Nursing is a dynamic profession, in that as your life changes so can your career in nursing change to fit your life. What I’ve learned throughout my academic and professional career thus far is that I thrive on the ever-evolving body of knowledge that is medicine and the particular fulfillment that comes with treating patients in various stages of life and disease condition.
About Karina Berge, MS, FNP-BC: Karina Berge is a Nurse Practitioner II in the Pediatric Cardiothoracic Surgery Department at the University of California, San Francisco (UCSF) Benioff Children’s Hospital, where she provides comprehensive care to pediatric patients suffering from congenital and acquired heart disease, and participates in case management assessment, planning, and evaluation under the supervision of an attending Pediatric Cardiothoracic Surgeon.
Prior to her role at UCSF, Ms. Berge worked as a Clinical Nurse II and subsequently as a Nurse Practitioner II for the Pulmonary Services Laboratory at the University of California Davis (UC Davis) Health System in Sacramento, CA. At UC Davis, she provided acute symptom management and care coordination services in collaboration with physicians and pulmonologists to patients suffering from pre and post lung transplantation, COPD, restrictive lung disease, asthma, pulmonary hypertension, cystic fibrosis, and lung cancer. She also served as a Pulmonary Rehabilitation Program Coordinator at UC Davis, where she created a proposal for the program’s conversion to a full-time program, updated educational materials and coordinated guest speakers, and supervised PRP patients in the pulmonary rehabilitation area.
Ms. Berge also worked as a Nurse Practitioner at Planned Parenthood Shasta-Pacific for two years, providing reproductive health services and education to both male and female patients, and as a Clinical Nurse II in the Pediatrics Intensive Care Unit (PICU) at the University of California, Los Angeles (UCLA) Mattel Children’s Hospital. She received her Associate Degree in Nursing from Mount St. Mary’s College in 2006, her Bachelor of Science in Nursing from UCLA in 2008, and her Master’s of Science in Nursing from UCLA’s Family Nurse Practitioner program in 2010.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Nurse Practitioner II at UCSF Benioff Children’s Hospital in the Pediatric Cardiothoracic Surgery Department? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Karina Berge, MSN, FNP-BC] As an NP II, I deliver comprehensive health care under the supervision of an attending Pediatric Cardiothoracic Surgeon in the cardiac intensive care unit (CICU) as well as the cardiac transitional care unit (CTCU). The majority of our patients are born with congenital heart conditions such as hypoplastic left heart syndrome, ventricular septal defect, complete atrioventricular canal defect or double outlet right ventricle. Our patients can face multiple surgeries and procedures, depending on the cardiac defect. It is my responsibility to prepare the patient and family for surgery. This includes ordering appropriate tests, lab work and performing a history and physical examination. Most importantly, we educate the patient and family about the surgery, what to expect the day of surgery up until day of discharge, answer all questions and concerns and finally consent the patient for surgery. This can be a very challenging time, so when appropriate we consult the “Child Life” team that specializes in insuring the emotional and developmental needs of the child are met during this visit as well as throughout the hospitalization. We also serve as consultants in the cardiac intensive care unit and provide care in the cardiac transitional unit. From admission and preparing patients for surgery to discharge planning and education, I function as an associate of the attending Pediatric Cardiothoracic Surgeon in the delivery of care to infants, children, and adults with congenital heart disease.
[OnlineFNPPrograms.com] You also worked as a Nurse Practitioner at Planned Parenthood, and as a Clinical Nurse II and Nurse Practitioner II at UC Davis Health System’s Pulmonary Services Laboratory/Pulmonary Rehabilitation Program. Could you please explain what your daily and long-term responsibilities were in these roles, as well as the team on which you worked and the patients you assisted?
[Karina Berge, MSN, FNP-BC] After finishing my graduate degree, I moved to northern California and worked at Planned Parenthood as a Nurse Practitioner (NP). As a clinician at Planned Parenthood, I performed well-woman exams, breast exams and medical assessments for gynecological conditions such as dysfunctional uterine bleeding, vaginal infections and dysmenorrhea. I also performed male examinations, sexually transmitted infection screening and treatment, birth control counseling and medication abortions. Our population included male and female adolescents and adults. Working in the underserved population has always been an interest of mine.
A few years later, I left Planned Parenthood and returned to the University of California system to work as a nurse in UC Davis Health System’s Pulmonary Services Laboratory/Pulmonary Rehabilitation Program. It became clear that acute symptom management was needed for patients who presented with breathing problems when attempting to exercise; wanting to engage with this need and help patients address their barriers to exercise motivated me to become an NP in the pulmonary rehabilitation program. At this time, we had a long waiting list to enter the program and really needed to expand. We created a proposal to expand the program from a part-time to a full-time program, adding another full-time position and a nurse practitioner to the program. Also in that time, we worked to align our program with national guidelines and achieved national certification.
Our program was a primary palliative care pulmonary rehabilitation program, meaning we focused on increasing patients’ quality of life and their ability to perform activities of daily living through the relief of symptoms, patient education and maintaining healthy practices such as exercise, appropriate oxygen use, adherence to medications, proper nutrition, and many other helpful practices for patients with chronic lung disease. Every patient would receive an individualized treatment plan that included daily and long-term goals. This treatment plan was comprised of several topics, including anatomy/pathophysiology of the disease, nutrition, medications, benefits of exercise, stress and coping with it, infections, and oxygen and environmental control. For some patients, understanding why they are taking a particular medication and how to take it properly is a goal that we would help them achieve. A long-term goal for many of our patients would be to lose weight, walk a mile or simply to not have an exacerbation. Our daily and long-term responsibilities were focused on guiding our patients to achieve these goals. Together, as a multi-disciplinary team, comprised of a medical director, a nurse practitioner, and respiratory therapists, we worked together to educate, support, guide, and advocate for our patients living with chronic lung disease
[OnlineFNPPrograms.com] You completed your MSN with a concentration in Family Nursing. How do you feel your graduate training in primary care and family nursing prepared you to work in pulmonary rehabilitation and pediatric cardiothoracic surgery care?
[Karina Berge, MSN, FNP-BC] When I chose to become a family nurse practitioner (FNP), and then to obtain a subspecialty in underserved populations, I was working as a PICU bedside nurse, which is very specialized. I wanted to broaden my scope to be able to work in primary care and within any age group as well. I’ve always had an interest in public health, especially the underserved. While being an FNP served me well in the pulmonary rehabilitation program, my PICU nursing experience helped in returning to pediatrics. From my degree in Community Health Education to being a PICU bedside RN to being an FNP in pulmonary and then to pediatric cardiac surgery, I’ve been able to use all of my education and experience in every step of my career thus far.
[OnlineFNPPrograms.com] Why did you decide to work in pulmonary rehabilitation and pediatric cardiothoracic surgery, and what academic and professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Karina Berge, MSN, FNP-BC] My decisions to work first in adult pulmonary care and then pediatric cardiac surgery were based on academic and professional goals, circumstances, and timing. Nursing is a dynamic profession, in that as your life changes so can your career in nursing change to fit your life. What I’ve learned throughout my academic and professional career thus far is that I thrive on the ever-evolving body of knowledge that is medicine and the particular fulfillment that comes with treating patients in various stages of life and disease condition.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in pediatric cardiothoracic surgery and pulmonary rehabilitation? On the other hand, what specific challenges have you encountered in your field of work, and how have you managed these challenges?
[Karina Berge, MSN, FNP-BC] I find that being a nurse is rewarding in many ways. Helping a person breathe better, for example, is life-changing, both for the patient and for me. Empowering patients to take back their lives from a disease that has seized it is rewarding. My time working on the Pulmonary Rehabilitation Program at UC Davis was incredibly rewarding because this program has the potential to become a center of wellness for people with chronic lung disease with a focus on primary palliative care. This is a new vision for pulmonary rehabilitation and it can be challenging to change a vision or an approach to care, as well as implement a new NP role. It took a lot of planning and extra work, but we were able to create a comprehensive program that went beyond the normal exercise and education.
Working in pediatric cardiothoracic surgery is hard work—physically, intellectually and emotionally. The patient, the parents and family, the surgery, the post-operative course, and working well as a team in high acuity, highly stressful situations, can be very challenging. For instance, with a very critical patient, multiple people can have different opinions regarding care for the patient. At times the outcome isn’t what everyone had hoped for and you have to be able to move on, accepting the fact that you did your very best. Understanding that it is a very demanding role and that every day has a new set of challenges is important.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in working in family nursing, pediatric cardiothoracic surgery, and/or pulmonary rehabilitation settings, what advice can you give them about optimally preparing for these fields while pursuing their degree?
[Karina Berge, MSN, FNP-BC] I think understanding why you got into nursing and the population that interests you the most should guide the process of choosing your field. For me, I always wanted to work in pediatrics and the underserved population. I also had a strong interest in education. Finding an area that combines all three interests will be the most fulfilling although, I’ve been fortunate to find passion and motivation in every area. I think that volunteering or shadowing in the field of interest is very important to understanding the NP role, responsibilities, schedule, and unique challenges in a given population. It is especially important to volunteer, shadow or network if you want to break into another area that is completely different from your past or current experience. It is also equally important to research the specific qualifications needed for the field of interest and the job market in the geographic area you plan to work.
Thank you Ms. Berge for participating in our APRN career guide interview series!