Importance of Safe Pain Management & Emergency Care with Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C
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.
Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C, joined us to discuss her passion for safe pain management care in emergency medicine, the key to being a good mentor, her advice for the future generation of advanced practice providers and more. Watch the interview below with Sarah Maxwell, Director of Marketing at ThriveAP and Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C or read the transcript below.
Meet Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C
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 APPs with impressive credentials and experience. Today, we are talking to one of our esteemed faculty members to gain their advice for thriving in an advanced practice career.
Please welcome, please join me in welcoming Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C. Thank you so much for joining us today.
Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C: My pleasure.
SM: Well, I know your time is very busy and very important, so I won't take too much of it up. I'll just kick us right off and could you give us a little bit about yourself? Some of your background, maybe where you practice and a little bit about how you got there.
EM: Sure. I am an emergency nurse practitioner and I practice in the middle Tennessee area specifically just south of Nashville, Tennessee in a smaller community hospital. I've been in emergency medicine, both as a nurse and a provider for a little bit over 15 years now. I was a nurse for eight of those, and I've been a nurse practitioner for about seven years now.
I kind of got started in emergency medicine accidentally on purpose. I went to nursing school thinking that I definitely wanted to do women's health actually did my rotations and discovered that I actually don't love women's health. For a variety of reasons, but did some rotations in the emergency room and immediately knew I had found my thing that I wanted to do and the rest is history. I became an ER nurse, got my CEN, which for anyone who doesn't know is a certified emergency nurse credential, then decided I would take the next step.
I went back to school for both a family nurse practitioner and an acute care nurse practitioner degree. I am triple board certified in family acute care and emergency nurse practitioner practice. And then because I'm a giant nerd, I went and got my DNP. And now I teach full time at Vanderbilt University School of Nursing and I practice part time in the emergency department.
SM: Wow. So you are busy! That's funny. I've heard from a few folks that are in more acute space, emergency or urgent care, similar stories where they say, "Oh, I knew I was going to be doing this and, you know, fill in the blank - never emergency or urgent," then they explain, they had an experience where, like you said, a rotation or they did something in there and it was like a light bulb. Boom, I need to be in the emergency room. It's like, all of a sudden, it just like called to them.
EM: Yeah, I think for a lot of people it happens that way because the ER or the ICU, for example, is such a dynamic environment, it's hard to explain. So, I think that once you actually get in there and experience it, it just clicks with you if you're an ER or urgent or emerging care kind of person and you're like, oh, this is what I wanted to do. I didn't know this existed, but this is what I wanted to do. You just fit.
SM: Well with that kind of in mind, what is your greatest passion within your role?
EM: I'm really lucky in that I work in a great environment that really nurtures learning and listens to us in what we think. I am really passionate about patient care and specifically alternatives to opioids and providing evidence based pain relief through a mixture of procedures and non-opioid medications and modalities such as physical therapy, biofeedback, to provide patients pain relief without the use opioids in the emergency department. In coming from the Northeast. I originally lived in New Hampshire where we started to see the opioid epidemic about 10 years before the rest of the country. I knew good people who got sucked into the opioid epidemic and opioid use disorder through a medical gateway when they were treated for a condition. So it's one of my huge passions, helping people manage pain and manage conditions without having to rely on opiates or, you know, relying on them for as little time as possible and really getting people back to their best function without using those kinds of medications.
"It's one of my huge passions, helping people manage pain and manage conditions without having to rely on opiates or relying on them for as little time as possible and really getting people back to their best function without using those kinds of medications." - Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C, ThriveAP Emergency Medicine Faculty
SM: That's so important. I know lately there's been different shows and movies that I think have kind of put a little bit of a spotlight back on that. You know it kind of fell off the radar. Not, I mean, not off the radar, but I feel like it's becoming more common and people are better understanding it and trying to think about it more than maybe they had been in the past few years.
EM: Yeah, I think when the public health emergency was declared in early 2017, it brought a lot of focus to it. And then, like with anything else, as time goes on, some of that focus sort of shifts because the world changes very quickly, and a lot of the movies and documentaries and podcasts that have dropped recently have sort of brought that back into focus.
SM: Yeah, that's a good way of putting it, yes. I think that's really interesting, and I think that's actually the first time somebody's brought that up as something that they're very passionate about, and it being something that they get to make such a big impact in their role.
EM: Yeah, I'm really, really passionate about patient pain control and symptom management because we do see people mostly in the very beginning phases of an illness in the emergency department. So if I can help them get on the right path, from day one, that just sets them up for better recovery later on and less risk of complications. If we just start with all of that multidisciplinary pain relief focus right from the beginning, then they don't get lost to the follow up and just dependent on medications to completely control all their symptoms.
SM: Absolutely. Obviously you've been in practice for a while and very passionate about what you do. Do you have any noteworthy accomplishments that really mean a lot to you?
EM: You know, it's funny, I don't know that there are any specific accomplishments or awards that I have that give me as much joy as interacting with patients and also students. I do teach and hearing from them that they are doing better or that my education or treatment in some way helped them. I mean, I love getting published, obviously, I love giving presentations - those things are very rewarding. But for me, honestly I got into healthcare to focus on my patients, the one to one connection, and just those days where you go to work and you might see 25 patients, but you actually really feel like you made a difference to one. I would say those are the things that make me feel most accomplished.
SM: I absolutely understand that. I think that's one of the unique things about working at ThriveAP that, you know, on those days that are, like you said, you see a bunch of patients, those days that are just long, there's a lot to get done, knowing that what we do makes an impact on patient lives at the end of the day- makes it worth it. Because we get to have amazing faculty like you who are so passionate, helping our students and helping our participants, so they can provide better care. It does make it worth it. Its the reminder that we are making an impact and t does make a huge difference.
EM: Yeah. And it helps carry you through those bad days when you saw 25 patients and, you know, maybe that day you missed something or you had a patient that was angry with you, or you couldn't give someone exactly what you wanted or they wanted. It does get you through those days when you have those noteworthy patient experiences.
SM: And you had mentioned having those interactions as well with with students or helping with that next generation. So what do you think makes a good mentor?
EM: Yeah, that's actually a great question. I think that even more important than clinical expertise or knowledge, which is definitely something we all look for in mentors, is a certain amount of compassion and humility. Someone who is incredibly knowledgeable without any humility doesn't really offer you much.
" think that even more important than clinical expertise or knowledge, which is definitely something we all look for in mentors, is a certain amount of compassion and humility. Someone who is incredibly knowledgeable without any humility doesn't really offer you much." - Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C, ThriveAP Emergency Medicine Faculty
I feel like the mentor mentee relationship is always a two way street. I always learn something from my students when we have, for example, clinical conference after their clinical rotations. I will always learn something from them and hopefully they come away with more from me than they have given, but it definitely is a two way street and to have someone who will listen to you and interact with you and offer something of themselves makes a really powerful relationship with someone that's mentoring you.
SM: Thinking through that, you're mentoring and you're teaching, what attracted you then to add ThriveAP onto your long list of responsibilities and things that you do all day?
EM: Well, you know, I just want to put more stuff on my CV. No actually I am really passionate also about transition to practice. I think I had a pretty typical transition to practice for my generation of provider. I was given two days of orientation and then put out to work, taking patients by myself. Fortunately for me, I went to a very robust emergency nurse practitioner program, where I had a lot of training on what to expect in the ER, and I had been a student in that emergency department before my hire. So I was a little bit ahead of the game, but I have seen coworkers now that have come and gone that came in, got a few days of orientation, were sort of thrown to the wolves and just did not thrive because they just weren't given the resources. It had nothing to do with their intelligence or their education or their ability to be a good provider.
They were just allowed to sink, so I feel like if I can help bridge that gap and give somebody the benefit of my experience, then I'm more than excited to do so. You know, transitioning to practice is always going to feel like a jump off a cliff, but if we can offer new providers something to cushion their landing, then we can really help them be more successful.
"Transitioning to practice is always going to feel like a jump off a cliff, but if we can offer new providers something to cushion their landing, then we can really help them be more successful." - Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C, ThriveAP Emergency Medicine Faculty
SM: Especially in a more emergent setting, right? Because it is so fast paced and you need that answer. You need to be able to act confidently, quickly, and efficiently. And with three days of orientation and clinical knowledge, that's not enough, especially with a growing APP workforce they just need more and they deserve more.
SM: So do you have any apps or journals or podcasts or anything that you use to stay up to date with medicine changing as quickly as it is?
EM: I'm pretty active in my professional organization, so that is for me the American Academy of Emergency Nurse Practitioners. I receive their journals. I read Advanced Emergency Nursing Journal. I subscribe to EMRAP, which is a continuing education podcast. That one you have to pay for but it does provide continuing education hours. I'm fortunate in both of my roles, both as a faculty and a clinical employee, I have access to UpToDate, and I am on there all the time looking things up.
I also subscribe to some newsletters that sort of collate recent findings, medscape of all things actually provides a good summary of recent findings. The American Academy of Emergency Physicians has a newsletter that is really helpful. Anything you can find that will give you sort of a synopsis of practice changing updates or new research that may be coming down the line is a great way to stay on top of things, there used to be a service that would do that for you, but they kind of shut down. So I'm searching to replace that. I also am a big fan of podcasts because I have a long commute. My commute to and from the university with traffic is about an hour and a half. So I listen to a lot of podcasts in the car. A couple of my favorite free ones are the pediatric emergency playbook and EM cases and I especially love EM cases because they're all Canadian. So they pronounce everything wrong and it makes me giggle while I learn.
SM: It keeps you engaged then, right?
EM: Exactly, exactly. My brain doesn't shut off because I hear them saying aboot and, you know, all these, all these words that are just are wrong.
SM: I'm actually located in Nashville too, so I feel you on the commute and on the podcast. I do a lot of that too. The traffic is nothing to joke about down here in Nashville.
EM: It is not, and no one around you has any idea what they're doing, so.
SM: No, I always think it's because so many people are not originally from Nashville, I think we just got all of the worst drivers from all over the country and they all converged here to just figure it out together.
EM: I agree with that statement. I do.
SM: So the podcasts are the way to go during that ride.
SM: Well, lastly, I would just love to get your advice for, for APPs of the future? You know, what kind of pearls of wisdom would you share with them to say, okay, this will help you, this is something maybe I wish somebody would have said to me while I was on this journey and while I was transitioning into practice that would have been helpful.
EM: Yeah, absolutely. I would say the biggest thing is nobody can know everything, especially in a field like emergency medicine where we touch upon every single specialty. So it's not as important that you know all the answers as it is that you know where to find the answers, that you know what your resources are, whether that's podcasts or uptodate or the great attending physician that you work with and you can always count on for help. Just knowing those resources is huge. You don't have to know everything.
The other thing that I would really say that I wish someone had told me was, don't be afraid to ask questions and don't be afraid to say, I don't know - either to the patient or to your coworkers. An approach where you are open to Feedback and learning is always going to be better than trying to just forge ahead and not really know what you're doing. The patient's going to do better, you're going to feel more confident, and your coworkers will have a lot more confidence in you when you can just say, I actually don't know the answer to that, let me find out, or I'm not sure how to treat this, let me look a couple things up, let me talk to my attending. Anyone who makes you feel less than or stupid for needing help, that's their problem, not your problem. Their perceptions do not actually reflect on you. You are doing what you need to do to keep your patients safe. And that's amazing. And that's exactly what you should be doing.
"Anyone who makes you feel less than or stupid for needing help, that's their problem, not your problem. Their perceptions do not actually reflect on you. You are doing what you need to do to keep your patients safe. And that's amazing. And that's exactly what you should be doing." - Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C, ThriveAP Emergency Medicine Faculty
SM: Absolutely. Gosh, that is a really great way to think about that because you're right. It's better to just say, I don't know, than to go through the motions. This is patient care that can have some big repercussions so it's okay to not know an answer. That's 100 percent acceptable.
EM: Yeah. And I find, you know, I've been doing this in different capacities for 15 years and there's still plenty of things that I don't know. And I have never yet had a patient get angry with me because I didn't know how to answer a question or wasn't sure of a diagnosis. If you are open and show your patients that all you're concerned with is giving them the best outcome and their safety, they are so happy to have you taking care of them and they trust you.
SM: Absolutely. That's a good point, too, because it brings up such a better, more fruitful relationship with that patient because they can trust you now, because you are being honest with them. You're being transparent and with the way medicine evolves every single day the likelihood of you knowing all the answers is slim to none. So it's okay to say, let me look into this. I know there's some new things happening. Let me find out for you. And then you can build that rapport too.
EM: Absolutely. And there's always going to be some weird thing that you have never heard of that comes in, whether that's, I mean, I swear they find a new genetic disease every other week nowadays and diagnose someone with it. So sometimes you just have to say, I've never heard of that. What is that? When they list off ten initials and they're like, I just got diagnosed with this. There's no shame in seeking knowledge even from your patients.
SM: Yeah, absolutely. I think that's really, really great advice that, you know, almost in any career too.
SM: I think that's something everybody could could benefit from hearing. Well, thank you so much for joining us today. I don't want to take up any more of your time, but I really appreciated the conversation and I think you shared some amazing advice that will really benefit folks. Thank you.
EM: Thanks. I love to talk about what I do.
SM: Well, and it comes through. Your passion absolutely comes through and that's a benefit to every patient out there. So thank you. Well, thank you everybody for joining us today and stay tuned to meet more of our faculty. Have a great day.
More About Erica May, DNP, APRN, AG-ACNP-BC, FNP-BC, ENP-C
is board certified as a Family, Adult Gerontology Acute Care, and Emergency Nurse Practitioner. She is an Instructor of Nursing at Vanderbilt University School of Nursing, where she teaches in the Emergency Nurse Practitioner program. Dr. May currently practices in the Emergency Department at StoneCrest Medical Center, in Smyrna, TN. Having seen the devastating effects of the opioid crisis, Dr. May is keenly interested in alternatives to opioid pain management in the emergency department. A love of the outdoors also drives an interest in wilderness and austere medicine, and Dr. May is an active member of the Wilderness Medical Society, as well as volunteering with the Tennessee Scenic Rivers Association to teach safety and rescue skills to recreational boaters. When she isn’t teaching or working in the ED, Dr. May enjoys spending time outdoors with her husband and two dogs.