The field of nursing is an incredibly exciting one! As RNs you have the ability to jump from one specialty to another (i.e. med/surg, public health, oncology, etc). It is similar as an FNP. I have friends who are Family Nurse Practitioners in post-kidney transplant care, gastroenterology, obstetrics and gynecology, as well as primary care. It is important to have a solid clinical foundation and solid critical thinking skills, but ultimately, much of your role and responsibilities will be taught on the job.
About Rebecca Lew MS, FNP-BC, CDE: Rebecca Lew is a family nurse practitioner at the University of California, San Francisco (UCSF) in the Women’s Health Primary Care Department, where she provides primary care services, education, and advocacy to patients experiencing a wide range of chronic and acute health conditions. Prior to her current role at UCSF, Ms. Lew was a Family Nurse Practitioner at the Chinese Hospital Association, where she provided primary care services to patients ranging in age from adolescence to late adulthood. During her time at the Chinese Hospital Association, Ms. Lew also developed two programs, the Teen Sensitive Services program, and the COPD Support Services program.
Ms. Lew earned her Master of Science from the UCSF School of Nursing’s Family Nurse Practitioner program in 2012, and her Bachelor of Science in Nursing from the University of San Francisco in 2008. She is certified as a Family Nurse Practitioner through the American Nurses Credentialing Center, and is also a Certified Diabetes Educator through the National Certification Board for Diabetes Educators.
[OnlineFNPPrograms.com] Could you please describe the path you took to train yourself for your current field of advanced practice nursing?
[Rebecca Lew, MS, FNP-BC, CDE] My interest in healthcare started as a teen, when I was a steering committee member for the Young Women’s Health Conference, a city-wide conference for teenage girls sponsored by the University of California, San Francisco’s (UCSF) Center of Excellence in Women’s Health. After doing some research, I decided that nursing was the route for me. I graduated from the University of San Francisco (USF) in 2008 Summa Cum Laude with my BSN degree. Throughout the 3.5 years of my education at USF, I worked as a medical assistant at a reproductive health community clinic, and worked as a patient care assistant at the University of California, San Francisco’s Medical Center.
I knew early on that I wanted to become a Family Nurse Practitioner. To be a competitive applicant, I felt that my experience as a Registered Nurse needed to reflect this through accruing work experience as a RN in the community. After graduating in 2008 with my BSN, I took a full-time position as a high school nurse with the San Francisco Unified School District and continued part-time/on-call work at multiple reproductive health clinics, as well as working at San Francisco General Hospital in one of their outpatient clinics, and volunteering at the Women’s Community Clinic in San Francisco.
I entered the Family Nurse Practitioner program at UCSF in the fall of 2010, and continued to work as a RN throughout my graduate education. I was very fortunate to be offered a full-time position at one of my clinical sites, Chinese Hospital. After graduation from the Master’s of Science program at UCSF in 2012, I spent almost 3 years at Chinese Hospital and earned an additional certification as a Certified Diabetes Educator. I left my position at Chinese Hospital after careful consideration to return to UCSF as a Family Nurse Practitioner in the Women’s Health Primary Care department, the same National Center of Excellence in Women’s Health that triggered my interest in healthcare as a teen.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Family Nurse Practitioner at the University of California, San Francisco? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Rebecca Lew, MS, FNP-BC, CDE] As a Family Nurse Practitioner and primary care provider, I assess, evaluate, diagnose, and treat patients with various acute and chronic health conditions. In addition to this, one of the most important aspects of my role is to be an advocate and educator to patients. Some common health conditions that I see in clinic include upper respiratory infections, urinary tract infections, asthma, hypertension, diabetes mellitus, back pain, and depression. I help patients manage these conditions by providing pharmaceutical treatment if necessary, providing education on prevention, and optimization of their health condition, and making referrals to specialists as necessary. For example, some acute conditions, such as a urinary tract infection, usually require a prescription of an antibiotic. Along with providing treatment for the infection, I also provide information on how to prevent another infection, as well as potential complications of untreated infections, and when to return to clinic.
For chronic conditions, such as hypertension, the treatment may include pharmaceuticals to lower the blood pressure, but it also includes counseling regarding lifestyle modifications related to exercise, diet, and weight management. For certain patients, the management of their hypertension may also include a referral to nutrition services, or weight loss management if appropriate, and definitely, includes follow up appointments to monitor the patient’s progress and level of control. As one can imagine, every patient is different and his or her needs are different depending on a variety of factors including cultural background, education, socio-economic status, religion, and genetics. As a FNP, I try to help my patients optimize their overall health status by working collaboratively with them and setting goals that are realistic and attainable.
In my practice at UCSF, I have my own panel of patients who are assigned to me as their primary care provider. In the Women’s Health Primary Care Practice, we have a mix of internal medicine physicians, family practice physicians, as well as adult and family nurse practitioners providing care to patients. We consult with each other and see each other’s patients as needed if the primary care provider is not available. Depending on the complexity of the patient’s health status, I also work and consult with various specialists in addressing the patient’s concerns and diagnoses that are beyond the scope of primary care.
[OnlineFNPPrograms.com] During your time as a Family Nurse Practitioner at the Chinese Hospital Association, you helped develop two patient programs, COPD Support Services and Teen Sensitive Services. Could you elaborate on these programs and their mission, how you got involved in these initiatives, and how you helped develop and implement them?
[Rebecca Lew, MS, FNP-BC, CDE] I started the Teen Sensitive Services with one of my colleagues, a Pediatrician specializing in Adolescent Medicine. The Chinese Hospital Association has several clinic locations. My Pediatrician colleague and I worked at separate locations and we both saw the need for access to sensitive services (reproductive health services) for teens in the San Francisco/peninsula region. Working as a high school nurse prior to starting my position at the Chinese Hospital, I understood the need for access to sensitive services, especially in the Sunset district of San Francisco, where our clinic was located. My colleague and I met with various school district nurses in the San Francisco Unified School District and discussed the needs of the teen students, as well as the services we would be able to offer to the teens. We developed a protocol and provided training for the staff of our clinics. Both my colleague and I communicated regularly with each other and the various individuals at the school sites to continually improve the program.
I developed the Chronic Obstructive Pulmonary Disease (COPD) Support Services protocol as a new program at the Chinese Hospital Support Services Clinic. We were already providing services including anticoagulation management (which requires monthly blood checks and medication adjustment for patients on Coumadin), as well as diabetes self-management education to patients within the Chinese Community Health Plan insurance network. COPD was identified as one of the most common diagnoses for admission and readmission to Chinese Hospital. One of the greatest needs that I was able to identify as a clinician serving this population was the lack of understanding on how to use inhalers properly and effectively. Gathering information from the most up to date guidelines, I created a protocol for COPD self-management, which included information on proper inhaler use, smoking cessation, nutrition, immunizations, exercise, as well as an action plan for patients who are decompensating from their disease process. After creating this protocol, I presented the program curriculum to an interdisciplinary committee, which included primary care providers, pulmonologists, and case managers. Once the protocol was finalized, we implemented the program within the support services clinic.
I am currently in discussion with a physician colleague within the Women’s Health Primary Care practice at UCSF to develop diabetes self-management group and individual counseling for our patients.
[OnlineFNPPrograms.com] You are also a Clinical Preceptor for nurse practitioner students at UCSF, as well as at the University of Miami and the University of San Francisco. Could you please explain what your responsibilities are as a clinical preceptor, and how you work with your students to develop an effective plan for professional growth and skill development?
[Rebecca Lew, MS, FNP-BC, CDE] As a clinical preceptor, my role is to help nurse practitioner students apply didactic information from the classroom into clinical practice. In the beginning of the preceptorship, students and I typically discuss their goals for the clinical period and we discuss various ways of achieving those goals. Throughout the clinical session, usually one to two trimesters, the students and I check in to make sure that they are achieving those goals. I give constant feedback as to where I feel students need to build more clinical knowledge, and also ask for feedback as to how I can be a better clinical preceptor for the student. One of the suggestions that I give students that worked well for me as a student was to pick one topic or develop one clinical question based on a case he/she saw that day. Knowing that students have a multitude of school and personal responsibilities, research on one topic/one clinical question is not difficult to complete. At the following clinical session, we discuss the topic in more detail.
[OnlineFNPPrograms.com] Why did you decide to become a Family Nurse Practitioner, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Rebecca Lew, MS, FNP-BC, CDE] As I alluded to in a previous question, I entered nursing school knowing that I wanted to become an advanced practice nurse, and specifically a Family Nurse Practitioner. I knew that I wanted to work in the community as a clinician, and the training to become an FNP gave me the capability to treat patients across the lifespan. From a practicality standpoint, the Family Nurse Practitioner specialty is also the broadest specialty, theoretically, increasing one’s employability.
With that said, I have not yet worked in a position as an FNP where I have been able to practice in the full scope of my training. In my current position, I see adults ages 18 and up, and I do not provide prenatal care, which is also apart of the FNP training. Ultimately, this detail did not deter me from taking my position, and it is up to the individual FNP how important it is to him/her whether they practice in the full scope of their training.
Working in Women’s Health Primary Care did not require me to do any sort of specialization. Most of the providers in our practice have a passion and strong interest in women’s health. My interest in women’s health issues started as a teen, so throughout my nursing career, I naturally gravitated towards opportunities working with women.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as a Family Nurse Practitioner? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Rebecca Lew, MS, FNP-BC, CDE] There are many rewarding aspects to working as a Family Nurse Practitioner. The long-term relationships that I build with patients is one the most treasured aspects of my job. When I provide education and counseling on lifestyle modifications and create goals with patients collaboratively, it is an incredibly rewarding feeling seeing patients slowly achieve these goals. I also love mentoring and training students and seeing them achieve success in their own professional lives.
It is an understatement to say that the role of an FNP is not a challenging one. Even if you do the best that you can as a provider, ultimately, there will be cases when untoward things happen to patients, or a patient’s disease process continues to decline. It can be a challenge professionally and personally to deal with these situations and to not think to yourself, “Was there something else I could have done?” It is important to seek out a strong support system to debrief about some of these challenges. One of my clinical instructors has become a close friend and mentor whom I often reach out to for advice and guidance. I also became close friends with four other nurse practitioners that I used to work with. We have dinner outings once every several months and debrief, laugh, and cry about our various professional and personal life experiences.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming family nurse practitioners, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Rebecca Lew, MS, FNP-BC, CDE] For current MSN students in a Family Nurse Practitioner program, my advice would be to study hard! There is a lot of clinical content to know, and although you will be learning a ton in your first position as an NP, it is important to have a solid foundation. If you intend to go into primary care, an additional EKG course can be helpful if you are not particularly comfortable reading electrocardiograms.
For prospective MSN students considering the FNP specialty, I advise you to seek out nurse practitioners. Speak to them in more depth about their roles and responsibilities, and see if their roles are in line with what you envision yourself doing professionally.
The field of nursing is an incredibly exciting one! As RNs you have the ability to jump from one specialty to another (i.e. med/surg, public health, oncology, etc). It is similar as an FNP. I have friends who are Family Nurse Practitioners in post-kidney transplant care, gastroenterology, obstetrics and gynecology, as well as primary care. It is important to have a solid clinical foundation and solid critical thinking skills, but ultimately, much of your role and responsibilities will be taught on the job. If you decide to specialize, or go into primary care, one of the most important considerations for yourself is, “What are you passionate about?” Find your passion! It makes going to work so much more enjoyable, and we as nurses are incredibly fortunate to have the flexibility to choose!
Thank you Ms. Lew for participating in our APRN career guide interview series!