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To mark the first day of Nurse Practitioner Week (8-14 December), we are excited to share this exclusive interview with Anthony Sokolowski, a highly experienced Nurse Practitioner and also currently the Director of the Australian College of Nurse Practitioners (ACNP). Anthony reflects on the role of a nurse practitioner, his career and experiences, how the profession can improve and the future of NPs.
If you’re interested in more stories like this, explore our articles on nurse practitioners or emergency nursing or leadership with nurses across Australia.
We’d love to hear your reflections on Anthony’s journey — share them in the comments or join the conversation in our private Facebook community.
Introduction
I have been a Nurse Practitioner for fifteen years and have twenty-four years of experience within NSW Health, primarily in critical care. Since 2020, I have served as a Director of the Australian College of Nurse Practitioners (ACNP). In this role, I advocate for Nurse Practitioners across Australia, supporting them in practicing to their full scope and overcoming barriers within the healthcare system through negotiation and promotion. I am committed to improving the health system by advocating for equitable access to services for patients and their caregivers. I have also developed and supported a national network for Nurse Practitioners, candidates, and students.
Within the Hunter New England Local Health District, I hold two positions. I have worked clinically as a Nurse Practitioner in the Belmont Emergency Department for fifteen years and have been the Nurse Practitioner Development Facilitator for the Nursing and Midwifery Directorate at Hunter New England Local Health District for eleven years. These roles have allowed me to lead projects at both local and district levels, influencing policy development by conducting research on Nurse Practitioner models of care and roles. Additionally, I am the lead for the Professional Performance Framework
What drew you to emergency nursing and how did that shape your path towards becoming a nurse practitioner?
My journey into emergency nursing began during a clinical placement in the emergency department of a tertiary hospital while I was a third-year nursing student. I was paired with a Clinical Nurse Specialist and worked the same shifts alongside them. This experience opened my eyes to the realities of emergency treatment and its operation. I realised how, as a nurse, I could make a significant difference in a person’s life during their most challenging moments. Even the simple act of offering a smile can have a positive impact on patients and their families.
Additionally, this placement allowed me to collaborate with highly skilled nurses who not only provided care but also educated patients and their families. I observed how they demonstrated leadership within the department by navigating difficult conversations and integrating evidence-based research into their practice. This experience greatly influenced my path toward becoming a nurse practitioner.
Can you walk us through a typical day as a Nurse Practitioner in your ED?
A typical day in the emergency department begins with determining which model of care I will be assigned to. Our department is relatively small and primarily utilizes two models: the Acute Assessment Area and the Fast Track area. Understanding which model I will be working in is part of my initial commitment for the shift.
The day starts with a multidisciplinary team (MDT) huddle, which includes nursing staff, medical personnel, pharmacy, and physiotherapy, and is led by the medical consultant and the Nursing Unit Manager. Once this meeting is complete, I may take over the care of patients as directed by the medical consultant or, more commonly, pick up new patients in my assigned area.
From this point, I engage in patient care, which includes taking medical histories, conducting relevant assessments, identifying any red flags, and determining whether any treatments have been administered or diagnostic tests performed. This process involves developing differential diagnoses and carrying out relevant diagnostics to rule out conditions that could cause significant harm. Throughout all of this, I prioritise communication, act with kindness, and work collaboratively with appropriate staff on the floor, keeping safety and evidence-based care at the forefront for the patients, their families, and my colleagues.
Once the appropriate mode of care for the patient is ascertained, they are either managed appropriately or discussed with the senior medical officer. Patients may also be referred to a specialist, either within the hospital, at a tertiary referral hospital, or privately. A discharge letter is completed for the relevant professional, and disposition occurs after discussion with the patient, their next of kin, and/or family members. The patient ages span a wide range, including a 2-year-old with community-acquired pneumonia, a 20-year-old with a dislocated shoulder, a 33-year-old female experiencing undifferentiated abdominal pain, a 54-year-old presenting with chest pain, a 62-year-old involved in a chainsaw accident, and a 95-year-old suffering from delirium after a fall.
There are always exceptions to the things I mentioned, but navigating the healthcare system can be quite tricky! After spending over 20 years in the emergency department, I have picked up a lot of knowledge and skills that help make this process easier. My goal is to ensure that patients get the timely care they need and deserve.
What are the most rewarding parts of working in emergency?
The most rewarding aspect of working in emergencies is the meaningful impact you can make on a community member’s life. Being part of an engaged and high-performing team offers benefits that enhance both personal and professional growth. It is incredibly inspiring to witness junior nurses advance their careers into management, education, or become Nurse Practitioners.
The ongoing support from medical colleagues in clinical decision-making and navigating complex patient journeys strengthens our resolve. This environment has also helped me develop expertise in having difficult conversations with patients, families, and staff, empowering us all in our roles. Each day, as I walk out of the hospital, I am reminded of the profound difference we’ve made in someone’s life, reinforcing why we do this important work.
What advice do you have for junior nurses moving into emergency as a speciality?
I would remind them not to be overwhelmed by the vast amount of knowledge needed to work in the emergency department. It is crucial to surround themselves with colleagues who can offer encouragement and support, as well as provide direction, emotional guidance, and professional assistance. Additionally, finding a way to take breaks is essential. One important piece of advice I received during my early years was that when they enter the department, they should embody the role of a nurse, and when they leave, they should leave all their responsibilities and stress behind within the hospital.
What are some of the ‘friction’ points that exist currently for NPs in acute settings or EDs?
Friction points often encountered by NPs) in the Emergency Department frequently stem from misunderstandings regarding their roles among both staff and patients. These challenges can be effectively addressed through strong leadership within the multidisciplinary team, particularly from nursing and medical leaders. Clarity and acceptance of the NP role depend on the service’s understanding of their Scope of Practice.
When this understanding is lacking, it can lead to confusion and underutilisation of NP skills. Additionally, resistance to NP-led decisions may create tension within the team, resulting in job uncertainty for the NPs involved. Addressing these issues is essential for maximising the contributions of NPs in the Emergency Department.
Another friction point is the need for a clear nursing pathway into the Nurse Practitioner role. For this to happen, nursing leaders must understand the path, which is not always straightforward and can vary based on individual circumstances. Gaining support to progress along this advanced practice pathway is crucial, as well as recognising the opportunities that arise once one is endorsed with the relevant experience and knowledge. This endorsement allows NPs to serve the community as well-trained health professionals capable of delivering high-quality and safe care to community members.
What’s something the public, doctors, or nurses frequently misunderstand about NP’s?
One of the common misconceptions about NPs involves their Scope of Practice, which highlights the extensive education, experience, and knowledge they bring to patient care. NPs complete advanced training in critical areas such as pathophysiology, physical assessments, pharmacology, differential diagnoses, diagnostics, and interpretation. This training empowers them to develop individualised treatment plans and manage patient care independently, while also having the authority to refer patients to other healthcare providers when necessary.
To obtain certification, NPs engage in at least 2,000 hours of advanced practice, followed by a total of 5,000 hours to become fully endorsed as Nurse Practitioners. Additionally, they must successfully complete a recognised Master’s program in Nurse Practice accredited by the Nursing and Midwifery Board of Australia (NMBA).
Addressing the misconception that NPs require a doctor’s oversight for all clinical decisions can enhance understanding and collaboration within the healthcare system. By recognising the full scope of services that NPs can provide, patients and healthcare staff can contribute to a more efficient and accessible healthcare experience, ultimately improving patient outcomes and satisfaction.
What were some of the biggest learning curves moving into the role of a Nurse Practitioner?
The transition from RN to NP typically involves several significant learning curves. Clinical decision-making and building clinical judgement is a steep learning curve, particularly in the first few months. This can often feel overwhelming; however, having a clinical supervisor and mentor is invaluable in supporting both your professional and personal growth. Diagnostic reasoning is also critical, requiring a systematic approach that involves gathering all relevant history and physical exam findings, interpreting these findings, and developing a differential diagnosis.
This process develops through exposure and experience, rather than relying solely on a textbook. Time management and efficiency are other skills to master by balancing workflow with documentation, which means staying on schedule while providing quality and safe care simultaneously, managing health records, and addressing other competing demands. It can be really challenging for a developing and novice NP.
Understanding the Scope of Practice is essential to know what you can do and what you cannot do independently, where collaboration is required, and navigating these boundaries can be confusing. Imposter syndrome is often felt by new NPs with self-doubt whilst working alongside experienced clinicians, but this needs to be highlighted as part of the process, whilst you build confidence in your training and expertise, which is often an ongoing process.
Looking back, what was it like being one of the early NPs in your region?
Reflecting on my past experiences at work, I realise that each day was filled with challenges. I often encountered resistance from nurses and nursing leaders who did not fully understand the role of NPs and were reluctant to embrace it. However, for those at the local level who took the time to comprehend the complexities of acquiring and maintaining the necessary skills, knowledge, and experience for the NP role, their efforts made it all worthwhile.
In the early days, I often felt isolated. It is commonly said that NPs find themselves torn between nursing and medicine; we are neither performing traditional nursing roles nor acting as doctors, placing us in a challenging middle ground. My transition from the Sydney hospital to Newcastle into an established NP role was more accepting, as I connected with local NPs. We often discussed the challenges we faced regarding policies, legislation, and the inability to provide timely care to the community, which frequently resulted in delays.
While many things have changed, some challenges still persist. In the first few years although I received support locally at my hospital, I had opportunities for frequent discussions with senior leaders in the organisation. This engagement helped them understand the role of Nurse Practitioners and ultimately made them more accepting, leading to the development of more NP positions within the organisation.
What advice would you give to someone considering becoming a nurse practitioner?
I am often asked this question, and I encourage individuals to build a supportive network that offers professional, personal, and emotional strength, as this is crucial. Remember that everyone has their unique pathway; while the journey can be challenging until you secure a training position for advanced practice, perseverance is key.
Start by pursuing postgraduate qualifications, and while doing so, reflect on how to balance family, social, and personal life. Additionally, engage in conversations with nurse practitioners in your organisation or network to learn how they forged their paths and to explore the opportunities that await you.
What are some major policy or governance works that you have been involved in? What has been your favourite project so far and why?
When I started my role in Nursing and Midwifery at HNELHD in 2014, one of my primary tasks was to develop a district-wide governance structure that included an evidence-based leadership framework. Since then, we have successfully established one of the strongest governance structures, involving local clinicians, managers, mid-level managers, Directors of Nursing, and executives, along with support networks like the NP Network. This effort has led to a growing workforce of over 110 NPs within our LHD.
Additionally, I have participated in two revisions of the NSW Ministry of Health working committees focused on state NP policy. I was also involved in establishing the governance structure for the Primary Health Network during its early days, particularly concerning aged care NPs. On a national level, I have served as an ACNP board member and program lead for the Professional Performance Framework for Advanced Practice Nurses, Midwives, and Nurse Practitioners
What do you envision in the next 10 years for Nurse Practitioners in Australia?
The most significant change anticipated for NPs in Australia over the next 10 years is an increase in the NP workforce. NPs will play an increasingly vital role in addressing shortages and filling gaps, particularly in primary health care and specialised areas. Recent government initiatives, such as scholarships for advanced practice nurses to obtain endorsement as NPs and initiatives supporting NP models of care in primary care, will lead to an increase in NP positions.
Another important change is the expansion of NPs’ scope of practice, spurred by the federal government’s ongoing review of the Scope of Practice and changes to various legislations, prescribing authorities, and policies. These measures will enable NPs to work to the full extent of their skills and training.
NP-led services are likely to become more common, providing valuable options for those who are unable to attend in-person consultations, particularly individuals with chronic illnesses or those from underserved communities.
Experienced NPs with more than 10 years of experience are adept at navigating the regulatory complexities that still surround the NP scope of practice, despite NPs being endorsed to practice in Australia. It is expected that, in the next decade, streamlining processes will be essential for maximising the NP workforce’s potential. This will help overcome funding challenges and create a clearer pathway for Registered Nurses to transition into NP roles.
Who are 3 people who have been most influential to you and why?
One of the most significant figures in my journey has been my Nursing Unit Manager in the Emergency Department, Sue. I vividly remember the first time we met. I was a fresh graduate, navigating the challenges of working in a medical ward at Mona Vale Hospital, trying to find my footing in the nursing world. Sue had heard about my interest in emergency care from the New Graduate coordinator, and one day, as I walked down the corridor, she spotted my name tag and greeted me with a warm smile.
She introduced herself and asked if I’d consider working in the Emergency Department after completing my new graduation year. That simple conversation changed everything for me. I went on to complete the Principles in Emergency Care Course, and before I knew it, I was part of the 2nd-year Critical Care Foundation Program, rotating through ED and ICU at Mona Vale. I even started in the ED a bit sooner than planned because there was a gap that needed filling. What stands out is how supportive Sue has been throughout my journey. She never hesitated to champion my growth and encouraged me to challenge the norm within the department.Â
She was always there to help me expand my skills as a Registered Nurse, guiding me in leadership roles where I learned to present to our Director of Nursing. With Sue’s mentorship, I could dive into exciting educational opportunities, like working with new BiPAP machines and engaging in research with the Clinical Improvement Network in those days. Having someone like her in my corner made all the difference in my professional development. In the first years, I learned how important this was.
On the night shift in those days, we had two nurses, including me and a regular locum, who only worked nights. I found this very exciting but emotionally draining. We had multiple cardiac arrests brought in at night. Notably, an infant who I later found out was a SIDS case, but this is not what we knew at the time.
As you can imagine, we had to work as a close team, and there was always check-in after a shift and before with each other as many were going through tough periods either at work or at home. This was very real for me and made a significant difference, especially when my NUM would frequently check in or call after sometimes horrific shifts. Â
Sue was an advocate for improving patients’ experience and best outcomes. During the summer, the ED was often overloaded with minor injuries and illnesses. I remember conversing with her one day as many of the junior doctors struggled to get through the workload. She told me I had a meeting with other NUMs in her LHD and told a story of how Hornsby Hospital had employed a Nurse Practitioner who was making an incredible impact in the ED, particularly the waiting room, and asked if I wanted to meet her. Of course, I said yes, and this was the beginning of my exciting challenging pathway.
I met the Nurse Practitioner who, in the first meeting, told me that if I was going to go down this pathway, it was not a straight pathway. There would be lots of challenges, particularly with nursing and medical staff, as you challenge the status quo. She then told me a story of when she started at Concord Hospital as a nurse practitioner supported by management, and all the medical staff walked out. Wow I thought and felt overwhelmed? How did you overcome this? She said it was a lack of understanding, and once the medical staff was informed of her role and it was theirs to support, their role relationships improved.
I later learned that Nurse Practitioner was one of the first Nurse Practitioners in Australia, and she became my mentor. I still have her number if I need to call her. As my career developed, I soon was involved in creating a TNP role at Mona Vale Hospital, again a first for the hospital and one of few in the state.
Challenges were felt daily, mainly by a small percentage of nursing staff who openly and closely talked about why he was doing something different without understanding. Once I found out, I was able to engage with these individuals, and again, this was a steep learning curve that I could not do without having Sue and now Jane in my corner. Â
As part of studying for my master’s, I also connected with Lea, who was our critical care CNC for the hospital. Again, this became a lasting relationship, and many times, she challenged my feelings. She often helped me review assignments, helped in ED when I was stuck due to limited resources, and provided me with an avenue for discussing project work, particularly the processes involved in making a project successful.
Her project focused on providing early treatment and investigations in the ED, which aligned beautifully with my master’s program. We had many discussions on how this could work and developed a resource package for nursing staff. Later, I found out that this was the original CIN role, which was soon rolled out in some of the Sydney Hospitals and, notably, JHH ED a few years later. Lea also helped me prepare for my interview at Belmont ED, which I was successful in.Â
Lastly but not least, Kelley, greatly inspired me through her exceptional leadership and commitment to nursing and midwifery. As the Nursing and Midwifery Nurse Manager for Clinical Leadership and Clinical Practice, she not only welcomed me as a project lead for the governance of Nurse Practitioner positions across HNELHD, but also fostered a supportive environment that encouraged growth and learning.
Her enthusiasm for understanding the intricacies of the Nurse Practitioner role and her drive to advocate passionately for it were truly remarkable. Thanks to Kelley, I discovered a new perspective on professional challenges and found a genuine interest in exploring innovative solutions after completing a Practice Development course.
She exemplified how to conduct difficult conversations with respect and positivity, which significantly influenced my communication skills. Even after she moved on to become the Chief Midwife in Queensland Health, her teachings stayed with me. I am incredibly grateful for her guidance, passion, and the way she encouraged me to critically reflect on my experiences, which has been invaluable to my growth.
How can we work better with other health professionals in the multidisciplinary environment?
Start by getting to know the roles, priorities, and challenges that your colleagues from different disciplines face. Once you have that understanding, it’s really important to build relationships with them as people, not just as coworkers. Try having informal chats during breaks; this helps create trust and makes those tough conversations much easier when you’re dealing with complex patient cases. Being genuine and authentic, especially when you ask for their expertise, shows that you truly respect their professional judgment. Plus, regular debriefs can really strengthen your connections by bringing in fresh perspectives that are invaluable.
What’s next for your career?
I am excited to embark on my next career move into university academia, where I will gradually engage in research, marking and teaching. My aspiration is to pursue a PhD in the future, once my children have graduated from secondary school. I cherish my current role, which beautifully balances clinical work with the opportunity to support the Nurse Practitioner workforce in my LHD. I am committed to learning from their experiences and inspiring them to share their journeys with others.
