Family nurse practitioners (FNPs) are advanced practice nurses. They can work in various settings, but often, they work in private clinics, in their practices, or with their roster of patients in a doctor’s office or practice. They usually work with a fair degree of autonomy and have patients with whom they can work through many different stages of their lives.
Often, an FNP may see multiple generations of one family, from babies to grandparents. Patients consult an FNP for many reasons, but one of them is for managing chronic or long-term health conditions. While the patient may also be under the care of a specialist in that condition, the FNP often provides the greatest continuity of care in the day-to-day management of the condition. As a result, FNPs can become specialists in managing chronic health conditions.
How to become an FNP
For those currently working as a registered nurse (RN) and keen to advance their career, becoming an FNP can be an excellent option. As well as working with greater autonomy, FNPs have good long-term job security and higher earning potential. Unlike the shift work of an RN, an FNP often works more stable hours, which is particularly handy when juggling a career with family life and other commitments. Further study is necessary, with many undertaking a Master of Science in Nursing (MSN).
However, for those who already have an MSN or even a Doctor of Nursing Practice (DNP) and want to become an FNP, Online Family Nurse Practitioner Post-Grad Programs with multiple entrance points like that offered at Wilkes University will be ideal. The coursework of the online Post-Graduate/APRN Certificate program will equip the students with the skills necessary to thrive in family-focused primary care, like disease prevention and management, health and wellness education, and counseling for patients across their lifespan. It also prepares graduates to take the national board certification exams appropriate to their chosen concentration.
A qualified FNP will see patients for many different reasons, but among them will be chronic conditions. FNPs will be there every step of the way, often from when the patient first develops symptoms to the management and the ups and downs of living with a long-term health condition.
What chronic conditions do FNPs help patients manage?
There are many chronic conditions, and an FNP should be prepared to help manage any of them. However, there are some reasonably common chronic conditions that the FNP will likely see regularly in their career, including the following.
Arthritis
Arthritis is a joint disease. There are more than 100 different types of the disease, and symptoms include pain, swelling and reduced joint motion. In severe cases, it can result in chronic pain and difficulty in walking or undertaking normal daily tasks. While some forms of arthritis tend to affect older people, it can affect people of any age. Some cases are autoimmune disease, while an injury, work-related damage or lifestyle factors such as excess weight might cause others.
Asthma
Asthma is a chronic lung disease where inflammation and muscle tightening around the lungs obstruct breathing, with symptoms being wheezing, shortness of breath and chest tightening, and a persistent cough. The causes tend to be genetic, exposure to environmental irritants, and factors affecting early lung development, such as prematurity and exposure to smoking.
Cancer
While we often think of cancer as a disease that you either recover from or die from, very often it can become a chronic condition where the cancer does not go away but becomes stable, meaning that the patient’s condition does not worsen. This is a chronic condition that needs careful management as the cancer can change, either becoming more aggressive again or going into remission. Chronic cancer can be managed for years, and although it may never be cured, it can happen that eventually the patient dies with cancer rather than of cancer.
Diabetes
Diabetes occurs when the pancreas does not make enough insulin or if the body cannot use the insulin. There are various types of diabetes, including gestational diabetes, which only occurs during pregnancy. It is not known what causes type 1 diabetes, which generally first appears in childhood. However, type 2 diabetes can be caused by poor diet, lack of exercise and genetics.
Epilepsy
Epilepsy covers a range of conditions that involve a tendency to have seizures that start in the brain. It can start at any point in life. There is often a genetic cause of tendency, either inherited or from a mutation in the genes. However, it is often brought on by a brain condition or stroke, tumors and meningitis.
Heart disease
There are different types of heart disease, such as coronary artery disease, heart arrhythmia, congenital heart defects, cardiomyopathy and valvular heart disease. Each one can have its own cause. They can evolve from another chronic condition such as diabetes or hypertension, or be caused by smoking, drugs, alcohol, emotional stress and caffeine. However, in other cases, a chronic heart condition is simply something that the patient was born with.
Hypertension
Hypertension is also known as high blood pressure. Often, there are no symptoms and it is only diagnosed when the patient gets their blood pressure checked. If the blood pressure becomes very high, there can be symptoms such as severe headaches, chest pain, blurred vision and difficulty breathing. The risk factors of hypertension include old age, genetic tendency, being overweight, drinking too much alcohol, and a high salt diet. Uncontrolled hypertension can result in angina, heart attack, heart failure and strokes.
How do FNPs manage chronic conditions in primary care settings?
As medical professionals who provide healthcare at all stages of life, an FNP will play a part in all stages of a chronic disease, and in doing so, will help improve the outcome for the patients and their quality of life.
Prevention
Prevention is better than a cure, and the FNP can help prevent chronic diseases, particularly if they are caused by lifestyle choices. FNPs can give dietary advice and advice on weight loss. They can also help patients access support to quit alcohol, drugs and smoking. As some chronic diseases emerge from other chronic diseases, by providing effective management of one chronic condition, they can help prevent further conditions from developing.
Diagnosis
As many chronic conditions start with mild or no symptoms, diagnosis can be difficult. As an FNP provides primary care, they may be the medical professional consulted when a patient starts experiencing mild symptoms such as breathlessness, fatigue or frequent headaches. Some conditions might be picked up through routine checks, such as when checking blood pressure. As medical professionals who get to know their patients, they may also be the ones who can pick up on any change in their health.
Exactly how autonomously an FNP can work varies from state to state, but generally they can order further diagnostic tests and analyze the results to help determine the condition. They can also refer patients on to specialists if necessary.
Treating
The treatment of chronic conditions can be complex and involve many different medical professionals. The FNP may provide some of that treatment, but they can also serve as case managers or coordinators, who make sure that the patient is able to see the professionals they need and ensure that all information is passed on to the relevant people. They can also act as a patient advocate, ensuring that the patient is able to access the treatment they need.
Monitoring
Chronic conditions need to be carefully monitored to ensure that the condition is stable and that any treatment or medication is working – this is a task often carried out by the FNP. As someone who is based in the community, the FNP is usually easy for the patient to access. Also, as someone who the patient knows well, they can often feel more comfortable seeing them, rather than a hospital physician who they barely know.
Often, an FNP will see a patient regularly. As part of the checkup, they might listen to the patient’s heart, take their blood pressure, and send blood and/or urine samples for testing. They can also talk to the patient about how they are feeling in their health and how well they think their condition is being managed.
Very often, the monitoring will result in reassurance for the patient that the chronic condition is being well-managed and that there are no signs of it worsening. However, if there is cause for concern, the FNP can order further tests or refer the patient back to a specialist to see if further treatment is necessary.
Often, particularly when a condition is newly diagnosed, monitoring involves checking that the medication is working and not causing any serious side effects. If necessary, medication or doses can be adjusted and then further monitoring can take place to see if this is working better for the patient.
Education
Developing a chronic condition can be emotionally and psychologically difficult for the patient. They are accustomed to seeing themselves as healthy and do not want to think of themselves as sick. Most of all, they want to be cured and get on with their lives. However, while a chronic condition may not be curable, very often if properly managed, a patient can feel well and return to living a fulfilling and enjoyable life. Generally, the best way to do this is to educate the patient on how to manage their condition for themselves, helping to minimize the need for medical attention.
Exactly how this is done will depend on the condition. It can be as simple as providing daily medication that the patient needs to take, but others are more complicated. A diabetic patient may need to be taught how to monitor their blood-sugar levels for themselves and perhaps learn how to inject themselves with insulin. Asthma patients can be taught how to use their inhalers and when they should take them.
Some chronic conditions can have triggers that cause problems. Epileptics, for example, may be advised on avoiding certain types of lighting, while many people with autoimmune conditions such as Crohn’s disease and ulcerative colitis can discover what dietary and lifestyle choices trigger flare-ups.
Many conditions, such as hypertension, diabetes and heart disease, can be improved by a healthier lifestyle. Education on healthy diets and safe exercise can improve those conditions and keep away any increase in the severity of the condition.
Additionally, the FNP can put the patient in touch with support groups that can provide many tips on managing a condition from those already living with the disease. This can allow the patent to feel less isolated and provide hope when they see how others are managing to live with their condition. Through education, many chronic conditions can be well managed and any treatment that the patient needs to do can quickly become a routine part of daily life.
The vital role of the FNP
Many medical professionals play a vital role in diagnosing, treating and managing chronic conditions. However, an FNP has one of the most positive and critical roles in managing chronic conditions and overall patient care. They bring with them advanced skills and knowledge that are aimed at this type of care and provide their patients with holistic care. FNPs are an asset to any medical practice as they ensure their patients’ improved health and wellbeing.
Jeff Keil is a professor of psychology. He has conducted numerous research studies on media effects including the effects of bullying on adolescents, and “sexy media” effects on sexual behavior.. DR Keil has written for Maclean’s, Motherboard, the National Post, and the Huffington Post.
