I loved the variety, the procedures, the critical thinking of the ICU setting, and the physiology. I also do really well under pressure and I am able to make focused decisions in the midst of chaos; that type of mentality is crucial in the ICU setting. Being a Pediatric Acute Care NP is such a great career. I have so many options when it comes to populations I can work with, from the most acute to least acute, and I enjoy that flexibility.
About Jennie Joyner, MSN, PACNP-BC: Jennie Joyner is a Pediatric Acute Care Nurse Practitioner at St. David’s North Austin Medical Center’s Pediatrix Medical Group, where she provides comprehensive health evaluations and primary care services to well and mildly ill infants in the Newborn Nursery. Prior to her current role, Ms. Joyner was a Pediatric Acute Care Nurse Practitioner in the Pediatric Intensive Care Unit at Dell Children’s Medical Center, where she cared for critically ill children by conducting health evaluations and critical care procedures, and coordinated the care of her patients.
Ms. Joyner received her Master’s of Science in Nursing with a specialization in Pediatric Acute Care Nurse Practitioner from Duke University School of Nursing in 2011, and her Bachelor of Science in Nursing from Milligan College in 2007. Before entering her graduate nursing program, she worked as a Registered Nurse in the Pediatric ICU Float Pool and the Neonatal ICU at Duke University Medical Center.
[OnlineFNPPrograms.com] Could we please have an overview of your academic and professional path in pediatric acute care nursing?
[Jennie Joyner, MSN, PACNP-BC] I received my Bachelor of Science in Nursing from Milligan College in Johnson City, TN but my career in healthcare started while I was in nursing school and worked as a Nurse Tech in the float pool at Johnson City Medical Center. It was during nursing school that I had a Nurse Practitioner as one of my professors and from that point on I knew that this was what I eventually wanted to do with my career. My professor was a Gerontology NP who seemed to have it all. She loved her role, had a good work/life balance, and she really felt that she was making a difference.
During my junior year I was selected to complete an internship in the neonatal intensive care unit (NICU) at Duke University Medical Center in Durham, NC. At the end of that summer, I was hired for my first position as an RN at Duke in their NICU. In the NICU I worked hard and was able to advance quickly as a nurse. I became a charge nurse (the nurse in charge of the NICU ward) and stabilization nurse (the nurse who attends all high risk deliveries in the NICU and helps with procedures throughout the unit, placing IVs, lab draws, PICC lines, arterial sticks, etc.) after just a year and half of being there. I went on to advance to become a Level 3 RN and earned my CCRN certifications in both pediatric and neonatal critical care from the American Association of Critical Care Nurses (AACN).
While at Duke, I worked as a RN in not only the NICU but also the Pediatric ICU (PICU) and Pediatric Cardiovascular ICU (CVICU) over the course of five years there. I completed my Pediatric Acute Care NP MSN degree at Duke during the last three years of that time. Graduate school was a challenge because I not only went to graduate school part time but also worked full time. This was demanding yet it was also an excellent experience for me because it allowed me to apply what I was learning in graduate school directly in patient care. Frequently I would spend night shifts studying with the fellows working in the PICU and discussing how patients were managed.
After graduating with my MSN, I relocated to Austin, TX and excitedly took my first Pediatric Nurse Practitioner (PNP) position in the PICU at Dell Children’s Medical Center, which was, at that time, the only children’s hospital in Austin. In the past few months, after having worked in the ICU setting for over 9 years, I decided to make a change in the acuity of my patient population and took a position in the Newborn Nursery at St. David’s North Austin Medical Center. I have been in the newborn nursery for the past 8 months and have really enjoyed this population and change of pace.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Pediatric Acute Care Nurse Practitioner for Pediatrix Medical Group at St. David’s North Austin Medical Center? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Jennie Joyner, MSN, PACNP-BC] As a Pediatric Acute Care Nurse Practitioner at St. David’s North Austin, I cover the newborn nursery. Typically in the newborn nursery, I see term and late preterm infants (>35 weeks gestation) from birth through the first few days of life. I have a lot of autonomy in this particular role as a PNP in that I see the babies and families independently. I admit each of the infants, complete daily rounds, and discharge each of my patients. On average I see around 10-15 infants a day depending on the census. I was the first PNP to join this group of 7 pediatricians. We work with nurses, medical assistants, OB/GYNs, lactation consultants, hearing screen techs, and other ancillary staff.
The infants I see can have a variety of issues from hyperbilirubinemia needing phototherapy treatment to diagnosis of congenital anomalies to management of normal newborn weight loss. Much of my work involves having a keen eye for the physical exam and recognizing normal variants versus abnormalities that could be life threatening for these tiny humans. I work with families on establishing breastfeeding, expectations for newborn behaviors and basic newborn care (i.e. feeding, bathing, vaccinations, etc.), as well as making sure families establish a medical home for their child or children.
The role differs from that of a Neonatal Nurse Practitioner (NNP) in that these are well newborns and so much of the focus is on preventive care and anticipatory guidance for parents. Neonatal Nurse Practitioners typically work in the NICU setting and are managing premature infants or infants who are critically ill.
[OnlineFNPPrograms.com] You were also a Pediatric Acute Care Nurse Practitioner in the PICU at Dell Children’s Medical Center for over 3 years. Could you elaborate on your core responsibilities in this position, and how they differed from those of your current work in the Newborn Nursery at Pediatrix Medical Group?
[Jennie Joyner, MSN, PACNP-BC] In the PICU at Dell Children’s Medical Center, I worked with a group of six to eight Nurse Practitioners and Physician Assistants, as well as nine physicians who were board certified in critical care. Our group covered both the PICU and the intermediate step down unit. In the PICU, there were two teams that each consisted of one NP/PA, a resident, and an attending physician. On average I would round on anywhere from three to six patients in the ICU based on acuity and census. We would have formal rounds as a team in the morning and then round independently throughout the rest of the day on patients, following up on interventions, plan of care, etc.
In this position I also did many procedures such as intubations, placing central lines, arterial lines, etc. We also would manage the entire patient throughout their stay in the PICU, adjusting ventilators, ordering medications, imaging, or therapies. We would also be responsible for consulting other specialties and helping to coordinate care, as well as writing daily progress notes along with admission and discharge notes, and updating parents. I would admit patients directly from the ER along with those transferred from other units as needed. I also helped teach residents, medical students, nurses, and NP students during my time in the PICU. Teaching is a great way to reinforce your own knowledge as well as help others.
This is all very different from my current role in the newborn nursery. Intensive care is just that–intensive, and it requires much more focus even though the patients may require a lot of attention to multiple different body systems. The PICU is a fast-paced environment that requires impeccable attention to detail and the ability to stay flexible in the midst of organized chaos at times. You can go from managing a child with status asthmaticus to placing a child on ECMO (Extracorporeal Membrane Oxygenation) post cardiac surgery to preparing for multiple trauma cases to arrive at the same time from a motor vehicle collision. The PICU is definitely a great place for those who thrive on adrenaline and those who are able to think and respond quickly, calmly, and effectively in highly stressful situations. I loved my time in the ICU environment and I do miss it often, but the newborn nursery is a nice change of pace, especially since becoming a mother myself.
[OnlineFNPPrograms.com] What is the difference between acute care pediatric nursing and primary care pediatric nursing? During your BSN program at Milligan College and/or your MSN program at Duke University, did you consider both areas of pediatric nursing, and if so, why did you decide to pursue acute pediatric care specifically?
[Jennie Joyner, MSN, PACNP-BC] The pediatric acute care degree focuses on areas of medicine with higher acuity in patient needs and more specialty focused skill set. Primary care focuses more on preventive care, growth and development, anticipatory guidance, and treating common less acute illnesses of childhood.
In the acute care setting, someone may work in the ER, ICU, with a surgery team or inpatient cardiology team for example. In primary care, positions are more likely to be in a general pediatric clinic, the newborn nursery, schools, or even in some outpatient specialties like pediatric endocrinology.
During both my undergraduate and graduate studies I was exposed to both settings through clinicals and when I was a float pool RN I would often float to multiple units within the children’s hospital at Duke. I also worked as a nurse tech in the hospital during my undergraduate years in a float pool and was exposed to many different areas of nursing with adults as well such as in the skilled nursing facility, psych ward, with post op CABG patients, medical surgical units, etc.
I chose to pursue the Pediatric Acute Care NP degree because I knew I wanted to have the ability to practice in an acute care setting but also wanted the flexibility to work in many different environments, where the Neonatal NP route would have limited me to neonates only. My motivation for staying in the PICU post MSN graduation was that I knew I loved the ICU, I felt most comfortable there and I thought it would be a great place to make a smooth transition from the role of RN to NP.
[OnlineFNPPrograms.com] Why did you decide to become a pediatric acute care nurse practitioner? What academic and professional experiences convinced you to follow this career path?
[Jennie Joyner, MSN, PACNP-BC] After working in the NICU for a few years I wanted to experience a little more diversity in patient population but knew I was meant to work with children. During the time I spent as an ICU float pool RN, rotating between the NICU, PICU, and Pediatric Cardiac ICU, I learned a lot and was able to gain exposure to a large variety of patients. I actually was on the NNP, Pediatric Primary Care, and Pediatric Acute Care tracks all at one point during my graduate work, but as time went on I felt I thrived in the acute care setting. It felt most natural, and I decided to stay with Pediatric Acute Care. I loved the variety, the procedures, the critical thinking of the ICU setting, and the physiology. I also do really well under pressure and I am able to make focused decisions in the midst of chaos; that type of mentality is crucial in the ICU setting. Being a Pediatric Acute Care NP is such a great career. I have so many options when it comes to populations I can work with, from the most acute to least acute, and I enjoy that flexibility.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in pediatric primary care nursing? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Jennie Joyner, MSN, PACNP-BC] Making the transition to Newborn Nursery and taking on a more primary care focus has been a really nice transition. Having lots of ICU experience really allows me to understand how important preventive care measures are and gives me first hand experience to help advocate for the safety and health of the babies. I would say some challenges are recognizing the resources you have available for your patients and how to best support them in maintaining and creating their best health. In the hospital setting it is nice because it is very much a team effort and there are lots of resources. Sometimes though patients will not listen to your advice or they have a negative association with Western medicine and that can be a challenge. Sometimes I think it is part of my calling to help bridge some of the gap between the fear mongering perception society has created in the community in regards to hospitals, hospital births, and western medicine in general, using holistic care that is available from a place of love and advocacy for true health. At present, there are a lot of patients who have a distrust of the medical community, and I feel my mission is to help bring greater connection with people who have these and other perceptions of the health care system, and to show them that we are not out to “get” people as providers in the medical community, but rather we have their best interests in mind and will earnestly work to help them attain and maintain sound health. It is really nice to have been a nurse and have spent so much time at a patient’s bedside, which allows me to know a more personal perspective on patient care.
I would say to any prospective students interested in becoming a pediatric NP, that it is a lot of work, but so rewarding and there is so much opportunity to influence positive health outcomes and give holistic care if you open yourself to it. I have often said I have the best job in the world right now; I get to say “Congratulations” everyday. How many people can say that about their day to day? I am honored I get to welcome so many babies into the world, and so many parents into parenthood. If you treat your career with honor, it honors you. Always remind yourself of why you went into this career, especially on the most challenging days and focus on the good coming from each patient under your care.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming pediatric nurse practitioners, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Jennie Joyner, MSN, PACNP-BC] I would say Pathophysiology will be one of your most important courses for any advanced practice setting as a nurse practitioner. Volunteer and shadow in many different areas to really get a feel for what is out there. The more experiences you have, the better informed you will be on what is a good match for you and what isn’t. If you are a nurse in the PICU for example, then do your clinicals in other areas like CV surgery, the ER, or a Bone Marrow Transplant unit so that you have a chance to try something new. Put yourself out there and take risks. The more uncomfortable you are during your learning, the more comfortable you will be when it is really you taking care of patients on your own. There is something to learn from every experience, so listen often and open yourself to the lessons.
Find mentorship; we are meant to be connected as humans, so build a supportive community for yourself that allows you to be your best. Remember the beautiful thing about the nursing field is you can always do something different. If you want to teach, do administrative work, work on IT issues, research, or direct patient care, there is something for you. Network and get to know others in the field you are interested in. Relationships matter and will serve you throughout your career. And lastly, have fun and enjoy the journey. Life is short; we only have this present moment, so make it a great one!
Thank you Ms. Joyner for participating in our APRN career guide interview series!