Surgical Nurse Practitioner

Nancy Brook is a Nurse Practitioner at Stanford Hospital and Clinics in Palo Alto, California. She has a Bachelors degree in Psychology, a Masters degree in Nursing and a Masters Degree in Counseling Psychology. For more than twenty years, she has been involved in patient care, education and has been actively involved in the oncology community. She is an active volunteer, and a  wish granter for Make a Wish. In addition to her clinical role, she is both a faculty member and a coach and mentor for nurses and nursing students.  Nancy has a very interesting story and career, and was very kind to come on the site and share it with us.  Enjoy!

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Nancy can you give us a brief synopsis of your career as a nurse?

I was always interested in helping people, and came from a family of doctors. I studied psychology during college, and then after graduation went on to receive my RN. I knew I wanted to be a Nurse Practitioner, so I returned to school and began a MastersDegree program.   I practiced primary care in a rural health clinic initially, and then was offered a position with a wonderful surgical group where I learned many of my skills. I have worked in a variety of specialty areas over the years, but have spent the last ten years supporting a surgical cancer practice at Stanford University in California. It has been a wonderful opportunity to expand my skill set, really impact my patients’ lives, and I am lucky to work with a surgeon who is very supportive of advanced practice nurses.  I spend a lot of time with patient navigation and education,  consulting, and currently am adjunct faculty for students in a Bachelors degree program in nursing. I also enjoy coaching nurses and those who are interested, at GlassSlipperConsulting.com.

What is it that lead you to further your education and become a NP?

I knew I wanted to work with patients in an outpatient setting, and I knew that Nurse Practitioners would play a key role in our healthcare system in the future. I also had a strong interest in preventive care and wellness programs. There were many graduate programs which offered Nurse Practitioner programs, so furthering my education was a clear choice for me. I also knew that I loved to teach, and if I wanted to be a faculty member, an advanced degree would be very important.

Can you tell us a bit about the program you attended?

I attended Vanderbilt University School of Nursing, in Nashville, Tennessee, a wonderful but very rigorous program. The program is excellent in that it offers many specialty options for Nurse Practitioners. It also allows students to come in at different levels of preparation: as LVNs, RNs, or BSNs. Ultimately everyone is able to work toward an advanced degree.

Can you tell us a bit about what it is you do as a surgical NP?  Your duties and average work day.

My position is fast paced, and every day is different. I see new patients along with an attending physician, see preop and post operative patients after surgery, manage wounds; remove staples, sutures, manage wound vacuum’s, do alot of teaching and collaborating with other medical specialists. One big piece of my job is pain management. This is a big issue and I write prescriptions and manage narcotics/ opiates for all our patients. Cancer pain is often under treated, and our clinic does a good job of helping patients with this problem.  I also do alot of counseling and education for patients and their families who need this so badly. My hours are variable, and I always have a cell phone/ pager in my pocket. I have long relationships with many of my patients and while many of them have passed on, I believe I have helped them to have a good quality of living with greater functioning as a result of our care.

What kind of roles do you play in these surgeries?   Do you perform these surgeries completely on your own or under a surgeon’s supervision?

Patient care in a surgical specialty involves much more than the actual surgery, but includes preoperative assessment and planning (deciding if a procedure is indicated and if so which one), preparing the patient for surgery by making sure they are appropriate and stable to undergo anesthesia, managing their medications, prepare them for what to expect, prescribing narcotics for postoperative pain management, managing drains, rounding in the hospital, prescribing physical therapy or other treatments to assist in their recovery and of course post operative assessments in the clinic setting.

I do not do surgery on my own, I am not a surgeon. Many NPs do simple procedures indepedently such as biopsies or simple excisions, but in my case working in a complex surgical cancer practice at Stanford, I assist as would a First Assistant in the OR (participate under the surgeon’s direction).

What is the most challenging part of your job?

The most challenging part of my job is the unpredictability. Many Nurse Practitioners work in outpatient clinics where they see patients and have a typical schedule. Since our service is a heavy surgical specialty and there are often inpatients involved, we rarely run on time! Sometimes surgery bumps our clinic so we start or end late, and every day is different. Sometimes my days can be very long. The other challenge is talking to patients about end of life issues. Many of our patients ultimately die.

Do you have any final words of wisdom for someone that may want to become a surgical NP themselves?

Final words of wisdom? If you are interested in a particular specialty, network with other nurse practitioners or physicians in that field. Do an observation, and attend courses to help you add to your skill set. There are some schools of nursing that offer excellent residency programs (Duke has an excellent Orthopedic Surgery Residency for Nurse Practitioners), and I truly believe that if you are interested and study hard, you can absolutely make the transition to a surgical specialty. There are more opportunities than ever before, and Nurse Practitioners are highly in demand! I am so grateful for the opportunities I have had so far in the nursing profession. I would be more than happy to connect with nurses or students who are interested