Bettering Brain Health as a Neurology Nurse Practitioner
Hear from neurology nurse practitioner Celia McIntosh on the importance of whole-person care and why meaningful advocacy starts at the bedside.
The specialty of neurology spans the brain, spinal cord, nerves and muscles of a patient. For nurse practitioners (NPs), specializing in neurology opens the door to a remarkable range of conditions and disorders — from depression, headache and migraine to Alzheimer’s disease.
That sheer diversity is exactly what makes neurology so exciting for many NPs — among them Celia McIntosh, DNP, RN, FNP-C, PMHNP-BC, CCRN, CEN, SCRN, CNRN, LNC, co-chair of the AANP Neurology Community. McIntosh’s 20-year career has spanned “neuroscience, clinical innovation, executive leadership in nonprofit organizations and social justice advocacy,” and here she speaks with the American Association of Nurse Practitioners® (AANP) about her specialty and how neuroscience and advocacy are connected.
One Specialty, Endless Variety
McIntosh’s career began with her working first as a home health aide, and then — upon becoming a registered nurse (RN) — working in what she calls “a variety of different, critical care areas,” including a cardiac step-down unit and the ICU. “I decided to go back and become an NP because I really wanted to do a lot more with patient advocacy,” she recalls. “I have a knack for lifelong learning, and I really wanted to improve health outcomes on a different level.”
After earning her family NP degree in 2011, McIntosh expected to begin her career as an NP in either primary care or a specialty practice. Instead, she found herself navigating a challenge familiar to many new graduate NPs. “I interviewed for NP positions over and over,” she recalls. “Some interview processes lasted several hours and included multiple meetings with physicians, NPs, managers and other members of the care team. Everything seemed to go well, but then another rejection letter would arrive, each carrying the same message: they had chosen someone with more experience. I remember thinking, ‘You knew I was a new graduate when you interviewed me. You knew I didn't have experience. So why put me through multiple rounds of interviews just to tell me you wanted someone with more experience?’” Although none of those primary care or specialty positions materialized, McIntosh refused to let the setbacks define her. Instead, they redirected her toward an opportunity she had never envisioned.
Today, as a seasoned neurology expert, McIntosh makes the case that the specialty could be a great fit for just about any NP. “Neurology combines a lot of the clinical complexity with whole-patient care,” she explains. “At any given time, you’re seeing a different variety of patient. Right now, I may be seeing stroke, in the next hour I may be seeing seizure and I may be seeing someone with myasthenia in a couple more hours. The flexibility and the variety of patients is really great.” What keeps McIntosh inspired is showing up for patients at the most critical moments of their lives. “Most rewarding for me is the ability to impact patient outcomes. You’re taking care of patients in critical moments.” Additionally, she says, “there’s a lot of innovation, and we’re always evolving as a specialty.” And the field is moving fast, with advances in stroke treatment, epilepsy management and neuroimmunology. “There’s a lot of ability to manage complex problems and have clinical expertise around decision-making.”
Rethinking Migraine: New Hope for a Misunderstood Condition
When it comes to migraine and headache, McIntosh is quick to point out that the conditions are “complex.” She explains that “[migraine] can be very disabling. Sometimes people throw around the term ‘migraine’ very loosely, but it can be very debilitating for the patient to the point where it’s affecting their day-to-day function. It can lead to disability.” She also makes sure to note that “migraine disproportionately affects women and is approximately three times more frequent in women than in men.” McIntosh clarifies as well that “90% of individuals living with migraine report significant disruption of their education, careers, family responsibility and just social life.” The good news: neurology NPs now have a growing set of exciting new therapies at their fingertips. McIntosh specifically points to calcitonin gene-related peptides, which she says, “help with pain transmission, vasodilation and some neuroinflammation,” and are “playing a big role in migraine physiology, pathophysiology.”
For McIntosh, the calling doesn’t end at the bedside. It also means addressing the social determinants of health — working with patients to tackle the vulnerabilities that stand between them and better brain (and whole-body) health. She believes, in fact, that neuroscience and advocacy are inherently connected. “My advocacy work is grounded in the belief of improving neurological health, and it really requires me to kind of examine the systems around it,” she says. “So yes, I’m working in the hospital, but a lot of problems that lead patients to the hospital are because of the environment around them. Maybe they don’t have good housing, and maybe that’s what’s impacting them. Maybe they don’t have transportation, so they can’t come to their appointments.” She sees her role as “recognizing those vulnerabilities and working to coordinate care from the outside to the home, to discharge again.”
Asked why she believes it’s important to be involved in AANP in general and in a leadership role as a community co-chair specifically, McIntosh is quick with an answer: “I would say that NPs are some of the most trusted professionals, and we have the ability to influence not only policy, but our professional areas. And we’re not alone — we have over 461,000 NPs. Being a part of AANP, you can have mentoring, professional development, advocacy opportunities and leadership. AANP is always looking for people that are willing to be change agents and to lead the charge.”
Connect. Collaborate. Advance Neurology Practice.
Looking to engage with NPs who share your interest in neurology? Join the AANP Neurology Community to connect with NP colleagues, exchange ideas, share clinical insights, explore emerging issues and strengthen the NP voice in neurologic care.