Category: Working Nurse Practitioners

Before becoming a nurse practitioner, I worked as an emergency department (ED) and flight nurse. Most days, I was excited to go to work. I enjoyed learning and experiencing new patient adventures with the support of my "work family," which encompassed my colleagues, ED technicians, registration personnel, physicians, and other staff members. We knew that we all played a role in keeping the department flow organized, creating a positive experience, and ultimately providing the best possible care to patients.

When I transitioned to a nurse practitioner role, this team-centered dynamic changed with it. Working in a different department and new position, I began to feel somewhat isolated from the rest of the team. While finding my place took a level of trust and relationship-building, it allowed me to successfully redefine my professional goals. Career development requires a practitioner to work among strangers, gaining familiarity with an unknown culture and establishing trust with a different "work family." However, NP evolutions also offer the opportunity to create a new team leader.

Benefits of Patient Care Teams

Nurse practitioners are able to create and lead patient care teams. Essential to delivering patient-centered care, these teams offer the following benefits:

• Improved coordination of patient care
• Enhanced patient satisfaction
• More efficient use of healthcare services
• Shorter and fewer hospitalizations
• Reduced medical errors
• Better patient treatment compliance

Patient care teams consist of at least two people interacting in a dynamic and interdependent relationship. They engage in effective communication and share the common goal of providing the best care for patients. Although a shared level of responsibility is understood and routinely practiced in healthcare, the absence of high-quality teamwork leads to poor patient outcomes, medical errors, provider burnout, and increased healthcare costs.

Personal Values of Team Members

NPs must establish effective patient care teams in their practice. Before doing so, there are five personal values to consider. The Institute of Medicine identifies the following personal values as integral to high-level patient care team success.

• Honesty: Team members strongly value effective communication within the team. This includes continuous transparency around aims, decisions, uncertainty, and mistakes. Honesty is critical for ongoing improvement and maintaining the necessary mutual trust for a high-functioning team.
• Discipline: Team members carry out their roles and responsibilities with discipline— even when it seems inconvenient. Similarly, members seek out and share new information to enhance individual and team functioning—despite potential discomfort. This level of discipline allows teams to develop and abide by their standards and protocols while finding ways to improve.
• Creativity: Team members are excited about the possibility of tackling new or emerging problems in a creative manner. They also view errors and unanticipated negative outcomes as valuable learning opportunities.
• Humility: Team members recognize differences in training, but do not believe that one type or perspective is superior to another. They also acknowledge that they are human and mistakes are inevitable. A fundamental value of working in a team is the opportunity to rely on each other and help avoid failures—regardless of where they are in the hierarchy.
• Curiosity: Team members reflect on the lessons learned in their daily activities and use these insights to continuously improve their individual work and the functioning of the team as a whole.

Principles of High-Level Patient Care Teams

After identifying these personal values in colleagues, the NP can move forward with developing a team.

The principles of high-level patient care teams include:

1. Defined leadership– Effective leaders must facilitate, coach, and model effective communication skills.
2. Shared goals– All members are involved in defining the team's purpose. This encompasses patient and family goals, as well as shared interest and ownership.
3. Clear roles– Each team member has a clearly defined expectation of their role, responsibility, and accountability.
4. Mutual trust and respect– Team members earn each other's trust and respect, allowing for diversity in opinions and continuous open-mindedness in reaching consensus.
5. Effective communication– High-functioning teams make communication a priority and consistently seek ways to improve these skills among all members.
6. Measurable processes and outcomes– Team members participate in a timely review and feedback of successes and failures. An impartial review enables process improvement and identifies any educational needs.

Studies show that healthcare teams are associated with the following professional advantages:

• increased job satisfaction
• more productivity
• decreased stress levels
• enhanced support for inexperienced workers

Creating a "work family" is a key priority for NPs. These tools allow NPs to lead, develop a strong team, and engage in effective communication. Leading to provider longevity, forming high-level patient care teams ultimately saves patients by improving the healthcare workforce.

A differential diagnosis is a list of potential conditions a patient may have. Through my experience as an instructor, I have found that NP students often struggle with this difficult task. However, this is an incredibly important skill to master, as it is a foundation for providing excellent patient care. Adopting a systematic way of thinking can help organize an NP's thoughts.

Differential Diagnosis Challenges:

• It is impossible to know every symptom for every single disease
• The process can take a lot of time and research
• Patients won't always be honest or tell the whole story
• There is no "one size fits all" approach

Steps to Completing a Differential Diagnosis

Following these steps will help new NPs develop a comprehensive differential diagnosis.

1. Taking a Good History

The first step in conducting a differential diagnosis is completing and reviewing an accurate and thorough evaluation of a patient's medical, surgical, social, and family history. An accurate medication list is important as well. These areas often include details that will be helpful to refer to later on.

2. Physical Exam

A great deal of information about a patient can be discovered without using a stethoscope. Watching posture, breathing, and other behaviors can provide a wealth of information. While a meticulous physical exam is critical, never discount the non-verbal clues displayed by the patient.

3. Diagnostics

A thorough review of a patient's available labs and diagnostic imaging is another important aspect. Tests will often definitively result in a diagnosis, but not always. In these cases, combining diagnostic results with the physical exam findings and patient history will be necessary for the diagnosis. Sometimes, testing will need to be ordered. Beginning to think about potential conditions can help determine which types of tests may lead to a diagnosis.

4. Thinking Process

Compiling a patient's history, physical exam, and diagnostic test findings requires the ability to synthesize the information. This is a skill that will not be learned immediately, but will instead develop over time.

An Experienced NP's Process

Here are the steps I take when developing a differential diagnosis. At this point in my career, I am able to do this in my head without writing it down. However, I would advise new NPs to take notes, as information can be overwhelming when clicking through charts.

Review

Review the patient chart (if available) and chief complaint of the visit before the patient arrives. Here, I can start to develop a potential list of causes for their symptoms. It is important to not let any bias cloud judgment, as keeping an open eye and mind is critical

Confirm

During the visit, confirm the patient's full and accurate history and perform a physical exam.

Data

Review any previous imaging or laboratory data that may be relevant to the patient's current presentation.

Question

Ask the patient many questions and most importantly, listen to their answers! Using the OLDCARTS system works best for me (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, and Severity).

Think

During the above steps, I will be going through a list of possible causes based on experiences with past patients. I also draw on what I have learned or read previously over the years. The main question I keep asking is "what could this be?"

System-based thinking is a helpful way to organize my thoughts. For example, if shortness of breath is a presenting symptom, I would think of all potential causes and compare them with the patient's exam findings and history to arrive at a list of differentials. Once I have a few differential diagnoses, I will review them, determine what fits best at the moment, and treat them appropriately. I include a list of the differentials in my documentation for easy reference by myself or another provider who may see the patient in the future.

Keep in mind that common diagnoses are frequent, and not every patient will have a rare illness that nobody has ever seen before. It does happen occasionally though!

Follow Up

Shortly after providing a diagnosis, I follow up with the patient to make sure there has been a resolution of their symptoms. If not, I begin looking into other causes.

Collaborate

If I don't know the answer or am unsure of what to do, I collaborate with another provider and ask questions. It is absolutely OK to not have all of the answers, and transparency with the patient is important. Letting a patient know that I don't have the answer but will do my best to find it will help put them at ease.

***

The process reviewed above is just one way to develop a differential diagnosis. As the new NP settles into practice, they will determine what works best for them. While obtaining a differential diagnosis is a critical skill for NPs, it will take time to fully master. Therefore, never hesitate to ask for support or collaborate with another provider. With enough time and experience, this will become much easier to accomplish.

Although the recent job landscape has felt uncertain, employers are still hiring nurse practitioners with an increased reliance on virtual interviews. Even recruiters are hopping on the videoconferencing trend for evaluating candidates.

As a nurse practitioner, you may be more used to communicating with patients, hospital administrators, and other healthcare team members in person. Wondering how to stand out from the crowd while behind a screen? Here are some tips.

If you haven't already done so, be sure to create a professional-sounding username for all programs and applications that you intend to use for virtual interviews.

This confirms your true identity and displays a sense of professionalism, giving your potential employer nothing to raise an eyebrow at. After all, could you imagine holding an interview with someone whose username is in_jail_out_soon?

While you're at it, make a professional email to share with employers and recruiters. You have probably outgrown your ilovehellokitty@yahoo email anyway.

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2. Lights. Camera. Clothing!

As a nurse practitioner, you already know how to dress professionally, but your ensemble is especially on display during virtual interviews. This requires you to take further steps, as the mix of lighting, cameras, and computer monitors can wreak havoc on your wardrobe.

• Avoid wearing clothing that either blends in or clashes with your background. Ensure that your clothing and background choices are not competing with each other. Speaking of background – it’s a good idea to do a sweep of what is visible behind you. Otherwise, you may not realize that your unmade bed or muted TV will show up in the background on-screen until it’s too late to do anything about it.
• Avoid wearing white, all black, or bright-red. Regardless of the lighting in your chosen room, the colors will display differently on your prospective employer's computer screen.
• Wearing white can overexpose your face and add a glow to their screen. Dressing in all black could do the same or worse—make you appear shapeless and blurry. Bright red colors also have the potential to bleed on screen and produce a halo effect for the viewer. All of these will distract the employer from what you really want them to see: your shining character.

3. Avoid the Slouch

In addition to making you look miserable on camera, slouching isn't professional. Instead of hunching over with your shoulders dejected, try the following.

• Sit up straight, make eye contact, and smile
• Rest your hands in your lap rather than crossing them over your chest or clasping them on the tabletop and keep hand gestures to a minimum
• Refrain from fidgeting in your seat or messing with items on your desk
• Avoid touching your hair and face

4. Eye-Opening Insight

Unexplained eye movement is distracting and can undermine the confidence you're aiming to project. Here are three ways to avoid those random eyeball swings:

• Set a focal point near the camera on the screen, and speak directly into the microphone. Pretending that the camera is a person can help you maintain eye contact.
• Print out all supporting documents, instead of having them pulled up on the screen for reference. This will allow you to refer to them with little movement or distraction to the person on the other side of the screen.
• Hide your self-view. Even if it's up in the corner, you will be tempted to look at yourself. Every time your eyes shift away during the interview, it's noticeable.
• Try your best to make sure you are in a quiet space free of noisy distractions such as pets and children. Not only can this interfere with how you hear your interviewers (and how they hear your responses), but constantly taking your attention off the video to tend to these disturbances can make for a disjointed and awkward interview.

5. From Formal to Personal

Virtual interviews have the potential to be stiff and formal, which can be worse than in-person interviews. To bridge the gap, here is a simple way to make a stronger connection.

• At some point early in the videoconference, use the interviewer's name.

• Without overdoing it, a simple and natural-sounding "Hello, Ms. Smith, great to finally meet you" can go a long way. If there are a few people conducting the video interview, remembering who’s who is also helpful – it is much more engaging to give a response such as, "Following up on Dr. Johnson’s question regarding my pediatric care experience, I’d like to go over my certifications.” Creating a personal connection is half the battle— especially when you are hundreds of miles apart. This little trick can help you feel more at ease too.

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6. Computer Savvy

You already know it's wise to check your internet connection, camera, and microphone well before a virtual interview. It's also important to ensure that you are familiar with the interview platform ahead of time.

But here are two things that you should never do on the day of a virtual interview:

• Don't update your computer's operating system or the program application that you will be using for the interview. Updates can disrupt settings and cause delays, forcing you to uninstall and reinstall the program and potentially lead to additional issues. You don't need the added stress, so save the updates for afterward.
• Never rely on your computer's battery to carry you through the interview. Be sure that you're plugged in ahead of time. Scrambling for a power source in the middle of an interview will make you appear unprepared, and the look of panic on your face won't send a comforting message either.

Healthcare providers face a wide variety of job stressors including demanding hours, personal risks, and emotional strains—and nurse practitioners are no exception. All of these factors can lead to burnout, a multifactorial state of physical or mental exhaustion due to job-related stress. One of the most threatening contributors to burnout in nurse practitioners and other healthcare providers is decision fatigue. While most individuals will manage some level of decision fatigue in their daily lives, the process of evaluating, diagnosing, and treating medical issues adds another layer of significant stress for nurse practitioners. In addition to causing burnout, persistent decision fatigue is exhausting and poses serious risks to both NPs and the patients they serve.

Decision Points

Heavy patient loads, short appointment times, and long work hours can all contribute directly to decision fatigue for nurse practitioners. There are many decisions involved in each step of managing health conditions, including evaluating, diagnosing, interpreting test results, implementing treatments, and ensuring follow-up. Evidence-based guidelines are frequently evolving to match emerging scientific advances across the medical field. Incorporating these changes involves another layer of decision-making in the healthcare setting. Nurse practitioners are required to make decisions during individual patient encounters, as well as when reviewing test results days later. In clinical practice, providers often make decisions regarding multiple patients simultaneously.

Provider Risks

Decision fatigue grows significantly over the course of a long or demanding shift, and may lead to a variety of effects on healthcare providers including:

• General fatigue
• Anxiety
• Lack of attention
• Difficulty concentrating

These factors affect providers' physical and emotional ability to care for patients and can impact their overall performance. This ultimately affects the ability to offer consistent quality care. As decision fatigue sets in, providers may inadvertently:

• Overlook important new or presenting symptoms
• Overprescribe antibiotics
• Take longer to make treatment decisions
• Overprescribe high-risk medications including pain medications
• Experience difficulty in resisting inappropriate treatments
• Order unnecessary laboratory, imaging, or diagnostic tests
• Suffer legal consequences related to poor decision-making in diagnosis and treatment

Patient Risks

Each patient deserves the full attention of their healthcare provider. However, the serious consequences of decision fatigue imposed on healthcare providers can extend directly to the patients they treat. These effects include:

• Delayed treatment
• Treatment with inappropriate medications
• Unnecessary diagnostic tests
• Misdiagnosis

Decision Fatigue Prevention

While decision fatigue cannot be eliminated entirely due to the ever-changing healthcare environment and ongoing demands around patient care, there are several important ways that employers and individual providers can prevent and reduce healthcare decision fatigue. This includes:

• Algorithms
• Prescription defaults
• Team-based care

Many excellent resources are available and easily accessible to providers to quickly reference during a patient evaluation. Algorithms, decision trees, and clinical pathways are available for a variety of common and complex illnesses and medical conditions. These tools offer a predictable clinical course based on sequenced interventions that guide clinicians in treating specific medical issues. Nurse practitioners can seek out these tools to guide their decision-making process. Commercially available clinical resource tools, such as Up-To-Date, offer current clinical pathways. Some electronic medical records have built-in decision trees for providers. These tools ensure appropriate care for presenting symptoms, and allow providers to easily and efficiently tailor care based on the specifics of patient symptoms. All of the tools utilize up-to-date, evidence-based guidelines aimed at providing consistent care for all patients. Effective clinical resources are imperative in fighting potential decision fatigue, as they help organize and minimize choices during times of critical decision-making and offer a clear path for treatment and improved patient health.

A key step in preventing and managing decision fatigue is recognizing the signs. Providers can monitor for signals of exhaustion, irritability, and rushing through work in themselves and their colleagues. Providers can also implement specific habits into their own practice to avoid entering a state of decision fatigue. Some simple but effective strategies to reduce day-to-day decision fatigue include:

• Scheduled breaks throughout the day
• Deep breathing
• Healthy snacking
• Brief periods of physical movement
• Re-checking E-scripts prior to sending
• Consultation support with other providers
• Consistent use of decision trees

To stay vigilant in patient care, addressing decision fatigue is more important than ever. Understanding what decision fatigue is, how it presents itself, and effective ways to prevent it will significantly impact the health and job performance of nurse practitioners and ultimately lead to better patient outcomes. By embracing healthy habits and clear clinical pathways, nurse practitioners can effectively minimize overload during critical decision points. By effectively managing decision fatigue in the healthcare space, providers will feel more supported throughout their demanding work days and can fully focus on providing the best possible care for patients.

The U.S. Bureau of Labor Statistics expects employment for nurse practitioners (NPs) to grow 45 percent from 2019 to 2029. Therefore, now is the ideal time to consider temporary clinical assignments—better known as ‘locum tenens' jobs, which is Latin for "to hold a place." These assignments cover all medical specialties and practice settings, with durations ranging from days to months.

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How Nurse Practitioner Locum Tenens Jobs Work

It's most common for locum tenens NPs to work with healthcare staffing companies, as they play a supportive role in NP licensing, credentialing, relocation, and placement. However, locum tenens nurse practitioners can also work directly for organizations as temporary employees or independent contractors. Here's a basic rundown of NP locum tenens positions.

The Healthcare Staffing Agency

Healthcare staffing companies handle temporary work contracts from hospitals, clinics, and facilities. Reasons healthcare employers use locum tenens can vary. Some need temporary support due to challenges filling permanent positions or covering for leaves of absence. Staffing agencies are actively involved in the NP placement process, ensuring that candidates are experienced and qualified.

The Contract

A quality staffing company will protect the interests of both the nurse practitioner and the hiring facility. Nurse practitioners can expect a legally binding contract outlining the terms of agreement such as the assignment, start and end dates, pay rate, and stipends. The temporary contract varies by location and facility and becomes an important element of the tax-related requirements associated with locum tenens work.

The Travel

For tax purposes, functioning as a locum tenen means temporary and periodic movement away from your tax home. So, how far away is "away from the tax home?" Although the IRS does not state an exact distance, it must be far enough that rest or sleep are required for the NP to perform the work.

The Reimbursement

Often, the NP pay package will contain tax-free reimbursements. The IRS expects tax-free reimbursements to be for expenses—not substitutions for wages. In order to qualify for tax-free reimbursements, the NP must have a legal and established tax home. This means not working too long in one place, or not working in the same area for more than 12 out of 24 consecutive months. The temporary contracts serve as proof of these requirements.

Pros of Locum Tenens Assignments

Nurse practitioners who enjoy the challenge of working in new environments often gravitate toward locum tenens positions. This is also a good arrangement for NPs who don't want to be tied down with a permanent position, or even for those looking for extra work on the side. Other advantages include:

1. No quotas. Locum tenens are paid hourly or weekly wages. With no productivity quotas, the primary focus is patient care.
2. Great pay. Reimbursement depends on the specialty and state that you work in, but it is always comparable to market value. NPs should negotiate a competitive hourly or weekly wage, along with travel or lodging expenses that are paid or reimbursed by the agency. Additional benefits may include malpractice insurance or free continuing medical education credits.
3. Flexibility. Will you work full-time, part-time, or extra shifts? When, where, and how long will they be? You can let the agency's travel team arrange housing and travel accommodations, or find it yourself. It's your choice!
4. Discover. Traveling involves discovering the culture and tastes of new places. It also means a variety of unique clinical experiences—from serving patients in rural areas to working with front-line technology in leading teaching hospitals. Even if your locum tenens assignment doesn't take you too far from home, exploring a different healthcare organization or part of town can give you a fresh perspective.

Cons of Locum Tenens Assignments

The unpredictable nature of locum tenens jobs is not suited for every nurse practitioner. Before you commit to this type of working arrangement, be sure you are aware of the following:

1. You will be expected to hit the ground running. You won't need a ton of experience, but you will need to know what you're doing. These positions do not offer long orientations or drawn-out breaking-in periods.
2. You will need to be alert. Recruiters don't work for you—they exist for their clients. Some staffing agencies will earn commissions on each NP salary. This isn't a bad thing, but it's important to recognize that not every recruiter will have your best interest in mind. The final choice is always yours.
3. You will need extra advice. Prior to beginning a locum tenen assignment, consult with your tax preparer. Discuss taxation laws, as well as taxable and nontaxable reimbursements in the states you're traveling to (if applicable). Do not depend on the staffing agency to give you tax advice.

RELATED: Keeping Your Sanity: How to Prevent Nurse Practitioner Burnout

How to Get Started As a Locum Tenens Nurse Practitioner

If you've weighed the pros and cons and come to the conclusion that you'd like to try out locum tenens NP positions, the following tips will make your transition much easier:

1. Know what you want. Do you need benefits, travel, lodging? Will you need a 1099 or W2 for payment? Where do you want to go? How far from home are you willing to travel? What are the practice laws in the states you're traveling to? Ask yourself these questions before you contact a staffing agency.
2. Make a timeline. If substantial travel is required, getting started means lining up your own travel readiness with the requirements of the state or region you're heading to, and then aligning that with current demand. Maintaining a multi-state RN license in a Nurse Licensure Compact state can help you find work faster while obtaining licensing for other states.
3. Research agencies. Choose at least four agencies with strong reputations. Good recruiters are those who return calls and follow up. It's not uncommon for NPs to use multiple agencies, depending on their needs.
4. Gather and organize. Keep all of the documents you need in one place. Make PDFs of licenses, certifications, vaccination records, reference letters, and CEUs so they are ready to email at a moment's notice.

The demand from the healthcare system on providers such as nurse practitioners appears to be growing daily. Whether it's driven by increasing patient volumes or the heightened requirements for insurance reimbursement, it can seem like an ongoing game of catch-up. While the ultimate goal of a healthcare system is to create high-quality and high-value care for its consumers, most of the responsibility ultimately falls on the physicians, nurse practitioners, physician assistants, nurses, and support staff. With ever-changing technology advancements and the continuous evolution of health disparities, it is critical to avoid the "it's always worked, so why change it now?" mentality. At the same time, attempting to achieve these goals without a proper plan can be exhausting, expensive, and inefficient. Therefore, it is important to understand the purpose of quality improvement and how to effectively execute performance improvement programs.

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Purpose of Quality Improvement

Some people question why providers, clinics, and hospital systems even worry about quality improvement, as they perceive it as "fixing what isn't broken." However, that is far from the truth. There are several reasons why quality improvement should be at the forefront of healthcare providers' radar, as it is imperative in the following:

• Improving the health of the population
• Enhancing the patient experience and outcomes
• Improving the provider experience
• Reducing the per capita cost of care

How to Design a Project

Designing an improvement project is a relatively simple process, and several factors should be considered beforehand.

• Clinical Setting: What is the available timeline? Which strategy for performance improvement is appropriate for this particular clinical setting?
• Current Performance: Are there any easily identifiable areas of improvement? Which performance aspect should be prioritized?
• Patient Population: What are the major features of the clinic's patient population (i.e. age, race, gender, health disparities)? Which intervention will have the most positive impact on the majority of the population?
• Institutional Commitment: Who will be at the forefront of the project? Who are the key stakeholders? Will this require a financial commitment?

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Plan-Do-Study-Act

A classic approach to the design and implementation of a quality improvement project is the Plan Do Study Act approach. This multistep process systematically breaks down the process and allows for proper monitoring of progress:

PLAN The first step of quality improvement is to identify a gap in care and define the goals for improving the performance. Quantify the desired improvement and set a timeframe to achieve the goal.

DO Complete the plan based on the defined time frame, ensuring that the duration is long enough to collect an apt amount of data.

STUDY Monitor the progress of performance improvement and compare the results to the goal that was set during the planning stage.

ACT Depending on whether the performance improvement was achieved, move forward with fully implementing, modifying, or resigning the program.

Ideas to Implement Into Daily Workflow

Primary care NPs can take the following steps to make concrete quality improvements in their offices:

1. Improving Annual Screenings in Wellness Exams: An annual screening can be time-consuming to complete, and time is not readily available in the medical world. However, continuously screening patients is imperative. Depending on the Electronic Health Record capabilities, patients may receive a request via online portal, email, or physical mail to complete and return by their appointment time.

2. Improving Slot Utilization in Primary Care: Effectively utilizing all available appointment slots is important to providing quality care and access to a patient population. One approach to improving slot utilization is to create a plan that schedules patients as close to the desired time as possible, rather than several days or weeks in the future and sending reminders. Additionally, in the case of cancellations, it is imperative to prioritize patients who were scheduled further out than clinically appropriate.

3. Increasing the Consistency and Efficiency of Medicare Annual Wellness Exams: Annual Medicare wellness exams are often lengthy, tedious, and time-consuming. However, they are pertinent for the geriatric patient population. To ensure that all patient appointments are consistent and efficient, a clinic may choose certain staff members to serve as the cardinal staff members who manage these appointments. Additionally, creating a checklist or flowsheet for these visits can keep them organized and boost the efficiency of each appointment.

4. Maximizing Patient and Provider Experiences by Improving Appointment Agendas: Creating appointment agendas can be an effective way to keep appointment times on-track and in turn allow a provider to see a larger patient load. A typical agenda design includes:
   • Asking the patient to list their concerns
   • Planning the visit by prioritizing immediate issues and saving the other concerns for a follow-up appointment
   • Reiterating the plan with the patient
   • Concluding visit and discussing follow-up

Continual monitoring of primary care workflow leads to efficient patient appointments and potentially better patient outcomes. Appropriate workflows can also reduce the incidence of provider burnout, as providers know what to expect for the workday and can prepare accordingly. If you already have a great workflow in your clinic, check out this list of other performance improvement projects.

Kesha Walton, DNP, RN, FNP-C is a practicing family nurse practitioner who also serves as an officer in an NP professional organization. During a recent meeting, the members discussed the noticeable decline in membership. This conversation alerted Dr. Walton to a professional concern and sparked an idea for her DNP evidence-based capstone project. Research for the capstone project revealed the following reasons for low participation in NP professional organizations:

• Personal and professional time constraints
• Cost of membership
• Working too much
• Lack of understanding around the nature of the organization

Are any of these reasons keeping you from joining an NP professional organization?

What Is a Nurse Practitioner Organization?

While many organizations exist, the national group that represents all NPs is the American Association of Nurse Practitioners (AANP). The AANP charges one affordable annual membership fee that connects the NP to one of eleven regions. Each AANP region has their own regional director and state representatives. Many other specialty NP organizations exist in conjunction with the AANP. All professional organizations share similar benefits:

• The ability to enjoy discounts on education and board certifications
• Access to practice and career support services
• The opportunity to engage in political advocacy
• The chance to collaborate through networking events

Acknowledging the professional expectation of membership, many NPs will pay the membership fee and take advantage of a few discounts and services. Identifying the unique value that you offer the organization is critical to accessing additional perks that are only known by those who participate in the group. NPs who are willing to actively engage in the organization are able to experience these unforeseen benefits.

Top Perks of Joining a Nurse Practitioner Organization

1. Discover a New Arena to Demonstrate Skills and Expertise

Finding like-minded professionals to support NP efforts and exchange ideas about current and future healthcare challenges is the key to staying engaged in your patient care practice. Taking an active role in subgroups of a professional organization showcases your value and unique perspective.

2. Increase Your Social Acumen

Social acumen refers to making the most of every moment you have with others. This means becoming comfortable with the "meet and greet" moments and other social rituals we use to connect with each other. You will develop a sense of confidence in making your first impression, which is critical to establishing memorable relationships and serving as a notable presence in the organization.

3. Find New Resources and Best Practices

Expanding your network of NPs and healthcare leaders will expose you to creative changes in your own environment. NPs who are excited to share novel projects, initiatives, and successes with their networks are a great source of support for making positive adjustments in your own practice.

4. Discover New Career Directions or Make a Job Change

A shared environment is a great place to hear what other NPs are doing, learn about jobs, and let others know that you are interested in new opportunities. Policy is a critical element of nursing. As the highest employment group in healthcare, it's important that nursing has representation in the government to guide lawmakers in patient protection and healthcare law. Ask to represent NPs on national committees or take part in research and data gathering to help legislators advance the NP role. You can also consider taking part in the Multi-state Reimbursement Alliance, an organization that tackles NP insurance reimbursement and credentialing. Additionally, the field of healthcare informatics requires educated professional users to participate in discussions about future needs and patient protection in the current internet age.

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5. Gain Recognition for Your Accomplishments

Many professional organizations offer fellowships and mentorship connections, which showcase accomplishments and guide industry contributions. Review award nominations and set professional goals for future consideration. Inform other NPs that you're interested in the awards and adding to NP professional contributions. Speak up and never apologize for it – NPs are educated, communicative leaders who deserve recognition for their accomplishments. Your success will inspire others, leading to future mentorship and a respected position in healthcare.

The Bottom Line: Become an Active Member of Your NP Organization

Joining a professional group offers an opportunity to develop relationships, share ideas, and expand your network. Being an active member provides you with a venue to maximize your strengths and improve on weaknesses. Active membership is about more than paying an annual fee and taking advantage of a few discounts. Consider investigating current policy initiatives and notifying members through emails or phone calls. You can also write articles for the organization's blog, suggest ways to increase membership, or participate in different committees. When people see your work, they will have a better idea about your competence and reliability—two aspects of NP life that are highly trusted and valued. Active membership allows you to gain recognition for your contributions, which ultimately leads to personal and professional growth.

RELATED: A 7 Step Health Policy Toolkit to Flex Your Political Muscle as a Nurse Practitioner

"If you want one year of prosperity, grow grain. If you want ten years of prosperity, grow trees. If you want one hundred years of prosperity, grow people."

This Chinese Proverb is a testament to the magic of networking with other professionals in a similar field. In fact, a survey conducted in 2016 revealed that 85% of jobs were fulfilled through networking. So why are nurse practitioners not actively practicing this method? It is not stressed in school, since our profession is not a sales-driven community. However, networking may land you in a top working environment, or provide you with connections that can continue to benefit you as you transform your professional identity.

Networking Tip #1: Offer Incentive

I am not suggesting you pay for your network, but sometimes it can help if you offer to treat your prospective referral with a coffee or lunch date. The life of a nurse practitioner is busy; work-life balance is an entire topic in itself. It’s courteous to offer to pay for a meal or coffee in exchange for picking their brain a little on their current career position. Suggest that they pick the best time and date for their schedule, so they are more willing to proceed with the meeting. During these unprecedented pandemic times, it may be harder to meet in person due to social distancing. This may work out in your favor for those who are busy! Familiarize yourself with Zoom, and suggest a quick Zoom call to check in and catch up. If you can't offer coffee or dinner, offer your help in some other way, such as promoting their practice or suggesting a referral program.

Networking Tip #2: Rehearse Your Questions and Conversation Starters

Consider your networking event like a very casual interview. Although you will most likely be conversing in a friendlier atmosphere, it is always a possibility a job may come from your networking experience. Write out a few points to make sure you cover during your meeting, and highlight any questions you have for your resource. It is also a good idea to have a quick, thirty second "elevator pitch" about yourself and your current job situation.

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Networking Tip #3: Scroll Through Your Rolodex

Not many people actually have a Rolodex anymore, but you understand the concept! The good news about obtaining a nurse practitioner degree is that you are required to have clinical time with other nurses, and this gives you an automatic contact list. These former classmates of yours may be working for employers who are looking for new providers, and they will be able to vouch for you first-hand and speak to your work and school ethic. Don't forget about the friends you made in nursing school, too! Many of them may have become NPs or advanced practice providers as well, and you can pick their brains about where they stand now. Sometimes it can feel awkward to message someone out of the blue, but more often than not your former schoolmate will be excited to reminisce and catch up. If you don't have their number, try messaging them on a social media platform.

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Networking Tip #4: Join a Facebook Group and Tidy Up Your LinkedIn Account

Facebook is a great tool to use for networking; the entire premise of the application is to mingle with other like-minded individuals. There are many local and statewide Facebook groups that pertain particularly to nurse practitioners and advanced practice providers, and they can be a great networking tool! The groups highlight many job postings, volunteer opportunities, and educational resources. This may also be an easy way to initiate a prospective in-person meeting, where you can have face-to-face contact with other NPs in your area. LinkedIn is a prime tool for networking – it is literally a network of millions. Update your profile picture, provide some links to your page, and ask some of your connections to endorse you and your skills.

“Networking is a lot like nutrition and fitness: we know what to do, the hard part is making it a top priority.”

– Herminia Ibarra

There is an art to networking, and these tips only brush the surface. It can sometimes feel uncomfortable approaching someone that you do not know very well, but most professions run entirely off of networking. Although the healthcare field does not rely solely on mingling to make business run, if you break your comfort zone a little and make the right connection, you may find yourself in your dream job that would not have been possible previously by a sea of online applications.