Life (and Work) After Nursing School: A Preview

When she began Columbia Nursing’s Entry-to-Practice (ETP) program, San Francisco native Anna Szarnicki wasn’t sure what job opportunities might be waiting for her as a psychiatric-mental health nurse practitioner. To her delight, she discovered a world of options, thanks to her informal mentor, Abby Stuthers '98, MPH, with whom she was paired for a unique day-in-the-life experience last January—a new initiative jointly launched by Columbia Nursing’s offices of student affairs and alumni relations.

The Winter Break Alumni-Student Connection paired more than 75 students with alumni working in their fields of interest, either in New York or back in their hometowns. The pilot program had two goals: first, to offer students an insider’s view of the broad range of career paths available to advanced practice nurses, and second, to expose them to the breadth of workplace options outside hospitals and in other settings they may not expect. That was also a goal of alumni, many of whose comments revealed a common theme: that advanced nursing practice rewards those who embrace entrepreneurship, value autonomy, and make leadership a habit.

Perfect Pairings

“I was blown away that Abby is doing exactly what I want to do,” said Szarnicki. Having experienced mentorship programs at other institutions in the past, she was pleased by the appropriateness of her match with Stuthers, who works in the setting and with the population that most interests her—an Upper East Side shelter for men diagnosed as MICA (mentally ill/chemically addicted).

During her time with Stuthers, Szarnicki learned that, depending on the level of bureaucracy and time constraints of a particular setting and population, psych NPs may spend a lot of time doing medication management and often find it challenging to focus on therapy and “quality time” with patients. Stuthers valued the experience, too. Curious about the ongoing changes in Columbia Nursing Psychiatric-Mental Health Nurse Practitioner program, she learned through Szarnicki that “it goes deeper into advocacy for patients, advanced practice, and for systems change that focuses on creating more humane, less bureaucratic interdisciplinary care environments for our patients who need greater access to services.”

Michelle Stupka, a first-year ETP student interested in becoming a pediatric nurse practitioner (PNP), was matched with Rachel Samuels '05 '07, PNP, who works with chronically ill children—most diagnosed with severe neurodevelopmental disorders—in foster care at The Children’s Aid Society. Stupka accompanied Samuels on children’s foster-home visits and at a specialty appointment at Kings County Hospital, where she met a young boy living with cerebral palsy and global developmental delays.

            “He was incredibly fearful of his medical appointment,” Stupka said, “but as we consoled him and tucked him safely back into the stroller, he smiled at me. He was nonverbal, but what he communicated through his smile really touched me. He lit up and it lit something up in me, too. It is a privilege to witness the resiliency in these children and it makes me even more passionate about a career in pediatrics; these children are truly inspiring.

“It exposed me to a population of medically fragile children in our community, and let me see firsthand how intertwined a family’s psychosocial situation is to the health and development of a child,” Stupka said. She learned that most of the children served by the Children’s Aid Society are from families who live in poverty and rely on public services such as welfare and housing assistance, and cannot provide their children with medical and supportive care. Many children are placed there because of other family problems, including mental illness, substance abuse, and domestic violence.

Out of the Box

Margaret Romero '98 '00, NP-C, lives and breathes entrepreneurship, working full time as the medical director of an integrative medical office on the Upper West Side of Manhattan, and leading a weight-loss business she founded. She was matched with second-year Adult Geriatric Primary Care Nurse Practitioner student Lara Trevino, whose main interest is in complementary and alternative medicine.

“From my clinical experience,” said Trevino, “it seems like patients are interested in taking active roles in their health but sometimes do not know how to manage the stress of their disease. I am interested in learning about alternative practices because it encourages preventative care that can be more individualized and comparable with a patient’s values, worldview, belief, and philosophical orientations toward health and life.”

Indeed, Trevino got the opportunity to learn firsthand from Romero, a 10-year veteran of the field, how integrative, or functional, medicine differs from mainstream, Western practice. For example, Trevino learned how to think more holistically, considering a person’s general well-being instead of focusing on separate body systems. She learned from Romero how “slowing down helps patients manage their lives and heal by maintaining good sleep hygiene, meditating, and learning appropriate nutrition.” She appreciated the time Romero took in evaluating patients and taking their histories—a full 45 minutes in one case—and suggesting combinations of functional testing, vitamin supplementation, and meditation—that would address a patient’s complaint.

“I applied this thinking with obese moms in the Bronx,” said Trevino. “One patient said she had stress headaches and would eat to relieve her stress. I encouraged her to watch free yoga and meditation YouTube videos, and she has significantly fewer headaches and has lost 20 pounds. She learned how to take an active role in her health care and feel motivated to improve her life.”

Romero believes that NP students should know that, with so many career options, including travel and per diem work or autonomous practice (in New York), they don’t have to feel locked in to hospital or clinic jobs.

“The fun part is creating the job and life that YOU want rather than relying on whatever full-time jobs are out there,” Romero said.

Stuthers agrees, saying: “Whenever I tell nonmedical folks what I do, their first question is always, ‘which hospital?’ Working in a hospital is a great fit for many people, but I prefer the autonomy, immediacy, and mission of the not-for-profit experience.”

Each One, Teach One

As much as they offered their students, the alumni reaped rewards from their experience, too.

“The thing that resonated with me was how I remember having many of the same questions she did when I was starting out as a new nurse,” said Samuels. “When there are so many opportunities and unknowns, where do you even begin?”

She turned that memory into a valuable experience for Stupka, who said it made her consider how nurses are in a unique position to see families’ socioeconomic challenges through the lens of health care, and how the cornerstones of nursing—advocacy, teaching, and patient education—address them. Samuels, who is also a preceptor for ETP students in their community health rotation, took Stupka under her wing when she requested a placement with her for this semester.

For Samuels, the reward was clear: “As a graduate of the same nursing program, I have the opportunity to come back and speak with incoming professionals such as Michelle, who will be joining me in a career that I love and am so passionate about; that’s exciting for me.”

Stuthers has a different take. “I entered nursing in the mid-’80s,” she said, “when the field was negatively publicized as one where experienced nurses were unreasonably tough on newer ones. I always want to be an example of how untrue that is today! Just by offering a little of our time and hospitality, we can add value to a student’s education and expose them to something they’ve never considered.”

“One of the most valuable aspects of my nursing education now is gaining insight and knowledge from experiences of those well established in the field,” said Stupka. “Having somebody to talk with who has gone through our program and who matches my own goals has been invaluable. I would be more than willing to give back in the same way.”

-Sibyl Wilmont '08