CNHS’s mission is CARE: care, advocacy; research; and education. As an advanced practice provider at CNHS, I keep the organizational mission statement in mind and apply it to my daily practice. To see work that you have collaborated on or helped to facilitate be successful in making a difference is gratifying and reinforces why always being willing to learn and adapt is so important in nursing and healthcare.
About Dr. Lisa Ring, DNP, CPNP, AC-PC: Dr. Ring has been a Pediatric Nurse Practitioner at Children’s National Health System (CNHS) for over 17 years and has worked in the nursing field for over 29 years in both a clinical and an instructional capacity. During her time at CNHS, Dr. Ring has served patients in the Division of Cardiovascular Surgery, the Division of Plastic and Reconstructive Surgery, the Division of Pediatric Surgery within Burn/Trauma Services, and Emergency Medicine. She also worked as an Adjunct Clinical Professor for The Catholic University of America, where she helped to develop and coordinate the University’s Acute Care Pediatric Nurse Practitioner track. Prior to her position at CNHS, Dr. Ring was a Nurse Practitioner at WakeMed, where she cared for newborns in the nursery and the neonatal intermediate care unit. She also worked as a Registered Nurse for Children’s National Health System and Massachusetts General Hospital.
Dr. Ring earned her Diploma in Nursing from the New England Deaconess School of Nursing in 1987, her Bachelor’s of Science in Nursing from George Mason University in 1995, her Master’s of Science in Nursing from Duke University in 1997, and her Doctor of Nursing Practice with an emphasis in Clinical Leadership from The Catholic University of America.
[OnlineFNPPrograms.com] May we please have an overview of your academic and professional path in pediatric nursing?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] I began my nursing career by earning a Diploma in Nursing from the New England Deaconess Hospital School of Nursing in Boston, MA. I received my BSN from George Mason University (Fairfax, VA) and my MSN from Duke University (Durham, NC). This year (2016), I graduated from The Catholic University of America with a Doctorate of Nursing Practice.
My nursing career has spanned 29 years. My first nursing position was as a staff nurse where I was hired into a yearlong orientation in the pediatric intensive care unit at Mass General Hospital. This first professional nursing position was the launching pad for my lifelong journey in pediatric acute care. I was certified as a primary care pediatric nurse practitioner (PNP) in 1998 and as an acute care PNP in 2007 through the Pediatric Nursing Certification Board. I have practiced in mainly acute care settings in the following areas: pediatric emergency care; trauma and burn; wounds and now cardiovascular surgery. I have also worked as a nursing staff educator and coordinated the acute care PNP track at The Catholic University of America.
[OnlineFNPPrograms.com] Could you please elaborate on your role as a PNP at the CNHS? Could you describe the different responsibilities you have had, the patient populations you served, and the medical teams on which you worked during your over 17 years at CNHS?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] I have spent the last 17 years in both advanced practice clinical and educational roles at the Children’s National Health System (CNHS). I started my NP practice in the pediatric emergency department (ED). I have held various roles at CNHS. Each role has both increased my knowledge and provided opportunities for growth and clinical experience within different specialties. Since returning to CNHS, other than my time in the ED and with staff education, my clinical practice has been with surgical teams, initially with the Trauma and Burn Service, as a wound specialist within Plastic and Reconstructive Surgery, and now with the Cardiovascular Surgery (CVS) team.
Although I have worked with various specialties, I have remained in acute care. I have brought lessons and knowledge learned from and to each position. Each clinical role has been structured differently; however, I have been able to apply the foundations of the role of the acute care PNP to each one.
On the Burn/Trauma Team, I was initially hired to provide continuity of care for pediatric burn patients discharged from the Burn Unit and also to patients referred from other institutions or providers in an outpatient clinic setting three days per week. For 2 of the 3 clinic days, I was the sole practitioner providing assessments and developing a plan of care. This was a very big change from having a team of experts and nurses working with me in close physical proximity in the ED. However, I was able to take my ED and urgent care experience to help triage and coordinate care, as well as provide appropriate collaboration with the pediatric surgery team, physical and occupational therapists as needed, as they were always just a phone call away if I needed their expertise. One clinic day a week, the Trauma/Burn attending surgeon/ program director, occupational and physical therapists and I staffed the clinic together. Since many patients returned to the clinic multiple times, having these clinics allowed us to consistently provide multidisciplinary continuity of care. This was a nice change from the ED, as I was able to see patients heal over time. I also consulted on burn management for ED patients. Having already worked for many years in the ED, I was able to easily collaborate with the ED staff to optimize both acute and follow up care for our burn patients.
I was the first PNP on the Wound Team. I worked with a very experienced clinical nurse specialist in providing consultation and wound management for just about all of the main campus CNHS specialty departments. While in this role, I developed standardized electronic consult and progress notes to optimize continuity and communication of care. I also helped to establish an outpatient wound clinic, where discharged patients could be followed up. This role was mainly a consultant role. In this position I gained a wealth of experience and knowledge working with many different specialties. I consulted on patients throughout all stages of health and sickness including patients coming in for well child visits as well as critically ill or dying patients.
The CVS nurse practitioner position came about as I had met and worked with both the CVS PNPs and surgeons in providing wound care management for post-operative patients. I was drawn to working with an established team of PNPs on a specific unit. In this current role, I collaborate with a team of PNPs, highly trained staff nurses, cardiologists and the CVS surgeons to provide daily care coordination and management for post-operative cardiovascular surgery patients on an in-patient unit. I have the opportunity to utilize my experience as an acute care provider to provide daily continuity of care. In this role, I am also able to apply my wound expertise as well as develop and promote efforts to improve clinical practice. I also have the opportunity to teach. Since our patients may acutely decompensate, my experience as an ED provider helps me to both triage and appropriately obtain resources for escalation of care. The biggest challenge for me has been to become better educated and more knowledgeable about the specifics of congenital heart defects and surgical repair.
[OnlineFNPPrograms.com] You are also an Adjunct Clinical Professor at the Catholic University of America, where you helped to develop and coordinate the acute care PNP track. Could you please describe the process of developing this track, and what classes, concepts, and skills you feel are essential for the proper training of acute care PNPs?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] In 2005, the Pediatric Nursing Certification Board developed the Acute Care PNP certification exam for those PNPs whose primary clinical practice focuses on acutely or chronically ill patients. I was part of this group as I was a primary care certified PNP working in a pediatric ED.
While in the pediatric ED, I became an item writer for the Pediatric Nurse Certification Board (PNCB). This experience led to my being recruited to participate during the development of the pediatric acute care exam. A few years later, I was asked to both help develop and implement the first acute care PNP track at The Catholic University of America, which I did until 2014 as I wanted to finish my DNP.
The Catholic University of America’s Graduate School of Nursing decided to develop an acute care track to meet the educational and clinical requirements for current and prospective students interested in obtaining an acute care pediatric certification. The Elective Track for Acute Care PNPs offered the following options:
- Post Master’s Certificate Program for Primary Care PNPs
- Additional Track for MSN PNPs (dually Prepared- AC-PC)
- Clinical Track for Post Master’s PNP-DNP students
The acute care certified PNP role is designed to meet the specialized physiologic and psychological needs of children with complex acute, critical, and chronic health conditions. Two courses are the foundation of the program. Advanced Diagnostics provides the PNP student with critical knowledge and skills regarding technological assessment modalities and procedures commonly associated with care of the acutely ill child. Complex Acute and Critical Problems in Pediatrics provides students with advanced understanding of the pathophysiological basis for problems that threaten the critically ill child. Students are also required to complete a minimum of 360 hours of clinical practicum in addition to the clinical rotations required for primary care. These acute care rotations typically include settings such as: acute hospitalizations, pediatric intensive care, emergency department, neonatal intensive care, long term care, and outpatient specialty clinics.
Nurses interested in pediatric acute care should gain pediatric nursing experience in areas of acute care. Taking advantage of opportunities to work with both physician and nurse practitioner providers will help with identifying differing provider role responsibilities and facilitating effective collaboration. In order to accurately identify and manage acute and complex patient needs, acute care PNPs should have a foundation in primary care. This foundation helps to build assessment skills to better identify physiological normal and variation from normals. Acute care PNPs need to have the ability to accurately prioritize care needs in constantly changing situations. It is important for PNPs to also learn how to effectively communicate and collaborate with providers and staff from multiple disciplines. Technical skills can be learned and competency attained with practice and repetition. Taking advantage of opportunities in current practice roles with active participation in simulation and in precepted clinicals will support learning and practice for specific procedures.
[OnlineFNPPrograms.com] You were also a PNP at WakeMed, where you cared for neonates in the newborn nursery and intermediate care neonatal unit. How did your role at WakeMed differ from that of a Neonatal Nurse Practitioner?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] My PNP career started in a well-child and intermediate care nursery in Raleigh, NC. This was my very first PNP position after graduation from a primary care PNP program. The National Organization for Nurse Practitioner Faculties (2014) has developed core competencies for all nurse practitioners. These competencies include the following: scientific foundation, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery system, ethics, and independent practice. Neonatal nurse practitioners (NNPs) receive advanced practice education for a very specific population which includes neonates through patients two years of age. NNPs are specially trained to practice in the following clinical areas though their graduate education: newborn nurseries, intermediate level nurseries, and neonatal intensive care nurseries. PNPs are trained and educated to provide health and illness care for pediatric patients, so there is some overlap with the primary and acute care PNP roles for neonates, infants and toddlers. Since I was certified in primary pediatric care, my practice at WakeMed mainly focused on the care and management of newborns in the newborn nursery.
I also participated in a follow up outpatient clinic providing well child care for neonates through the toddler age group. After being trained and gaining clinical experience and expertise with newborns, I was then precepted and trained to work in the intermediate care nursery. The NNPs managed patients and performed procedures in the neonatal intensive care unit and were primarily responsible for the most complex and fragile patients. The NNPs did not staff the outpatient clinic. The PNPs coordinated care for less complex patients and did not perform procedures.
[OnlineFNPPrograms.com] Why did you decide to work in advanced pediatric nursing specifically, and what path did you take to discover that this field of advanced practice nursing was right for you?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] I had always known I wanted to work in pediatrics but didn’t know where until I went on job interviews after nursing school graduation. My first nursing position was a yearlong precepted nurse internship at Massachusetts General in Boston, MA. This is where I developed my passion for acute care. After working in a few different PICUs (as a traveling nurse) I decided to take a position in the pediatric emergency department at CNHS. I found I enjoyed the ability to work with non-urgent and critically ill patients. In this environment I had the opportunity to learn many skills and gain experience as a clinician through various nursing roles. At the time, we did not have PNPs in our ED; however, there were former ED nurses, now PNPs staffing the urgent care clinic. Also, one of my nursing colleagues was in graduate school to become a PNP and did a clinical rotation in the ED. This is when I first became interested in becoming an advanced practice nurse. As a staff nurse, I had always been eager to participate in as well as develop education and learning opportunities. Attending graduate school to become an advanced practice nurse seemed like the best way to provide a path and options for more learning opportunities and independent practice. I have always felt that I made the right decision in becoming a PNP.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in advanced pediatric nursing? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] It is a privilege and a great responsibility to provide care for ill patients and their families. I have met and worked with some amazingly strong and inspiring patients and families who are always with me and remind me daily of why I do what I do. CNHS’s mission is CARE: care, advocacy; research; and education. As an advanced practice provider at CNHS, I keep the organizational mission statement in mind and apply it to my daily practice. Due to clinical and family experiences, I have had the opportunity to identify areas where we can make changes to improve patient experiences. To see work that you have collaborated on or helped to facilitate be successful in making a difference is gratifying and reinforces why always being willing to learn and adapt is so important in nursing and healthcare.
Challenges are also opportunities. As the first PNP on the Wound Team, I recognized that it was important for the Wound Team to be able to effectively communicate wound care and management to nursing staff and other providers. Developing an electronic note to provide transparency was an important endeavor but also posed challenges as this was a new way of documenting for the team. Thankfully with effective communication and collaboration we were successful in providing enhanced transparency and communication of wound care to multiple services.
I have been a nurse for a long time and have seen and been through many changes and challenges throughout the years. I think anyone entering the field of advanced practice nursing should be prepared to navigate and coordinate multidisciplinary services in sometimes very stressful situations.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming PNPs, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Dr. Lisa Ring, DNP, CPNP, AC-PC] Gaining experience as a clinical nurse is definitely an asset and provides a foundation for becoming an advanced practice nurse. Nurses are immersed daily in challenging situations and this experience is invaluable. It takes patience, skill and experience to work as an effective team member in a high acuity environment. I think nursing students should participate in a variety of clinical experiences. You never know where you will end up and all experiences build on each other. If you know for a fact you really want to work with children and families, then working in a facility that focuses on pediatric care is a good idea. Many of my opportunities and experiences have come about because of someone I met or from a learning experience I took advantage of. Volunteering in an acute care environment will provide a great experience and also give students an opportunity to see how different providers and team members work together. Our organization offers clinical observation opportunities and also has volunteer positions and this is a great way to get your “learning” foot in the door.
I have included some web site references below which provide helpful information about the role of the acute care PNP. If there is one piece of advice I will kindly share, it is that over the years I have learned that everyone you meet in your life or career either impacts you, or you impact them along your nursing journey in one way or another.
- American Association of Nurse Practitioners (2016). Retrieved from https://www.aanp.org/education/student-resource-center/planning-your-np-education
- Children’s National Health System. (2016). Retrieved from http://childrensnational.org/
- National Association of Pediatric Nurse Practitioners (2016). Retrieved from https://www.napnap.org/students
- National Organization for Nurse Practitioner Faculties (2016). Nurse Practitioner Core Competencies. Retrieved from http://www.nonpf.org/?page=14
- The Catholic University of America (2016). Graduate School of Nursing. Retrieved from http://nursing.cua.edu/graduate/msn/index.cfm
Thank you Dr. Ring for participating in our APRN career guide interview series!