My daily responsibilities as a PNP at Children’s Health are to provide outpatient care to all allergy patients, with a focus on food allergies. Most of my assessments include taking a detailed history, physical examination, and allergy skin and serum testing. I evaluate the patient as a whole based on their history and test results. With patients that have food allergies, I will recommend that they continue to avoid specific foods or have them return to the office for an ingestion food challenge. An ingestion food challenge is a procedure where we reintroduce the food under close observation to see if the allergy is tolerated.
About Maria Crain, CPNP AE-C: Maria Crain is a Pediatric Primary Care Nurse Practitioner at the Food Allergy Center at Children’s Health in Dallas and Plano, Texas. At Children’s Health, she cares for children suffering from a wide range of allergic disorders. Ms. Crain has been working in the field of allergies, with a focus on food allergy, for the past 10 years, and is also a Certified Asthma Educator. She is an active speaker and has published numerous articles on food allergies and pediatric nutrition. Prior to her role at Children’s Health, Ms. Crain worked as a Nurse Practitioner at the Jaffe Food Allergy Institute at Mount Sinai Medical Center in New York City.
Ms. Crain earned her BSN at the University of Pittsburgh in 1999 and her Master’s degree in nursing from New York University in 2004, where she specialized in Pediatric Nurse Practitioner. She is certified by the Pediatric Nurse Certification Board (PNCB) as a pediatric nurse practitioner (PNP) and is licensed as an APRN in the State of Texas. Prior to her graduate program at NYU, Ms. Crain was a Senior Nurse Clinician in general pediatrics at New York University Medical Center.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Pediatric Nurse Practitioner for Children’s Health? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Maria Crain, CPNP AE-C] My daily responsibilities as a PNP at Children’s Health are to provide outpatient care to all allergy patients, with a focus on food allergies. Most of my assessments include taking a detailed history, physical examination, and allergy skin and serum testing. I evaluate the patient as a whole based on their history and test results. With patients that have food allergies, I will recommend that they continue to avoid specific foods or have them return to the office for an ingestion food challenge. An ingestion food challenge is a procedure where we reintroduce the food under close observation to see if the allergy is tolerated. This does result in occasional severe reactions. However, an ingestion food challenge is the gold standard test in diagnosing true food allergy. I perform these procedures 2-3 times per week. I am also managing patients that have asthma, allergic rhinitis, atopic dermatitis, as well as drug and insect allergies.
For asthmatic patients, I typically order and interpret pulmonary function testing if the child is over six years old. I also manage their medications based on their history. With allergic rhinitis, I prescribe allergy medications and sometimes prescribe allergy shots. Many of our patients also have eczema, and I usually provide the family with an eczema care plan and recommendations based on national guidelines. I will also order allergy skin testing for patients with true drug and insect allergies.
I am also co-investigator on most food allergy research studies that are conducted in our center, along with my supervising MD, Dr. John Andrew Bird. My role is often a supervisory role, especially when the attending is not present. We often perform ingestion food challenges to high risk patients, meaning that it is likely the child will have an allergic reaction in our office. I am there to provide direction to the research nurses and act as the provider. On a daily basis, most of my role includes training by organizations that provide our studies, as well as documentation in the chart on the patients we see that are in the study.
[OnlineFNPPrograms.com] You also worked as a Pediatric Nurse Practitioner for Jaffe Food Allergy Institute. Could you please explain your daily and long-term responsibilities in this role, and how you collaborated with a larger team of healthcare professionals to address patient needs?
[Maria Crain, CPNP AE-C] This position was very similar to my current position but differed in that it was an international center for food allergy and food allergy research. Patients from all over the world sought the care of this office for their children with food allergies. I was able to work directly with the experts in the field and Dr. Sampson and Dr. Sicherer taught me everything I know about food allergy. I worked with all the physicians in that center and the job was more intense because there were several allergists with whom I had to collaborate and see patients. It was complicated but it taught me time management skills, and improved my clinical skills. Dr. Sicherer always included me on any type of educational offering that was provided to the allergy fellows and I feel this has only helped to improve my clinical decision making over the years. Due to my experience in the Jaffe Food Allergy Institute, I was able to assist in the development of the food allergy center in Dallas with Dr. John Andrew Bird.
[OnlineFNPPrograms.com] Why did you decide to become a pediatric nurse practitioner and specialize in food allergies? What academic and professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Maria Crain, CPNP AE-C] Basically, I decided to become a pediatric nurse practitioner to further my education in nursing. I realized I had an interest in food allergies when I interviewed for the position at Mount Sinai. I knew nothing about it, and it seemed very interesting to work in an area where I could learn from experts in the field, and become an expert myself. It is such a focused medical condition and I knew that I would do well in something very specific. I also always knew that I loved taking care of children, and that I enjoyed educating families. I was also considering surgery because I liked the post-op education that I witnessed by the PNPs while working at NYU Medical Center.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in pediatric primary care nursing and food allergy care/education? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Maria Crain, CPNP AE-C] I think the most rewarding aspect for me has been the ability to become an expert in a specific field of pediatrics. As a result, I feel more confident in my role as a PNP. I have been asked to speak at major allergy conferences and travel all over the United States. I don’t think my experience is a common one. After 10 years of working closely with allergists, I have learned that it is important to develop a relationship with your physician colleagues as well as nurse practitioners. They are extremely knowledgeable and are trained differently than nurses. It has helped me look at patients from a medical and nursing model, which I feel overall benefits my patients.
About two years ago, I was asked to see patients independently from the physician and this is different from my role at Mount Sinai and my initial role at Children’s Health. This was definitely a transition for me but has helped me grow as a practitioner. My new role required me to develop my own medical plan for patients, without being able to easily consult the physician. In that way, I have improved my decision making skills and have become more time efficient. I have taught myself that if I don’t know something, that I can always ask or consult the MD later or ask my other NP colleagues. If I do not know something, I am generally honest about that with the patients too.
[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?
[Maria Crain, CPNP AE-C] My advice would be to get out there and learn as much as you can from all healthcare providers that you come in contact with. Once you graduate from school you will still have your co-workers to refer to, but it is much easier if you have a thorough knowledge base. It is also a good idea to make a list of your strengths and weaknesses, and address your weaknesses early on if possible. I went into a specialty primarily because I knew that I would do a better job if I learned a topic really well, rather than general pediatrics. This is a personal preference. However, I do think that it is important to have some years of clinical nursing under your belt before becoming a PNP. I have worked with other NP’s that have less experience and I think the job is much harder that way. Due to the changing healthcare environment, I would also recommend any type of classes related to billing.
Thank you Ms. Crain for participating in our APRN career guide interview series!