Tracy Cardin, ACNP-BC, entered college as a criminal justice major, believing her talent for crafting sound arguments and her passion for defending her point of view would translate into a successful law career.
Less than a year later, Cardin visited her gravely ill aunt and discovered her true calling. “I noticed a lot of small things: Her fingernails were a little long, her hair was sort of unkempt, and the environment wasn’t as clean as I would have liked,” Cardin says. “I didn’t feel the people who were caring for her were putting in the time or effort to make her as comfortable as possible. I didn’t see a lot of tender loving care, and I honestly felt I could do a better job.”
Cardin changed her major, pursued a nursing career, and now has 22 years of experience providing inpatient care.
“It’s a privilege to take care of patients, and hospitalists have a wonderful opportunity to impact the quality of care they receive,” says Cardin, one of seven nonphysician providers (NPPs) in the Section of Hospital Medicine at the University of Chicago Medical Center. She also is Team Hospitalist’s only NPP member. “They are the reason I do what I do—and the reason I love what I do.”
Are there similarities between being a nurse practitioner (NP) and a litigator?
You definitely have to advocate for your patients. Both fields allow you to see the stories of the human condition. In my job, it’s all about the patients’ stories—how they came to be here and fitting your care for the patient within their narrative. And like the legal setting, people often find themselves in the healthcare world at a time of crisis. I like being there to help people in those times.
Why did you choose to practice in a hospital setting?
I like the objective data you get in a hospital. You have lab work, imaging, and vital signs. It helps create a better picture of what’s going on. I like that it’s very acute. Patients have a problem, hopefully you fix the problem or at least stabilize the person, and then they can go home. I also like that it’s fast-paced and varied. The hospital truly is one of the places I’m most comfortable.
What is your biggest professional reward?
When a patient knows it’s time to go home and die—when it’s their time and they are ready to go—and they need someone to help them get through that process. When patients and their families move from trying to solve unsolvable problems to an acceptance of their mortality, it’s a beautiful journey, and I really like helping them navigate that journey.
How would you describe the relationship between the physicians and NPPs in your program?
Like all relationships, it has gone through an evolution. It started with the “getting to know you” stage, during which the physicians weren’t sure what the NPPs do and the NPPs were very anxious to show our capabilities. There was this pushing and pulling. Over time, thanks to excellent leadership, we have a model that utilizes NPPs to the maximum of their capabilities. We have a very collaborative, collegial group, and it’s a special place to work. I have the utmost respect for the physicians, and I feel they have the utmost respect for our abilities.
Do most HM programs that bring on NPPs go through growing pains?
In the beginning, often there’s a little drama or controversy. Someone oversteps their bounds, someone is too rigid and doesn’t allow a mid-level provider to do something, or someone gets their feelings hurt.
How can you survive that process without the partnership breaking down?
It’s like when you’re driving a car and it starts to pull off the road. If you overcorrect and turn the wheel too hard, you’re going to end up crashing. Instead, you just turn the wheel a little bit. It’s very important that you don’t panic and try to overcorrect. Sometimes only a small adjustment needs to be made. If everyone is committed to one another, it will work out.
What advice would you give to NPPs who are thinking about joining an HM program?
First, be ready to work hard. It’s very rewarding, but it’s a rapid pace and it’s stressful. Second, align yourself with someone who is sympathetic to and supportive of the role of a mid-level provider within a hospitalist group. Third, never give up, because hospital medicine is a great career.
What advice would you give to physicians whose programs are considering hiring NPPs?
Check out the SHM website (www.hospitalmedicine.org), because it is a tremendous resource. Also, treat the NPPs the same way they would treat another physician. Give them the same assistance, invite them to the same meetings, and give them the same education or training. Realize that even though physicians, NPs, and physician assistants have different educations, everyone brings their own skill set to the table that adds to this stew of excellence.
How do you see the role of NPPs evolving as they become more prevalent in HM?
Given residency work-hour reforms and the fact there are not physicians to do all of the work, NPPs are going to be utilized much more. NPPs bring a ton of experience to the care of inpatients, so a hospital medicine group should utilize them in all kinds of roles, whether it’s orienting new physicians or educating nursing staff about the care of their specialized patients. NPPs also can take on leadership roles as part of quality improvement projects. We are going to be needed in patient care, but we shouldn’t just be relegated to patient care. The experience is there to help in many other areas.
You have spoken about the integration of NPs in hospitalist programs at two HM meetings and will do so again at HM12. What does that mean to you?
It’s my passion. I’m fascinated by the entire process. I always say, “Why am I up here speaking about this? Because I’ve made every mistake; learn from me.” My program director [Chad Whelan, MD, FHM], who was so calm and so rational and helped me integrate so well, has impacted me so greatly. I get to pass that on to other people, and it’s a tremendous opportunity.
Mark Leiser is a freelance writer in New Jersey.