Insider look into the life of a Chronic Disease and Older Persons Nurse Practitioner

We are very excited to have interviewed Ryan Semera (RN, CDE, NP), Credentialled Diabetes Educator, Nurse Practitioner, Accredited Nurse Immuniser, BSN, GCertDiabEd, MNursPrac

Meet Nurse Practitioner Ryan Semera

I am an endorsed Nurse Practitioner. I currently work as a Chronic Disease and Older Persons Nurse Practitioner and also as a Custody Health Nurse Practitioner. I am also a Credentialled Diabetes Educator (CDE). I do work in private practice as a CDE and as a diabetes NP for a geriatrician’s group in Melbourne.

My educational background is: Bachelor of Science in Nursing and an overseas RN qualification. Graduate Certificate of Diabetes Education, Master of Nurse Practitioner and Master of Nursing (Diabetes Management and Education) and I am also currently enrolled in Master of Mental Health Nursing. Outside work, I enjoy watching documentaries, crime shows, and international cooking shows.

I also have a YouTube channel which I don’t want to divulge here yet as my current contents are “a day in a life” videos which are very different from what I do work-wise. I am in the process of changing my content, I want to incorporate nursing topics and Nurse practitioner topics, I just need time to plan it carefully and think of contents that may be useful for other nurses, aspiring NPs and students.

For Ryan’s website go here

You have been an ANUM, CNS, CNC, NP – can you describe the differences between these roles?

ANUM
When I as an Associate Nurse Unit Manager (ANUM), I was in charge of the whole functioning of the ward/department I was working in. Ensuring that care plans are followed, referrals are sent through, that there is a smooth admission and discharge of patients in the ward. The ANUM role supports the NUM and acts as a NUM whenever the NUM is not around. The role is 50% clinical and 50% management.

CNS
When I was a Clinical Nurse Specialist (CNS), I was specialising in the chosen portfolio I have nominated when I have applied for the CNS role initially. My portfolio back then was diabetes because I have a diabetes qualification. It is a senior nursing role that acts as ANUM when the ANUM is not around, so I was doing in charge shifts when no ANUM can do it. I was the source of clinical information about my chosen speciality.

CNC
When I was a Clinical Nurse Consultant (CNC), I consider my role as one step higher than a CNS. I was functioning as an expert in my field of speciality. I was a CNC in diabetes in various tertiary hospitals. Patients and other health professionals consult with me and refer to me. Each state and territory have different role descriptions for CNS and CNC, sometimes these two roles are interchangeable. In Victoria, a CNC is higher than a CNS when it comes to grade and classification.

NP
As a Nurse Practitioner (NP) the role is very different. NPs are the highest clinical nurses we have in the health system. They have a minimum of a Master’s degree qualification and must have studied core university units in order to be endorsed through AHPRA. These units are research, pharmacology and advanced health assessment. NPs can prescribe medications and treatments, order diagnostic, pathology and imaging tests, diagnose patients, admit and discharge patients and refer patients to other health professionals and medical specialists.

What is a Chronic Disease and Older Persons Nurse Practitioner?

A chronic disease NP manages people with chronic conditions such as chronic health failure, chronic respiratory disease, chronic kidney disease, diabetes, cancer diseases, etc. to name a few. The chronic disease NP is responsible for the provision of and leadership of advanced clinical care for patients, residents and clients and the community in accordance with care plans developed in conjunction with the resident or client, their medical officer and other members of the health care team. Leads, manages, directs and supports the care team that works alongside them to ensure that care is delivered within team members’ scope of practice, is evidenced-based.

I finished my nursing degree in 2005 and since then I have been practising as an RN. When I was working in one of the acute assessment units in Melbourne I saw a diabetes educator reviewing once of our patients, that ignited my interest in doing more for my patients and having more qualifications. I always believe that nurses are highly skilled professional and can do more.

How to become a Nurse Practitioner or Chronic Disease and Older Persons Nurse Practitioner?

To become an NP, you must have at least 5 years post-graduation work experience and 3 of that 5 years must be in a field you want to specialise e.g. ED or oncology and you must demonstrate to the university and AHPRA that you are practising at an advanced level. A senior nursing role does not immediately mean you are an advanced nurse. If you are an RN and doing beyond what is expected in your role, that is advanced nursing. You also need to have a letter of support from your employer; you need to nominate a mentor/s e.g. doctor, NP.

You need to have 5,000 working hours as an advanced nurse in the last 6 years and a master’s degree university qualification. So anyone meeting these criteria can be an NP, plus dedication and commitment. NP specialities are broad, you could practice in chronic disease or you could practice in a specialised area such as palliative care. Other areas are mental health, primary care, perioperative, cosmetic, maternity, anywhere a nurse can work.

I chose chronic disease because it encompasses a lot of medical conditions. It is a big area to specialise in. I want to practice in my full scope and potential, I don’t want to limit myself in one field, I want to manage my patients holistically and be involved in every health issue they have.

Where do you mostly work as an NP and what are the main types of patients you see?

I work for a large health organisation in Melbourne’s east. I also work privately in a GP practise setting and also provide specialist consultancy for various residential aged care facilities around Melbourne. I see patients with varied health care needs, it could be adjusting their medication doses, it could be starting them on new medications, and it could be follow up reviews post blood tests or imaging tests or patients needing specialist referral if their case is very complex. My role is clinical or medical, basically what a medical doctor does. I contribute to their care plans and the usual tasks such as prescribing treatments, ordering tests, and referrals.

You are also a Custodial Health Nurse Practitioner! Can you discuss this role?

Yes I work as a Custody Health Nurse Practitioner. This area is new to me. I have always wanted to engage myself in mental health. I see people in prison cells most of them are alcohol and other drugs patients and with mental health issues. When they are in custody waiting for a court trial, they are under our care, so ensuring that their regular medications are charted and ensuring that they are not withdrawing from alcohol and/or recreational drugs. If they are, ensuring that there are medications charted or prepared ready for the nurses to give in case they are withdrawing later on. We refer them to the hospital if they have injuries and if they fall really sick.

A typical day for me; I open our database and review patients in our list, we go to the various police station within Melbourne Metro and regional areas such as Geelong, Ballarat, Bendigo, Morwell to name a few. Depending on the demand that different police stations have, as a prescriber, we write down medications and do assessments especially to those who fall sick and new detainees. If I go regional, for example to Melton, the driving could be long enough to cover my whole shift. Or if I drive around the metro, I could see a few patients in different police stations.

Can you also talk about diabetes nursing?

Diabetes is a chronic and progressive disease. The number of affected by this disease is increasing daily, and there are still a lot of people out there who are not diagnosed. It is still unknown until now what causes diabetes, the ones we know today are all theories. So basically it is an autoimmune disease, the pancreas is either not producing enough insulin or producing enough insulin but is not working well.

Three common types of diabetes: Type 1, requires insulin all the time; Type 2 diabetes, mostly lifestyle-related; gestational diabetes or diabetes in pregnancy, hormonal changes causing insulin function to be altered. The common issues I clinically manage are hypoglycaemia and hyperglycaemia, medication management that includes reviews and starting on new ones. Empowering patients to manage their diabetes at home successfully. Prevention of micro and macrovascular complications and referral to an endocrinologist and other allied health professionals. Referrals are mostly coming from GPs, they usually ask for medication reviews and general diabetes education.

I schedule patients’ appointments to see me regularly, depending on the status of their diabetes. If they are newly diagnosed, then I have to spend more time with them, they are the ones who need a lot of diabetes education, education about their meds, diet, exercise etc. they also need NDSS (diabetes register) done, might need glucometer- they need to know how to use it. Ideally, I will see my patients regularly probably 6 monthly if they are stable or 3 monthly if not stable or earlier if they are on a new medication.

You are interested in moving into MH. What draws you into this area?

The number of people accessing mental health care is increasing significantly. Mental health is very important in health care. For patients to successfully participate in care planning of their own health, they need to understand their health. If their mental status is not as good as other mentally healthy people then they will not be able to look after themselves. I am working in the mental health sub-speciality of AOD, which really interests me. Managing people who are unwell due to alcohol, opioid, cannabis, stimulant abuse and psychosocial illnesses effectively, makes me more satisfied with the job that I do.

What are some myths or common misconceptions that you want to debunk about Nurse Practitioners!

That NPs are second rate doctors. No, NPs are first-class nurses. That NPs will replace doctors, No, NPs will fill in the big gaps in the health care system. NPs must have a university Master’s degree with core units of study in pharmacology and advanced health assessment, these units will give NP aspirants the knowledge they need to be effective NPs.

Other people would say that working in Custody Health is dangerous. No, you don’t actually render care to patients in cells alone, custody officers are protecting you and making sure you are safe in treating prison cells patients. It is one of the most challenging fields of nursing to specialise, but it is also a great area to work in to hone your abilities and learn new things.

What are the most rewarding and difficult aspects of your area of work?

Rewarding: when I see my patients go through withdrawal symptoms successfully because of the help by rending correct treatments.
Difficult: as expected, dealing with difficult behaviours, although I am getting used to it now. It is more difficult when patients’ do not divulge more information about their health. There are few reasons why: they are intoxicated, heavily “drugged” from taking prohibited drugs or just do not want to share more as they think that the information they will share will be used against them.

What pathway would you like to see the future of NP’s take over the next 10 years?

That nurses will do more. That NPs will be known more in the community.

What are some great resources that have helped you along the way?

There are more than 2,000 NPs in Australia. Each of their stories inspires me to be a more effective NP. Yes, there are issues we are facing currently as NPs in Australia, but I am confident that it will be resolved very soon because NPs are the future and it is inevitable.

What makes a good nursing manager in your opinion?

ANUMs and NUMs are senior leadership roles. They must drive change and influence people to change them and the service positively. They need to have compassionate care. They are leaders and managers as well. Nurse managers need strong communication and leadership skills. They should be adept at coordinating resources and personnel and meeting goals and objectives. They must be effective leaders who can strike a balance between working with the nursing staff and the healthcare facility administrators

How can we work better with other health professionals in the multi-disciplinary environment?

Strengthen collaboration with them. Respecting each others’ profession and field of work. Establishing linkages with them and ensuring that these links will stay healthy so that it will lead to a harmonious working relationship. It will be great to incorporate each others’ personal values with professional values, these will help us in working with other professionals effectively.

For other great Nurse Practitioner content, go HERE