Interview with Nachole Johnson, Family Nurse Practitioner, Author, and Founder of Renursing Career Consulting LLC

Nachole Johnson, FNP, is a float nurse practitioner, prolific author, and business owner who is well-known in the nursing field. Nachole has worked in nursing since 2001 and followed a laddered approach to her education and career, working from the role of nurse’s aid up to her current nurse practitioner role. In addition to her daily work and entrepreneurial projects, Nachole is a frequent contributor to Minority Nurse Magazine and DailyNurse.com. She is also a prolific blogger on her own website, Renursing.com, where she discusses topics from nursing history to challenges in nursing practice today.

You work as both an NP in occupational health and urgent care and as an author, can you walk us through a typical day in your life?

For the most part, a typical day for me involves a lot of multitasking. During the day I work a typical Monday through Friday schedule, but with varying day shift hours. I may go in as early as 7 AM some days to as late as 11 AM. My job is as a float nurse practitioner in a large occupational health and urgent care network, with 90% occupational health and 10% urgent care mix on any given day. I float to 13 different clinics in the local metro area, so I always check my schedule the day before to see where I’m working the next day. Houston is a big city and my commute can take anywhere from 20 minutes to over an hour with traffic in the morning depending on the clinic I’m working in that day.

While in the car, I keep myself occupied during the commute by listening to podcasts, an audiobook, or talk radio. At work I can see anywhere between 20-40 patients on a given day, depending on which clinic I’m scheduled at for the day. As you can tell, my workday is usually pretty busy, but I love my job. If I have time in between seeing patients, I research book topics, approve edits from my editor or graphic artist, and if it’s a good day, I may even write a paragraph or two of a new book I’m working on since I always carry my iPad.

After work, I eat dinner and then work out. I enjoy staying active and do so by going to boxing class, taking a long walk, or doing Pilates. After my workout, I shower, and then it’s back to work for me. As an entrepreneur my evenings are spent catching up on emails, working on my website, or writing. Right now I’m finishing up my nurse practitioner board review and nurse practitioner mnemonic series books. After those are done I’ll be able to focus on other book ideas and projects.

You followed a fairly classic career ladder in nursing (educational ladder), what advice would you give other students considering a laddered approach to nursing education?

It is a long approach, but well worth it in the end. I didn’t plan on working my way up the career ladder when I started in nursing as a CNA. I did know I wanted to be a nurse, but at that time, I didn’t know what kind of nurse I wanted to be (LPN or RN). My knowledge about the path I should take to become a nurse was limited when I first started out. Once I became an RN (associate’s degree), I do remember not wanting to go back to school, but eventually did after realizing I wanted to advance in the profession. I’m now a Family Nurse Practitioner and couldn’t be happier with my choice. I don’t have any plans to go back to school at the moment, but who knows? That may change in the future since I enjoy learning.

My advice for those who are starting in the nursing profession- think about where you would like to see yourself in five or 10 years. I thought I did this but didn’t have a specific goal of anything but becoming a “nurse.” Get really specific about your career goals and work towards them. If that involves stair-stepping your career because you don’t have time to go directly through school or want to minimize student loan debt, do so. If you have the opportunity to get your BSN as your starting point in your career, do so. There is no right or wrong answer here, just be specific with your overall goal. As for me personally, I do see one clear benefit of taking the classic career ladder approach; I am more confident as a nurse practitioner since I have been a nurse at multiple levels. LPN school, RN school, and FNP school were a breeze for me since I continued to build on from my initial education as a CNA and every other level after that.

What do you recommend nursing students look for when choosing a nursing degree program?

First and foremost, I always tell prospective nursing students to choose their education wisely. When looking for a school remember that the school you ultimately choose can have lasting effects on your nursing career. Going for the easiest and cheapest option is not the best considering you will be responsible for peoples’ lives when you get out of school. If this isn’t enough to scare you, I don’t know what will. When I graduated from LPN school I felt honored that I was in the position to care for someone’s precious child (pediatric home health). Many times during that first year I was in awe of the tremendous responsibility I had and always worried about making a mistake. I went to a great school and still felt unprepared at times. Imagine how my outlook would have been if I went to a school that was considered “easy and cheap.” I honestly don’t think I would have made it as far as I have in nursing if I took the easy way out.

I remember while in LPN school I had a fellow student tell me she was looking for the easiest job once she graduated. She was not interested in learning more than she had to and had her sights set on working in a clinic directly after graduation. I was appalled at her attitude, and even as a nursing student, I thought, “I never want to potentially put my patients in a harmful situation because I took the easy way out and didn’t want to learn all I could as a nurse.” Continuing education is vital in the nursing profession, not only for yourself but for the patients you care for.

Secondly, review the school accreditation and the NCLEX pass rates of all programs you are considering. These are very important points to consider. If the school you choose is not accredited or loses its accreditation, you may not be able to graduate or the state board may not even recognize your degree. This is a hard lesson to learn from but can be avoided by properly vetting the schools you are interested in beforehand. Within the last year, there was a major shutdown of a well-known school for accreditation issues. Many nursing students were left without a degree or the ability to transfer credits to another school. What if you go to a school that is accredited, but doesn’t have great NCLEX pass rates? You run the risk of not passing your board exam because your school didn’t adequately prepare you to be a nurse. This ultimately wastes time and money.

Lastly, let’s look at your nursing school choice from the eyes of a potential employer. Many people don’t take this into consideration when applying to nursing school but trust me, potential employers do. Unfortunately, some schools have a negative reputation for producing poor quality nurses (i.e. lack of knowledge of basic nursing skills, no initiative to learn, unprofessional behavior) and employers have started to pick up on that. If given the opportunity to hire candidate A from a reputable school with limited skills vs. candidate B from a less reputable school with limited skills, the employer is likely to hire someone from a more reputable school. This is a reality that has to be taken into consideration when looking into nursing programs.

What two or three things can help students get the most out of a nursing program at the undergraduate level? At the master’s level?

First and foremost, for students to be successful in either an undergraduate or master’s level program they need to identify their motivation for getting the degree in the first place. If they are looking for an easy way to become a nurse (or advanced practice nurse) and making money is the only goal in life, they’ll be sadly mistaken and disappointed in their overall nursing experience. Money is important, but it should never become the sole motivator for wanting to become a nurse or advancing a nursing degree. Many nurses have pursued their career for money and end up burned out and hating their career in the long run because they didn’t go into it for the right reasons.

Secondly, learn the proper way to study while you are in school. Don’t study just to regurgitate the information for an exam only to forget it soon afterward. Study to truly learn the material. Read, highlight, record lectures, watch YouTube videos – whatever it takes to solidify a concept you are having trouble with. It is okay to deviate from the assigned book and self-study with your own materials and resources when you are in school to learn a concept. The same goes for when you are in your clinical rotation and you encounter a disease, disorder, or medication you are unfamiliar with. Go home and read up on it to bank that information in your brain for future reference. You never know when you’ll need that information in the future.

Lastly, one of the most important pieces of information I’d suggest for those in an undergrad or graduate program is to begin prepping for your board exam well before you graduate from school. Ideally, you should be studying for your exam in the last year of school, but buckling down and studying during your last semester will help too.

When I was in school for my nurse practitioner degree, I used a review book to supplement my normal course books. When studying a particular subject in class I always followed up by reading my review book and completing the practice questions included. I found that studying this way improved my test scores in school. Not only did my exam scores improve in school, but when I took my board exam after graduation, I was familiar with every question asked on the exam. Supplementing your course books with board review resources helps tremendously with long-term retention.

Because of my experience, I began writing a nurse practitioner board review series for those pursuing Adult-Gero Primary and Family Nurse Practitioner certifications. The books are written on individual subjects (pulmonary, cardiology, health promotion, etc.), instead of as a compilation so students can conveniently study one subject at a time. The books cover basic anatomy and physiology, common disorders within that system, and include practice questions with detailed rationales at the end.

In your experience, what are the biggest challenges that nurses face today?

There are many challenges in nursing that you begin to realize the longer you are in the profession. Something that today’s nurses face that I did not encounter when I graduated is difficulty getting their first job after graduation. When I graduated from my associate’s degree program, I had eight job offers to choose from. Unfortunately, many of today’s nurses don’t have the luxury to choose from one job, let alone eight. Many new nurses are having trouble finding their first job because employers have such a wide pool to choose from for each position. Because of this, they can also choose to be pickier when screening candidates.

Another challenge I believe nurses face today is the fact that most are overworked and undervalued in their role. Nurses have a lot of responsibility, particularly in the hospital setting. Sometimes it can be overwhelming, especially if the area you work in is short-staffed or you’re just having an overall busy day.

Would you do anything differently in your education or professional experience if you had the opportunity?

If I had been asked that question three years ago, I probably would have responded that I shouldn’t have progressed up the career ladder the way I did. Now that I have been a practicing nurse practitioner for a few years, I’m glad I did and wouldn’t change how I ended up where I am today. As a nurse practitioner, I’m constantly learning new things on a daily basis and building upon my knowledge base from when I first started nursing. It took me a long time to get where I am, but looking back it was well worth it.

What is your proudest moment as a nurse to date?

I have had many proud moments as a nurse, but I have one particular moment that stands out. Before becoming a nurse practitioner, I worked in an extremely busy cardiovascular recovery room taking care of people who had just undergone open-heart, lung, and other vascular surgeries.

I took care of a patient one day that I still think of today. She was in my unit for a lung biopsy and I remember being extremely busy during that shift. She was so patient with me and watched me run around the unit (since we were an open unit with only curtains for privacy) trying to get everything settled. I didn’t ignore her, but I hadn’t gotten a chance to really speak with her on anything more than a superficial level.

She was fairly young, in her 30s, and her history included cancer. From my post-op assessment, I knew the biopsy that was just completed would most likely prove that the cancer had not only returned but had metastasized to other parts of her body. When I finally had a chance to breathe we began chatting and she told me she was a nurse and I thanked her for being so patient with me that day. She went on to tell me that she was a single mom of a 12-year-old son and asked me to call him to give him an update. In the unit I worked in, phone calls between patients and family were not allowed due to the way the unit was set up. Luckily, she was in a bed near a phone that the staff used. When she asked me to call her son, I responded, “I’m going to allow you to update him yourself.” I dialed the number she gave me and handed her the phone.

She beamed the entire time she was speaking to her son on the phone. After she was done she graciously thanked me and told me to “never get sick.” By that comment, I knew that she also was aware her cancer had spread. Our brief interaction was one of my proudest moments as a nurse simply because although I felt like I didn’t do much that day, I made hers by a simple act of kindness and compassion. Because of my interaction with her, I never underestimate how a small act of kindness can affect someone’s life.

We thank Nachole for finding the time to provide us with her insights and advice! To learn more about Nachole, her experiences, and advice for prospective and working nurses, see her website Renursing.com. You can also visit Nachole’s author page on Amazon.