Efrain Morales, RN, MSN, APN, FNP-BC

By Erin Flynn Jay

Efrain Morales decided to become a Family Nurse Practitioner (FNP) after spending 6 years as an RN in different settings ranging from medical surgical to critical care to psychiatry. He graduated with a BSN in 1997 and initially practiced as a staff nurse in inpatient and outpatient/community psychiatry. Morales also worked from 1998 to 2009 at an acute care inner-city hospital in various settings, including medical surgical, oncology, psychiatry, acute care/emergency, and administration as a nursing supervisor.

Ultimately, Morales saw himself making critical decisions. As an RN, he frequently found himself contemplating more than nursing assessments, duties, and care plans. He was intrigued by the medical assessment and the decision-making processes. He decided the next best step would be to become a nurse practitioner so he could make the critical decisions necessary for quality patient care.

“Working in the ER, I worked directly with NPs. I observed NPs in action assessing patients, making diagnoses, making medical decisions, and initiating and re-evaluating treatment plans. I became inspired to utilize my nursing profession and knowledge to optimize patient care as an advance practice nurse,” he said.

Morales became an FNP in 2009.

The most difficult part about becoming certified was “finding time to manage school, studies, and my own personal life and professional development. I still had to work full time. Finding time to balance everything was the most difficult,” he said.

There was no specific study tactic Morales used to prepare for the exam. He studied everywhere and anywhere. In the car, he used index cards, listened to audio, watched videos. He quizzed himself. Anytime there was a spare moment, he found a way to study.

Morales said there is nothing he wished he did differently to prepare for the exam. “Everyone learns differently and grasps information in a different way. I surrounded myself with studying aids at all times,” he said.

Due to recertify in November 2019, Morales continues to study programs for continuing education credits. He said the scholarly work is ongoing and not last minute to recertify.

Morales now works in a private dermatology practice. There are no specific dermatology CE requirements he needs to take to work in that setting. However, as an FNP, he is required to have a variety of CEs that span the scope of his certification. Therefore, he always tries to include CEs in dermatology, which also helps improve his practice.

The skin had always been an object of fascination for Morales. “I remember as a very active and daring child and teen coming home almost daily with some sort of abrasion or contusion. I was always amazed how the skin was able to regenerate and repair. As an RN, assessing and maintaining patients’ skin integrity was a crucial part of my practice, so my intrigue and love of dermatology continued.”

On a typical day, 99 percent of his patients are for medical dermatology; only one percent of his practice is cosmetic. He sees approximately 40 to 60 patients a day. A not-so-typical day would be when Morales sees very few patients and when he doesn’t see a variety of ages. He sees patients ranging in age from newborns to the elderly.

Morales’s favorite part of being an FNP is the patient interaction. “I love encountering patients in the current state they are in when they see me. My job is to connect with them, not just to diagnose and treat them,” he said. “It’s taking more into consideration than their present state and what’s evident in front of me in their illness.”

When asked about any memorable patients, Morales recalls a child he cared for. “Practicing in dermatology as an NP, I had a grade school child with a significant disease. His parents could not afford many of the medicines, emollients, and personal gentle skin care products. The child lived on the same street where I grew up. He reminded me of myself,” said Morales. “I felt compelled to do much more for him and his family. I purchased all the necessary noninsurance-covered emollients and products for him and with his parents’ permission, I made a house call to deliver a care package and spent much more time helping them. The patient improved significantly, and I felt so very humbled and honored to be able to help.”

How does he feel he helps his patients the most? “Having and utilizing up-to-date evidence-based knowledge is the foundation of great patient care and is truly essential. However, as a healthcare provider, I also believe is it very important to be truly and fully present and committed during every patient interaction. We all have personal lives filled with our own potential distractions that can potentially interfere while we are practicing. I am fully aware that patients can quickly recognize if we are distracted and are not genuine. I strive to provide every patient with my utmost attention in order to provide holistic and evidence-based care,” he said.

“When I can see and be with patients for that moment, that’s all that matters to me. That to me makes every patient very special,” he concluded.

 

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