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Since 2020, the American Association of Nurse Practitioners® (AANP) has honored, recognized and memorialized members of the Fellows of the American Association of Nurse Practitioners (FAANP) whose lifelong careers have had a profound and enduring impact on the profession and the NP role. FAANP Legacy Award honorees demonstrate the vision, innovation, courage, persistence and inspiration that are essential components of the NP legacy.
AANP spoke with 2022 FAANP Legacy Award recipient Dr. Ruth Kleinpell about her choice to become an NP, the evolution of the NP role over the years and the ways in which NPs can forge a path forward through the pandemic to become leaders in their communities.
Ruth Kleinpell: Well, my background is critical care nursing. I worked as a staff nurse in the intensive care unit (ICU) for over 15 years while pursuing my graduate degrees. I obtained my master’s in nursing and my PhD before securing a position at Rush University College of Nursing in Chicago.
In the 1990s, the university was developing an acute care NP program to compliment the other programs offered at the College of Nursing. As part of that, the college reached out to faculty and some of our senior nurses to go through the pilot program in order to take the first national certification exam and teach in the program. That’s how I started — by taking the first national certification exam for that specialty.
Kleinpell: Before that time, I had been interested in outcomes. My graduate work had been looking at outcomes for patients after an ICU stay. Because the acute care NP role was new, I had an idea to look at the role and outcomes related to the position. I remember I had a discussion with our dean at the time and she said, “Well, the school will give you some pilot money if you want to conduct a survey with the first national cohort to take the certification exam.” So, I did just that.
There were more than 900 nurses across the U.S. who took that exam and were sent the survey. This was before the online survey tools existed — only hard copy surveys. We sent them through the mail with the paid postage envelopes and got a good return rate back. From there, I sought some pilot funding. What started out as a one-year study actually evolved into a five-year study.
Every year, we would revise the survey and send it out to people who responded in the prior years. We had over 400 individuals who answered the survey every year for five years. That laid the foundation for me to pursue research and study outcomes for advance practice registered nurses (APRNs).
Kleinpell: We see that the role continues to evolve with new areas of opportunity for NPs. The pandemic brought to light the role that NPs and all APRNs play with respect to providing health care, particularly to vulnerable populations. NPs stepped up to meet patients’ needs — switching direction to help staff COVID-19 testing locations and serving to lead throughout all phases of the pandemic. The nightly news featured NPs, other APRNs and health care providers in hospital settings that the public had never really seen before. That really helped to shine a light on the NP role.
Certainly, there’s a growing need for new practice areas. We saw the growth of telehealth, but there are other developing roles, as well. It’s great to see that we continue to have a record number of applicants to programs nationally. Advanced practice nursing is a lifelong career with many different roles — inpatient, outpatient, clinic, rural health — that can spin off into other facets, such as teaching.
Kleinpell: We definitely need to remove barriers to practice. For many years, I had practiced in the state of Illinois, which is a reduced practice state. I relocated to Tennessee, where I have been practicing for seven years now. Prior to practicing in a restricted practice state like Tennessee, I did not realize the barriers that NPs face. Here in Tennessee, APRNs need the lifelong supervision of a collaborating physician. Those working in primary care must have 20% of their charts reviewed on a monthly basis and pay a consulting fee to their collaborating physician.
When the COVID-19 pandemic occurred, there were several of our colleagues who reached out to the Tennessee Nurses Association to conduct a survey on the impact of the pandemic on APRN practice in the state of Tennessee. As we began to network with others, there was an interest in looking at this impact in other states, as well. What began as a statewide survey became a nationwide survey.
The survey ended up representing all 50 states — those that have Full Practice Authority (FPA), as well as those with practice restrictions — and what was surprising to me is how significant institutional policy barriers, like hospital bylaws or facility policies, are to NPs across the country.
Since then, we have published a series of articles and given presentations to continue advocating for APRNs — especially in our state of Tennessee. We’ve had much more support from Tennessee legislators who really saw the role APRNs played during the pandemic, especially in rural counties, and have shown support for removing some of the restrictions within our state. State by state, I think we’re seeing progress in removing some of these unnecessary barriers, but we still need to do more to ensure all barriers — whether from state or federal law or institutional policy — are retired.
Kleinpell: I’ve been involved in some initiatives looking at clinician well-being and clinician wellness. During the pandemic, these topics became more prevalent, and people have been keen on addressing these issues to promote a better work-life balance. I think most of us tend to do a lot of work in our lives and focus intensely on our work, but the pandemic gave us all time to pause, reflect on our careers and ask ourselves what we are doing for our own well-being.
A lot of work has been publicized to prioritize and spread awareness of mental health. As health care providers, we must understand that “It’s ok not to be ok.” We should reach out and seek counseling or debriefing after stressful events without having any stigma attached to that need. APRNs have many demands on their position and their time. The idea of returning home from work to log in and complete your documentation is not the best way to take control over one’s work.
Thankfully, there are more discussions occurring in the work setting about a healthy work environment. Whether it’s positive communication, teamwork or promoting those traits within the organization, APRNs are in a key role to lead these initiatives and champion resources that are available nationally to help themselves and others realize their wellness potential, such as the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience.
Kleinpell: The Fellows group is an important part of professional networking, as well as an opportunity to showcase the APRN role within AANP. When I was inducted, it was a small cohort. Now, we have so many members who have attained fellowship, which has allowed us to hold special sessions at AANP conferences and evolve our newsletters into a great networking and communications strategy.
All this helps to showcase fellowship in AANP as a true career opportunity for NPs. The ability to capitalize on the knowledge and expertise within the Fellows group has been a tremendous benefit of the organization as it has grown in overall membership.
Kleinpell: NPs within their own role can showcase their leadership capabilities. Many NPs are involved in leading initiatives within their organization — whether it’s serving on a committee or implementing a new policy or protocol. Often times, they innovate and change the way care is provided to make improvements in patient care without showcasing what they’ve done. NPs should reflect on what they’ve done in their practice and highlight their work through internal newsletters, official manuscript publications or presentations. APRNs are really contributing and serving as leaders, so they should take credit for their work and make its impact more visible for key stakeholders in their organization.
Kleinpell: I would say to get involved. I joined AANP when I was a new NP. I’m a firm believer that when you join an organization, you need to do more than have a membership. You need to be involved and be engaged, so I have served on a number of committees. I had the opportunity to help establish the Acute Care Specialty Practice Group. Over the years, I increased the number of sessions available at conference regarding acute care practice and published articles in the journal regarding different aspects of the subject.
The networking capabilities that are within the organization are just phenomenal, so by getting involved and networking, you meet people who you wouldn’t have otherwise. I have colleagues across the nation who I can call at any time and collaborate with on various issues. AANP as an organization has been a tremendous professional opportunity for me, not only in terms of networking with colleagues, but also learning from others and further developing in my own role as an NP.
The road to becoming an AANP Fellow starts with making an impact on the NP role. One of the best ways to work toward that goal is by getting involved with your national professional organization. If you are looking to make outstanding contributions in the fields of clinical practice, research, education or policy, then consider joining your colleagues at the 2022 AANP National Conference — Online.
Attend this event to select from more than 80 continuing education (CE) sessions, learn the latest developments in NP-delivered care and network with like-minded NPs from across the country. With the ability to access all the sessions at your convenience through July 27, the online national conference is the perfect opportunity for busy NPs to grow professionally from the comfort of their own home.