Pediatric Nurse Practitioner
One of the best trends in nursing is the sheer number of nurses who have been working in the field for most of their adult life. Mary Beth Koslap is one of those nurses, having been registered for more than 40 years and having worked in hospitals, intensive care units, new born nurseries, and health care centers. Amazingly, even after such a long career, Koslap isn’t jaded and still says she loves working with children and seeing them grow into confident young adults.
Koslap’s long career has produced a wealth of knowledge about her experience and when she agreed to the interview we were not-so-secretly jumping for joy at the thought of all of the advice and experiences she could impart on our readers. To her credit, her answers lived up to expectation, going into extraordinary detail and offering plenty of nuanced information about her career path that would interest any aspiring nurse. Enjoy!
Can you tell us a little bit about the work you have done as a registered nurse?
I have been a Registered Nurse and then a Nurse Practitioner for over 40 years and there are so many things I have done in nursing. I have worked in hospitals in pediatrics where I was an Assistant Head Nurse and on an adult medical unit where I was also an Assistant Head Nurse. I have also worked in the Intensive Care Unit, New Born Nursery and the Emergency Department. I have been working in Public Health for over 25 years. In public health I have made home visits and worked in the community health centers seeing both adults and children. As a nurse practitioner I see children who are my own patients as their primary care provider in the health center. As the coordinator of child health I am also responsible for immunization policy and practice for all age groups as well as all pediatric policy. What makes it such an enjoyable experience is the ability to do something to help every patient regardless of the diagnosis or problem.
At what point did you decide that it was the right thing to go back to school to become a NP?
I had been working in the health center for several years as the Triage Nurse where I saw all of the patients who walked into the health center and made decisions on weather they needed to be seen immediately or could come back for an appointment. I kept thinking to myself that I could really assess diagnose and treat those children myself rather than send them back to the provider. And I thought my nursing education had prepared me to offer something unique to primary care. It is the ability of the nurse to treat patients holistically and to involve the family in the care of the patient is what I believe is unique to nursing. During this time I was also encouraged by 2 of the physicians I was working with to go on to be a Nurse Practitioner. Both of them told me I had the intelligence and passion and diagnostic reasoning skills to pursue a Masters degree to become a Nurse Practitioner.
How difficult was it to get into the program?
The application process was very rigorous. All Nurse Practitioners now must have at least a Masters degree to sit for the certification exams and many now have Doctorates. I had to write a statement on why I wanted to become a Nurse Practitioner and what I expected once I began to practice. It really invoked a great deal of soul searching and determining if I was ready to take on the challenges of the role of Nurse Practitioner. Also I needed excellent grades and of course there are endless forms to be completed, transcripts to send for and then there is the waiting to see if one has been accepted. I still remember the excitement when I opened the acceptance letter from Stony Brook University School of Nursing and how I thought about this new adventure I was about to undertake. A few years ago I saw the need to advance my education further by obtaining a doctorate. After another rigorous admission process which also included a statement on why I wanted a Doctor of Nursing Practice and what I planned to do with it once I obtained it. I also had to develop a proposal for a capstone project which involved implementing an evidence-based project.
Can you describe your educational experience?
Nurse Practitioner education is very rigorous to say the least. The course work prepares the potential Nurse Practitioner to assess, diagnose, treat and prescribe medications for a variety of medical conditions. Some of the courses I took includes pharmacology, advanced bio-physiology,child health nursing, and role of the Nurse Practitioner. I also took clinical courses during which I saw and treated patients under the supervision and guidance of an experienced NP. In doctoral school some of the courses I took were biostatistics, epidemiology, systems theory, and advanced clinical nursing. My capstone project took almost 18 months to complete and involved interventions to prevent overweight in pre-school Latino children. The programs also assist the NP student in developing critical thinking skills which are essential to safe and effective practice.
As a NP you specialize in pediatric patients, can you describe your work for us? What is a 9-5 in your life?
I see children who are healthy and need health supervision along with their parents as well as children who have a variety of conditions. I also field calls from providers in the community such as physicians, school nurses and other NP which are related to immunizations and the safe and effective administration of vaccines. I also get questions from other providers requesting information on the latest practice guide lines for a variety of conditions. My day starts out reviewing lab work from the previous day and attending to urgent issued which have arisen since the day before. I then begin seeing patients which can range from newborns through age 21 years. Each age offers different rewards and challenges when caring for them. While I am seeing patients the phone rings with questions from other providers and other staff members come to where I am seeing patients with questions regarding the care of children. During a routine visit I take the child’s current history with emphasis on growth and development for well children who are seeing me for physicals. After assessing the needs of the child and the family I design a teaching plan in my mind and implement it. My big focus is on health education of both the child and family to prevent health care issues in the future. By asking a lot of questions I can determine the health care needs of the child and the family’s ability to meet those needs. If the child is sick then I assess the current problem and implement a plan to resolve the health care issue. On days that I do not see patients I work on grants and pediatric policy. That can mean writing grants, grant reports, answering more questions and general supervision of my staff.
To a lot of people working on pediatrics is terrifying, and difficult, what is it that made you choose pediatrics as a specialty?
I could not have chosen another specialty because I love children no matter what age they are. Children are honest and up front and what you see is what you get. It is also very gratifying to work with children because they are the future. Making sure they stay healthy and happy as children goes a long way to helping them become healthy adults who can contribute to the society. Pediatrics is also very challenging since each different age group proposes a different set of needs and issues. I love it because things are constantly changing which is mentally challenging and keeps me on my toes. It is also very gratifying to watch a mom who was so unsure of herself with her new baby become a confident parent who delights in her child’s growth. I watch school aged children learn how to be part of a team as well as independent thinkers. Teens learn how to unfold and dry their wings so that they will make good choices when confronted with life’s problems. And then there are the challenged children who offer a completely different set of issues and problems. I help the mom develop plans for the care of the child and how to find the help she needs in the community. And most importantly I help the mother and the family come to the conclusion that even though this special needs child which is not what was planned for but who will bring its own special rewards.
What about your job challenges you?
I would have to say that it’s in addressing vaccine refusal. Well meaning parents who have heard so much negative information about vaccines will sometimes refuse one, or all, of the ACIP recommended vaccines. My job is to address parental apprehensions and explain that there is no scientific basis for their concerns. Most parents ultimately choose to vaccinate their children, but it’s the families – and some nurses too – who are not vaccinated that I worry about the most. I worry about the health of their children, who may end up with first-hand knowledge of vaccine preventable diseases. I worry about my nurse colleagues, who not only put themselves and their colleagues at risk, but our patients as well. Some may say that there is nothing you can say or do to change the mind of a vaccine refuser, but I say we must continue to try.
Can you describe something about what you do that is exceptionally rewarding?
I love sharing my knowledge of vaccines with others. Whether it is parents, nurses, or providers, each group gives me a tremendous sense of satisfaction, knowing that I have contributed to their education and ultimately their confidence in immunizations.
Parents hear so many things about vaccines and they truly want to do what’s best for their children. By taking a few minutes to anticipate their questions, and then responding in a thoughtful, sensitive manner, I help them resolve their concerns. It’s also an honor to have so many nurse colleagues contacting me for information. When it comes to other busy providers, I realize that they have so many different things to confront, so it’s gratifying to know that I am able to expedite answers to their questions and clarify information with detailed sources.
I also find watching children grow up happy and healthy and the confidence parents exude in their ability to parent extremely rewarding. What other specialty allows providers to help shape the future!
Do you have any final words of wisdom for nurses looking to go down the NP career path?
I would say be passionate about what you do. Be a patient advocate. Never stop reading and learning yourself so that you can always offer your patients the best available evidence for their care. Nurses are scientists as well as fierce patient advocates. Research should be part of your daily life. We need to find the evidence and scientific support for what we do to document the effectiveness of Nurse Practitioner practice. And do not forget to always smile. A smile shows you care which is what nurses do best.