Nurturing the Next Generation of Compassionate, Market-Ready Providers

Libbie Hall has served as the Program Director for the Family Nurse Practitioner master’s degree Program (FNP) at Columbia Nursing for nearly 20 years. In addition to overseeing course content and enrollment, she monitors clinical placements for nearly 200 students enrolled in the program each year.

Hall teaches several classes including the Family Care practicum and its clinical component. She practices at two Washington Heights outpatient clinics affiliated with NewYork-Presbyterian Hospital providing care to underserved New York City families. She earned a bachelor’s of Nursing Science from William Patterson College, a post -certificate with a concentration in diabetes from Yale University, a Master of Nursing Science degree from Pace University, and a DNP from Columbia Nursing.

Q: The FNP program at Columbia Nursing is our specialty with the largest enrollment. How does our program differ from FNP programs offered at other schools?

Our students learn to educate their patients on how to maintain their health, not just how to prescribe medications. When they graduate, they are market-ready, compassionate providers.  Our program is based on consecutive learning:  Our FNP students are taught how to take full patient histories and provide physical exams in their first semester.  Next, they learn to develop diagnoses and care plans based on the patient’s presenting symptoms. Finally, they learn to care for patients throughout their lifecycle in their clinical rotations.

These rotations represent a full range of health care settings: a newborn nursery, an inpatient hospital setting, a nursing home.  Columbia Nursing provides carefully vetted rotations to all of our students, while some nursing schools require students to obtain their own clinical placements. In addition, many of our clinical placements have an interprofessional component. Our students build connections with doctors, pharmacists, social workers, and other professionals with whom they will eventually collaborate in the workforce.

Q: A lot has changed in the last decade: Primary care providers, including family nurse practitioners are increasingly delivering care in outpatient sites like urgent care centers, and retail health clinics. How has this new clinical climate changed the way we teach our students?

Columbia Nursing’s FNP program continues to evolve to meet the need of our changing health care system. Our curriculum reflects the reality that patients are living longer with multiple complex, chronic conditions. Take diabetes treatment, for example.  Two decades ago, just a handful of medications controlled diabetes. Today, we rely on multiple forms of insulin, renal protecting drugs, lipid lowering medications, and glucose lowering treatments.  We’ve also incorporated eye and foot exams for diabetes patients into our curriculum based on Joint National Committee guidelines.  Our patients’ psychological needs have changed as well: Twenty years ago, depression held a much stronger stigma and fewer people sought treatment. Today, our students learn to screen for depression and PTSD.

In the past, insurance companies paid for almost everything, but now, many drugs and therapies require prior authorization. Our students are taught how to negotiate with managed care companies on behalf of their patients.

Q: Columbia Nursing’s FNP program approaches patient care broadly, taking into consideration the family’s physical, emotional, mental, and social needs. When students are integrated into their clinical rotations, how are they educated to provide care within this framework?

One way we prepare our students to provide holistic care is by placing an emphasis on teaching them how to take a thorough patient history. Certain questions can uncover important information: If the patient is unemployed and uninsured and can’t afford the treatment you prescribe them, if they rent a room in an apartment with no access to a kitchen where they could prepare healthy meals to better control their weight. I recently examined a patient in my clinic with one of the worst cases of psoriasis I had ever seen. He had resorted to using an herbal remedy that his mother sent him from South America, which may have made the condition worse. I knew that he was uninsured, so I sent him to an Emergency Department where he would be seen quickly and receive a referral to a dermatologist.

Q: Throughout your tenure at Columbia Nursing, you headed several NP clinics in the Washington Heights community. What benefits and challenges have you experienced working with a primarily immigrant, economically disadvantaged population?

I have treated children who now bring their babies to see me!  I’ve witnessed patients endure difficult hospitalizations, the death of family members, the suicide of their children. I’ve learned economically disadvantaged patients care about maintaining a state of good health for them and their families.  I’ve seen that some of these patients don’t like traditional medicine, so I try to incorporate holistic modalities like acupuncture, acupressure, physical and occupational therapy into their care.

The knowledge deficit of many patients is one of my biggest challenges. Sometimes underserved patients place too much value on getting a scan or test performed even it’s not necessary.  Advantaged patients tend to research their conditions more. Disadvantaged patients can bring inaccurate medical information or outmoded remedies into the appointment, hoping you will validate it.

Q: How can newly minted nurse practitioners be better eased into the workforce?

I think that formal nurse residencies for graduate nurse practitioners are a great way to ease new grads into the workforce. Residencies can integrate what they learned in the classroom and in their clinical rotations, without adding extra didactic work. Participating in a residency program will empower nurses by providing them a structured transition to adapt to a new work environment.