Often knowledgeable in both Eastern and Western medicine, a holistic nurse practitioner (NP) will combine alternative treatments and medicines with traditional methods to care for patients in need. The basis of holistic nursing, or "complementary care", is addressing the treatment of a disease by treating the person as a whole – focusing not just on the pathology of the disease but also on the mental, spiritual and emotional state of the patient. The holistic NP is concerned primarily with wellness and how it can be maintained, and that guides his or her approach to patient care.
Most holistic nurse practitioners – and holistic nurses for that matter – attend traditional nursing schools. At the graduate level, holistic NP students will select a patient population on which to focus: adult gerontology, family, neonatal, pediatric, psychiatric, or women’s health. Unlike nurses in a traditional NP program, a holistic nursing student will learn both conventional and complementary healing practices.
When it comes to holistic specialization, the options vary by program, but broadly speaking complementary and alternative modalities are categorized into the following domains:
Holistic NPs might choose to pursue one or more modalities and maintain separate professional certifications to practice these modalities in their individual states. Each certification requires the completion of relevant course material, plus the passing of an examination and payment of course fees. Two organizations work together to advance the field as a whole: American Holistic Nurses Association (AHNA), a membership organization, is an excellent networking vehicle while additionally providing educational resources, and American Holistic Nurses Credentialing Corporation (AHNCC) is the certifying body.
Per an interview with Judith Sweet, RN, FNP-C, NC-BC, CHTP, who taught in the University of San Francisco's Integrated Complementary Healing Adult Nurse Practitioner specialty program for ten years, certifications can be of great value. Her certification in Healing Touch – an energy healing modality – created a solid foundation for her inpatient work in the Palliative Care Service at UCSF.
However, she did not feel the need to pursue certification as a holistic nurse, as she felt her multiple trainings, certifications in modalities and her approach to healing qualified her as such. The AHNA lists these as the values for pursuing certification:
As with pursuing a career as a traditional nurse practitioner, the work day of a holistic NP is impacted first and foremost by the medical setting in which he or she chooses to work. The setting greatly determines to what degree holistic training can be incorporated into patient care. Pursuing additional training in these modalities can bring great benefits to patients and to those NPs looking to treat beyond the disease and focus on the wellness of the patient as a whole.
Traditional and holistic NPs often work in similar environments. Judith Sweet worked in a conventional medicine primary care practice in a large medical center outpatient clinic. Her profile detailing her specializations in complementary and integrative healing enabled and drove certain patients to seek out her care. Working in such a conventional medical setting meant that she had to work within the standard procedures set forth by her institution (and in this case the state of California). This also generally meant that first and foremost patients were treated from a conventional Western medicine approach, but when appropriate or requested she could incorporate/recommend additional treatments.
Overall, a holistic NP’s day will look a lot like that of a traditional primary care NP in that the majority of the day is devoted to patient visits (during which the NP is: diagnosing patient illnesses and other conditions, treating illnesses and conditions, educating and counseling patients and prescribing medication), charting, consulting with physicians and colleagues on patient treatments, and replying to emails and voicemails related to patient care.
The day-to-day and work environment for a holistic NP can also be quite specific and vary significantly from the aforementioned – sometimes focusing on one modality. Sweet mentioned a colleague who through a teaching medical university was provided a grant to focus her work in Healing Touch on referred patients who were hospitalized.
To better understand what this specific holistic care modality looks like, Healing Touch is an "energy therapy" in which the practitioner uses gentle hand techniques with the goal of re-patterning the patient's energy field and accelerating the healing process. It is based on the philosophy that each person is a field of energy and subsequently in constant interaction with others and the environment. The goal of this work is to engage the energetic interaction between practitioner and patient to restore harmony to an energy system that has been disrupted by stress, pain or illness. It is used as a complementary part of a treatment plan, and not viewed as a sole cure for illness – the origins of these therapies lie in those shamanistic and Asian practices, which have been used in healing for thousands of years.
Sweet herself leveraged her holistic certifications to further enable flexibility of work within a conventional medical setting. For a few years, she consulted with inpatient Palliative Care service and provided Healing Touch care on patients in the hospital setting receiving end of life care.
Holistic NPs may also choose to work in private practices, birthing centers, privately out of patients' homes, or through integrated medical facilities. In these settings holistic NPs may have a bit more bandwidth to bring in their holistic training. For example, in a birthing center such integrative modalities as massage, music, touch therapy, meditation and aromatherapy may be incorporated in assisting with labor and delivery.
For a holistic NP, as for a traditional NP, the work can be both physically and emotionally demanding. For significant portions of the day, the practitioner will be on his/her feet. Additionally, for holistic NPs, the modality dictates the physical demands of the work – massage being one of the more demanding, requiring consistent, enduring physical strength.
Emotional demands can also be extremely high in this field. Generally, practitioners are working with patients struggling to re-enter a state of wellness. Working with sick and or dying people can bring great benefits to both patient and practitioner – but these interactions require an emotional openness and steadfastness that can drain the practitioner. "Of course there are always emotional sides to taking care of people – whether one is working with healthy people, people with disabilities and/or illnesses, or people in the last stages, days, or hours of their lives. How one deals with those depends on so many factors – one's spiritual beliefs and base, one's sense of boundaries, one's social support systems. Anyone going into any field of nursing needs to be aware that they will be learning and growing emotionally and spiritually, as well as intellectually," says Sweet of the demands of the work.
Learning to ensure a work/life balance in this field is critical. Fortunately, nurse practitioners developing the skill sets required for practicing holistic/complementary care can utilize some of these modalities to maintain their own well-being.