Episode 8: Career Pivots — Nurses Who Took the Leap

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsord

Oh, hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation resources and hope. One episode at a time. So today on Nurse Dot podcast.

April Kapu

And that's when they both said, you know, nurses, we can provide advanced education and training and they can do this.

Cara Lunsord

Joining us today, April Carper, DNP, and president of the American Association of Nurse Practitioners. April was named one of 50 of the most influential clinical executives by Modern health Care in 2022. April shares with us today how she has committed her career to advancing and delivered care and increasing access to NP care across all settings. I'm your host, Kara Lunsford, registered nurse and VP of community at Nurse AECOM.

Okay, so April Koppel is an amazing last name, too. It sounds Hawaiian a little bit.

April Kapu

It is.

Cara Lunsord

Is it Hawaiian?

April Kapu

It did. Daniel, it's so Hawaiian.

Cara Lunsord

Did you marry Hawaiian?

April Kapu

I did. We've been married for almost 33 years and met my husband in Hawaii and been married ever since. Have a beautiful Hawaiian family. I'm so lucky.

Cara Lunsord

That's beautiful. What's the word for family? What is the Ohana? Yes. Thank you. Ohana. I have a patient up in Oregon. Her father is Hawaiian, and he'll send me these beautiful, beautiful messages. And I don't know, is this just a Hawaiian thing? Our men in Hawaii just way more in touch with their emotions? Or is it just very.

April Kapu

Sincere, very open, full of aloha, I guess, is what you say, but full of love and just really everybody's family.

Cara Lunsord

That's what I get. You know, he calls me sister and he and I just get these beautiful, beautiful messages from him. And I was like, oh, my gosh, I just love these Hawaiian men. They're amazing. So good for you.

April Kapu

And the phrases, the Hawaiian phrases, I never know what they mean, but they're so lovely to listen to the language. You know.

Cara Lunsord

It's beautiful as it really is gorgeous. So let's jump in here really quick. You are the president of the American Association of Nurse Practitioners.

April Kapu

That's right.

Cara Lunsord

I let you have I stalked you a little bit? Okay. LinkedIn stalking a little like now. I just I looked you up. And so you've been a nurse 30 years.

April Kapu

Since 2004? Actually, I think so.

Cara Lunsord

2000

April Kapu

A long career in health care. But a nurse since 2004.

Cara Lunsord

So did you do something before you were a nurse?

April Kapu

I did. I taught in health science and also was a social worker. That was my first degree, was in social work. My second degree was as a nurse. And then I had more degrees after that, I guess.

Cara Lunsord

Oh, you have a lot of degrees. I am a okay.

April Kapu

I am also. It has nothing to do with age.

Cara Lunsord

I mean, you're massively accomplished. So I'm just going to touch on the fact that you said you were a social worker before because social work is hard.

April Kapu

Mm hmm.

Cara Lunsord

It is really hard profession.

April Kapu

It is. And my first job out of school was for a place in Hawaii that the prosecuting attorney, it was called victim Witness Kokua and I worked with victims of domestic violence. And it is hard. It's very emotionally challenging. And I think that was part of the reason that I began to look for something that combined the counseling and the support with more tactile things, being able to really do something with your hands to really help.

So I worked a lot with nurses in a lot of different ways in Hawaii, and that really kind of got me on the road to, Hey, you know what? I think I'm going to go on and pursue nursing.

Cara Lunsord

That's incredible. Well, my hat's off to you because nursing is difficult. Social work is incredibly difficult. All of it can really pull on your heartstrings and can be a place of burnout. And I think that a lot of nurses can relate. And I'm sure any social workers that are listening can absolutely relate to the amount of burnout that they're experiencing.

There's only so much tragedy and trauma that a person can see.

April Kapu

Right? Right. And that has really been even more prevalent over the last two or three years. It's been really challenging with COVID 19 being a new virus that was so unknown and just attacking. It was really challenging, especially for the nurses that nurse practitioners that worked in the ICU. Death and dying was all too real and all too often, and that was really hard and early on in COVID.

There were a lot of strict visiting policies, so families couldn't come in, and so having that time at those very precious moments had to be spent on virtually or on the phone. And, you know, the nurse, the nurse practitioner is the one that's there in person. Yeah. So it has been challenging, especially over the last couple of years.

Cara Lunsord

Absolutely. So you started out in social work and then you went into nursing school. Where did you initially go to nursing school?

April Kapu

I have done all my nursing school at Vanderbilt. Vanderbilt School of Nursing. Yep. And I love it here. I'm still here now and have just really appreciated the depth of education that they provide. So I did get my master's in nursing and my interest was critical Care ICU loved taking care of patients after heart surgery, so helping them get back on their feet, making sure their medications were reconciled, spending time with the families to kind of talk about what's next after heart surgery, What's life like after heart surgery?

I loved working with the surgeons, anesthesiologists, the other nurse practitioners, nurses, just a fantastic team. And then in 2009, Vanderbilt Medical Center built a critical care tower, and that doubled the number of ICU beds that they had. And by that time, I had gone on to become a nurse practitioner in the CVI. You really love that. And in 2009 was offered the opportunity to bleed the building out of nurse practitioners in all of our ICU.

24 seven And it was a great opportunity to step into a leadership role. But I realized at that time I needed a lot more skill in terms of finance and, you know, macro systems management, things like that. So I went back and got my doctorate in nursing practice and absolutely loved building out those teams. We expanded teams in surgery in a lot of different areas across the hospital.

And in 2014, I took the position of Associate Chief Nursing Officer for Advanced practice at Vanderbilt Medical Center and was able to build out advanced practice across the system. Just an amazing opportunity to work with so many wonderful leaders in health care and really optimize the use of the nurse practitioner. It's just been wonderful. They've been so welcomed and our system and when I left, moved over to the School of Nursing and took on the role as president of ANP last summer, we were up to about 1400 advanced practice professionals.

So it was really, really a wonderful opportunity.

Cara Lunsord

That's incredible. I've personally always felt that if I've worked somewhere and there has not been that role of an advanced practice nurse and I'm kind of solely reliant on working just with the physician, that you definitely can feel that there's just a gap in the kind of care that you can provide because the physician is stretched pretty thin and it can be very, very difficult for the physician to have to take care of all of these patients.

And then for you to have that good collaborative, multidisciplinary approach and without a nurse practitioner there to kind of in a way be like the quarterback. So oftentimes when I have a nurse practitioner available, it's like having that quarterback.

April Kapu

Right where sewing up all the details, making sure all the details are attended to.

Cara Lunsord

Yeah, especially when there's a lot of different specialties involved. That's where I really find it incredibly helpful, as in our end that you can rely on this nurse practitioner to really be seeing the big picture, to really see holistically. I think they're very holistic thinkers and they're trained and because they're nurses, I think they're naturally a little bit more holistic thinkers.

And so they're able to see like, okay, this is the cardiologist, this is the endocrinologist, this is the neurologist like, And they're able to take all of those specialties and really pull this plan together, which is something that then we're able to all execute, which is really amazing.

April Kapu

And share that plan with the patient and the family in a way that they understand and they're engaged. I think that's one thing that we do as nurses so well. And the philosophy of nursing is exactly that. It's comprehensive, it's holistic, and that's nurses, that's advanced practice nurses of all types. But as a nurse practitioner, really to engage the patient and the family, everybody doesn't just drop in and everybody's not the same.

Everybody comes from a different place. They may work, they may not work, they may have a home, they may have a multigenerational home. They may speak a different language. They have a different culture, different experiences, different experiences with health care throughout their life. And we really are attuned to that. And how do you take your diagnosis, your plan, and how do you really make sure that that adapts to your lifestyle so that you're engaged in that?

And that's what we do really well?

Cara Lunsord

Yeah, absolutely. It's something that's I guess if I if I hadn't decided to start my own company and build a piece of technology, I had two pathways. I was either going to go back to school and become a nurse practitioner or I was going to start a company. And I decided to start a company, which then both are pretty challenging.

They were both very challenging.

April Kapu

And both.

Cara Lunsord

Both very costly, by the way. But I really saw myself as a teacher. I love teaching. Probably one of the things that I love the most about nursing is that you have this incredible opportunity to really connect with your patients, really be able to like you said, explain things in a way that they can really absorb it. Because when you speak to them and with them and not at them, right, they then have the opportunity to become more educated about their health, to have better health literacy.

And I think nurse practitioners are really that pathway to better health literacy for the public.

April Kapu

Right. And health equity. I mean, that is another thing that we are so focused on is making sure health care is available to everyone everywhere. And I always love to talk a little bit about the origin of the nurse practitioner because that's really how the profession was born. You know, back in the 1960s or so. I don't know if you've heard of Loretta Ford and Dr. Henry Silver.

He was a pediatrician. She was a pediatric nurse, lived in Colorado, and they were really consumed with how do we make sure that patients, families, children get health care across all of these areas of Colorado? And that's when they both said, you know, nurses, we can provide advanced education and training and they can do this. This is how their profession was built and this is how we can, as nurses, really meet that need.

And so that's what we're seeing today. I mean, the nurse practitioners have grown wrapped over 355,000 nurse practitioners in the U.S. today. That's a growth of over 9% just since last year, mean we really are in a hub.

Cara Lunsord

It's exciting because access to health care should be one of our number one priorities. Coming up after the break.

April Kapu

That is really a big area of growth. Just meeting the patients where they are. Last time I looked at the Hearst website, we were up to 99 million Americans that lacked access to primary care.

Cara Lunsord

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There are far more nurses than there are doctors, which means that there's a lot more opportunity for those nurses to then become advanced practice nurses and then potentially be able to stand up their own clinics and things like this. Now I know that there are some states that are petitioning for them to be able to practice more autonomously, Right?

Is that true?

April Kapu

It is in 26 states and D.C. nurse practitioners have the licensure authority to practice to the full extent of their education and training. So we have a national standards today for accredited education, clinical training and national board certification in the area that we practice national. And yet the licensure authority lies with the state. And so the rules and the regulations around that license that lie with the state and 26 states and D.C. and two territories, laws have been updated where nurse practitioners are able to practice to the full extent of their education and training.

And in those states we have seen an increase in the workforce and an increase in nurse practitioners working in historically underserved areas, in rural communities, in urban areas, nurse practitioners are wanting to do this. And so those states have removed these barriers, unnecessary barriers, so that NPS can practice across all of these settings. So we have a ways to go, but we've tipped the scale.

There are 24 other states that we really would like to update the law so that NPS can do just that provide access to care, focus on equitable health care, high quality care. We provide excellent care, and that has been demonstrated over and over again throughout the last four or five decades that our care, our outcomes of care are excellent because we're very focused on the patient and making sure that patient gets well coordinated care.

And so having a nurse practitioner in the community right down the road in a retail clinic accessible via telehealth, driving up in a mobile health van to provide vaccinations and screenings, seeing patients in the home that is really a big area of growth is just meeting the patients where they are. Last time I looked at the Hurst Web site, we were up to 99 million Americans that lacked access to primary care.

Cara Lunsord

Which is actually health care. Right? Real health care. Real health care is preventative care. It's just so hard to get in to see someone. There was a while back in California. We used to have this. It was called Heal. It was an app and it was a mobile. Are you familiar with it? Heal. Have you ever heard?

April Kapu

I've heard of that, yeah.

Cara Lunsord

So it was phenomenal. I had all of my physicals done by either a heal physician or a nurse practitioner. They would come to my house, I scheduled it. I would step away from what I was doing and then go have my physical. And they actually had a medical assistant with them who was drawing my blood, taking it to the lab for me.

And this was all covered by my insurance. And then they had to leave California because California has independent contractor laws. And I have seen a major shift in just the lack of accessibility to that kind of health care. I'm really hoping that that kind of model starts to expand in other areas. And maybe California will start to change some of their laws so that we can start to have that kind of thing here.

But do you know of any any of that kind of on demand nursing that's available in other states?

April Kapu

Yes, And I love to talk about it. We have just right here where I work in Nashville, we began a program and on call service where we do exactly that and making sure that people have ready access to health care and they can have it in their home if that's the most convenient. If it's an acute need, we can come to their hotel or their office.

It's just so convenient. And in today's world, people want to be cared for. When they want to be cared for, they don't want to wait three weeks, four weeks, six months, just like you said. And they're not going to. What we're seeing is people are when they need care, they're going to get it. What's important is when they come in to be seen that we establish that provider patient relationship, that we do do the screenings and the well exam to make sure that we are providing anything that could possibly pop up, that we are following blood pressures and their blood glucose.

And if they have diabetes, all those chronic conditions. This is health promotion, this is chronic disease management. Think of the downstream impact, less visits to the emergency room, less visits to the hospital because we have prevented some big things. So it is a conundrum to me that we would pull something like that back when it's actually so important people are getting engaged in their health care just to expect that everyone's going to go to a system of being seen in six months or however long.

It's just not the way our generations now are thinking.

Cara Lunsord

Absolutely. So I do think that to what you're saying, that there's this trajectory towards kind of going back to that type of like the House call. Right. You know, when you picture like the doctor with their little doctor bag and.

April Kapu

Girl circle, it's full circle.

Cara Lunsord

It just goes to show you that like some things were not broken before. Sometimes we fix things that we're not actually broken. Like we should have just done more of that, right? Like, we should have kept doing that. We should have kept doing it with that physician and that nurse in Colorado who did when they realized, oh, we can actually expand and give more access to people by just training nurses.

And it's really interesting. I just did a podcast with Lemonade Media and the Cost of Care is an amazing podcast, by the way, the cost of care. And one of the guests had been a nurse for 40 years. She worked her way into administration and everything, and she talked about the times of when she was first a nurse, like in the seventies.

And she said literally, our job was to empty the ashtrays for the doctors. We were considered like handmaidens to the doctors. That was our job. They were like, we were in all white. We were angels of mercy. We had to be pristine. We had a ring on one finger like our wedding ring. And we had a watch and that's it.

And that was in like the seventies combined. How far we have come.

April Kapu

We have a long way. We have come a long way. And I when you say all that, I think about what I do as a nurse practitioner in the ICU. I am going over every system, neuro, pulmonary, cardiac, making sure every detail has been attended to. And the surgeons that I work with, they're in the O.R. performing surgery.

And so what I'm doing is providing all the care in the ICU so those patients are all well-informed, ready to go, can move to their next level of care. It has come a very long way. And now we have NPS in every setting, just like we talked about. But a lot of NPS in primary care and in settings like schools.

This is where you really pick up on big needs in health care settings like, like correctional facilities. There's nurse practitioners that get on the bus, that go out to a correctional facility, provide care to people that really need care. So having nurse practitioners in all of these different types of settings, employer health, there are some employers who have found that it is much easier to have a nurse practitioner run clinic in their company, in their business for their employees than having them go out.

So we are making sure that care is everywhere, but we have a long, long way to go. Like I said, you know, almost 100 million people lacking access to primary care. We have 158 million people that lack access to mental health services in a time when it's so needed. So we need more, we need more nurses, we mean more support.

We need support for education so that we can go on and get the education and training needed to be able to provide this much needed care.

Cara Lunsord

Yep. And so if you're a nurse, I think you said 24 states where we're still trying to kind of get that autonomy right. So if you're a nurse in one of those 24 states, if you're a nurse practitioner, let's say in one of those 24 states and you really want to lobby for change, what is your best course of action?

Like, what do you recommend that they do to really try to change the laws in their state so that they can start providing this type of access?

April Kapu

Well, the simplest thing to do is get in touch with your legislator, tell them your story, tell them what these barriers are, why this is limiting you from being able to provide more access to care. I mean, that's just as simple as it is. I remember early when the pandemic hit. Just having a conversation with the legislator saying, I'm in Tennessee.

It's it's a restricted state. We have a lot of barriers. And one of those is, is that we have to have a career long contract with a physician. It's a mandated contract. And then we have to pay for that. And then and it's those fees aren't regulated. And then what is required is a 20% charter review every month, a retrospective chart review of the charts, Nothing that would impact the patient in the moment by any means, but that's required.

And I remember early on in pandemic, just having that conversation with the legislator going, really, if we have to meet that law, we are literally with the volume of patients that we're seeing right now and the lines, the drive through lines and the lines around the building of the clinics with all of the patients coming in COVID 19 symptoms, if we did follow that, we would literally be pulling physicians off the front lines, putting them in an office to do chart review.

It just makes no sense. We all need to be out there every single one of us. And so unnecessary barriers like chart review, it's outdated. And we need to allow the nurse at any category to practice to the extent of their education and their training. That's what they've been educated to do and that is outlined so well in the future of Nursing Report 2020, 2030.

So one thing you can do is have those conversations. But the American Association of Nurse Practitioners, which is why I love my organization, we're the largest NPS organization in the U.S., is that they are so great about advocacy and we have state government affairs team, federal government affairs team, and they make sure every single member knows what's happening in their state and what's happening federally so that we can more collectively work together to update laws.

So there are a lot of things you can do, but having conversations, having a relationship, telling your story to the legislators are those are quite impactful. And then collectively and being part of a national association where you're bringing together volumes of data that demonstrate why it's so important to improve patient care, to increase access, to care, to have health care that is equitable and available to everyone.

So those are a couple of things.

Cara Lunsord

I think that's perfect. I think that the listeners will truly appreciate everything that you are bringing to this episode today.

So many of these nurses, nurse practitioners, providers, clinicians in general, everyone who has been involved in health care, especially over the last three years, is facing an incredible amount of burnout. The amount of trauma that they experience and witness tragedy and how that affects them over time. The nurse practitioner is out there going, Why? Why is this so hard?

Like, am I alone? Am I the only one who thinks that this should not be so difficult or that I should be able to provide care, access to care? It's validating when they hear someone say, You're right, you should be able to provide more access and you should be able to work to the full extent of your license.

You shouldn't be hindered in any way because of some kind of ridiculous law that that is not serving the greater good. And that's what allows people to go ahead and then say, you and I am going to do something about this. I'm going to move forward and I'm going to effect change.

April Kapu

One person's voice can make a difference, and that one person speaking with their legislators make the laws, speaking with the legislator, telling them their stories so powerful and so important. But collectively we can say it even louder. You've said a lot about burnout, and I've got to just stop for a minute with that and just say and acknowledge that nurses have been through so much and this past two, three years, nurse practitioners have been stepping up over and over again in all settings, and this is on top of their regular job.

They're getting out, they're going to work the hotline, they're going out to work in the vaccination clinic. They're going to see patients in the home. They've been working extra overtime. The physical exhaustion is there, but it's the mental and the emotional exhaustion. These are the components of burnout, and we're seeing it higher than ever before. It was there before the pandemic.

It's very much there now. And just to speak with everyone listening, that there are solutions to this. And some of those solutions are a healthy work environment, work environment that you're heard that you can speak up, that you're valued, that you enjoy working with the team that you're on. That's what can really get you through. Having readily available mental health services and you know, I'm very committed to this, but having immediate available services, if you need to debrief, if you are grieving, if you are so exhausted, you don't know how you're going to be able to go home and care for your family to be able to talk that through.

These are solutions that are already in place that can help to mitigate burnout. And one I've heard over and over again from NPS who have experience burnout in the past. They have said, I've made a change in some way, some way I've made a change. I balance what I do now. I've joined this club or whatever, but they've made some sort of change.

So I think burnout is real and I think that we as nurses, as nurse practitioners, really need to look inward and really do our own check in to our own health and wellbeing and how are we doing so that we can continue to do what we absolutely love to do and enjoy doing that and be able to give of ourselves, but from a very healthy perspective.

So I am glad you mentioned the burnout again. I think that's something that's not going to go away until we address it as a country.

Cara Lunsord

Yeah, and I and I love the fact that we have started to make a separation between burnout and moral injury. Moral injury is like and somebody gave a really great example of it. It's like when you're expecting a candle to stay lit in a hurricane. And when you say, I'm just burning my candle at both ends, well, that's that's kind of burn out, right?

If you're burning your candle at both ends, that's a little bit of a personal problem. Like you're taking on too much. You're probably not setting good boundaries. And there's some stuff that you could do to change your situation. Then there is moral injury, which is I want to go and be able to practice to the full extent of my license.

I want to be able to practice safely. I need to have all of the tools and equipment and supplies and staffing available to me to be able to do this safely. And I am reliant on you as a facility to provide me with these things. And if you cannot provide me with these things, then every single day, regardless of my professional boundaries, regardless of my personal boundaries, even if I have all of that in place and I keep going back into an environment that is not allowing me to practice safely and it's not allowing me to provide the type of care that I expect of myself that puts me at risk or liability for making

a mistake. And all of that's happening because either I don't have enough staff, enough leadership and enough equipment to be able to do my job. All of that now is on the responsibility of the facility, right?

April Kapu

The clinic, the hospital where you work. He said that so well, and it's almost giving permission. It's almost giving permission to say it's okay. What would you say to yourself if you weren't in yourself? If you could put yourself beside you, would you let yourself work all those hours? Would you go back and work at a place that didn't provide those safety rails and support to you as a professional?

One of the things I have absolutely love to do over the last at a gap year president elect and your president for two years and you're past president. So about I'm about a year and a half into the president. One of the things I have been able to do that has just been so rewarding is I've been able to go to different universities and speak with students.

Some are in their bachelor's master's doctor. It's all everyone together. Some are finishing up their DNP, some are finishing up their MSN, but they're all nursing students. And even though they've had this fantastic education, they haven't had time to really think about things like burnout, moral injury, you know, how to prepare for that. They haven't had time to think about what does full practice authority mean, What's that going to do to impact me and my practice that has been so rewarding to be able go and have these conversations with students that are so excited, they're ready to be done and they're ready to sit for their boards.

They're ready to apply for those positions. But to hear these types of things that are let's talk about some other supports that you should really be in tune to so that when you go out, you know, it's not just you by yourself. You've got all of us, an entire association behind you that has just been fantastic to speak with nurses entering into their next step of their career.

Cara Lunsord

This has just been it's just been a wonderful, wonderful, wonderful interview with you. I think we have provided the listeners with just a wealth of incredible information. So it doesn't matter if you are a nurse, if you're not a nurse, if you're thinking about being a nurse or you have a nurse in your family or you're a nurse practitioner, every single person who's listening to this podcast today is able to walk with something.

If somebody is looking for a clinic or something that is run by nurse practitioners, is there a good place for them to go to be able to find something near them? Is there?

April Kapu

Actually, there is. We have this wonderful app. It's called NP Finder, so you can Google it, but it's through a map. The American Association of Nurse Practitioners, it's called NP Finder. You type in your ZIP code, you can find all the NPS in the area. And I would say to your listeners, if you have not seen a nurse practitioner or talk to a nurse practitioner, I would encourage you to do that.

Just recently we celebrated our National Nurse Practitioner Week. I had a lot of interviews celebrating nurse practitioners and what I was so humbled by is on many interviews I was all set to talk about what's a nurse practitioner, This is what we do. And everyone had a story. They had a story like, you know, my niece is a nurse practitioner and a doctor is going to be a nurse, whatever that might be.

But many of them said, I see a nurse practitioner and I asked, you know, is it because their outcomes are so great and they're good at, you know, keeping your diabetes in control? Her blood pressure control, It was not any of that every single time they would say because they listen. How powerful is that?

Cara Lunsord

It is, I think one of the greatest gifts of being a nurse. Nurses who take the leap and decide to go into become nurse practitioners. It is because they want to have the time to sit with the patients. They really want that time. Well, I am massively grateful to you for your time. I am sure that you are so busy and so to give me an hour of it, I can't even thank you enough, April, and you are welcome back to this podcast any time you want.

April Kapu

Well, thank you. It's been so nice to talk to you. It's just been really a great opportunity to just share some really pivotal moments in my life, my journey, but to talk more about what I love most, and that is supporting nurse practitioners.

Cara Lunsord

Thank you so much. If you are a nurse who enjoyed this episode and you have an idea for future episodes, you can connect with me by downloading the nurse dot com app. See you there.