Ruth Adewuya, MD: Hello, you are listening to Stanford Medcast, Stanford's CME podcast where we bring you insights from the world's leading physicians and scientists. This podcast is available on Apple Podcast, Amazon Music, Spotify, Google Podcast, and Stitcher. If you're new here, consider subscribing to listen to more free episodes coming your way.
I am your host, Dr Ruth Adewuya. In honor of Women's History Month, our Hot Topics miniseries share stories of women in medicine. Today, I am chatting with Raji Koppolu. Raji Koppolu is a board certified pediatric nurse practitioner with a general surgery service, and Manager of Advanced Practice Professional Development at Lucile Packard Children's Hospital Stanford in Palo Alto, California.
In addition to the direct clinical care she provides pediatric general surgery patients, she is responsible for leading several programs to support the professional development of advanced practice providers, including launching an inaugural APP fellowship program for new graduate nurse practitioners and physician assistants.
Raji completed her Bachelor of Science in Biology at Tufts University, her Bachelor of Science in Nursing at Johns Hopkins, her master's in nursing at the UCSF School of Nursing, and her Master's of Study in Law at UC Hastings College of Law. She is a past president of the National Association of Pediatric Nurse Practitioners and is currently pursuing her Doctorate of Nursing Practice Degree in Executive Leadership at Johns Hopkins. Thanks for chatting with me today, Raji.
Raji Koppolu, NP: Thank you so much for having me. I'm excited for this discussion.
Adewuya: Me too. This episode is part of our Hot Topics mini-series where we share stories of women in medicine, so I'm really pleased to be able to talk to you and hear your story and share your journey. If you could just start by telling us more about your role as a nurse practitioner.
Koppolu: Absolutely. I have been so honored to serve in the nursing profession now for over 20 years, and most of that time has been here at Stanford Medicine Children's Health, and so I've been really lucky to have a diverse set of roles in that time. Started here as a nurse in our pediatric cardiac intensive care unit, and that led to my first nurse practitioner position in an inpatient pediatric acute care unit. So, I worked with a team of nurse practitioners providing care to children who had surgery for a congenital heart defect or had undergone heart transplant.
And the role was wonderful because I got to learn so much about the nuances about pediatric cardiac anatomy and pathophysiology. And at the time, I took a really keen interest on the transition of these patients from hospital to home, and making sure that was a successful transition. And in doing so, I got bit by the surgery bug and I realized I wanted to expand my practice to care for patients with a variety of surgical needs.
And so, I started working with our pediatric general surgery team in 2009. And in this role, I work both on the inpatient and ambulatory side. When I'm on the inpatient side, I take care of neonates to adolescents who have had surgery for a variety of needs. And then, I also have the opportunity to see patients in our ambulatory clinic, not just our general clinic, but also some of our subspecialty clinics, where we care for patients with more particular diagnoses. And what I love about this particular practice is I get to learn a little about a lot of different things.
We see patients in the NICU with congenital defects. We see children that are admitted to critical care after having had a trauma. We take care of pediatric oncologic processes and take care of the more emergent cases that come through the emergency room. So, it's just a really diverse practice and I've been able to be a part of building some of our subspecialty clinics and then professionally start to think about scholarly work and presenting and publishing and disseminating more knowledge in some of the work that I've done.
So, clinically, that's been my role as a nurse practitioner and the majority of my time now, I also have the opportunity to serve in a management position, which has been wonderful. I've been able to manage teams of advanced practice providers and now I'm serving in an inaugural role, supporting the professional development of all of our nurse practitioners and physician assistants here at Lucile Packard and namely, have been working on the launch of a postgraduate fellowship program for new graduate nurse practitioner and physician assistants. So, it's been a wonderful journey, a lot of diverse roles, and I've been really lucky to be here for this long.
Adewuya: It sounds really exciting and it sounds really robust, the fact that you were able to lean in your passion areas and switch from one specialty to another. I'm curious, what led you down this path? A lot of us in the sciences, I think from a very young age, we either want to be a doctor, a nurse. Was that your story? Did you know that you wanted to pursue nursing early on?
Koppolu: The only thing I knew is that I wanted to work with children. I loved all of my teachers growing up. I thought maybe I would have a career in teaching, I wasn't quite sure. And then when I got to college, I ended up majoring in biology and fell in love with science. And so, I had two very formative experiences at that time, that led me to pursue a path in nursing and then to become a nurse practitioner. One of them is that I was studying abroad in London and I got to travel and I visited Geneva, Switzerland, where I got to visit the headquarters for the World Health Organization as well as the International Red Cross Museum.
And I remember walking in that day and seeing this incredible exhibit about nursing and all of the roles that nurses had had and the impact that they've had globally. I just was very inspired by seeing that exhibit. And so, I returned back to college before my senior year and I was selected to be part of a program in New York, where undergraduate college students got to shadow and learn about different health professions and just get a sense of different types of health care roles.
And so, I had a chance to shadow a pediatric neurosurgeon, and in that department met one of the first pediatric nurse practitioners that worked in their oncology department. And I was completely inspired. I loved her approach with patients. She really had this unique blend of bridging science with the compassion and thoughtfulness that falls in the nursing profession. She is somebody who inspired me. And then I went back to school and pursued my career in nursing and to become a nurse practitioner.
Adewuya: It's very interesting how we all find our way into clinical work. I think everybody's story and everybody's journey is a little different, and how such an experience shaped your career trajectory. You have a Master's in Nursing, which was a requirement at that time. And so, in addition to your undergraduate work, you had to pursue a Master's of Nursing. After doing your undergrad and knowing that you had to take an additional degree program to become a nurse practitioner, why did you still consider that extra, additional work?
Koppolu: Yeah. Well, once I had earned my Bachelor's Degree in Biology, I had to earn a Bachelor's Degree in Nursing to become a registered nurse. So, I did that. Nursing school exposes you to obviously all different patient populations and it, for sure, solidified my interest in pediatrics. And so, when I thought about it and started again talking in meeting with nurse practitioners, I thought, "I want to advance the scope of my practice and really be able to have more hands-on, direct patient care with patients."
And so, after working as a nurse in pediatrics for a little while, I then decided to go back and just focus my master's degree to become a pediatric nurse practitioner, which was great, because then all of my didactic and clinical experiences were focused in pediatrics. And I had wonderful faculty and an amazing cohort of peers in my class. And now that we all have been in practice for some time, it's just been really rewarding to go back and see how much influence and impact we've all had in all of the different areas that we've chosen to work in and pursue. That was really what drove me down that path. And again, never wanted to do anything else but work with children.
Adewuya: You stayed true to that childhood aspiration and passion. And in preparation for this conversation, looking into your background, discovering that you are also very interested in law, how did this interest in law come about and the overlap between law and nursing?
Koppolu: It might sound like an odd answer, but I love learning new languages. I speak Spanish. I love hearing and learning about new languages. And the more I worked clinically, I realized that in order to have greater impact for pediatric patients, I wanted to learn more about the law and policy, so that I could be a better child health advocate. So, it truly came from an interest of wanting to learn a new language and that was the language of the law and of a policy, to better develop those skills.
And this particular degree was an inaugural program where health care professionals joined the program and there were physicians. I was the only nursing professional. Social workers, the health care administrators. Those that were working in health care that didn't have, per se, an interest to practice the law as an attorney, but to learn more about how the law impacts health.
And so, we took courses in things like tort law and health care transparency laws, and public health law, public health and homelessness, to better understand legal reasoning, legal doctrine, and how they can be influential in implementing policies and regulations. And so, it was really fascinating. It was a wonderful introduction to interdisciplinary, interprofessional education. We would be presented the case, and we would all chime in about the clinical things and we would hear about their legal arguments. And it was fascinating. It was just a really interesting discussion and I think a really nice way to appreciate how both can really work together and are important in advocacy.
Adewuya: Can you elaborate a little bit more and talk about your current work? Tell us more about your work in health policy, in QI, and also some of the implications that work has brought about.
Koppolu: Absolutely. One of the things that I remember very clearly from this program was the potential that we have to advance health, really, and in my case, nursing science and nursing care, through informed law and policy. And so, at a local level, one of the things that I was working on at the time was injury prevention. I was a pediatric surgery trauma NP. I was seeing all of these children getting admitted with injuries and thinking to myself, "To what extent do policies that we create help prevent injury in children?" And I specifically was interested in looking at window fall prevention.
And so, we were seeing a number of children that were being admitted after sustaining a window fall. And I had no idea that this was actually more common than I realized, not just locally, but also around the country. And so, I published a health policy brief that looked at city and state laws that were addressing window fall prevention, not just from a public health awareness standpoint, but also from the perspective of installing window guards and other types of safety devices to prevent children from falling, and the extent to which those policies started to change the incidents of falls in those cities and in those states.
That's been really wonderful because it's allowed me to develop more of an understanding again about these laws and policies and then serve on statewide injury prevention coalitions that then look at potential legislation down the road, that might inform not just this injury, but other types of injury prevention spaces.
So, that was something I took away from it. And one of the honors that I've had a few years ago was to serve as the president of the National Association of Pediatric Nurse Practitioners. And so, all of this work and experience really helped me at that time, because then I started to think about more federal policies that were supporting child health and child health access. And I didn't know it at the time, but I served just at the start of the pandemic. And so, we were addressing all kinds of important things to support children's hospitals, to support access to care, to support mental health, and to support our workforce. And so, I think all of those things practically, and my studies, really helped inform and prepare me to understand how I could best serve as an advocate and a leader. And again, not just locally, but on the national level too.
Adewuya: That's excellent. And congratulations in the opportunities and how you've shepherded these different organizations during really critical times. What I'm hearing is the importance of clinicians to understand, and I really like how you framed laws, like the language, I really like that. But to affect health care in a positive way, it requires clinicians being a part of the other steps in the process, which includes policy and goes beyond direct patient care.
And as you were talking about the window fall and that injury, I was putting myself in a committee meeting that you were in, where you can speak to the real life consequences of the policies that policymakers may not be aware of. And what a powerful intersection between clinical work and policymaking. And I guess this is a little bit of a inspirational call to action for other clinicians who may have passion in this area, who may be interested in being a part of the movement and being a part of these other organizations outside of clinical care. So, I was just reflecting as you were talking, how amazing your story and your professional career and where it's brought you and how inspiring it is for other clinicians as well.
Koppolu: Thank you. And thank you for encouraging our listeners to think about that. And I think it's been an organic and it's natural course the more we work with patients and the more we develop what those passions are. For me, it was wanting to be part of something bigger, whether that was at an organizational level, state level, and then eventually a national level, to feel like you can have that impact.
And I think that means really, again, understanding how these processes work and the role that you can play and to bring your specific area of expertise to that table. And to now see it and see the results of a lot of this work, it's very rewarding and really feels like you're hopefully leaving a very impactful thing behind.
Adewuya: What's next for you in this work? What are you currently doing? What's exciting, what's coming up?
Koppolu: Again, love learning. And so, I'm back in school now, I'm pursuing my Doctorate Degree in Nursing and Executive Leadership and furthering my understanding of health care and organizational systems and leadership. And when I served as president and as I go through my studies now, one of the things I've become very passionate about is the pediatric workforce. And again, as somebody who never wanted to do anything else but work with children all this time, it became unfortunately clear to me that we really have a paucity of individuals who are pursuing a career in pediatrics and certainly then in pediatric subspecialty care.
And so again, putting on my advocate hat, I felt compelled to say, "What can I do to hopefully encourage young individuals to pursue a career, certainly in health care and hopefully then in pediatrics?" And so, I do see my future work always, again, advocating for children, in this sense, for the provider workforce and doing what I can to help build an interest in a pipeline of those that are really interested in dedicating their careers to serving children and their families.
And part of that is not just the growth in the workforce, but also thinking about the programs that help support children and their health care and their access to health care. But then also thinking very much about the diversity of our workforce and in all of its forms, of making sure that we have a workforce that is reflective and mirrors the diversity of the children we care for, but also brings new thoughts and new perspectives and new experiences that will hopefully make the professional role that much more rich. I see myself wanting to continue to work in that space going forward.
Adewuya: What notable work. And as you said that you were back in school again, I'm like, "How are you doing all of this?" That's the million dollar question. In a really busy clinical environment, you have a leadership role and then you're adding school back again. How do you juggle it all?
Koppolu: There isn't a magic answer. I think with time, you do get better at time management. And at the end of the day, I think when you're really passionate and want to do something, you find a way to make it work. And I think part of it is those skills. Part of it is having wonderful support of the people around you and my colleagues, my family and others, who just support me and motivate me. I've had wonderful mentors in my career that have not told me what to do, but just know me well enough to encourage me and guide me along the way.
And the other thing is just having grace. Nobody can do everything all the time, but you take it step by step and you take the good with the bad. And some advice that I always like to give myself and those that I work with is, "It's okay to say no. It's okay to set those boundaries. It just means you're saying yes to something else that you're prioritizing." And so, just making those conscious and thoughtful decisions day by day, little by little.
Adewuya: I really like that. Saying no is basically saying yes to something else. What I'm hearing from your journey is how you've been able to leverage your interest in different things and craft a career that really speaks to your passions. And I'm wondering if you can share for people with multiple interests that seem very different from one another, what advice would you give them to finding the intersections between them?
Koppolu: I think that sometimes it just takes some personal reflection about the common thread that ties these things together. I think about different things I've done so far in my career and they all tie back to child health, it's just in a different way. So, in one role, it's as a clinician providing care to patients. In another role, it's as a child health advocate. In another role, it's educating future nurses and nurse practitioners who want to work in this profession, work with children. And then in other avenues it's as a leader.
And so, they all seem different and they all [inaudible 00:18:01] different skill sets, but at the end of the day, the true north is all of it is related to hopefully being a great advocate for children just in different ways. So, I think that's really important. And knowing that all of these multiple interests, although they're very diverse, they can be very complementary. And so, your work as a leader will help support you as a clinician, will help support you as an educator. Whatever paths you choose in your career, they all are very complementary to one another.
Adewuya: Whether to your educational journey or career journey, I imagine it hasn't been smooth sailing all the way through. As a form of giving advice and sharing with our listeners, what were some of those biggest challenges?
Koppolu: Well, I think a lot about my educational journey in my professional career, and it's always felt like a journey of firsts. I'm the first nurse in my family, first nurse practitioner in my family, first to travel across the country from New Jersey, where I grew up, to pursue my educational dreams and professional goals. The first to serve as a manager for our medical subspecialties. The first to be a part of this fellowship program I'm building.
And so, I think probably one of the most challenging things is not always having a roadmap, not always having a bit of a guiding light of how you're supposed to do things and where you're supposed to go. So, that's always been challenging. But at the same time, I learned a great quote after the pandemic, I think it was Winston Churchill who said, "Never let a good crisis go to waste." And so I think about that, especially in light of what we've all gone through, through this pandemic, that the challenges are there for a reason, and while they are hard and while they present themselves, at the outset, you really do learn something from them and there's always something to be gained from them.
And so I think, again, having great mentors, having people that just support me along the way and really encouraged me, made those challenges that much easier. And had they not been there, I don't think I would end up being the professional that I am now.
Adewuya: You've answered my next question, which was, what helped you keep going? And it sounds like it's good mentorship, a good support system and a commitment to whatever your north was. You knew what you wanted to do, which is everything surrounding caring for kids and for children, and basically just used that as your guiding star.
Koppolu: That's exactly right. I would say first and foremost, it's patients. It's getting to work with children every day. They motivate me because they are resilient and they are strong and they are flexible, and I learn from them every day. So, they're a primary source of motivation. Community, the people around you, my colleagues that I am so honored to work with, all of the other advanced practice providers here that I've met, here at Stanford and around the country, all of our multidisciplinary team members, I'm inspired by them and motivated by them.
And of course, my family. I'm the daughter of immigrant parents who sacrificed so much for my sister and me, and we've had such wonderful opportunities to grow and learn. And I think about that now as an adult, how much sacrifice they meant and what an investment that was. And so, I hope to do them proud and to have that investment really be paid off in the end. So, definitely, family, community and that true north, exactly, is I think what's helped me.
Adewuya: I'm certain that your parents are beyond proud with everything that has been accomplished. I'm also a child of immigrants, and so I know that as you get older, you're more aware of the sacrifice, but I also know how incredibly proud parents are of their kids.
As we wrap up our conversation, let's end with some advice that you might have for nurse practitioners who are minorities in their field. Any takeaways for them that you'd like to share?
Koppolu: I would say that you provide value. You provide a very unique and distinct voice to your patients and your families and to the professional role. And that your experiences, your perspectives, your ideas, again, will only make this professional role that much more rich and that much more meaningful. And just always keep that in the back of your mind.
Work hard, of course, but remember to give yourself grace in the process. It is not easy. It's a lot of work and there are ups and downs, but to just take each day as it comes and be flexible. And I think, again, keeping that perspective of that unique value that you will provide, I know that you'll be successful.
Adewuya: That's really powerful. We all have this value that we add into the cog of the health care system. I'm very thankful that I got to hear a little bit of your story and the great work that you are doing and that you're continuing to do to serve the pediatric population. Thank you so much for sharing your story with me today.
Koppolu: Thank you so much for having me.
Adewuya: Thanks for tuning in. This episode was brought to you by Stanford CME. To claim CME for listening to this episode, click on the claim CME link below or visit medcast.stanford.edu. Check back for new episodes by subscribing to Stanford Medcast wherever you listen to podcasts.
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Managing Director, Center for Continuing Medical Education
Stanford University School of Medicine
Pediatric Nurse Practitioner
Stanford Children's Health