I think it is very important to have a broad understanding and respect of how the hospital system works together before becoming an advanced practice nurse. I have worked in many different positions in the hospital, which has really provided me with the respect required to do my job properly. There is no better way to understand how hard someone’s job really is besides doing it yourself.
About Carol Darwin, MSN, AGNP-C: Carol Darwin is an Emergency Medicine Nurse Practitioner at Harrison County Emergency Department, where she provides acute medical services to individuals suffering from moderate to severe injuries or ailments such as head injuries, lacerations, and chest pain. She is also a Nurse Practitioner for Norton Healthcare’s Immediate Care Center, where she treats patients experiencing moderate health conditions such as the flu, nausea, chest colds, and other common ailments. Prior to her work as a nurse practitioner, Ms. Darwin worked as a Critical Care Registered Nurse at Kosair Children’s Hospital, within the Pediatric Intensive Care Unit, where she provided critical care nursing, as well as patient assessments, lab interpretations, and treatments for severe conditions and disorders. After working at Kosair, Ms. Darwin worked as a Registered Nurse in the Operating Room at Baptist Health Louisville, where she assisted physicians in preparing patients for surgery and during surgical procedures.
Ms. Darwin is certified as an Adult-Gerontology Primary Care Nurse Practitioner through the AANP. She earned a Bachelor of Arts in Political Science and International Studies from Indiana University Southeast before going on to earn her BSN in 2013 from Bellarmine University. She received her MSN with a concentration in Adult-Gerontology Nursing from South University in 2015.
[OnlineFNPPrograms.com] Could you please give us an overview of your academic and professional path?
[Carol Darwin, MSN, AGNP-C] My educational background begins with a Bachelor’s degree with double majors in Political Science and Asian studies and a French language minor. I am very grateful to have completed this education, as it provided me with a well-grounded sense of culture and better understanding of world politics. I initially pursued a PhD in Asian Studies, but I decided to join the work force in sales. I worked in sales for some time, then I decided to return to school to pursue an accelerated Bachelor’s degree in Nursing at Bellarmine University. I come from a very medically oriented family with a mother as a nurse and father as a heart surgeon, which helped to pique my interest in health care.
This program required the utmost dedication, as you must complete the degree in one year. I worked pro re nata (PRN)–that is, on an as needed basis–as a unit secretary and monitor tech in the Open Heart Recovery Unit of Baptist East, and then proceeded to work PRN as a PCA and Monitor Tech at Norton Brownsboro Hospital in the ICU. While at Norton, I became a Norton Healthcare Scholar, maintaining at least a 3.0 GPA throughout my accelerated BSN. I completed my BSN in May 2013, then took a Pediatric ICU position at Kosair Children’s Hospital. While working in the PICU, I began pursuing my MSN as an Adult Gerontology Nurse Practitioner through South University. This was an online program that could be completed anywhere in the United States and CCNE accredited, which I greatly appreciated. After completing the accelerated BSN, I wanted a break from the classroom. I currently hold my BLS, ACLS, and PALS certifications. I also maintain my Drug Enforcement Administration license, as well as my Indiana and Kentucky licensures as a Nurse and Nurse Practitioner. Additionally, I am a member of the Emergency Nurses Association, Kentucky Board of Nursing, and the Sigma Theta Tau Honor Society of Nursing.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as an Emergency Room Nurse Practitioner at Harrison County Hospital? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Carol Darwin, MSN, AGNP-C] My role in the ER and Acute Care Center of Harrison County is rather unique. Their ER is run with one Physician and one Nurse Practitioner. Like most ERs, we use the numerical value system 1-5 to grade the severity of the patient’s problem (1= severe trauma, will die without intervention and 5=no severe threat, strep swabs, etc). The Nurse Practitioner will typically see patients with grades 3-5 leaving the more severe patients to be seen by the physician. Additionally, if there is a severe trauma or code, the NP will assist the physician in any way possible during the code. As an NP in this setting, I care for adult and pediatric patients with conditions ranging from acute respiratory distress (pneumonia, COPD acute exacerbation, bronchitis); chest pain with EKG interpretation; DVT, cellulitis; ingrown nail removals with digital blocks; UTIs, renal calculi; severe cerumen impaction removals; acute joint injuries (sprains, meniscus tears), laceration repair, local prep; GI issues (acute cholecystitis, hepatitis, pancreatitis, GERD); acute depression; fertility issues and gynecological emergencies, and more. In a daily shift, I typically see several pediatric patients with no severe illnesses and adult patients who are suffering from traumas from motor vehicle accidents, head injuries, migraines, belly pain, and chest pain. I also typically see the patients requiring laceration repair, as these can greatly delay the physicians. The ER is very much a treat and release scenario. The acute problems are managed, and the patient is either admitted to the hospital for further care or released.
We try our best in the ER to assist the patient in finding a solution to their primary problem, but we typically provide them with a referral and send them on their way. The ER is not meant to manage primary care problems or long-term illnesses. My patients typically require diagnostic labs, x-ray, pain medication, pelvic exams, and antibiotics to treat their illnesses or injuries. My total time spent with a patient varies greatly and depends entirely on their present problem. For example, it takes me about 5-10 minutes to determine if a patient needs a Flu/Strep swab to rule out these illnesses. Typically, I can diagnose strep with just a description from the patient, and once the diagnosis is confirmed, we will get the patient the proper antibiotic and get the patient discharged. I work directly with the nursing staff and physician to determine diagnoses and treatment. The nurses are incredibly helpful and knowledgeable at Harrison, and I greatly value their assistance. Additionally, the ER would not run smoothly without the secretary and nursing assistants. They are certainly wonderful aids to keeping the workflow going smoothly.
[OnlineFNPPrograms.com] You are also an Immediate Care Center Nurse Practitioner for Norton Healthcare. Could you please elaborate on this role, and how your responsibilities, team, and work setting differ from those at Harrison County Hospital?
[Carol Darwin, MSN, AGNP-C] I am actually just beginning my position in the Immediate Care Center (ICC) at Norton Healthcare, however the Immediate Care setting differs greatly from the ER. I generally work about 8-12 hours per week at the ICC, and I can work anywhere between 4-12 shifts or more at Harrison. The ICC is far less acute care with acute referencing the severity of injury. Typically patients within the Immediate Care setting require treatment for chest colds, Influenza, headaches, nausea, vomiting, and diarrhea, fever, and other common ailments. The Immediate Care center does not treat lacerations, vehicular traumas, chest pain, or other more severe problems. They do treat children just as the ER treats children, but I will not see children at the Immediate Care Center until I complete my Pediatric post-Master’s which I am currently in the process of applying for. I can spend more time with a patient at the Immediate Care Center, and my charting occurs at the bedside while visiting with the patient, but the delineation of tasks remains the same as it does in the ER. The NP is there to diagnose and treat, but not perform labs or other tasks. The patient population is also different in the Immediate Care Center. Harrison County Hospital is considered a rural hospital. The Immediate Care Centers are located throughout Louisville, KY and Southern Indiana, and as such we see a more diverse population.
[OnlineFNPPrograms.com] Why did you decide to become an adult-gerontology nurse practitioner, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Carol Darwin, MSN, AGNP-C] I chose to become an adult-gerontology nurse practitioner, as I was unsure if I wanted to complete a specialty NP certification. Simply put, I chose the shortest possible route to become a NP in order to enter the workforce and gain some understanding of what type of NP I wanted to become. My knowledge as a pediatric critical care nurse gives me so much understanding of complicated pediatric illnesses to observe for as a NP, but the lack of certification as a pediatric NP does present the possibility of legal issues, which is why I am looking into solidifying my career with additional education. I feel as though I greatly enjoy working in the ER, but the fast pace can be very draining at times. The paperwork and charting can be quite exhausting and often take twice as long as the time required to see, diagnose, and treat the patient. I am contemplating specializing as an Emergency Medicine NP, but I have not made this decision. There is always time to continue your education as a NP, which is one of the reasons I love this career path.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as an adult-gerontology nurse practitioner thus far? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Carol Darwin, MSN, AGNP-C] I have greatly enjoyed the work I have completed thus far as an NP. However, I would really advise nursing students to broaden their horizons and try as many nursing positions as they can before becoming a NP. I think it is very important to have a broad understanding and respect of how the hospital system works together before becoming an advanced practice nurse. I have worked in many different positions in the hospital, which has really provided me with the respect required to do my job properly. There is no better way to understand how hard someone’s job really is besides doing it yourself. I know how tiring it can be to be a nursing assistant and how behind you can become so easily as the unit secretary, so I know how much to value their assistance. It is vital to respect everyone, not just whom you consider your equals or superiors.
I imagine my career will evolve and grow, just as I will over the years. I am the mother of one child, and I do plan on having another, and most likely once both of our children are school age, then I will be working full-time, possibly in the fast paced ER. I would also suggest trying to work in the ER or ICU if you are thinking about becoming a NP, unless you want to become a NP in specific practice areas like Women’s Health or Psych (then I would advise working in those areas as long as possible). The ER and ICU are very challenging units that really help you build the foundation of nursing and understand that you should never overlook the smallest of details as it could lead to a much bigger undiagnosed issue.
[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?
[Carol Darwin, MSN, AGNP-C] For current and prospective MSN degree students, I would advise you to begin studying for your boards once you begin your clinical rotation. There are so many types of board exams, some of which are specific to your specialty, and if you are choosing to complete that specialty for your MSN, remember to only study those areas that will be covered on the exam. I completed both the Fitzgerald review course and the APEA board review course. APEA was provided to me by my school and I paid for Fitzgerald out of my own pocket. From personal experience, I can say I would much rather complete the APEA course via the DVDs rather than the in person Fitzgerald review. It is helpful to be able to complete the course at your own pace, rather than trying to cram 2 years’ worth of knowledge into a single weekend review.
Additionally, I would advise you try and complete a clinical rotation under the direction of a physician, as this is most likely whom you will be working with. Completing a clinical practicum rotation with a physician provides you with a different mentality and understanding of how to treat patients.
Thank you Ms. Darwin for participating in our APRN career guide interview series!