Anniversary Issue November 2021

SPECIAL ANNIVERSARY ISSUE

NOVEMBER 2021

How NP Student Founder,

Dr. Little is Nursing with Intention

Inside this Issue

Influencers You Should Know Brianna Bradley Clara Jones Naomi Morson

Best Dressed at Clinicals Lifestyle Creep What it is and how to prevent it The Ultimate Guide to Care for Veterans And more!

NURSING WITH INTENTION SCHOLARSHIP DETAILS INSIDE

Contents

Anniversary Issue November 2021

Feature Column

05

Best moments of NP Student Magazine

08

Meet our 2021-2022 Advisory Board

07

Influencers You Should Know

11

Best of NP Student Magazine 2020 - Where are they now?

18

Have you ever served?

13

From DNP to Developer: NextLvl projects with Dr. Cashmere Miller

21

Lifestyle Creep: What it is and how to prevent it

22

Best Dressed at Clinicals

15

23

What every NP should know about standards of care and documentation

The Patient Perspective Cover Model Dr. Patrice Little Photographer Jason Grindle Photography © Venue The Cupcake People

Letter from the Editor

W

hen we first launched in 2018, I was nervous about how the magazine would be received and unsure of how this publication would unfold. NP Student came on the scene engaging the nursing community in a way no other nursing organization and publication had done before. In this issue, we celebrate the growth of a platform that has proven to be by your side even in the darkest moments of life and practice.

We started with doing Facebook live interviews featuring products and services to help you navigate NP school. Then, in 2019, we began featuring NP experts on our YouTube channel for inspiration because let’s face it, we all get into a funk sometimes. By 2020, our digital platform had over 300,000 impressions and three approved courses that offer contact hours. It’s no surprise that our 2021 theme was Nursing with Intention because everything thing we did was with you in mind.

In retrospect, I’ve always led a life of intention when it comes to my well-being, career, and relationships. I didn’t realize I was modeling that for you until now and here’s how: 1. I am selective with my time and only participate in activities that matter.

2. I strive towards the big picture and remain open for occasional compromise.

3. I embrace living in the moment yet I’m guilty of hanging out in the clouds when thinking about the future.

4. I schedule daily breaks to remain balanced and abundantly resourceful.

5. I take pride and joy in seeing others soar after an encounter with me because it feels good to make a difference.

We are now entering 2022 with the wisdom, courage, strategy, and tools to be great in how we serve you in and out of school. My wish now is for more students and faculty to take the lead in this platform that was built just for you.

Thank you for three spectacular years!

Cheers,

Patrice Faye Little, DNP, FNP-BC CEO and Founder, NP Student Magazine NP STUDENT | NOVEMBER 2021

4

Best moments of NP Student Magazine

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tor of the Year, 2020 M.O.D.E.L. Precep John KampSchmidt, NP

Breonna Leon All Smiles as Host of NP Week for NP Students 2020

ginp and Dr. Little Kadia Prospere, @kadiatheyo k Segment 2019 Behind the Scenes, Let’s Tal NP STUDENT | NOVEMBER 2021

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NP Student Magazine™ (NPSM) is the premier digital lifestyle and educational publication for Nurse Practitioner (NP) students. Since 2018, we have solely dedicated our time to keeping NPs updated with every aspect of their lives in and out of school.

As the first platform to offer curated content to help NP students throughout their lifecycle. We highlight extraordinary lives and link students to resources to help them dominate their learning experiences. We are thrilled to share ideas from students, and some of the best NPs and leaders in the profession to inspire you to make the best decision for life, career, and business.

Direct inquiries or comments to the editor: NP Student Magazine P.O. Box 1773 Duluth, GA 30019 For SUBSCRIPTION INQUIRIES or BACK ISSUE ORDERS, email info@npstudentmagazine.com For ADVERTISEMENT INQUIRES call 770-325-5236 Opinions expressed by contributing writers, Nurses as Writers’ interns, and guests are their own and not necessarily those of the publisher or editor.

Articles appearing in this magazine may be reproduced with written permission and appropriate credit given to authors and NP Student Magazine.

The editors welcome unsolicited manuscripts and photographs.

The publisher reserves the right to accept or reject prospective advertisements that appear in this publication.

Please email submissions to editor@npstudentmagazine.com NP Student Magazine is a glossy, full-color and full-size magazine, available by mail to every major NP employer throughout the United States. © 2021 A publication of NP Healthcare Solutions, LLC. Printed in the U.S.A.

Founder & CEO

Patrice Little, DNP, FNP-BC Editor In Chief Intern

Katelyn Barker Reviewers

Dr. Genevieve Mbamalu DeAnna Emborski Marketing Director

Jason Cadogan Photographer

Jason Grindle Contributors

Jovan Johnson, MBA, CFP®, CPA/PFS Melody Saheb, MSN, RN Anna Sanchez, MSN, PMHNP-C Hahnah Williams, Esq, RN Special Thanks

Tia Wheeler-Barnes Dr. Leslie Neal-Boylan Angela Childs Charisse Chitolie Elizabeth Francis Richard Galarza Jaquitta Williams Graduate Nursing Student Academy

NP STUDENT | NOVEMBER 2021

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INFLUENCERS YOU SHOULD KNOW

by Melody Saheb and Katelyn Barker

S

ocial media, for the past decade, has taken the world by storm. Social media has impacted people across the world with ever-changing trends and influences. Even with all the popularity social media has with the public, platforms like Facebook, YouTube, Instagram, TikTok, etc. could not stand alone without the help of the influencers that engage with the public and in your case influence practice.

We had an opportunity to connect with some NP influencers and here’s what they had to say.

Clara Jones

Brianna Bradley

You know her as @NurseClara

You know her as @brithenp

Playlist Top Three

Playlist Top Three

■■ Warriors by Allen Stone

■■ Anoti by Wizkid

■■ Wading in Waist - High Water by Fleet Foxes

■■ Cycles by Jonathon McReynolds

■■ The King by Sarah Kinsley Who is your biggest influencer(s) and why?

My mother. She has taught me to be unashamedly myself, to be passionate and to be curious. Her sacrifice in bringing me to the US, leaving her life behind so that I could have a better life is incredibly courageous and brave.

Talk about the biggest failure you’ve had.

What did you learn from it?

In nursing school, I failed my first skills validation of inserting a foley catheter. I prepared on my own and thought I was doing it right, though I was anxious and nervous. I thought that failing this 1 validation meant that I wasn’t meant to be a nurse. Failing this and revalidating taught me that 1. working collaboratively is vital to providing safe care and 2. Our failures only make us stronger.

You can bet that I’ve not missed a foley since!

■■ Straightenin by Migos Who is your biggest influencer(s) and why?

This may sound cliche, but God is my only influencer. He is the only person I strive to be more like, each and every day.

Talk about the biggest failure you’ve had.

What did you learn from it?

I really don’t recognize my failures as a failure because it has a negative connotation. I like to call them life defining moments because if they never happened I wouldn’t be who I am today. Everything that didn’t go as planned in my life helped me to learn, heal, and grow.

Naomi Morson You know her as @Naomi_moves Playlist Top Three ■■ Green Mountain State by Trevor Hall.

■■ Got You by Michael Franti.

■■ Que Más Pues by J Balvin & Maria Becerra

Naomi Morson Who is your biggest influencer(s) and why?

My collaborating physician. I bet you didn’t see that one coming! I am extremely for full practice authority, but in the state of Georgia, a collaborating physician is required to practice. Honestly, I could not have asked for a better doctor to work with. She is smart, extremely compassionate, and I have learned so much from her. I am grateful we landed together!

Talk about the biggest failure you’ve had.

What did you learn from it?

In my undergrad program, I made a C in one of my courses and was dismissed from the nursing program. I was devastated. I had a lot going on in my personal life that I let interfere with my classes. I had to work incredibly hard to appeal this, get back into the program, and graduate. It set me back an entire year. Honestly, I thought about giving up on nursing. But I knew deep down it’s what I was meant to do, and decided I wasn’t going to let one off semester and one bad grade determine my future. I ended up graduating with both my bachelors and masters degrees with honors.

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Meet our 2021-2022 NP Student Advisory Board NP Student Magazine is privileged to have the support and strategic partnership of our Advisory Board – comprised of a diverse group of experts representing business, finance, policy, military services, and practice. The board’s involvement is invaluable in expanding our student audience to include global networks. The board meets quarterly with the administrative team to provide their perspectives and advice to help move our mission.

What should every NP student know?

NP school takes commitment. It is very reminiscent of traditional undergraduate nursing in that it consumes much of one’s time and understanding how to balance school, work and life is very important to being successful.

I think it is also important that NP students remember to make time for self-care. Knowing when to walk away from the books and take a breather is so important to maintaining a sense of balance and inner peace to be able to carry on.

Melody Saheb, BSN, RN 2nd Year NP Student Georgia Baptist College of Nursing

What should every NP student know?

When you are applying to NP programs, check to see that the School is 1. accredited by the Commission on Collegiate Nursing Education (CCNE) 2. arranges your clinical placements and 3. requires you to verify your clinical skills through a rigorous process. “Fully online” is convenient but often does not meet these three criteria. A school that asks you to find your own clinical placement or just gives you a list of preceptors may cost less but your time and education is worth so much more.

I strongly recommend that you become a family nurse practitioner (FNP) even if you prefer pediatrics or adults.

The FNP credential is the most marketable!

Andrea Brassard, PhD, FNP-BC, FAANP, FAAN Associate Professor at the University of Maryland Baltimore School of Nursing NP STUDENT | NOVEMBER 2021

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What should every NP student know?

NP Students should: ▶▶ have a high degree of integrity. ▶▶ have a level of commitment to their chosen profession. ▶▶ have a passion for serving others. ▶▶ be committed to lifelong learning.

Captain Gregory Edwards Retired U.S. Marine

▶▶ strive to become intentional listeners for patient needs.

What should every NP student know?

I think every NP student should know that it is important to focus on clinical experience. Hands-on experience gives a different level of understanding.

Candice Selby Davie

What should every NP student know?

NP students understand that being an APRN is more than a way to escape the bedside. You must have the true quest for knowledge as the learning curve is steep from RN to ARNP and expectations are high as a new graduate!

Shane Grindle Family Nurse Practitioner

What should every NP student know?

The difference between a nurse and a nurse practitioner is not a topic that comes up in everyday conversation. I feel it is important to know who is taking care of you and how their roles differ.

Katelyn Barker 2021-2022 Editor In Chief

NP STUDENT | NOVEMBER 2021

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Viola Davis Georgia State Representative

Jovan Johnson, MBA, CFP®, CPA/PFS Financial Advisor and Planner

There’s more...we need your help too!

Would you be interested in participating as a reviewer? Reviewers evaluate articles based on NP Student Magazine’s guidelines.

Email Katelyn@npstudentmagazine.com for more information if this interests you.

Best of NP Student Magazine - 2020 Where are they now?

We checked in with our Best of NP Student Magazine 2020 Alumni family for tidbits of wisdom and updates.

Read High-yield Med Reviews’ story.

High-Yield Med Reviews Being a Best of recipient was one of our biggest highlights in 2020. Since then, our CEO and founder, Dr. Anthony Busti was honored to be invited to the NONPF annual conference to speak on the future of NP education. Our Institutional Account team has been working with many NP faculty members at NP programs and program directors across the nation to implement our integrated approach to pharmacology curriculum that includes courses for Advanced Pharmacology and NP Clinical Rotation Support.

We continue to offer an excellent review course for Pharmacology and Therapeutics. We also have helpful resources for students and clinicians including Top Drugs Review eBooks and Landmark Clinical Trials Reviews.

What should every NP know? The Nurse Practitioner profession is a high calling. It is easy to get bogged down when you are in school and focused on passing the course or exam, but keep your eye on the goal - the patients you will serve.

If you can strive to understand and apply the information you learn, you will be better equipped for clinical practice. Your patients will benefit from your hard work and commitment to excellence.

Dr. Anthony Busti

For more info visit https://www.highyieldmedreviews.com

Is there a book, podcast, workshop, or course that has made your life easier as an NP student? »» Nominate your favorite for Best of NP Student Magazine 2021. »» Nomination ends on December 15th »» Visit bestofnpstudentmagazine.com to nominate today!

NP STUDENT | NOVEMBER 2021

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From DNP to Developer : NextLvl projects with Dr. Cashmere Miller Photo credit: Cashmere Miller, DNP, APRN, FNP-C

NP Student: Tell us about you and nursing.

Dr. Miller: I am a Christian, wife, and mother of 3 boys. I grew up in Long Island, New York in a small, impoverished town called Wyandanch. I moved to Atlanta to pursue my college education in 2005. I have had a myriad of life experiences that have paved my career path to become a nurse practitioner and inspired me to work in areas where I can serve vulnerable populations. I have firsthand experience living in underserved communities and have experienced several forms of vicarious trauma. I am a huge proponent for health promotion and increasing health literacy in disadvantaged populations.

I am also very passionate about caring for people who are at increased risk of health-related problems. Many of the mentorship roles and professional experiences that I have held have afforded me the opportunity to better understand what health disparities exist. In a former role as an intern at the United States Department of Agriculture (USDA) Food and Nutrition Service I was imparted with a new awareness of how nutrition availability correlates heavily with lowering risk factors for food insecurity and chronic disease.

NP Student: What is a DNP? What inspired you to get one? What was your project about?

Dr. Miller: A DNP is a clinical practice degree that prepares advanced practice nurses to be leaders in the nursing profession and improve patient care through evidence-based practice. I was inspired to earn my DNP because I desired to be equipped at the highest level in my profession as a clinician, leader, and a researcher. Additionally, as a Family Nurse Practitioner with a practice-focused doctoral degree, I am committed to making evidenced-based changes that will improve the health of the patients that I serve. My DNP project focused on improving the transition from pediatric to adult healthcare. This project was influenced by my experience working as a public health nurse at DeKalb County’s Children’s Medical Services program. The program supports families caring for children with special health care needs. While working in this role I realized that many adolescents in the program with chronic medical conditions struggled to have a smooth transition to adult healthcare.

NP STUDENT | NOVEMBER 2021

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NP Student: What was your biggest challenge and how did you navigate it?

Dr. Miller: My biggest challenge initially was finding the right team to help me with the software development part of my project. I did not want to spend a ton of money to complete my project so began to look for help within my university. I was fortunate to find a professor and program coordinator of Information Technology and Informatics at Mercer, who loved my idea and was willing to assist me. I was able to connect with several professors and students who helped with the design, prototyping and coding for the project.

NP Student: Why is collaboration important when it comes to education/business?

Dr. Miller: Collaboration is important when it comes to education and business because it improves productivity and leads to more innovation. Collaborative learning has been shown to develop higher -level thinking skills in students. In business, it is a powerful tool to grow your network, solve problems, and save money.

My collaboration with Mercer University’s Information Technology department is part of the reason my DNP project was successful.

There have been a myriad of students who contributed to the website development and coding for the smartphone app. Additionally, several professors have been involved by teaching classes related to the project.

NP Student: What are you working on today?

Dr. Miller: Today I am working toward refining the features of the smartphone app. I want to ensure that it has the necessary components to aid the adolescent and medically challenged population with their health care needs and be a valuable resource. I really would like for the app to be useful for adolescents during their transition into adult healthcare. I am in the process of building a team to complete this project. My goal is to encourage health promotion and address some of the socioeconomic challenges. Throughout this process I also realized how practical the app can be to other populations. Therefore, upon completion of this project I intend to use the smartphone app to help individuals in other vulnerable settings.

NP STUDENT | NOVEMBER 2021

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What every NP should know about standards of care and documentation 1. What NPs can and cannot do is determined by their state practice environment and board of nursing. What’s the best way to communicate NP standards of care to an employer who has never hired an NP? Before communicating the NP standard of care to an employer, the NP must first ensure that they understand the NP standard of care. As a new NP, it is important to know how the legal system defines “standard of care,” and to what standards NPs are being held. Different states define “standard of care” in slightly different ways, but the medical “standard of care” typically means the degree of care and skill of the average health care provider who practices in the provider’s specialty, taking into account the medical knowledge that is available in the field. As a NP, you have a responsibility to treat your patients according to the standards that are recognized by your profession as being acceptable treatment.

Here are five key ways

the NP can gain knowledge of the standard of care in their specialty: (1) join a state and national NP association, (2) take continuing education courses that focus on the treatment of patients in your specialty, (3) subscribe to and read medical journals within your specialty, (4) become familiar with your state’s NP practice laws, and (5) review clinical practice guidelines collated by the National Guideline Clearinghouse. If you find yourself in a situation where you need to communicate the NP standard of care to your employer, then you can use one or more of the above documents to do so. You can also reach out to your NP association to request resources to assist you with this communication.

2. What are some key documentation tips for NPs? Accurate and appropriate documentation is key to protecting the NP in medical practice lawsuits.

A medical malpractice lawsuit can be deterred when there is strong documentation supporting the excellent care that was given. This is because plaintiff’s attorneys are less likely to accept representation when there is documentation refuting the plaintiff’s claims. Depending on the state that the NP lives in, medical malpractice lawsuits can be brought as late as 2 or more years after the incident. If the NP is sued in a medical malpractice lawsuit, the NP’s documentation will assist the NP in remembering the excellent care that they gave the patient. The NP will rely on their

documentation when testifying in a deposition

review and consideration. Contract negotiation

and/or trial. Here are some key tips for ensuring

is a crucial part of the NP job hunt! Think about

appropriate NP documentation:

(1) thoroughly

it this way – the NP contract solidifies the NP’s

document informed consent discussions, (2)

work schedule, salary, benefits, vacation time,

document

and continuing education. In addition, many NP

consults,

patient and

noncompliance,

communications

referrals/

with

other

contracts include non-compete clauses which

providers in the daily progress note, (3) document

restrict where the NP can work for a certain period

when diagnostics are ordered, reviewed, and

of time after their employment has ended. Here

discussed with the patient, (4) sign the chart on

are five things that every NP should do before

a timely basis, (5) follow facility policy for late

signing an NP employment contract:

entries, (6) follow the facility’s EHR policy for copy/ paste, and (7) be aware of EMR features that prepopulate fields and remember to “unclick” pre-

■■ Research the average salary and benefits for the NP position being considered. The easiest

populated information that is not accurate.

way to research average salary and benefits is

3. What key things should an NP look for when

held similar positions. The NP can also review

by inquiring with other NPs who hold or have

negotiating NP contracts?

job posting sites where NPs self-report their

New NPs are typically very excited to receive a job offer! Sometimes, this excitement causes a new NP to sign an employment contract without proper

this research when negotiating their salary and

salaries and benefits. The NP can reference benefits.

NP STUDENT | NOVEMBER 2021

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■■ Beware of vague contract terms. The contract

■■ Carefully review the liability insurance provision.

occurrence policy will cover this claim because

should clearly define the NP’s responsibilities

NPs absolutely need medical malpractice

the policy was active when the NP provided

and compensation.

The NP should request

insurance coverage to protect themselves

services to Patient A.

that vague and overly general contract terms be

from disputed services that result in a medical

revised for clarity. For example, if the contract states that the NP is required to “take call every other weekend,” the NP should ask that the contract state the exact day(s) and time(s) that the NP will be on call. As written, this language could mean that the NP will be on call for 24 hours starting Friday close of business to Monday start of business. The NP should also

malpractice claim. Medical liability insurance is also required in almost all states. The NP’s contract typically indicates whether the employer will provide malpractice insurance coverage for the NP, what amount will be provided, and who will pay the premiums. A standard contract clause can state that the employer pays the premium

■■ Next, “claims-made policies” cover claims that arise from services rendered during the policy period when the claim is also reported during the policy period. For example, an NP is covered

by Employer B’s claims-made policy in January 2021 and that coverage continues until October 2021 when the NP resigns from Employer B’s

for the NPs medical malpractice insurance, and

employment.

In November 2021, the NP was

the coverage would be at a certain amount per

sued for care that he provided to a patient in

clarify their “call” responsibilities when their “call

incident. As part of the contract negotiations,

March 2021. Since the NP is no longer covered

weekend” falls on a holiday or during a scheduled

the NP should determine what the employer’s

by Employer B’s claims-made policy, the policy

vacation. If the contract states that the NP is

insurance plans address. Does the plan include

would not cover this claim even though the care

required to work “full-time”, then the NP should

excess and umbrella coverage to cover damages

took place when the NP worked for Employer B.

inquire whether 40 hours/week is considered

in situations where the NP’s liability is found to

Will the NP, therefore, be responsible for paying

be more than the primary insurance coverage?

for defense attorney fees and damages? The

Does the plan include license protection benefits

answer is “yes” if the NP failed to purchase tail

to cover the NP’s legal fees if the NP is faced with

insurance coverage. Tail insurance effectively

a licensing Board investigation? As part of the

extends the limits of the NP’s former employer’s

“full-time.” The contract should include a defined number of hours that the NP is expected to work each week.

■■ Carefully review the employment termination

contract negotiations, the NP should ask their

provision. The NP contract typically addresses

potential employer for a copy of their insurance

the circumstances in which the contract can be

policy. The NP can also contact the insurance

terminated and the requisite number of days for providing notice. Typically, the contract will allow the employer to terminate the NP for a list of designated reasons which is known as

agency that wrote the policy to inquire about the details of such policy.

■■ Carefully review the tail coverage provision.

What happens when an NP is sued by a

“termination for cause.” The NP should ensure

patient that they serviced when working for

that they are comfortable with the different

their previous employer?

reasons that will allow their employment to be

employer’s insurance plan cover this claim

terminated. The NP should ask their potential

against the NP? The answer depends on the

employer to revise this provision to remove any reason that they are not comfortable with. The contract may also state that the employer can terminate the NP for any nondiscriminatory reason which is known as “termination without cause.”

The NP should ensure that this

provision is mutual allowing the NP to also end their employment without cause. The NP should carefully review any consequences for ending their employment before the end of the contract term. For example, some NP contracts state that the NP can end their contract for any reason by providing the requested notice.

However, the contract will typically include the consequences the NP will face for ending the employment before the end of the contract term such as paying an early termination fee, repaying

Will the previous

type of policy the NP had at their previous job and whether the NP took the necessary steps to protect themselves before they switched jobs.

In general, tail coverage protects the NP against medical malpractice claims that are not covered by the NP’s current liability insurance plan. To understand tail insurance coverage, the NP must first understand the difference between “occurrence”

and

“claims-made”

insurance

policies.

■■ Occurrence policies cover claims that arise from services rendered during the policy period regardless of when the claim is reported. In

claims-made policy.

In other words, tail

insurance covers claims for past incidents that are reported after their previous claims-made policy is terminated.

■■ Tail insurance coverage can be expensive. The NP should ensure that the contract spells out who is obligated to pay for the tail coverage. As part of the contract negotiations, the NP can ask their employer to pay for the tail coverage.

If the contracts list different conditions that affect tail coverage payment such as the length of the NP’s employment, then the NP should negotiate these conditions carefully.

For

example, the contract may state that the NP must be employed for at least 2 years to earn free tail coverage. The contract may also state that the NP must pay for the tail coverage if the NP leaves their employment before the end of the contract term. The NP should review these conditions carefully and negotiate terms that they are not comfortable with. NPs should ask an attorney to review any tail-payment language that they do not understand.

other words, occurrence policies provide lifetime

Hahnah Williams is an attorney and registered

coverage for incidents that occur during the

nurse who owns a law firm in Atlanta, Georgia;

policy period regardless of when the claim is

Hahnah Williams, Attorney at Law, P.C. As a

reported. For example, the NP serviced Patient

registered nurse turned lawyer with over 20 years

A in March 2020 while working for Employer A,

of combined experience, Hahnah brings a unique

benefits, forfeiting bonuses, etc. The NP should

who had an occurrence policy. The NP resigned

perspective to the representation of healthcare

ask their employer to remove any consequence

from Employer A in January 2021.

professionals.

that they are not comfortable with.

A sued the NP in March 2021. Employer A’s

Patient

For more information about

Hahnah, please visit www.hahnahwilliams.com

The purpose of this article is to provide general information, rather than legal advice or opinion. It is accurate to the best of the author’s knowledge as of the date of the article. Accordingly, this article should not be viewed as a substitute for guidance and recommendations of a retained professional and legal counsel. Attorney Hahnah Williams does not assume any liability for how this information is applied in practice or for the accuracy of this information

NP STUDENT | NOVEMBER 2021

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Have you ever served?

The Ultimate Guide to Care for Veteran

W

ho is a veteran? A veteran is someone who has served in the Army, Navy, Marine Corps, Air Force, or Coast Guard. They can be Active Duty, National Guard, or Traditional Reserves.

It is critical that all providers are able to identify our veterans who are at risk for both medical and behavioral health comorbidities. It is essential that we do our due diligence in screenings especially when it comes to suicidality, homicidally, alcohol and substance use. All of those of us in healthcare need to continue to enhance the treatment, increase resilience and guide veterans to find their purpose in life again. In this paper, I will share with you on how to approach and care for a veteran.

by Anna Sanchez, PMHNP-C

Veterans Today According to the US Census, there are roughly about 20 million veterans which is about 7.5% of the overall population. Currently, there are about 2 million women veterans in the United States which is about 10% of the overall veteran population. Presently, 1% of the U.S. population are actively serving in all branches of the military.

Veterans’ age ranges from 18 to over 100 years old. Many have deployed and served in the World War II, Korean War, Vietnam War, and other conflicts to protect our country. Many have been ordered to deploy around the world for the global war on terrorism. Many serve in different contingencies and humanitarian missions around the world.

Most Active Duty bases have Medical Treatment Facilities or MTF. After the veterans retire or separate from the military, they utilize health care services at the Veterans Health Administration (VHA). To increase access to healthcare, the U.S. Department of Veterans Affairs launched its Veterans Community Care Program from the 2018 Mission Act. This empowers the veterans to have different options for both their medical and mental health care. Currently, less than 50% of veterans receive their medical care from the VHA.

Screening for military service Due to the Mission Act, veterans are now being seen in the civilian sector. Healthcare workers in the community need to start screening patients for the military background. According to the Family Medicine Journal, (N=54) about 56% indicated that they have never asked their patients about their military NP STUDENT | NOVEMBER 2021

18

service. Only 19% stated that they do ask about military service in their patient population. In this small study, 71% had agreed that it is important to know if their patient was a veteran in order to properly care and provide education to this population.

What is the importance of screening for military service? In a 2012 study in the Journal of Public health, 596 veterans from the Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) showed that about 13.9% had a positive screen for post-traumatic stress disorder, 39% screened positive for alcohol abuse, and about 3% had screened positive of probable drug abuse. Take note that Army soldiers and Marines had worse mental health issues than those in the Air Force and Navy.

It is the responsibility of healthcare workers to have the awareness of historical events and other humanitarian efforts that our military service members have been involved in. You as the provider need to be comfortable in addressing your patient’s veteran status. Healthcare workers should have the knowledge on these global engagements because our veterans have lived experiences that a regular patient may not have witnessed. This puts your patient, the veteran, at higher risk for both medical and mental health illness.

On your initial assessment, a thorough History and Physical Exam cues the provider to the issues that affect our veterans.

Gather information on the Chief Complaint, History of Present Illness, Medical History, Psychiatric History, Family, Social, and Military History.

The military screening is done by simply asking, “Have you ever served in the military?” If the answer is yes, continue by asking “Which branch of service, Army, Marines, Navy, Air Force or National Guard?” Never assume that everyone who served in the military are soldiers. They can be Sailors from the Navy or Airmen from the Air Force, etc... Most veterans are proud of their military service. Inquire about “how many years did you serve? Were you in the Enlisted rank or an Officer?” Inquiry about their jobs in the military is critical for the injuries they may have. Never assume that everyone carried a gun and were “boots on the ground.” Continue by asking, “What is your MOS?” The military uses this acronym and it stands for Military Occupational Specialty Code. The Air Force branch uses “AFSC” as the Air Force Specialty Code. Continue by asking, “Where were you deployed?” Was this deployment in peace time or during a conflict? Were they involved in humanitarian missions in disaster zones? This will give you further clues of what your veteran may have witnessed during their deployments. Assess your patient on their military discharge papers, “Honorable discharge, general discharge under honorable conditions, other than honorable, bad conduct discharge due to court martial, dishonorable discharge, or if your patient was separated medically. Assess your patient for any childhood traumas they have witnessed. Assess if they were in zones of conflict as combat, accidents, Military Sexual Trauma or MST, and/ or suicides by their peers.

Providers in healthcare settings need to utilize screening tools such as the Patient Health Questionnaire-9 (PHQ9) NP STUDENT | NOVEMBER 2021

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in Korea, Vietnam, Iraq, Afghanistan, and southwest Asia. This may have affected the respiratory system depending on the types of the ways that were burned. Wind direction, proximity, frequency of exposure, and amount of exposure. Multiple chronic comorbidities are linked to our veteran’s medical health diagnosis.

Our veterans, both males, and females die by suicide at a much higher rate than nonveterans. Multiple risk factors such as depression, anxiety, military sexual trauma, PTSD, alcohol, illicit substance use, retirement, transitions in life, aging, chronic medical and mental health comorbidities, and/ or gun ownership put veterans at a higher risk for suicide.

Collaborative efforts from the health care team including the veteran is important in the treatment plans.

to assess for depression. The Generalized Anxiety Disorder (GAD) assesses anxiety. The PCL-M screening tool is the gold standard to assess for PTSD, The Mood Disorder Questionnaire (MDQ) to screen for Bipolar/Mood Disorder.

The veteran population is a diverse population who come from all walks of life. Once the uniform is worn, they form a unique bond of brotherhood and sisterhood. The life experiences of those in the military are expansive. They are well educated.

They are subject matter experts in their fields. They have professional skills in which they have trained rigorously. Caring for veterans is not one size fits all. Use your assessment tools.

Healthcare providers need to critically think of the possibilities of the major psychological mental health disorders such as Major Depressive Disorders, Anxiety, Traumatic Brain Injury (TBI), Post Traumatic Stress Disorder, Personality Disorders, Conduct Disorders, Aggressive Behaviors, Alcohol Use Disorder, and Substance Use Disorders.

It is of importance to always assess safety due to suicidality, homicidality for safety. It is important to assess for a history of suicide, family history of suicide, intent, and plan. Access to firearms is also important. The military currently has a campaign called “GO SLO” where S stands for safes, L for Locks, and O for outside of home storage of lethal means.

This slogan helps build a time and space between someone in distress and accessibility to lethal means.

According to an article in 2017 from Science Direct, there is a “relationship between physical and mental health. This research shows a strong link between mental and physical health. Due to rigorous military training, veterans may have suffered musculoskeletal injuries that result in chronic pain.

Many have had exposure to blast injury. Many have hearing issues due to exposure to loud noises. Many have invisible wounds from what they have witnessed that resulted in PTSD. These findings have been reinforced from another study from the National Institute of Mental Health that shows a positive relationship between chronic illness and mental health that puts our veterans at a higher risk for a chronic medical illness that increases their risk for mental health conditions.

Those who served in Afghanistan, Syria, Djibouti, and the Persian Gulf War may have been exposed to airborne hazards and burn pits due to the combustion of trash in the open air and other waste material. Many have hearing loss and chronic pain.

Many health issues are coming to light due to the exposures

Warm secured office space provides veterans with feelings of safety. Each veteran has different unique needs. Veterans must be treated with a team-based approach by collaborating with different specialties that include mental health services.

Validate their emotions. Be mindful of the words you use.

Listen attentively and without judgment. Try to remove politics, religion, and your views about wars during patient visits.

Assess for suicidal thoughts and safety. Help your veteran find their purpose again in life. Give them options for volunteering in the community. They took their oath to serve and protect our country. Those in healthcare took their oath to protect patients that included the men and women in the military.

Anna Sanchez is dual certified as a Family and Psychiatric Mental Health Nurse Practitioner and treats both civilians and veterans. She has worked in health care for over 33 years. She proudly serves the U.S. Air Force for 11 years now as a Traditional Reservist for the 94 Air Lift Wing/Aeromedical Staging Squadron.

She is the Founder of Hope Center for Veterans.

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Lifestyle Creep: What it is and how to prevent it

by Jovan Johnson, MBA, CFP®, CPA/PFS

W

hether you just finished residency or received a promotion, lifestyle creep is real! Do you really need that new BMW and luxury condo? If you are like me, once you receive a significant raise or bonus, you begin to think of all of the possible ways you could potentially spend that money. I mean, after years of sacrificing and living off peanut butter and jelly sandwiches, getting a raise or bonus feels like the lottery. However, it is important to invest in yourself first. For every dollar that comes in, you should commit at least 15% to investing back into yourself.

Write down all of your long-term goals and the

What Is Lifestyle Creep?

Bonus: If Your Bank Allows, Set Up Custom Alerts

Lifestyle creep, sometimes referred to as lifestyle inflation, is the act of upgrading your standard of living as your discretionary income increases.

This can keep you stuck in a bad financial cycle, while preventing you from building an emergency fund or properly saving for retirement.

In this article, I am going to discuss ways that you can resist lifestyle inflation as your income increases.

Create a Zero-Based Budget Listen to what your budget is telling you, not the income number on your pay stub.

finances that would be required to fund them.

Revisit this list frequently, to always remember why you are saving money. When making a purchase, ask yourself is it worth it to take money away from my long-term goals? Some purchases may seem small at the moment. For instance, spending $5 per day on Starbucks seems harmless right? However, that accumulates to a total annual cost of $1,825. As you can see, small purchases add up very quickly and can hinder you from building up your savings.

Custom alerts are a great way to avoid overspending (overdraft fee) and potentially detect fraud early.

Jovan Johnson, MBA, CFP®, CPA/PFS long-term savings (emergency fund, retirement accounts),

checking

account

for

everyday

expenses, checking account for bills & utilities, and a checking account for fun. Then update your direct deposit account preferences at work, to have your paycheck split between your various checking and savings accounts. This will remove

Set up alerts with your bank to be notified whenever your account reaches a certain dollar limit. This is very helpful to keep you on track with your budget. Let’s say you create an alert for your “fun” account whenever the account balance is less than $50. This is a cue for you to dial down your spending on wants for the remainder of the month.

Taking control of your finances is a journey,

Establishing a realistic budget is key. That way if your income increases, the portion you save vs. spend will remain the same. A Zero-Based Budget is where you assign each dollar that comes in a job. The end goal is to have $0 leftover each month. You can start with the 50-30-20 rule.

50% for needs, 30% for wants/giving, and 20% for savings (paying off debt falls in this category).

Make sure you always invest in yourself first.

you and your emotions out of the equation.

Start saving with a small percentage, like 10% of each paycheck, to get in the habit. Then, at the end of each month, increase that amount by 1% until you reach your monthly savings goal.

if spending $300 on some new shoes is in the

Disclosures

budget, then enjoy it!

None of the information provided is intended as

With a 50-30-20 budget, you will get to enjoy up

investment, tax, accounting or legal advice, as an

There are apps like YNAB (You Need A Budget) or Mint to assist with creating a budget.

Automate Paying Yourself First To avoid the temptation of overspending on “wants”, put your savings on autopilot.

Treat your savings like another monthly expense.

Create at least 5 separate accounts: short-term savings (emergency fund/irregular expenses),

Create a Splurge Fund It is important to reward yourself sometimes for all of your hard work.

not a destination. After years of hard work and sacrifice, you deserve to enjoy your money and treat yourself. However, you must do so in a strategic way that doesn’t sacrifice your longterm financial goals. Follow the tips outlined in

However, you must do so in a way that is strategic.

this article to be in “control” of your financial

Including a “fun” category in your budget will help

situation and keep lifestyle inflation in check.

you not feel guilty for treating yourself. I mean,

to 30% of any raise or bonus. For instance, let’s say you get a raise of $1,000 per month. $500 will

offer or solicitation of an offer to buy or sell, or as an endorsement, of any company, security, fund,

be allocated to needs, $300 to wants/giving, and

or other securities or non-securities offering. The

$200 to savings.

information should not be relied upon for purposes of transacting securities or other investments.

Keep Your Eyes on the Big Picture Lifestyle inflation can be a real threat to your long-term goals such as: purchasing a home,

Your use of the information is at your sole risk. The content is provided ‘as is’ and without warranties, either expressed or implied. Piece of Wealth

purchasing a new car, traveling outside of the

Planning, LLC does not promise or guarantee any

country, purchasing rental properties, or paying

income or particular result from your use of the

for a child’s college education.

information contained herein.

NP STUDENT | NOVEMBER 2021

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BEST DRESSED AT CLINICALS

by Katelyn Barker

blazer: @aritzia blouse: @shopdressup pants: @lululemon shoes: @dolcevita tote: @anthropologie

Jenn Torre @jennltorre Emory University

Pants: Loft Side zip high waist skinny leggings Black, Bordeaux, Navy Original price $79.50 On sale: $35 Shirts (left to right) 1. Burgundy shirt: Nordstrom Rack Brand: DR2 $25.00 2. Ruffle trim shell blouse: Loft Original price: $49.50 On sale: $18.00 3. Floral Shirttail blouse: Loft Original price: $49.50

Alejandra Patterson

On sale: $18.00

@little_margarita_rn

Shoes: Lucky - bought from Zappos

University of Alabama Birmingham

$50.00

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The Patient’s Perspective

by Katelyn Barker Have you ever asked your patients if they know the difference between a nurse and a Nurse Practitioner? It’s not a topic that regularly comes up in discussion yet “nurse” is a broad term that is used to describe all levels of nursing.

As patients, we often talk about what a surgeon, dermatologist, or other specialist does yet most of us do not know the difference in nurses. What every NP should know is that one rarely explains the difference between registered nurses (RNs) and nurse practitioners (NPs). And, before starting this internship, I thought RNs and NPs did the same thing and required the same training. In the past couple of months, I learned that there are varying levels of nurses starting from certified nurses assistant (CNA) to Doctor of Nursing Practice (DNP). In general, I feel we should never underestimate the importance of patients knowing who is taking care of them and how their roles differ.

Why should you care?

Nursing is broad and most nurses assume patients understand what’s going on with their care. What we know is that: 1. Nurses act as the middle-ground between patients and physicians.

2. If we have a problem, nurses advocate for us and share our concerns with the physician.

3. Nurses interact with us longer than physicians.

Now I know that NPs’ role overlaps with what the nurse and the physician does which is pretty cool. Even though they both require different training and play a vital role in our care, from a patient’s perspective, we just want you to tell us who you are and what you can do. It matters to us and influences our decisions about our care.

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