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Julia Kull, RN, NP


Why did you decide to become a nurse practitioner?
After several years as a nurse on a psychiatric intensive care unit, I felt ready to further my education in pursuit of a more autonomous role. It was essential for me to continue having patient contact in a clinical role. Working in mental health prior to my return to school, I was certain there were many ways an NP could enhance the care available to people living with a serious mental illness, and that is my ongoing goal.

How do you feel you help patients the most?
The first NP position I held involved attending to the physical health needs of people admitted to hospital due to acute mental illness. Their varied needs required a range of care strategies from health promotion and education to minor or chronic illnesses management and (at times) addressing acute physical concerns in the midst of serious psychiatric symptoms. I valued the flexibility of my role and found that my past experience enabled me to address people’s needs in a sensitive and holistic way.

I now work in a psychiatric outpatient clinic, mainly with people who have lived with a serious mental illness such as schizophrenia or bipolar disorder. The program assesses and treats people involved in an offence who, due to a mental disorder, are found either not criminally responsible or unfit to stand trial. We also provide ongoing care for people with serious mental illness who have been through the criminal justice system. I primarily provide routine mental health followup to outpatients, in collaboration with a team that includes psychiatrists, community forensic mental health specialists, psychologists and support workers. As a team, we are able to provide more comprehensive care to an often underserved and stigmatized population. As an NP, I can also draw on my primary care education, as many of our patients have comorbidities that may otherwise not be easily addressed.

What is the most rewarding aspect of your job, and what is the most challenging?
There are many rewards that come with this role — though sometimes they can be hard to quantify, as the process of recovery can often be complex and non-linear. It is always gratifying to see people make strides in their lives, learn to trust our team members and become more engaged. We work with many who are required to participate in treatment and many who participate in followup voluntarily. At the end of the day, I find most people want to feel that they achieved successes on their own steam, not because they had to. Helping people feel empowered in their recovery and appreciate the choices they make may mean stepping back from finding personal rewards, but building the therapeutic relationship along the way is what I love about this role.

The most challenging aspects of this job really come down to the social determinants of health, the past trauma people have endured and the barriers, which can be very difficult for people to overcome despite the support that may be available. We still don’t have all the resources we need at a broad level to support health, and it can be very frustrating to observe how difficulties in the system can impact individuals.

More about Julia
I would highly recommend that mental health centres consider creating NP positions and evaluating the results. We need to offer improved primary care access for people living with a mental illness, and I can attest to the benefits of putting mental and physical health services in the same location. NPs can also improve access to mental health care, though there may not yet be many of us who are involved in this field. I would love to hear from other NPs who share this interest or practice.