Did you know that nurse practitioners can work in primary care and specialty care?
In this episode of “& so much more,” our host Cami Smith sits down with Morgan McDowell, the Director of APP (Advanced Practice Provider) Education and a nurse practitioner at Centra Health to answer these questions and more. Together, they delve into the world of healthcare education and debunk some common misconceptions surrounding clinicians who are not doctors.
Morgan, an APP herself, sheds light on the comprehensive education and training that Advanced Practice Providers undergo. From nurse practitioners to physician assistants, APPs play a vital role in healthcare delivery that is effective and patient centered.
In their discussion, Cami and Morgan also help us to understand the extensive knowledge base and skills that APPs possess. Directly challenging the stereotypes often associated with non-physician caregivers, this conversation ultimately helps us to understand the vital role that these providers play in shaping the delivery of healthcare both now and into the future.
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Transcript
Cami Smith:
Hi, and welcome to & so much more. My name is Cami Smith and I am your host, and I am here with Morgan McDowell, who is the director of APP education, as well as a nurse practitioner here at Centra. We're going to have a conversation today about this term APP. What is it? What does it represent for your care experience here at Centra? I know that before I came here to work at Centra, my primary care was a nurse practitioner. I did not know that that categorized her as an APP, nor did I know what an APP was, so I think that there's some education to be done. There's so much we can learn to better inform us as community members, as patients, as we're stepping into a primary care relationship. So, Morgan is the go-to for this, and I'm so excited to have you here. Before we jump into all of that, we unpack everything, tell us a little bit about yourself.
Morgan McDowell:
Sure. Well, thank you so much for having me. This is going to be really exciting and fun. I've been a nurse practitioner at Centra for about seven years now in urology, so I specifically work in a specialty practice, but you're right, nurse practitioners, advanced practice providers can work anywhere in specialty, outpatient, inpatient, primary care, all across our health system, which is really cool.
Cami Smith:
Okay. What brought you to Centra? When did you come to be a caregiver here?
Morgan McDowell:
I actually worked first in primary care, and that's pretty typical of a lot of our advanced practice providers across our systems. I worked in primary care out of Richmond, Virginia. I'm from the state of Virginia, and got an opportunity to interview here, which would actually put me a little bit closer to home. I have family in the community and close by, so it was really important to me to be close to family and to really feel a part of my greater community, and I really feel that here in Lynchburg.
Cami Smith:
Oh, I love that. So Lynchburg native?
Morgan McDowell:
Not a Lynchburg native, but not far up the road.
Cami Smith:
Okay. All right. Well, I love that you get to be here close to family. It is such a great community in this, I want to say the Centra health system area from Bedford to Danville to Lynchburg. There's so much history, and so it is a fun place to be. So nurse practitioner, what is your role as nurse practitioner before we jump into what is an APP and then we'll kind of dig a little deeper?
Morgan McDowell:
Sure. Absolutely. So most of your nurse practitioners are going to be registered nurses first. Most of your nurse practitioners have RN experience at the bedside, but they also either have a master's degree or even a doctoral degree in nursing. They are credentialed and licensed through their professional organizations and the state to come in and provide care. That means they can see you clinically, they can order labs and tests. They can provide essentially all of your primary care and specialty care in a lot of different ways in conjunction and collaboration with your physician care team.
Cami Smith:
Okay. Very cool. So what is an APP? An APP?
Morgan McDowell:
I know, I feel like we play constant alphabet soup here, right? It's a lot of language and a lot of letters to remember and keep straight. When we think about an advanced practice provider, we're thinking about any one of four different groups of people. We're thinking about nurse practitioners, we're thinking about physician assistants or physician associates, as they're sometimes called now as well, for abbreviations PAs. We have our nurse midwives, which is a huge group at Centra Medical Group providing care for women as well. Then we also have our CRNAs, so our anesthesia nursing team, which is in the hospital providing anesthesia care for our patients as well.
Cami Smith:
Okay. I mean, that's a lot of different types of providers. I think about when you're coming in and you're setting up, you want a primary care. How many of those different types of APPs are available as a primary care doctor?
Morgan McDowell:
Absolutely. You're typically going to see in the primary care setting your nurse practitioners or your PAs.
Cami Smith:
Okay. That will be at any one of our CMG nationwide or anywhere where you're going and you're facilitating a relationship?
Morgan McDowell:
Absolutely. We have APPs pretty much in every primary care facility that we have at Centra, from Farmville to Moneta at the lake, at the village, to Bedford, to Danville, to Keysville, to Brookneal, all the places, which is really great.
Cami Smith:
There's so much. There's a very wide field where, I mean, really anywhere you go, you have the option to choose an APP as a primary care. What else? What other types of appointments will you experience care from an APP?
Morgan McDowell:
Well, we also have APPs in a lot of our specialty practices at Centra, so it'd be that cardiology, urology, neurology, general surgery, CT surgery. Our cardiovascular team has a huge group of advanced practice providers providing care. Inpatient, outpatient, and the urology group, for instance, where I work, we see patients only in the office right now. We take call, for telephone call. We're getting patients ready for surgery to go to the OR with our surgeons. We are managing their chronic medical conditions from a urology standpoint. It's just a really great relationship because we all get to work together as a team to provide excellent care.
Cami Smith:
Yes, I love that. As someone is coming in to make an appointment, they're looking for primary care. There seems to be this misunderstanding that an APP cannot provide the same level of care as an MD or DO, and that's a huge misconception. How can you bring some clarity to that?
Morgan McDowell:
I think helping our community understand that this is the education that these folks have. They are fully educated and prepared to take care of you no matter where you are in life. Healthy, well, sick, not sick, all of those things. What a great opportunity in our community to have kind of a different viewpoint and a caretaker that's really invested in your health and wellbeing, and you're going to find that with an advanced practice provider in primary care. Those are the folks that are your window to your specialist, right? It's so important that you see your primary care provider on a regular basis.
Cami Smith:
It's a relationship that's going to provide so much insight into your care.
Morgan McDowell:
Absolutely.
Cami Smith:
As director of APP Education, what does that role look like? What type of initiatives? How are you approaching education for APPs?
Morgan McDowell:
Well, that's a great question. The role is new, and so it's a work in progress. But what we've learned over the last few years, one with COVID, we haven't done a lot of good work at communicating our expertise through the Centra networks. We have experts in every area at Centra in so many different ways, be that a physician or an advanced practice provider. We've really getting backs to providing local education for our specialty providers, our primary care team, and even our community providers as well, which is really huge.
Cami Smith:
Has there ever been a situation where you have had to provide that level of clarity to either a patient or a caregiver to just help with some of the misinformation that's out there?
Morgan McDowell:
Oh, it happens all the time. I think my best example is very personal. There's often scenarios in the specialty world where one of my physicians is called to the operating room urgently because they're on call and that patient that's on their list to be seen clinically is then flipped to me or one of our other nurse practitioners in urology. So immediately you might be walking to the room where someone's not expecting to see a nurse practitioner, maybe has never seen a nurse practitioner clinically, and it's a really great opportunity to have that conversation to say, "My name's Morgan. I'm the nurse practitioner. I'm so sorry. Dr. Passman had to go to the emergency room, but I'm going to provide excellent care for you today. I've read your notes, I've read up about you. This is what I know. Tell me more."
I think opening that conversation up, really having a moment to connect with that patient, especially if they've never had a nurse practitioner before providing their care. It's important to build that relationship and trust and it doesn't happen immediately, right? You have to have time to do that. It's really wonderful when you can go into that patient encounter and convert someone who wasn't... Maybe was a little bit more concerned about seeing a nurse practitioner for the first time, and they come out of that room and say, "Hey, you know what? That was really great. I'm going to follow up with you in a few months."
Cami Smith:
Oh, that's wonderful.
Morgan McDowell:
It is. It's really nice to build those relationships and show folks that "we're here to take care of you too and we're working with your physician team to do that."
Cami Smith:
I love your approach of "I'm here to provide you excellent care." I think creating that first experience that that person's going to have with an NP or in many cases any kind of APP, and you're making it a good one. You're kind of setting the stage. Have you ever had a negative experience where you've had to educate?
Morgan McDowell:
Sure. Well, I think just recently Robbie Price and I did some presentations about APPs and what we can do. I was amazed at some of the folks we were educating, and these were actually people in healthcare. These were not just community members, but really didn't know that nurse practitioners can prescribe controlled substances, that we can order and interpret lab results. We can order imaging and review that. We can refer you to a specialist, sign death certificates, refer to home health and hospice. There's a lot of confusion about what we can and cannot do, but truly we're less limited than we are capable. There's a lot of opportunity here to continue to educate our community about those things.
Cami Smith:
It sounds like there is some definite work to be done. If there was one point that you believe would be most crucial to help change this understanding, what would that one message be for the community, and I guess for caregivers as well?
Morgan McDowell:
Yeah, so it would probably have to do with the fact that all of our advanced practice team at Centra are really some of the best and brightest in their field. These are people that are highly educated, highly experienced in a lot of ways, and really just want to partner with you for your best life.
Cami Smith:
What can you tell me about the uniqueness of each type of APP?
Morgan McDowell:
Yeah, great question. Complicated question, but a great one. I think one of the biggest differences, for example, between a PA and a nurse practitioner is going to be that the PAs have a very generalized education. PAs can graduate from school and really, truly go into any area of medicine. They can go into primary care, they can go into specialty clinic, whereas your nurse practitioner is going to be more focused in school and have a specific certification. A great example of that is at Centra is that we have neonatal nurse practitioners. These folks only take care of our neonatal patients up at the ICU at Virginia Baptist, so fresh brand new babies coming into the world, which is really amazing, and we have a phenomenal team of them.
Another example of this would be where you have psychiatric mental health nurse practitioners, and these are our team members that work at our counseling center, that are going to be working in our brand new EmPATH Unit when that's up and ready and already working in consult work at the hospital. The slight difference there is you may see folks in different areas doing different things, but they have the education to do that.
Cami Smith:
Yes. The important takeaway really is that when you come here to Centra, whether it's for primary care or a more specialized visit, there is going to be someone as a part of that care team who's going to take very good care of you.
Morgan McDowell:
Absolutely.
Cami Smith:
Yes. That actually sets up a conversation that we are going to be having in one of our upcoming podcasts where we're going to talk about what the entire care team looks like, and that will include the APP side of things, the medical doctor side of things, but also the different ways that you can step into care and find care here at Centra, so be on the lookout for that. But thank you, Morgan, so much for helping us see the intricacies. There's so many little intricacies, but it's so important for a patient to feel that much more comfortable to step into a room. I hope that as you all are making these appointments, that when you meet a nurse practitioner, you can actually sit back and really understand that you're getting excellent care. Thank you for listening today on & so much more.