A Tale of Two Nurse Practitioners: Q & A

Cammie Acevedo APRN & Stacy Pascarella, APRN

Introduction

Cammie: Hello, everyone. I am Cammie Acevedo, Nurse Practitioner and owner of Balance Wellness and Primary Care.

Stacy: Hi. I'm Stacy Pascarella, nurse practitioner, and I work with Cammie. Some of our patients have given us positive feedback on how they enjoy our social media videos, and mentioned how they would like to get to know us a little bit better. We thought what better way to help people get to know us than to interview each other? We hope you enjoy this quick Q & A session to learn more about us.

What inspired you to become a nurse practitioner?

Stacy: I loved being a bedside nurse, working in many different fields like neuro, cardiac, and the ER, which I loved the most. For years, I was having terrible headaches, accompanied by balance issues. I went to my primary doctor more times than I can count and was told it was sinus issues, allergies, migraines, and even menstrual period issues. As you know, it turned out I had a brain aneurysm. Not feeling heard or valued prompted me to continue my education so I could expand my abilities to help people. As a nurse, I always advocated for my patients, but as a nurse practitioner, I can advocate and actually order the tests I feel are necessary to find the answer.  

Cammie: I’ve always loved being a part of healthcare and being able to help others. Throughout the years and having worked alongside many different types of providers, I’ve seen  a lot of good, but also a lot of bad. I have been able to take those things I’ve learned along the way and incorporate them in a way that enhances the patient experience. Ultimately, I wanted to continue to grow as a clinician so that I can make a bigger impact on my patient’s lives and their overall health outcomes.

What sets your primary care clinic apart in terms of services and patient care?

Cammie: Access to care and affordability. I hear time and time again that people are waiting weeks, even months, to get an appointment with their providers. Being able to offer same day or next day appointments in most cases as well as the flexibility of offering in-office and telehealth visits is very important to us. We also strive to be affordable. When coming up with fees for our services, Stacy and I have brainstormed on how we could structure our fees so that it doesn’t have a significant impact on the patient financially. We don’t want anyone to struggle when choosing between healthcare and their regular life expenses. Obviously, this is a career for us. We want to be able to provide for our families as well, but we can still do that and give our time to our patients without them having to sacrifice financially. 

Stacy: It’s true. We have received a lot of feedback from patients who are often in disbelief that we offer a telehealth sick visit for only $39. Many people tell me their insurance deductibles and co-payments are higher than our visit fee. You have done a good job to make sure our services are accessible to everyone. 

What challenges have you faced as a nurse practitioner and clinic owner and how did you overcome them?

Cammie: That is an easy one to answer. Being a provider comes naturally to me. I care about people and want to help them. The biggest challenge is the business aspect of it. We are not taught that in nursing school. When creating my practice and throughout the first year, I handled pretty much everything on my own. I actually even designed the website myself. There is not one single class in nursing school that teaches you this. The only way to overcome this was to be willing to be a student to that, and navigating my way through it all while making sure to follow the right protocols and policies. I am thankful when you (Stacy) joined me earlier this year. We both jumped in and have tackled it together. We have the same drives and goals and are both learning together so I’d say we’re a pretty good team. 

Stacy: You are absolutely right. I don’t think people understand that there is no manual that says, “Hey. This is how you start a clinic.” There is no blueprint available to follow or telling you exactly what to do. Everything we have done so far was done after conducting research on the legal and best way to proceed. It can be very complicated. It is a chore, but we are glad we have been successful with figuring it all out. 

Cammie: Not to mention the hours and hours spent researching and combing through government websites and statutes to ensure we are doing everything correctly.

Stacy: All of the phone calls to AHCA and the Department of Health. I feel like I am on a first name basis with them now.

Can you describe your philosophy on preventative care and how it plays a role in this clinic?

Cammie: That’s simple. Health prevention starts with education. The most important thing we can do for our patients is to educate them. Not only educating them on how to recognize signs and symptoms of disorders, but also on screening tools and diagnostic testing available for early detection. This requires that we stay up to date on current guidelines and screening resources available so we can better educate our patients. We empower them to be self-aware and inform them of what screenings are needed based on certain criteria. 

Stacy: You do a great job educating patients. Even educating me. You have a wealth of knowledge in Women’s Health and you have definitely helped me learn more so I can better educate my female patients. 

How would you say you approach building a stronger patient-provider relationship?

Stacy: I listen to my patients. My patients give me feedback and tell me they had never felt listened to or felt their concerns were taken seriously. I try to hear them and get to the root of what the issue is. I don’t want to just put a band-aid on it. I think a lot of times in healthcare, we have focused on band-aids instead of root cause. Take hypertension. A person is given medication for their high blood pressure, but are they being educated on potential causes like diet, weight, and things they can do to implement on their own to improve their own health. Not saying medication isn’t beneficial, of course it is, but there are other things we can do to help improve our health. 

Cammie: I totally agree. I feel we hear that over and over again from our patients. They say they felt heard after they meet with you or me. We may not  always be able to come up with an exact solution, sometimes we have to refer out, but we do listen and work to provide thorough evaluation and treatment recommendations.

How do you feel you stay current in advancements in healthcare in order to stay current with best practices?

Stacy: I read all of the time. It is not an exaggeration. I probably read 2-4 articles every day. Mostly everything I read is peer reviewed or evidenced based, but I also read op-eds and opinion pieces because they spark thought and conversation. I also teach. I teach BSN students and have precepted dozens of nurse practitioner students. I always strive to stay on top of latest research so when I am teaching students, it is current and best practice. 

Cammie: Everything is constantly changing. If you ever meet a provider who says they know everything about everything, don’t believe that. It is not true. We definitely work to stay current and try to remain up to date on all of the new and best practices.

How do you involve patients in their plan of care and decision-making process?

Stacy: I encourage patients to do their own research. I recommend to not always take things at face value but look for something to back it up. I show them how to research properly and differentiate between evidenced-based, legitimate sources and non-legitimate sources. I encourage patients to email me articles or bring them in during their visit so we can review together. This is the only way to teach someone how to properly research and know that what they’re reading is true. 

Cammie: There is so much information at everyone’s fingertips, but it is not always good or accurate. So it’s  great that you show them the difference. 

Stacy: It is so important. If you think a patient hasn’t already googled their symptoms before they called or made an appointment, you are wrong. I don’t discourage patients from looking up information and growing their knowledge base. Education is key. This is why I stress the importance of legitimate sources.

Just for fun, if you could have any superpower, which one would you choose and why?

Cammie: One of my biggest challenges in life is juggling all of the everyday duties between being a mom to five children, a wife, a business owner, it is hard at times. I would love to teleport so I can be at all of the places I need to be without commuting. 

Stacy: Maybe your superpower should be the ability to clone yourself. We know that is unethical, but in this case, it may be needed.

If you could have picked any other profession outside of being a healthcare provider, what would you have chosen?

Stacy: Well, if I was more talented, I would definitely be on Broadway, sing and dance. I love Showtunes. My husband doesn’t. He hates when I turn them on in the car. He fell asleep during Phantom of the Opera at The Kennedy Center, in a tuxedo, on the second row of the orchestra. If you’re looking for a more practical answer, then maybe a politician or lawyer, more like a political activist who fights for the people and human rights. 

Cammie: I think you missed your calling. You should’ve been a stand-up comedian. If you don’t know Stacy, and haven’t met her, she is very funny. 

Stacy: The ones who think I’m funny are in the minority for sure. I think there are about 6 people who think I’m funny. 

Conclusion

Stacy: On a serious note, I have thoroughly enjoyed the past year with you. I can’t wait to build this practice up to what we know it can and will be.

Cammie: I hope you've enjoyed this. It’s a little insight into us as everyday people and why we do what we do. We look forward to seeing you and hope you check us out in the new clinic!