I should be certified and licensed as an PMHNP in KY by August (and you know what I am going to do with that set of initials).  As soon as I get this piece of paper, I will create my study plan.

Next, a job. I already have my private practice doing what I do, but if I want to truly put theory into practice, I need to create my own psych-mental health residency in the form of employment. Thus far, I have ruled out MSN or DNP university positions. I have had interviews and opportunities, but frankly, the teachers I admire most are the ones that can back it up with a few years of clinical practice. As someone who preaches to my BSN students to "be the nurse you would want as your nurse," I have an obligation to "be the teacher I would want as my teacher." I am most interested in the VA and had an interview for a few positions this week. I did my own reflective journal on this, but will wait to hear one way or another before I post my thoughts on the experience.

The capstone is completed, and I want it published. Since the topic involved interdisciplinary research, it is a bit more difficult to find a home than it would be for straight nursing. I have a few ideas that I plan to explore this coming week.

Next week, I am jumping out of a plane with the Golden Knights as part of the Army Medicine Experience Tour at the Brooke Army Medicine Center.  The American Psychiatric Nurses Association  was kind enough to ask me to represent the organization and I am especially looking forward to learning about all the work they are doing with Traumatic Brain Injury and PTSD at the Center for the Intrepid.

Speaking of APNA, this September I was invited to take part in a task force on local chapter operations. I and a colleague will also be presenting a pre-conference session on integrating Traditional Chinese Medicine in the psych/mental health setting at the 26th annual convention in Pittsburg.

Phew, school might be over, but the learning and leadership is just beginning!

Sunday, June 3, 2012

Congratulations Doctor Nurses!

The degree journey has ended, but the DNP adventures are just beginning. As the responsibility for improving the future of healthcare was laid upon us, so was the realization that we all have the strength and knowledge to meet the challenges ahead. Here are some highlights from the convocation and graduation of the UTHSC DNP class of 2012!
Pre-Graduation festivities at a lovely Vietnam Restaurant with the largest, most diverse psych/mental health DNP class that was . . .  or ever will be.  

The faculty address by Melody N. Waller reminded us of the many dimensions of love and loss that come with the nursing profession. Hearing all of the great capstone projects my peers have been working on, especially with diabetes, vulnerable populations, and health promotion behaviors, was inspiring.

Hooded by Cheryl C Stegbauer, who gave me the best complement of my life during Philosophy of Science when she told me I was a thinker.

This Dr. Nurse was voted Class Troublemaker - expect great strides in mental health advocacy from this one! 
With two future Dr. Nurses who are destined for great advancements in integrative care!

After being handed my fake diploma  (actually a lovely picture of the campus),  Chancellor Steve J. Schwab shook my hand and said "Congratulations doctor. Well done."  He did this for the thousand-odd graduates after delivering an address exemplifying how our current knowledge will comprise just a fraction of our future knowledge in a career of life-long learning and innovation.

And so it is official!