Driving Your Clinician Career with Passion Featuring Ryan Nadboralski, MSN, FNP-BC, ANP-BC

Featured ThriveAP Faculty Discussion: Ryan Nadboralski, MSN, FNP-BC, ANP-BC

At ThriveAP we are honored to have an expansive faculty of expert speakers and APPs with impressive credentials and experience. Today we are talking with one of our esteemed faculty members to gain their advice for thriving in an advanced practice career. 

Ryan Nadboralski, MSN, FNP-BC, ANP-BC, started working in a rural family practice setting that also included management of hospital patients. While Ryan is a Family Nurse Practitioner he loved the challenge of inpatient care and after 5 years transitioned to hospital medicine. He has since settled into his current role in urgent care and ER while also mentoring and teaching clinical students. Ryan is passionate about teaching and helping students and new practitioners learn the role and what can make them a success in the dynamic setting of evidenced based medicine. Watch the interview below with Sarah Maxwell, Director of Marketing at ThriveAP and Ryan Nadboralski, MSN, FNP-BC, ANP-BC, or read the transcript.

Meet Ryan Nadboralski, MSN, FNP-BC, ANP-BC

Interview Transcript

Sarah Maxwell: Hello, my name is Sarah Maxwell. I'm the Director of Marketing at ThriveAP. At ThriveAP, we are honored to have an expansive faculty of expert speakers and advanced practice providers with impressive credentials and experience. Today I'm going take a few moments to get to know one of our faculty members a little bit better and gain some of their advice for thriving in advanced practice career. Please welcome Ryan Nadboralski, MSN, FNP-BC, ANP-BC.

Thank you so much for joining us today. I'd love to hop right in and have you tell us a bit about yourself, your practice, where you live. Let's get to know you a little better.

Ryan Nadboralski, MSN, FNP-BC, ANP-BC: Sure, you bet. I live about 20 miles south of Green Bay, Appleton, Wisconsin. Right now I work about a 50% kind of position in urgent care in a small clinic just outside of Green Bay. Prior to that I actually worked in hospital medicine for about 12 years or so. So I have both inpatient and outpatient experience, but right now doing urgent care and then picking up some locums positions from time to time, either in emergency department, urgent care, or in the hospital. It gives me a little bit of flexibility there to do that given my background.

SM: That's interesting. We were always family medicine for the longest time and we knew we needed to scale and support NPs and PAs in other practices. You're kind of covering the gambit of all the ones that we knew right away we needed: urgent care, emergency medicine, and hospital medicine. Those are the ones we wanted to tackle.

RN: Yeah. And I think as far as nurse practitioners, and PAs those are probably the the largest segments that NPs/PAs are working in, right? Whether that be family practice, emergency, or hospital medicine. More so now over the last 10 years or so to support the physician staff. It's worked out well. My first job that I ever had was in family practice in a very rural clinic. And that rural clinic was attached to a critical access hospital. So I got to do family practice four days a week and then practice,  hospital medicine on the weekends.

SM: Oh, that's so cool. That's such a unique dichotomy, getting to really see both sides of the fence and have that experience. Did that help you select the path you wanted to take.

RN:  Yeah. I did that for about five years and then I got more of a passion for internal and hospital medicine so I moved into the bigger community hospitals in Appleton and Nino, Wisconsin. That's what kind of transitioned me into the hospitalist role for over 10 years.

SM: Wow. That's awesome. So what drove you then with all this experience to want to work with ThriveAP?

RN: The opportunity with ThriveAP and trying to reach out to a mass number of new  learning NPs/PAs is what really intrigued me about this. I could pass on some of my knowledge, not just to one student that I am mentoring at the time, but to a whole group of students. I think what intrigues me the most and what I found from feedback is most beneficial, is getting those real world experiences. Those new practitioners can see how somebody who is more seasoned, I won't say old, but more seasoned, how they deal with some of these situations that they're coming up with on a daily basis, but really have no experience.

SM: Right. And you mentioned mentoring. What do you think are some of those ideal attributes that you would find in a mentor or maybe that you experienced as you were becoming more seasoned?

RN: Good question. I think number one, patience. Patience is a virtue, right? Having patience with new providers so they can make some mistakes and learn from those mistakes. There's not a always a right and wrong in medicine either. There is maybe a best practice and a better practice and sometimes a way in which we've been doing it for years, which isn't always the best, but just having the patience to work through why some of those things may be better in certain situations is fantastic. But I also found my students appreciate the honesty that I have in the role. Not everything is great a 100% of the time and there's challenges, whether that's challenges with administrative issues trying to implement a program that would work well, but there may be roadblocks in administration and trying to sell them a certain thing. So getting students to realize that there are some issues that you're going to encounter in the role that are above and beyond medicine that are barriers and those barriers you need to work through.

I like to be a little bit lively and interactive with my students as well, and I think getting them to think. A line that I, I always use is, "tell me what you're thinking right now." Not giving them the answer per se, but saying, "Hey, you are here alone in a rural clinic.You have no other resources. What are you going do? Let's think through it." And if the answer's wrong, that's okay. This is the time to think through and make those mistakes, and then learn from them.

SM: Absolutely. It's about, let me understand how your brain's working and what path you're following to get to your answer. So even if it's a wrong one, I understand that, because then you can better help. Here's that thought process that you had. Here's that piece where. Just change this and, and you would get there, right?

RN: Yeah. And after years of practice I probably take certain things for granted that I think are known, but maybe they're thinking of it in a little bit different way. That puts a light on how I should teach that a little bit better.

SM: I forget that often too, obviously being in marketing, somebody will ask me a question, and to me it's obvious, right? To me, obviously you do X, Y, Z because I've been doing marketing for my entire career, and then I realize, no, it's not obvious to everybody, and their question actually makes me think of something else that maybe I should be doing it differently. It's kind of both a mentee and mentor teaching each other in some ways.

RN: Absolutely and I was just going say, there's not a week that goes by where I have a student who I don't learn something from them. "Well, they said my clinical instructor said this, and this is, and so let's talk about that, why that might be right, wrong. etc." I spoke to a collaborating physician once who had participants in the ThriveAP program, and he had mentioned something similar. He said, "they actually taught me something that you guys were going over in your program that I just hadn't heard it addressed in that way before. That is a different way to approach the same kind of case, the same type of scenario that gets you to the same answer, but a different approach to it." I just thought that was the most interesting thing.

SM: Yeah. Absolutely. Well, so tell me a little bit about what is your greatest passion in your role?

RN: Yeah, so I won't say, Hey, my greatest passion is to help everybody, right? We all want help people but I think above and beyond that is, being there for others. I think of that in a few different ways.

In the various roles that I've been in when I've been in hospital medicine. Looking people in the eye as they're going through the dying process and helping them through that. Also helping family members through that. I've had comments that, "I've never had that explained to me that way. Thank you." Having that said from a family member is priceless. For good or bad, and I think this is some issues with the healthcare system in general. That a often we don't have the the time. There are time constraints in the clinic to talk about end of life issues or palliative care, that sort of thing. So we encounter that first in the hospital and for patients' family, to explain why they're not eating at end stage dementia or why they can't breathe in end-stage COPD, why they're back in the hospital six times in the last six months for CHF. That's certainly all important and getting that thanks from patients and or family members is rewarding.

I think there's certainly a passion I have for teaching. I've been doing that since I've been in practice, well, after about two years in practice. I probably had my first student at that point and I enjoy teaching and I learn from my students just as much as they learn from me sometimes. I want help them prepare. To be the best practitioners that they can

SM: I think I say this every single time, but every time I think what's so unique and really beautiful about the advanced practice community is everybody is so giving of education. Everybody wants to share. It's not as much of a, "No, I learned this. You go and figure it out on your own." Everybody is so excited to mentor and to be a mentor and to have this amazing mentor. It's just a really cool community in that way of expertise and knowledge sharing.

RN: I would agree completely. I think that the advanced practice providers that are out there that I have met, I mean the vast majority of them, are willing to help you either be a, a full-time mentor versus, "Hey, I just have a question about such and such condition."  There are oftentimes in urgent care where I see an odd looking fracture and I just text one of the nurse practitioners from ortho who's always around and they'll say, "Hey, send me a picture of that x-ray."  And that's fantastic. I'm learning and I continue to have mentors in those areas that I struggle with sometimes. Hematology, oncology, I mean, it's a career of lifelong learning, that's for sure. It never ends, so you have to be passionate about it.

SM: Absolutely. So I'd love to know, what is something that is really noteworthy, an accomplishment of yours, in your career? I mean, it's a very impressive career, is there something, if you had to say, Hey, that's, that's something I really like to hang my hat on. What would that be?

RN: Yeah, you know, about, 8-10 years ago or so, I had the opportunity to present at the Society of Hospital Medicine Conference (SHM) the big national conference for hospital Medicine, which was fantastic. I did this paired up with another gentleman from the east coast, we were presenting about the collaborative care model. Basically what that is as a model of care in the hospital where the providers, the nurses, the respiratory therapists, the pharmacists would all sit down and round together. And so there wasn't a whole lot of this back and forth. But I got to present about that model which was awesome because I was living it. We were doing something new and it was my first, I guess, big speaking opportunity that I had. But it was a joy to be there in front of a large audience of people that really wanted to learn about this new system that I was actually leading.

SM: Fantastic- you're in it, you're creating it, you're living it, and it's always nice to have that moment of somebody who wants to learn from you and you're doing really neat thing.

RN: Yeah. And it was at a level that I wasn't presenting to my hospital staff or something. It was at a level that, that I had never been at, so it was a great experience for me. And got me involved and more comfortable with relaying some of what we're doing in our hospital out to the country.

I've had some other leadership roles, leadership of our code blue committee in the rural hospital to see how we are going to deal with that. I did create a lot of order sets for hospital medicine as well when we transitioned from paper charts to the electronic medical record on the inpatient side. Those are all great accomplishments that I think really helped everybody out.

SM: Absolutely. And that goes back again to the knowledge sharing and "how can I streamline this and be more efficient for everybody?" Because when you are all more efficient in practice it makes care more efficient. It makes patients have better experiences. It is really full circle when you're in that space.

Well, I would love to know what is some advice that you would give the future NPs and PAs, the ones of today and the ones that we hope can follow your career path and be success as successful as you in the future, what's some advice you would give them?

RN: I would say the best I advice I would have is use your resources. Don't think that you know everything and it's okay that you don't know everything and it's even okay, patient forward facing to say, "I don't know the answer to that but I'm going find out for you and get back to you." I did that a lot early in my career. We had good mentors in our clinic and physicians I could go to and bounce ideas off of. I think patients really respected that I don't know everything but that I'm going to find out the answer for them and I'll get back to them. I think, just like in the hospital, I don't know everything about med dosing and dosing complex antibiotics or things like that. I use my pharmacy resources quite often. So use your resources out there to help you along.

I would say one other thing, always keep in mind the medical, legal, decision making that you are going to portray. This is more for protection of yourself. From a very early standpoint, my mentor ingrained in me, don't put yourself in a box with your charting. Your charting, allow that to explain your thoughts. Don't put yourself in a box. Use your thinking of why you think this diagnosis is appropriate, but others are also possible and that doesn't put you in a box if you ever face some medical legal challenges down the line.

SM: I think that's the first time I've heard that one. That's interesting!

RN: All of my lectures include some medical, legal, charting and reminder about that and some descriptions of what I say, "I think this is an acute sinusitis because of X, Y, and Z symptoms, but I can't exclude other possibilities." I've learned it from two particular mentors that stressed that quite often and none of us, to my knowledge, have been in court.

SM: No, that's smart. I mean, and it's unfortunate, but it's something that you really have to be smart about and think through. It's good if you're giving advice and helping the future NPS and PAs understand that because it is something that's important to their career and important to their employer organizations, the systems. It is really crucial.

RN: Yeah, I think it is one of those things that is overlooked often, but shouldn't be overlooked and should be taught actually in all of the courses that you're going through. But, although all of us have to go some through some sort of minimal legal course that's out there, it's not based on really what you should do in practice.Your charting means everything, if you get called to a case three years later you're going to have to rely on your charting.

SM: Yeah. You have to kind of go back to that record that you have because gosh, how do you remember something from three years ago? Especially I think in, in your type of practice, it's a lot of folks, especially now. They're, they're in quick and you have to solve it fast. So that's important. Information.

RN: Yeah. Just something for everybody to think about. And, I'm happy to discuss that further with anybody who has questions on what I kind of do.

SM: Well, I know your time is super valuable, so I don't want take up too much of it, I want to thank you so much for being here today and for sharing your expertise and your advice. We're so appreciative.

RN: You bet. Happy to help and happy to help everybody else out there. Thank you.

SM: And thank you everyone for joining us and stay tuned to meet more of our faculty. Have a great day, everyone.

More About Ryan Nadboralski, MSN, FNP-BC, ANP-BC

Ryan Nadboralski MSN, FNP-BC, ANP-BC, is a Family Nurse Practitioner who has over 20 years of health care experience. He grew up in the Milwaukee, Wisconsin area and graduated from the University of Wisconsin- Madison with both his Bachelors in Nursing and then as a Nurse Practitioner. Ryan started working in a rural family practice setting that also included management of hospital patients. He loved the challenge of inpatient care and after 5 years transitioned to hospital medicine for over 10 years. He has since settled into his current role in urgent care and ER while also mentoring and teaching clinical students. Ryan is passionate about teaching and helping students and new practitioners learn the role and what can make them a success in the dynamic setting of evidenced based medicine.  

We are truly honored to have faculty of Ryan's caliber in our unmatched expert network. If you're interested in learning directly from experts, like Ryan, apply for the ThriveAP program today!