APP Champion: Karie Canada, NP, Pediatric Cardiovascular Medicine, American Family Children’s Hospital

If your child has open heart surgery at American Family Children’s Hospital (AFCH), they likely will be seen at some point by Karie Canada, pediatric cardiovascular nurse practitioner.

Karie works with pediatric patients born with heart abnormalities—congenital heart defects (CHD)—and those with acquired heart disease. One of the primary patient populations she works with is children with single ventricle heart disease and newborns who need surgery shortly after birth. CHD can lead to problems with any part of the heart, including the upper (atria) and lower (ventricles) heart chambers, the atrial and ventricular septae, the large and smaller blood vessels and the heart valves. Genetic conditions can also be associated with CHD.

“The patients in our single ventricle population typically require surgery shortly after birth, at 3–4 months, then again at 3–4 years. I assist with our successful interstage home monitoring program for these babies,” says Karie. “Many of our patients are born at UnityPoint Health – Meriter Hospital but can be referred to us from any hospital in the region. After surgery at American Family Children’s Hospital, our little patients are cared for in our pediatric intensive care unit (PICU) by a collaborative team. Our pediatric heart care team will continue to oversee these patients’ care as they grow and develop.”

UW Health Kids heart specialists provide experience and expertise in caring for the tiniest hearts. In fact, our team offers advanced heart surgery at American Family Children’s Hospital, which ranks among the nation’s best hospitals for pediatric cardiology and heart surgery.

UW Health is lucky to have Karie and her incredible dedication to her young patients. As a pediatric cardiovascular nurse practitioner, she provides comprehensive and seamless care for patients and families coping with cardiovascular conditions. Nurse practitioners enhance communication among team members, provide continuity of care and facilitate inpatient throughput. They also carry out therapeutic procedures as well as monitor, maintain and report on the progress of patients to the supervising physician. On the inpatient units, they initiate transfers and discharges, place orders, and evaluate new consultations with the entire pediatric heart specialist team.

Karie first worked at the University of Florida Health Shands Hospital in the PICU as a bedside nurse. She moved to Wisconsin in 2008 and worked in the PICU at American Family Children’s Hospital from 2008–2016. While working, Karie went back to school and earned her Master of Science degree in Nursing from the University of Alabama to become a primary care nurse practitioner. In July 2015, she accepted the position for an advanced practice provider (APP) in cardiovascular pediatric medicine.

“During my years as a bedside nurse, I had a passion for working with patients with cardiac disease. I often would care for post-surgical cardiac patients and loved learning the anatomy and physiology of cardiac disease. Although my job can be challenging at times—there is always something new to learn in cardiology—to watch our patients recover from surgery and go on to thrive in life is extremely rewarding.”

Karie enjoys the interstage home management part of her job, which is essentially the period between the first and second surgery for single ventricle patients or those with similar physiology. This is a crucial time as these patients can be very tenuous. It also puts added stress on the families due to the tasks and monitoring that must be done at home.

“During the interstage period, we monitor many things such as weight, oxygen saturations and feeds. I typically call the patient’s family about twice a week to check in. They can page me if they have any concerns or questions. Most of the patients graduate from interstage at about 3–4 months of age, but there are some unique circumstances where I follow kids for a few years,” Karie explains. “My favorite part is building relationships with the families and watching the children grow. It’s valuable time. My goal in the interstage program is not only to make sure the child is thriving but also offer resources, education and support for the family going through a stressful time in their life. I have several patients I keep in touch with even after I no longer see them in interstage. To see these children grow and thrive is the ultimate goal.”

Karie attributes patient success to the team approach in providing care. She works alongside pediatric cardiothoracic surgeons, cardiac anesthesiologists, cardiac intensive care nurse practitioners and intensivists, physician assistants, nurses, nutrition specialists, pharmacists, respiratory therapists, physical therapists, and occupational and speech therapists who are specially trained to care for newborns with heart defects.

“I am fortunate to work with such a collaborative team to provide the best care for our patients. The thing I value the most about this collaboration is we all bring different experiences, thought processes and values to provide comprehensive decision-making,” says Karie. “We do see a variety of complex congenital heart disease patients since we are a referral center for many health systems throughout Wisconsin, Illinois and South Dakota.”

Outside of work, Karie finds time to get involved in community education and volunteering. Her cardiology team is active in the American Heart Association Heart Walk in Madison each year. In fact, she was team captain for a few years prior to COVID-19 and organized fundraising and a face-painting stand at the event.

“Since the pandemic, we have been restricted on social events for the local CHD support group, which used to be held at AFCH. Support groups are a wonderful way to create community, offer support and nurture a healing environment for our families. I am hoping we will be able to resume them soon.”

APP Champion:  Mike Horowitz, PA, Emergency Medicine, University Hospital, East Madison Hospital

Mike Horowitz has always loved emergency medicine. It’s fast paced, unpredictable, requires astute assessment skills, flexibility and the ability to function in a high-stress department. Working as an EMT/firefighter in the past, Mike says emergency medicine just comes naturally to him, maybe even instinctual. “It’s always been my home base. I’m often seeing a patient on their worst day. My day-to-day is their worst day.”

Mike is a physician assistant (PA) in the emergency room, working at both University Hospital and UW Health at The American Center. He’s been with UW Health for five years. About a year ago, he took on the role as assistant medical director for Waunakee and Sun Prairie emergency medicine services (EMS). He assists with education and training for physician assistant students, prehospital providers and advanced practice providers.

Mike became a physician assistant in 2013 after earning his Master’s of Physician Assistant Studies at Drexel University and 18-month postgraduate residency program in emergency medicine at Einstein Medical Center Philadelphia.

PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications and often serve as a patient’s principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. They practice in every medical setting and specialty, improving healthcare access and quality.

Mike also pursues his passion for emergency medicine by volunteering as a medical provider for a local street medicine program called Madison Area Care for the Homeless OneHealth (MACH OneHealth). With compassion and respect, the organization works to bridge gaps in area healthcare systems by connecting with people experiencing homelessness. “We bring medical attention, preventive care and acute care services to local homeless populations,” Mike says. “I visit Madison homeless shelters about once a month or every other month, about 3–4 hours each time.”

Mike says MACH OneHealth helps with whatever is needed, such as chronic illness management, primary care, general health concerns or acute medical issues. “We often work with them to avoid hospitalizations, and if they do need emergency attention, we refer them to the emergency department (ED) and work together to coordinate that care. We advocate for housing and general health and wellness. It’s totally independent and volunteer funded. It’s really rewarding work.”

Teamwork is essential in the ED. In fact, when Mike was asked to describe his teammates, he says teamwork and people are really the crux of how the emergency department works. “Rarely is the emergency room the definitive care for a patient. But there are times when it is, and that is one of the reasons why I’m in medicine. We can be the safety net for those patients. I discuss cases with other providers and work to transfer patients for specialized care. Sometimes it takes several phone calls to outside agencies or other units, depending on what they need. There are a lot of great people within UW Health who really want to get involved in their care.”

Mike says his colleagues are a pleasure to work with. “Not enough can be said about how great the emergency room staff are—they are fantastic. The heart of a high-functioning healthcare organization is the team element. The emergency room is a well-oiled machine.”

The intensity of an emergency can provide a memorable moment for anyone, whether you are on the giving or receiving side. “I can’t recall a specific experience but maybe a cumulative experience,” Mike says. “Critical care, street medicine and emergency care are all that I do. One of the reasons I went into medicine was to have the fluidity of working in that environment. My mission as a physician assistant is to serve the underserved. That has kept me grounded. Caring for a patient who has no place else to go. Helping them navigate the healthcare system—sometimes it’s a real struggle—I’ve found that many times my role can be very helpful with those aspects of care.”

Mike says his patients have taught him how to stay humble because things can often surprise you in medicine. “Emergency medicine can become depersonalized with medical issues glossing over the personal aspects of a patient. My patients have taught me not to lose any thread of humanity,” he says.

Mike understands that patients have emotions and fears. Many times, he works with a patient’s family to help in the care process. “Sometimes patients lack income and/or other resources, so I like to help them find the resources they need for care. These issues all impact the way they see their care. If I don’t take a moment to learn about a patient and their frame of reference, I’m doing them a disservice.”

APP Champion: Emelle Holmes-Drammeh, PA, Obstetrics and Gynecology, UW Health 20 S. Park Clinic.

Throughout Emelle’s 14 years in the medical field, she has always had a desire to take care of women.

Her love for medicine started when she was a young girl living in Gary, Indiana. “I was in fifth grade. I wanted to be a doctor. I would read encyclopedias from cover to cover and was fascinated with the human body and how it worked,” she says with a smile.

Emelle’s mother was a nurse and avid volunteer, which is where Emelle says her investigative medical curiosity started. Her path in medicine quickly switched when she learned how daunting and long her education and training would be to get her medical degree. “I wanted to be a mom and start my family as soon as possible. I learned about the physician assistant career and the rest is history, as I would be able to have the best of both worlds.”

After she completed her Bachelor of Science degree in Pre-Medicine and Chemistry at Mount Mary College in Milwaukee, Wisconsin, she earned her Master of Science degree in Physician Assistant Studies at Samuel Merritt University in Oakland, California. Emelle then worked for a few years in colorectal surgery at UW Health in Madison, prior to starting and completing the Mark B. Adams Postgraduate Surgical Residency for PAs at the Medical College of Wisconsin in Milwaukee. She says she loved working in the hospital setting and especially in the operating room.

“I enjoy advocating for all patients through the complexities of the healthcare system. I am a proud advocate for women and especially women of color.”

Emelle is involved in several community health initiatives, including humanitarian work in The Gambia, West Africa, where she does an annual back-to-school drive for different community primary schools in the country. She also works as a member of the Madison-Kanifing Sister City to help bring donated medical supplies and other resources to the country. Emelle is a physician assistant preceptor, leading obstetrics skills labs and she serves on two UW Health diversity, equity and inclusion (DEI) committees, one for PAs and the other for OB-GYN. She is also a parent member of the DEI committee at Prairie View Middle School in Sun Prairie. In 2018, Emelle and previous colleagues started a local not-for-profit called Beat the Blues Cruise that brings awareness to suicide prevention. Recently, she started her training to become a doula through the Harambee Village in Madison. 

Last year, Emelle wrote a statement of support for H.R.6142 Black Maternal Health Momnibus Act of 2020, which was introduced in the House in March. This act would direct the Department of Health and Human Services to address maternal health outcomes among minority populations. And in 2016, she developed a pain protocol at the hospital where she previously worked, that decreased narcotic use in the postpartum population by 76 percent over three years. This protocol was presented and adopted systemwide. She was also just notified, pending senate confirmation, Gov. Evers has appointed her to the newly formed Physician Assistant Affiliated Credentialing Board.

Emelle is proud of the work UW Health is doing with DEI in dismantling healthcare disparities and racism. “We are doing important work but we need to do more. We all need to take a step back and really check ourselves for those biases that we do not even recognize we have. We have to check them at the door of every patient’s room and give them the same level of care that we would want our own family members to receive.”

“One memory that touches my heart is when I worked in the OB-GYN inpatient unit at a local hospital. There was a patient I was going to see after her second delivery. When I walked into the room, her husband started yelling, “She’s here! She’s here!” It startled me. I didn’t know what he was talking about. The patient came out of the bathroom and when she saw me, she began to cry. She went on to state that when she had her last pregnancy, it resulted in an emergency C-section. She said she remembered me holding her hand and calming her down as she was whisked away to the operating room where I helped deliver her baby. I don’t recall that time, because I aim to treat all of my patients that way. But it makes my heart happy because it reminds me that our actions have great impact on the people we come in contact with.”

Emelle says her patients have taught her that we all have a lot in common in terms of our anatomy and the disease processes we may experience. “Where we differ is in the communities we come from and the life experiences we have had. All these things make us who we are. I’ve learned that when I see a patient who presents with pelvic pain, and all work-up has been negative, I must look at her as more than another young woman with pelvic pain. There is so much more to them than their chief complaint. By tapping into who they are as people, understanding their experiences and treating them holistically, we can actually heal their spirits as well as their ailments.”

When asked to describe the team of professionals she works with at UW Health, she said she is surrounded by very kind providers, nursing staff, medical assistants and schedulers who all work together to make the ship run. “Not one of us can do the job alone. They are dedicated, consistent and caring.”

Emelle lives in Madison with her two daughters, Taylor (12) and Nyima (7), and her husband of 9 years, Lamin.

UW Health is proud to employ more than 800 advanced practice providers (APPs) — nurse practitioners, physician assistants, certified anesthesiologist assistants, certified registered nurse anesthetists and certified nurse midwives. Our practices span Dane County and the surrounding region with primary care, specialty ambulatory care and inpatient services provided at UW Health hospitals and clinics and many outreach locations.

We advance the UW Health mission by providing exceptional care for our patients, teaching the next generation of learners and promoting health in our communities. UW Health has a growing APP leadership structure through the Office of Advance Practice, which includes a senior director of Advanced Practice, APP managers, APP supervisors and APP leads. UW Health has a dedicated council to support and advance the practice of APPs within our organization.

APP vision

Our vision is to be the best APP workforce in the nation. We will excel in patient care, academics and the betterment of humanity. In doing this, we will contribute on a national scale to APP practice and professionalism, healthcare research, public policy and advocacy, clinical excellence, and interprofessional healthcare education. We will provide innovative, cutting edge and patient centered healthcare. We will be remarkable.

Office of APP structure

At UW Health, we understand that making the decision to change jobs or take your first job can be a difficult one. Whether this is your first position, you are relocating, or looking for a new opportunity within an academic health care environment, we hope to make this decision a little easier by answering some of the most frequently asked questions that have come in from our new advanced practice provider candidates.

Benefits, licenses and malpractice

Are my license/certifications reimbursed?

After hire, Advanced Practice Providers (APPs) that work at lease a 0.5 FTE or greater, will be reimbursed for professional expenses required to practice in their position, such as a WI, PA, APNP license, national recertification, Drug Enforcement Agency (DEA) license or other certifications required by the department or specialty.

Is a DEA required for my job?

Yes, in order to be an ordering provider in Health Link, our electronic health record, and obtain clinical privileges, a DEA is required prior to being hired (with the exception of clinical anesthetists).

Do you provide malpractice insurance?

Corporate malpractice coverage is provided in the amount of $1,000,000 per incident, $3,000,000 annual aggregate.

How much vacation time is provided?

Paid time off is a combination of vacation, personal and sick days. The accrual is based on years of service with UW Medical Foundation and is pro-rated per pay period.

Orientation

How long is the credentialing/privileging process?

It currently takes 90 days for a new APP to become credentialed and privileged with UW Health. New grads may take longer as we can’t start the credentialing process until you have your national certification and applicable state licenses.

What type of employee orientation do you offer?

We have an APP-specific orientation designed by APPs for APPs. Topics for initial orientation include welcome by our APP managers, being an APP at UW Health, risk management, billing/coding/compliance, patient experience, clinical protocols and policies, communication and professional opportunities for APPs, to name a few.

APP orientation is offered once a month. All new employees must attend orientation prior to beginning their clinical duties. As a new APP, you will attend new employee orientation on your first four days of employment, with additional 60- and 90-day follow-up orientations.

What does the orientation process look like in my department?

Each department offers a slightly different orientation experience. Orientation may include time with other providers (physicians and other APPs), support staff such as nurses, receptionists, medical assistants, and orientation to ancillary departments such as radiology and physical therapy. 

Professional development

What is offered for continuing medical education (CME)?

We offer competitive CME benefits to assist our APPs with professional expense fees, as well as fees associated with job-related continuing professional education such as seminars and conferences.

What opportunities do you provide to be a preceptor for future APP students?

Preceptorships are coordinated through the Office of Advanced Practice. Those who have been employed at least two years, are interested in precepting students, and have satisfactory clinical performance and teaching assessment are matched through the Office of Advanced Practice.

Do you have advancement opportunities for APPs in your organization?

There are opportunities for advancement based on an your area of interest, including:

• Committee involvement at the organizational, department or clinical level
• Leadership development programs
• Clinician teacher experiences (precepting)
• Participation in research, poster presentations or lectures
• Project workgroups
• Quality improvement initiatives

Do you offer tuition reimbursement?

Yes. We offer education assistance to our employees that have been employed for one year and work at least a 0.5 FTE or greater.

Miscellaneous

How many other APPs will I be working with in this position (department, specialty, sub-specialty)?

There are APPs employed across most specialties within UW Health in both ambulatory and inpatient settings. We encourage candidates to inquire about the number of APPs who will be part of their immediate team during the interview process.

What is the culture of the department/team that I would be working with?

APPs are part of the provider complement and integral to our clinical teams, meeting the needs of the clinic, inpatient service and our patients. At UW Health, we expect and demonstrate a culture of support, respect and collaboration. We recognize the invaluable contribution that APPs bring in achieving cost-effective, high-quality and patient- and family-centered care. We support practice at the top of APP license.

Do you have opportunities to pick up on-call/additional hours?

Opportunities for additional hours are determined at the department level based on clinical and business needs.

How is compensation determined?

UW Health is committed to providing all employees with a competitive level of compensation. This is done through a comparison of UW Health salary ranges to compensation benchmarks in the external labor market. Compensation rates for new hires will also be established in a similar manner to be competitive with the external labor market based on the job and an individual’s experience, education and or expectations.

Central to our academic mission, UW Health offers learning experiences to nurse practitioner, physician assistant, certified anesthesiology assistant, nurse anesthetist and certified nurse midwifery students through affiliations with partnering schools.

Student placement process

The demand for highly trained certified anesthesiologist assistants, CRNAs, nurse practitioners, physician assistants and midwives continues to grow, at UW Health, regionally and nationally. Central to our academic mission, UW Health offers learning experiences to advanced practice provider (APP) learners. We actively collaborate with a small number of regional academic programs to provide high quality educational experiences.

UW Health has active, collaborative relationships with the preferred academic programs, focusing primarily on Adult-Geriatric primary care, Adult-Geriatric acute care NP, Physician Assistant, Family NP, Pediatric NP (specialty rotation only) and Midwifery population of foci. We do also partner with national programs in specialty areas of foci such as Certified anesthesiologist assistant, Women’s Health NP and Neonatal NP programs.

Preferred affiliate academic programs

• UW-Madison School of Nursing
• UW Physician Assistant Program
• Marquette University
• UW-Milwaukee
• UW-Oshkosh
• UW-La Crosse — CRNA students
• Medical College of Wisconsin — CAA students

Other Affiliated Programs (list is not exhaustive)

• Rush University (Neonatal NP program)
• Edgewood College
• University of Chicago-Rockford
• Frontier University

We are currently not accepting new affiliation agreements. If you are unsure if we have an active agreement on file with your university, please contact your program’s clinical placement department.

Restrictions for APP Students who are UW Health Employees

• The UW Health preceptor cannot be the employee’s paid supervisor, manager or provider in the same practice location where employed.
• The employee’s clinical rotation cannot take place at the same location where they are a paid employee.
• The employee’s cannot complete clinical hours during work hours; the employee’s student work must be completed on unpaid time.
• The employee must be onboarded as a student and use the student access for their clinical rotation (e.g., Health Link student access).

Application process

Your college or university program director and the UW Office of Advanced Practice will arrange your clinical experiences.  Based on high demand for student placement, we have a centralized process for assigning and matching learners with preceptors. We prioritize our UW Madison school partners primarily and UW Health employees attending our current affiliated programs next. In addition, we limit rotations at UW Health to two rotations per student to provide experiences at other organizations and to allow opportunities for other incoming learners.

SNRA and MSA students interested in anesthesia rotations can find program specific information on the Department of Anesthesia Clinical Anesthetists – Department of Anesthesiology – UW–Madison.

UW Health uses myClinicalExchange to receive APP student placement requests, assign preceptors, and onboard students. If the school is familiar with mCE and an active Affiliation Agreement is on file, the school placement coordinator (NOT the student) can submit the request into mCE at any time. Please note deadlines below. If the school is not familiar with mCE, please have the placement coordinator contact the APP Office at app@uwhealth.org for more information.

Because we have a centralized process for requesting preceptor availability and learner matching, we request that neither the school nor student reach out directly to our staff requesting sponsorship. All requests must come directly through myClinicalExchange.

The following deadlines are for entering student clinical rotation requests, decisions for available matching are generally available six weeks after the deadline.

• Fall semester: May 1
• Spring semester: Oct. 1
• Summer placement: March 1

Upon successful placement, students are matched with a provider (CNM, NP, PA, or MD) who is committed to creating a positive, comprehensive learning experience, customized to meet students’ individual and course learning objectives.

UW Health offers its Advanced Practice Providers (APPs) several opportunities to continue to grow and develop as a clinician, researcher, content expert, advocate or leader, to improve clinical care and service to our patients.

Opportunities for professional growth include: 

• Continuing medical education
• Leadership training, development and job opportunities
• Council membership and project workgroups
• Journal clubs
• Publication, poster presentation and speaking opportunities
• Medical mission and community volunteering opportunities

Continuing Medical Education (CME) opportunities

We offer CME benefits to assist our APPs with professional expenses, as well as fees associated with job-related continuing professional education such as seminars and conferences.

• Advanced Practice Provider Grand Rounds are learning and networking opportunities for all APPs across UW Health, which offer CME credit via teleconference. Grand Rounds also are a great opportunity for our APPs to present an area of expertise to their colleagues or prepare for a larger conference or poster session.
• Department/Division Grand Rounds are offered on a monthly and sometimes weekly basis to the faculty and providers within a respective department or division. Topics vary based on department/division and area of specialty and are offered for CME.
• Provider Skills and Procedures Workshop: Hybrid course offering online recorded content and in-person skills training.

Leadership training, development and job opportunities

Investing in our next generation of institutional leaders, including APPs, is critical for the viability of the organization. We develop leaders in areas such as acting systemically, business perspectives, coping with pressure and adversity, forging synergy, influencing, leadership and power, results orientation, risk taking/innovation, self-awareness and sound judgment.

• Training and development: Through UW Health’s Learning and Development platform, APPs are offered various classes to meet their individual learning needs. Classes include conflict resolution, communication style, foundations of management, leadership development and more.
• APP leadership job opportunities: The Office of Advanced Practice serves as the central resource for APP advocacy, support and organizational programming. It also provides opportunities to become part of the APP leadership team, which includes positions that partner with respective department and division leadership to advance and optimize the role of APPs across the organization.

Council membership

• Advanced Practice Provider Advisory Council: The Advisory Council supports professional advancement, recognition, provider wellness and professional networking for APPs across UW Health. In partnership with the Office of APPs, the council participates in various activities including, but not limited to: Review and creation of policy, professional advocacy, provider wellness, communication strategies and other activities as requested or assigned by the APP Office or other organizational committees or workgroups. Appointment is every three years.
• Advanced Practice Nurse and Physician Assistant Credentialing subcommittees: As workgroups of the Medical Credentialing Committee, these subcommittees include CRNAs, APNs and PAs who review and recommend our CRNAs, APNs and PAs for new or continuing privileges and participate in ongoing and focused professional practice evaluation. Appointment is every two years.
• Advanced Practice Provider Scope of Practice Committee: The purpose of this committee is to establish and maintain standards for NP/PAs scope of practice at UW Health, based on legal and clinical requirements per state, federal and UW Health policy and bylaws. This committee meets quarterly to discuss inquiries that have been brought forth by individuals within the organization. Workgroups within the committee then seek to understand what affects the practice, working to optimize both NP/PA scope of practice and UW Health policy. Appointment is every three years.
• Other committees and councils: Our APPs are involved in various councils and committees throughout the organization. All of these committees are voluntary and are selected based on application, self-nomination, recommendation or selection by the council/committee chair.

Publication, presentation and other scholarly activities

UW Health encourages APPs to participate in research, educational programs, article publications and poster presentations. Our APPs deliver grand rounds to physician faculty, nurses, and other APPs. Our employees lecture in our UW–Madison School of Nursing and UW–Madison Physician Assistant Program and serve as affiliate and/or permanent faculty.

Volunteer opportunities

At UW Health, we strive for work/life balance. There are opportunities for APPs interested in participating in volunteer activities, providing preceptors for APP students and working with medical mission groups. If you are interested in volunteering, you are likely to find an opportunity through UW Health.