I realized that there was a huge knowledge deficit for many women. It often stemmed from the fact that we were not empowered and comfortable asking questions when we saw our health care providers. In other parts of the world women often do not have access to healthcare and reliable information. I realized how powerful educating a woman about her body could be in transforming so many other aspects of her life.
About Alexandra Sherman, MSN, WHNP-BC: Alexandra Sherman is a Women’s Health Nurse Practitioner at Alameda Health System, where she provides women’s health services such as routine physical examinations, pap smears and screenings for breast and cervical cancers, contraception guidance and prescriptions, family planning support, and management of reproductive health issues. Ms. Sherman also works as a Gynecological Oncology Nurse Practitioner for BASS Medical Group, where she provides patient education and support to women with endometrial, ovarian, or cervical cancer.
Prior to her positions at Alameda Health System and BASS Medical Group, Ms. Sherman worked for over six years as a Nurse Practitioner and Quality Management Clinician at Planned Parenthood Mar Monte, where she conducted medical assessments, managed of a wide range of gynecological conditions, trained and supervised staff, and precepted students. Ms. Sherman earned her Bachelor of Arts in Political Science from Boston College in 2007 and her Master of Science degree in Women’s Health Nurse Practitioner from Boston College’s William F. Connell School of Nursing in 2009.
[OnlineFNPPrograms.com] May we please have an overview of your academic and professional experiences in women’s health nursing?
[Alexandra Sherman, MSN, WHNP-BC] I earned my bachelor’s degree in political science from Boston College and after graduating, I continued straight on to their Master’s Entry program. While finishing up my master’s degree I began working at DotHouse Health as an RN in the Ob/Gyn and Adult Medicine Departments. I completed my master’s in nursing in 2009 with a specialty in women’s health. That summer I passed my NCC Women’s Health Nurse Practitioner boards and moved to California to begin working as a clinician at Planned Parenthood, eventually becoming a Quality Management Clinician. In 2011 I volunteered with Prevention International: No Cervical Cancer (PINCC) as an instructor. I have taken two trips with PINCC to Nicaragua to teach local health care providers how to screen for and treat cervical cancer. In 2014 I left my position at Planned Parenthood and began working in the Ob/Gyn clinic at Highland Hospital in Oakland. I have recently begun working part time in a gynecological oncologist’s office in the BASS Medical Group. In all of my clinical roles I have also precepted students from local Bay Area nursing schools such as UCSF and Samuel Merritt University.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Women’s Health Nurse Practitioner at Alameda Health System? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Alexandra Sherman, MSN, WHNP-BC] As a Nurse Practitioner in the Women’s Clinic at Highland Hospital, I commonly see women for their routine gynecological care such as cervical and breast cancer screening. I do a lot of teaching and counseling regarding family planning. If a patient is interested in contraception, I explain each method to help her make her choice. If she is not interested in contraception, we talk about how to optimize her chances of conception, such as well lifestyle modifications that can help her have a healthier pregnancy. I also participate in our colposcopy clinic, where I follow up on any abnormal pap smears. My visits generally involve physical assessment, collecting samples or taking biopsies, and writing prescriptions. I see both new patients with acute high-risk problems such an ectopic pregnancy, and manage women with chronic illnesses such as polycystic ovarian syndrome (PCOS) or lichens sclerosus.
At Highland Hospital, most pregnancies are managed by our wonderful midwives, so it is quite rare for me to see women during their pregnancy unless they are experiencing an acute problem such as bleeding in the first trimester, vaginitis, or an upper respiratory infection and see me in our walk in clinic. I also provide counseling and ultrasound dating for women who wish to terminate their pregnancies. We have a relationship with several of the local nurse practitioner programs in the area, so often times part of my responsibility in the clinic involves precepting a student from one of these programs. Our women’s clinic staff consists of physicians, nurse practitioners, and physician assistants. We often work together co-managing patients with especially complicated conditions.
The most common problems affecting our patients are socioeconomic. Our hospital sees some of the most impoverished folks, some of whom have significant barriers in accessing care and perhaps have not accessed care in a number of years. It’s very challenging to provide care to people who may struggle with things that many of us take for granted, such as simply getting to the hospital for an appointment. I often have to be creative in the way I deliver care to my patient by doing follow-ups by phone, or trying to schedule multiple visits all in one day. Luckily our hospital consists of a great number of specialty providers. Often, I am able to troubleshoot simple issues for patients by curb siding a provider in another department. I can ask them the question rather than putting in a referral for a patient and creating an extra visit. I’ve also become well versed in which medications are covered by Medical and which ones are prohibitively expensive.
Alameda County is one of the most diverse counties in the country, with immigrant populations from all over the world. On a given day I may see patients who speak five or six different languages. Since moving to California I’ve built on my Spanish skills and have now become able to communicate effectively with my monolingual Spanish speaking patients. For other patients we have access to live interpreters as well as a phone interpreter line for rarer languages.
[OnlineFNPPrograms.com] You are also a Gynecological Oncology Nurse Practitioner for BASS Medical Group. Could you explain your responsibilities, patient population, team, and work environment in this role, and how they differ from those of your current role at Alameda Health System? Could you describe more specifically what the field of gynecological oncology involves, and how you became interested in this area?
[Alexandra Sherman, MSN, WHNP-BC] My role as a Gynecological Oncology Nurse Practitioner is to see patients once they have completed their treatment for endometrial, cervical, or ovarian cancer. At these visits we do the recommended surveillance, which can be something as basic as education about symptoms of recurrence or involve ordering labs and imaging. A lot of our visits are protocol driven, working off of the guidelines of the National Comprehensive Cancer Network (NCCN). Occasionally I see a newly diagnosed patient and get them ready for the visit with the gynecologic oncology surgeon by ordering labs, imaging, and collecting histories. As each type and subtype of cancer can dictate different follow up, I work very closely with my supervising physician. Our team at BASS is very small and is composed of myself, the surgeon, and a medical assistant. Our patient population is very varied, we see women of all ages and from all walks of life.
I have always had an interest in oncology and was fortunate to have two clinical rotations at Dana Farber Cancer Institute when I was in nursing school. It was thrilling to work with such brilliant minds, several of whom were on the forefront of very important cancer research. Oncology is also a field with a constantly evolving practice, which definitely appealed to my love of research and data.
[OnlineFNPPrograms.com] Why did you decide to work specifically in women’s health and obstetrics/gynecology, and what academic and professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Alexandra Sherman, MSN, WHNP-BC] I think I had my first “aha” moment when I was learning about the female reproductive system and family planning in nursing school. I realized that there was a huge knowledge deficit for many women. It often stemmed from the fact that we were not empowered and comfortable asking questions when we saw our health care providers. In other parts of the world women often do not have access to healthcare and reliable information. I realized how powerful educating a woman about her body could be in transforming so many other aspects of her life. For example, family planning can be a tremendous force in interrupting the cycle of poverty. Additionally, women who are about to have a child are on a precipice of a massive life change. There are so many opportunities to make small interventions that can really set the woman and her child up for success. A few weeks into my maternal child health clinical, and I was hooked.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in women’s health nursing? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Alexandra Sherman, MSN, WHNP-BC] I think the first part of this answer really piggybacks on my answer to the last question. It is really amazing to work with women. I’ve heard some really incredible stories from women in all kind of circumstances. I’ve also had the opportunity to practice women’s health nursing abroad through PINCC. PINCC is an organization whose members travel to parts of the world where women do not have access to cervical cancer screening and teaches medical professionals in those countries how to screen for and treat precancerous lesions. It has been so inspiring to see how something as simple as a cup of acetic acid can literally save lives.
As far as challenges, I think one of the most challenging aspects of the job for me, and something I continue to work on every day, is staying optimistic in the face of some really difficult truths you face every day. Seeing women for very sensitive services can sometimes expose a lot of ugliness that is in the world around us such as rape, domestic abuse, and perpetual cycles of poverty. It can be heart wrenching at times to see what women around the world have to endure. I’ve learned to try to focus on the small things we can do, and to listen for women to tell you what it is they need rather than making assumptions. I’ve also been very grateful to work with a lot of incredible providers. It is always helpful to talk to a colleague about a rough day you had, even if all they can offer is some comforting words. Working as a new graduate, I always made it a point to purse interests that were not related to my work in my off time. It is very easy to let your work consume you, especially when you deal with emotionally complicated issues. Make sure you are taking care of yourself and keeping up relationships with the people who can keep you in good spirits.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in working in women’s health nursing and obstetrics, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Alexandra Sherman, MSN, WHNP-BC] I know it is completely overwhelming to try to learn everything. Don’t worry about memorizing treatment guidelines or algorithms. When you are in the field you can look these things up. Practice active listening as much as you can. Try to have contact with as many patients from as many walks of life as you can. If you have any foundations of other languages, practice speaking those languages! These are things that will help you to feel more at ease in your first role. The nitty gritty details you can look up as soon as you walk out of the room. I still look up things all the time, and I will for the foreseeable future. Medicine is constantly changing, so do not feel pressured to memorize things, except of course to pass your exams! If possible, try to spend time volunteering or working in a medical office. My job as an RN at DotHouse definitely helped me pass the boards because I was putting that knowledge into practice every day I was at work. It helped us to study in groups and talk to other students who had already passed their exams in previous years.
[OnlineFNPPrograms.com] Could you please describe how you see advanced practice women’s health nursing evolving as a field, based off of your professional experiences? What work settings typically employ women’s health nurse practitioners, what role do they play as part of a larger healthcare team, and how do you see their position changing over the years?
[Alexandra Sherman, MSN, WHNP-BC] I think it is a really exciting time to be a Women’s Health Nurse Practitioner. It seems like we’re ubiquitous now, whereas even seven years ago when I was looking for my first NP job, there were not as many of us around. I think the future of women’s health nursing looks a lot like how our department at Highland operates. Currently the nurse practitioners and physician assistants see all of the routine and uncomplicated patients. We typically co-manage our more complex patients closely with an attending, and when things start to get complicated or the patient becomes a good candidate for surgery we refer to one of our attendings. Our hospital serves a very large population of high-risk individuals and without a solid staff of nurse practitioners and physician assistants this would not be possible. We are able to streamline care so that everyone’s time is used more efficiently.
Nurse practitioners are going to be instrumental in getting care out to all of the folks who are entering the health care system through the Affordable Health Care Act. We can work in rural settings and get care out to a huge number of patients who otherwise would be waiting or driving long distances to see a provider. I see nurse practitioners also becoming more independent in their practice and having a more collaborative rather than supervisory relationship with physicians.
Thank you Ms. Sherman for participating in our APRN career guide interview series!