Nurse Practitioner

The field of Nurse Practitioners has been around for quite a while. However this career field has exploded in popularity  in the last decade with many nurses realizing that they would like to further their education, their scope of practice and their autonomy.

Becoming a Nurse Practitioner seems to be a logical step in the evolution of many nurse’s careers.   Figuring out if it is the right step for you is quite another thing.   One of the best ways to do this is to simply ask someone who did it!   Dr. Joyce Mikal-Flynn has been a nurse practitioner for over 20 years.  She currently practices as a NP and teaches at Sacramento State University where she is an associate professor in the School of Nursing.

We asked Dr. Mikal-Flynn to share her thoughts on her career as a nurse practitioner, covering how she became a nurse practitioner, her thoughts on the job market and what to expect for students aspiring to this profession.

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What was it that first drew you toward becoming a nurse?

I simply thought it would be a great profession. I enjoyed science and working with people. I worked as a volunteer during my adolescence and enjoyed being in the hospital.

What was your first job in nursing after school?

I joined VISTA (Volunteers In Service To America) and was a public health nurse(PHN) in a migrant and seasonal farm worker clinic. I thought I was joining otherpublic health nurses but it turned out I WAS the nurse. It was a sharp learning curve and included significant anxiety about exactly how to serve this unique community. I worked diligently and ultimately felt I did a great job. In addition to having a wonderful experience I was also exposed to a new profession, what was to become my long term profession: a nurse practitioner. I never knew this role existed until I worked at this clinic. Once I completed my contract at this post I sought out nurse practitioner programs (NP) and enrolled in the NP program at University of California, Davis.

At some point you went into public nursing and ICU nursing, can you tell us a bit about those transitions and what you liked or disliked about the two areas?

There was nothing I really disliked, in fact some of it was the same. PHNs do a great deal of independent decision making but are limited in scope of practice, limited in diagnostic abilities and prescriptive abilities. Also, I wanted more in terms of knowledge. I wanted/needed more information on pathophysiology, microbiology, physical exam skills and general patient care that I did not get with an undergraduate degree. When I went back to school, I built on my work as a PHN, and in critical care, taking advanced courses in pathophysiology, microbiology, physical exam and pharmacology. I enjoyed being pushed to another level of formal education and clinical practice, enabling me to practice with deeper knowledge and understanding of direct patient care.

After my PHN practice I worked in a medical surgical ICU. The PHN role made an easier transition into the family nurse practitioner (FNP) role than critical care. You do not focus on the same things in ICU as you do with an outpatient practice. A similar aspect of both PH and ICU nurses that relates well to a NP practice is the level of critical thinking and independent decision making, which again, is what drew me to them and ultimately to a FNP professional role. I just wanted to know more and be more in charge!

When did you decide to become a nurse practitioner?

As I said, shortly after graduating with a BSN (Bachelor Science in Nursing) and viewing the role first hand while working in the public health clinic after college. I was amazed at the role. I was impressed with the independent decision making, the collaboration with physicians and the role in terms of patient care. This type of nursing practice just resonated with me.

Where did you work as an NP?

I have always worked with Sutter Medical Group in Sacramento, California. My specialty is in family practice, which I did for several years. Now that I am a professor, I see patients one day/week in an urgent care clinic. I have thoroughly enjoyed the role and practice. Especially the relationships with MDs. It is very collegial and respectful on both parts.

Could you give us an idea of what the current job market is like for an NP?

There ARE jobs. You may begin your practice in an underserved area, very rewarding but tricky for a new grad because there may be less support and you might feel a bit isolated. All the larger health care organizations use NPs; Sutter, Mercy, and Kaiser. NPs can consider many options such as; practicing independently, working in a larger group practice in both inpatient and outpatient practices. Additionally, there are jobs working with subspecialists like cardiologists, dermatologists, emergency room docs, internal medicine, pediatrics, OB/GYN…they are even used as second assistants with surgeons. Of course there is some special training, but  they do it.

What are some of your likes and dislikes regarding this profession?  Are there any hurdles you have had to jump that someone aspiring to be a nurse practitioner should know about prior to starting their educational journey?

I see no problems. NPs have been around for quite awhile and the initial issues have been dealt with thanks to the wonderful nurses who came before, paving the path and guiding our current practice. NPs are sought after now. Initially there were issues, mostly with MDs. They were worried their practice and jobs, especially those in family practice, were at risk. This is not the situation at all. My experience and those of my colleagues is that we get along very well. Both professions have a unique role in health care that is valued and understood as being separate but complementary.
What is important to know about the NP role is that it does take more education and clinical hours. It is an advanced role thus more is expected. Plan on getting a bachelors degree and a masters. You will most likely spend a total of 6 years with your formal education.

If a student was in a situation where they were deciding on becoming either a MD, or an NP, what in your experience would you tell them is the greatest differences between the two professions to help them make their decision?

There is a difference. MDs have ultimate responsibility clinically, no question. However, as mentioned before, it is collegial and complementary. MDs do have more clinical training and formal education  — NPs may have a 6 year course of education, where MDs, have 8 years of education, 4 years of undergraduateeducation, 4 years of medical school, then, depending on their choice of specialty practice, their residency is 3-4+ years after medical school. MDs practice a medical model, NPs straddle both roles. They focus on the nursing model but incorporate the medical model as well. This divergent role is a fun and interesting way to practice. NPs, typically, are more holistic. MDs follow an allopathic model.Interestingly, I do see MDs taking on more of what is traditionally thought of as nursing practice, as they work to be more open to holistic aspects of a person’s health and wellness, a focus of nursing practice. In deciding which role fits for you, there are several aspects: time, money, focus of practice and perceived abilities. It is an individual decision – both are great!

Do you have any final words of wisdom for the students looking to follow a similar career path as an NP?

It was the best professional choice I made. I love my practice. I appreciate this role in patient care and the collegial relationships with MD partners. It is intense. It is trying at times for sure. However, I really like what I know about patient care. I loved studying beyond the RN role, both clinically and didactically. I appreciate what I know and can do as a direct result of that educational path. I felt too limited as a RN. This role allows me to enter into patients lives in a significant and meaningful way — with my diagnostic abilities and understanding the person as a whole—the medical AND nursing model.

Dr. Joyce Mikal-Flynn recently wrote a book entitled; Turning Tragedy Into Triumph. MetaHabilitation; A Contemporary Model of Rehabilitation. The book details a new system of rehabilitation built on her research. The system focuses on empowering individuals, focusing on not simply surviving but thriving, not in spite of a trauma but as directly result of the crisis.

If you would like to learn more about becoming a Nurse Practitioner Visit our Becoming a Nurse Practitioner page.