Liaison Pulse

At the end of July, I spent five days on the NIH campus attending the Summer Omics Nursing Institute (SONI). A cohort of 61 nurse faculty, students, and practitioners enjoyed a week immersed in state-of-the-art methods and their application to precision health and symptom science (National Cancer Institute, 2026). Inspirational and enriching as the experience was, I couldn't help but wonder: Who will teach this to the rest of nursing?

The first calls for the inclusion of genomics content in nursing curricula occurred over 60 years ago (Seibert, 2020). Since then, despite establishing the essential genomic nursing competencies in 2005 (Jenkins & Calzone, 2007), we haven't made nearly enough progress toward understanding or implementing this knowledge. Calzone et al. (2024) report that the integration of the competencies into nursing curricula remains highly uneven, that continuing education in genomics for nurses is limited, and that the genomic capacity of the nursing workforce remains constrained. Commensurately, genomic literacy scores among practicing nurses, students, and faculty remain low (Dante et al., 2025). A lack of genomic knowledge and lack of confidence in its application have been identified as primary barriers to implementing genomic information in patient care (Hines-Dowell et al., 2024). Although we have known about this gap in genomics knowledge among the nursing workforce for decades, we have nevertheless failed to close it.

With the advent of AI chatbots purposefully designed to help patients understand their own personal genomics and obtain consent for genetic testing, we risk abdicating our expert role as patient educators and translators of medical information (Siglen et al., 2025; Nazareth et al., 2021). We advocate for human interaction to validate chatbot outputs, but can nurses reliably meet that need? If nurses do not understand the foundational genomics and artificial intelligence technology which underpins these clinical tools, what role do we serve in the delivery of precision healthcare?

These tools represent a clear step forward for patient autonomy and precision health, but they are not infallible. Further, AI cannot replicate the human element of care which is characteristic of nursing. The modern nurse needs AI literacy just as much as genomic literacy. Our patients are counting on us to close these gaps in our education and training.

While the literature on AI literacy in nursing is nascent and rapidly evolving, there already exist several published frameworks to help guide the development of AI literacy and competency among nurses (Hoelscher & Pugh, 2025; Kobeissi et al., 2025).

Gaps in nurses’ understanding of AI and genomics also have important implications for healthcare equity. Genomic reference datasets substantially underrepresent non-European ancestries, which produces higher rates of uncertain and misclassified variant results in the populations already least well served by our health systems (Sirugo et al., 2019). Building an algorithmic tool on that foundation risks exacerbating errors and perpetuating biases if outputs are not properly contextualized. In the 2026 AI in Nursing Practice Think Tank, the American Nurses Association identified algorithmic bias in AI tools with the potential to worsen patient safety risk and health disparities. They also note the lack of nursing-specific governance for evaluating AI tools. If asked to use an AI tool in the workplace, a nurse who is fluent in neither genomics nor AI cannot confidently catch a wrong output.

Nurses need to be present when these new technological tools are designed, validated, and regulated (Demiris et al., 2026). We cannot merely be trained on them after deployment. The ANA (2026) named advancing AI literacy and competence and sustaining cross-sector collaboration among its five near-term priorities. Academic–practice partnerships and direct engagement with industry are essential. But we do not get to be in those rooms just because we care. We get there based on our expertise. Building that capacity starts with each of us.

In closing, I recommend to my fellow graduate students: Be intentional seeking out workshops, institutes, and classes which fill these gaps and share what you learn with your colleagues. Consider institutes like SONI, Genomics for Social Scientists (GeSS) or the Bruce Weir Summer Institute in Statistical Genetics. You might also take a cognate in a topic like machine learning, and join an organization like the American Medical Informatics Association (AMIA) or the International Society of Nurses in Genetics (ISONG). We are the largest segment of the healthcare workforce. The technologies which shape precision healthcare will be implemented with us or without us. It's time to earn our seat at the table.

References

American Nurses Association. (2026). Artificial intelligence in nursing practice: Consensus findings from the ANA AI in Nursing Practice Think Tank. https://brand.ana.org/s/2wrfjrh9xqm7bk67mmgfgspn

Calzone, K. A., Stokes, L., Peterson, C., & Badzek, L. (2024). Update to the essential genomic nursing competencies and outcome indicators. Journal of Nursing Scholarship, 56(5), 729–741. https://doi.org/10.1111/jnu.12993

Dante, A., Masotta, V., Paoli, I., Caponnetto, V., Caples, M., Laaksonen, M., Kamenšek, T., Petrucci, C., & Lancia, L. (2025). Genomic literacy in nursing: A systematic scoping review of the literature. BMJ Open. https://doi.org/10.1136/bmjopen-2025-100054

Demiris, G., Oh, O., Ulrich, C. M., Bin You, S., Cho, H., & Villarruel, A. M. (2026). Artificial intelligence and nursing science: Opportunities, challenges, implications, and guidelines. Nursing Outlook, 74(3), 102770. https://doi.org/10.1016/j.outlook.2026.102770

Hines-Dowell, S., McNamara, E., Mostafavi, R., Taylor, L., Harrison, L., McGee, R. B., Blake, A. K., Lewis, S., Perrino, M., Mandrell, B., & Nichols, K. E. (2024). Genomes for nurses: Understanding and overcoming barriers to nurses utilizing genomics. Journal of Pediatric Hematology/Oncology Nursing, 41(2), 140–147. https://doi.org/10.1177/27527530231214540

Hoelscher, S. H., & Pugh, A. (2025). N.U.R.S.E.S. embracing artificial intelligence: A guide to artificial intelligence literacy for the nursing profession. Nursing Outlook, 73(4). https://doi.org/10.1016/j.outlook.2025.102466

Jenkins, J., & Calzone, K. A. (2007). Establishing the essential nursing competencies for genetics and genomics. Journal of Nursing Scholarship, 39(1), 10–16. https://doi.org/10.1111/j.1547-5069.2007.00137.x

Kobeissi, M. M., Maria, D. M. S., & Park, J. I. (2025). Artificial intelligence 101: Building literacy with the AI-ABCs framework. Nursing Outlook, 73(4). https://doi.org/10.1016/j.outlook.2025.102445

National Cancer Institute. (2026). Summer Omics Nursing Institute [Overview]. https://events.cancer.gov/ccr/summer-omics-nursing-institute

Nazareth, S., Nussbaum, R. L., Siglen, E., & Wicklund, C. A. (2021). Chatbots & artificial intelligence to scale genetic information delivery. Journal of Genetic Counseling, 30(1), 7–10. https://doi.org/10.1002/jgc4.1359

Seibert, D. (2020). Genomics in nursing education. Journal of the American Association of Nurse Practitioners, 32(12), 785. https://doi.org/10.1097/JXX.0000000000000529

Siglen, E., Vetti, H. H., Lyssand, A., Dahl-Michelsen, T., & Bjorvatn, C. (2025). Patients' and healthcare professionals' experiences with implementing the Rosa chatbot in mainstream genetic testing for hereditary breast and ovarian cancer. Journal of Genetic Counseling, 34(5), e70119. https://doi.org/10.1002/jgc4.70119

Sirugo, G., Williams, S. M., & Tishkoff, S. A. (2019). The missing diversity in human genetic studies. Cell, 177(1), 26–31. https://doi.org/10.1016/j.cell.2019.02.048

In anticipation of the World Health Organization’s ([WHO], n.d.-a) “World Breastfeeding Week 2026” next month, I wanted to highlight why breastfeeding promotion is relevant for GNSA members and offer actionable ways to further associated public health goals. Breastfeeding provides optimal nutrition to infants and is highly protective of both baby and mother’s health during and beyond the postpartum period. Consequently, experts view breastfeeding as a universal public health imperative. Despite an initiation rate of 84% and interest in sustained breastfeeding or breastmilk expression, most American mothers don’t reach their personal duration targets or those of experts since only 27.9% of infants are exclusively breastfed through six months of age (National Academies of Sciences, Engineering, and Medicine [NASEM], 2025). This disparity is often driven by systemic barriers to breastfeeding, such as returning to work or school or “limited access to breastfeeding education and support services during the perinatal period” (NASEM, 2025, para. 6). The Healthy People 2030 initiative has set a national objective to increase the proportion of infants exclusively breastfed through six months to 42.4% by 2030 (Office of Disease Prevention and Health Promotion [ODPHP], n.d.).

This is where I see opportunity! Nurses have the power to positively affect change through patient education and advocacy. Many GNSA members are aspiring or already practicing advanced practice clinicians in prime positions to start conversations about breastfeeding with clients in clinical rotations and practice settings. We know how critical continuity of care is in improving health outcomes. In the context of breastfeeding, continuity of care means connecting families to resources to help them meet their personal duration goals and advance our collective public health initiatives (U.S. Centers for Disease Control and Prevention [CDC], 2026a).

I encourage you to take action multiple ways for World Breastfeeding Week 2026. First, expand your breastfeeding knowledge. Lactation support is notoriously not well-covered in didactic or clinical healthcare profession education. Visit the WHO’s (n.d.-b) Breastfeeding website and the CDC’s (2026b) Breastfeeding Recommendations and Guidance page for fact sheets, educational materials, and downloadable resources. Then, on August 1, visit the World Breastfeeding Week webpage to learn about this year’s themes and resources. Next, engage patients in open conversations. Ask peripartum patients about their goals, questions, and concerns related to breastfeeding. Offer evidence-based guidance and identify resources and barriers beyond the immediate postpartum period for comprehensive continuity of care.

Lastly, adopt a public health advocacy perspective. Every U.S. state and territory, and the District of Columbia, have laws explicitly protecting a woman's right to breastfeed in any public or private location where they are authorized to be, however legal protections do not guarantee compliance (Office on Women's Health, 2026). Take a moment to evaluate the public spaces you frequent, such as colleges, community centers, and sports facilities. Do they provide adequate accommodations to support breastfeeding families? Perhaps you or others you know are currently breastfeeding. Advocating for yourself, your family, your colleagues and community, as well as your patients, allows you to take part in this important movement. Let’s practice using our voices as we step into our roles as graduate-prepared nurses by applying evidence-based practices to improve healthcare outcomes related to breastfeeding.

References

National Academies of Sciences, Engineering, and Medicine. (2025, September 10). To improve breastfeeding rates in U.S., report recommends creating national strategy, enacting paid federal family and medical leave [Press release]. https://www.nationalacademies.org/news/to-improve-breastfeeding-rates-in-us-report-recommends-creating-national-strategy-enacting-paid-federal-family-and-medical-leave

Office of Disease Prevention and Health Promotion. (n.d.). Increase the proportion of infants who are breastfed exclusively through age 6 months — MICH‑15. Healthy People 2030. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-exclusively-through-age-6-months-mich-15.

Office on Women's Health. (2026, March 18). Laws that support breastfeeding. U.S. Department of Health and Human Services. https://womenshealth.gov/its-only-natural/fitting-breastfeeding-your-life/laws-support-breastfeeding

U.S. Centers for Disease Control and Prevention. (2026, April 16). Strategies for continuity of care in breastfeeding. https://www.cdc.gov/breastfeeding/php/strategies/public-health-strategies-for-continuity-of-care-in-breastfeeding.html.

U.S. Centers for Disease Control and Prevention. (2026, April 27). Breastfeeding recommendations and guidance. https://www.cdc.gov/breastfeeding/php/guidelines-recommendations/index.html.

World Health Organization. (n.d.-a). World breastfeeding week. https://www.who.int/campaigns/world-breastfeeding-week

World Health Organization. (n.d.-b). Breastfeeding. https://www.who.int/health-topics/breastfeeding#tab=tab_1

For many nurses, pursuing graduate education is more than a career goal; it represents a commitment to advancing the profession, improving patient outcomes, and preparing for leadership roles in an increasingly complex healthcare environment. However, rising educational costs and declining funding opportunities are creating significant barriers for nurses seeking advanced degrees.

Recent legislative and policy changes affecting educational funding, loan repayment programs, grants, and tuition reimbursement opportunities have made graduate nursing education less accessible. These challenges extend beyond individual students and have implications for the future of the nursing profession.

The United States continues to face shortages of nursing faculty, advanced practice registered nurses, nurse leaders, and nurse researchers. When qualified nurses are unable to pursue graduate education because of financial constraints, these workforce shortages are likely to worsen. The National Academies of Sciences, Engineering, and Medicine (2021) emphasized that strengthening the nursing workforce requires sustained investment in nursing education and leadership development.

One of the most pressing concerns is the nursing faculty shortage. Across the country, schools of nursing struggle to recruit and retain qualified faculty members, limiting enrollment capacity and reducing opportunities for future nurses. Many experienced nurses are interested in becoming educators but are deterred by the financial burden associated with graduate education. Without continued investment in advanced nursing education, the faculty shortage may persist and further restrict the pipeline of future nurses (AACN, 2025a).

Due to these challenges, advocacy is crucial. Nursing organizations, educational institutions, policymakers, and graduate students must work together to protect and expand funding opportunities for advanced nursing education. Scholarships, loan repayment programs, tuition assistance initiatives, and workforce development grants remain essential to supporting the next generation of nurse leaders, educators, and advanced practice providers.

According to the Health Resources and Services Administration (2025), workforce demands will continue to challenge healthcare systems over the coming decade. Graduate-prepared nurses are essential to expanding access to care, addressing faculty shortages, promoting innovation, and preparing future nurses for practice. AACN's updated Essentials (2026) further reinforce the need for advanced nursing education that prepares nurses to lead healthcare transformation, promote health equity, and respond to evolving population health needs.

Protecting access to graduate nursing education is not solely an educational issue; it is a workforce and public health priority. Continued investment in graduate nursing education strengthens the nursing profession, supports healthcare delivery, and improves outcomes for the communities nurses serve.

Call to Action

The future of nursing hinges on the capacity of current and prospective nurses to access advanced education without insurmountable financial obstacles. Graduate nursing students, nurse educators, healthcare organizations, and professional nursing associations must persist in advocating for policies that broaden educational funding opportunities and fortify pathways to advanced degrees.

As members of the nursing profession, we can:

• Engage with local, state, and federal legislators regarding funding for nursing education programs.
• Support legislation that augments scholarships, grants, and loan repayment opportunities for graduate nursing students.
• Participate in professional organizations, such as the GNSA and AACN, that champion nursing education, workforce development, and healthcare policy reform.
• Share personal narratives that elucidate the tangible impact of funding decisions on nurses, nursing faculty, and patient care.
• Encourage employers and healthcare systems to allocate resources towards tuition assistance and educational advancement programs for nurses.

One easy step you can take right now is by signing up for AACN’s Take Action alerts at https://www.aacnnursing.org/policy-advocacy/take-action. This allows nurses to quickly communicate with Congressional representatives regarding current legislation affecting nursing education and workforce policy.

I began my career as a nurse with the expectation that much of my professional path would remain in hospitals. Now, after more than 15 years as an ICU RN, hospitalist APRN, and outpatient APRN, I know this is not necessarily the case. As APRNs continue to expand their roles in healthcare delivery, it is increasingly important for professionals to explore opportunities beyond traditional employment. APRN students can and should begin to explore the possibilities of independent practice after graduation. Independent practice and private practice ownership are no longer distant possibilities, but realistic options for APRNs who are willing and excited about the possibility to step into leadership.

APRN Entrepreneurship

Few graduate nursing programs teach APRNs how to build, operate, and sustain private practice. As a result, APRNs must depend on their professional network including mentors to learn how to operate their own private practice. Despite these challenges, graduate school provides a valuable opportunity to explore independent practice options and begin gathering the knowledge, resources, and connections needed for success. Below are some clear steps to help you get started as you consider independent practice.

The Value of Experience and State Practice Laws

Before formalizing a plan to open a private practice, it is important for APRNs to build the practical confidence and competency needed to succeed, whether through experience in a hospital, clinic, or healthcare organization. After building on their competencies, an APRN should familiarize themselves with their state’s practice requirements. Scope of practice laws can vary widely between states and determine whether physician collaboration is required.As of 2025, there are 30 U.S. states and territories, that allow APRNs to practice independently with Full Practice Authority (FPA) (Feeney, 2025). Upon licensure, the state of California offers FPA opportunity to nurse practitioners in a phased, step-wise manner, rather than full independence immediately (California Board of Registered Nursing, 2026). Therefore, it is important to check the specific legislation related to the state where you will practice.

Registering a Business

Once an APRN understands their state’s practice laws, they can establish their business structure. One option for operating a private practice is registering it as a Limited Liability Company (LLC). Registering as an LLC can often be completed through the Secretary of State’s website. Applicants are required to obtain an Employer Identification Number (EIN) and apply for a group National Provider Identifier (NPI) number. The process of securing a group NPI is similar to the process of securing an individual NPI.

Insurance, Collaboration, and Practice Tools

Securing malpractice insurance is another critical step for creating a private practice as an APRN. Practitioners who provide telehealth services should also consider coverage that includes cyber liability. Although occurrence-based malpractice coverage may be more expensive, it is often preferred for long-term protection. For practitioners working in states that require physician collaboration, a collaborating physician will need to be identified. It would be valuable to consider physicians who were previous colleagues. A collaborating physician can also be found through online platforms such as Single Aim, which connects APRNs with collaborating physicians. It is important to interview potential collaborators and ensure the partnership aligns with one’s goals and practice needs.

Finally, selecting an electronic medical record (EMR) system is essential. The best platforms are modern, user-friendly, and have reasonable billing and collection rates. Some EMR systems offer credentialing, billing, and revenue cycle management (RCM), which may reduce startup costs. When selecting an EMR, you may want to consider the following factors: HIPPA compliance, the use of AI for dictation, lab ordering and imaging order integration, built-in telehealth/video visit integration, patient portal functionality, E-signatures, and data encryption and backup systems.

Conclusion

Building an independent APRN practice requires preparation, persistence, and confidence. With proper planning and support, APRNs can successfully become independent providers and expand access to high-quality healthcare in their communities. To help students be better prepared in considering private practice opportunities, graduate nursing programs should consider offering courses or resources that can support students interested in establishing private practices.

References

Feeney, A. (2025). Nurse practitioner practice authority: A state-by-state guide. Nurse Journal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

California Board of Registered Nursing (BRN). (2026). Assembly Bill 890 (Wood, Chapter 265, Statues of 2020). https://www.rn.ca.gov/practice/ab890.shtml

Critical thinking, by nature, is a cognitive learning process of analyzing information, forming a plan, and making a decision, thereby providing patient satisfaction and safety (Nemati-Vakilabad et al., 2021). As professional nurses, we are continually learning new skills, acquiring new evidence-based research, and applying this in our daily patient practices. Newly graduated nurses have the beginnings of these skills, and as mature, seasoned nurses, we need to find ways to help our new nurses build on them. Academic education begins in both didactic and clinical settings.

Patel and Metersky (2021) explain that truly understanding a patient involves connecting what you know with what you do in practice. This connection is achieved through reflective practice and bridges the gap between nursing theory and hands-on care. Upon graduation, these new nurses find themselves in the real world, struggling to grasp the knowledge their employers demand, leaving them in a state of mindful disarray. Not that their education lacks theoretical teaching, but they question whether experience is teachable. Mentoring these new nurses entails not only refining their skills but also refining their thought processes. The best learning experiences occur through repetition and recognition of actions.

Abdalhafith et al. (2025) support the idea that nursing knowledge of critical thinking stems from gaining confidence in performance and attitudes toward nursing tasks, fostering self-efficacy, and strengthening knowledge of making clinical judgments. Closing the gap between inability to perform and knowledge can be affected by organizational factors, such as turnover rates and patient flow rates. The effect on nurses’ judgement due to anxiety and feelings of being overwhelmed can result in task-oriented rather than cognitive thinking. As preceptors, we need to foster open communication to enhance positivity, support confidence, and build their critical thinking skills. Positive reinforcement and encouragement of performance not only enhance skills but also reduce anxiety and foster a positive attitude.

Another supportive stance for newer nurses and current staff alike is organizational education. Ongoing educational support on disease protocols and newly acquired equipment is a must-have to keep everyone on the same page. For a new nurse, nothing is worse than not knowing how a piece of equipment works or the correct protocol for a procedure. As our newer nurses mature, gaining confidence in themselves and deepening their understanding of clinical reasoning, we, the preceptors, lead these new nurses by reinforcing theoretical knowledge and applying it in complex patient care situations, much like educators who bridge classroom learning with practical skill development.

References

Abdalhafith, O., Rababa, M., Hayajneh, A. A., Alharbi, T. A. F., Alhumaid, B., & Alharbi, M. N. (2025). Critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis

Management: A systematic review. BMC Nursing, 24:424. https://doi.org/10.1186/s12912-025-02986-1

Nemati-Vakilabad, R., Mojebi, M. R., Mostafazadeh. P., Jafari, M. J., Kamblash, A. J., Shafaghat. A., Abbaso, A. S., & Mirzaei, A. (2021). Factors associated with the Critical thinking ability among nursing students: An exploratory study in Iran. Nurse Education in Practice. 73(2023),103814. https://doi.org/10.1016/j.nepr.2023.103814

Patel, K. M., Metersky, K. (2022). Reflective practice in nursing: A concept analysis. International Journal of Nursing Knowledge, 33, 180–187. https://doi.org/10.1111/2047-3095.12350

I have always been fascinated by healthcare and aspired to care for people, protecting and enhancing their lives, even from a young age. I became a nurse in 2002 and an Adult Nurse Practitioner in 2005. Soon after graduation, I began practicing in hospitalist medicine, where I have had the opportunity to learn from brilliant colleagues and teach new nurse practitioners. Fast forward 20 years, with great trepidation, I decided to go back to school with the aspirations to practice at the highest level of my professional scope. I am now in my final semester of the Doctor of Nursing Practice program at the University of Florida, striving to keep an equilibrium between professional, academic pursuits, family commitments, and personal life. With self-reflection, I have concluded that returning to school after so many years has been both challenging and rewarding. Most importantly, it has taught me that learning is an ongoing journey and should be embraced at each season of life.

The primary obstacles I encountered were time management and the balancing of the roles and responsibilities I carry. Being a wife, mother, nurse practitioner, and student has been trying and complex. However, it has also amplified the value of each role. Rather than stressing over the time constraints of the range of obligations I balance, I intentionally focus on the value and positive impact of the opportunities. The multitude of adversities has compelled me to be disciplined, prioritize, and more efficiently manage my time. It is a blessing to have a family, a gift to be able to go back to school, and a privilege to help save lives as a profession. Balancing life requires intentionality, planning, and flexibility, but how we choose to perceive difficulties can transform adversity into valued achievements.

At times, raising three teenage daughters seems more taxing than my doctoral studies or professional practice combined. Offering guidance, teaching, and demonstrating values in action have become an integral aspect of my daily parental routine. I suspect my ongoing pursuit of education models multiple life lessons to my girls. It is essential to take risks, embrace new experiences, and be courageous even when uncertain of the outcomes. Learning is a lifelong process that promotes both professional and personal growth. We should always strive towards goals and set new dreams at all stages of life. Curiosity, perseverance, and self-improvement are values I hope to model to them. Challenges can be faced with confidence, and the most important component is merely our willingness to try.

When anyone asks me, “How has it been going back to school?” I always respond with a single word, “humbling”. Never in my life have I been humbled in such numerous ways. I have re-learned scholarly writing, APA format, extensive new content, AI, and technology. Participating in a fully online program has required me to acquire proficiency in technology platforms, applied abilities, and concepts at an accelerated pace. At the expense of a smirk, or even an eyeroll, my teenagers have assisted me countless times as I acquire new skills with technology. The demanding adjustment process, troubleshooting, and navigating hurdles have forced me to develop resilience, personal growth, and confidence in myself and my capabilities. Prevailing over my frustrations with technology has successfully reinforced the value of perseverance and adaptability.

Returning to school after almost 20 years has been a sobering and perspective shifting journey. Changing my perspective on balancing multiple roles and responsibilities has allowed me a new path to grow and overcome the fears and doubts that once hindered me. Learning is a lifelong journey worth pursuing, enriching both personal and professional evolution, but more importantly, inspiring growth and character. After many years away from the classroom, it has been an honor to rise above my fears and embrace something new, leading by example to my teenage daughters. Education, specifically in healthcare, does not have a finish line, nor is it something that is completed after graduation. Attaining knowledge is an ongoing journey. This humbling, but profoundly rewarding, experience has taught me that it is not about what you know but rather being brave enough to keep learning.