I think the most rewarding part of working as an ACNP in neurocritical care is the relationships with patients and their families. Often times neurologic injury is abrupt and sudden and life altering for the patient and their families. We spend a lot of time meeting with patients and families communicating and explaining their diagnosis, plan of care and prognosis. Recovery from neurologic injury is often a very long road and presents a major challenge for patients and families.
About John Kenna, ACNP-BC: John Kenna is an Acute Care Nurse Practitioner at the Neurological Intensive Care Unit at the Medical University of South Carolina (MUSC), where he cares for patients in the Level I Trauma Center. Prior to his position at MUSC, Mr. Kenna worked as an Acute Care Nurse Practitioner across several different medical centers and hospital settings, including the University of Massachusetts Memorial Medical Center, Lifespan, and Beth Israel Deaconess Medical Center’s Division of Neurosurgery.
In addition to his clinical work at MUSC, Mr. Kenna has worked extensively in graduate nursing program development and instruction as an Acute Care Nurse Practitioner Program Coordinator for the Northeastern University Bouvé College of Health Sciences and as an Assistant Clinical Professor for the University of Rhode Island’s College of Nursing, where he coordinated and developed the new Acute Care Nurse Practitioner Track in September of 2010.
Mr. Kenna received his BSN from the University of Rhode Island in 2005, and his MSN from Northeastern University in 2008. Prior to his enrollment in graduate nursing school, he worked as a Staff Nurse in the Emergency Room at Beth Israel Deaconess Medical Center, and as a Registered Nurse for the Medical/Surgical Intensive Care Unit at The Miriam Hospital.
[OnlineFNPPrograms.com] Could you please give us an overview of your academic and professional path in nursing?
[John Kenna, MSN, ACNP-BC] After graduating with my Bachelors Degree in Nursing from the University of Rhode Island College of Nursing in 2005, I worked as Registered Nurse in a Medical/Surgical Intensive Care Unit at The Miriam Hospital in Providence, RI. In 2006 I was accepted to the Acute Care Nurse Practitioner (ACNP) program at Northeastern University in Boston, and graduated in 2008 with a Masters in Nursing. While in graduate school I worked in the Emergency Department at Beth Israel Deaconess Medical Center (BIDMC). Upon graduation I accepted a full- time position with the Division of Neurosurgery at BIDMC and was appointed as Coordinator of the ACNP Program at Northeastern University. Looking for an opportunity to more fully utilize my education and experience, I accepted a position in the Neuro-Trauma Intensive Care Unit at the UMASS Memorial Medical Center in Worcester, MA.
In September, 2010, I accepted a position with the University of Rhode Island, College of Nursing as an Assistant Clinical Professor of Nursing to coordinate and develop their new emphasis in Acute Care NP track (ACNP). At that time, I also accepted a full-time position in the Neuro ICU at Rhode Island Hospital.
In 2015 my wife and I moved to Charleston, SC in order to escape winter in the northeast. I am now currently working full-time in the Neuro ICU at the Medical Center of South Carolina (MUSC), a level 1 trauma center in downtown Charleston. I continue to work closely with the University of Rhode Island contributing content to their ACNP track.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as an Acute Care Nurse Practitioner in the Neurological Intensive Care Unit at Rhode Island Hospital? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[John Kenna, MSN, ACNP-BC] My role in the Neuro ICU at Rhode Island Hospital (RIH), UMASS and MUSC are very similar. My responsibilities involve rounding on the patients in the ICU and evaluating their condition in order to develop a plan of care for that day. We order a variety of tests including blood tests, XRAYs, CT scans, and ultrasounds to name a few. We also perform a number of procedures including endotracheal intubations, central line placement, chest tube placement, bedside ultrasound and lumbar punctures. Members of the team typically include a Neurointensivist, Nurse Practitioner or Physician Assistant, Registered Nurse, Pharmacist, and Nutritionist. Other members may include a Neuro ICU Fellow, Neurology, Neurosurgical, Anesthesia Residents, Pharmacy Resident and students of all backgrounds. We develop a plan as a team of experts, to best meet the needs of our patients and provide them with the best chance to recover from neurologic injury. We work closely with the Neurosurgeons and Neurologists to manage a variety of neurologic injuries including a variety of Stroke (Ischemic, Hemorrhagic, Subarachnoid Hemorrhage), Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI) and Neuromuscular disorders such as Guillain-Barre Syndrome or Myasthenia Gravis.
A Level 1 trauma center is typically an Academic Medical Center, which is able to provide comprehensive care to patients who are the most severely injured. Academic Medical Centers or Health Centers are hospitals and other types of medical facilities that are affiliated with Schools of Medicine or Schools of Nursing. These centers typically have 24 hour access to specialty providers such as Trauma Surgeons, Neurosurgeons, and Anesthesiologists, among others specialties. Given the specialty care provided by these institutions, it is estimated that these centers can increase a patient’s chance of survival by up to 25%.
[OnlineFNPPrograms.com] You also worked as an Acute Care Nurse Practitioner at Beth Israel Deaconess Medical Center Division of Neurosurgery, where you managed inpatient care for patients in the Neurological Intensive Care Unit, Step Down Unit and Floor, and also assisted Neurosurgeons in the operating room and in the follow-up clinic. Could you explain your core responsibilities in this role, and how they differed from those of your current position at Rhode Island Hospital?
[John Kenna, MSN, ACNP-BC] As a member of the neurosurgical team, the role and responsibilities were a bit different than as a member of a Critical Care team, however, these teams work very closely. As a member of the neurosurgical team, we would be responsible for the initial evaluation of the patient’s primary neurologic problem and determine if they needed immediate neurosurgical intervention; if they did, we would provide that. If they did not, then we would determine the most appropriate setting for them depending on their needs, whether that would be the Intensive Care Unit (ICU), the Step Down Unit, general neurosurgical floor or even home based upon how closely they needed to be monitored. We would also assist in the Operating Room and follow-up with patients in clinic. For many of these patients, they require very close neurologic monitoring and that’s where the Neuro ICU team comes into play. This team is dedicated to the ICU and although very focused on the patient’s neurological needs they also take into account all other body systems (ie, respiratory, cardiac, GI, renal etc.). There are a variety of Neuro ICU structures depending on each institution; however, all aim to provide the best quality care possible.
[OnlineFNPPrograms.com] What motivated you to work in acute care neurological nursing, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[John Kenna, MSN, ACNP-BC] My motivation to be in critical care stemmed from a day spent in the Medical/Surgical ICU at The Miriam Hospital in RI when I was an undergraduate. I spent a day during one of my rotations and knew immediately that is where I wanted to be. After working there full time as an RN it reinforced my love for the critical care setting and reinforced that I wanted to be an Acute Care NP because that track would allow be to be in that setting going forward. When in graduate school I was undecided in which setting I would be after I graduated. I had done a number of rotations in Trauma at Massachusetts General Hospital, which was an amazing opportunity, and ICU rotations at UMASS in Worcester, MA.
During my final semester in graduate school, an NP from BIDMC neurosurgery gave a talk about neurological emergencies and that was what inspired me to explore that area. He would later be my manager when I graduated and took a position with Neurosurgery at BIDMC. I learned more than I ever imagined in this role. They did not have a neurosurgical residency program, which allowed nurse practitioner students to spend a tremendous amount of time in the Operating Room and functioning very independently. However, although we would see our patients in the ICU, and work closely with the ICU team, we would not directly manage the other organ systems and critical care needs. Knowing I wanted to be in an ICU setting and given my background in Neurosurgery what better place than to be in a Neuro ICU? None, as far as I was concerned.
[OnlineFNPPrograms.com] You are also an Assistant Clinical Professor and Coordinator of the Acute Care Nurse Practitioner Emphasis at the University of Rhode Island, and were the Acute Care Nurse Practitioner Program Coordinator for Northeastern University Bouvé College of Health Sciences. Could you elaborate on your responsibilities in these two academic settings? What classes have you taught/do you currently teach, and how do you provide support and guidance to students interested in advanced practice acute care?
[John Kenna, MSN, ACNP-BC] I have always enjoyed teaching. I think that is why I have always loved my job given the tremendous amount of teaching we do with patients and their families. As nurses we are very trusted and I think still one of the most trusted professions in the US, if not the world. In order to be trusted, you have to know what you’re talking about. I always had fantastic professors and mentors and wanted to share what I learned with others. When offered the opportunity to coordinate the Northeastern ACNP program after graduation I thought it was a chance to do that. Two years of coordinating and teaching in all of the ACNP specialty courses allowed to me to have a vast understanding of the content. Given the ACNP specialty is relatively new and not many programs existed in the northeast, when the University of RI offered me the opportunity to start the first ACNP specialty track in RI, I could not pass it up. Since 2010 we have graduated many ACNPs and have provided many institutions and the residents of RI with extremely well prepared providers. As their educator and preceptor, this opportunity allowed me to share my knowledge and experiences as well as learn from them.
ACNP programs are distinct from Family Nurse Practitioner, Women’s Health, and other types of nurse practitioner programs in that ACNP programs focus on adults and older adults with acute/critical illness and chronic illness. Students of ACNP programs often complete their clinical rotations in Emergency Departments, Intensive Care Units and other inpatient areas. That said, though there is a content focus on inpatient illness, you will also find ACNPs in outpatient settings as well, including Congestive Heart Failure clinics, Pulmonary clinics, and rehabilitation centers to name a few.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as an acute care nurse practitioner in advanced neurocritical care? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[John Kenna, MSN, ACNP-BC] I think the most rewarding part of working as an ACNP in neurocritical care is the relationships with patients and their families. Often times neurologic injury is abrupt and sudden and life altering for the patient and their families. We spend a lot of time meeting with patients and families communicating and explaining their diagnosis, plan of care and prognosis. Recovery from neurologic injury is often a very long road and presents a major challenge for patients and families. As providers in the ICU we are a pivotal, but also a very small part of patients’ long road, which may include weeks to months in the ICU or in the hospital and then weeks to months in rehabilitation. Some patients are able to make remarkable recoveries and others are not. Prognosticating who will do well and who will not is very challenging and something we are not very good at as a whole in Neurocritical Care. However, that being said, one of the most rewarding parts of the job is seeing a patient who had a small chance of a meaningful recovery come back and visit the staff. It reinforces that although we see a lot of devastating injuries in a very mentally and emotionally challenging work environment, that there is hope and we need to do our best to provide the best care possible to give them the best chance to recover.
My recommendation for preparing and managing these challenges is to always listen, never be too sure of what the future holds and take care of yourself. Always listen to your patients and their families. Never be over confident and sure of the outcome, patients will amaze you all the time. Take care of yourself, your family and live life, because you never know what may happen.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming acute care nurse practitioners or working in neurosurgical and neurocritical care nursing, what advice can you give them about optimally preparing for this field while pursuing their degree?
[John Kenna, MSN, ACNP-BC] I think the first thing one should consider is what type of environment and population do they hope to work in when they graduate. That will help guide their decision as to which track of NP focus they would like to pursue. Also I highly recommend shadowing providers in different settings and taking advantage of your clinical rotations in grad school. This is your chance to explore different areas in health care and get a feel for what you think you may like to explore further. It reminds me of when I was in my first semester of nursing courses in my undergraduate program and everyone thinks they know what setting they want to work in until they do a rotation in the setting and they all realize that is exactly what they do not want. So use your rotations as an opportunity to open your mind or confirm what you already know.
Choosing a specialization can be difficult, but it is necessary. You will have to choose a track in order to sit for the appropriate board exam. There are a number of different tracks that allow for working in both in-patient and out-patient settings, Adult-Gerontological Acute Care NP (ACNPs), Adult-Gerotological NP (ANPs), Pediatric Acute Care NP, Pediatric Primary Care NP, Family NP (FNPs), and Certified Registered Nurse Anesthetist (CRNA) to name a few. Remember if you decide you want to choose a different track later in your career, many programs offer certificate programs, which are often 12 months long and allow you to certify in another area.
Thank you Mr. Kenna for participating in our APRN career guide interview series!