Children are extremely resilient, and are much stronger than adults. They can go from the brink of death to asking you to play with them within hours. That has always been and will continue to be my greatest reward. I keep every drawing, card, sticker, and any other trinket that I have ever been given by a patient, and I will hold them in my heart forever. Being thanked by parents for helping bring their healthy child back to them is also extremely rewarding.
About Jessica Dean Murphy, MS, CPNP-AC: Jessica Dean Murphy is a Pediatric Acute Care Nurse Practitioner who works in a pediatric ICU at Sinai Hospital in Baltimore through the company MEDNAX. As a PACNP, Ms. Murphy provides full scope care to critically ill children, including children with life-threatening complications due to asthma, diabetes, seizure disorders, cancers or blood disorders, or due to injury.
Prior to this role, she was a Pediatric Oncology Nurse Clinician at Johns Hopkins Hospital, where she took care of children with cancer or those requiring a bone marrow transplant. Ms. Murphy earned her Bachelor of Science in Nursing from Stevenson University in 2008 and her Master of Science in Advanced Practice Nursing – Pediatric Acute Care from the University of Maryland Baltimore in 2012.
[OnlineFNPPrograms.com] Can we please have an overview of your academic and professional path in acute care and pediatric nursing?
[Jessica Dean Murphy, MS, CPNP-AC] I earned my bachelor’s of science in nursing in 2008 from Villa Julie College (now renamed Stevenson University). After graduation, I worked as a pediatric oncology and bone marrow transplant nurse at The Johns Hopkins Hospital for 4 years. I then went on to earn my master’s degree in Pediatric Acute Care Advanced Practice Nursing in 2012, from the University of Maryland at Baltimore. Since that time I have been employed as a Pediatric Critical Care Nurse Practitioner in the Pediatric Intensive Care Unit at Sinai Hospital of Baltimore. I am a certified by the Pediatric Nursing Certification Board (PNCB) as a Pediatric Acute Care Nurse Practitioner (CPNP-AC) and also maintain certification in Pediatric Hematology/Oncology Nursing (CPHON). I am an active member of the National Association of Pediatric Nurse Practitioners (NAPNAP) and serve as the current treasurer of the Maryland Chesapeake Chapter of NAPNAP.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Pediatric Acute Care Nurse Practitioner for MEDNAX? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Jessica Dean Murphy, MS, CPNP-AC] Working for MEDNAX, I function as an independent practitioner (similar to a physician) to manage a 6 bed pediatric intensive care unit. The scope of practice for a nurse practitioner currently varies state-to-state. I am fortunate that I have always practiced in Maryland, a state that recently passed a Full Practice Authority Act, giving nurse practitioners the ability to be used to the full scope their training intended, and therefore I do not require any physician oversee, co-signatures, working under a MD’s license, etc.
In my current role, I am responsible for managing critically ill children aged 1 week to 21 years including bedside assessments, ordering medications, ordering and interpreting labs and tests, admitting and discharging patients, consulting specialists as appropriate, and providing patient and family education. I work as part of a multidisciplinary team including nurses, respiratory therapists, social workers, physical therapists, child life specialists, and attending physicians (doctors). The most frequent types of patients that I manage are children with severe, life-threatening asthma attacks, since Baltimore City has a very high asthma rate. These patients and their parents and other family members often require a great deal of education about what things can trigger asthma and how to avoid them, why it is important for family members to not smoke, that smoking outside the home is still harmful to children with asthma because the smoke lasts on clothing, and how important it is to take asthma seriously. This can be a big challenge, because many people do not realize this so-called 3rd-hand smoke exposure, and are reluctant or struggle with smoking cessation. Seeing their child critically ill in an intensive care unit can sometimes be an agent for change to smoking cessation. As part of our team, social workers help offer resources to quit smoking and ensure families can afford their asthma medications. I also talk with the patients’ primary care provider to ensure follow-up and referral to a pulmonologist when necessary.
[OnlineFNPPrograms.com] Could you explain the differences between acute, subacute, and primary care advanced pediatric nursing? What types of patient conditions do nurse practitioners and nurses treat in acute, subacute, and primary care settings, respectively? During your BSN/MSN programs and internships, did you gain exposure to different pediatric care settings? What motivated you to work in pediatric acute care specifically?
[Jessica Dean Murphy, MS, CPNP-AC] Acute, subacute, and primary care refers to the level of illness and complexity of the patient populations. In acute care advanced practice, you would most likely be practicing in a hospital-based intensive care or critical care unit, where patients are “unstable” and need frequent monitoring and assessments. Nurse practitioners taking care of these patients would have graduated from an acute care pediatric nurse practitioner program. Typical patients in this setting are very sick, and can be a child with any life-threatening condition.
Subacute advanced practice nursing usually refers to a step-down unit (patient is no longer critically ill but still requires monitoring). It may also refer to a rehabilitation facility. Subacute advanced practice is not a separate degree for pediatrics, and can depending on the role be filled by an acute care or primary care PNP. Typical patients are children who had a prolonged illness or life-changing event, such as a car accident or other severe trauma.
Primary care advanced practice nursing is managing children in an outpatient setting, such as children receiving their yearly check-ups. This role is performed by a PNP who graduated from a primary care PNP program, and would be outside the scope of practice for an acute care PNP such as myself to perform.
During my BSN program, I was exposed to many different pediatric, adult, and geriatric settings. Specifically for pediatrics, I had a rotation working with a nurse on a pediatric medical-surgical unit as well as a rotation with a school nurse. During my MSN program, I rotated around various acute care pediatric settings including time with a school-based clinic NP, a pediatric surgery NP, a pediatric ER NP, a pediatric oncology NP, a pediatric hematology/sickle cell NP, and a pediatric solid organ transplant NP. All of my experiences were invaluable and have shaped me into the practitioner that I am today. I ultimately chose to go into pediatric acute care advanced practice from my earlier work as a pediatric oncology nurse. I wanted to continue to take care of these types of patients and other children with life-threatening illnesses and help them win their fight.
[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? How did your work as a Pediatric Oncology Nurse Clinician IIM at Johns Hopkins Hospital impact your decision to go back to school and become a PACNP?
[Jessica Dean Murphy, MS, CPNP-AC] I always enjoyed medicine and helping others, and since a very young age I wanted to be either a nurse practitioner or a pediatrician. When I was 13, my doctors found a tumor under my right arm. They did not know what it was, and with my father being a survivor of melanoma skin cancer at a young age they were worried, so I had surgery to remove it. Fortunately, the tumor was benign and I did not require any more treatment. From that moment on, I wanted to be a pediatric oncology nurse, to care for the other children who weren’t as lucky.
While working as a pediatric oncology nurse, I worked with a team of physicians at different levels of training including residents, fellows, and attendings. Although nursing was a part of the interdisciplinary team, I would at times be frustrated when the physicians would dictate the plan of care for my patients that I may not agree with. I wanted to be able to be more of a part in making the decisions, and therefore I went back to school to pursue my master’s degree and became an acute care pediatric nurse practitioner. Upon graduation, there were no jobs in my area available for pediatric oncology nurse practitioners, so I took a job in a PICU where I would be able to take care of oncology patients as well as many other diseases, which has been an invaluable and very rewarding experience.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in pediatric acute care nursing? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Jessica Dean Murphy, MS, CPNP-AC] Children are extremely resilient, and are much stronger than adults. They can go from the brink of death to asking you to play with them within hours. That has always been and will continue to be my greatest reward. I keep every drawing, card, sticker, and any other trinket that I have ever been given by a patient, and I will hold them in my heart forever. Being thanked by parents for helping bring their healthy child back to them is also extremely rewarding. As a parent now myself, I treasure this even more so.
That being said, there is no greater pain in this world than the death of a child. No matter what you do, how hard you fight, sometimes you just can’t win. For my field of practice, sometimes it is a baby with SIDS, sometimes it is a child with cancer, sometimes it is a child with an unusual bacterial infection. No matter the cause, it ALWAYS hurts. Every nurse and nurse practitioner will experience a death of a patient at least once in his or her career. My advice to future nurses and NPs would be to take care of yourself, know your limitations, and know its okay to cry. I know sometimes my career will be hard, but the good always outweighs the bad.
[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?
[Jessica Dean Murphy, MS, CPNP-AC] Many people have this false idea that you have to do adult med-surg nursing before you can go into any specialty, especially pediatrics. This is not the case. I have never been a nurse for adults, and have never even been a general pediatrics nurse. From the beginning of my career, I have been a pediatric specialty nurse, and I have no desire to ever change that. If this is what you want to do too, know that it is possible!
On the path to becoming a pediatric nurse practitioner, I would definitely recommend making the most of your pediatric rotation in your BSN program. Make sure your professors know that this is what you want to do as an RN, and advocate for yourself to be placed in a pediatric field for your senior practicum. If you are unsure if pediatrics is your field, volunteer with children. I spent many summers at a camp for siblings of cancer patients, starting my sophomore year of college, and from there I knew that this is what I wanted to do. To those still in high school, definitely get involved in volunteer activities or other ways to be around kids, such as babysitting, lifeguarding, or coaching sports.
After completing your BSN and getting at least 1 year of experience in a pediatric unit, look at pediatric nurse practitioner schools around you. The acute care specialty has only been around for a little over 10 years, so those programs are much harder to find. If you want to continue practicing in a hospital setting, acute care is your best bet. Primary care would be for you if you want to see healthier, outpatient-based children.
After choosing and starting your program, it is important to advocate for yourself in order to get the most out of your training. If you think you want to be an ER PNP, reach out to local ERs and see if any PNPs are taking students for clinical practicums. Use your resources. NAPNAP is a national organization of pediatric acute and primary care nurse practitioners, and membership with this group can help with networking in the student role and into practice. They also have an annual conference with up-to-date educational opportunities as well as test-prep courses for certification exams.
Thank you Ms. Murphy for participating in our APRN career guide interview series!