NP Scope Volume 2: NP Week Special Edition

NP SCOPE

Volume 2

The NP Week Edition

Join the Functional Medicine Movement PTSD/OCD: A Deep Dive

Tea Rituals for NPs Building Empathy

Table of Contents

An Ode to NPs NP Week 2025 takes place from November 9th to the 15th.

Embracing Constructive Criticism How to recognize critical feedback as a blessing in disguise.

This special edition of NP Scope showcases the profound impact nurse practitioners make on the well-being of people across the globe and equips students and clinicians with essential tools for navigating all facets of the modern healthcare sector. As an NP, you provide much more than medical care. You act as a patient advocate, trusted confidant, and an essential pillar in the communities you serve. During grueling shifts that often involve adrenaline rushes and heartbreak, you are a steadfast source of warmth and positivity. During this NP Week, Fitzgerald celebrates our vibrant community of NP students, clinicians, and faculty members, all united in the mission to help people live longer, healthier lives. Knowledge is power, and we are on a mission to provide everything you need to succeed. From comprehensive test preparation materials to engaging CE courses, riveting podcasts, and dynamic live events—Fitzgerald offers something that supports every practicing NP. We are proud to present the second edition of our signature magazine, NP Scope, your trusted hub for actionable career advice, clinical insights, and exclusive interviews with our brilliant faculty members. Here’s to you, and here’s to another year of learning, leading, and uplifting those you so tirelessly serve.

The Future of Functional Medicine Reframe your clinical mindset and unlock new career ventures.

A Week Well Spent Your guide to balancing productivity with restoration during this year’s NP Week.

Professional Liability or Malpractice Insurance Build an airtight defense system in the event of a malpractice case.

Calm in a Cup It’s teatime! Sip on these mindfulness tips.

When Anxiety Isn’t Just Anxiety When a chronic worrier enters your office, get ready to think outside the box.

Healing With Empathy A Fitzgerald faculty member shares how a lifechanging diagnosis shapes her practice.

—Fitzgerald Health Education Associates

DAY 2: Explore a New Specialty

DAY 4: Consider Practice Ownership

DAY 6: Reflect on Your Progress

NP Week KICKOFF

“The days are long, but the years are short”. This saying can be particularly poignant for healthcare professionals. While the daily grind seems endless, your career can fly by in an instant. Wherever you are in your professional journey, you are meeting countless milestones and learning new things. Try writing a letter to the version of you as an NP student, new graduate, or novice clinician. Think about how different life felt back then, the things you’ve accomplished since the start of your career, and where you want to go in the future. Tell your past self that it’s okay to feel discouraged, tired, or conflicted, because all of your experiences (both positive and negative) have shaped you into the person you have become today. When you think about the big picture, the little challenges seem worth it. After completing this exercise, you may find ways to stay motivated and get a boost of self confidence.

Have you ever dreamed of opening your own clinic but not sure where to start? The path to business ownership might be simpler than you think. Fitzgerald offers educational content that guides NPs through the intricacies of the practice startup process. Learn about financial considerations, marketing, legality, LLC registration, budgeting, staffing, and more. Attend the “Opening Your Own Practice: The Elite NP Way” webinar hosted by successful NP and practice owner Justin Allan, or learn from entrepreneurial Fitzgerald faculty members Sally Miller and Wendy Wright in the “Starting Your Own Practice” episode of the NP Professional Series.

After you’ve passed boards and secured a clinical role, it’s easy to get pigeonholed into a specific area of medicine. This year's NP Week is the perfect opportunity to check out new practice areas. Evaluate which body systems or disciplines you know the least about and carve out time to explore them. You’re guaranteed to learn something new, and you may even discover a career path you’ve never considered. It’s also important for NPs to stay on the pulse of which healthcare modalities patients are most interested in. Functional medicine is rapidly gaining popularity. This field both caters to market demand and challenges NPs to think critically about patient diagnostics, treatments, motivational interviewing, and more. Fitzgerald offers a plethora of courses that can help NPs discover their new passion, including the brand new Functional Medicine course.

A Week Well Spent: Make the Most of NP Week The rest of the year is spent caring for patients, but this week is the time to focus on you! Here are seven ways to enrich your professional life in seven days.

DAY 5: Write for a Clinical Journal

DAY 1: Get Some Quality Shut Eye

DAY 3: Try New Types of CE

While this will certainly take more than a day, NP Week is a great time to expand your horizons into medical writing. Getting published in an esteemed journal can bolster your CV/resume, unlock new professional opportunities, and establish yourself as a leading voice in your field. Brainstorm topics you have advanced knowledge of and dive into the editorial process. Options include case studies or clinical pearls from your specialty, opinion pieces on healthcare trends, pharmacology updates, or case-based explorations into the impacts of healthcare policy or regulations. Research journals that best align with your values and practice areas and learn about the application process for each. Get feedback from trusted peers or supervisors, and once your work is fully polished, put yourself out there and submit!

You can’t pour from an empty cup. Sleep deprivation has been shown to severely impact cognitive function and decision making, which can lead to potentially dangerous mistakes or oversights at work. However, not all sleep is good sleep. To truly rejuvenate, you should aim to get between seven to nine hours of sleep per day. To promote a healthy sleep cycle, be sure to put down all electronics at least an hour before bedtime. This especially applies to work devices like cell phones or pagers. If possible, avoid caffeine at least six hours before bedtime in order to fall asleep quickly and stay asleep longer. Getting at least 30 minutes of sunlight per day is a powerful tool for regulating your circadian rhythm. Optimizing your body’s internal clock can facilitate natural sleepiness at appropriate times.

DAY 7: Celebrate You & Your Fellow NPs

Fulfilling CE requirements can feel tedious and repetitive, especially when you’ve stuck to one format for an extended period of time. In honor of NP Week, switch up your CE regimen with new ways to learn. Do you exclusively utilize on- demand courses? Try attending an in-person session instead! By breaking free from your usual routine, you can engage with peers, meet Fitzgerald faculty in the flesh, and allow the information you learn to truly permeate. If you’re looking for ways to save on CE, sign up for some of Fitzgerald’s free continuing education opportunities. Both live and recorded versions of our NP Talks webinar series are available now, and feature hyper-focused topics such as respiratory disease, adrenal health, epigenetics, suicide prevention, and more.

Nurse practitioners come from all walks of life and occupy an array of clinical roles. But all are united in the mission to make the world a healthier place. Nursing can be a thankless job, so it’s important to give kudos to yourself, your peers, and your mentors.

This NP Week, don’t just go through the motions—make it meaningful. Whether you're catching up on rest, exploring a new clinical niche, or finally drafting that journal article, take time each day to invest in you. You’ve earned it, and the impact you make every day is worth celebrating.

Setting Up for Teatime

Fluorescent lights. A humming microwave. People chatting. While your break room may not exude a spa-like ambiance, you can still cultivate a soothing atmosphere. The key to a mindful tea ritual isn’t about the space around you—it’s about the space within you. Inner peace often comes with boundary setting. Think of your cup of tea as a sanctuary—this is the place where chaos ends, and tranquility begins. Create a mini mental boundary: “This is my minute.” Be sure to silence your phone, pager, or other devices to prevent disruption. You can use nonverbal cues with others to signal that you are taking a pause and getting some “me” time in. Try wearing earbuds, even if no music is playing. Hold your mug with intention—sit facing away or at a slight angle, focusing inward. You can also use your mug to elevate your tea ritual. Buy a mug with a phrase or mantra that resonates with you, or opt for one with shapes and grooves that fit well in your hand. The sensations of holding this mug can serve as a way to ground you in the present moment.

STAYING ALIVE Calm in a Cup: Tea Rituals to Reduce Stress Transform break time into a powerful wellness ritual. Breaks during an NP shift aren’t just mandated by law: they’re essential for keeping you on the ball. It may be tempting to tune out during your break with endless scrolling, tv watching, or small talk, but this can be doing you and your patients a disservice. Research shows that taking time for a true reset— free from screens or excess stimuli—is needed to refresh the mind and prevent errors. Instead, treat yourself to a piping hot cup of tea with a side of mindfulness.

Slip into a Meditative State

The biggest challenge when adopting any mindfulness ritual is staying accountable and consistent. Prioritizing yourself isn’t selfish; it’s essential to sustaining the care you give others. With consistency, this small act becomes a daily anchor—a reminder that your well-being matters. Let each cup be more than a beverage; let it be a boundary, a breath, and a moment just for you. Protect it, repeat it, and watch it restore you. Making it Stick

Start your ritual by engaging your senses while preparing the tea. Notice the aroma, warmth, and color. Focus on the moment while sipping—pay attention to taste, temperature, and sensation. Practice deep breathing in sync with your sips to enhance relaxation. Reflect briefly: set a calming intention or silently express gratitude. Mental exercises can also be incorporated into teatime. Practice structured breathing, including the box breathing method, the 4-7-8 breathing method, or diaphragmatic breathing. You can take a symbolic approach by “exhaling” negative thoughts or anxieties with each breath cycle. Affirmations can be a quick and powerful way to stay resilient in tough times. Stick with one that resonates with you most. Some popular affirmations include: “In this moment, I pause and return to myself.” “I am centered, calm, and steady—even in motion.” “The world can wait. I deserve this breath.”

Curating Your Tea Menu

If you’re a newbie tea connoisseur, the vast selection of tea strains and flavors can be overwhelming. Set an intention for what you want your tea to help you with—whether that be anxiety or pain relief, a gentle energy boost, or just a way to warm up your body. Here are some tea recommendations: Chamomile & Lavender: Chamomile soothes the nervous system (apigenin → mild sedative effects). Lavender (linalool) adds a calming floral aroma that helps reduce tension. Green Tea (with Jasmine or Mint): Low caffeine offers mild energy support, while jasmine or mint adds a mood-brightening lift. Tulsi (Holy Basil): This is an adaptogenic herb that helps regulate cortisol and support the body’s stress response. Lemon Balm: Perfect for times of emotional overwhelm, lemon balm naturally boosts GABA, easing nervous tension and irritability.

The Stress-Busting Properties of Tea

There is a strong link between tea consumption and mental stillness. L-theanine, a compound in green tea, increases alpha wave activity in the brain. Heightened alpha wave levels can facilitate relaxation. Alpha waves also play a role in selectively inhibiting irrelevant information, a process that may be impaired in anxiety. This can help you maintain focus when you return from break. Anxiety can also manifest in physical ways, which may lead to chronic pain or nagging discomfort throughout the workday. Menthol, which is found in some peppermint teas, has a natural muscle- relaxant effect. This can relieve tension that often ramps up in stressful situations, while also serving as a natural way to reduce headache or digestive pain.

“I care deeply—now I care for me.” “I am allowed to rest, even briefly.”

VITAL VIEWS

When Anxiety Isn’tJust Anxiety: Recognizing OCD, PTSD, and Panic Disorder in Primary Care By: Trae Stewart, PhD, MPH, MSN, MS, MN, PMHNP ‑ BC

Nuanced First ‑ Line Interventions

overlap between panic disorder and trauma histories. Thus, when a patient describes unpredictable surges of terror, clinicians should always probe for developmental trauma.

Therapeutic response hinges on matching the modality to the diagnosis: OCD : High ‑ dose selective serotonin reuptake inhibitors (SSRIs) are required—fluoxetine 60mg or sertraline up to 200mg—maintained for at least 12 weeks before judging efficacy. Simultaneously, refer for exposure and response prevention; medication alone rarely produces remission. PTSD : Trauma ‑ focused cognitive ‑ behavioral therapies (TF ‑ CBT, EMDR) remain first ‑ line. SSRIs (sertraline, paroxetine) offer modest symptom relief; adjunctive prazosin (1–15 mg) targets trauma ‑ related nightmares. Panic disorder : Begin sertraline 25 mg daily and titrate slowly to minimize early jitteriness. Interoceptive exposure exercises and cognitive restructuring can be as critical and effective as pharmacotherapy. Routine benzodiazepine monotherapy is typically discouraged due to dependence and interference with exposure learning. Urgent psychiatric referral is typically indicated for psychotic features, treatment non ‑ response, or active suicidality.

Panic Disorder: Fear of Fear Itself

Panic disorder is characterized by recurrent, unexpected panic attacks accompanied by persistent concern or behavioral change related to the attacks. The episodes peak within minutes and manifest with autonomic storms—palpitations, paresthesia, choking, derealization—and often drive patients to visit emergency departments convinced of catastrophic myocardial infarction. Key differentiators from PTSD include the absence of a specific cue and the presence of nocturnal attacks, which wake the patient from sleep and strongly favor a panic phenotype. Agoraphobia develops in roughly 59% of cases and, left untreated, can culminate in housebound isolation. Because panic disorder frequently co ‑ occurs with major depressive disorder, alcohol misuse, and other anxiety disorders, an integrated treatment plan addressing all conditions is essential. This three-pronged approach can be used to effectively evaluate patients for mental health conditions and co-morbidities. Targeted screening: Incorporate the PC ‑ PTSD ‑ 5 and the 18 ‑ item Obsessive ‑ Compulsive Inventory– Revised (OCI ‑ R; cutoff ≥21) into annual wellness visits or whenever “anxiety” is the chief complaint. A two ‑ item validated screener (PHQ ‑ PD) can flag probable panic disorder in less than one minute. Rule out medical mimics: Thyroid dysfunction, stimulant or cannabis use, arrhythmia, and vestibular disorders can masquerade as anxiety syndromes. A basic work ‑ up of TSH, ECG, and urine toxicology helps narrow the field. Assess lethality: The combination of PTSD and panic disorder can triple suicide risk. Direct, empathetic inquiry into current suicidal ideation is mandatory whenever severe anxiety, trauma, or compulsions are present. A Three ‑ Step Diagnostic Algorithm

Anxious distress is among the most common complaints in primary care, yet the label “anxiety” all too often serves as diagnostic shorthand for phenomena that are, neurobiologically and therapeutically, worlds apart. Misclassification is rampant: up to 71 % of generalized anxiety disorder and fully 86 % of panic disorder cases are first coded incorrectly and the mean delay from obsessive ‑ compulsive disorder (OCD) onset to detection exceeds 17 years. Such errors matter. Patients with unrecognized panic disorder may cycle through costly cardiology evaluations, survivors of trauma who receive generic “stress ‑ reduction” handouts can devolve into dissociative flashbacks, and covert compulsions in OCD flourish when exposure ‑ based therapy is withheld. High comorbidity muddies the water further—98 % of individuals with panic disorder meet criteria for at least one additional psychiatric diagnosis. This article synthesizes practical, high ‑ yield strategies for distinguishing OCD, post ‑ traumatic stress disorder (PTSD), and panic disorder during routine visits, thereby sharpening diagnostic accuracy and improving outcomes.

disturbing thoughts?” Particular vigilance is required in the perinatal period, when nearly 17 % of new parents experience infant ‑ focused intrusive thoughts that respond to maternal ‑ specific exposure and response prevention.

The Hidden Logic of Obsessions and Compulsions

OCD afflicts 1 %–3 % of adults yet remains widely misread as generalized worry. The hallmark is the presence of intrusive, ego ‑ dystonic thoughts— contamination fears, violent images, taboo blasphemies—followed by repetitive rituals enacted to quell the distress. Because patients often feel ashamed, presentations are indirect: recalcitrant hand dermatitis or irritation from excessive washing, interpersonal conflict driven by constant reassurance ‑ seeking, or unexplained lateness due to covert checking routines. Distinguishing features include: Content that is clearly unwanted and resisted, unlike the rational future ‑ oriented worries of generalized anxiety. Time cost—compulsions consume ≥1hour per day or cause marked functional impairment. Insight—most patients recognize the irrational nature, differentiating OCD from psychotic delusions. A single screening question can be revelatory: “Do you find yourself repeating actions until they feel ‘just right’ or avoiding situations because of

Trauma’s After ‑ Echo: PTSD and Its Complex Form

Asking the Right Questions

PTSD is anchored in a history of actual or threatened death, injury, or sexual violence, followed by four major symptom clusters: re ‑ experiencing, avoidance, negative alterations in cognition, mood, and hyperarousal. Presentation is often delayed—symptoms may surface months or even years after the precipitating event—and patients frequently minimize or omit the trauma in initial interviews. The five ‑ item Primary Care PTSD Screen (PC ‑ PTSD ‑ 5) affords brevity and sensitivity; three or more affirmative responses warrant further assessment. Complex PTSD (cPTSD) adds chronic affect dysregulation and relational disturbances, typically rooted in prolonged childhood maltreatment. Emerging data shows that cPTSD markedly predisposes individuals to panic attacks and agoraphobia, accounting in part for the high

One clarifying question— “Does your anxiety have a signature thought, memory, or bodily surge?”— can redirect a patient from diagnostic limbo toward targeted, life ‑ changing care. By unmasking OCD’s hidden rituals, listening for the echo of trauma in PTSD, and recognizing panic’s abrupt autonomic storms, primary care clinicians can transform a vague “anxiety” label into precise treatment pathways that alleviate suffering and restore function.

Want more mental health insights from Dr. Stewart? Check out the Grand Rounds for the PMHNP: Obsessive-Compulsive Related Disorders course, presented by Fitzgerald.

Using the SMART Framework The SMART Framework, which stands for Specific, Measurable, Achievable, Relevant, and Time-bound, can be used to put feedback into action. Specify: Instead of vague goals, specify what exactly should be worked on. For example: instead of “get better at charting”, pose the challenge as “practice clear and eloquent note taking”. Measure : Come up with a set metric to gauge success. For example: review one chart per week with your preceptor and get their opinion on its quality. Achieve: Small, realistic, and obtainable goals can boost confidence. For example: aim to fill out five charts per week properly. Keep relevant: Your goals should be focused on a particular facet of your job description. For example: if you are looking to get better at charting, don’t focus on diagnostic accuracy at the same time. Be timely: Set a timeframe to track your progress and reflect on results. For example: reduce the amount of charting errors I make by 50% in the next four weeks.

How do I accept constructive criticism in a professional way? When you get feedback of any kind, be sure to: Listen actively: Pay attention to what the person critiquing you has to say before forming an opinion about the encounter. It may be tempting to come up with defenses for your behavior while they’re speaking, but it’s important to hear them out first. Pause before responding: Allow yourself time to process what has been communicated to you. Later on, you may regret a knee-jerk response that is emotionally charged. Ask clarifying questions: If something about the interaction confuses you, or if parts of their feedback seemed vague, you should absolutely ask them to expand their statements. This will help you learn more quickly and avoid repeated errors. Express appreciation: Though it may not seem like it in the moment, constructive criticism can be a gift. Being called out for a mistake or shortcoming can protect both patient well-being and your license. How do I make the most out of the feedback I receive? As you receive feedback over time, you may notice patterns. Think critically about how situations that went poorly are connected, and what skills were being utilized during those times. This may clue you in on what needs to be improved, reexplained to you, or practiced further. advantage. Ask yourself, “what can I learn from this?” rather than “what’s wrong with me?”. This leaves you with an open mind, rather than a poor or pre- occupied attitude that can lead you to make more mistakes.

CAREER CORNER

Embracing Constructive Criticism

Learn to take all kinds of feedback in stride and become a better clinician. You’ve finished your education, aced your boards, and are now part of the workforce. But obtaining your license doesn’t mark the end of your learning journey. Foundational skills are mastered by trying new things and engaging with experienced clinicians. Critique should be expected and welcomed from those in higher positions with advanced credentials. Here, you’ll learn how to process critical feedback and use it to bolster your clinical toolbox.

What is constructive criticism in clinical environments?

How do I process constructive criticism in a healthy way?

Throughout your tenure as a medical provider, you will work with people of diverse backgrounds and personality types. Some of your supervisors may be more upbeat or warmer than others. It’s important for you to know how to interact with all colleagues in a healthy way. Constructive criticism is structured around a path to improvement. For constructive criticism to truly be productive, it should be specific, actionable, and objective. However, not all feedback will sound pleasant or particularly friendly. When receiving critiques in the workplace, focus on the person’s intention rather than their delivery. Despite their tone, does the individual clearly state what needs improvement, and how to achieve it? If so, this feedback can be internalized in a beneficial way. Conversely, non-constructive feedback is vague, overly harsh, and may be targeted at an individual’s identity rather than their actions. Non-constructive critique does not give someone a clear roadmap to success. If you are being routinely subjected to interactions of this nature, you may not be in an environment that facilitates learning.

When you hear negative things about how you handled a patient interaction, charting duties, or a hands-on clinical procedure, it’s easy to take it to heart. You may feel that these words are a reflection of your self worth or who you are as a person. In reality, this cannot be further from the truth. Constructive criticism should be seen as an opportunity, rather than a judgement. Critique from a supervisor is a perfect chance to pause, reevaluate how you approach a challenge, and utilize the strengths you do have to change your future behavior. A conversation with a supervisor that includes constructive criticism can be uncomfortable. It’s easy to get overwhelmed with emotion and miss some of the things they say. These difficult feelings may even skew your reality—it might feel as though you are being scolded or “yelled at”, even if the interaction was neutral and diplomatic. In these situations, remember to listen first, and react later. Lead with curiosity, rather than self-deprecation. Instead of filling your head with negative self-talk, think about how you can use this feedback to your

Practice Self-Acceptance, Strive for Excellence

Implementing feedback relies on creating a careful balance between internalization and steadfast self-assuredness. Constructive criticism should be used as a tool to reach goals, not a way to validate your insecurities. Remember: every NP was new at their job at one time. Facilitate engaging dialogue with those who once walked in your shoes, and you’ll become a top-notch provider.

FUNCTIONAL MEDICINE

Tapping Into the Demand The future is already here. Since 2014, the Cleveland Clinic’s Center for Functional Medicine has proven that integrative, data-driven care can thrive within the U.S.’s major healthcare systems. Meanwhile, independent NPs across the country are embracing FM in innovative ways—through cash-pay models, hybrid wellness programs, and Functional medicine offers answers. By asking why a disease occurs rather than merely what it is, NPs have the ability to uncover reversible contributors like inflammation, nutrient deficiencies, hormone imbalances, sleep deprivation, and stress. Patients will often gain clarity, empowerment, and genuine partnership. Addressing Systemic Gaps America’s health system is in crisis; over 60% of adults live with a chronic condition, and 88% show signs indicating metabolic dysfunction. Meanwhile, burnout among healthcare professionals is at an all-time high. The traditional system prioritizes volume over value, forcing both patients and providers to pay the price. Functional medicine is the next chapter of patient- centered healthcare—and nurse practitioners are its authors. With their clinical skill, empathy, and autonomy, NPs are poised to lead a system that values disease prevention over prescriptions and partnership over power dynamics. lifestyle, diet, sleep, and stress factors Targeted lab testing like thyroid panels, cortisol mapping, and advanced metabolic profiles Validated screening tools such as PHQ-9, GAD- 7, and insomnia or menopause assessments Food-as-medicine nutritional discussions which help patients better understand the role of inflammation in full-body health Educational handouts on gut health, hormone balance, and supplement protocols Even small, simple shifts—such as incorporating motivational interviewing or emphasizing self-care —can transform the patient experience. Patients notice when they are being listened to rather than managed.

How to Get Started Ready to integrate functional medicine principles into your practice? Here’s how: Learn the science: Build a foundation in root- cause, systems-based care. Partner instead of direct: Empower patients through shared decision-making. Always stay curious: Follow FM leaders, join professional FM groups, and keep up with emerging research. Lead boldly: The next evolution in healthcare isn’t coming—it’s here. And it needs NPs at the helm. You asked, we’ve delivered! Fitzgerald’s new Functional Medicine course has it all—from integrative medicine basics to high-level clinical guidance for addressing complex conditions with holistic modalities. Registration opens soon. virtual consulting practices. Some NPs are developing specialty niches in hormone health, autoimmune disease, gut repair, or chronic fatigue. Others are creating online supplement dispensaries, which provide passive income for clinicians without inventory overhead. These platforms allow NPs to make tailored product recommendations and share links via social media—expanding access and enhancing patient compliance. As technology continues to advance, functional medicine continues to become even more data- driven. Wearables and apps are empowering patients to track glucose, sleep, stress, and gut function in real time. The demand is undeniable. Patients are tired of short visits and fragmented answers. They want comprehensive solutions that make sense. And when NPs step into the functional medicine space, they don’t just meet that need—they redefine what healthcare can be. By embracing functional medicine, you are not only expanding your scope but also restoring the heart of nursing—to educate, to empower, and to heal. This is more than a movement; it’s a return to purpose.

The Future of Functional Medicine: Why Nurse Practitioners Are Leading the Next Evolution in Healthcare

Fitzgerald’s resident functional medicine specialist breaks down how NPs can tap into this rapidly evolving wellness movement. By Jenni Gallagher, APRN Director, Elite NP Functional Medicine Certification Program

Healthcare is evolving, and nurse practitioners are perfectly positioned to lead this transformation to a “different kind of health care”. Patients are increasingly disillusioned with the conventional “one-size-fits-all” approach. They want to be heard, understood, and become partners with providers—not lectured. The growing demand for root-cause-oriented care has given rise to functional medicine (FM), a patient-centered model that looks beyond symptom management to uncover why illness occurs in the first place.

Functional Medicine Philosophy Functional medicine is a paradigm shift. Instead of focusing on rudimentary disease classification and pharmaceutical protocols, functional medicine examines the complex intersection of genetics, environment, and lifestyle that shape a person’s health. It’s proactive, preventive, and profoundly personal. Nurse practitioners, with their holistic and relationship-based approach to care, are the ideal professionals to drive this change. At its core, functional medicine emphasizes systems-based, cellular-level healing. Rather than treating prevelant, chronic diseases as isolated conditions, FM explores the shared metabolic and inflammatory pathways which connect them. It replaces the “pill for every ill” mentality with a comprehensive focus on nutrition, gut health, & hormones. Compared to mainstream medicine’s protocol-driven and reactive model, functional medicine is: Root-cause focused, not symptom-focused Patient-based rather than protocol-based Preventive rather than reactive Collaborative rather than provider-centered

Implementing Functional Medicine in NP Practice

Nurse practitioners are grounded in whole-person care—a philosophy that mirrors the very foundation of functional medicine. The theories of Jean Watson (Caring Science) and Dorothea Orem (Self-Care Deficit Theory) highlight what nurse practitioners have always known: healing is about empowerment, partnership, and connection. Functional medicine allows NPs to extend these values through a clinical model that integrates advanced diagnostics, lifestyle coaching, and patient education. Many NPs already practice autonomously and own their clinics, making it easy to weave FM services into existing structures. Moreover, FM reignites what many providers have lost—joy in practice. FM re-centers the provider- patient relationship around collaboration and discovery, not paperwork and productivity quotas. Integrating functional medicine doesn’t require a total overhaul of your practice. Many NPs begin by enhancing their current workflows with simple tools: Comprehensive intake forms that capture

Defense expense benefits: which cover a portion of lost wages during a hearing, trial, or if the NP is named as a defendant License protection and occurrence-based coverage: if the policy was active when the incident occurred There may be differences in annual costs of individual policies, so it is important to compare coverage between different companies and select whichever one that offers the most comprehensive coverage and not just based on cost. If the NP is a business owner, they may want to consider more than just the above types of coverage and include asset protection. This type of planning protects the clinician from any claims made on one’s personal assets, such as their home, investment accounts, and other properties. When an NP is negotiating their contract, they should inquire as to how the employer plans to provide insurance for the NP, as well as pay the NPs portion of the premium. It is essential that every NP advocates for the same limits of liability as their physician and PA colleagues. By understanding coverage options and staying informed, healthcare professionals can practice with greater confidence and security. Malpractice insurance is a cornerstone of responsible practice. By investing time to select appropriate coverage and policy, NPs not only protect their careers, but also uphold the integrity of the care they provide.

Choosing the Right Coverage There are many factors to consider when selecting liability coverage. It is expected that employers will offer the same coverage to NPs as their MD and PA colleagues. This includes the same limits of liability. Typical coverage for aggregate insurance is a maximum of $1 million/3 million in aggregate that can be paid during the policy period, which is typically one year. There are two types of liability limits that must be considered whenever a clinician is choosing a policy: per claim (or per occurrence) and aggregate limits. Per claim is the amount that an insurer will pay for a single claim or incident. Aggregate limits are the maximum amount an insurer will pay for any claims filed during the policy period. Some key features of liability coverage include occurrence-based policies, claims-made policies, shared limits, and coverage gaps, as well as license protection, independent legal counsel, and portable coverage. While many of these terms may seem daunting, it is essential that every NP knows the intricacies of malpractice coverage to insure that they are carrying the appropriate amount of coverage. It is important for NPs to be prepared if an adverse action report or malpractice case is brought against them. Occurrence Insurance Occurrence insurance can be a smart choice—as this will provide seamless coverage for any incident that occurred while the NP in question was employed and insured, regardless of when the claim is filed. This provides protection even after a policy expires, as long as the policy is paid and current during the time of the incident. Occurrence-based policies tend to be more expensive than claims-made policies, though occurrence-based policies provide long-term coverage and security. The clinician is covered even after leaving that place of employment.

Courtroom Insider Professional Liability or Malpractice Insurance By Vanessa Pomarico-Denino, EdD, FNP-BC, FAANP Professional liability or malpractice coverage is essential when claims are filed against an NP for negligence or error. While it is rare, the rate of nurse practitioners named in a lawsuit between 2012-2021 was 3.9%. There is a myriad of reasons why a clinician gets sued—malpractice (improper practice or failure to provide professional services that results in injury, loss, or damage), or negligence (failure to act in accordance with standards of care, failure to follow up, refer, or disclose necessary information). One can be accused of negligence but if there is no injury, then there is no case that can prove malpractice. A clinician can be accused of malpractice if a patient incurs an injury caused by lack of knowledge, experience, or skill set. This includes exercising reasonable judgment or care, failure to diagnose, improper performance, and failure or delay in treatment. Research demonstrates that good patient/provider relationships yield better outcomes due to higher patient satisfaction with NP care. Despite our best efforts, knowledge, and experience, mistakes happen and having the appropriate coverage will help the NP avoid personal expense if they are named in a lawsuit. Data related to lawsuits against NPs demonstrates lower numbers as compared to the number of physician lawsuits, but the NP can still be named as a co-defendant in any malpractice case. Practicing in a full practice authority (FPA) state does not increase the risk of being sued.

Claims-Made Insurance Choosing a claims-made policy will only cover the NP while the policy is active regardless of when the incident occurred. If the NP leaves a place of employment, retires, or leaves the profession entirely, they will still need to purchase extended reporting endorsement or “tail coverage”—a policy that remains active in the event a lawsuit is filed even years after leaving practice. Employer-provided policies will only cover the clinician if they are acting on the employer’s behalf, and do not cover any personal injury or Good Samaritan Acts. These types of policies may not cover the NP for certain expenses incurred during a trial, such as lost wages and other personal expenses. Should an NP carry their own policy in addition to their employer coverage? If the NP works in an additional facility separate from their main job, or participates in any type of volunteering, consulting, or teaching obligations, it is typically recommended that they carry their own supplemental policy. Supplemental coverage will cover some of the expenses associated with a lawsuit. Self-insurance supplemental policies may not provide the same comprehensive coverage as employer malpractice insurance that is generally offered through local hospital risk management policies. There may be some overlap between the policies, but each policy may have coverage that the other policy does not provide. Individual coverage policies will typically include other aspects that employer-provided coverage does not. Examples include: Maximum claim coverage: the limits of liability that one is required to pay as a result of a professional claim against them in a medical lawsuit

Stefanie Remson MSN, APRN, FNP-BC FACULTY SPOTLIGHT

What is the most overlooked sign of RA you have seen in clinical practice?

Fitzgerald Health Education Associates

Fatigue. Fatigue is often overlooked by clinicians because it’s subjective, multifactorial, and doesn’t fit neatly into the traditional biomedical model of RA. It's not directly asked about or measured at regular office visits, and, outside of lifestyle modifications and sleep aids, there are not many direct medical treatment options for it. Unfortunately, for many patients, it’s often the symptom that most erodes their daily functioning and sense of well-being.

Ms. Stefanie Remson is a family-certified nurse practitioner who graduated from the University of Nevada, Las Vegas’ Family Nurse Practitioner Program. She has worked in critical care/pulmonary, primary care, urgent care, and infectious disease. She also plays a very active role in the rheumatology community, where she is CEO of rheumatoidarthritiscoach.com, an online educational organization providing resources to people living with rheumatoid arthritis.

Stefanie Remson

Healing with Empathy

What can NP students do during their education to better understand RA?

Fitzgerald Health Education Associates

Fitzgerald faculty member Stefanie Remson, MSN, APRN, FNP-BC, sits down with Fitzgerald for a candid discussion on the ways her rheumatoid arthritis (RA) diagnosis has helped transform her clinical philosophies.

Listen to your patients. Engage in online platforms and support groups, too. This patient population truly understands their disease, treatment plans, and options. The American College of Rheumatology has this great resource on rheumatic diseases, too.

Stefanie Remson

What is one thing you wish fellow medical professionals understood about RA?

How does your personal experience living with RA help you to provide quality care to RA patients?

Fitzgerald Health Education Associates

One thing I wish fellow medical professionals truly understood about RA is how invisible its impact often is. On the outside, patients may look “fine,” but they are navigating constant pain, fatigue, and emotional strain. Recognizing this hidden burden—and validating their experiences—can make a huge difference in building trust, providing effective care, and supporting their quality of life.

Living with rheumatoid arthritis myself gives me a firsthand understanding of the physical and emotional challenges patients face daily, from unpredictable pain and fatigue to the frustration of navigating treatments. It allows me to empathize deeply and listen more meaningfully to my patients’ concerns. I can anticipate the impact of flares on their daily lives and offer practical, realistic strategies for effective symptom management. This personal experience strengthens my ability to provide compassionate, patient-centered care and to advocate effectively for their needs. I strongly believe, in a crazy way, that getting diagnosed with RA made me a better medical provider all around. In 2022, CreakyJoints thought so, too!

Stefanie Remson

Want to learn more from Stefanie?

What is the most promising research/data you have seen (recently) for potential RA cures/treatment modalities?

Fitzgerald Health Education Associates

Check out the Grand Rounds for the FNP and AGPCNP: Infectious Disease Roundup course, available now.

Neuroimmune modulation! Among the most promising developments is neuroimmune modulation, particularly through vagal nerve stimulation. A 2024 study presented at the ACR Convergence conference demonstrated that this approach effectively reduced inflammation and improved symptoms in RA patients who had not responded adequately to conventional therapies.

Stefanie Remson

Thank you for reading! Here’s a little gift for you.

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