In honor of National NP Week, The Clinical Advisor is featuring nurse practitioners (NPs) who are advancing the profession. Today we celebrate Michelle M. Kelly, PhD, CRNP, CNE, who practices as a pediatric NP in a designated free and charitable community-based practice providing pediatric primary care to uninsured children. Dr Kelly is also an associate professor at Villanova University M. Louise Fitzpatrick College of Nursing in Pennsylvania and is a research fellow at the University of Rhode Island, College of Nursing. She became a certified pediatric NP in 1997, and a certified neonatal NP in 2005.
Q: What unique programs or projects have you participated in to advance patients’ health?
Dr Kelly: After many years of research and advocacy, I recently published the first set of recommendations for addressing the implications of preterm birth history in life-long health. Long-term outcome studies assert that while outcomes vary, people born preterm are at risk for cardiovascular, respiratory, mental health, and behavioral conditions.
Q: What aspects of your profession are most rewarding?
Dr Kelly: In my previous role as a neonatal nurse practitioner, my most rewarding experiences were those that allowed me to be a part of the first few months of a preterm neonate’s life. Navigating the fragility of a preterm infant’s initial days, and helping them transition to life at home is humbling and awe-inspiring.
Q: Who is your most memorable patient and why?
Dr Kelly: My most memorable patient is an adolescent I cared for recently. She was new to the US and experiencing somatic symptoms that were the result of anxiety and depression she was suffering in high school. I am not a mental health expert and in our small clinic we do not have the luxury of layers of mental health support. I spent time with the young woman (assisted by a tremendous interpreter), made some short-term plans for her, and scheduled frequent check-ins. She is memorable not because of the care I provided but, because she represents a poignant gap in access and equity in our health care system — a gap that must be met by access to primary care. If not for this small clinic, this young woman may have spiraled into self-harm or worse; her experience is not unique.
Q: How do you avoid burnout?
Dr Kelly: During the early months of the COVID-19 pandemic, I was at a loss. Pediatric clinics were not seeing patients, I was teaching virtually, and felt I was not making a difference. Frustrated and concerned, I reached back to an old skill and started sewing masks. Ultimately, I provided close to 2000 masks to our community food bank, family, friends, and colleagues. The repetition of the sewing was soothing and gave me something practical to do with my hands and my energy.
Q: What do you know now that you wish you knew when you entered the NP field?
Dr Kelly: I wish the LACE (Licensure, Accreditation, Certification, and Education) consensus model for APRN regulation and other advocacy for alignment between education and practice population were mainstream when I started practicing in 1997. I recently heard a presentation that used the term “misaligned” to describe primary care NPs working in acute care. I resembled that comment. One of my first roles was in a pediatric cardiac care unit, while my education was primarily in primary care. I managed because I was an experienced pediatric intensive care unit nurse and had great support. However, I was practicing outside of my scope. When I think about that I cringe; I did not know any better. Due to shortages of providers, I am discouraged to learn that misalignment is still happening, particularly in neonatology.
Q: Any last words of advice for our readers?
Dr Kelly: I would like to remind every NP to make the time to speak to middle school and high school students about nursing and about advanced practice nursing. Take the time to encourage the next generation of nurses, particularly those who may not otherwise have access to encouragement toward health professions. It is important to instill early the belief that a career in health care is within their grasp.