Nurse practitioners. Last month was nurses’ month – yes that’s correct, we have been upgraded from the previous nurses’ week. As the month comes to an end, I would like to briefly reflect on the role of the nurse practitioner (NP) in the epilepsy field.
Figure 1. Team of Epilepsy Nurse Practitioners – from left to right: Sarah Tefft, CRNP 3+ years, Erin O’Connor Prange, CRNP 20 years, and Barbara Beck, CRNP 15 years (now retired).
History of the NP. The first NP program was created in Colorado by Dr. Loretta Ford and Dr. Henry Silver in 1965. The program was created to increase patients’ access to pediatric care. There are now more than 355,000 licensed nurse practitioners in the United States. I tend to tell people the difference between a nurse practitioner and physician assistant is that a nurse practitioner has their advanced degree in a specialty area whether that be pediatric-primary care, pediatric-acute care, family, psychiatric, or women’s health, to name a few.
NPs in Epilepsy. Nurse practitioners play a vital role in caring for patients with epilepsy. The most difficult piece of integrating into the role of a nurse practitioner in epilepsy is having to learn the “ins and outs” of epilepsy care. My advanced degree is in pediatric-primary care. While my degree was not geared towards any one specialty, it gave me the necessary tools to continue to learn and develop a fund of knowledge specific to caring for patients with epilepsy. Fortunately, my nursing experience in neurology as an epilepsy and ketogenic diet nurse helped prepare me to enter this new role as a nurse practitioner in epilepsy.
NPs in Neurogenetics. As I stated above, my advanced degree prepared me for a job in an outpatient pediatric practice. Throughout graduate school, I had exposure to both primary care and subspecialty clinics, where I learned valuable clinical pearls that stay with me today. Genetics education is a small part of undergraduate and graduate nursing curriculums, and for this reason, we rely on our clinical practice to learn the implications of genetics in epilepsy. For any nurse practitioner looking to enter a genetics clinic, being a part of the resident teaching clinic was the best way for me to learn and build upon my knowledge. I felt supported by everyone I work with from the attendings and genetic counselors, to the other residents and fellows learning alongside me. This clinic has also been able to increase access to care for genetic testing in epilepsy and neurodevelopmental disorders.
Why use a nurse practitioner? I like to think that an advantage I bring to clinic is seeing a bigger picture of the patient and their family. As an epilepsy nurse, I would spend hours working on medication and nursing approvals for families. Now when ordering genetic testing, I take into consideration the who, what, where, when, and why. At times it might make more sense for families to meet their deductible and then pursue genetic testing when it is a nonurgent situation. Genetic testing is becoming more and more affordable but ordering it at more strategic times is something I help families think about and this might vary differently if the test was ordered by a physician.
Resources. Nurses tend to be exceptionally resourceful. As such, nurse practitioners can often help patients and their families solve things like giving a bad tasting medication, requesting an IEP in school, and finding support locally. Nurse practitioners can also run vagus nerve stimulation clinics as well as now deep brain stimulation clinics. I have a ketogenic diet clinic to help make recommendations in adjusting the diet for the best possible outcome. Nurse practitioners also work in collaboration with physicians in a variety of specialty settings, including epilepsy and neurogenetics. Having a nurse practitioner as a part of the team increases access to neurogenetic testing for patients with an unknown cause of epilepsy and neurodevelopmental disorders.
Future. It will be critical in the future to continue and expand upon NP educational opportunities in subspecialties. I hope to one day see more post-graduate certificate programs in subspecialties. I look forward to the growth of nurse practitioners in epilepsy and the expansion of these programs to both contribute to widening nurse practitioners practice as well as providing additional resources for families in the field of epilepsy.
This post was co-written by Sarah Tefft and Alexandra Buonomo.
