Transcript: AANP President Interview

Liz Rohr:
Well, hey, there, it's Liz Rohr from Real World NP and you are watching the Real World NP YouTube channel. We make weekly episodes to help save you time, frustration and help you take the best care of your patients. In this episode, I'm talking with Stephen Ferrara, he's a family nurse practitioner and the president-elect of AANP as of very recently. And he is a wonderful, wonderful person and I've had the pleasure of knowing him for a little while now. And what we talked about are concerns that nurse practitioners have about NP education, what AANP is, what it does, how it works, how NP education works, and some of the issues that are facing us in this profession as nurse practitioners.

Liz Rohr:
We also talked about how we can help with all of the challenges that we talked about. Without further ado, I'm going to share my interview. I hope you enjoy it. If you haven't grabbed the ultimate resource guide for the new NP, head over to Realworldnp.com/guide. You'll get these episodes sent straight to your inbox every week with notes from me, patient stories, and bonuses I really just don't share anywhere else. Without further ado, here's my interview. Awesome. Thank you so much for being here. So, would you introduce yourself for the people?

Stephen Ferrara:
Sure, and first thank you for having me. I am Stephen Ferrara. I am a family nurse practitioner. I hold a few different roles. One is as president-elect of AANP, I just began this term at the end of June. This will be a one-year term as president-elect, and then the president's term will start June of next year, so June of 2023 and will last two years.

Liz Rohr:
Oh, cool.

Stephen Ferrara:
That's what I'm looking forward to, but I'm on the board of directors of AANP now, and I'm also the associate Dean of Clinical Affairs at Columbia University School of Nursing, and that's my primary full-time job at Columbia as a Associate Professor and Associate Dean.

Liz Rohr:
Awesome. Thank you.

Stephen Ferrara:
Welcome.

Liz Rohr:
Thank you so much for being here.

Stephen Ferrara:
That's my pleasure.

Liz Rohr:
What we did was we asked the people in the Real World NP community some questions for you, and you and I have talked before about, I think, there's a pretty big misconception about what AANP is and what it's not, and what it controls or it doesn't control or what it influences and what it doesn't.

Stephen Ferrara:
Right.

Liz Rohr:
Just to kind of set the stage, a lot of the questions that I got from people were about NP education and they were feeling really frustrated with NP education, not being standardized or perhaps as rigorous as they'd like it to be or frustrated with finding preceptors themselves. And that being a real challenge, which is absolutely those are super valid challenges. I think the expectation based on those questions is that AANP is in charge of that. With that said, can you tell us about what AANP is and what it does and how it works?

Stephen Ferrara:
Sure. Thanks for everybody putting questions in advance. I think that's really helpful to guide this conversation, and it's a good opportunity to talk about AANP. So, AANP is a membership professional organization. We are the voice of the nurse practitioner currently at over 120,000 members across the United States. We exist to help advocate for the profession to help provide continuing education for the profession, to help the health of the profession, and that's at the core of what we do. Now, it gets very confusing because there's another entity called the AANP Certification Board, which many people take for their national certification exam, and that is a separate entity from AANP. That is the test that one takes to become a nationally board certified as a nurse practitioner, and the other option is a ANCC. It gets very confusing with all these acronyms that are out there totally, but that is really wholly separate and apart from the membership organization of what is known as a AANP.

Liz Rohr:
Yeah, that is so fascinating. I think I did not understand that myself, like I thought they were the same and I think the other part that you and I had talked about is that there are both, there's a national AANP as well as state based AANPs. Can you talk a little bit about that?

Stephen Ferrara:
Sure. So, AANP represents nurse practitioners nationally, and the number of states have their own state organizations that have affiliations with AANP in it. But again, those are separate entities at the end of the day, so it gets very confusing, especially when we're talking about state licensure issues, that is always going to be legislated at the state level, not nationally. In those situations, AANP will work with the state NP organization to try and move legislation that removes barriers to NP practice forward. It really is a collaborative approach that AANP and the state organizations undergo and it gets somewhat confusing. At the federal level is still legislation that takes place, when we think about federal legislation, think about Medicare. Medicare applies to everyone over age 65, and it's applicable whether you're in one side of the country or the other side. It's exactly the same, but that's never going to be state licensure rules for nurse practitioners.

Liz Rohr:
I see. I see. I guess, just maybe a couple of examples would be helpful. It sounds like in terms of the full practice authority questions, that's like a state based specific issue compared to, what are some of the other national issues that AANP works with, things like that?

Stephen Ferrara:
Sure. I'll give you two examples on the national level. One is my favorite to talk about is diabetic shoes.

Liz Rohr:
I love this.

Stephen Ferrara:
This is one those issues that it just doesn't make any sense.

Liz Rohr:
It makes no sense. I guess the context, maybe set the context for students nurse practitioners.

Stephen Ferrara:
Okay. This is for Medicare beneficiaries. So, somebody with Medicare as their primary insurance. Medicare does not recognize nurse practitioners to sign the form that authorizes a diabetic shoe company to supply the shoes to the patient and be reimbursed by Medicare. It's not exactly correct to say that nurse practitioners can't order diabetic shoes, we can, but the problem is the company supplying the shoes is not going to get paid by Medicare. And the current statute, federal legislation only recognizes physicians and podiatrists to order these treatments, if you will, these interventions. This has been an issue that has been many years in the making. It does require Congress. So, your U.S. Senators and house of representatives to pass a bill in each respective chamber of Congress, and then to be signed by the president of the United States.

Liz Rohr:
Wow.

Stephen Ferrara:
That's how difficult it is to get what makes...

Liz Rohr:
I see.

Stephen Ferrara:
... complete nonsense, or not being able to provide something that there's no controversy over, like nobody's opposing.

Liz Rohr:
Nobody cares.

Stephen Ferrara:
But it takes a huge effort to move forward. That's one example. The other example that has actually had some success in recent weeks is nurse practitioners being able to see injured workers, federally injured workers under worker's compensation law. Currently, if a federally injured worker is going to their clinician, they can only be seen by a physician currently and other acupuncturist and some other disciplines, but nurse practitioners are not allowed to bill for services when it comes to a federally injured worker under worker's compensation.

Liz Rohr:
That's super helpful. I'm going to put a pin in that. We'll come back to what AANP is working on nationally, but I want to pivot a little bit to the topic of education. I had such an enlightening conversation with you about how NP education works. Could you speak to your understanding of how the NP education system works as it relates to AANP?

Stephen Ferrara:
Sure. So, it's a good question.

Liz Rohr:
Or it doesn't, actually. Sorry, go ahead.

Stephen Ferrara:
No, it's good. It's a good sort of starting point because AANP is not an accreditor of NP programs. We never were and there's no sort of plans to become that. So, when it comes...

Liz Rohr:
Basically, AANP is not in charge of NP education?

Stephen Ferrara:
No.

Liz Rohr:
We'll start with that point, but continue. How does it work?

Stephen Ferrara:
No, it's not in charge of NP education at the schooling level to become a nurse practitioner. That's a space that there are nationally accredited bodies that accredit programs nationally, to be able to provide these programs to the public, right? And it's linked to federal money, right? When there is when a program's accredited by one of the nationally recognized accreditors, then you can apply for federal financial aid, but AANP is not in that space, but we get targeted oftentimes and say, well, why isn't AANP doing anything about this?

Stephen Ferrara:
Well, that's not the composition or mission, if you will, of this organization. That's not to say we don't have discussions and conversations with stakeholders across different areas within nursing, of course, we do. We're trying and making sure that we're having the conversation with these stakeholders and making sure that we bring to light some of the issues that students are having, especially when it comes to finding clinical placements and preceptors and all the struggles that exist these days for NP students.

Liz Rohr:
Yeah. Can you speak a little bit to what the NP organization, what the accrediting organizations are?

Stephen Ferrara:
Yeah. The two recognized ones are AACN, the American Association of Colleges of Nursing, AACN. And through that organization, their accreditor is CCNE, CCNE, and I'm not going to attempt to...

Liz Rohr:
That's okay.

Stephen Ferrara:
... figure out what CCNE stands for, and the other side is NLN, the National League of Nursing. So, they have their own accrediting standards, but these are essentially the two organizations that are recognized by the federal government to be able to certify NP programs.

Liz Rohr:
Cool. Then they also set the educational standards as well?

Stephen Ferrara:
Well, they set what NP programs follow, yes, but they don't do that in a vacuum. They do work with other organizations. Another organization that comes to mind is it's called NONPF, the National Organization of Nurse Practitioner Faculties.

Liz Rohr:
Non competencies. Yep.

Stephen Ferrara:
Yes, exactly. They are an organization of NP faculty. They're also not an accreditor or a regulator in this space, but AANP is working with them to make sure that when we're talking about NP programs, that it's evidence based, it's with the current literature and that we're keeping up with what the demands of the healthcare system and our patients require of us to do, to be safe and licensed and high quality nurse practitioners. There's a lot of crossover, but again, if you're looking for pointing fingers, it has to be, yes, we are a conduit, AANP can be a conduit and should be a conduit, but your one's frustrations really can't be blamed at least for this issue on AANP.

Liz Rohr:
I would love to know, and hear from you about what is like, so we can be really clear, what is it that AANP is currently working on? And what are some of the things also that you want to bring as the new president-elect? That's so cool that you... I didn't realize it worked in that president-elect for a year and then the two year term. That's really cool. What are they currently working on? What are some things that you would like to bring?

Stephen Ferrara:
Yeah, it's a great question. We have this acronym, we like acronyms of PEARL and P-E-A-R-L, P stands for practice, E is education, A is advocacy, R is research, and L is leadership. So, we are looking at within that terminology to have nurse practitioners represented. When I talk about education, it's more continuing education rather than pre-licensure graduate education. That's the context, right? There are programs for leadership to develop leaders and give additional skills for nurse practitioners or we have two conferences a year that are contact hour focused. One is in the summer, the other is in the fall, and there are tremendous efforts to make sure that there are nurse practitioner presenters presenting the latest evidence based practice and to provide opportunities to acquire those required continuing education credits. When it comes to practice, well then, that's everything having to do with NP practice.

Stephen Ferrara:
So, whether it be at the federal level, whether it be at the state level, we're trying to influence and eliminate those barriers to practice. It shouldn't be harder for patients to seek care from a nurse practitioner, and how can we eliminate some of those things? With that, comes the advocacy and research, not just necessarily research about nurse practitioners, but it's research led by nurse practitioners. What types of evidence based treatments are out there these days, what are quality improvement projects that NPs are leading and leading to ultimately hopefully better patient outcomes? All of that happens within AANP. What I'd like to do is address some of the issues that are out there. One is preceptors, right? How can we increase the preceptor pool for NP students out there?

Stephen Ferrara:
The model that I believe, this is my opinion, is that the one to one precepting, it's not sustainable anymore. We need one preceptor to multiple NP students, right? How do we do that? That's the hard part, but I think, conceptually, the idea of one to one with 355,000 nurse practitioners today in the United States and thousands of students in school right now, it's just not a model that we can continue relying on. We need to seek new ways to be able to precept the future NP workforce. That's one of those top priorities that I'm committed to. Others will continue to be a full practice authority for nurse practitioners, eliminating these arbitrary barriers and what can we do to work with those state NP organizations? We're at a point now where we have 26 states are considered full practice authority. We tipped over the halfway mark.

Liz Rohr:
Nice.

Stephen Ferrara:
But we still have 24 states that still need full practice authority. Again, it's not just full practice authority for full practice authority sake. It's being able to practice and provide your patients with the care that you were educated and prepared to provide without getting an unnecessary signature, because the form that you're trying to fill out requires a physician signature, which is so frustrating, right?

Liz Rohr:
Yeah. Well, the diabetic shoes is a great example, visiting nurses, very frustrating.

Stephen Ferrara:
Yeah. Exactly. Those are two of my top priorities, as I am trying to figure out, where the needs are, where I could help with my experience. My prior experience is I was the executive director of the state Nurse Practitioner Association in New York, when we passed full practice authority in New York state. I'm hoping I could share some of those successes avoid some of those pitfalls that we encountered and set reasonable expectations all while being responsive to the needs of what the members of this association want from their professional membership organization.

Stephen Ferrara:
It's hard because 120,000 people are a lot of people, are a lot of nurse practitioners and nurse practitioner students. So, how do you keep the balance? How do you know... How can you be responsive to voices who are on polar opposite ends of the spectrum? It's not easy to do, but the way I will approach it and how I try to approach it is what does this mean in the context of our patients, right?

Liz Rohr:
Yeah. Yeah.

Stephen Ferrara:
Are we doing everything we can to advocate for our patient and have them ideally have ideal outcomes? If we're not doing that, well then, we need to reexamine our positions and perhaps realign with something that is more patient-centric.

Liz Rohr:
Yeah, exactly, exactly. I guess, I just wanted to add in about the whole education conversation. I don't have the answers, right? But I guess just for context for someone listening is that like, and you can please chime in, this is just what I understand of how... I think it's not just at nurse practitioner education, I feel like it is like the healthcare system in general. Because I think there's... I don't know. I wonder if there's misunderstandings as well. I don't know what the solutions are to improve the preceptor shortage or that challenge of finding preceptors, but just to also give some context, physician associates, I know colleagues that I've had have traveled several hours to different states.

Liz Rohr:
They may have had assigned preceptors, but that's part of their kind of set expectation. Then when it comes to physician education in their residency, like as medical students, and then as residents, until they become attendings, they have government funded programs, right? That's their training as they have funding. And so just for some contextual information for people who aren't familiar or somebody listening who's not familiar with the way the physician education works versus PA versus NP, it is a real challenge, I think, and I don't think that there are unfortunately easy solutions.

Stephen Ferrara:
They're not easy solutions, and it's a great point. Physician education is funded by the federal government to the tune of billions of dollars a year, whereas graduate nurse education and that's all nursing, not just nurse practitioners is in the millions. Our method of training and preparation is different than physician. I'm not saying ours is better. I'm not saying the physician model is better, but I think what we need to do is recognize where we are, question whether this is the best way to do what we're doing these days, and really try to move forward with that understanding. The one thing about medicine and even PAs to a degree is that it's a very centralized gatekeeper system when it comes to programs and residency slots. There's a certain number of slots. And if you don't match, then you don't match and that's it.

Liz Rohr:
For physicians. Yeah.

Stephen Ferrara:
Yeah, for physicians. When it comes to nurse practitioner and nurse practitioner programs, there is no centralized gatekeeper. You're relying on each individual NP school to find those preceptors. Again, I question and say, is that the best way we could solve these issues today? I tend to think, no, I think we need to have something else, a new approach that makes it easier for students to be linked with preceptors. Again, like you, Liz, I don't claim to have any of the answers, but I do want to find solutions and I want to think out of the box and I want to be able to do my best to meet the needs of the members of this organization, and that's my number one focus.

Liz Rohr:
Absolutely. I guess last question for this episode. Hopefully, we can have you back. But last question I think is a lot of people want to... There are so many really big hearted nurse practitioners, especially in this community that want to see the profession succeed. They want to give the best care to their patients. They really want to make a difference. Whether it's from frustration of their education, for example, or their own personal healthcare experiences, or they just really want to get involved with AANP or other organizations, like what would you recommend to somebody listening to this or watching this who is wanting to get involved, whether it's with education reform or with their local chapters or on the national level? What would you recommend whether... How can they best help if there are some options for people to help?

Stephen Ferrara:
Yeah. I think that's a great way to sort of talk about how one can get the most out of their professional organization. I will use myself as the example and I am on the opposite side of that. I was actually brought into my state association because I happened to go to a local event and thought it was interesting. But I mean, ultimately I think I would've gotten involved at some point, but it was really a mentor, someone who became a mentor of mine said, you're coming with me.

Liz Rohr:
No option.

Stephen Ferrara:
Right. Pretty much no option. Now, not everybody's going to have that setting. I think first you have to be present, right? I do think you'll get out of your association what you put into it, right? And merely paying the membership fees, you may take advantage of a member benefit every now and then, but you're not going to necessarily feel connected to a community of nurse practitioners. I think that the way to get involved is every state has a state liaison and a region director. And when you log into your AANP portal, their photos and contact information show up on your dashboard, so reach out to them. That would be the best way to say, hey, I want to be involved in insurance issues that we have in our state that insurance companies are not reimbursing nurse practitioners at all, right?

Stephen Ferrara:
They won't credential me as a nurse practitioner. So, that's one example, right, of a way to get involved, their contact information is there, and here's the other thing, that we have to be mindful of. I would love that there's an opportunity for everybody who wants to volunteer when they want to volunteer on the time period that they want to volunteer, but that's hard with 120,000 people, right? What I would ask is don't get discouraged if you do reach out to someone and don't get an immediate response back. If that's the case I would say, get in touch with me, get in touch with the current AANP president, April Kapu.

Stephen Ferrara:
We're ever present on social media. We are really to serve the members of this organization and we want an organization that is representative of the profession, representative of the patients that we serve, and that is a welcome place for all. I mean, I'm thinking of utopia organization but it's the truth. I know that when it comes to, when we think about the composition of members of this organization, I mean, we have members who were the first nurse practitioners ever in their state, right?

Liz Rohr:
Wow.

Stephen Ferrara:
It's like, they're the first nurse practitioner ever, like their licensed number is one, right?

Liz Rohr:
Amazing.

Stephen Ferrara:
We also have nurse practitioners who graduated yesterday, right?

Liz Rohr:
Yep.

Stephen Ferrara:
We need to be mindful of how do we appeal to the seasoned nurse practitioner versus the very unseasoned nurse practitioner. That's the other piece is that don't keep your ideas to yourself. If you want to see something in this organization, I encourage you to share that and help us make this association as best as it can be. At the end of the day, in an association, our people.

Liz Rohr:
Totally.

Stephen Ferrara:
If we're not mindful of the constituency of the membership, well, then we wouldn't be doing our job as an association.

Liz Rohr:
Absolutely. You feel like the best way to kind of communicate the desires, because I just thinking of the context of a lot of the newer grads are kind of swimming, drowning a little bit, so they might not have the time to be volunteering, but if they're interested in sharing their views is the best place to share with the AANP national website or...

Stephen Ferrara:
Yes.

Liz Rohr:
... their state websites. Cool.

Stephen Ferrara:
Yeah. I would say for AANP in particular, go to the AANP website, there's contact me forms and I know that's very antiquated and you want to be able to text somebody and send a direct message, but there are social media accounts, Facebook and Instagram and Twitter and LinkedIn, that you can definitely send messages to those accounts and they will go to the AANP staff that will then disseminate it to leadership. Again, we're looking for trends, we're looking for voids where we can fill in.

Stephen Ferrara:
The other thing to do is if you do have the opportunity to go to a conference, it's a good way to get out there to do some, when we're back fully in person, to do some networking face to face. Those are great opportunities. Then the other conference that I really like is usually it's in the spring in February, March is the health policy conference, and this is the opportunity. It's a very policy focused agenda. Then it usually concludes with having lobby days on the hill. So, you'll go in groups based on your address and you could actually get to meet with your legislator...

Liz Rohr:
Oh, cool.

Stephen Ferrara:
... or their staff, and it really is, and this is where I've spoken with my legislators years ago about diabetic shoes, right? And I'll never forget, I tell this story a lot, but it is where I was pouring my heart out, right? Like diabetic shoes, and the legislator looked at me and said, "You're talking about shoes, right?" Yeah. And they said to me, this is a no brainer. Right, it is a no brainer.

Liz Rohr:
Right.

Stephen Ferrara:
But again, it's not like snapping your fingers and having it happened.

Liz Rohr:
Yeah, the process. Yeah.

Stephen Ferrara:
You feel empowered to be part of the process of shaping the identity of this profession and that's why I got into this. I want to lead this profession in some way, shape or form. A little bit better than when I found it, and if I have anything to do with that, I consider it sort of a win. That's what I'm looking to do.

Liz Rohr:
Awesome. Well, I guess one other thing I wanted to add is like, a little bit more context is that everyone is a volunteer, right, with AANP?

Stephen Ferrara:
That's right.

Liz Rohr:
Right. Okay. This is not your full-time job.

Stephen Ferrara:
No.

Liz Rohr:
You do this on top of your full-time job in addition to everybody else. I think another context just to share is like people becoming a member is actually, financially, it's like 200 something dollars a year, right? And people get their benefits and they get continuing education. Like this actually does make a really big difference, right? Because like the more people that are members, the more resources financially, AANP as an organization and smaller organizations have to do the work that they want to do, right? Am I understanding that correctly?

Stephen Ferrara:
That's exactly right.

Liz Rohr:
That's where the money comes from is membership and that's how we make...

Stephen Ferrara:
Membership dollars on all of the programs and all of the benefits that AANP offers as well as annual conference. That's another way that we generate some non dues revenue to help the association and it's a nonprofit organization, right?

Liz Rohr:
Yeah. Yep.

Stephen Ferrara:
So, nobody's, there are no shareholders that are making money here, the funds, the membership dues goes to staff time and any resources that we put out, paying rent, all these things that organizations need to do, because they're physical entities at the end of the day, but yeah. It's a huge organization, lots of opportunities for people, lots of benefits for people, and I hope, it is my hope that we see people taking advantage of that, becoming involved in it, and hopefully making sure that we have a pipeline of future leaders and people who are willing to say, hey, I want to get involved. I want to volunteer my time, my talent, and be able to impact the profession in a way that you feel you need to impact it.

Liz Rohr:
Totally. Totally. Well, thank you so very much for being here. I appreciate you so much. Thank you so much for all your hard work, for taking the time, and hopefully, we can do another chat another time.

Stephen Ferrara:
Yeah, I'd love to, Liz. Thank you so much for having me back on, and I look forward to seeing you again soon.

Liz Rohr:
Thank you.

Stephen Ferrara:
All right.