Faculty Spotlight with Program Director Melody Wilkinson
March 8, 2018
Melody Wilkinson, DNP, APRN, FNP-BC, is the program director of the Family Nurse Practitioner Program at Georgetown University School of Nursing & Health Studies. She believes that the classroom is a community of learning, and that her role in this community is to facilitate. This means that she shares her clinical experiences with her students and takes advantage of the program’s online platform to spark discussion on topics like the opioid epidemic and HIV specialty care.
Wilkinson began her career at Georgetown in 2011. Five years later, she was named recipient of the Novice Faculty Excellence in Clinical Teaching Award from the American Association of Colleges of Nursing, in recognition of her “commitment to a dynamic classroom environment.”
In the following Q&A, Wilkinson shares with us the complex and gratifying challenges of working in HIV specialty and primary care, the importance of establishing relationships with patients, competency-based Nurse Practitioner (NP) education, and what makes Nursing@Georgetown unique.
Could you start just by giving us a little bit of background, telling us about yourself and your educational and professional experience?
I have been a FNP since 1999 and most of my clinical career has focused on providing care to people living with HIV. I graduated with my BSN from West Virginia University in 1998 and, after graduation, I immediately enrolled in an FNP Program. I completed my FNP in 1999 from Vanderbilt University. I later completed my DNP degree at Duke University.
What drew you to primary care as a field of study?
When I began my undergraduate nursing program, I thought that I wanted to work as a nurse anesthetist. I worked as an intern in the open-heart recovery unit during my BSN program, and I realized that was not the direction I wanted my career to take. During the first semester of my senior year, I completed my community health rotation. I spent time with a school nurse and a community health nurse. During these experiences, I realized that I was passionate about community-based health.
I enjoyed engaging with patients in their native environments, which is so different than hospital-based nursing. When taking care of patients in a hospital-based setting, you are often not able to see the long-term outcomes of your interventions, whereas with primary care, you are able to follow the patient over time. I was also drawn to the idea of establishing relationships with patients and being a part of their health care team over time.
Where does your passion for HIV prevention and chronic disease management come from?
After graduating from my FNP program, I spent a few years working in adolescent medicine. I enjoyed the psychosocial complexity of adolescent patients. However, adolescents tend to be very healthy, and I began to miss seeing more medically complex patients. So, I applied for a job at an indigent HIV clinic.
I knew that the demographics of the patients served in this clinic were psychosocially and medically complex. Honestly, it was a huge learning curve. I had only been an FNP for three years when I took my first position caring for HIV positive patients. However, it defined my career. I was a part of an interdisciplinary care team and we provided specialty care to a cohort of uninsured, high-risk HIV positive patients. The work was very demanding and exceedingly rewarding.
You’ve spoken nationally on topics related to HIV. What lessons do you hope listeners take away from your presentations?
Management of HIV has evolved so much over the years and the focus has changed with time. When I started doing HIV work in 2002, treatment options were much more complex, limited, and difficult for patients to tolerate compared to what is available now. As we have experienced these changes, the focus of what is important for health care providers has also changed. Much of the discussion about HIV is now centered around the role of the primary care provider who is co-managing the patient with the HIV specialist.
The primary care provider plays a fundamentally important role in caring for HIV positive patients. The importance of routine screening cannot be underestimated. And, as patients are now living long and full lives, routine health promotion, disease prevention, and management of comorbid conditions such as hypertension and diabetes is very important.
With the number of new HIV infections leveled at approximately 50,000 infections per year since the mid-1990s, what are some of the newer challenges the Centers for Disease Control and Prevention faces concerning HIV prevention?
While the number of new infections remains high, the demographics of those most commonly acquiring new infections has changed. The southern United States has been disproportionately impacted. Young black men are also disproportionately impacted. These changing demographics challenge us to rethink prevention strategies.
What has been most rewarding for you, working as an FNP?
Establishing relationships with patients and providing medical care over time has been the most rewarding aspect of my work as a FNP. For example, I have met women who are newly diagnosed with HIV late in an unplanned pregnancy. I have been with them during overwhelming and fearful times. We address their emotional health while aggressively implementing evidence-based medical interventions to ensure both the mom and baby are healthy. And then, years later, I get to see pictures of their happy, healthy children. I really enjoy that.
As a primary care provider, we often see patients during times of personal loss, grief, and major transition. Everyone has these experiences and when caring for people over time, it is inevitable that you will see patients during these times in their lives. I feel like there is a sanctity to the relationship between a patient and a provider and I am humbled that patients share their lives with me during those moments. I am so often impressed by their resilience.
Can you tell us a bit more about your teaching philosophy?
I believe that the classroom is a community of learning and I view my role as a “facilitator” of learning. As adult learners, graduate students bring tremendous experience to the classroom and that needs to be a part of the learning process. I value those experiences and perspectives that students bring to the classroom. I also practice clinically one day a week, and I think it is important for me to share about my clinical experiences with students. That requires an element of trust and vulnerability because it is important to share what goes well along with things I wish I had done differently. I find that students are very receptive to this type of openness and that it creates a mutually safe learning environment.
I am always honored when alumni reach out to me on social media or ask to meet for coffee when they are in town. I enjoy watching students move from being nervous in FNP 1 to practicing as a FNP colleague. That is so rewarding.
Your research focuses on online clinical training. Can you explain how this topic informs Georgetown University’s Family Nurse Practitioner curriculum?
I could talk about this question for days. Between 2011 and 2017, I have given over 21 national and international presentations on the best practices in education. I am very passionate about clinical practice, but also about the best ways to deliver quality education to online graduate students. We are often invited to present about best practices and evidenced-based teaching and learning strategies because we have a nationally recognized FNP program.
I will share one important example. There is a national discussion about moving NP education toward a competency-based model. Historically, clinical education has been focused on attaining a set number of clinical hours. While competency-based education sounds superior in theory, it is very difficult to operationalize. Faculty at Georgetown worked to develop a mastery rubric for NPs that creates a framework for operationalizing competency-based education. We presented the work last year at a national conference and the feedback from the NP graduate education community has been astounding. We are now participating in the national discussions regarding setting standards for competency-based education. So, we use research to guide the design, implementation, and evaluation of our program, but we also influence the national issues that are important to the future of NP education.
What would you say to aspiring FNPs looking to specialize in HIV prevention and disease management?
I would encourage them to develop a strong foundation in primary care. You will need additional specialized training after graduation to learn the complexities of HIV management. This is achievable if you have a strong grasp of basic primary care.
I would also encourage them to follow their passion. There is a need for HIV specialized clinicians.
What are some benefits of the online format?
I think that the most obvious is that students don’t have to relocate. This, in turn, creates additional benefits in terms of diversity within the classroom. It is fascinating to have students from rural Alaska, urban Detroit, and suburban San Diego in the same class. Think about the opioid epidemic and how it might be different in each of those communities.
This format facilitates tremendous diversity within each class. It also affords us the opportunity to recruit the best faculty from across the country.
What sets Georgetown University’s FNP program apart from other programs?
The Jesuit values are integrated across the curriculum and that provides a unique learning experience for students. It is essential that students learn evidence-based guidelines, but that they also learn how to care for disenfranchised and underserved patients. Students will find that many of their faculty practice in underserved settings and bring those experiences into the classroom. We look for opportunities outside of the classroom to integrate these values into the student experience. For example, Nursing@Georgetown recently took 11 students to rural West Virginia for three days of experiential learning.
Our class sizes are small, every student is assigned a faculty mentor, and faculty actually visit students in their communities. The faculty expertise and their commitment to the student experience distinguishes the Nursing@Georgetown program.