1

An Analysis of an Interview with Emma Palinski, MSN, CRNP-BC

Kate L. Hughes, MSN, RN

Youngstown State University

NURS 7003

June 25, 2022

 2

An Analysis of an Interview with Emma Palinski, MSN, CRNP-BC

This interview was with Emma Palinski, MSN, CRNP-BC who currently works as an infectious

disease nurse practitioner at a large, urban, academic medical center. Several important themes

emerged throughout the course of the interview, all of which are issues and topics important to nurse

practitioners across the United States. These topics, which will be discussed and analyzed during the

course of this paper, include the importance and impact of nurse practitioners in the current inpatient

healthcare climate, challenges and barriers to advanced nursing practice, and potential changes on the

forefront of advanced practice nursing.

As a nurse practitioner working in the acute care setting, Ms. Palinski spoke at length about the

importance of interdisciplinary cooperation in her daily practice. As expected, she collaborates

extensively with the attending physicians and her fellow advanced practice providers on the infectious

disease team in order to effectively plan care for each patient for which they are consulted. Ms.

Palinski’s description of her daily work as a member of the interdisciplinary care team spoke to the

importance of collaboration in complex patient care, a critical component of the core competencies of

advanced practice nursing. Nurse practitioners must be able to work constructively with other clinicians

by acknowledging each individual’s expertise, exchanging ideas, and remaining focused on achieving the

goals of care unique to each patient (Joel, 2018).

 3

More surprising than the work she does within her specific team, was the frequency with which

Ms. Palinski works together with many nurse practitioners from other disciplines in the hospital to

provide cohesive care for the patients, often without needing consultation from their physician partners.

Though unexpected, this model of care is supported by the literature. A meta-analysis of the care

provided by nurse practitioners in acute and critical care settings showed no difference in hospital

mortality or overall hospital length of stay among patients cared for by nurse practitioners compared

with those cared for by attending and resident physicians. Furthermore, intensive care unit (ICU)

mortality was actually lower among teams of nurse practitioners (Kleinpell et al., 2019). Along with Ms.

Palinski’s experience, this data highlights the continued importance of nurse practitioner presence in the

acute care setting. As healthcare continues to become more complicated—both in terms of the

complexity of patient illness as well as the intricacies of navigating insurance and reimbursement issues

—nurse practitioners will likely need to become even more common in inpatient hospitals. It is already

well known that dependence on nurse practitioners for primary care has been increasing in both rural

and nonrural areas (Barnes et al., 2018). Given the importance of continued focus on reducing the

number of hours worked weekly by resident physicians, it is likely that nurse practitioner usage in acute

care will continue to rise (Kleinpell et al., 2019).

During the interview, Ms. Palinski spoke about the barriers she has faced as a nurse practitioner

in a limited practice state. Unsurprisingly, most of her discussion focused on the significance of nurse

practitioners obtaining full practice authority. She discussed the issues she faced personally as she
 4

worked to acquire credentialling at the hospital in which she practices as well as the complexities of

creating a practice agreement between herself and her collaborating physicians. As one physician has

already left the practice, she has already had to make alterations to that agreement. Instead of making

patient care safer, Ms. Palinski feels that this process is placing undue burden on nurse practitioners and

the physicians with whom they practice. There is extensive evidence that limited practice authority

impedes access to healthcare for many people—particularly communities and populations who already

experience disparate health outcomes (Poghosyan, 2017). It seems reasonable that Ms. Palinski fears

these continued limitations will create similar outcomes among hospitalized patients.

When speaking about changes she would like to see for the future of advanced practice nurses,

Ms. Palinski’s experience as one relatively new to her role made a significant impact. She spoke about

the challenges she has faced during her transition from bedside nursing to nurse practitioner.

Interestingly, she views her decade of bedside nursing experience as having both positive and negative

impact on her work as a nurse practitioner. Unsurprisingly, she has relied extensively on the assessment

and clinical judgement skills she gained in her years as a bedside nurse; these skills have allowed her to

make quick, effective decisions that have resulted in positive patient outcomes. Intriguingly however,

she spoke about the difficulties she has experienced functioning in the provider role with limited control

over the timing and methodology by which her orders are carried out. This interprofessional role strain

is one that is common to new nurse practitioners as they transition from the side to the head of the bed,

as it has colloquially been described (Painter, Sebach, & Maxwell, 2019). Though Ms. Palinski felt that
 5

changes to the graduate education of nurse practitioners may help to ease this transition, research has

shown that employer-based residency training programs can be effective at bridging education to

practice—both upon entry to practice when beginning work in a new area of specialty (Painter, Sebach,

& Maxwell, 2019).

 6

References

Barnes, H., Richards, M., McHugh, M., & Martsolf, G. (2018). Rural and nonrural primary care physician
practices increasingly rely on nurse practitioners. Health Affairs, 37(6), 908-914.

Joel, L.A. (2018). Advanced practice nursing: Essentials for role development. F.A. Davis Company.

Kleinpell, R., Grabenkort, W.R., Kapu, A., Constantine, R., & Sicoutris, C. (2019). Nurse practitioners and
physician assistants in acute and critical care: A concise review of the literature and data 2008-
2018. Critical Care Medicine, 47(10), 1142-1149.

Painter, J., Sebach, A., & Maxwell, L. (2019). Nurse practitioner transition to practice: Development of a
residency program. The Journal for Nurse Practitioners, 15(9), 688-691.

Poghosyan, L. (2017). The untapped potential of the nurse practitioner workforce in reducing health
disparities. Policy, Politics, & Nursing Practice, 18(2), 84-94.
https://doi.org/10.1177/1527154417721189.