During the Futures Program in 2021, I learned a lot about how to manage long-term care patients, which included weighing the risks and potential rewards of aspirin in our older patient population, minimizing polypharmacy, and broaching palliative care as an ongoing discussion over several visits. But what struck me the most during this conference was how unique my experience as a nurse practitioner was compared with that of other providers — namely, physicians.
For the 2021 Futures Program during the Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine, I was actually the only nurse practitioner in attendance. As far as I knew, everyone else was a physician. I felt both special and underqualified, but I soon realized how different my professional experience was from that of the other attendees. Many of the Futures physicians were in their first year or two of residency, and they’d had limited interaction with patients in long-term care settings. Others had just begun their residency; they’d just graduated from medical school and thus had had little direct experience with patients at all.
I had come in with seven years’ experience in caring for patients as a registered nurse at the University of Maryland Medical Center on a neuro intermediate care unit. Our unit was also an acute-care setting: many of our patients had neurodegenerative conditions that had just been diagnosed, and they would soon be transferred to long-term care or subacute rehabilitation facilities. I worked together with the interdisciplinary team to facilitate their smooth transitions to these settings. I had always wondered how my patients did after their discharge from the intermediate care unit, and that prompted me to become a nurse practitioner in long-term care.
Nurse practitioner preparation is different than physician training. Typically it involves undergraduate training as a nurse then a masters or clinical doctoral degree in a specified population, such as adult gerontology primary care, and varying years of clinical experience as a registered nurse. Nurse practitioners are able to draw upon their bedside experience as registered nurses to inform their clinical skills in symptom management. As the only advanced practice provider during the 2021 Futures Program, I learned how this unique perspective on symptom assessment and management was especially helpful working in the PALTC setting. For instance, nurse practitioners are used to a collaborative process, and many of us see the value of fostering good working relationships with certified nurse assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs) because of their own experiences in direct care at the patient’s bedside.
The Futures Program also helped me recognize how helpful it is to work collaboratively with physicians. During my training as a nurse practitioner, I realized what a challenge it was for me to embrace creating accurate differential diagnoses and how many times I had benefited from collaboration with physicians. Their education is focused on diagnostics, and their expertise has proven invaluable to me as a new nurse practitioner. My collaborative experience with physicians and other members of the interdisciplinary care team has helped me embrace the holistic care and management of my patients.
Overall, the Futures Program has helped me gain confidence in myself as a provider and in the holistic experience I can bring to my patients in long-term care, and I have learned more about how I can share this perspective with other providers.
Dr. Waksmunski is a doctoral prepared nurse practitioner at Complete Care at Heritage Center in Dundalk, Maryland.