The Role of an Advanced Practice Provider in Your Colorectal Surgery Treatment

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland clinic podcast, exploring your digestive and surgical health from end to end.

Hi everybody. And welcome to another episode of Butts & Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio.

And so today we're going to have a member of my team, Stephanie Norman, who's a Certified Nurse Practitioner in Cleveland Clinic's Department of Colorectal Surgery in our Digestive Disease & Surgery Institute. We're going to talk a little bit today about the role of advanced practice providers in your surgical treatment.

Stephanie, thanks for joining us on Butts & Guts.

Stephanie Norman: Alright thank you for having me. I'm excited.

Dr. Scott Steele: So tell us a little bit about your background, where you're from, where'd you train and how did it come to the point that you're at the Cleveland Clinic?

Stephanie Norman: So I started my nursing career over in pediatrics, in the M Building actually, with the hematology-oncology department. We did a little bit of multivisceral transplant there. So I saw a little bit of small bowel transplants with kids. And then while I was in pediatrics, I had a few nurse practitioners that I worked with side by side, and I found an interest in how they were being advocates for their patients. And I really took an interest to become a nurse practitioner, so I went to school at Ursuline College over in Pepper Pike.

And then when I was doing my clinical, I actually was lucky enough to have clinical with Anna Worthams, who works there. And I was a little nervous going into colorectal surgery, because I didn't know exactly what that would mean. And I followed Anna around and she was a wonderful teacher and I absolutely fell in love with it. I was very surprised, to be honest. But I decided that if a job ever popped up and when I was ready to apply for jobs, that I would apply. And I was lucky enough to have that opportunity and I was lucky enough to be hired.

Dr. Scott Steele: Well, we are lucky to have you here. And so can you give our listeners an overview of what an advanced practice provider does? And I know it can be widely variating, but just give us a little inside peek.

Stephanie Norman: There's many specialties. I'm in the family practice. So I can see individuals who are younger, not infants, all the way up to adults and geriatrics. And we kind of play a role as a provider. We can be, if we're in internal medicine, primary care provider for our patients, we can go into a specialty like I am in colorectal surgery. And what we do is we have our own patient load, but we do work under the supervision of a physician or a doctor.

But otherwise, we can manage, come up with care plans, prescribe, do a lot of things that other providers are able to do. And then we can learn different skill sets within our specialties and get certifications and do things as well. I know that Abby Turza when she was there, she was doing [inaudible] and she got specialized in that. So it's nice that we have a lot of variety in our job to be able to expand our knowledge and our skillset.

Dr. Scott Steele: So what made you want to become a nurse practitioner?

Stephanie Norman: I believe it really was working with the nurse practitioners over in pediatrics and seeing how much of an advocate they are. I'm a little biased towards nurses, being one myself, but I do feel that we have a very special role with our patients. We take care of them, we get orders from the doctors and we carry them out from step one to step three.

And I found that I love having that patient connection and I feel like that's a skill a lot of nurse practitioners do being a nurse. And I just really wanted to do more for my patients. In simple terms, I just wanted to be that advocate on a different level. And I knew I was limited as a nurse. And so I knew that if by becoming a nurse practitioner, I could get to where I would want to be to help the patients that I worked with.

Dr. Scott Steele: So when would a patient see an advanced practice provider like yourself versus a surgeon?

Stephanie Norman: So in my specialty, I see patients for new referrals, for things as rectal bleeding, hemorrhoids, but then I also see post-ops. But when it comes to a surgical sense of trying to decide what kind of surgery, getting consent for those types of procedures, they would have to see a surgeon, but for other things like rectal bleeding, constipation, and pelvic floor, I'm able to see these patients and kind of work them up to see if they need some kind of surgeon or other specialty on.

Dr. Scott Steele: And then take it to the next level. You mentioned this briefly, but how does the APP or certified nurse practitioner work with doctors, nurses and other staff in the department like ours here at the Cleveland Clinic?

Stephanie Norman: So I work rather closely with them. I again, see their post-ops, I'll see pre-ops and do an H&P, which means doing a physical exam, going over their medications before surgery, making sure there's nothing that's missed. And I will also see patients that maybe a surgeon has seen before and I’ve seen in post-op, and if they have a wound that means continuous monitoring, I will see those as well and kind of manage them as time goes on until it heals or we feel like it's appropriate to just watch and wait.

So in that sense, I feel like I work with the surgeons to kind of help manage their patients in a way of making sure that they're staying on track for the treatment or plan of care that they're doing. I know some of the nurse practitioners here will do surveillance for cancer patients. So we see them every three months and do an exam, look over their labs, and kind of make sure that we're monitoring them in that sense as well.

Dr. Scott Steele: Truth or Myth: nurse practitioners can be a person's primary care provider.

Stephanie Norman: True. We can. We do work under physicians, under the internal medicine, but we can manage our own patient load as a primary care physician.

Dr. Scott Steele: Truth or Myth: nurse practitioners cannot order prescriptions.

Stephanie Norman: That's false. We can order prescriptions. We do have limits to certain prescriptions of how long we can. So that would be narcotics. We have a limited amount of days that we are able to prescribe them, but we do and are able to prescribe prescriptions.

Dr. Scott Steele: So what advice would you give to aspiring nurse practitioners who are just starting out in nursing school or maybe even on their first assignments?

Stephanie Norman: I would say keep an open mind. As a nurse, you see many things as a nurse and we're introduced in your clinicals as a nurse to many fields. So going into training for a nurse practitioner to just be open-minded and willing to learn. There's so much opportunity to grow as a nurse practitioner, we have so much variety and space for that. And I think just hard work and really using your resources, really asking questions, establishing those relationships as you go through school is really going to help you in the outcome.

I'm blessed to have had the clinicals I had, the teachers, but most importantly, during my clinicals, the staff I was able to experience and have educational sessions with really helped me, I think, to become the nurse practitioner that I today.

Dr. Scott Steele: So now it's time to get to know you just a little bit better. So what is your favorite sport?

Stephanie Norman: Soccer. I am a soccer fanatic, and horseback riding. I do consider horseback riding a sport. Those were my two main things growing up. I played club ball and I was trying to go for college, but I unfortunately tore my ACL my junior to senior year, so I was not able to, but I did play in undergrad for like a club soccer team. So we got to travel and play different state colleges, which was awesome.

Dr. Scott Steele: So what is your favorite food?

Stephanie Norman: Food, that's a hard one. I'm always eating, I feel like. That's a little joke in the office. I would have to say my favorite food would probably be potato skins. I love a good potato skin. Something good about them.

Dr. Scott Steele: That's a first on Butts & Guts. What is your favorite movie?

Stephanie Norman:The Outsiders is one of my favorite books and it became a movie and it's one of my favorite movies.

Dr. Scott Steele: And you get one trip to go anywhere in the world, where are you going?

Stephanie Norman: It used to be Bora Bora, but I think recently, I would love to go back to Honduras, which is actually where I was born. And so I think it would be really great to bring the family there and kind of walk the lands that I was born in.

Dr. Scott Steele: That's absolutely fantastic. So give us a final take-home message for our listeners regarding nurse practitioner or just the whole process of how you fit into this world, and just some more information.

Stephanie Norman: I think as nurse practitioners, we are mentally great for a team. We have both the experience of a nurse and as a provider. So we can take both of those mindsets into one when we approach a patient and their plan of care. And just in general, I think there's a wide variety and opportunity for nurse practitioners to grow into and become into specialties. And I think it's a great career and I can't wait to see where I go.

Dr. Scott Steele: Well, we're so glad to have you here. And so for more information to learn about colorectal surgery and the various treatment options here at the Cleveland Clinic, please visit clevelandclinic.org/colorectalsurgery. That's clevelandclinic.org/colorectalsurgery. And to speak with a specialist in our Digestive Disease & Surgery Institute, please call 216.444.7000. That's 216.444.7000.

And remember, it's important for you and your family to continue to receive medical care, get regular checkups and screenings. And rest assured here at the Cleveland Clinic, we're taking all the necessary precautions to sterilize our facilities and protect our patients and caregivers.

Stephanie, thanks so much for joining us on Butts & Guts.

Stephanie Norman: Thank you for having me, Dr. Steele.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.