Queen Essays

Transcription AA

Dr. Llalando Austin

Before we get started I want to tell you guys that I love an interactive audience ok so if I pose

questions to you feel free to raise your hands or provide feedback. I want to start by asking you

guys how many of you know or can tell me what the job description of an anesthesiologist

entails? Anyone in the audience? Usually the people in the front are the ones that are all over it

and the ones in the back are like I’m here for a reason. Well how about this gentleman back

here? Ok. Alright. Loosely. I’d say that I agree with you 100% but yes an anesthesiologist is

basically a physical. These are people that have gone to medical school, whether it is allopathic

or osteopathic in nature. The went to school for four years. Went further to complete their

residency in anesthesia to be licensed as anesthesiologists. By a raise of hands in here how many

of you have hear of a Certified Nurses Anesthetists, or a CRNA? Alright that’s most of you guys

I’d say, maybe about 50% of the class. Now here’s a big question, how many of you have heard

of an Anesthesiologist Assistant or an AA? Much greater than I anticipated. And we’ll get into

the difference between those three as we move forward but I want to start and open with

basically a little video for you guys.

VIDEO (2:14)

My toes are cold why can I feel them? When does the anesthesia kick in? Wait! Wait a minute!

That burns. Why am I feeling this? Check that out…omg what are you doing? Stop please! I can

feel that! This must have been done with a serrated knife. Stop please! The carver never used a

serrated knife before did he? Doesn’t he like precision? I told you she did this to herself. It looks

like she used a grapefruit knife. Who cares what it was, shit head?! Stop! I can feel it! I can feel

the pain! I can’t take it anymore. Stop please!

END VIDEO (4:15)

Alright. So an episode here of Nip/Tuck. How many of you can maybe point out some

things that you saw in this video just now. Anything you noticed-good or bad? Ok good. The

physicians or whomever these individuals were. Anything else? So this is an example clearly of

something that happens in anesthesia but it happens very infrequently…and that is awareness

under anesthesia. What you learn in a program such as this one is how to effectively manage

your patients in a perioperative environment alright?

Slide 1 [05:21]

So as we mentioned before there are three recognized anesthesia care providers and these

three anesthesia care providers are recognized by CMS for reimbursement purposes and also by

the federal government. The anesthesiologist was the first one I mentioned that individual who

had completed medical school and moved on to complete their residency. Anesthesiology

Assistant, however, which is this specific program, is an individual who has completed an

undergraduate degree, much like you all are doing right now, in some discipline. Now that

discipline doesn’t have to be any specified discipline. However, these individuals do need to go

back and complete the pre-med course work if they have not already done so. And what pre-med

course work am I speaking of? The same coursework that would be required to get into medical

school. So your chemistries, biologies, we’ll get into these as we move forward. And after you

meet the admissions requirements of getting an undergraduate degree, completing the pre-med

coursework, you then go on to anesthesia school which is approximately twenty-seven months of

duration depending on what school you attend. Nurse Anethetists, or Certified Registered Nurse

Anesthetist, I don’t’ know if that’s going to be a test question or not, hopefully if there’s a test

question it will be about AA specifically, CRNA on the contrast is an individual that has a

Bachelor of Science in Nursing, goes on to work in the field of nursing in critical care or at least

one year of critical care experience prior to applying to anesthesia school which is specific to

those individuals that have degrees. Same amount of duration, it’s about 27 or 28 months. Some

as high as 30 months or so but approximately the same. If at any point in time even during the

presentation feel free to ask away.

Slide 2 [07:26]

So an anesthesiologist, or you’ll hear the term ‘anesthesia care team’ and this team is a

model that we follow which basically means that to work in the anesthesia care team model,

there are all three of those anesthesia care providers that you just learned of, so an

anesthesiologist typically does the supervising. They’re usually supervising CRNAs or AA at

about 4 at a time. So you can see how this is a cost-effective practice, right? The cost that it

would take to hire one single anesthesiologist who can only work in one room at a time, for that

equivalent cost you can likely hire at least three CRNAs or AA which can obviously cover three

times the rooms.

Slide 3 [08:20]

But we work under the direction of the Anesthesiologist, meaning he’s our supervisor.

And I guarantee you if any of you guys have already or if you will, and hopefully you won’t, but

if you’re having some sort of surgical procedure or have, more than likely, I’d probably say

there’s about a 90% chance that your anesthesia was provided by a CRNA or an AA. Because

again, like I said, Anesthesiologists do mostly supervisory type work. Programs such as this one

will train you extensively in all things in the peri-operative realm inclusive of effective and

adequate monitoring of a patient during surgery. Well that face looks familiar. This is from an

older brochure, I don't know it looks like somebody knows what they’re doing maybe. But

currently there are a total of ten AA programs. Ten schools that have AA programs. Now I’ll tell

you that the AA concept originally began in the late 60’s and from that point until 2006, there

were only three schools. Since 2006 when Nova brought…err..the concept of a program at Nova.

From 2006 to today, an eight year span, there has been a 200% increase of growth in AA

programs. So currently there are ten AA schools. There are two that affiliated with the school

that I’m speaking to you from. Nova Southeastern University has their main campus in Ft.

Lauderdale and also where our original AA program was established. Then we also have this

program which is actually located in the Brandon/Tampa area. So there’s only two schools in

Florida, lucky for you there’s one that’s pretty much in your backyard. We have one school in

Connecticut, we have a school at the University of Colorado, there are two schools in Georgia;

Emory and South, there is one school in Missouri-University of Missouri Kansas City and a few

others. All ten of these schools are CAAHEP accredited programs and also accredited by a

subset of CAAHEP, which is the ARCAA or the Accreditation Review Committee for AA

programs. So our roles as anesthesia care providers is basically to manage a patient

perioperatively, which is surrounding the operative environment, perioperatively. So we will

obviously monitor patients preoperatively, entraoperatively, and postoperatively. Now I pose a

question to you or multiple questions. Anyone tell me maybe what an anesthesia care provider or

an AA do in a preoperative realm? One back here-I love the back. Ok absolutely. We want to

assess when the patient last had something to eat. Do you know why that may be important? No?

Ok absolutely…anything in the stomach can obviously come out of the stomach and there are a

number of reasons why that may happen. There was one comment back here as well. Say that

again? Mmkay. So we definitely in the preop environment we will assess multiple things that

will delineate exactly how much anesthesia we can give to a patient. So we want to know the

patient’s height, weight, how sick they are, how healthy they are, to know if they have any

allergies, which would obviously forbid us from using certain types of drugs and anesthetics. The

patient has an IV placed usually we conduct the preop interview which gives us all of this

information. Alright. Anyone have any idea of what we would di intra operatively? Which is

during the procedure? This side of the room? Ok so you’re monitoring the amount of anesthesia

a patient is receiving and you’re also monitoring a number of other things. Vital signs tells us

everything we need to know about the patient. And I think you had a comment. Same thing.

Right. Very good. And there’s a number of things obviously that can point us in the direction of

whether that patient is having some discomfort or not. Postoperatively. What we do as anesthesia

care providers post-operatively, after surgery. Pain management is a big one. So yes the residual

anesthetic, whatever it may be, needs to be eliminated from their system via some means. And

this depends on how we give it to them. If we give them an IV drip, then it just has to be

redistributed. If they get it in a gas, then we eliminate it the same way we gave it to them via

them breathing it in they need to expire it out. And that is approximated by many things. For

instance, that individuals’ respiratory rate. So you guys seem to have a pretty good understanding

so far of what things would be expected in these various phases. Now the intraoperative phases

has three phases itself. There is induction, there is maintenance and there is emergence. And this

usually you’ll hear some people describe this as like flying a plane. So there’s a takeoff where

it’s a lot of busy work, usually. And then when you reach altitude, or the maintenance phase, and

if everything goes well we do absolutely well….we do minimal to our patients. We monitor our

patients and if you’re perfect we’re on cruise control. Then there’s the landing for us, which is

emergence, or waking the patient up from anesthesia. And much of our titration and control of

many of the things we use in anesthesia, you will really see requires art. Similar art that you

would expect to see while flying a plane

Slide 4 Video Two [02:37]

So where do we work? As AAs we can work basically anywhere in the hospital. Anywhere and

everywhere. And you’ll find that this is one fo the areas in anesthesia that I feel that is maybe

one of my preferred options or areas is that I can come in to work, do pediatrics one day I can do

cardiac case one day, neurosurgery another day…and even if you work in the same area of

anesthesia or surgery, no two patients are alike. So that, in and of itself, mandates, you treat each

patient with their own individual considerations. So that is one of the benefits and things that I

loe so much about my job is that there’s so much variety. It’s not like a call center, it’s not like I

can establish a routine of everything I’m going to do with my day because that can easily be

thrown off by one or two different things. Areas that we can work in: general surgery, pediatrics.

General surgery is going to be like if a patient comes in to have their gallbladder or appendix

removed or any type of laparoscopy or something of that nature. Pediatrics are kids. Anything 18

and under is a kid. SO some of them are really big. Obstetrics and Gynecology, you can also

work in open heart surgical procedures, ENT procedures which is otolaryngology, and

neurosurgery which would be inclusive of spine procedures and anything to do with the brain or

skull for various reasons, maybe tumor, bleeding, further, we can work in orthopedics which is a

very popular area of anesthesia because you get to do a lot of different things. Not only do you

get to provide general anesthesia, which is what you guys generally think of when you think

about anesthesia: put the patient to sleep, wake the patient up, and take them to recovery. But in

this area, you can also do peripheral nerve blocks which is just numbing one extremity or

specified body parts. We can do epidurals, we can do spinals. All of that would be taught in a

program like this one. And actually for the past three weeks we’ve been teaching our current first

year students neuraxial anesthesia which are epidurals and spinals and they’ve already gone into

clinical rotation and had the opportunity to do them so they’re leaning very quickly. General

ophthalmology are your general eye procedures, vascular surgery, thoracic surgery. I love

thoracic surgery and after I finished anesthesia school this was pretty much my specialty.

Thoracic and neuro surgery. Which I like is because there was this ability for us to use this

specific airway adjunct which allowed us to ventilate only one lung while not ventilating the

other so that the surgeon can work on the lung that we’re not ventilating and we can still breathe

for the patient with one lung so this is very exciting stuff. Transplants, trauma, you name it.

Pretty much anything that comes into the ER, at some point, if it’s severe enough, probably will

be required to come to the operating room. OK if it’s a car accident, or someone’s shot or

someone’s stabbed or any of these things

Slide 5 VIDEO TWO [06:13]

So as I mentioned before the requirements for our program are that tyou have a

bachelor’s degree. And this bachelor’s degree is not a specified concentration as I mentioned. It

can be in anything. Food Science. Engineering. Biology…any of these things. However,

regardless of your undergraduate degree, you need the necessary pre-med prereqs. And here they

all are. These are our required pre-reqs, but in additional to the required prereqs, we have

recommended. GRE, well if you’ve been on top of it you’ll know that the formatting for the

grading of the GRE has changed, so therefore you need an approximate score of 310-somewhere

in there is going to be a competitive score or you can take the MCAT. Either one of these exams

you definitely have to take. Oftentimes I get the question of which one should I take? Well that’s

an easy question-if you have a remote interest in going to medical school, take the MCAT. If you

do not, then I would spare myself all the stress and I would take the GRE.

Slide 6 VIDEO TWO [07:43]

You’ll find that all of their varied backgrounds. These are usually or typically the most

popular degrees of people that apply to our program have. And the reason is that many

individuals that apply to our programs were those that maybe at one time considered anesthesia

school and then they kind of looked at things and said you know status of healthcare today and

eight years of school and who knows how much debt and twenty-seven months and you

know…salaries as they are I think it’s a better choice to go to anesthesia school. Me it was

exactly the same. I had no knowledge of what an AA was and I worked in health care and I was a

respiratory therapist. I worked at the time at University Community Hospital right up the street,

now it’s Florida Hospital Tampa and I still work there I just work in Anesthesia. But you know I

was working and getting ready to apply to medical school and completed all of my prerequisites

and then a fellow RT who I was working with came past this information that there was some

new program in Florida, I’m going to check it out-why don’t you do the same thing? So I did and

the minute that this was offered to me, I decided that I wasn’t even going to fill out an

application to medical school. I’m going to do this. So you can see many individuals have that

same sort of entry to the AA profession. Sometimes we receive individuals or applicants that

have some sort of clinical or healthcare experience. Is it required? No. But I’m going to tell you

right now that the current class of first year students that we have, none of them have clinical

experience. They’re a relatively young group, most of them right out of undergrad. If you

contrast them to maybe the class that I was in when the program at NSU was established I’d say

about 40% of us had healthcare experience. Three of us were Respiratory Therapists, we had a

physical therapist, physician assistant, nurse practitioner, we had a guy that went to medical

school but didn’t complete his anesthesia residency in the allotted time, we had some other

individuals with healthcare experience as well. So these are just some of the healthcare clinical

work that you will see that maybe some of our students will present with.

Slide 8VIDEO TWO [10:12]

Now our curriculum and our program itself is a 27 month program which basically broken into

largely two units. The first year where you’re learning most of your didactic, very little clinical.

Second year is where there is heavy emphasis on clinical training and almost no didactic training

at that point. In the second year students are on clinical rotations 40-50 hours per week learning

various ways of practicing different types of anesthesia. This is just an example of one semester.

I like the sigh. The timing was impeccable. This is just an example of one semester. This being

the second semester. So we admit students annual and we admit them so they start the end of

May or the beginning of June and they run for twenty-seven consecutive months. Semester two

starts in September. All the courses you see in the darker writing is basically what you’d see as a

first year students. So for any student that started in June and this is thei second semester. They

would be taking these courses, the darker courses. Now I put other courses up here, the lighter

ones, like Anesthesia 3 because you’ll see that our second year students are in full time clinical

rotations and you can see the difference in the load there. Now I will tell you again, these

studnets are doing 40-50 hours a week with clinical rotations and when they come out they’re

really sharp anesthesia care providers. So anesthesia lab this is basically where we expose our

studnets to a siginicant amount of high fidelity simulation training. As Dr. Cooperman had

mentioned, if you came to our actualy campus, you will find that we heavily utilized high fidelity

simulation training. Now who knows what high fidelity means? Someone knows. This guy?

Very precise. That’s a very good definition, gery accurate too. So I’d so that basically it’s

representative of simulation materials that very, very closely mimic what would be expected in a

real situation. So these simulation mannequins breath, they blink, talk, scream, cry, they respond

to the anesthesia drugs that we give exactly as you would expect to see in a real patient. Very,

very interesting to see. And I think the first time you see it it might be a little shocking especially

considering we have a pediatric mannequin too and he looks a little scary but he does all the

same thing. He responds exactly as a kid would that you’d provide anesthesia for that kid. So

anesthesia lab is where we’re learning all of these things. We use a lot of high-fidelity

simulation. We also utilize a lot of task trainers. Or things specific for a certain type of airway, or

not airway, but anesthesia process. Applied physiology for anesthesia practice is very close to the

physiology that you guys might take like if you’re taking it in a combination with anatomy and

physiology. It’s physiology but it’s set to the specific practice of anesthesia so how would we

apply that in anesthesia. Pharmacology for anesthesia practice is an example of a course in which

you learn all of the drugs. And there are a ton of drugs to use in anesthesia. We’re probably the

specialty that utilizes the most varied application of drugs. So for instance we’re the only

specialty that utilizes the volatile agents, or the inhalations, or the gases that we use to keep you

asleep. And then then there’s that we use to render one unconscious that we call induction

agents, there’s muscle relaxants which obviously paralyze a patient, there’s narcotics an

obviously analgesics and multiple types of drugs, classes of drugs and things you use in that

course. Principles of instrumentation and monitoring will be a course in which you learn about

an anesthesia machine, you learn about various monitors that we utilize to monitor the patient

perioperatively. Principles of Airway Management is one of the courses that I teach and this is

basically the bread and butter of the anesthesia care provider. We’re considered airway experts

and this is where you learn how to asses one’s airway and how to place airway adjuncts. For

instance that one device I mentioned about isolating one lung and breathing independently of

each other, this is the course where you learn that. Intubation, which is the process of passing an

endotracheal tube into one’s trachea. Writing for medical publication, we’re the only anesthesia

AA program that offers these writing courses. And we do that because we don’t’ just like to

prepare competent anesthesia care providers, but we like to prepare leaders and so therefore we

like to apply that knowledge and ability to publish documents, poster presentations, speaking,

lectures, and things like that. And finally Principles of Life Support which is something that

occurs in the semester it’s where you’re going to take your basic cardiac life support, advanced

cardiac life support and also your pediatric advanced life support as well. You can tell this

semester is intense because it took about ten minutes for me to speak off of that one slide.

Slide 9 VIDEO THREE [00:00] Clinical rotations, you know I mentioned that in the first semester there’s no clinical rotations.

First semester, you’re inundated with high-fidelity simulation training in the lab. Second

semester, the same thing maybe just a little bit of growth. You grow from semester one to

semester two. Again, this is going to occur in the lab. And semester three is where you being to

have some clinical training. And we easer our students into clinical. Maybe about two to three

days per week so they can make that adjustment affectively. So the first year you can anticipate

that at minimum you will get about 300 clinical hours. Most of our students have about 350 or

so, first year. IN the second year, full time clinical rotations, but the minimum is at 1700 hours.

Most of our students probably do 1900-2000 hours in that second year. And if you combine the

two there’s a minimum of 2000 hours that you need to successfully finish and none of our

studnets have any issues with that. And in the lab there are about 382 hours of laboratory

teaching as well. So if you did attend our campus, and I would recommend that you did. First,

you may see myself or one of my faculty members. You may see this gentleman here, Mr. Eric

DeRise. But another thing that you’d see is both of our fully functional operating rooms that we

have. So if you’ve gone into an operating room or if you’ve done some shadowing in an

operating room you kind of get a layout of the land, and what you’ll find on our campus is very

very close to what you would expect to see in a real operating room. So surgical lights,

everyone’s wearing the attire, the blue, the masks, and everything of that nature, we have a

patient on an OR table we have an anesthesia machine which is always on the anesthetists right,

we have an anesthesia cart which is always behind the anesthetist which is where you would

obtain all of your drugs and tools and things you would need in anesthesia.

Slide 10 VIDEO THREE [02:28]

We are the largest on the east coast. Largest of any AA program as far as our functioning

operating rooms. We also have a designated pre-ope and post-op area. So this is where we’d

learn those things in a pre-op interview and managing a patient after surgery as well. Where we

would do that is our pre-op or PACU, and modified ICU

Slide 11 VIDEO THREE [03:08]

First on our campus, you’ll see that we have, Nova Southeastern University has a total of

five adults, 2 pediatric, and two infant high fidelity simulation mannequins. On our campus we

have two adults, one pediatric, and one infant. So on the main campus they have approximately

the same equipment that we do. That right there is just a picture of the pediatric. He actually

doesn’t look that scary right there.

Slide 12 VIDEO THREE [03:38]

So how much can one expect to make completeing a program such as this one. Getting out

there…you’re first job, how much can you expect to make. Well pretty much in anesthesia

wherever you work, you’re going to make a significantly large amount of money which should

be considered, but not the heaviest consideration. Salries range foerm about 120,000 to about

180,000 or so but you will find that on average coming right out of school you can expect to

make anywhere from 120,000-160,000 starting out. Alright? As a starting salary. In addition to

that you expect a lot of flexibility in your schedule. You can see why this becomes a little more

favorable than medical school. You’re going to have a high salary and then you’re going to have

lucury in the flexibility of your schedule. You don’t have to take calls is you don’t want to. If

you want extra money you can work and take calls and things like that. You can work ten hour

shifts, eight hour shifts, whatever. I’ll tell you when I graduated, the year that I finished. I

worked over at the hospital in Clearwater at Morton-Plant, and I worked three 13.5 hour shifts.

So I worked three days and I was off, that was it. I worked 40. 5 hours per week making these

types of salaries. If you wanted to you could work an entire separate job if you wanted to to

supplement that. SO very important points. Right now I’m the director of the anesthesia program

in Tampa, so limited clinical ability, but I still do work clinically. But basically I’m an

independent contract with the hospitals. SO I make my own hours and my own schedule. I work

when I feel like going in to the hospital. Average job offers that you can expect to have right out

of school are largery going to be depend on your clinical abilities. When you’re on that second

year and you’re completing you’re clinical rotations, that’s where these anesthesia groups are

looking at you to see if you’d be a good fit with their group ad also a good opportunity for you to

see if you want to work for that hospital or that anesthesia group. But approximately three to four

offers right out of school. So no problems getting a job, and when you get a job there’s definetly

going to be a pretty satisfying salary to accompany that. Currently, all of our students that

graduate from our program they all get jobs. A really, really solid point to consider for our

program is that as licensed practitioners you have to take that board exam and you have to retake

that board exam every six years. That face was priceless! So actually I have to take my

recertification exam this year in June, so I’ve been preparing for that. But we have 100% first

time pass rate. The first time our students take the exam, 100% of them pass. Last year-100%.

The year before that-100%. This year, our students haven’t taken their exam yet they take it in

June. But with the tools we utilize and the practices we use to prepare them, I anticipate that

100% will pass, which basically means you’re going to pass your certification exams, you’re

going to get a job, and you’re going to get paid well. Ok well Anesthesiologist Assistant’s

currently work currently in 18 states. And we work in these states either by delegatory authority

which is under the license of the supervising anesthesiologist, or by regulatory authority which is

by licensure. In Florida you have to have a license from the board of medicine to practice. So

therefore it depends on where you’re transitioning to or moving to…you may have to apply for a

separate license if you move to Georgia for instance.

Slide 13 Video Three [08:15]

So what about the future of anesthesia? Well there is a shortage of anesthesia care providers and

that’s not anticipated to change very much in the coming years. Therefore, our program remains

extremely competitive, about as competitive as medical school is for obvious reasons. But the

demand will continue to increase and that means more highly skilled anesthesia providers and

that means more AA’s. Any questions? We have a question right here. Dropout rate of the

program. Very small. We only take 30 students a year in Tampa. Ft. Lauderdale accepts 45

students per year. Now, with 30 students per year and if 3 of them left, there goes 10% attrition

right there. Usually what we’ll find is that we’ll lose one or two students. But the bigger reason is

why. And I’ll first one of the major reasons for that is that the individual kind of stumbled across

this and didn’t’ really know what they were getting into and then they get into the operating

room and they’re like whoa and then they get adjusted to this or attempt to get adjusted to the

course load and they decide that this is not what they want to do. And then individuals

sometimes have health reasons or family reasons. The important thing is that it’s not due to

failure of getting through the program and I think that is largely due to the help and assistance

that is provided by the faculty and program itself. We do an extended amount of work so that

even if we see that a student is having difficulty in a certain area, we jump all over it extremely

quickly and help them and hope they graduate and do well. Other question? Ok. Very good

question. And this gentleman right here knows more about the specifics of the applications, but

I’m going to say right now about two hundred applicants. And our application window itself

opens on July 15th of one year and runs all the way until March 15th of the subsequent year. And

we usually have our interviews from about October to March. Any other questions? It is

extremely rigorous and I would liken that to medical school. Could one work through medical

school? Probably. Is it wise to do so? Probably not. Most of our students, all of our students, we

tell them you can’t basically maintain a job…it is extremely difficult and this can be a tough

program if you make it that way by doing too many things at one time. Question back here?

Minimum GPA if you open up that brochure it says 2.75. However, that is not competitive, so go

with that. What’s the recommended? It varies. Clearly if you don’t have a 2.75 your application

won’t even be received by what we like to see is maybe around a 3.2 or 3.3 at least, you’ll see

that some come in with 3.8, 3.9. or 3.7 and some of them 3.1 Does it mean you won’t get called

in for an interview if you don’t have a 3.1?No it doesn’t mean that because we don’t at one

specific thing when we look at applications, we look at the all-encompassing application

package. So understand we look at other areas too. Question in the back? Very good question.

Short answer to the question is yes. Now, the bigger and better question is who has to pay for it?

Well if you’re working for an anesthesia group they pay for it, you don’t have to pay for it. Even

if you did have to pay for it, it’s not that much. It’s like $2,000 a year or something like that, it’s

not that much, but you don’t have to pay for it. I think it would depend on the other components

of your application. For instance, if your GPA is a 2.9 and you didn’t’ have all three of the letters

of recommendation that we require and your GRE score was a little low, but you had some

clinical experience, you can see how we kind of have to asses these from multiple angles and just

not looking at specifically one thing. But it does look good because it means that you’ve

interacted with patients before and that means something. I’ll say too that starting out in

Anesthesia school as a respiratory therapist. First semester we’re taking Principles of Airway

Management and I’m thinking to myself man this course is extremely easy, why am I taking this

course? Because it was everything I was already expected to know as a respiratory therapist but

building on top of it. So I kind of felt like I started out with maybe a slight advantage over other

classmates of mine that didn’t have healthcare experience. But I’ll tell you that the program does

a great job of taking individuals of varied backgrounds through the program so they collectively

end up right on par with each other when we’re graduated. So that’s what I think is important.

What type of personality do we look for? There’s no one size fits all rule. It’s just that we can

gauge the ability to do certain things in the interview and through our questions but I think one of

the core qualities that I look for in the applicants is hard work, willingness to work hard, and I

think that if you have that even if you don’t gain concepts as easily as others, you’ll make it

through and you’ll be fine because you’ll work harder than you need to. And that’s one of the

things I appreciate in applicants. And that’s just me. Tuition for our program is about $35,00 a

year, so for two years. And of course there is an expense you can add to that for books and

housing but I myself as an anesthesia student took out loans only for what I needed. I did some

work as an RT on the weekends I know it’s not recommended. Because if you violate everything

you’re not supposed to do, you’ll be the director of these programs, so that’s a lesson learned.

You had a question? A lot of people do. A lot of nurses before they went into nursing school

couldn’t stand the sight of blood. A lot of physicians who were, I sometimes go into work and

there’s some medical students there and he falls and someone has to catch him and take him out

of the room because he’s fainted in the operating room. So many people start there but as you get

exposed to certain things, I think that’s where everything kind of takes care of itself so it’s

something that you might be concerned about but if you gain that experience and gain that

confidence and see these things on a daily basis, you know someone’s chest wide open,

someone’s head open or face in half of something of that nature then it doesn’t bother you. It

doesn’t bother me. In that second year you will have some online requirements but not very

extensive. Why is it only in 18 states? There’s’ a lot of politics involved in anesthesia in general.

And it is such that…of course our ultimate goal is to be in all 50 states but we’re only recognized

as an anesthesia care provider in certain state. And I think the better and more important question

is that if you want to see growth in all 50 states, what does growth look like so far? Well, when I

was, well prior to be being a student in anesthesia school, I think there were probably ten states

at the time. And you know that span of difference between eight years there has been 8 states

that have been opened resulting from opening more schools and making more individuals

knowledgeable about what we do, that sort of thing. There’s also you know the political aspect of

how we’re viewed in the eyes of the CNAs, these sorts of things. There are a lot of politics and I

definitely advise you to make yourself knowledgeable of these things before you go into a

program such as this one. But they exist, there’s politics in every profession. Question? My

personal opinion. I’m through the roof, I love what I do. I couldn’t imagine doing anything else

and that is the reason why I’m teaching and working to assist others with the transition that I

made. This thing is something like a piece of gold hidden under a chair-nobody is going to

recognize it. Nobody knows what an AA is. It takes going to discussions and lectures to figure

out hey this thing even exists. So I feel it’s my duty to assist in making you guys knowledgeable.

I wouldn’t change one thing about it. I graduated. I was. I thought I was doing pretty well as a

respiratory therapist. You know I was working three days a week, happy with what I did, made

pretty good money, then I finished anesthesia school in my twenties and making this kind of

salaries and working the way I want to work and it’s just like man this is really really nice> The

variety, I love the patients…you get to do everything! Since working in obstetrics, place a spinal

in a young lady whos having pain so that she’s numb form the waist down so she can proceed to

having her kid or c-section or maybe place an epidural so she can give labor to her baby. These

things are very rewarding to see that you assisted this young woman and how difficult it would

be and how much pain would she be in in this process> So it’s very rewarding. I want to call up

Mr. Eric Derise and I’ll answer your question too. Training. Training in that they pretty much

supervise while we work in the operating room and take care of the patient. Now can an

anesthesiologist do that? Absolutley. Do they do that in some places? Absolutely. But most

places adopt that anesthesia care team as I mentioned.

Nursing, Dr. Poff

Hello I’m Dr. Poff from the College of Nursing and we’re here to share with you information

about our discipline, give you some ideas about options that you may have. I’m going to share a

little bit about the history of nursing, the educational process of nursing, and some of the history

of the education process. Our mission in the College of Nursing is healthcare transforming lives,

creating the nursing leaders of tomorrow, and the research that improves health. We are located

on the Northwest side of campus if you haven’t visited us yet. We’ve got a beautiful building

with 75,000 square feet, we’ve got a state of the art simulation center, we’ve got state of the art

classrooms, we’ve got bio behavioral lab for research. So it’s an incredibly dynamic place and I

encourage all of you to stop by and check us out.

Slide 1 [01:07]

So according to the American Nurses Association, nursing is the protection, promotion,

and optimization of health and abilities. It’s the prevention of illness and injury. It’s the

alleviation of suffering through the diagnosis and treatment of human response and it’s advocacy

in the care of individuals, families, communities, and populations. So you can see this definition

includes quite a bit of information. We are promoting health, so when we look at the concept of

health we’re looking at someone’s health; they’re physiology, their psychology, their family

relationships, and their culture. So we define health very broadly and we learn about health from

all of those perspectives. We’re interested in the prevention of illness and injury so we do treat

people who have disease processes and we help to manage their help but we’re always thinking

about preventing the disease process and if they do develop the disease process, how to help

them live with it. We work with the alleviation of suffering through the diagnosis and treatment

of the human response. So as nurses, we are aware of a human’s experience, their development,

their goals, their responsibilities, we study their experiences of their health and with that

information we are diagnosis or identifying how we can assist and guide them through their

health condition. So that’s an essential part of what we do as nurses and how we’re educated.

And because of all of that wonderful knowledge and experience we have, we’re advocates. And

we advocate for communities, families, individuals, and populations. So when you think of

nursing, a lot of people think about clinical roles and we work directly with them in the hospital

settings, we’re with them for 8 or 12 hours and we’re communicating their health status to the

rest of the team on a very regular basis. We’re advocating for their needs, we make

recommendations or referrals. But in addition to that, nurses advocate on health policy levels.

We have people working in very high levels of health administration and leadership to be able to

advocate for the needs of people based on that grounded experience of our disciplinary

perspective.

Slide 2 [03:32]

We have a very rich history. So when you get into the history of nursing, you’re looking at a

profession that is really an ancient tradition. Health care has always taken place. There’s always

been care of the sick that’s often been done by families at the bedside. And then there was some

organization of that in the military and religious orders. So I think that people who love and

fought for what they love, thought about what they could do to help people when they were sick.

So military and religious orders would provide care to the ill. And then in 1860, Florence

Nightengale was really a revolutionary in modernizing nursing. She was a British woman from a

wealthy family who really went against her families’ desires for her life to study to be a nurse.

She systematically observed the patient she was caring for in the Crimean War and those

observations were sort of the foundation for modern nursing. And she advocated for nurses to be

educated in both theory and practice. United States Nursing developed in 1872. We had our first

3 schools of nursing in New York, New England, and Boston. And in 1923 there was the

Goldmark Report which stated what the content of nursing education should be. And in 1924

Yale opened its first nursing school that had its own budget and its’ own department. In 1934

there was a doctorate degree for nursing at New York University. A PhD is the highest academic

degree amongst disciplines. And then in 1965, the American Nursing Association issued a

position paper advocating the BSN degree as the minimum education preparation for nursing

practice. We do still have other options for nursing education. But we’re moving it, and there is a

mandate to move it into the Baccalaureate preparation. In 2010, the Institute of Medicine of has

made a statement about nursing saying that nurses should practices to the full extent of their level

and training, nurses should receive higher levels of education and training through an improved

education system that promotes seamless academic progression. Nurses should be partners with

physicians and other health professionals in redesigning the United States’ Healthcare system.

And nursing is an affective workforce for planning and policy making. So that’s coming from

our disciplinary peer in medicine. The Institute of Medicine is making statements about nursing.

And nursing education programs are responding to that need so we are constantly revising and

improving our systems to help our students become life-long learnings and advance in their

medical options

Slide 3 [06:42]

Now I want to share a little bit about nursing roles

VIDEO

What is it? It’s you. Ok Emma I know it’s now your favorite but it’s time for your medicine, ok?

One, two, three. Emma Emma bo Bemma banana fanna fo femma, fi fo fo femma, emma. How

do you feel sweetie? Good. You did a really good job, ok?

END VIDEO

So that’s a great example, it gives you a picture of a male, whose not typically association with

nursing, but we have a large number of males coming into the discipline. And you see the nurse

looks like he’s doing something very simple there. But actually requires a lot of knowledge in

terms of that child’s developmental needs, he’s aware of the diagnosis, he’s aware of her

medication regimen, he’s aware of her needs during her hospital stay, and he’s part of her

professional team, but he didn’t just go in and give her the drug, he did it in a way that was

engaging and connecting with the patient. And it was a nice example of how we’re educated to

provide care. You can see here that nursing has many roles. We work in acute care settings,

ambulatory outpatient clinic settings and health departments, we work with pediatric and

geriatric patients so patients across the life span. And then nursing also has scopes and standards

of practice for the discipline, but there are also scopes and standards of practice with different

specialties. So if you go into nursing for your undergraduate degree, you get an exposure to a

variety of areas of the lifespan of health delivery, but you can specialize and there’s a scope and

standard and there’s certification so you can be recognized as an expert in different areas of

nursing. We’ve got some examples here of corrections nursing, so that’s forensics,

cardiovascular nursing, nursing informatics, hospice and palliative care, and addictions nursing.

So those are just a few examples in which you can specialize within your undergraduate degree,

or the bachelor’s degree. But core to that, you are a life-long learner and by nature,

interdisciplinary. You work with a health care team and we establish leadership capacity in our

management of patients individually and in our advocacy roles. So you get all of that in your

education in the process of becoming a nurse. So a lot of people want to know how much am I

going to make. Well, nurses actually do quite well.

Slide 4 [09:21]

We have approximately 3.1 million nurses practicing in the United States. The good news

for you is the median age is 46 and more than 50% are near retirement, so we need nurses to

come into the healthcare system. This graph is basically showing you the supply of nurses until

2020 and the demand is going up so there’s going to always be a need for nurses. And the

median salary of a nurse in Florida is $64,000 a year. So those are the awesome opportunities

you have with a Bachelor’s degree in nursing. To specialize, to make good money, to be in

demand, but that’s not all. You can continue on.

Slide 5 VIDEO ONE [10:10]

There are advanced education options clinically. The Master’s Level Nurse Practitioner.

Nurse Practitioner graduates have the knowledge, skills, and abilities necessary for independent

clinical practice. NP core competencies are acquired through mentored patient care experiences

with an emphasis on independent and interprofessional practice. And the different roles within

advance practice nursing are a certified nurse practitioner, a certified nurse midwife who helps

people through pregnancy and delivery, and certified nurse anesthetist and certified nurse

specialist. And we also have advanced clinical roles at the doctoral level which I’ll talk about in

a little bit. So what do advance practice nurses do? I’ll show you another little clip from the

American Association of Nurse Practitioners

VIDEO

Nurse Practitioners are leading the charge for providing quality healthcare for America.

With advanced degrees in primary, acute, and specialty care, nurse practitioners are at the

forefront of our healthcare future. NP’s lead the way in diagnosing, ordering and evaluating tests,

prescribing, treating, and educating patients nation-wide. I’m one of the millions that choose

nurse practitioners as my primary care provider. Nurse Practitioners are patient-centered,

accessible, and high quality health care.

END VIDEO

So advanced practice education builds on our incompetency. But we learn patient care at

the bedside, working with the interprofessional team, and then we grow in our autonomous

decision making for patients

Slide 6 VIDEO ONE [11:48]

And we’re educationally prepared to assume responsibility and accountability for assessment,

diagnosis, and management of a patient health status including prescription of pharmacologic

and non-pharmacologic interventions. SO we work with medications to prevent and manage

disease processes and we also are educated to do a lot of behavioral counseling as well as

referrals for non-pharmacological interventions

Slide 7 VIDEO ONE [12:24]

So nurse practitioners…this is 2013 data, we’ve actually grown in numbers since then.

We have 171, 000 nurse practitioners. Certified Nurse Midwives about 13,000, Certified

Registered Nurse Anesthetist who provide care for patients during surgery and provided pain

management and anesthesia, 47,000. 87.2% of Nurse Practitioners are prepared in primary care

and 84.9% of Nurse Practitioners see patients and are reimbursed by Medicare and Medicaid.

And then 44.8% of Nurse Practitioners hold hospital privileges. And then this gives you some

information about some different areas of practice that Nurse practitioners Provide Care in.

Acute Care where they’re managing patients in the hospital setting, adult and family

Practitioners care for patients frequently in the ambulatory care setting as well as primary care

and gerontology. Oncology, working with cancer management. Pediatric primary care. We have

psychiatric/mental health Nurse Practitioners who work in a role where they’re providing

psycho- pharmacologic agents for patients who have psychiatric conditions as well as educating

to providing therapy and counseling and women’s health nurse practitioners provide care for

women specifically.

Slide 8 VIDEO ONE [13:40]

Vital statistics in terms of income-we have CRNA’s who tend to make about $159,000,

CNMs-$90,000, CNS, or those that work within clinical research roles in institutions usually

make about $67,000, CNPs- $96,000. And again this is 2013 data so it’s gone up a little bit since

last year. So not only can you become a bachelor’s prepared nurse, become certified in a

specialty, make a good living, go on to become a nurse practitioner, grow in your skills and

diagnostics, diagnostic reasoning, and autonomy with patient management, make more money.

We also have the doctoral level of education. We have two doctoral degree options. The Doctor

of Philosophy is the PhD degree and it represents the highest level of formal education for a

career in research and the scholarship in discovery. PhD graduates develop the science of the

profession, the steward the profession and educate the next generation of nurses. It defines the

discipline’s uniqueness and maintains professional integrity. In the academic setting the PhD is

the highest level you can obtain within a discipline. So within the university, there are PhD

degrees available to many disciplines, but nursing has a PhD and has had one since the 1920’s.

The DNP option. The Master’s preparation is a very intensive preparation and it does have

people have an understanding of scholarship as well as clinical practice. And there was a

recognition from other disciplines that the number of credit hours that a nurse was taking to get a

master’s degree was equivalent to a doctoral degree. And nursing, in accord with other clinical

disciplines such as medicine, pharmacy, psychology, physical therapy, audiologoy, those are all

disciplines that have clinical doctors. And so nursing has developed this clinical doctorate

option. And it’s also a terminal degree in the discipline and offers an alternative to a research

focused degree. So instead of new knowledge development, the DNP involves nurses who are

implemented the sciences developed by PhD prepared researchers. And they often work with

health outcomes, quality improvement, and health care delivery. There are clinical residencies in

specialty areas of practice in addition to the master’s level education in addition to policies and

health care leadership policy improvement. So this gives you an example of some leadership

roles in nursing.

Slide 9 VIDEO ONE [16:42]

This just shows a diversity of different people that are in leadership. I’m going to point

out a few of them. Here, this woman is a nurse in the Center for Medicare/Medicaid services, this

is a group that’s responsible for managing a $180 billion dollar budget. It insures healthcare

coverage for 100 million Americans. It has ten regional offices and over 4,000 employees

nationwide. CMS administers Medicare, provider’s funds and guidance to all states for the

Medicaid and children’s health insurance. And now with the passage of the Affordable Care Act

in March of 2010, CMS is responsible for implementing insurance reforms in the exchange

programs. Linda Aikens, here, she’s is the director for the Center of Outcomes and Health Policy

Research. She has conducted research on the healthcare workforce and the quality of healthcare

in the United States and globally. She’s recognized internationally with 12 Europeans Countries,

China, and South Africa, for her leadership and utilizing performance measures to demonstrate

the relationships between nursing care and patient outcomes. She’s basically shown data that

baccalaureate prepared nurses have patients with less morbidity and mortality and higher patient

satisfaction and outcomes. Courtney Liter is a Dean at UCLA School of nursing. He’s a

professor of nursing, medicine, and public health, and the director at UCLA Patient Safety

Institute and the Assistant Director of the UCLA Health Team. He’s an international expert in

gerontology. His clinical research is based on chronic care issues affecting older adults. He’s

recently served as the lead investigator for Pressure Ulcer Incidents and Prevalence in US

Hospitals. This work is associated with the US government’s decision to stop paying for hospital

acquired pressure sores. So we have patients who are immobile and they have issues with skin

integrity that lead to some pretty severe complications. And so his work is working to prevent

that and minimize those risks. And then Beverly Malone is a former dean who also worked in the

Clinton Presidential Administration. She’s currently the CEO at the NLN, the National League

of Nursing, and one of two national accrediting bodies for schools of nursing. So you can see

that we have leadership roles that are beyond the clinical practice scope and that they are

working at pretty high levels of policy, administration, and research and knowledge

devleopment.

Slide 10 VIDEO TWO[01:47]

(No spoken words)

Slide 11 VIDEO TWO [01:53]

So I’m going to share a little bit now about my experience becoming a nurse practitioner.

I kind of put this in the perspective of where you guys and what your thoughts are about moving

forward. So I want to share a little about my experience. I was in Health Occupations Students of

America in High School. My mom was a nurse. I loved to hear her stories about nursing. It was

just kind of all a part about my identity and who I was. Now I wasn’t completely sure I was

going to be a nurse, but I knew something in healthcare was my goal. I did Health Occupation

Students of America in high school and I just kind of started school knowing, getting into

college, I wanted to get into something in health sciences. I pretty much declared my major in

my freshman year.

Slide 12 VIDEO TWO [02:40]

I went on and got my Bachelor’s degree in nursing from Florida State University and

then my masters here at USF, so I’m a bulls nurse. And then I finished a doctorate at the

University of Central Florida in Orlando.

Slide 13 VIDEO TWO [02:58]

My early career was in rehabilitation nursing so I helped patients who had experience

with strokes or spinal cord injuries and then I moved into women’s health, mother/baby,

postpartum, labor and delivery, and high risk obstetrics, then I moved into the advanced practice

role of women’s health and family practice. And then I transitioned into a faculty role with the

College of Nursing and a research degree.

Slide 13 VIDEO TWO [03:27]

SO early interest was in sciences and humanities, health occupations, I got involved with

and was ready to go, and I think you all are in the Health Sciences Major so I think you all know

who are preparing to have the prerequisites to get into your upper division program and that’s

important because there are strict requirements to get into the program and to eliminate multiple

semesters in school is helpful to have your plan set up to be able to prepare you to get into the

upper division program as soon as possible, as soon as you’re eligible.

Slide 13 VIDEO TWO [03:54]

So microbiology, Physiology, Anatomy, Nutrition. I worked outside of school. I actually

worked as a waitress which was actually pretty good experience in terms of time management,

service, and having to juggle a lot of things at one time, which nurses often have to do in a

clinical setting. But I do think it’s valuable for anyone who’s going into Health Services to get an

opportunity to work in a health care setting to get a sense of what the day to day activities were. I

did volunteer at the rehab hospital because I was thinking about physical therapy, I kind of

observed and realized that I didn’t want to be that focused and specialized and that’s what helped

me to choose nursing. But I do think it’s a good decision if you have the opportunity to be able to

work part time in a health environment because it will help inform your decision and help you to

know what you’re getting in to.

Slide 13 VIDEO TWO [04:54]

And then Nursing School. There were challenges and it was incredibly intense. You’re all

here so you probably have that character and personality to want to be in this intense program

because anything in Health Sciences is challenging. It is very different than an arts and science

major. You’re up early for clinical, 8-12 hour days, high levels of responsibility, in

Fundamentals of Nursing Class the professor stood up and said this it he only undergraduate

major in which you can kill somebody. It scared me to death. But you have to have a little bit of

a health fear because you do have a significant amount of responsibility in terms of the kinds of

experience that you get. You do have mentors, you do have guides, I don’t want to say you’re

completely on your own, but certainly you are working with people who are in vulnerable

situations and you need to have a certain level of responsibility to be able to manage that.

Slide 13 VIDEO TWO [05:50]

But the opportunities are incredibly character-building. There is a professional identity

associated with being a nurse. I knew that when I finished the degree I was going to be able to sit

for licensure and I was part of a profession, and I expressed it early that it’s a profession that has

a long history and a very solid identity. You get very close to your classmates. We have teams at

the USF College of Nursing, so even though we’re a big school and a big college, you can get to

know a small group of people and you’ll go through experiences together, so you’ll make very

close and lifelong friends. And then I had the opportunity to learn about health care delivery on

rotations from birth to death. It was just, it’s an incredible education. You’re not just getting it

theoretically. Well, you do get theory, you think about it, but you’re actually in the field and

dealing with people in all stages of life. I knew I wanted to get an advanced degree so I was

planning on becoming a nurse practitioner. I love labor and delivery and I loved actually really

liked aging and hospice. So it was interesting I loved the beginning of life and the end of life. I

always liked the idea of helping someone move through a transition or the idea of helping

someone who was sick wasn’t so exciting to me. But in thinking about it I wanted to help the

person get better. And so that was sort of my interest initially in rehabilitation nursing.

Slide 13 VIDEO TWO [07:21]

My first position was in rehabilitation nursing, I was up in Tallahassee when I finished

and then I moved to this area and I worked with Brandon Medical Regional Center and worked

in labor and delivery. I knew I wanted to go to graduate school so I was in clinical practice my

first few years of nursing, I took the GRE and statistics; there were some prerequisites to get into

the master’s program. And of course we have our licensure exam so to become a clinical nurse to

be able to practice you have to pass a national standardized exam. So I passed that before starting

those first couple of roles. So I thought I wanted to be a Certified Nurse Midwife because I loved

birth and loved the idea of it and was working in labor and delivery. But, it was actually my

experience while working in labor and delivery, while I loved what I did, it’s an incredible

phenomenon, there’s nothing like it in the world, it’s an incredible privilege, I realized that

babies aren’t always born during the day, they come at all kinds of hours, and I’m somebody

who likes to sleep at night and be up during the day, so it wasn’t quite the lifestyle that was

something I wanted to take on. But I knew I wanted to continue my education so I went into the

family nurse practitioner program here at USF and the education in the master’s program

prepares you very well to be both a clinician and a scholar. So I had graduate opportunities in

terms of clinical courses.

Slide 13 VIDEO TWO [08:48]

Pathophysiology, pharmacology, advanced health assessment, theory, health populations,

and I did the family NP track. Now I was still a pretty new nurse. I had been working for only

three years and now I was back in school and back in a clinical setting in the Department of

Family Medicine. This was the late 1990’s and in a primary care role you’re establishing a

relationship with a patient over time. They come to see you and they share a lot of details and

information about their life and the 1990’s was the decade of the brain and there was a lot of

drug development for people with depression/anxiety, bipolar and schizophrenia, and some of

those, especially those conditions, particularly anxiety and depression treated with serotonin

uptake inhibitors was taking place is the primary care setting and I really wanted to have more

knowledge of this. In addition to just helping to manage some of the complex dynamics that I

was identifying in the patients who were coming to see me. So I both the mental and family

health track in my master’s program. And I’ve always never strictly worked in mental health but

I’ve always woven that into my practice as a NP. So in addition to the clinical preparation, I was

prepared well with scholarship for theory, research, and processes and I was interested in end of

life so I got the opportunity to do some directed research in hospice at that time. So then I got

certified as a family nurse practitioner after graduation, I did have an opportunity to work in

women’s health and I worked with a group of nurse midwives in my initial role but decided I

wanted to expand my horizons and worked with the department of Family Medicine here at USF

and worked as a clinician as an NP and we were in an academic medical setting so I worked with

patients as an NP and was able to have a lot of autonomy in my practice, worked with nursing

students, we had College of Pharmacy, Physical Therapy-well…not physical therapy at the time,

Public Health, so I worked with a multidisciplinary team in that role. I was assessing,

diagnosing, and prescribing, I had firsthand knowledge about our national health priorities,

cardiovascular disease, cancer, risk prevention, and I ‘ve been able to help people live over time

with their diabetes, high cholesterol, some chronic pain conditions, so I’ve had an opportunity to

work with patients with a variety of health conditions, and basically in addition to my diagnostic

reasoning…when you become an NP you start with the nursing approaching, you’re working

with the interdisciplinary team, you rely a lot on the decisions of the physician, and then you

move into this role where you need to make the decisions for the patients, you need to make the

diagnostic call, you need to know which drug to order, you need to know what test to prescribe

and so you really shift to more of the medical model of thinking. And this takes up a certain

amount of your considerations when you’re learning that, but as I grew in my experience as an

NP, the nursing really starts to come out. Once you start a master, that challenging new role, the

therapeutic use of self, diagnosing the human response, understand how a person is living with a

condition really started really to come into play. And then my education as a mental health

clinician helped me to better communicate with patients and so the process that you go through

in terms of your internal development as a clinician and it’s a great gift and a great benefit. So

the accomplishments that I would like to share with you in my role development as a nurse

practitioner

Slide 13 VIDEO TWO [12:56]

Is that I’ve developed a deep understanding of health and healing of people across their

lives. I’ve had the opportunity to work with inter professional teams, I’ve had the opportunity to

teach and mentor nurses and undergrate and graduate level as well as medicine, public health,

and pharmacy. I’ve had the opportunity to network with other nurses I’m involved with multiple

professional organizations, I presented my research at multiple conferences. I’ve gotten to travel

to California, Ft. Lauderdale, Phoenix, Indianapolis, New Orleans, and Austin and basically with

my doctoral work be able to develop some creative applications of my experiences to be able to

help improve health care. So thank you for the opportunity, I’m now going to turn it over to

Brittany.

Slide 13 VIDEO TWO [13:49]

Ok well thank you Dr. Poff, and just to sort of reintroduce myself, my name is Britny

Chabalowskui and I am the director of the pre licensure nursing program here at USF. We did

have another instructor that was scheduled to be with us today, Dr. Kathy Katts, however she had

an emergency and was not able to join us. So I’m just going to review a little about her career

because we wanted to give you different examples of where nursing can take you. So Dr. Poff is

a very accomplished advanced practice nurse. She has shared her story and showed where her

career has taken her. Dr. Katts is a great example of where nursing can take you in leadership. So

I’m just going to talk a little about her and again in her absence I hope I do her some justice.

Slide 13 VIDEO TWO [14:32]

She went through a diploma school of nursing. Now, diploma schools of nursing don’t

really exist anymore as far as I understand, that was sort of the old school way of becoming a

nurse. Now our earliest eentry level is an Associates of Sciences which will get your nursing

license. So she was in diploma school nurse and after she received her diploma and registered

nurse license, she went on to get her Bachelor’s degree. And then her bachelor’s degree in

nursing as well. Master’s degree trained in Management at the University of Pennsylvania, and

finally a PhD. So Dr. Katts is one of our instructor’s now, she’s one of our assistant professors.

So early in her career sh

Slide 13 VIDEO TWO [15:19]

So early in her career she worked in the ICU-the medical surgical and intensive care

units. She was a very, pivotal, staff management person, a TGH, she went on to become the

assistant director or nursing, she was in that role for a while. So that’s a pretty impressive role to

be directing all of nursing at Tampa General Hospital. So she’s had really a fabulous career.

Slide 13 VIDEO TWO [15:45]

She went on to become Chief Nursing Officer, Vice President of Nursing and eventually

assistant professor with us. So she had also held some leadership roles outside of the clinical

setting. So she was on some nursing boards. Department of Health, so she served on the

department of health in New Jersey. That’s a very important role for nurses. We do not just

impact indiviudals or families, but the community as a whole. And regional national and I want

to talk about her international impact and conferences that she had or was involved in.

Slide 13 VIDEO THREE [00:00]

She helped to develop and deliver senior specialty elective. When you leave nursing

school you are trained as a generalist nurse, but there are many specializations that you can get

into. It’s very difficult to get into that sometimes because your nursing school is going to prepare

you to be a generalist. So Dr. Katts was instrumental in developing these training modules that

would allow brand new graduates to have this special set of skills. So that would allow them to

go into the operation room for example or the lab where they put stints into hearts. So she was

instrumental in that. Magnet certifications for hospitals or health care provider agencies are a big

deal. It really means that it’s great to work here, our patients are satisfied, they have great

outcomes and it’s a very hard certification to attain. Dr. Katts was instrumental in getting that

certification for Tampa General. She alkso was instrumental in putting together the United States

Air Force Nurse Transition Program. There were only a couple of sites in the country that do

that. These are new air force nurses that are getting ready to deploy. We put them through a very

intensive clinical training program. We do part of that here at USF, so we do their skills refresher

and simulation here, but they do their clinical training at Tampa General.

Slide 13 VIDEO THREE [01:31]

Again these are some of the senior electives that Dr. Katts worked with. So working with

oncology or perioperatively, or working in the operating room).

Slide 13 VIDEO THREE [01:37]

OK so there’s Dr. Katts, that’s what she looks like. So this was their international Magnet

consultation. So in addition to working on Magnet status here, she worked with a board of

leaders that actually got magnet status for a hospital in Moscow, Russia. And again another

pictures for the United States Airforce Transition Program which is a fabulous program.

Slide 13 VIDEO THREE [02:07]

Ok St. Petersburg. That’s where she went. But they worked together, they went over, the

TGA leadership including Dr. Katts went over into Russia and helped them to build their

infastrucutre and helped them attain the first even international Magnet status that had ever been

awarded. So that was a really big deal and just speaking with her and hearing her speak about it,

it was a very monumental role and piece of her career that she is very proud of.

Slide 13 VIDEO THREE [02:35]

Again, she planned for three years and worked with that medical center over there to

receive that Magnet certification. Really very impressive

Slide 13 VIDEO THREE [02:45]

Again with the collaboration with the US Air Force there are only three sites in the

country, of which we are one. We do have air force educators. We have two fabulous Air Force

Colonels that help us with this program and one of them joined when she was in her late 40’s and

early 50’s because it was right after 9/11 and her son also joined. Her son signed up so she said

I’m going to sign up with you. So she is a fantastic fabulous lady and she’s a Colonel now in the

Air Force and she helps us run this program here at USF.

Slide 13 VIDEO THREE [03:20]

Here are the first graduates of the Air Force Transition Program. And again it’s a ten

week program. We do some of that training here at USF in the College of Nursing and the

Clinical Hours and done at Tampa General.

Slide 13 VIDEO THREE [03:32]

So Practice and leadership. Strong leadership on the part of nurses, physicians, and others

will be required to devise respond to all of the changes that are going on right now in our

healthcare delivery system, especially now. We have so many changes coming down the pink.

So having a strong voice as a leader in nursing in very, very important, however as Dr. Poff said

as well, we do work in an interdisciplinary practice so we rely on everyone and everyone’s a part

of the team. I personally think we’re the best part of the team, but that’s just me. Ok so those are

two very illustrious careers that I just told you about-Dr. Poff in advanced practice and Dr. Katts

in leadership did some really great things, so I’m going to give you my story which is maybe a

little less traditional than I think the other two. So here’s the first one, this is not me, ok? I still

gross my parents out when I talk to them about my day I work. My dad’s a pilot and my mom’s

an event planner. Nobody knows where this gene came from in me where I wanted to go and do

this touching people kind of thing. So I had kind of a bumpy road getting here and I think…I

wanted to share that with you guys because you’re in this course and you’re starting out here

thinking where is this path going to lead you, and frankly I didn’t know at the time. I knew I had

a very strong interest in sciences like anatomy and physiology. Originally I thought I’m going to

medical school, that’s what I want to do. And I’m going to be a doctor and I’m going to have a

fancy car and a nice big house. So I thought what do I need to do to get there. I did my first

degree in cellular and molecular biology, loved it, science geek at heart. I started to notice some

things about the people who were next to me in lab, like they couldn’t’ make eye contact,

couldn’t make conversation, there were some types of personality flaws in my lab partners I’m

just going to say that…I’ll just say it. I just thought well I’m not really sure how you’re going o

walk into somebody’s hospital room and deliver bad news or have a therapeutic conversation

with them. You know, we’re working on a project together and you’re…you know…starting at

your feet. So I started thinking maybe I’m not in the right place and maybe needed to start

thinking about something else. And then I started thinking about four more years in medical

school, 4-7 years in residency, tons of student loans, let’s see, they will call you in the middle of

the night incessantly, and so I thought maybe this isn’t the right path for me. But you know and I

loved the science stuff but I certainly didn’t want to do this with a pipette for the rest of my life,

ok? That’s a whole nother carpal tunnel syndrome. So then I thought let me look into PA

school, maybe I want to be a Physician Assistant, maybe that’s what I want to do. So I started

looking at schools that were nearby, and at that time none of the PA schools would accept you

unless you had 2,000 direct patient contact hours. So I thought well how am I going to get that,

what’s the fastest way? So I was already volunteering as a firefighter so I went on to get my

paramedic certification. And I loved it, I had such a graet time, itw as like the most fun anyone is

allowed to have within the law. And I was so excited because I was taking care of patients which

is exactly what I wanted to do. At this point I was kind of like well I think I want to do this but

all I’ve done is watch TV shows, documentaries, and done really well in all of my science

courses, btu what if somebody throws up on me? What if I see something really gross and I pass

out? How do I know this is really something that I want to do? And that’s actually how I ended

up in the fire department. I thought let me just dip my toes into the pool and make sure that I can

do this. And it was cool, it was good, I still don’t’ like throwing up, I don’t think anyone is really

going to like that, but I did get rid of my sympathetic puking. So I thought that was a good step,

OK people don’t like it when you puke back on them, but that only happens once or twice. But I

wanted to do more, I was having such a great time going to people’s homes, going to scenes,

scooping them up, you know fast-paced like making a big difference. But I get to the hospital

and I had to turn in over. I was only able to do this much. I was like what are you doing in there?

Oh I want to help out with that, can I do that? And my guys would have to put me back on the

ambulance like we need to go back to the house, it is time. So I just wanted to do more. And

when I was in there, when I was in the hospital, I was starting to get a good feel for who did what

and I got a good feel for who is really running the show, and that’s the nurse. So I said that’s the

job that I want to do so I started looking into nursing because unlike medical school or even PA

school where you have to say I’m going to be X kind of doctor and I’m going to board in this,

I’m going to do my residency in this…like speak now or forever hold your peace you never get

to change. And for nursing I was like so I can be a school nurse one day and then go work in

labor and delivery the next day? Ok cool sign me up. Or I can go on and get my advanced

practice degree and I can independently or I can see patients in a clinic or I can go teach. So I

really saw that as the place where my opportunities would be boundless. So I saw this as the next

opportunity for me. So I already had a bachelor’s degree so I signed up for an accelerated

nursing program. Also the reason I didn’t become a paramedic was because I married one, so

you know, shift work and that’s not a fun way to live life so I was like I don’t want to do this

anymore. I do remind him quite frequently that I did his job for free for a very long time. He just

says that was my dumb fault so that’s ok. So accelerated nursing program-my next stop. It was

intense, it was a lot of fun, I think Dr. Poff eluded and I’ve been out of nursing school for a long

time now…I remember my first day of clinical, I remember my first day of class, I remember a

lot of stuff from nursing school. So those things really get etched into your memory or your

psyche, your soul, whatever. It’s a very, very intense process. Becoming a nurse was very

exciting, but there was definitely a lot to learn. It wasn’t just about the sciences. It was about

how to talk to people. How do I interview a person and get them to trust me? How do I build that

relationship? How do I teach somebody? Ok so now I know all of these 50 cent words but now

I’ve got to go teach someone with a fifth grade education about their diabetes. So there was

definitely a whole lot more to this process than understanding what a gram negative bacterium

was. I loved it, it was awesome. So when I graduated my first job was in a medical surgical unit.

I worked in a teeny hospital in Western Maryland. So typically here like in the big city, your

floors will specialize in something like neuro or orthopedic injury and surgery. We didn’t’

specialize in anything. We did everything that came down the pipe. So it was a great experience.

So I had surgical patients, I had chronically ill patients, I had morbidly obese patients, I had

orthopedic patients. It was a fantastic experience and I loved it, but I really wanted to get back to

my roots becaseu I’m just a blood and guts girl like from way back. So I’m like the grosser the

better, so brains, guts, arms chopped off, I’m your girl, that’s me. OK babies being delivered, not

me. So that’s why I’m glad we have nurses like Dr. Poff-like that is way out of my wheelhouse.

So I ended up back in the emergency and trauma department, back to my first love. And I had a

blast there. I just loved learning everything new and anytime a new procedure came our or a new

medicine came out I was like let me learn that; let me teach everyone else about it. I started a

trauma committed there where we reviewed all of our trauma patients and asked questions like

what could we have done better? Where did they go? What happened to them? And this was just

when I was just a baby nurse right out of the gate. But what I really found was that when new

nurses or students were coming in, that’s when I would have the best time. Because my

coworkers kind of were like eye rolling because they didn’t’ really want to hear about the latest

and greatest of whatever we’re doing. But I was like oh a student nurse, come here! I’ll show

you, let’s go talk to this patient! Do you want to see a wound? Put your finger in there! No it’s ok

I’ll ask him, it’s alright, it’s ok. That’s where I really found my passion, that’s what I love to do.

As much as I loved nursing, I love making new nurses. Maybe it’s a little hubristic, I’m like OK

I’m just going to make you in my image, it’s a little inappropriate, but you know out into the

world you go. So I’m not sure how I’ve affected the nursing profession, but you know. So I

started my Master’s Program and didn’t know where it was going to take me. I focused on

Management and Education. So I didn’t go into an advanced practice role. I didn’t’ see that that

was me, that it was something I wanted to do. I know that if I changed my mind I could do that

later. I could add that on as a post master’s certificate if I decided to become an advanced

practice nurse. It wasn’t for me at the time. So this I where I kind of started out. And I started

teaching at the University of Tampa. Really liked working over there, but I had a better

opportunity to work over here so now I’m a bull nurse, that’s just how it works. So as an

Instructor here at the University of South Florida I’ve gotten to do pretty much everything across

the board in nursing education. So I’ve worked in clinical, taught classes, both online and live,

I’ve done simulation which is something I’m really excited about, so we have human patient

simulators, but…I bring my kids in all the time because it really creeps them out…because they

blink and they breathe and they talk to you and so you can do all kinds of bad stuff to our human

patient simulators…so if you kill them it’s ok, we just reset them. So that’s one of the things that

I love the most because it’s a really great fun way to learn. So I did a lot of simulation in our

program. I was eventually promoted to the director of the pre-licensure program and again in

some ways I think this part of the profession has chosen me, but I’m glad to be here and I want to

keep going. I’m currently in PhD school which is…I don’t want to say exciting because you

guys are in school, you know what school is. I don’t’ have to lie to you. But I really feel like I

made the right decision. I don’t ever regret not going to med school, not going to PA school. And

I tell my students all the time. I say you know…I read the admission essays of I want to help

people and I want to make a difference…this job makes a difference, it does. I tell them I’m the

nurse, I’m the hub, I’m the spoke on the wheel, and everyone else is the spoke. They all work for

me, ok? Physicians, PT, Occupational therapy, [pharmacy, respiratory therapy, they all work for

me. I coordinate that patient’s care. I’m at their bedside for twelve hours a day. I am their

advocate, their protector, their voice, I’m the person who takes care of them. I am the one that

knows that they don’t have a car and can’t go get their food at night. I’m the one that knows that

they’re allergic to cats, but if her daughter moves in, they’re bringing the cat with them. Other

providers don’t’ know this about my patient. So I feel like I picked the absolute best career

because I get to do everything. I’ve even told my doctors in the ER that they work for me. They

think that’s ok. Well they called me assertive. I don’t know what that really means but its ok, I

don’t really mind.

Slide 13 VIDEO FOUR [0:00]

Alright well that’s my story. Now what for you guys? I totally sold you on being a nurse.

This is what you need to do next. We have information sessions at the College of Nursing

routinely. So if you check on our website, they will list them there for you. We have fantastic

pre-nursing advisors. They will help you with what prereqs you need, they’ll help you fix your

GPA if it needs fixing, what are the next steps. And if you choose not to come to our college of

nursing, which I don’t know why you’d look anywhere else, you want to make sure they’re

regionally accredited and CCNE or NLN accredited, of course we are all of these things. The

kind of caveat or watch out is that there are some proprietary schools out that that are happy to

take you in, charge you a lot of money, and they’ll give you a degree in nursing and qualify you

to sit for your boards. However, if you want to go on and get your bachelor’s degree or master’s

degree if they are not accredited, those credits do not count. They will not transfer or apply for

further education. So you just gotta really make sure you know what you’re getting into. You

want to target for a bachelor’s degree for a number of reasons that Dr. Poff mentioned. While

that is currently not our entry standard, it is becoming more of the accepted place that we want

our nurses to go. So many of the hospitals here in the area, if you are Associates Prepared, they

want you to get your Bachelor’s degree usually within two or three years of being hired. So if

you start out with a Bachelor’s degree you’re already one step ahead of the game. So, very strong

historical foundation. And also because I know I was back and forth between PA and NP what

do I do, what’s the difference between the two? PA’s were actually established during the

Vietnam War. They were transitioned from our front line medics. They were doing a lot of

procedures that didn’t really fall into category…it didn’t really fall into nursing, it didn’t really

fall into med school, but they were like super, super smart, did a lot of stuff, had a lot of great

experience. So that’s kind of the evolution of the PA role. So that kind of goes back to the

1960’s, that’s when the PA role was started. And nurses had been around since the Crimean War.

So we got them by a lot on the timeline. So that’s our first thing. So a very, very strong

foundation for us. Being a nurse it’s not like…I don’t get doctor’s coffee, I don’t put mints on

pillows…that’s just not what I do. I’m not a waitress, but yes waitressing skills helps. It’s like

hey can I top off your iced tea? Can I get you a little more morphine? It’s a little bit of the same.

But that’s not what I do. I coordinate my patient’s care, I take good care of my patient, and I

know that I make a difference. And that’s where we all start out in general, the bedside. And

that’s where we learn our practice, it’s how we learn our trade. It’s how we learn to treat people

from all walks of life the same. We provide the same care and service to everyone. You learn a

lot about yourself in this career that’s for sure. And the one place you learn a lot about yourself is

probably in nursing school. One of the things you learn is how tough you are, or how tough you

aren’t. I know it’s almost the end of the semester, so I’m out of tissues, but I also have a box of

chocolates in my office. So you can come and take some chocolates, gather yourself, and then

come back. It’s a tough career. I’m not going to lie to you. This is a really tough job. But

anything that is worth doing is hard. It’s just hard. But I love my job because I know at the end

of the day I’ve made a difference. That I held somebody’s hand when they died because nobody

else was there. Or been there at the beginning of life. I know that…that’s important to me. That’s

better than shoving papers around, sharpening pencils. Lots and lots of career options just with

your bachelor’s degree. You can make a full and long career just with your bachelor’s degree. I

don’t’ want to leave you with the impression that you must continue your education, but our

good ones do, ok? Go on to master’s degree and then doctoral level, which we talked about. We

have a lot of nursing students who….this is what I don’t ever want to read on an essay because I

can get a job when I finish. Ok it’s true, but you’re not going to last in your profession. It’s an

upshot for sure. It’s a lot of hard work, but you’re going to get a job because nurses are in huge

demand. Very, very well-respected discipline. People know that we are not waitresses, that we’re

the ones at the bedside making a difference. This career choice ages well. I worked in ER and

trauma unit, I had people take a swing at me, throw stuff at me…I don’t want to be 70 and doing

that. I’m not a good wrestler anyway, but I’m sure when I’m 70 I’ll be an even worse wrestler.

So this is a job where you can transition into…like if you decide I’m getting to old for this. I’m

working at a call center. I’m going to be the nurse on the phone. Take your medicine and then

call your doctor or go to the ER. So there are really so many ways you can take this career into

so many different directions. The best part is you don’t’ have to decide right at the front, you can

change any time you want. It’s not task-focused at all. Opportunities: unlimited. SO I think we

have a few more minutes right? Questions? Yes there are some, but they’re not as formal I guess.

So the question was about making transitions besides going into education. So like for me from

going to a medical/surgical floor and then going to the emergency department I had a number of

different certifications that I needed to get. I did go through a training program where I..you

know there are different skill sets on both sides, but I didn’t have to go back to school and get a

degree. Really it was just about applying for the job and talking to the manager and saying I

would be a really good fit because I used to be a paramedic and I’m a super great nurse on the

med/surg floor and I think I would do really well here. So there’s nothing formal about that, it’s

just making that decision. And a lot of those transitions, like if I wanted to go to labor/delivery,

they could take me and train me in those specific skills, but I already have the nursing base…so I

can do that…I can pick up the phone and move to L and D tomorrow if I want. So that’s a pretty

tough one. We have a lot of patients that are in our general, medical, surgical units. Then we

have patients that are in our critical care areas. So the evolution of that is that we have patients at

home now that would have been in our med/surg unit 5 years ago. Patients in our med/surg unit

that would have been in ICU 5 years ago. So I think that the need and the model will be

changing. We’re looking at more of a medical home, but critical care is always in demand.

Med/surg is where most are going to be. Yeah, definitely. And that’s just a different model. We

have to consider that medical home. You know, tele health is the big one now. So we may not

have to have people get on a bus and come in to the doctor’s office. We may just skype with

them. You now, like hold up your wound, let me see it. Show me your pill bottle. Show me how

you take it. Show me how you inject your insulin. So that’s really where I think our model is

moving. Because we just can’t sustain the patient population that we have in the acute care

facility. So I can’t say for sure that this is the kind of nurse you need to be to get a job because

it’s just blowing up all over the place. But the opportunities I think are going to change, just a

little bit. Did that answer your question? Ok going from your associate’s with prereqs to

Bachelor’s degree currently our program is six semesters long. We do enroll once in the summer

and once in the fall. So it’s 5-6 semesters depending on when you enroll. We are currently going

through a curriculum revision that I’m hoping we will launch next year, but I think that those

semesters will stay the same. We’re just realigning things. So about 5-6 semesters for our upper

division students and about 4 semesters for our second degree students. So those are students

who already have a bachelor’s degree. Correct, yes. So four semesters. So the only challenge for

some of my second degree students is if you get your first degree in Art History, you might not

have your micro, and your bio, so you’ll have to obtain those prerequisites before you enter the

program, but once you get in then its four semesters. Now I would probably say if like right now

this is what “m doing and I want to be a nurse just go straight for it. Otherwise I would say you’d

be pretty covered with just a general bio degree because you’re going to get those things that you

need like Micro, A and P, Nutrition, I would say other degrees that we’ve had that have come

in…I would say public health is a good adjunctive learning strategy, health sciences is a good

one. Because you get to pick as you move along, or do you not get to pick? Ok so everything is

covered in health sciences, absolutely. But you guys will do…you will start here and then apply

to the nursing program? Or do you do the whole degree here? Sorry I don’t get to this side of

campus very often. Ok so yeah then obviously health sciences is going to cover all of those

prereqs for you. And it sounds like a pretty good program that you have where you get

everything. I’m sorry we don’t leave our corner of the world very often. We’re in our USF

Health corner. That’s kind of a tough one because you’re like right in between, you’re at the

halfway point. That would be a good one for our advisors because they would be able to look at

your progression so far and it wouldn’t hurt if you got all of your prereqs to throw your hat in the

ring. Now there are other considerations like financial aid, number of credit hours that you take

here. So you know like the whole take 15 get out in 5, whatever you’re supposed to be doing.

Four? Oh. Four. Like I said my little world is all I know. But I think that would be a more

specific question for our advisors so they can actually look at your transcript. Alright so excellent

question. The balance of students we take…we do take more upper division students or

‘traditional’ students than we take of our second degree students. And there are a number of

reasons behind that that have to do with our clinical collaborative partners and so on.

Historically, the GPA for the upper division incoming students, like our traditional students, is

about 3.8. So that’s our average GPA. Our GPA for our second degree students is usually a little

bit lower, like a 3.5 of a 3.6 and something that is because sometimes you go to school when

you’re 18 and you don’t take it as seriously as maybe you should and your first degree doesn’t’

look as impressive as your next degree is going to look. So that’s what happens to that pool of

applicants for us. I will tell you in addition to overall GPA we look at first attempt grades so if it

took you three times to get an A in micro that’s not as good as if you got a B the first time. We

also look at your prerequisite grades and we have you write a personal statement. The personal

statement is pretty heavily weighted. I don’t want anyone to think omg I got a 3.2 or a 3.3 on my

first degree I’ll never get in…absolutely not true. We look at kind of the whole picture. We look

at where you’re coming from, what’s your motivation to be a nurse, what’s your experience, so I

don’t’ anyone to feel like they can’t apply. We’ve taken. 3.0’s. And I know that’s kind of like a

low GPA, but it’s a competitive program. So interesting question and I would say the answer is

that we don’t know yet, ok? To be honest with you, I haven’t seen much impact practice at this

point. Because it’s still rolling out at this point. So much like the roll out and sign up, we don’t

know everything that’s going on. So the way it’s going to impact us is we don’t know yet. I will

tell you that no matter what healthcare looks like, we will always need nurses. So what DR. Poff

was saying is that there is definitely much more focus on prevention and wellness. It’s not our

current medical model. Our current model is treatment of illness. So nurses aren’t trained from

day one in prevention, wellness, education, and all those things. There was a fabulous

documentary that was saying that physicians don’t even get trained in nutrition. And there were

physicians that were interviewed that said I know what to do once you’ve had a stroke, but I do

not know how to tell you to prevent it. That’s what nurses do. That’s what we do. We teach you

how to eat to prevent your diabetes from killing you. We teach you how to take your medicine

we make sure you have an appropriate exercise regimen, so I think the ACA when we look at it

through that lens, it can only pump nurses up and help us. And I think people in general. People

who wait to get sick is kind of lousy, so. Well thank you guys very much I hope to see you over

there.