KimberlySlate2
It’s challenging and it’s hard work” says Kimberly Slate, “but if you’re passionate about helping people, then no matter what you encounter, at the end of the day it’s rewarding.”
Slate is a nurse practitioner with Finn Medical Associates, an internal medicine practice that’s part of the Baptist Medical Group. Stitched onto her white lab jacket is a string of blue initials — DNP, APN, and FNP-BC. To some patients, this may seem confusing, but each of those designations reveals Slate’s role in the increasingly complex world of American healthcare.
Fifty years ago, the nurses most patients encountered were either RNs (registered nurses) or LPNs (licensed practical nurses). These women (and in those days, nurses were indeed overwhelmingly female) had completed two to four years of study at an accredited nursing school. In 1965, however, pediatrician Henry Silver and his assistant, Loretta Ford, with the University of Colorado School of Medicine started the nation’s first nurse practitioner program, which was essentially graduate-level training. As a result, nurse practitioners (designated by “NP” as part of their title) have completed what is essentially a master’s degree in nursing.
Some, such as Kimberly Slate, have earned the equivalent of a Ph.D. The “DNP” on her jacket distinguishes her as a Doctor of Nursing Practice. “APN” means Advance Practice Nurse, and “FNP-BC” stands for Family Nurse Practitioner – Board Certified.
So how did all that come about for her? Born and raised in Memphis, Slate earned her BSN degree, or Bachelor of Science in Nursing, from Harding College in Searcy, Arkansas. “I had two sisters who were nurses,” she says, “and one of them was 13 years older than me, to the point where she was almost a mother figure, so she was a big influence.”
She returned to Memphis, where she worked as a registered nurse with the Neuro-Intensive Care Unit at Baptist Hospital. After a year, she transferred to the emergency room at what was then called Baptist East (now the main campus of the hospital system). After six years, she returned to school, this time attending the University of Tennessee Health Science Center, where she earned her master’s degree in 1995.
“You’re now called a nurse practitioner, but you can follow different tracks,” she says. Among them: acute-care NP, psych nurse NP, neonatal NP, and women’s health NP. “A majority of master’s-prepared nurse practitioners go into family practice, so that’s what I did.”
She joined Finn Medical Associates in 2000, where she works closely with Dr. Cary Finn, nurse practitioner Andrea Jones, and the other nursing staff. But a few years ago, Slate decided to take her training a step further. In 2012, she returned to UTHSC and earned her Doctor of Nursing Practice diploma, or DNP.
This designation means she is now “Dr. Kimberly Slate,” a title she knows can be confusing. “I don’t want the patient to think I’ve misrepresented myself,” she says. “When I work with Dr. Finn, I want the patient to know, this is the doctor, and I’m the nurse practitioner.”
According to the American Association of Nurse Practitioners, more than 140,000 nurse practitioners are treating patients in the U.S. It’s hard to pinpoint the exact numbers in Memphis, but the Greater Memphis Area Advanced Practice Nurses group lists more than 1,800 active members.
Their day-to-day world — whether they are designated FNP, DNP, or whatever their level of education and expertise — varies from state to state. Nurse practitioners don’t have “full authority” in the state of Tennessee. “We are considered mid-level providers. We have more training than regular nurses, but not as much training as physicians,” Slate explains. She is qualified to assess and diagnose patients, and she can do minor procedures, such as placing sutures, draining an abscess, or removing a mole or skin lesion; more complicated procedures are off-limits. She is allowed to write prescriptions. “But if I write admission orders to the hospital, Dr. Finn is considered the supervising physician, and he has to sign off on those orders within 24 hours.” Basically, current law requires that a medical doctor supervise at least 20 percent of the work done by nurse practitioners in Tennessee.
She emphasizes that the real difference between an MD and FNP is more complex than that, and can’t be measured so precisely. “Both doctors and nurses assess, diagnose, and treat, but I think our approach is different,” she says. “Nurse practitioners take more of a holistic approach, where we look at individual health risks and needs and try to develop individualized care. We look at the whole patient, not just their disease state.”
As a result, she says, “we can develop a unique relationship with our patients because we can get more into education and counseling. And it’s very rewarding to see your patients come along and improve, based on how you’ve counseled and educated them.”
“Nursing is one of those rare careers where you have the blessing to be a part of people’s lives, even if it’s during difficult times. I've had some amazing experiences.” — Wendy Likes, DNSc
Slate enjoys the range of patients she sees with a family-care practice. “You name it, and we see everything. You never know what’s going to come in the door.” In recent years, however, the most difficult cases have involved patients addicted to pain-killers.
“The opioid crisis is challenging because there are patients who are truly in pain, and they’ve been in pain so long that they now have an addiction,” she says. “But you have the state on your back, telling you to lighten up on the prescriptions. We’re under a microscope, examining how many controlled substances we’re writing each month. You don’t want to get red-flagged, but you want to take care of your patients, too.”
In recent years, Slate has seen more men becoming nurse practitioners. “I don’t know if people are finally getting over the stereotype that nurses have to be women,” she says, “but I have an older son, and three of his friends are now nurses.”
No doubt some of them are attracted to the prospect of job security (some experts predict the demand for nurses to increase by 30 percent over the next few years), and the good salaries. According to the U.S. Bureau of Labor Statistics, the average salary of a nurse practitioner in 2018 was $118,000, with nurse anesthetists bringing home upwards of $160,000 yearly.
Slate has also seen other significant advances in her field. Last year, she was the first nurse practitioner named to the Baptist Hospital Board of Directors. “I feel very honored,” she says, “and I think Baptist has done a good job recognizing the value of nurse practitioners.”
Polly & Penney
Polly Scholze, FNP, and Penney Williams, FNP
Downtown, two nurse practitioners have seen a need, and hope to meet it. Last year, Penney Williams and Polly Scholze teamed up to open 901 Health & Wellness, a medical clinic staffed entirely by nurse practitioners and medical assistants. Located on the ground floor of the old Merchandise Brokers Building at 364 South Front, the center is a walk-in clinic, offering a wide range of services.
Both women probably never thought they’d embark on such a venture. Raised in Kennett, Missouri, Williams worked as a licensed practical nurse in that city, before her husband’s job brought her to Memphis. After a career that saw stints as a nurse with a thoracic surgeon, and director of patient access at St. Francis Hospital, she earned her BSN degree from the University of Memphis. “I then just went straight on and got my Master of Science in Nursing,” she says.
At the U of M, she met Scholze, who had earned her nursing degree from the University of Wisconsin at Eau Claire. She also came to Memphis when her husband was transferred here. She first worked on the medical/surgical floor of Baptist Central and then earned her MSN at the University of Memphis. Rhodes College students may recognize her name; for six years she worked in the campus infirmary there, while also working for Methodist Minor Medical Centers around town.
“Then we decided to venture out on our own,” says Williams. “Polly and I had noticed a lot of patients who didn’t have access to primary care. They would come to us [at the emergency clinics] but we were very compassionate about being able to educate and do more for those patients.”
Williams and Scholze thought Downtown needed a medical clinic, noting the boom in housing in the South Main area. “We always wanted the concept of ‘one-stop shopping’ where we could write prescriptions for acute illnesses, run labs and x-rays, and provide other services,” she explains. “My first internal medicine experience was in a rural setting, so you are forced to learn a little about everything. Pulmonology, cardiac, renal — we’ve seen it all.”
Without an MD on board, the two have a collaboration with a local family-practice physician, Dr. Kavita Kansagra, who oversees certain aspects of their work. “She is available if we need to consult, and she is required to sign off on 20 percent of our charts,” says Williams.
Finishing touches are still being put on the new clinic, and both women are excited about the interior plans. “We’re trying to do a Memphis-themed clinic,” says Williams. “For our exam rooms, we’d like a B.B. King room, and others featuring Beale Street, Memphis in May, the Tigers, the Grizzlies, and even the 901 soccer club.” Patients can’t miss the large photo of Elvis, having his blood drawn, in the reception area. The striking image was taken by her father-in-law, longtime Memphis photographer Bob Williams.
Scholze agrees with Kimberly Slate with Finn Medical Associates that nurse practitioners spend a lot of time educating their patients. “We’re the ones who help organize somebody’s entire healthcare,” she says, “and we’re here to help pull it all together.”
Wendy Likes
Wendy Likes, DNSc
Wendy Likes is quite emphatic about the role of nurse practitioners: “We are integral parts of the healthcare team. We talk and relate to patients in different ways from physicians. We communicate more at the level of that person.”
Her enthusiasm for the profession is understandable, considering she is the dean of the University of Tennessee Health Science Center College of Nursing and holds a Doctorate of Nursing Science degree (the precursor to the Doctor of Nursing Practice diploma).
“I always wanted to be a nurse,” Likes says. “I really wanted to be around people, helping them.” She grew up on a 100-acre farm outside Shelby Forest. With her twin sister, she would play nurse while her sister played teacher. “I was such a nerd when I was little, and loved how the human body functions,” she recalls. “I would even take my parents’ encyclopedia and highlight things like the heart or lungs.”
She earned an associate’s degree in nursing from Arkansas State and came to Memphis, where she worked for St. Jude Children’s Research Hospital. After a while, she earned a BSN from the University of Memphis, followed by an MSN at UT, then her DNSc at UT. “What’s funny is that I became a nurse, and my sister became a teacher,” she says. “So we ended up being the things we played as children.”
It’s all work and no play now, since Likes also founded and directs the Center for HPV and Dysplasia at UT, designed to assess and treat cancer and pre-cancerous conditions. Despite the workload, “it’s an awesome career, and it truly is a passion. It’s given back to me probably more than I’ve given it, as far as the satisfaction of helping people.”
As nurses, she says, “we’re drawn to be there to help people, and nursing is one of those rare careers where you have the blessing to be a part of people’s lives, even if it’s during difficult times. I’ve had some amazing experiences, and I don’t want to tear up about some of them. But we have the intimacy of being there, holding their hand. It’s a different level of care that we can provide, compared to our physician colleagues.”
Likes is encouraged by the growing trend for nurses to obtain four-year degrees, as opposed to the two-year associate degree. “We have wonderful data that shows that baccalaureate nurses improve outcomes and increase safety,” she says. “We just think differently. We have more clinical reasoning and more critical thinking skills that we teach nurses at the baccalaureate level.”
Currently there’s a nursing shortage that shows no signs of abating. “We can’t produce enough nurses,” she says. “We don’t have the faculty or the clinical placements. So it’s a great profession. There’s job security, and it’s good pay.”
In the Memphis area, students have their choice of earning their four-year BSN degree at the University of Memphis Loewenberg College of Nursing, the UTHSC College of Nursing, and the Baptist College of Nursing. Other schools, such as CBU and Southwest Tennessee Community College, offer two-year nursing programs.
Likes is also encouraged by the number of men entering the nursing profession. “We need our workforce to look like the communities we serve,” she says. “And so we seek diversity in ethnicity, race, gender, and sexual orientation. All these things are more important in nursing than in other fields, because of the contact we have with our patients, and the need to connect with them in a really unique way.”
She knows change is needed in her profession, and she continues to push for “full authority” — the ability for nurse practitioners to treat patients without the oversight of physicians.
She sums up her career in this way: “I hope most of us want to leave this place better than we found it. And for nursing, this is our way of doing that.”
