Advanced Nursing Practice with Joanna Johnson, NP

Mark Royer: Welcome to Charting My Future. I'm Addy Hammer and today we're exploring advanced practice nursing rules. Every career starts with a question. What do I want to do with my future? For me, that starts with kids, healthcare and the desire to make a difference. I'm meeting the people who chose these paths and discovering where my own might lead. Today's guest is Joanna Johnson. She is a clinical nurse specialist and acute care nurse practitioner. She holds a master's in the science of nursing from Murray State University. She currently serves as the Critical Care Clinical Nurse Health Specialist for Deaconess Health Systems. Ms. Johnson, thank you so much for joining us today. Thanks for having me, Addy. Of course. So my first question for you is how did you decide this was the right field for you? So I'm gonna give you a genuine answer. and I think it's important to know whenever you're exploring what you're gonna do in college and thinking about your careers. I went into college thinking that I wanted to be an attorney and got into college and started really loving anatomy and physiology. I was performing very well and I had a professor that said, Why don't you start tutoring people in anatomy and physiology? So I started doing that and making a little bit of money on the side. And he said, You know, why don't you think about going into nursing? And I said, No, I think I'm gonna be an attorney. And funny enough, I started talking to my dentist who I'd been going to since I was a child, and told him I wanted to be an attorney. And he said, Do you want a family? And I said, Yeah. And he said, I think you should think about a different career. So truly that's how I started thinking, okay, I had this. Anatomy and physiology teacher kind of steering me towards nursing. I'm tutoring people in anatomy and physiology. I like this. Not really good at arguing with my parents and getting my way. So I went ahead and shifted gears and applied to nursing school. So that is how I got into the field of nursing, which led me into my advanced practice degree. Okay. Walk me through the path from where I'm sitting now, 16 and a junior, to being able to sit in your chair. Okay. I love that question. I think it's important to keep an open mind. So I think that society as a whole puts a lot of pressure on us. And we think, okay, I need to figure out this thing that I want to be. And then I need to fit myself into that. And if you keep an open mind as you go through these classes and you start to find out what do I like, what do I not like, it'll start guiding you into what you want. So from sitting where you're at and getting into where I am today, taking the path you would go through a nursing program. you'd have to decide what would work best for you. There are two-year nursing programs that allow nurses to get their degree and then practice while getting their advanced degrees. There are benefits to that because if financial constraints are something that you have to worry about, often the hospitals will pay for your tuition to get your bachelor's degree and your master's degree. also making those decisions if you want to get some experience along the way. I did practice for about five years before I got my master's degree, and it gave me a lot of clinical bedside experience. So so kind of taking that route and going through those steps and getting the associate's degree or getting the bachelor's degree in nursing, practicing, and then getting into a master's degree. So an advanced practice nursing role, whether it's a family nurse practitioner, there are different types of advanced practice nursing roles. Family nurse practitioner, there's an acute care nurse practitioner, a CRNA, which is a nurse and ethicist, or the role that I'm currently practicing in, which is a clinical nurse specialist. That role is somewhat unique in that it functions in three different spheres of influence. So we look at organization-wide change like quality metrics and driving good quality outcomes, reducing the mortality or the death rate of the patients that are in our hospitals, reducing hospital acquired infections, we look at that. We also impact the patient in the family. And then we do a lot of things that impact nursing as far as their structure, the way that they function, and the care delivery model. So kind of picking which area of interest that you're in and then taking that master's program to get there. Okay. What is the skill that matters enormously in your job that nobody would guess from the outside? So the role that I'm currently practicing in, and I hold two degrees as an advanced practice nurse, I am an acute care nurse practitioner and a clinical nurse specialist. I would say with this role, what people wouldn't expect is that I think in systems. So if you come to me with a problem where some people might be focused on the end point of that problem. I'm more focused on what lined up to get to the end where that problem is. There's typically six or seven things that might line up that lead to the problem that we're looking at. So my brain thinks more in terms of systems and that may that may be something that you might not see just at face value. What type of work did you do after your nursing degree? And why did you decide to pursue additional training after that? So I'm gonna give you another genuine real world answer that's not something that looks pretty in a you know in a picture. so whenever I got out of my associate's degree for nursing, I did that program in southern Illinois. So I moved to Evansville, Indiana and started working as a bedside nurse on a like a general med surge floor just to kind of get my feet wet with what it was like to take care of patients and be a nurse. At the same time, I enrolled at USI, the University of Southern Indiana, to get my bachelor's degree. So kind of pursued that at the same time. The hospital paid for that degree, which was beneficial to me. After a year of doing that, I decided that I thought that I wanted to be a CRNA. So to do nurse anesthesia. In order to do that, you had to have critical care experience, you had to go through and get your pediatric advanced life support, your ACLS, so those types of things. So I started taking steps to pursue that. As I got into critical care nursing, I fell in love with it. CRNA school can be very intense as far as your clinical hours go. And at that time, the hours that you worked in your clinical hours were pretty intense, and that wouldn't have been in alignment with having a brand new baby. So I took an educator role at the age of 23. I became the ICU educator, and in that role, I truly wasn't prepared for the job, but I had the drive. So I taught myself the best practices and researched and learned and started building education programs for the ICU and then stumbled into this notion of a clinical nurse specialist and how this could allow me to pursue a master's degree, but still be doing, you know, this kind of clinical change agent type work and touching patients and impacting nursing. So I applied to Murray State. They had a critical care clinical nurse specialist program. I got into the program and, you know, went through those steps. And so from the time that I became an RN to the time that I finished my master's degree was about five years. What is the most difficult part about this job that nobody warned you about? that is a tough question. The most difficult part of the job is that you constantly have. loops open. And so you have multiple projects that are going on at once. So you might have 10 different things that are priorities of yours, but you can only get so far with one and then you're waiting for other things to happen before you can close that loop. Versus when I was functioning for the last eight years as an acute care nurse practitioner, my individual encounters, so my interactions with the patients, even though their plan of care continues on, that encounter kind of closes out. Or I also worked in the intensive care unit. So each patient interaction then gets handed off to the next provider that's coming in for the next shift. But with this role, you kind of have a lot of different things. Irons in the fire per se. Okay. What percent of your day spent caring for pediatric patients? Well, that's an interesting question, too. So I have actually, in the 22 years of experience that I have, I have never cared for pediatric patients. my Acute carse practitioner allows me to care for 13 and older. Now, in our trauma ICU at Deaconess Health, we do care for pediatric patients. So I am looking forward to opening up that opportunity in my career to impact the quality pieces. I won't individually care for that patient, although I'd love to rock a baby if they need me to. but I will get to drive change that will hopefully positively impact our pediatric population. If I wanted to pursue a similar career path but take care of more kids, how should I go about that? Yeah, so that's a great question. There's two ways that you could do it. If you chose the route of the family nurse practitioner, that would take you through the path that I took. So you would get a master's in the science of nursing and you would choose family nurse practitioner, which would allow you to do birth until death. So you can take care of all across that lifespan. the other areas that would allow you to do that would be if you were to go through a specific pediatric clinical nurse specialist track. Those are highly specialized tracks that lead to excellent jobs because they're highly sought after. it would take you through a program that will give you enough clinical hours in the specialty of pediatrics to get you that The ability to sit for your certification for pediatrics in the field of being a clinical nurse specialist. Okay. So a lot of kids my age are being pushed towards coding, AI, and engineering. What is one thing that you do that a machine cannot? So I love this question. And before I took this job, I actually told myself. I did this job before, I will say that. So for eight years I worked as a nurse practitioner, but before that, I was a clinical nurse specialist. So I know what the functionality of the job is. And knowing that AI can create efficiencies, AI is massively important in a job like this. So I took some classes on they're called master's classes. They're almost like a podcast type situation where they're interviews with people from Yale, Harvard, the people who are Doing the data on AI and talking about these efficiencies. I think that getting into a job like this, you're going to be bringing in AI. You're going to have to educate yourself on it and understanding that it takes a human to to interact with AI. AI cannot act alone. So any AI that I use requires my human input. It requires my systems thinking. It requires me to To go through and add emotion or add, you know, additional analytics to that. And so I think it's important to know that in a world where it feels like we're being pushed towards that, it's going to integrate into all of our roles and make our roles change in some ways and be more efficient. So I think you can have the best of both worlds. If I shadowed you for one day, what do you think would surprise me the most? I think that if you shadowed me for one day, the Thing that would surprise you the most would be the complexity of the intensive care unit. at your age, I had only seen intensive care units on TV. So, yes, you see things that are, you know, this is life support, and you see, you know, Ivy drips and Ivy tubing. But what you don't see is some of the human emotion that goes into caring for these patients that are so highly complex. getting to see the system work as a whole. So see the patient in the bed, see the nurses that are caring for them, see the physicians, the whole plan of care develop in a multidisciplinary setting and be carried out is a highly complex, beautiful thing that occurs. And it just gives you a deep appreciation for how our most vulnerable patients are cared for. What does a normal workday look like hour by hour? So a normal workday for me, there is no normal. So my day to day is different every day, which I do love. In my previous role, my day-to-day looked pretty much pretty similar just depending on the patient population that I was seeing. But in any given day, I will be doing duties that are on the priority list of the organization, or it can flex to a highly complex patient. So if a patient becomes critically ill and they need an expert at the bedside to help guide them through something that we Call like a low volume high risk type procedure or a low volume high risk patient, patients that are requiring ECMO, which is extracorpical membrane oxygenation, which is like a highly specialized device, a heart-lung bypass machine, those types of patients, they wipe everything off of my priority list and then I funnel my resources to there. So my day, while it may be structured. can shift at any moment based on what the needs are of the of the patients and of the organization. Okay. What is one piece of advice that you would give to a junior who wanted to pursue your career? So my piece of advice would be listen to your gut. You typically, we as humans typically know inside like what is what is best and we'll feel kind of this this nagging or this urge towards it. And if it's your gut is telling you and it's aligning with your beliefs, your morals, your values, if you do something that you love, you never work a day in your life. So I would say listen to your gut and pick something that you love. Okay, great. Thank you so much. Yeah, of course. Thanks for having me.