Finding a Home as a Nurse Practitioner in the STI Field

Over the past 15 years, I have been trying to become an expert sexually transmitted infection (STI) practitioner. As nurse practitioners (and I assume as physician assistants), we are in a space where we practice similarly to our physician peers; however, we are often seen as inferior, which means we are underrepresented in places where our expertise could be both influential and beneficial. Organizations that lead in the creation of national guidelines and policies have often been created by MDs/DOs and PhDs, leaving out a varied and diverse perspective; this holds true to the STI field. The most recent STI guidelines are curated by physicians and PhDs with only one RN, although her RN is not listed in the workgroup member's byline. Similarly, the Centers for Disease Control and Prevention–funded Prevention Training Center Fellowship only allows MDs or DOs to join the fellowship. Whereas if a patient were to visit a Prevention Training Center for STI care (or their affiliate center), they would very likely see a nurse, nurse practitioner, or physician assistant. These nurse practitioners and physician assistants represent a change in STI clinic care. Historically, only physicians would be in leadership roles at prevention training centers; however, people like Philiana Liang, PA-C; Barbara Wilgus, CRNP; and Brittany Sanders, DNP, are listed in leadership positions across the country. The rise in nurse practitioners and physician assistants serving not only in leadership and experiential roles in prevention training centers but in community centers and other STI-related clinics like planned parenthood is likely to continue and expand shaping the future of STI care. The overall increase in nurse practitioners and physician assistants providing direct STI patient care is not just due to our love of the field (although this is also true!). There are additional competing factors, such as the widely reported national physician shortage, which specifically impacts infectious disease physicians.1 Despite the shortage, our STI/ID physician colleagues are some of the most collegial and willing to collaborate physicians. These physicians are kind, knowledgeable, witty, willing to laugh, and most importantly eager to form a partnership with nurse practitioners and physician assistants that is described as filled with mutual respect and trust. This relationship allows those nurse practitioners who do not have autonomous practice (e.g., myself in Pennsylvania) to practice with a collaborative agreement, allowing nurse practitioners to work within their scope and provide a high level of care for patients that otherwise would likely not see a provider or end up in an emergency department. This is a seemingly universal experience in the STI field and not an experience I hear about universally in other fields. In addition to the respect from STI physicians provided to nurse practitioners and physician assistants in clinical practice, I should also mention the respect and collegiality that other researchers provide each other in the field of STI. Coming from a field where you often hear “nurses eat their young,” I was very nervous to reach out to experts, I had not had great experiences with experts in other fields and was expecting similar responses. However, I was very fortunate to have found my clinical love first (STI) and a fantastic collaborating physician (Dr. John Goldman at University of Pittsburgh Medical Center Central PA) who encouraged me to pursue whatever would promote my career. Using my clinical experience, I pursued a research degree with STI prevalence as a focus. Since I moved to research later in life, I was unfortunately unwilling to uproot myself and move. Thus, I obtained a PhD at a university not well known for STI research and did not (and still does not) have a large breadth of STI researchers. I focused on methodologies in my PhD, pulling from my clinical experience to strengthen the STI aspect and then when I was offered a position as faculty at Penn State, I decided to get serious about my career. I knew that I was not going to have an STI career while at Penn State if I did not network. Networking, which I thought was going to be very hard, proved much easier than anticipated. I was chosen to attend the American Association of Sexually Transmitted Diseases (ASTDA) career development symposium. At this symposium, I outlined my goal of finding an expert STI mentor. Five of the six senior faculty who attended had offered mentorship in some capacity, and I maintain contact with every one to this day. They have all been instrumental in shaping my career in ways I did not think possible. They have also helped me to understand that senior faculty often do more to build their mentees up and have connected me with other experts who I now collaborate with. I suppose this is a nice story of how I have come so far with the support of such great STI mentors and ASTDA, but that does not explain the relationship to this journal in its 50th year. Simply, this journal is where it began; my first STI-related publication was published in this journal, and I am sure I will make a point to publish my last publication here. In addition, my STI mentors from the ASTDA career development symposium are either on the editorial board of STD, an associate editor, or well, the editor-in-chief. I would say I got lucky, but I do not think that is the case. I think STD has something special. In closing, the STI field will continue to change and adapt, and although I never questioned my desire to get into STI related research, it was made easier by the help everywhere I turned. If you are looking to make a home somewhere, just know that STD will welcome you. I have never found a kinder and more willing to collaborate group. Even the busiest among us has taken time to field an email about STIs and find some way to build you up. No matter your background, you are welcome here.