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APP Spotlight: Christopher Boelter, ACNP

Thursday, October 17, 2019
C Boelter

For Christopher Boelter, ACNP, a literal hard day’s work isn’t even the end of a shift. As an acute care nurse practitioner for our Neuro Intensive Care Unit (Neuro ICU) Boelter works with neurologists, neurosurgeons, and other providers to make sure that compassionate, state-of-the art care is delivered to every patient in our neuro ICU 24 hours a day, seven days a week. In this week’s “spotlight” interview, Boelter talks to us about his daily work, his teaching role in the Duke School of Nursing, and how his current work compares to his previous job working at a coronary ICU in Charleston, West Virginia.

What are your current responsibilities within our neuro Intensive Care Unit? What does a typical day for you look like?
I am an acute care nurse practitioner in the Neuro Intensive Care Unit. I work 26-hour shifts. We start the day by getting sign-out from the off-going NP. Then we conduct interdisciplinary rounds to discuss the plan of care for each patient. The afternoon is spent implementing the plan, following up on diagnostics, lab data, consulting team recommendations, and procedures. I am also admitting patients that come to the Neuro ICU during my shift.

Aside from the clinical portion of my role in the Neuro ICU, I also help create the monthly Neuro ICU provider schedule. Based off of requests and fellow and resident weeks in the unit, I create a call schedule that ensures provider coverage for all 24 beds within the unit 24/7 each month. I enjoy this role because it allows me to collaborate with our ICU directors, fellowship director, neurology, and neurosurgery. 

In addition to your work in neurocritical care you’re also an instructor in the acute care NP program at the school of nursing. What does that work involve, and how does it fit in with the rest of your work?
I am a clinical associate faculty member for the ACNP program at the School of Nursing. I have been in this role now for 2 years. The program is now an online program, so most of the work is completed online, except for 3-4 days each semester, when the students are required to be on campus for “On Campus Intensives.” Each semester, I am assigned a cohort of students. This semester I have 10-12 students. I am responsible for overseeing each student’s clinical rotation, grading assignments, participating in virtual group discussions/presentations, and being a mentor for ACNP students. During “On Campus Intensives,”, I am involved in case study simulations, lectures, and teaching stations, such as central line and arterial line placement. 

This fits into my primary job as an ACNP in the Neuro ICU. All of the didactic content, simulations, and teaching stations, are relevant to an ACNP role in critical care medicine. As an associate clinical faculty, I have to stay current on several aspects of critical care, not just neurocritical care, so it is beneficial to then be able to apply the most up to date knowledge to my clinical practice. When ACNP students are assigned clinical rotations in the Neuro ICU, I tend to be familiar with the students, their previous clinical rotations, strengths and weaknesses, which I can use to apply to individualize the rotation experience for each student. 

It is a satisfying feeling to know that you are helping foster the growth of ACNP students and mentor them through their transition from a RN role to a provider role as an ANCP. It is the primary reason why I teach at the School of Nursing. I had great mentors throughout my schooling and believe this is an opportunity to give back and share my knowledge and expertise with current and future students.

Previously you worked in intensive care at the Charleston Area Medical Center Health System. How did that work compare to your work here at Duke? What’s the biggest difference between those two systems?

Charleston Area Medical Center (CAMC) is a health system in Charleston, WV. I was a nurse in the Coronary Intensive Care Unit. I was a bedside nurse and intermittently was a Charge Nurse at nighttime.

The work is different because you would be comparing two different roles, one role as a bedside nurse and another as an ACNP. Also, the patient populations are vastly different. In the CICU, you would be dealing with NSTEMI, STEMI, cardiogenic shock, and acute decompensated heart failure, just to name a few conditions. In the Neuro ICU, you are seeing large ischemic strokes, hemorrhagic strokes, subarachnoid hemorrhages, traumatic brain injury, and status epilepticus, among other conditions. The knowledge I gained in the CICU has been invaluable though, because even though I am working in an environment where patients have a primary neurologic issue, you still have patients with a history of CHF, prior MI’s, irregular heart rhythms, valvular disease, etc. Being exposed to this as a bedside nurse has given me experience that is beneficial when managing patients who also have acute cardiac issues. 

The biggest difference between the 2 institutions is the sheer size of DUMC in comparison to CAMC. CAMC is a 956-bed regional referral and academic medical center, but is stretched across 4 hospitals. The CAMC Memorial Hospital campus, which is where I worked as a nurse, is only a 268 bed hospital. Coming to Duke and seeing the large medical campus, all of the medical specialties, medical school, and school of nursing, was overwhelming in comparison to what I was used to.

What do you enjoy most about your work?
I would have to say the most enjoyable part of my job is the people I work with! I believe the people you work with plays such a large role in your outlook on overall job satisfaction. My nurse practitioner colleagues are all great! We have a good mix of experience, ranging from 20+years to newly hired NPs. There is a sense of family amongst our NP group, which I like. I also enjoy working with the nurses in the Neuro ICU, as well as the RTs, pharmacists, Neuro ICU fellows, attending physicians, and neurosurgery residents. I believe I have created great working relationships amongst all of the disciplines that make up the Neuro ICU and look forward to continuing those relationships in the future.

What’s the hardest part of your job?
The most difficult part of my job is sharing bad news with families regarding their loved ones. We take care of patients and their families during their worst times. Discussing prognosis and goals of care during these times is never easy and I feel as though it will never get easier. You are not only taking of the patient, but also their family!

What other passions or hobbies do you have outside of the Department?
Outside of work, I enjoy spending time with my family! My wife, Ashley, and I also have a son, named Brooks, who will be 2 years old soon, and a golden doodle named Gus. Brooks is non-stop energy and loves being outside, so we tend to frequent the Durham Life and Science Museum. I also enjoy sports. I am an avid golfer, but since Brooks was born, I have not had the opportunities to play as much as I would like. I also enjoy NFL football (Go Eagles) and Duke Basketball! If we are not in Durham, we usually find ourselves venturing up to Lake Gaston in the warmer months.

Boelter

Boelter, Ashley, and Brooks enjoy a visit to the Life and Science Musuem’s Pumpkin Patch Xpress.