Advanced Practice Nurses Provide Continuity, Enhance Care
"Advanced practice nurses help ensure that patient care is seamless within a complex health care system. Facilities like UW Hospital and Clinics are dedicated to making sure patients don’t fall through any cracks. Administration and physicians represent the bricks of the organization, and professional nurses are the mortar. APNs provide continuity so that any cracks are very few and extremely narrow."
- Ellen Langrehr, MS, RN, ACNP, CCRN
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Margaret "Muggs" Helin, MS, RN, APNP (left), and Ellen Langrehr, MS, RN, ACNP, CCRN, both nurse practitioners at UW Hospital and Clinics, discuss a pediatric patient's chart |
- Supporting and complementing the superior care delivered by nurse clinicians at the bedside and in the clinics
- Providing education and learning opportunities to patients, students and staff
- Collaborating with nurse and physician colleagues, and other health care
professionals, at all levels of the organization - Delivering and coordinating care to specific populations of patients
"We serve as something of a 'bridge' throughout the continuum of care," notes Ellen Langrehr, MS, RN, ACNP, CCRN (Inpatient Cardiology Consult Service). "As nurses ourselves, we understand the challenges of delivering high quality care on a daily basis. APNs bring additional education and expertise in a way that benefits the patient and the organization as a whole."
Five categories of APNs practice at UW Hospital and Clinics:
- Clinical nurse specialists (CNS)
- Nursing education specialists (NES)
- Nurse practitioners (NP)
- Certified nurse midwives (CNW)
- Certified registered nurse anesthetists (CRNA)
Each displays a different skill set - but all contribute significantly to the professionalism that characterizes the body of nursing at UW Hospital and Clinics.
CNS and NES: Different Roles, Common Goal
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Terry Gion, MS, RN, CRRN, says clinical nurse specialists serve as health care provider, patient/family educator, consultant, researcher and leader |
maintain and advance competency within their chosen area of practice. In the past, UW Hospital and Clinics had combined the functions of CNS and NES, but separated them in 2004 to emphasize the important role each played.
"We focus on a specific patient population," explains Terry Gion, MS, RN, CRRN (Rehabilitation Clinical Nurse Specialist), who practiced both as a nurse clinician and case manager earlier in her career. "Besides providing care ourselves, we also serve as consultants to nurse clinicians and other health care providers - either from our own unit or others. Our practice is always evidence-based, and we conduct literature reviews to ensure we are providing patients with the best care possible."
When providing an overview of the CNS role, Gion says she typically lists health care provider, patient/family educator, consultant, researcher and leader.
The NES focus, on the other hand, is to provide educational opportunities to professional nurses - which, ultimately, also enhances care delivery.
"We focus on conducting nurse orientation, for instance," explains Sara Moldenhauer, MS, RN, AOCNS (Nursing Education Specialist for Oncology), who joined UW Hospital and Clinics in October 2006. "We also develop curricula for ongoing education, like in-service training. Overall, we are charged with providing assistance to the nursing staff to improve professional practice and support the advancement of their career goals."
Optimally, the CNS and NES practice collaboratively.
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Sara Moldenhauer, MS, RN, AOCNS (left), and Bethaney Campbell, MN, RN, AOCNS, epitomize the collaborative roles of nursing education specialist and clinical nurse specialist |
In fact, the two have developed a highly effective working relationship.
"We not only understand our own roles," notes Moldenhauer, "but also understand the other's. Earlier in my career I practiced as a CNS and Bethaney practiced as an NES. We have a unique appreciation for the other's responsibilities - because we 'lived it.'" She adds that the two met frequently early in their collaboration to clarify roles, and that they continue to work on consistency in communication with managers and staff.
NPs Integrate Principals of Nursing with Medicine
UW Hospital and Clinics considers itself fortunate that 104 NPs provide care to patients in the hospital and clinics. Master's prepared and primarily employed by the University of Wisconsin Medical Foundation, NPs epitomize the collaboration between nursing and physician colleagues.
UW Hospital and Clinics turned to NPs a number of years ago when rule changes limited residents to working 80 hours a week.
"This created an opportunity for NPs to step and fill a critical gap," notes Langrehr, who was instrumental in developing the acute care NP track in the School of Nursing. NPs provide a single point of contact for patients throughout a patient's length of stay or episode of care, she points out. "We are often the provider that sees the patient in clinic, during hospitalization and for any follow-up care."
Throughout the process, NPs work closely with attending physicians, physicians-in-training and nurse clinicians, as well as other members of the health care team. For instance, Langrehr serves as a member of the cardiology consult service, "a traveling heart team" that provides consultations to patients on other services with cardiac issues – like chest pain, murmurs or abnormal ECGs. In collaboration with the attending cardiologist, she evaluates patients, consults with providers on the primary service and writes orders as necessary.
Margaret "Muggs" Helin, MS, RN, APNP (Pediatric Surgical Nurse Practitioner) - who initially earned an associate degree only to continue with bachelor's and master's programs - notes that she appreciates the opportunity to collaborate with other disciplines, as well as the autonomy afforded NPs.
"It provides a wonderful opportunity for professional growth. And it is gratifying to recognize the trust and respect that NPs are given at UW Hospital and Clincs - among disciplines and at all levels of the organization," she says.
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Leanne Hammerschmitt, MSN, RN, CPNP (left), and Rosemary Neider, MS, APRN, BC, AOCN, say serving as nurse practitioners allows them to integrate the principles of nursing with those of medicine |
"There was a day when physicians were not as accepting of NPs. But that has changed drastically. Here at UW Hospital and Clinics, our physician colleagues are grateful for our assistance, and regard our insights and recommendations with respect."
She adds that she finds practicing as an NP allows her to integrate the principles of nursing with those of medicine.
NPs likewise provide critical support to the nursing staff.
"One of our most important roles is that of resource to nurses," adds Leanne Hammerschmitt, MSN, RN, CPNP (Pediatric CNS, Certified Pediatric Nurse Practitioner). "The direct patient care we provide is very rewarding, but it is also gratifying to work with the nursing staff in providing education to the patient and family."
A newer addition to the UW Hospital and Clinics cadre of NPs is Rebecca Anderson, MSN, RN, APRN-BC (Heart Failure Nurse Practitioner), who joined the organization in June 2007 as a member of the heart failure program. She says she was drawn to the field because NPs "don't focus only on the disease process, but on the impact a medical condition has on all aspects of the individual."
Likewise, Anderson said the appeal of practicing at UW Hospital and Clinics was great because of the academic environment it offered and because "everyone I have encountered here - from the director of nursing through the physicians to the nurses at the bedside - has emphasized the value of collegiality among all health care professionals."
In short, Langrehr notes that NPs create an advantageous environment: patients benefit, UW Hospital and Clinics benefits - and the individual NP benefits.
"I can honestly say that I am using everything I learned during my 34 year career today at UW Hospital and Clinics," Langrehr said. "It is very gratifying."
Margaret "Muggs" Helin, MS, RN, APNP, and Dennis P. Lund, MD, who serves as surgeon-in-chief at the American Family Children’s Hospital at UW, say the collaborative relationship between APNs and physicians results in better care for patients
CRNAs Provide Care in the OR
Certified registered nurse anesthetists (CRNAs) are likewise integral to the delivery of superior care at UW Hospital and Clinics. They practice collaboratively with supervising anesthesiologists and clinical nurses - as a patient is being prepared for surgery, during the procedure itself and immediately afterward as the patient resumes consciousness.
CRNAs note they are afforded a wide range of professional opportunities at UW Hospital and Clinics. They participate in the care of patients being treated with both low complexity and high acuity procedures, and are able to assist in supporting the education of medical students.
CNMs Support Women and Families
Certified nurse midwives (CNM) hold a unique position at UW Hospital and Clinics. They practice at the East and West clinics and the Access Community Health Centers and, as licensed independent practitioners, have admitting and discharge privileges at Meritor Hospital.
"In addition, we write orders, and consult with other providers when patients present with conditions beyond our scope of practice," says Ann Rifenberg, MSN, RN, CNM (Nurse Midwifery Manager).
Eight CNMs are employed by UW Hospital and Clinics - "which provides a very collaborative and supportive environment," Rifenberg says - and deliver between 450-500 infants a year.
"We attend to women throughout their labor and direct care not just to the mother, but to the whole family," Rifenberg notes.
CNMs are master's prepared nurses with certification in midwifery, and spend a great deal of time educating patients about nutrition, education and other issues central to maternal and infant health.
APNs Facilitate Effective Care
Overall, APNs contribute an extensive array of skills to the organization.
"We bring a wealth of experience," Langrehr points out, "and, even more importantly, we are available and accessible to share this with staff, patients and their families. APNs have also developed a sense of savvy about how a healthcare organization runs and have learned to be team players. In a nutshell, we know how to get things done."
Their wide range of responsibilities brings APNs a tremendous sense of satisfaction.
"If I had to do my whole life over again, I'd want to be right here, right now, doing exactly what I am doing," says Gion. "It's incredibly rewarding."