Keeping Your Options Open: Is Nursing at an Independent Pediatric Practice Right for You?
America is experiencing a severe nursing shortage. Due to high demand, those who are able to meet the challenge of obtaining a nursing degree have many employment paths to choose from. Here are the stories of three nurses who share why choosing to work for an independent pediatric practice was right for them.
The Impact of a Severe Nursing Shortage
While we previously addressed the general staffing shortage in healthcare with Dr. Hiral Lavania, there is one type of worker that many independent practitioners and clinics need most—nurses. For students who choose nursing as an occupation, the outlook is sunny—the demand for registered nurses is projected to grow by 6% from 2021-2031, and 9% for nurse practitioners, according to the U.S. Bureau of Labor Statistics. Pay for nurses is also on the upswing. However, the pipeline of future nurses, made up of students beginning their education to earn a nursing degree, is unfortunately in a state of stagnation due largely to nursing education staffing shortages. Interest in nursing is high, and even enjoyed a surge during the pandemic-plagued year of 2020. Unfortunately, many qualified applicants are turned away due to lack of resources: 80,521 applicants in 2020 alone, according to the American Association of Colleges of Nursing (AACN).
The nursing shortage is being felt by large hospitals and smaller independent practices alike. For both seasoned and beginner nurses, the options for employment introduce a host of choices: from hospitals to traveling, to home nursing and more. However, for many, working for an independent practice might be the right choice due to the more predictable schedule, the sense of community, and the greater freedom from bureaucratic oversight. Here are the stories of three nurses and what drove them to choose a career working at an independent pediatric practice over other potential career pathways.
“After looking into it, I ultimately chose office nursing over hospital nursing. The hours were much better, with no nights or weekends. Often, there are fewer politics than in a large clinic, and less pressure to churn patients through, allowing providers to spend more time with patients and their families.”Korryn Lennstrom, North Seattle Pediatrics
A Great Option for Working Mothers
For Korryn Lennstrom, RN of North Seattle Pediatrics in Seattle, WA, working for an independent clinic, where she has been for the last 27 years, has been the right fit for her. Korryn began her career working as a Labor & Delivery nurse for seven years when she decided to make the switch to a private practice after having her own baby. “After looking into it, I ultimately chose office nursing over hospital nursing,” stated Lennstrom. “The hours were much better, with no nights or weekends. Often, there are fewer politics than in a large clinic, and less pressure to churn patients through, allowing providers to spend more time with patients and their families.”
“I found the culture at the independent practice much more supportive than what I had experienced in the hospital. In fact, the staff at the practice I chose became like a family. However, I did have to take a pay cut moving from the hospital to an independent pediatric practice. For me, it worked out because my husband had a good job, and my income was supplemental. Not all nurses can afford the pay cut.”
For Becky Hanson of Essex Pediatrics in Essex Junction, VT, working for an independent pediatric practice was a no-brainer. “After nursing school, I knew I wanted to go into pediatrics. With a young family, I did not want to work nights. The independent practice setting at Essex Pediatrics allowed me to choose a schedule that worked for me, mostly weekdays and some weekends so my husband and I could handle childcare between the two of us.”
Hanson also mentioned that recruiting can be difficult for independent practices and there are a reduced number of nursing candidates applying for jobs at smaller organizations. “I think part of the reason for that is there is a push for hospital-based nursing when you are in nursing school, likely due to the high demand. You don’t really get to learn much about working in a small environment like an independent practice or clinic.”
Lennstrom has since been promoted to full-time clinic manager. “Later, when my supplemental income became my only income during a divorce, I was promoted to managing the floor of the clinic, as well as the technology updates. That was around 2014. The timing was actually perfect, because it was around that time that we began the transition from paper to electronic records.
“Back in the old days, we were updating the physical patient charts with sticky notes that had to be added to the written record later—it was a lot to keep track of. Soon after going electronic, we adopted Physician’s Computer Company (PCC) as our electronic health record (EHR) system. The training they provided was perfect and made my new job easier. For example, using PCC instead of paper charts allowed the providers at the clinic to quickly look up labs for patients. PCC really had a positive impact on our workflows, which is so important with the current nursing shortage.”
Part of a Team, Not a Machine
Stacey Carpenter, also of Essex Pediatrics, has a background in hospitals and government-funded healthcare, but has preferred many of the benefits of working in a smaller independent practice. “It is a great relief to not have to worry about being one small part of a very large system that may not take the particular needs of your department into consideration when making sweeping decisions,” says Carpenter.
“For example, [in a hospital] a new policy might be introduced due to a situation that occurred on a mental health floor, but that policy does not correlate at all with the circumstances that might happen in the pediatric department. Too often there are overarching policies introduced that affect the whole hospital or system that may not easily translate on different floors. It’s hard to communicate that in a large healthcare system because there are so many layers of administrative burden.”
Carpenter described some of the issues she experienced working in pediatrics in the hospital setting. “In the general pediatrics department where I worked, we treated all ages and all conditions. Our pediatric floor had a nurse-to-patient ratio of one nurse to four patients. However, that could mean a mix of any four patients, from everything to an accident victim in traction to an infant having trouble feeding, to a patient suffering from pneumonia. As nurses, we had to place eyes on each of our four patients every hour. In the situation I just outlined, you might spend 45 minutes just getting the infant to feed successfully. That gives you 15 minutes to dedicate to your other three patients. It was the worst during a night shift because the usual daytime volunteers and parents would not be there to lend a helping hand. Frankly, those situations made me feel uncomfortable and unsafe because of the limited care I could provide.”
Carpenter described the mentality in the hospital setting more as “checking the boxes,” whereas both Carpenter and Hanson commented on the intimacy they are able to develop with families and with the other staff members at the small independent practice where they both work. “In the smaller setting, it is much more of a team feeling,” commented Carpenter. “Even in the toughest situations we are able to rally and use each other’s strengths to overcome obstacles.”
She continues, “Our guiding practice has always been, ‘How do we give the best care to our families?’ Everything we do is driven by that question. Sometimes the answer is providing very personalized care that is not possible in a large healthcare facility. For example, we are able to offer home visits in some situations like a family having one child with special needs that makes it hard to bring the other children in for frequent visits, or in-home lactation consultations for new mothers.”
Pandemic-Related Changes
According to Carpenter, often smaller independent practices are in a better position to make quick adjustments in the moment. “During the pandemic, when things were popping up so quickly, being a smaller clinic allowed us much greater flexibility to pivot what we were doing to accommodate our patients’ needs. In Vermont, the schools had very strict protocols regarding returning to school after COVID or COVID-like symptoms. We were pummeled with calls and triage. We were able to work with PCC to order requisitions, making it much easier to triage quickly and send patients to another facility for testing. Because we are smaller, we were able to make quality improvements in hours or days instead of weeks like it might take in a larger setting.”
According to Lennstrom, there were temporary culture shifts brought on by the flurry of activity during the pandemic. “Back when I started, we had a great deal of camaraderie, with regular staff parties. Over time, as the practice grew larger, the faces in the clinic changed, and the attendance at special events began to wane. During the pandemic, it got worse. After being there now for as long as I have, I have been there longer than any of the doctors,” Lennstrom laughed. “Things have changed a bit since the beginning of the pandemic, but still the sense of family here is much more than I ever experienced in the hospital setting.”
The pandemic brought difficulties that required a team effort from clinic staff to overcome. “Even before the pandemic, we had to extend our hours to provide the appointment times our families needed and to stay competitive with other local pediatric clinics,” stated Lennstrom. “However, once the pandemic began, some nurses on staff were furloughed and the remaining nurses had to be flexible with their hours to meet patient needs.”
Hiring enough staff was a challenge even before the pandemic, but since 2020, it has become even harder. “Sometimes it seems like a rotating door. Young nurses come to us for training, then leave, often for better pay at a large healthcare system. However, when you do that, there is a loss of autonomy, and a loss of stronger relationships between the staff and with our families. Multiple generations have brought their children here. We get to know the parents, grandparents, and children. You just can’t put a price tag on that.”
A Controversial Staffing Choice
One trend that Carpenter mentioned seeing is that in the face of nursing shortages and lack of competitive pay, some independent practices are replacing licensed nurses with medical assistants (MAs) who are not licensed. While adding MAs can be beneficial to help keep practices running smoothly, replacing licensed nurses with them may expose practices to unnecessary risk. Training and education requirements for MAs vary widely from state-to-state, according to the American of Medical Assistants (AAMA), and the duty to ensure the proper training is in place is often up to the employer. Additionally, it is illegal in some states to replace licensed nurses with MAs. Medical assistants must work under the direct supervision of an on-site physician, which can be limiting. The concern is that clinical work might be inappropriately delegated to an MA who may or may not have received the proper training for the task at hand.
According to the American Academy of Family Physicans (AAFP) training for MAs can range from a few months of vocational coursework to a two-year Associate’s Degree. MA certification is not required, and only about 15% of MAs have obtained either a Certified Medical Assistant (CMA) or a Registered Medical Assistant (RMA) credential.
In contrast, Registered Nurses (RNs) are required to obtain either an Associate’s or Bachelor’s degree in nursing and pass the National Council Licensure Examination (NCLEX). Some may even apply for board certification after at least two years of clinical experience. While hiring more MAs during a nurse staffing crisis may put a band-aid on the situation, an MA should not act as a replacement for an RN in a clinical setting because of the significant difference in the level of education and training required.
“Finding the best providers to work for and having the best coworkers you can really trust on your team truly is a joy not to be taken for granted. The pay may be less competitive, but life is about so much more than the money.”Stacy Carpenter, Essex Pediatrics
Final Thoughts
Lennstrom cautions that to be successful, younger nurses need to go in with the right expectations. “Lots of students go into pediatric nursing with false assumptions. As long as you realize that it’s going to be busy, and it’s going to be hard work, you are ready to start your pediatric nursing career.”
According to Hanson, “Both hospital settings and private practices require highly trained nurses with specialized clinical experience, especially in pediatrics. All nurses are different with different strengths and weaknesses. The hospital setting might not work for everyone, and the same goes for private practice. I would encourage all nurses to try a range of different experiences. You never know what might be the right fit for you—it might be in a place you never considered.”
Carpenter also urges both practicing nurses and nursing students to keep their options open as far as which setting to choose for their careers. “The main thing to remember when considering working at an independent practice is that people matter,” she urges. “Finding the best providers to work for and having the best coworkers you can really trust on your team truly is a joy not to be taken for granted. The pay may be less competitive, but life is about so much more than the money.”
Allyson Howard is a firm believer that well-crafted stories can redefine brands and organizations, reinvigorate internal and external business communications, and engage and inform consumers in groundbreaking ways. Her BA in English and Education from the University of Iowa, as well as her MS in Professional Writing from NYU, have positioned her to create a wide range of content tailored to communicate unique brand voices and messages. She lives outside Chicago with her family and enjoys cooking for loved ones and reading.
Brought to you by PCC
The Independent Pediatrician is brought to you by PCC, which provides tools and services to help pediatricians remain independent and in control of their practices.
PCC itself is a fiercely independent business. As a Benefit Corporation, it puts the interests of its clients, community, and employees on an equal footing with those of its shareholders.
To learn more about successful independent pediatric practices, read PCC’s Client Success Stories.
