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Q+A: An Interview with Leslie Hopkins

Photo by John Russell

 

Leslie Hopkins, DNP, APRN-BC, FNP-BC, ANP-C, director of the Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) specialty, shares why our nation’s aging population, referred to as a “silver tsunami,” and health care reform are coming together to make Adult- Gerontology Primary Care Nursing a very smart career choice.

Which patients can an Adult- Gerontology Primary Care Nurse Practitioner see?
Anyone who is age 13 and older. We have one of the broadest scopes of practice for any advanced practice nursing specialty. So if you are not interested in taking care of infants and young children, but are concerned about providing wellness, managing diseases and chronic health issues, this specialty is for you.

Are there any trends that make this a hot specialty right now?
Today, one out of every 10 people in the United States is age 65 or older. By 2030, one out of every five people will be in that group—that’s more than 72 million people—according to the Department of Health and Human Services. Our nation’s aging population is growing significantly at a time when medical schools are not graduating enough geriatricians, and that’s where AGPCNPs can fill a vital and growing gap. Also, according to the National Health Council about 50 percent of the adults in the U.S. have at least one chronic health condition, and a larger number are at risk for developing a chronic condition.

Are AGPCNPs more than geriatric providers?
It’s about being a health care provider to a wide swath of our country’s population. AGPCNPs have the ability to see the same person from the beginning of their adolescence through the adult years. This specialty embraces that many adults live well into their elder years (older than 80), while recognizing that today’s adolescents face more and more “adult” problems such as obesity, type 2 diabetes, sexually transmitted diseases and even drug or alcohol abuse.

What is the difference between a Family Nurse Practitioner and an Adult- Gerontology Primary Care Nurse Practitioner?
AGPCNPs typically provide care to adolescents and adult patients who can discuss their own health, rather than dealing with young children. Since we are not instructing about pediatric care, we spend that time teaching about special considerations among adult patients—syndromes specific to adult patients and the normal versus unusual changes due to the aging process.

What brought you to this role?
I originally studied accounting at Lipscomb University in Nashville. I was successful, but didn’t see it as a lifelong career trajectory for me. I wanted to get an education in something that could take me a lot of different directions and have more direct interactions with people to help them. Therefore I came to Vanderbilt for my MSN. My first job was in a clinic in rural Northwest Tennessee.

I loved my patients, but it was too far away from my friends and family. I was able to secure a position working with the Vine Hill Community Clinic, which at that time was part of the School of Nursing. Soon after, there was an opening to teach the Adult Primary Care course at Vanderbilt, and my role continued to grow from there. That was 18 years ago.

Did you always want to be some sort of teacher?
I’ve grown into the role of a teacher. I wasn’t born to be a teacher. Students make a person a better educator and the kind of students we have at Vanderbilt expect a great deal from the faculty—push you to be the best you can be. I’ve learned as much from my students as they have ever learned from me.

What makes you excited about teaching in this program after all these years?
It’s the kind of students we attract. They are eager and passionate and ridiculously smart. The School administration gives us the support we need to do our job well, and the colleagues I’m surrounded by are very talented educators and clinicians.

How long has Vanderbilt offered this program?
The Adult Nurse Practitioner Program, now the Adult- Gerontology Primary Care Nurse Practitioner Program, was established in 1999. Since that time, the specialty has grown and evolved to meet the demands of patients and the health care system. Lately, there is a nationwide movement that recognizes that all adult nurse practitioners will be essential to care for adolescents, adults and older adults due to the aging of our country’s population. The adult nurse practitioner program and the gerontology nurse practitioner program have been rolled into one comprehensive program and certification.

The VUSN Adult-Gerontology Primary Care Nurse Practitioner faculty team: Seated (L to R) Karen Hande, Jenny Kim; Standing (L to R) K. Melissa Smith, Leslie Hopkins, Abby Parish, Travis Dunlap and Kanah May Lewallen. Not pictured: Carrie Plummer. Photo By John Russell.

Why is the geriatric component so important?
We need to provide care for seniors in a different way and acknowledge their unique health issues. People without geriatric knowledge often discount a symptom as a typical sign of aging when it’s not. For example, if an 85-year-old woman is anemic, it’s not a normal symptom of aging. It means we need to figure out what else is going on. Incontinence is not a standard change of aging. It almost always occurs in women due to pregnancies that can contribute to lax pelvic floor muscles, can be the result of OB-GYN surgeries, decreased estrogen, etc.—but none of that makes it a “normal” part of aging.

What are the most important components of this curriculum?
The most important thing is that this program is evidence-based. We are teaching up-to-date standards of care and best clinical practices to the students. All of our faculty either have or are pursuing a doctoral level of education. Our faculty remain active in clinical practice. For instance, I practice in the Vanderbilt Williamson County walk-in clinic system and Vanderbilt Health at Gaylord Opryland, providing care to employees and their families.

What are the toughest classes?
Pharmacology! There is a vast amount of information, and things are always changing as new medications become available and others are taken off the market. We discuss how the cost of medicines impacts usage and ways to help patients get their medicines by enrolling in pharmaceutical company programs, discontinuing unneeded medications, etc. We spend a lot of time on the topic of polypharmacy which is an issue with many adult patients, but especially the elderly population.

What is the culture and tone of the program like?
Our faculty are passionate about what we are doing. We provide a nurturing, learning environment. Most of us have recently been students pursuing doctoral education, so we have a respect for students and the responsibilities they have outside the classroom as parents, partners, caregivers to other family members and more.

Tell me about the transformation students make?
The transformation is profound. I see our students convert their dreams and aspirations into a tangible, meaningful career that will be a lifelong journey.

Why do people choose this specialty?
Our students want relational experiences with patients. They want the broader understanding of providing primary care—not only disease specific, but also social, psychological and family issues—that go along with caring for someone as they age.

Is acute care included in this program?
No, acute care is provided by health care teams in a hospital emergency, surgical or trauma department. Adult-Gerontology Acute Care nurse practitioners manage patients with more unstable chronic health conditions. It is a separate educational track and national certification.

What is the program format?
We offer a modified distance learning format with a mixture of face-to-face learning, online instruction and clinical rotations. Baccalaureate-prepared nurses don’t have to relocate to Nashville to complete this program. They travel to campus periodically for pre-scheduled blocks of days. There is a lot of flexibility with how they can personally manage their day-to-day academic work. Our students and faculty are a cohesive group in constant contact with each other.

Do most students work while in the program?
About 50 percent work in some capacity.

What is the advantage of coming to Vanderbilt?
Our teaching faculty are engaged content experts with deep clinical experience. We focus on the student experience to make sure they have individual communication. We provide a safe learning environment, and by “safe” I mean it’s OK to ask questions, admit what they don’t know and learn from their mistakes.

What is the significance of being recently named a Hartford Center?
We were recently awarded membership in the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), having demonstrated the highest level of commitment to gerontological nursing. With the quickly-expanding aging population, it is critical that VUSN commits to preparing a nursing workforce that is prepared to care for this population. As a NHCGNE, we are able to collaborate efforts with other Hartford Centers and have more opportunities to network with organizations that are committed to improving geriatric nursing education and training.

What qualities does a student need to be successful in this program?
Words that come to mind are: self-motivated, organized, technologically savvy, possessing interpersonal skills and accepting of a wide range of cultures and beliefs.

How many students do you enroll each year?
Typically around 50, and we get to know each student and help her/him on the educational journey.

What is the most transformative class for students?
Our clinical sequence of courses, where our students take content they’ve learned and put it into practice. It’s the point at which they start interacting with patients, conducting histories and physical exams, deciding what lab work to order, interpreting lab work, formulating diagnoses, choosing medications to prescribe, managing illnesses and referring to specialists when appropriate. These experiences allow them to see how they can improve health outcomes.

Where do your graduates get jobs?
Most of our graduates go on to work in outpatient primary care, and you’ll see more of that as more people enter the health care system. There just aren’t enough primary care providers. It’s a common misperception that with this certification, most people work in nursing homes. Some do, but with such a broad scope of practice, these advanced practice nurses have a wide variety of choices for employment.

What do you want everyone reading this to know?
Real estate agents tell you that what matters most in a home purchase is “location, location and location.” To me, the most important factor in selecting a program is “faculty, faculty and faculty.” Our faculty are the foundation of our program. They are doctorally prepared, energetic and enthusiastic about providing care to adults of all ages. Our graduates stay in touch with us, come back to teach and even become preceptors for future students, because of the close student-faculty ties.

– Kathy Rivers

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