One APP Fellowship Graduate Perspective

When graduating from an APRN program, you’re faced with two choices: enter directly into the workforce or complete postgraduate education in the form of a fellowship. Like an increasing number of APRNs, Jaclyn Miezkowski decided to complete a fellowship upon her graduation from the University of North Carolina - Chapel Hill, where she earned both her BSN (2009) and FNP (2013) degrees. This is her story. 

APGAP: Please tell us a little about your background and what you do now.

Jaclyn Mieczowski: I have more or less grown up in the healthcare world. I am a third generation nurse, perhaps it may even be in my blood. I started volunteering in a nursing facility when I was in middle school and worked in medical records as a clerical assistant through high school and college. I spent my summers home from college sorting and organizing NICU charts and getting birth certificates signed and completed. I graduated from UNC Chapel Hill in 2009 with my BSN. During my college years I served as the Vice President on the Student Nursing Associate Board for UNC Chapel Hill and also as the Vice President of the North Carolina Student Nursing Association. Upon graduation I began working in a fast paced ER setting. Unfortunately, I did not have much support as a new graduate nurse and felt my initial introduction to "real life" nursing to be stressful and overwhelming.

During my first few years in the ER, a fellowship/mentoring program was created to train new graduates, and I saw a significant benefit for our new hires and new graduates. They had a support system and base that would have been helpful during my transition from nursing student to bedside nurse.

I worked in the ER for four years - acting as bedside nurse, triage nurse, fast track coverage. I learned and grew from my experience there and enjoyed some of the autonomy in practice that was associated with that role. I made the decision to proceed with furthering my education and returned to UNC - Chapel Hill. I graduated in 2013 with my degree, FNP.

Given my previous experience as a new graduate and my struggle to grow and develop without support, I sought out fellowship programs. I was fortunate enough to be selected as the first candidate for the Urology APP fellowship program at Atrium health.  

At the completion of my fellowship I felt like a competent provider capable of providing excellent urologic care to my patients. I felt confident in my role and was able to hit the ground running without further orientation. The fellowship also provided an opportunity to interact with my faculty and have more or less a year long interview with them. At the end of my fellowship I knew I wanted to continue as a provider within our practice and I was hired into our group. 

I currently work as an FNP at Atrium Health in Urology with the majority of my practice specifically in Urologic Oncology. I continued to keep my role diverse and work in a variety of settings- hospital, OR, clinic, and now a bit of administration. I have also become more involved with our hospital system and the growth of our resident program. I served as the chair and chair-elect of our hospital APP Central Division Council for Atrium Health. Our board worked on a mentorship program, provided educational updates to our providers and held an annual symposium for our APPs. In addition, I have also played an active role on our urology resident development and evaluation committee.  In December 2018 I was selected to be the Urology APP Chief and also sit on the APP Chief Board for Atrium Health. As Chief of our department I work with 14 other APP providers to provide excellent patient care and represent our APP team within Atrium.

APGAP: Where did you complete your fellowship, why was it valuable?

JM: I completed my fellowship in Charlotte, North Carolina at Atrium Health. My fellowship experience was incredibly valuable to me. My program was a yearlong experience with a three-month ICU rotation component followed by a nine-month rotation through a variety of Urology settings. My APP mentor was heavily involved in the OR and was the primary OR assist for our department. Prior to this experience, I was in the OR twice observing, but had little exposure. My mentor was passionate about the OR and it was contagious. He trained me to also be a surgical assist - an experience I did not know I would be able to have or know prior that I would also have a passion for. In addition, my skill set became incredibly diverse. I had the time and opportunity to train on procedures I would not have been able to otherwise. 

By the end of my program I was able to independently perform cystoscopy and stent removal, cystoscopy with complex catheter placement, prostate biopsy, prostate ultrasound, fiducial marker placement and Vantas Implant placement. I was also exposed to a variety of urology working environments and was proficient at working in multiple settings including managing patients in the hospital, outpatient clinic and OR first assisting. 

APGAP: Why do you think nurse practitioners should complete a fellowship?

JM: I think there are many reasons to consider completing a fellowship program. 

1. They provide structure to what can be a stressful transition to practice.
2. They provide opportunity for professional development and opportunity to meet and interact with mentors.
3. They offer time to build a diverse skill set and trial a variety of settings (OR, clinic, rehab, hospital, pediatrics, GYN etc.).
4. It is a year long interview for both the APP and the department to see if that setting is the best fit.
5. The fellowship also provided "built in friends." I moved to Charlotte without knowing anyone here. I have made lifelong friendships with several people I met in fellowship and found their support and encouragement invaluable over the years. As they have moved to different cities and states they also act as a network as well.
6. Our fellowship program helped with state board compliance including navigating documents like delineation of privileges and collaborative practice agreements and QIs. This documentation can seem a bit daunting at first and helps to have guidance to ensure you are compliant in state and within the hospital system

APGAP: What networking opportunities did you gain from your fellowship?

JM: So many careers develop thanks to mentorship. The fellowship allowed me to interact with providers in leadership and other departments. I was given the opportunity to develop collegiality with other providers and was identified as someone interested in advancing and improving our department and our hospital. I have worked within our department as a committee member on our Resident Evaluation and Development Committee, ERAS/RERAS initiative, Urology OR Assist Coordinator and most recently I was selected to be the APP Urology Chief.

The fellowship also connected me with leadership at Atrium health and I was selected to be a committee member on the APP Central Division Council at Atrium Health and also acted as Chair. I have also been a part of Coordinating Council, Chief APP council and was selected to author an ICU procedure book chapter - I will be writing on urologic procedures. The fellowship gave me exposure to leaders within our system. I would not have bumped elbows with these individuals without my fellowship program providing these connections and I look forward to more opportunities to come.

APGAP: If you had one piece of advice for nurse practitioner students, what would it be? 

JM: Consider a fellowship, but if that is not possible seek a position with a strong support network and an orientation that sets you up for success.

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