“The MSO is the mechanism for accountability for professional practice,” he says. He is also active in SHM’s NP/PA Committee and now sits on SHM’s Public Policy Committee.
The story: “Working as a nocturnist has given me the flexibility to look into advanced management training,” he says, including Six Sigma green belt course work and certificate training. While at DeGraff, he heard about a call for membership on the NP/PA committee.
“They quickly realized the benefits of having someone with a background like mine on board,” he said. “As a nocturnist, I started going to more meetings and getting involved when the easier thing to do might have been to drive home and go to bed.”
Along the way, he learned a lot about hospital systems and how they work.
“Having been in healthcare for 23 years, I know the hierarchical approach,” Facklam says. “But the times are changing. As medicine becomes broader and more difficult to manage, it has to become more of a team approach. If you look at the data, there won’t be enough physicians in the near future. PAs and NPs can help fill that need.”
Crystal Therrien, MS, ACNP-BC
Lead nurse practitioner, affiliate practitioner coordinator, Department of Hospital Medicine, University of Massachusetts Memorial Medical Center, Worcester.
Workplace: UMass Medical Center encompasses three campuses in central Massachusetts, including University, Memorial, and Marlborough. The hospital medicine division covers all three campuses with 40 to 45 FTEs of physicians and 20 of APPs. Therrien has been with the department since October 2009—her first job after completing NP training—and assumed her leadership role in June 2012.
Responsibilities: Therrien supervises the UMass hospital medicine division’s Affiliate Practitioner Group. She works with physicians on the executive council, coordinates the medicine service, and coordinates cross-coverage with other services in the hospital, including urology, neurology, surgery, GI, interventional radiology, and bone marrow transplants.
Hospitalist staff work 12-hour shifts, providing 24-hour coverage in the hospital, with one physician and two APPs scheduled at night.
“Because we are available 24-7 in house, I work closely with our scheduler. There is also a lot of coordination with subspecialty services in the hospital and on the observation unit,” she says. “I’m also responsible for interviewing and hiring AP candidates, including credentialing, and with the mentorship program. I chair the rapid response program and host our monthly staff meetings,” which involve both business and didactic presentations. She also serves on the hospital’s NP advisory council.
Before Therrien became the lead NP, her predecessor was assigned at 5% administrative.
“I started out 25% administrative because the program has expanded so quickly,” she says, noting that now she is 50% clinic and 50% administrative. “To be a good leader, I think I need to keep my feet on the ground in patient care.”
The story: Therrien worked as an EMT, a volunteer firefighter, and an ED tech before pursuing a degree in nursing.
“I grew up in a house where my dad was a firefighter and my mom was an EMT,” she says. “We were taught the importance of helping others and being selfless. I always had a leadership mentality.”
Therrien credits her physician colleagues for their commitment and support.
“It can be a little more difficult outside of our department,” she says. “They don’t always understand my role. Some of the attendings have not worked with affiliated providers before, but they have worked with residents. So there’s an interesting dynamic for them to learn how to work with us.”
Kimberly Eisenstock, MD, FHM, the clinical chief of hospital medicine, says that when she was looking for someone new to lead the affiliated practitioners, she wanted “a leader who understood their training and where they could be best utilized. Crystal volunteered. Boy, did she! She was the most experienced and enthusiastic candidate, with the most people-oriented skills.”