The beauty of going into the field of nursing is it allows an individual to be exposed to countless possibilities and specialties--there are so many directions one can take one’s career!
About Amanda Ruch, MS, AGPCNP-BC: Amanda Ruch is an Adult-Gerontology Nurse Practitioner with an extensive background in operational management of health care facilities, as well as adult and geriatric medical management and palliative care services. She began her nursing career as a nursing assistant, and subsequently became a Registered Nurse at Frederick Memorial Health Systems. She progressed to health administration and leadership positions, as an Assistant Director of Nursing and then the Director of Nursing at Buckingham’s Choice, a Continuing Care Retirement Community (CCRC) owned by Integrace, Inc, formerly known as Episcopal Ministries for the Aging (EMA). During her tenure as a Director of Nursing, she managed the nursing division in the outpatient medical clinic, the assistive living unit, and the long-term care/rehabilitation unit. She earned her ADN from Frederick Community College in 2000, her BSN from the Deaconess College of Nursing in 2010, and her Master of Science with a focus in Adult-Gerontological Nurse Practitioner from the University of Maryland Baltimore.
After graduating from her MS program, Ms. Ruch became an Adult-Gerontology Nurse Practitioner at EMA Health Services, the medical division of Integrace, Inc., serving in two separate communities; Copper Ridge and Buckingham’s Choice, where she managed acute and chronic conditions in predominately geriatric clients. She also made house calls for the independent residents, at Buckingham’s Choice’s. She is currently a Nurse Practitioner at National Spine and Pain Centers, an outpatient setting that specializes in delivering pain management services.
[OnlineFNPPrograms.com] May we have an overview of your academic and professional background in adult-gerontology primary care nursing?
[Amanda Ruch, MS, AGPCNP-BC] When I was first deciding if I wanted to become a nurse, I became a nursing assistant to determine if providing care to others was my calling. I was first introduced to being a geriatric nursing assistant at a local nursing home and I fell in love with helping others. Over the years, I worked in a variety of healthcare settings which included: nursing homes/long term care facilities, rehabilitation centers, and a hospital. At the hospital, I was cross-trained to be a unit secretary and a technician. I put myself through an ADN program, taking two classes a semester and working full time. Needless to say, it took me awhile to obtain my ADN, but I graduated in 2000 from Frederick Community College.
As a Registered Nurse, I worked in the following settings: hospital (medical surgical and telemetry) for years then I transitioned to a Continuing Care Retirement Community (CCRC), with the goal of obtaining a nurse management position eventually, to assist with my future career track. After a year of being a charge nurse in the skilled/long term care unit, I accepted the position of Assistant Director of Nursing; a position I held for six years. I then was promoted to Director of Nursing (DON); a position I held for three years. While I was the DON, I obtained my BSN at Deaconess College of Nursing. I was inducted into the Sigma Theta Tau, Pi Chapter. During my tenure as a DON, I had one deficiency free survey, which is very high honor within the LTC setting. Each year long term care (LTC) facilities are subject to a rigorous process by the Center’s for Medicare and Medicaid Services (CMS) to ensure the facility is operating per the regulations governed by the state and federal government.
Over the years, I missed the clinical aspect and applied for the Adult-Geriatric Nurse Practitioner (AGNP) program at University of Maryland. While I was in the AGNP program, due to the demands of the program, I had to step down from my role as DON and worked as a Registered Nurse Assessment Coordinator in two other facilities, which were owned by the organization that owned all of the communities. I was inducted in the Sigma Theta Tau, Phi Pi Chapter. I graduated with a Master’s of Science Degree with a concentration in Adult/Gerontology Nurse Practitioner. I then passed my boards and became credentialed through the American Nurses Credentialing Center (ANCC), earning the credentials AGPCNP-BC (Adult/Geriatric Primary Care Nurse Practitioner – Board Certified). I transitioned into my CRNP (Certified Registered Nurse Practitioner) role in a geriatric internal medicine practice at EMA Health Services. During this time I found my passion in palliative care and pain management. I decided to pursue pain management experience as a Nurse Practitioner at National Spine and Pain Centers, which is a pain management outpatient setting. I will be transitioning to a position in a Palliative Care and Pain Services group in the fall of 2016.
In addition, I was asked to present a class through the Odyssey Series, which is part of the Mini-Medical School Program at Johns Hopkins University. The class is entitled “Managing the Medical Needs in a Geriatric Patient.”
[OnlineFNPPrograms.com] Could you please describe your role at National Spine & Pain Centers? What types of patients do you serve, what medical conditions do they struggle with, and how do you help them address their health challenges?
[Amanda Ruch, MS, AGPCNP-BC] I am responsible for performing outpatient consultations for new patients with various symptomatology that produces acute and chronic pain. In addition, I see patients for acute visits and follow up visits for established patients. There are various demographics (age ranges 16 to 95+ years of age) that I care for and implement their plan of care based upon their diagnosis and insurance coverage. With a variety of insurances, a provider must be aware of coverage, not to financially burden the individual. It is important to establish a good rapport with the patient and work together on establishing a treatment regimen that is realistic and which the patient is able to accomplish.
A typical consultation encompasses review of referring and primary care progress notes, diagnostic studies (laboratory, X-Rays, MRI, CT scan, etc.), obtaining a thorough medical and social history, review of systems, performing a complete physical examination, diagnosing and implementing a plan of care, and providing education regarding condition(s)/diagnosis, medication, and diagnostic testing. A follow up visit is for established patients with acute or chronic conditions, evaluating the patient’s status, medical and social history, obtaining a pertinent review of systems, and reviewing and evaluating their medication regimen. Depending upon the status of the condition, medication adjustments and ordering of diagnostic testing may be warranted. Patient education may also be required for follow up visits.
I currently work alongside a team of fantastic individuals: three full time nurse practitioners and one part time nurse practitioner, one physician assistant, an anesthesiologist, registered nurse(s), medical assistants, and a team of supportive staff. The healthcare providers work together to collaborate to improve patient care and outcomes.
[OnlineFNPPrograms.com] You were also an Adult-Gerontology Nurse Practitioner at Integrace, Inc. Could you elaborate on this role, and how your daily responsibilities and team differed from those of your current position?
[Amanda Ruch, MS, AGPCNP-BC] During this time, I was the full time medical nurse practitioner in a 120-bed care facility that specialized in dementia care, which included Assisted Living, Long Term Care, and Sub-Acute Rehabilitation. I covered all resident care needs, both acute and chronic conditions. I also saw patients for discharge visits and assisted the coordination of care in their community. In addition, I primarily focused on acute care visits for the independent living community in the Wellness Center and provided house call services in a CCRC setting. I also managed chronic conditions.
My daily responsibilities differed from my current setting in various ways. First of all, I did geriatric internal medicine and focused on a variety of acute and chronic medical conditions and managed end of life care, versus working in a specialty within an outpatient practice focusing on pain management.
[OnlineFNPPrograms.com] Why did you decide to become an adult-gerontology primary care nurse practitioner, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Amanda Ruch, MS, AGPCNP-BC] I have always been passionate about providing quality care to patients. My career as a nursing assistant and registered nurse focused on adult and geriatric patients, and as a result concentrating in adult-gerontology primary care seemed like a natural progression. When I was a nurse manager, I missed the clinical aspect and felt like I would make more of a difference if I became an advanced practice nurse. In addition, I wanted to give back to the community I live in by providing adults with quality healthcare.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as an adult-gerontology nurse practitioner? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Amanda Ruch, MS, AGPCNP-BC] There are countless aspects of working as an AGNP that are rewarding. Examples include patients telling you that you are one of the first providers to actually listen and value their input, feelings, and thoughts. I have had loved ones of those facing the end of their lives thank and hug me for easing the patient’s suffering. Patients sharing their lives and feelings, especially when they are vulnerable and you are able to provide comfort to them. It is also rewarding when you have a follow up visit and the patient tells you that they are feeling better because of the care you provided.
On the opposite end of the spectrum are the challenges. Providing care to demented patients, you have to rely on your assessment skills since these patients cannot fully participate in their review of systems and history of present illness. Dealing with personalities of patients and families brings about its own set of challenges, especially when both parties are very strained, as emotions can run high and make effective communication difficult. It is important to focus on the patient outcome and be empathetic.
Being in any aspect of nursing, regardless of position, requires kindness, compassion, empathy, and knowledge. One must never stop challenging oneself and growing.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming adult-gerontology nurse practitioners, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Amanda Ruch, MS, AGPCNP-BC] I recommend to those who are unsure if they want to become a nurse to first work as a nursing assistant. This allows the individual to become comfortable with personal care and organization. Regardless of what level of education, students should set goals for themselves and if they want to pursue higher levels of education they should select schools, research the programs, and contact the schools to determine what credits would transfer into their program(s) from previous schooling.
If one would like to volunteer in a setting, I would recommend a long-term care or assisted living setting. This would allow the individual to develop communication skills with the elderly, all the while bringing joy to the elderly. For students preparing for licensing exams, I recommend taking a preparation course. This will ease some of the stress of taking the examination, especially if they schedule the examination shortly after graduation and the course. Those who want to become an advanced practice nurse/CRNP should inquire about the admission criteria of the programs that interest them, and evaluate whether their background as far as their career and the demographics they cared for match the requirements of their programs of interest.
As far as picking a specialty versus a general practice, it is up to the individual’s passion and interest. General practice training provides nursing students with a board spectrum of knowledge, whereas a specialty allows the individual to fine tune his or her knowledge on specific conditions and medications. While general practice training may offer more flexibility, specializing in a certain area of advanced practice nursing can also be beneficial, particularly if there is a dearth of practitioners in a given field of advanced nursing.
[OnlineFNPPrograms.com] What is the difference between adult-gerontology acute care and adult-gerontology primary care, in terms of the work settings, the types of patient conditions treated, and the certifications necessary to work in either field? How much does a nurse practitioner’s specialization dictate his or her work setting?
[Amanda Ruch, MS, AGPCNP-BC] Acute care versus primary care varies in practice settings. Acute care nurse practitioners (ACNP) primarily work with patients who are critically ill, such as those patients housed in the intensive care unit. Adult-geriatric primary care nurse practitioners (AGPCNP) focus on patients with acute and/or chronic conditions and disease processes that do not require complex surgical procedures, intensive treatment, and/or monitoring. Primary care nurse practitioners can work with patients in a variety of settings such as outpatient settings, long term care settings, etc.
The skill set nurse practitioners must develop is often dependent on the specific patient population they focus on, and their specialty area of practice. The ACNP uses invasive and noninvasive technologies, interventions, and procedures to address severe patient conditions.
Both acute and primary care are responsible for diagnosing, assessing, and managing numerous conditions in patients in various stages of disease processes. In addition, adult nurse practitioners, regardless of whether they are acute or primary care, can treat a patient who is 13 years of age to the end of life. Different states have different practice guidelines, and therefore the key is for nurse practitioners to review their state’s advanced practice guidelines to ensure the individual provider is safeguarding the health and wellbeing of their patient(s) and operating within their scope of practice.
The beauty of going into the field of nursing is it allows an individual to be exposed to countless possibilities and specialties–there are so many directions one can take one’s career!
Thank you Ms. Ruch for participating in our APRN career guide interview series!