Interview with Gulay Gulek, MS, ACNP-BC – Acute Care Nurse Practitioner

While acute care nurse practitioners can definitely specialize in one field of medicine, they are not limited to one area of interest. Sometimes trying areas of practice that you have never tried before can lead to a new professional passion, so it is advisable to keep open to new opportunities. Attend conferences in your specialty at least once a year. Become a member of your professional association, and play an active role in different communities of advanced practice nursing that are relevant to your work. Network with people who are in your profession.

About Gulay Gulek, MS, ACNP-BC: Gulay Gulek is an acute care nurse practitioner at University of Washington, Harborview Medical Center’s (HMC) Neuroscience Critical Care Unit. At HMC, Ms. Gulek provides care and counseling to patients suffering from conditions such as stroke, spinal cord injury, Guillain-Barré Syndrome, traumatic brain injury, myasthenia crisis, aneurysmal and traumatic subarachnoid hemorrhage, meningioma, and pituitary tumors. She also helped to establish Neuro-ICU Advanced Registered Nurse Practitioner (ARNP) services at HMC, and co-developed the Neuro-ICU handbook for staff reference. Prior to her role in the Neuroscience Critical Care Unit, Ms. Gulek worked at HMC’s Neurological Surgery department, treating patients experiencing Neuro-trauma, complex spinal cord injury, brain tumors, and other severe conditions.

Ms. Gulek earned her Bachelor of Science in Nursing from Hacettepe University School Of Nursing in 1996, and her Master of Science in Nursing with a specialization in Adult/Critical Care from the University of Massachusetts Graduate School of Nursing in 2004. After earning her Bachelor’s degree, she worked as a registered nurse in multiple medical settings, and as an ACNP at Beth Israel Deaconess Medical Center.

Ms. Gulek started her PhD in Nursing in June 2015 at Washington State University. She was an invited speaker at the Asian Congress of Neurological Surgeons in 2012, as well as at the Turkish Neurosurgical Society in 2013 at the National Conference, and is an active member of ARNP United, located in Washington.

Interview Questions

[OnlineFNPPrograms.com] Could you please describe the path you took to prepare for your current field of advanced practice nursing?

[Gulay Gulek, MS, ACNP-BC] I attended a vocational high school for nursing; after graduation I started working at Ankara Numune Hospital Neurological Surgery service in 1991. In the meantime, I attended the Hacettepe University School of Nursing and earned my BSN degree in 1996. Hacettepe University is considered one of the great nursing schools in Turkey. I moved to the United States right after graduation, and studied English for several years since I did not know any English when I moved to the country. My BSN degree was found to be equal to USA standards and I passed my NCLEX exam in 1999. I worked at Southern New Hampshire Medical Center, Premier Medical Staffing in telemetry, critical care, ER, and Geriatric Psychiatry. After over 2 years of work I decided to earn my masters degree, and enrolled at the University of Massachusetts Graduate School of Nursing, in the Adult Acute/Critical Care Track with a Cardiology subspecialty. I graduated from this program in 2004, and was also awarded for outstanding student of the year at the graduation.

I passed my Acute Care Certification Exam through the American Nurses Credentialing Center, and took some time off after graduation. I found my first Advanced Registered Nurse Practitioner (ARNP) job at Beth Israel Deaconess Medical Center Department of Neurosurgery, where I worked from March 2005 through July 2006. I moved to Seattle, Washington and started work at the University of Washington, Harborview Medical Center in the department of Neurological Surgery from March 2007 through April 2010, subsequently transitioning to a Neuro-Critical care ARNP role in 2010.

[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as an Acute Care Nurse Practitioner for Harborview Medical Center (HMC)? What types of patients do you serve, and what kinds of medical conditions do they suffer from? How do you help patients manage their conditions through direct care, coordination of medical services, and staff/patient education?

[Gulay Gulek, MS, ACNP-BC] I started to work at Harborview in 2007 in the Department of Neurological Surgery. We would start rounds early in the morning with the residents, which included ICU rounds as well as caring for in-patient floor (i.e. non-ICU) patients. An Advanced Registered Nurse Practitioner (ARNP) position opened up in 2010 in the Neuro-ICU. I was really interested in this work setting, as it was the first time in the history of Harborview that ARNPs were going to be part of the ICU team. Previously ARNPs mainly worked on the wards or outpatient clinics.

Neuro-ICU team consists of an attending physician, fellow, resident, bedside Registered Nurse, and ARNP. The nature of the service involves multiple disciplines, including neurosurgery, neurology and other consulting services. At HMC, ARNPs manage their own set of patients, and their daily responsibilities differ depending on the service needs or structure of the institutions. My colleague and I were hired to Neuro-ICU to manage patients and for the continuity of care. Resident rotated every month, and usually attendings are changed a week at a time, and so having ARNPs always there provides structure and stability to medical services in the ICU; we know the work flow, we orient residents to service each month. My colleague and I had set high standards for possible future ARNP services to follow same model and envisioned quality of care, and good communications between the services.

HMC is a Level I trauma center as well as a Comprehensive Stroke Center to WAMI states (Washington, Alaska, Montana and Idaho). Our patient population experiences conditions such as severe brain injury/neuro-trauma, aneurysmal subarachnoid hemorrhage, complex spine and spinal cord injury, and ischemic stroke. In a larger sense, we have the whole team to manage these patients. As an ARNP on this team, I am responsible for the care of designated patients on a particular day. Tasks involved in caring for these patients include gathering all relevant medical data, discussing patients’ conditions with the team, and formulating a plan for the day that I then present to my team for recommendations of revisions or additions. I will follow all of my patients’ test results, communicate them to the team, and if need be I will call the consulting team to recommend that disease-specific conditions be evaluated for a given patient (i.e. more care coordination than direct patient care). For example, if a patient comes in with a brain injury, but also has facial fractures, then I will call the plastic surgery team to come evaluate the patient, and will follow their recommendation etc. I have also played an active role in the designing of disease-specific order sets when we moved to computerized order entry.

Given our complex patient population, I felt that the Neuro-ICU handbook that was given to residents was not sufficient while they are in the very specialized ICU setting, so I took the initiative to design a more comprehensive book that describes work flow, specific disease management strategies, etc.

[OnlineFNPPrograms.com] Why did you decide to specialize in neurological surgery and neuroscience critical care, and what path did you take to discover that this field of advanced practice nursing was right for you?

[Gulay Gulek, MS, ACNP-BC] I discovered neurosurgery as I started my first job as a young nurse in a Level I trauma center in Turkey. At that time, I had very limited choices in where I could work, due to my experience level and the fact that I was also attending college to get my BSN degree at the same time. The neurosurgery service gave me the flexibility of working at night and going to school during the day. When I graduated from my BSN program at the Hacettepe School of Nursing, I also won the lottery for a US permanent resident card. I started my nursing career in the USA, and after a year of working as a Registered Nurse I felt ready to start my master’s degree. To get a feel for it, I took one elective class at the University of Massachusetts, and fell in love with the course content. Thereafter I decided to enroll in graduate school. The intensity of the program and learning new skills were very exiting to me.

Initially I was thinking that I would work in Cardiology so I took additional classes in cardiac care and earned my cardiac subspecialty. Of course, when you start looking for a job reality hits, and I ended up getting a job in the department of Neurosurgery as an ARNP in Boston because of my previous experience in neurosurgery. That fit well with me; I really loved neurosurgery when I was working as an RN, and for some reason I wasn’t thinking about applying to a job in neurosurgery until I saw the job postings after graduation, but I’m so glad it worked out the way it did. The job itself was very demanding, as I was managing all the patients from ER consults to floor patients to post-op patients. We (the group of ARNP/PAs with whom I worked) didn’t have residents so we performed all the patient care from admission to discharge. For instance, I would admit the patient, meaning that I’d place the orders, complete the admission history and physical notes, manage patient care on a daily basis, follow all the tests and imaging, call consulting teams, discuss with the attending, coordinate all patient care, complete the discharge summary, initiate follow up appointments, etc. I am so grateful for that experience because it made me a better clinician, and helped me clarify my role as an ARNP. I am glad neurosurgery came my way–I love the work, and I can’t think of myself working in any other clinical area at this point, it just my niche.

[OnlineFNPPrograms.com] You have worked in a wide range of settings and in many different areas of critical care nursing, including geriatric, emergency care, gastro-intestinal, urologic, orthopedic, cardiac, and coronary. Based off of your experiences, how would you say the responsibilities that APRNs have in these various settings differ? How are they similar?

[Gulay Gulek, MS, ACNP-BC] Working in different settings as an RN gave me a broader perspective of nursing, and assisted me in learning about different types of disease processes and how to take care of these patients. I intentionally wanted to have diversity in my experiences to help me understand the system in the USA. Below I’ve provided a general overview of the various medical settings in which I have worked, and the types of patients and patient conditions I encountered on the job:

  • Medical/Surgical: I cared for patients who had complex medical problems such as diabetes, hypertension, atrial fibrillation, chronic kidney disease, as well as patients who needed surgeries including elective spinal stenosis, gall bladder removal, and big bowel surgeries.
  • Geriatric Psychiatry: I worked with mainly older adults who suffered from depression and behavioral issues.
  • Emergency department: I encountered small to medium traumas, including acute myocardial infection, flues, limb fractures etc.
  • Urologic: I worked with patients in need of prostate biopsies and TURP (transurethral resection of the Prostate.)

[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as an acute care nurse practitioner in neurosurgery and neuroscience critical care? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?

[Gulay Gulek, MS, ACNP-BC] The most rewarding aspect of working as an acute care Nurse Practitioner is really being able to see patients leave your ICU after being in coma, or able to return to their usual way of life after experiencing a serious health condition. I have two distinct experiences regarding that. Recently, we had very young gentleman who came in with severe brain injury, and was in a coma; he stayed in the hospital about 2 months, then spent some time in a rehabilitation center. His family was devastated. I held the family conference with two other providers. His type of injury was difficult to predict but we usually recommend at least a year for the recovery trajectory. So the decision was to wait and do everything we could to help him to recover. 3 months after discharge he walked in to my office with his family. This was the kind of reward I could get from nowhere else.

Second experience was on the inpatient floor service. A 19 year old man was transferred to floor from ICU, and during the transfer he was unresponsive and unable to follow commands. One day I walked in his room, as I examined him, he started moving for the first time. I was really excited. As time went by, he became more alert and started walking with the assistance of a physical therapist, and over time he was qualified to transfer to inpatient rehabilitation service. One day he came to visit us after his discharge, and he told us that he had a job. These two patients both had “Diffuse Axonal injury” (which is a severe form of brain injury that can lead to permanent and debilitating damage), and both recovered well. These experiences also gave me great insight into how to approach family, and the ICU experience overall.

Specific challenges are sometimes the little things like communication issues, time management, disagreements over a patient plan, and heavy patient load. Communication issues are really universal in the healthcare: sometimes in the form of misunderstandings, sometimes in the form of lack of communication between colleagues. We take this very seriously and try to minimize and look for other ways to improve communication.
In general, I try to handle the issues I encounter in a calm way, and focus on the solution rather than problems. Also, sometimes you just need to ask for help from your co-workers or your chief of service, and sometimes tact, discretion, and/or silence are helpful in allowing conflicts to cool down.

[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in working in neurological surgery and/or neuroscience critical care, what advice can you give them about optimally preparing for these fields while pursuing their degree?

[Gulay Gulek, MS, ACNP-BC] My recommendation to a prospective MSN student is to find his/her passion, and to work from there. Students should ask themselves, “What lights my fire professionally? Am I happier at the bedside? Do I prefer to work in an inpatient or an outpatient setting? Do I want to be an educator or a researcher?” In their practicums, students may look into specific areas in which they want to work, and I recommend they be proactive and find preceptors that work in that area.

While acute care nurse practitioners can definitely specialize in one field of medicine, they are not limited to one area of interest. Sometimes trying areas of practice that you have never tried before can lead to a new professional passion, so it is advisable to keep open to new opportunities. Attend conferences in your specialty at least once a year. Become a member of your professional association, and play an active role in different communities of advanced practice nursing that are relevant to your work. Network with people who are in your profession.

For the licensing exam, I highly recommend taking a preparation course that is offered, and to prepare adequately. However, do not wait too long to take your exam, and try not to procrastinate and think that you are not ready yet. Once you take your exam, reward yourself with something, a trip, vacation, or anything that makes you feel relaxed.

Thank you Ms. Gulek for participating in our APRN career guide interview series!


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About the Author: Kaitlin Louie is the Managing Editor of OnlineFNPPrograms.com, and creates informational content that aims to assist students in making informed decisions about graduate programs. She earned her BA & MA in English from Stanford University.