The Five Advanced Nursing Roles that Nobody Knows About

GroupofNursesA Registered Nurse (RN) works in various settings and with different patient populations. You can find him/her caring for people in world-class hospitals or in the slums of third-world countries. He/she is the central point of care for a patient and their beacon of advocacy. What most people do not know is that there are so many pathways in a nursing career. These rewarding roles are in high demand and cater to an advanced specialty, thus all requiring post-graduate education.

  1. Nurse Practitioner (NP) – A nurse practitioner is an advanced practice registered nurse (APRN) that can perform a comprehensive physical exam and medical history, order medical treatments, diagnostic tests, and medications for acute and chronic medical conditions. There are different types of NPs: pediatric, geriatric, family, women’s health, and mental health. He/she may work in inpatient settings like hospitals or in outpatient settings like clinics. They bridge the gap between RNs and MDs and are a critical and up-and-coming role in the ever-changing and complex American healthcare system. A patient may choose to have a nurse practitioner as a primary care provider to collaborate with their medical care.
  1. Clinical Nurse Specialist (CNS) – A clinical nurse specialist is a source of knowledge and expertise for RNs to consult with in the diagnosis, treatment, and prevention of disease. They help implement evidenced-based practice interventions within three spheres of practice – with patients, nursing staff, or within the healthcare system. He/she can work with different populations, settings, or diseases.
  1. Certified Registered Nurse Anesthetist (CRNA) – A nurse anesthetist specializes in the administration of anesthesia. Their scope of practice includes all anesthesia techniques including local, spinal, epidural, etc. and usually practice under the supervision of an anesthesiologist. They are an important figure in anesthesia care in our armed forces and in third-world countries.
  1. Nurse Manager/Administrator – These nurse leaders are responsible for managing a nursing unit. He/she coordinates the quality of care provided by staff and manages the environment in which that care is delivered. They are sources of direction and knowledge and a unifier in a nursing team.
  1. Certified Nurse Midwife (CNM) – A nurse midwife specializes in midwifery. They function as the primary care provider for relatively healthy women during pregnancy whose births are not classified as complicated or “high risk.” They can also provide gynecological care and newborn care. They offer a unique medical practice away from hospitals and respect the wishes of how a woman wants to give birth. He/she is a figure of empowerment in women’s health.

Angelica is a fourth-year nursing student with a minor in English hailing from New Jersey. She has studied or worked in all the major Boston hospitals. Angelica is also a columnist for The Huntington News and enjoys writing creative non-fiction. 

Photo source: OnlineNursePractitionerPrograms.com

“Things Change and it’s OK”- Advice from a Nursing Alum

Clockwise from left: NU Commencement in 2009; Machu Picchu - 2008; NU Alumni event at the Red Sox/Giants game in San Francisco 2013; After completing the San Francisco Half Marathon in 2013

Clockwise from left: NU Commencement in 2009; Machu Picchu – 2008; NU Alumni event at the Red Sox/Giants game in San Francisco 2013; After completing the San Francisco Half Marathon in 2013

This guest post was written by Michaela Coté, a 2009 nursing alum and now a Registered Nurse on a Med/Surg floor at Alta Bates Summit Medical Center in Oakland, CA.

I graduated with my degree in Nursing on May 1, 2009. This year, May 1st fell on a Thursday, a #throwbackthursday or #tbt to the Instagram world. As I scrolled through my Instagram app during lunch, #tbt after #tbt popped up of old friends back at their Northeastern graduations. At first I couldn’t believe it. 5 years?! Then I looked around my work break room and down at my faded scrubs I bought on my first coop. Yup, 5 years.

So, here I am. I’ve been out of college as long as I was in college. Time flies, and boy do I need new scrubs. Alas, here’s what I have to share.

Things change and it’s OK. I am a Nurse. When I started college, I was told I could do whatever I want, wherever I want, and just maybe my student loans would get paid. When I graduated, every hospital was on a hiring freeze, meaning I couldn’t even pay my student loans. I got lucky (thanks to a NU connection!), and landed a job that would have originally been my last choice. I now love my job so much so that I have yet to get a new one. Now, the healthcare system has taken a turn and my job is once again on the line. One of the reasons I went into healthcare was because there would ‘always be jobs’. But, things change and I can’t do a thing about it except make the most of it. The first job you land might not be the one you want, but how do you really know? We are young and we have time. Things will work out, they just do.

Save. From our co-op experience of having steady full time jobs, we should be good with money at this point. Whether that’s true or not is another story. Personally, while my paychecks may have helped to pay some bills (kind of…), they also made it very possible for me to go in and out of Lord & Taylor sales (which are are AMAZING if you’re not aware). In any case, it’s time to get serious about money with your first official job. Set up your retirement plan and do it before your first paycheck. That way, you’ll never know
how much cash you could be making, and your retirement fund will be off to a great start. It’s like you’re putting money away for the Lord & Taylor sales of year 2055, right?!

Loans are memories. You have no choice but to pay back your loans, so try to put a positive spin on them. Each month when you sit down to make your monthly payment, think about what an amazing time you had at Northeastern. Think about the hours you spent in the caf freshman year. Think of the numbers of pitchers you drank at Connor’s (that co-op paychecks also funded), and the amount of ‘last calls’ you thought were necessary at Our House. Think of the lifelong friendships you made and the laughs you’ve
shared. Think of the ridiculous amount of free t-shirts you have, the sporting events, the fact that you shopped at Wollaston’s despite the crazy mark ups, the Marino center, T rides, the Pru, being a part of a Red Sox World Series, your co-op experiences. Whatever it is, you loved Northeastern, you had a great education and experience, and you are lucky to get a monthly reminder of that. My brother went to a state school and has no loans. Sucker. He gets no reminders of how great college was.

Travel & find a ‘hobby’. You are young and most likely have only yourself to look after. You now accrue vacation time at your new fancy job, and you make real money (hopefully). You no longer have to study. Your free time is your free time. Go see the world! You have the resources and the time, so get out there and make the most of it before you’re tied down. On that same note, you have FREE TIME. Find something new to do. Take up one of those ‘hobbies’ job interviewers always think you have. Read a book that isn’t a
textbook. Start playing a new sport. Take up a new activity. Make a personal non work and school related goal for yourself. Don’t you dare let this time and freedom waste away.

Congratulations on your graduation. Go show the world what an amazing person Northeastern helped make you. Use your Northeastern connections and brag about your coops. You will do great.

Michaela Coté is a Registered Nurse on a Med/Surg floor at Alta Bates Summit Medical Center in Oakland, CA. Many thanks to her co-op advisor, Jacki Diani, for putting her in touch with a past NU professor who at the time worked at the medical center and introduced her to a hiring manager for an interview. Feel free to contact her at Michaela.cote@gmail.com

Blood Pressure Cuffs and Paintbrushes: Insight Gained from Pediatrics

BCH logo

This post was written by Angelica Recierdo, a third-year nursing student with a minor in English. She has worked/studied at many of the major Boston hospitals and is also a columnist for the Huntington News.

Heartbreaking and funny – two words that could be used in a film review for a romantic comedy, or rather in my case, working in pediatrics.

To me, working with the older adult patient population for my first co-op as a nursing student was the boot camp of medicine. You’re caring for people at the end of their lives that may be bitter, confused, careless, or a little bit of each. It can be draining and surely leaves a novice jaded or with the toughest skin by the end of it.

So when I accepted an offer to work at Boston Children’s Hospital it was a new and exciting venture, a breath of fresh air. I went from working 40 hour weeks consisting of rotating day, evening, and night shifts on a huge 30+ bed inpatient cardiology unit to a comfy and fun 10-bed outpatient infusion clinic. The biggest struggles my new patients faced were missing a day of school, which stuffed animal to play with, and whether their parent was present to hold their hand when the IV catheter got inserted.

The Center for Ambulatory Treatment/Clinical Research is the official name for this infusion clinic serving patients of all ages, backgrounds, and medical histories. A lot of our patients are immunocompromised meaning that they are so severely prone to infection that they need to be infused regularly with intravenous immunoglobulin (otherwise known as antibodies to help support their immune system.) These are the kids that more often times have Purell on their hands rather than Crayola marker.

Another portion of patients have some form of Irritable Bowel Disease (IBD) like Crohn’s or Ulcerative Colitis. I’ll never forget one ten-year-old boy who so openly shared with me that he could not be a firefighter when he grows up because how could he save people if he always had to go to the bathroom? (Kids really say the darndest things).

We also see a lot of Cystic Fibrosis and Cerebral Palsy patients as well. Their bodies protected in high-powered wheelchairs, eyes glossed to one side, with either the most contracted or most flaccid limbs you’ve ever felt. I try to joke with them and have learned that any kind of response like the fluttering of the eyes or a tighter hand grip means they’re listening. Children are always listening and it’s important to always give them something novel to think about.

I find myself laughing in a new way at work. It’s not forced or awkward the way social situations tend to be when interacting with other adults. It’s a genuine chuckle, throwing my head back or slapping my thigh. I find my voice rising to the next octave, trying to gain a toddler’s trust with one hand wielding a blood pressure cuff and the other a paintbrush. So many wonderfully amusing things happen at a children’s hospital.

For example, to electronically document vital signs on a computer application, there is an option that prompts the clinician to choose what position the child is in during the vital signs measurement. The three options are sitting, standing, and supine. But it warms my heart that my biggest worry is figuring out how to chart such movements as dancing, kneeling, crawling, or squirming.

I have learned that it’s important to always remember the time when a decorative Band-Aid covered up pain, when animal crackers and apple juice nourished us, and when a coloring book was sufficient distraction. Working with sick children has taught me ways to cope with profound stress and how to truly make the best of given situations. It’s not normal for a five year old to know where her “good” veins are, but that kind of acceptance and courage is of a caliber that is seen much later in life, or in some, never at all.

Angelica is a third-year nursing student with a minor in English hailing from New Jersey. She has studied or worked in all the major Boston hospitals. Angelica is also a columnist for The Huntington News (http://huntnewsnu.com/?s=angelica+recierdo)  and enjoys writing creative non-fiction.