Working as a Nurse Practitioner, you get to directly affect lives on a daily basis. You meet needs when someone is at their lowest point. It is a rewarding but challenging role. [...] I never imagined after graduating from a Family Nurse Practitioner program that I would be caring for patients with such complex medical conditions. Taking care of these patients from their first day in the hospital to their last revealed the impact you can truly have on a person’s health when you are running a tight ship and giving excellent care.
About Jen Wiles, MSN, MBA, FNP-BC: Jen Wiles is a Family Nurse Practitioner at Minute Clinic, where she provides primary nursing care services to patients across the age spectrum. Prior to her role at Minute Clinic, Ms. Wiles was a Nurse Practitioner at UNC Healthcare, where she provided pre-, post-, and perioperative inpatient nursing care at UNC’s Neurosurgical step-down unit and on the neurosciences floor. Ms. Wiles also worked as a nurse practitioner in inpatient and outpatient care in the Trauma and General Surgery departments at St. Vincent Indianapolis Hospital, and at Indiana University Health within the adult and pediatric emergency care divisions.
Ms. Wiles earned her Bachelor of Science in Nursing from Gardner-Webb University in 2008, and her Master of Science in Nursing from Vanderbilt University in 2010. She is currently enrolled in an MBA program at North Carolina State University, with the intention of entering a healthcare management role post-graduation.
[OnlineFNPPrograms.com] Could you please describe the path you took to train yourself for your current field of advanced practice nursing?
[Jen Wiles, FNP-BC] I began my nursing career pretty young, obtaining an ADN from Gardner-Webb University (GWU) and becoming an RN when I was 20 years old. I immediately began the BSN program at GWU after graduation and obtained my BSN in 2008. I graduated with my MSN from Vanderbilt University in 2010 and became a licensed Family Nurse Practitioner in the state of Indiana a few months following. All of my experience as an RN was in emergency services, both as a staff nurse and travel nurse. My nursing career took me to mostly academic medical facilities with trauma centers in South Carolina, Connecticut, and New York City; though I did briefly do a stint as a camp nurse in Michigan. I moved to Indiana for my first position as an NP because it was important to me to continue in the emergency room, and I found a position for a new graduate there. I quickly realized that while I loved the emergency room as an RN, as an NP, I was more interested in being a part of the entire care plan for a patient. I moved into an inpatient/outpatient role with trauma and general surgery at St. Vincent Hospital in Indianapolis. I loved inpatient care and also missed North Carolina so I took a position with inpatient Neurosurgery at UNC Health. Recently, I have grown interested in healthcare management and innovation, leading me to pursue an MBA with NC State University. Minute Clinic offered a flexible schedule that fit well with my desire to stay in practice while furthering my education. I am currently in my 2nd year with Minute Clinic and in the MBA program.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Family Nurse Practitioner for MinuteClinic? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Jen Wiles, FNP-BC] Retail Health is a growing service in the healthcare industry. I currently work as a Family Nurse Practitioner with Minute Clinic. During a typical day, I will see patients for skin conditions, respiratory infections, bladder infections, vaccinations, administrative/camp/sports/DOT physicals, chronic disease screening, weight management and smoking cessation consults, and for numerous other acute medical needs. Patients come to retail health clinics for the affordability and convenient access to medical care. We recently began using a new electronic medical record and are now able to connect with other healthcare providers across the nation. This gives us access to patients’ medical history and keeps their primary care providers in the know about their current health status. We are able to refer patients to higher levels of care or back to their primary care providers when needed and encourage them to obtain regular medical care when they lack it. We also provide education and counseling as to their chronic medical conditions, encouraging compliance and follow up.
[OnlineFNPPrograms.com] You also worked as a Nurse Practitioner at UNC Health Care, providing inpatient neurosurgical care, medical management, discharge planning, and education to patients. Could you elaborate on your responsibilities in this role, and how the work, your team, and the environment differed from those of your current position at MinuteClinic?
[Jen Wiles, FNP-BC] During my time at UNC Health I wore many hats, though my official job position was as the adult inpatient Neurosurgery Nurse Practitioner. I cared for patients pre- and post-surgery in the Intermediate Surgical Care Unit and on the neurosciences floor. I worked closely with five neurosurgeons, a neuro-oncologist, and a neuro-endocrinologist. I also frequently collaborated with ENT, infectious disease, and endocrinology. The Neurosurgery service was growing while I was there, with additional residency spots approved during my tenure. I, along with the Neurosurgery residents and rotating interns, provided the majority of the direct provider care to these patients. This was a new position when I joined, and it was created to provide consistency on the Neurosurgery service as interns rotated through monthly, making changeover frequent. During my time, I did not only provide direct patient care. I facilitated intern orientation and supervision on the service, provided educational inservices for the nursing staff who were new to neurosurgical care, created a protocol for the inpatient stay and follow-up of patients admitted for Minimally Invasive Pituitary Surgery, and standardized wound, follow-up, and discharge education for our patients.
[OnlineFNPPrograms.com] Prior to your role at UNC Health Care, you worked as a Nurse Practitioner for St. Vincent Indianapolis Hospital, in both the inpatient and outpatient Trauma and General Surgery care units, as well as at Indiana University Health, where you cared for adult and pediatric patients in need of emergency care. Could you elaborate more on what these positions involved, and what kinds of conditions you addressed on a daily basis?
[Jen Wiles, FNP-BC] My first positions as a Nurse Practitioner were in the emergency room at Indiana Health University–Ball Memorial Hospital and with trauma services at St. Vincent Hospital– Indianapolis. In the emergency room, I mostly care for ER patients with a triage acuity level between 3 through 5. These are patients who present with anything from a minor cut to abdominal pain. I occasionally cared for patients with stroke or respiratory symptoms and at a level 2. This emergency room served all ages, and as a Family Nurse Practitioner, I was often assigned women and children as my patients as some of the physicians and physician assistants were only qualified to see adults.
At St. Vincent, I strictly worked with those 15 years of age or older. I worked on the Trauma Surgery and General Surgery service. The General Surgery patients at this facility were seen by two rotating physician groups. One of these groups also took trauma call. There was a trauma or general surgeon assigned to each service, and in the evenings there was generally one Nurse Practitioner or Physician assistant covering both. We did not cover General Surgery during the day, but there was a dedicated midlevel provider for Trauma during the day shift. We ran trauma codes, performed consults for both services inpatient and in the emergency room, admitted patients, ordered labs, tests, and treatment, answered nursing pages, planned and ordered discharges, and follow-up with patients in the Trauma clinic.
[OnlineFNPPrograms.com] What motivated you to work in acute care nursing and family nursing, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Jen Wiles, FNP-BC] During a clinical rotation in my ADN program, I was placed in the pediatric emergency room at Spartanburg Regional Hospital and quickly felt at home. I loved the acuity and variety of this setting. I also quickly learned that I love taking care of children. I was concerned about limiting my job options if I strictly focused on acute or pediatric care; family practice seemed like the perfect specialty to allow me to see a variety of patients of varying acuity and in all age groups. While I still look back fondly on my time as an emergency room nurse, I felt limited as a Nurse Practitioner in the emergency room. I wanted to know what happened to my patients and was constantly calling up to the floor to check on them. I would sometimes continue to think about their outcomes even weeks or months later. It was clear that I wanted to spend more than a few hours with my patients in this role. The transition into inpatient surgery, specifically trauma, allowed me to continue seeing a variety of patients with a high acuity; however, now I was able to see them throughout their hospital stay and even in follow-up.
I realize that my career has been a bit different, starting in acute care and then moving to a more primary care role. While I had a steep learning curve when starting my job at Minute Clinic, I knew that I could deal with any emergency that walked in the front door. I do feel that this can be a huge stressor for family nurse practitioners. I, on the other hand, felt comfortable with the emergencies but needed to brush up on antibiotic dosing. However, I also know that well trained family practitioners are great emergency practitioners. Being very comfortable with the “normal” patient allows you to quickly observe when something is wrong. I believe the key is knowing your strengths and being comfortable asking questions.
strong>[OnlineFNPPrograms.com] You are also working on your MBA at North Carolina State University. Could you elaborate on how you plan to connect your MBA to your background in nursing, health care, patient education, and nursing leadership?
[Jen Wiles, FNP-BC] During my time at UNC Health, I had the pleasure of getting to know one of the members of the executive team. She previously worked as a Nurse Practitioner and is now in charge of hospital operations. My original intent when enrolling in an MBA program was to climb the ladder at an academic medical center. I deeply desired to be a change agent for a facility and the healthcare industry. I had the opportunity to work on quality improvement projects, and loved that this work affected so many patients at once versus the individual impact of clinical practice. During my first year in the MBA program at NC State University, I quickly realized all of the avenues to effect change in the healthcare industry. I am currently focusing on innovation and entrepreneurial management. While I may still pursue executive leadership in a hospital, I am also interested in healthcare technology. I am keeping my options and plans open, but I do find the thought of running or partnering with a healthcare start-up to pique my love of variety and excitement.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as a family nurse practitioner and acute care nurse practitioner? On the other hand, what specific challenges have you encountered in these fields of work, and how have you managed these challenges?
[Jen Wiles, FNP-BC] Working as a Nurse Practitioner, you get to directly affect lives on a daily basis. You meet needs when someone is at their lowest point. It is a rewarding but challenging role. My time at St. Vincent and UNC Health were my two most rewarding positions as a Nurse Practitioner. I never imagined after graduating from a Family Nurse Practitioner program that I would be caring for patients with such complex medical conditions. Taking care of these patients from their first day in the hospital to their last revealed the impact you can truly have on a person’s health when you are running a tight ship and giving excellent care.
One of my challenges as a Nurse Practitioner is matching my love of acute care with my training in family practice. As laws and regulations for our field change, it is important for students to ensure that they are being trained appropriately for their desired scope of practice. I was fortunate to have a lot of on-the job credentialing and training and supportive physicians since I worked mostly in facilities with residency programs. Another challenge has been finding my place in the patient care team. The profession is changing rapidly and we are still relatively young in the healthcare industry. It is important to advocate for your place on the team and your knowledge and skills. Find a way to work at the top of your license while remaining in your scope. The final challenge is finding a balance in your background in nursing and new role as a provider. You will often find yourself mediating between physicians and nurses, and it is important to be diplomatic while also staying true to your training as a patient advocate.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming family nurse practitioners or acute care nurse practitioners, what advice can you give them about optimally preparing for these fields while pursuing their degree?
[Jen Wiles, FNP-BC] As the nursing profession grows, it is extremely important to keep up with new requirements and regulations. As our profession becomes more adopted and utilized, our scopes may go through periods of growth and shrinkage. We may add even more specialties to reflect that of medical programs or become more generalized in order to fulfill a gap in care. I believe that advance practice provider specializations allow a student to gain important knowledge and experience for their future careers. If you know that you only want to work with women or pediatrics or in psychology or acute care, your program of choice should reflect this intent. It will make you more qualified and competent for these positions. That said, nursing allows many people the opportunity to dabble in many areas of healthcare. A generalized or family specialty allows you to take care of almost any patient that walks in the door. However, if regulation on acuity is enacted and on-the-job training is no longer sufficient to expand your scope, you may be limited in your ability to work in hospitals or for acute care services.
I strongly recommend either working for a while as a nurse or taking time to volunteer in varying settings to find what you really love. Keep in mind that your role as a Nurse Practitioner is very different from that as a nurse, and like me, you may not love the same service or area in both roles. As a nurse, you are taking care of patients, utilizing the orders of someone else. While great nurses will advocate for their patients and be a part of the planning process, they are ultimately the “doers” of the orders. However, in my role as a Nurse Practitioner, I am now making decisions that greatly impact another person. I am performing complete examinations, looking over the diagnostic tests, and putting the pieces together to make a diagnosis. I then have to come up with a treatment plan that will lead to the best outcome. You begin to worry about the financial situation of your patient or their compliance. Sometimes the easiest or best treatment plan can be different from patient to patient.
I gravitated towards emergency clinical experiences during my Master’s degree training because this is what I loved as a nurse, and I wish I would have varied my experience. I may have realized sooner that a different patient relationship better fit my evolved role and responsibility. Also, don’t forget that there are a multitude of options to advance your career as a nurse. While becoming an advanced practice provider may seem obvious, nurses can work as administrators, politicians, lobbyists, consultants, educators, etc. Nursing has a high burnout, and I always advise every nurse or nursing student to figure out what they truly love and dislike about their positions and be open to many options and opportunities in your career to maximize the benefits. What you start out doing as a nurse will likely not be what you end up doing. Allow yourself the ability to grow and explore.
Thank you Ms. Wiles for participating in our APRN career guide interview series!