Health care has incurred many changes over the years. One of the most controversial ones that I have observed is using more APPs in the outpatient clinic setting. This includes yours truly: I’m an APN working in a community gastroenterology clinic. What do APNs working in these spaces do? What is the value we bring into our practice and to our patients?
Let me back up a bit and give you some information about my career trajectory. I’ve been an APN for over 11 years (I have FNP-BC designation by my accrediting body, ANCC), and was an RN for 16 years before that. The first eight years of my APN work were in the primary care setting with an internal medicine doctor. I learned so much from her and I carried my own patient panel. I left her practice when it became a corporate clinic and moved on to her husband’s gastroenterology practice (alongside another well-seasoned APN). I’ve been here in the gastro clinic for a little over three years now and can’t imagine a job that is more challenging or exciting.
One of the first things I did when I got my new role was to attend the American College of Gastroenterology postgraduate course and soak up as much information as I could. Gastroenterology is much more than colonoscopies and GERD! It’s also fatty liver disease (MASLD), cirrhosis, Crohn’s, ulcerative colitis, and many many other conditions.
Initially, my central responsibility was to see patients coming in for routine screenings, and to learn about the various disease states seen in GI. I have quickly adapted and now see patients with complex health concerns as well. I have and continue to treat all GI conditions you would expect to see in a community-based practice; I just don’t do the dirty work, so to speak, of procedures requiring a physician’s skill.
On a typical day, it is not unusual for me to see 17-plus patients a day in clinic, with a majority dealing with IBS. Those IBS visits are long and in-depth, and because I’m trained to educate patients as a nurse, the relationships developed with these patients can be pretty special. Unraveling their symptoms and helping put the puzzle pieces together so they can feel better is incredibly rewarding.
My hobbies are weight training and nutrition, and having been an IBS-C patient myself, I have a unique perspective when it comes to discussing resources that actually are helpful and explaining what can be triggering. It took two years and endless reading and searching for accurate and helpful information, plus FODMAP diets and supplements, and treatments three times for methanogenic overgrowth to get my own gut to behave. Being able to connect with patients on that level allows me to also address the psycho-social aspect of IBS.
I’ve also been able to study and learn how to treat more complex disease states that require a lot of office follow-up visits that would normally take the physician away from performing valuable procedures. When it comes to hepatitis C, IBD, and other autoimmune diseases that affect the GI tract, I can save patients’ and doctors’ valuable time by seeing patients sooner than a doctor who has to work around a busy schedule fitting in clinic and procedures would. As an APN, I have the flexibility to sit with patients and really hear their concerns, take a detailed history, and discern what might be the differential diagnosis instead of a 15-minute appointment where patients feel rushed in and out.
Finally, as a former cardiac critical care nurse, I have the clinical background to recognize sick when I see it, and to advocate for patients to be imaged or undergo endoscopy urgently. Nurses are also good at dealing with and educating families. We are used to having hard conversations, like those about cancer or about when procedures are really not in the best interest of a patient.
My doctors trust me and I trust them. I go to them with a lot of questions and they are great at explaining conditions that I know, but don’t have the benefit of experience in the field to understand the nuances of. They know that I will come to them when I am in the weeds, when I am unsure, or if I question what appears to be one thing, but ends up being another. We are truly a team of health care professionals that depend on one another for answers. My APN partner is the go-to guy for all things liver. He’s an amazing resource and is often asked questions about treatments for hepatitis by the MDs in the area. The amount of respect we have for one another is felt by the patients and our staff. I have been incredibly lucky to always have had the pleasure of working with amazing doctors who mentor me.
As to the question up top about the value of APNs (and by extension, APPs) in the outpatient setting? The answer is simple: There are specialty roles we can fill, despite no specific certification for APNs in most specialty areas of medicine. We bring our nurse training and our subject matter expertise to help our doctors get the time they need — and our patients the care.
How has your unique background helped you in your current role? Share in the comments!
Allison Falin is a nurse practitioner in Maryville, TN. She enjoys weight lifting, hiking in her nearby Smokies, and just being outside. She has practiced as a NP for 11 years and RN for a cumulative 27. She and her husband have three adult children and four dogs. She is on threads as @alliefnp. Allison is a 2024–2025 Doximity Op-Med Fellow.
