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Welcome to the Nursing Edge Unscripted, the NLN podcast where we dive into the topics transforming nursing education and practice. I'm your host, Dr. Kellie Bryant from the National League for Nursing, and I'm joined by my co-host, Dr. Raquel Bertiz, who is our senior manager at the NLN. In this episode, we're exploring the importance of genomics, how it helps us predict disease risk, personalize treatments, and transform patient care. But here's the question
for us as nurse educators. Are we preparing students to step into a health care world where genomics is part of everyday practice? To help us answer that, we're joined by two incredible guests. one an expert in teaching genomics to nurses and the other a nurse practitioner who applies genomics in clinical care. Together we'll discuss why genomics education matters for every new graduate and explore practical
ways to weave it into our curriculum. Whether you teach in the classroom, simulation center, or clinical setting, you'll find strategies you can take back to your own work. Before we dive into the full conversation, let's share some of our reflections right after the taping. Raquel, that was, that was that was an amazing podcast. That was awesome. And we are definitely into something that would have to be
looked at in nursing education. I think right a lot of times genomics we look at this as high level concepts but after having this great conversation with our experts they're
really not. They're like, everyday life. I know they brought up a good topic that it this can't be save all of this for one course you know or have a genomics course it's something that needs to be threaded throughout it's not just I'm maternity so obviously we touched upon genomics when I was in school because we talked about genetic testing and maternal testing. This is something that affects every age. It should be in every course.
But what's important is what do we teach? And I think that's what nurse educators need to know. So I'm so glad to hear that there's competencies out there. That's a start, right? Because there's so much to cover. So what is essential? What is important? Whether it's a you know BS student, baccalaureate or it's a you know advanced practice, right? Right. Student and and it's really it's application from even pre-birth. Right. So
pre-birth to even end of life to death. So you see the application of genomics, the science of it. And what was great too because both of us
are simulationists. I during the conversation I saw so many opportunities where do simulation to help with you know bringing those competencies home and and and providing learning and teaching strategies for our students such as just having a simulation on how do you deliver news to someone that they just got the test results back on let's say BRACA1 and 2 and now they've tested positive what does that conversation look like so have using simulation to practice some of
those difficult conversations I know so in. You're already designing the simulation right there and then. I can't help it. I was even thinking of, oh, what what pre-work should be assigned here, right? So, it was really great. Yeah, it's good. I think a lot of our listeners will really enjoy this podcast. [Music] Let's turn from our reflections to the experts driving this important conversation. Genomics is transforming nursing practice at every level from the classroom
to the bedside. To explore this, we're joined by two experts. Our first guest is Dr. Deborah Himes who is an associate professor at Brigham Young University and also a nurse practitioner in clinical genomics with the San Francisco VA VISN 21. Our second guest is Dr. Cindy Snyder, who is the director of clinical and screening programs at the Georgia Center for Oncology Research and Education. We're thrilled to have both of you here joining us today. Great to be here. All right,
so started. Thank you. I want to first, even though I did introduce you and and you know state your title, can you tell us a little bit more about your roles and what your position is at your current institution? And I'll start with
you Cindy. So my main responsibility here at the Georgia Center for Oncology Research and Education and that is short we'll say Georgia core C O R E. I am the advanced clinical genomics nurse practitioner that administers and is responsible for the genetic screening program that we do in partnership with the department of public health.
So I actually work in public health genomics and women who are seen within public health departments are screened for hereditary breast and ovarian cancer and if they screen positive they're referred to me for genetic testing and and that's my main responsibility here at Georgia CORE. So I did work in clinical practice prior to this at a hospital system for about 36 years and in the last part of my career there did the I was in a hereditary cancer risk assessment clinic
there. Okay. Well, thank you. Very interesting position. And Deborah, can you tell us a little bit about your role where you're at the VA? Yeah, sure. So, I'm full-time associate professor at Brigham Young University. I teach genomics to both undergraduate and graduate students and I worked as a women's health nurse practitioner for several years before obtaining my PhD. And there I focused on genomics. And so recently I've begun working part-time with the San Francisco
VISN 21 genomics clinic. In there, I primarily do intake visits and coordinate patient cases as they're preparing for diagnosis and testing and then collaborate with the physicians. And I got to say I love genomics and I am so excited that we're talking about it today. Yes. I don't feel like we
talk about it enough. So, I'm glad that we're having this podcast because as someone who was a nurse faculty, you know, I don't think there's enough genomics in our curriculum, at least to the extent that it really needs to be. So, let's dive in. So, that's sort of kind of my first question. How would you explain the relevance of genomics in everyday nursing practice to educators who are listening to this podcast who may not feel comfortable with teaching the content?
So Deborah and I talked about these questions beforehand. So I'm going to try to try to give some perspective on the first one here. And so I'm a family nurse practitioner by trade, but I've been a nurse since 1983. And so I have all degrees related to nursing practice that you can actually have from an associate to a doctorate in nursing practice. And I've seen,
you know, genomics grow from 1983 to now. But I just finished the AANP online national on demand conference and I can't tell you how many times I heard in these presentations the word genomics, epigenetics, pharmacogenomics, genetics in presentations from women's oral health, which they talked about hereditary gingival hyperplasia, to lipids. And so it's so very important for nurses, BSN and graduate level nurses, to have a clear
understanding of this information. You know, guidelines for practice follow the evidence that is out there and so we have a lot of evidence and research to support practice with genomics and pharmacogenomics, but the guidelines take a little bit longer, you know, to to be updated based on that research. And so I think it's just very important for nurse to have nurses to have a strong understanding of these concepts so they'll be ready when the guidelines are updated. Thank
you. Deborah, do you have anything to add to that question? Genomics is important because as you said it applies to everyday nursing. I think that the biggest misconception is that genomics is a specialty and it is not. It applies to every nurse at every level and in every setting of practice. I was just very curious about the how do we kind of like give specific, concrete examples of how genomics is really transforming
patient care? So kind of like sometimes we talk about yes genomics pharmacogenomics they're, they're so abstract. So can you give one specific example for how genomics can really create or enhance patient outcome? I can. Yeah. That's what you do every day, right? I mean I can tell you there is a very cheap genetic screen and that's a family history and taking a
three generation pedigree. And when you look at a family history and you look at three generations, you can start to pick up patterns within that family and you can determine that this family may be at increased risk for a certain disease process
or for cancer. And I think it's just, you know, that's one thing right there where you can make a really huge impact on patient care when you look at that family history and look for those patterns that are oftentimes, you know, may be hereditary and certainly related to genetics. Yeah, and that ties up very well with what we do as nurses, right? Assessments. But yeah, I'm just imagining like, okay, how I'm going to do assessments and get that like three generation pedigree,
right? So, I think those are the practical aspects of care that I have in mind. But, but thank you for that answer. And and I want to bring up something that happened just last week. So last week I went to see my health care provider for my yearly exam and it was interesting because soon as I sat down I had to do this questionnaire and I didn't really know what it was and it was all about the genetic history, my family history. So, I filled out the questions like who had cancer,
what age, all these things. And then I it said that I was at high risk for what I didn't pass the screening test, whatever it was. And then they offered me a genetic screening test. And she gave me this brochure and and you know, she asked me if I wanted to participate in this extensive genetic testing and it had a list of all these different
things that they were going to test me for. And you know, she wasn't sure if insurance was going to cover it, but they would, you know, get back to me and tell and once they looked at my insurance and then I could decide which test I wanted to include. I remember BA1 was on there, BA2. I can't remember all of them. That was new to me. Is this something now that we're going to start seeing commonly in when we go to get our physical?
So this is what's happening now with in the state of Georgia, which I'm as far as I know is the only state that has this public health genomics program where women who come in are screened with a family history tool for hereditary cancer. But this is also happening at mammography centers. So there's a hospital system in southwest Georgia who screens women who when they come in for their mammograms with a tool to determine if they're appropriate for genetic testing for hereditary
breast cancer. So this is becoming part of the regular process that women and men go through when they're going in for their health care and talking
to their health care providers. and Raquel as far as how do you do it a three generation pedigree you know oftentimes this stuff has to be embedded within EHRs and they often times are and they're getting better the the electronic health records are getting better at documenting family history and that kind of like leads me to another question about like misconceptions that nurse educators have about genomics and its role in
nursing, right? Because earlier we said, "Oo, it sounds so specialized, right?" But what do educators think in in your experience and what misconceptions have you encountered from educators about genomics and its role in nursing, right? Yeah. So as I mentioned, I think that the biggest misconception is that it is a specialty and does not apply to whatever area they teach. And you know this bears out in research when nurses are asked is genetics important? Yes. Is
genetics used? Are you using it? No. So how can something be important if it's not practiced? I think what nurse educators sometimes don't realize is the extent to which the things they are doing are informed by genetic principles and genomic principles. And I think that if we learn to call those out, then we will be helping students feel comfortable that they understand these principles. And as we recognize it, we'll
be able to build on that information. A lot of times cancer is the go-to for genetic practice and you know Kellie experienced that in her primary care and that's Cindy's area of expertise but genomics has practical implications in primary care early detection risk identification diagnosis acute and chronic disease nurses you wouldn't think nurses in the emergency department may need to understand genomic principles, but they do. And I'll give you an example, sudden cardiac death
in a teen who's playing sports. A child comes into the ER and best attempts are made to save. And if the child's not saved, having genetic information about this child can be helpful to other family members. There's there's a common misconception that oh, we can just test everyone else and find out. But it it's not that simple. Sometimes the things that we're looking for haven't been defined
clearly. And to know what's present in somebody who was affected by disease and whether or not siblings has that have that can be very helpful. So an ED comes out with a plan. We're going to draw some blood to biobank if we have a sudden cardiac death and the RNs are in a position to support that or not support that, right? If they have the misunderstanding that, well, we can just test everyone who's possibly affected and not understand the information that testing that
family member could have. They may not participate in that. So, it it affects every area. I have a question. I want to tie it back to nursing education because the field of genomics, like you said, is broad. It's vast. there's so much that you know content-wise that we can cover under the topic of genomics. So when it comes to nurse educators what is essential that we want whether it's a BSN student, APRN student what are those essential core topics that you think that
they should have before they graduate? I like you, Deborah. I'm a woman's health nurse practitioner. So, I had some exposure because we did prenatal screening. So, I know a little bit about, you know, some areas of genomics within my field. But what do you think are those key essential elements that every graduate needs to know regardless
of what, you know, level they're at? Right. So fortunately we have some essential genomic nursing competencies and they were originally developed by the ANA and ISONG way back in 2009 and their most
recent update came in 2024. So hot off the press and these cover topics such as Cindy mentioned covering family history understanding genetic testing what they can and can't show because as we know patients have tests and they ask their nurses about it if you're a nurse practitioner you're ordering the test application of genomic science in terms of pharmacogenomics and how bodies
respond on to drugs. But there's a lot of ethical, legal, and social implications for genetics that you can dive into a little bit because some of the ethical principles are across the board apply. But there's additional ethical principles that maybe we haven't been taught in our ethics classes or that relate a little differently in genomics. Yeah. and and tagging along with nursing
education and our roles as nurse educators. So what strategies or teaching methods have you found most effective in helping our learners or our students connect genomic concepts to clinical situations? Yeah. So my my favorite way of teaching is to explain a principle and then provide a resource and give them practice. And to do that you need to have case studies and examples. But I'll teach my students for example principles of inheritance. That's very basic
genomic science. Something's autosomal dominant, right? And we like to make our pundit squares, but Punnett squares are about genetic inheritance, not necessarily about phenotype, meaning how it translates into the body, right? And so what you'll find is that students need to understand things like incomplete penetrance or variable expressivity or de novo mutations. Teach these principles and then show them how they can look
up information about those principles online. Then give them a case study and ask them what would you what would you tell your patient? I do this with my nurse practitioner students and my RN students. I think it's also important to highlight that it's under it's important for them to understand the concepts but they also need to be able to communicate those concepts to patients in living room talk. Okay? Because if you are using high-level language to patients you're
going to not get through those concepts. And so I think because I use analogies, I often, you know, talk about genes like recipes in a cookbook. And patients understand that. They understand. I said, "We're all different. Look on this screen right here. We're all different. We all have a little variation in our recipe. We're not clones of each other." And when we do testing, we might find a variation. And we don't know what it means yet. It
doesn't mean it's bad. Doesn't mean it makes the cake bad. it could make the case better. So when you use analogies like that when you're talking to patients, it helps it bring it down to living room talk and and then that way they can grasp that concept a little easier. So I think it's good to help nurses of any level to be able to learn how to do that too. And you know what I was thinking? Yes. Kellie, do you know what I was thinking when
you I know. Yes. simulation and you know you know what oh sorry what Cindy's talking about is that nurses really have to be bilingual right so we have to be able to read the research and read the resources and understand what that means and then we have to be able to explain it to our patients in a way that is accessible for them and as we do this we're going to really increase genomic
literacy in our patients Right. Yeah. And so while while you were explaining those, I have to kind of like reflect on my own understanding of what genomics is. And really that takes kind of like the the professional's ability to understand before you can even translate it to layman's term, right? I think that's an essential competency, right? We were talking about essential competencies like the living room language or kitchen language if you... Exactly. Exactly.
back in the early 2000s when they learned with BRCA 1 and two that there were large deletions that they were not initially testing for. How do you explain a large deletion to a patient? Well, I came up with an analogy of like a book. Okay. If you have a book and you proofread a book one letter at a time, you're not reading the book. You're proofreading the book one letter at a time. You're not going to know if there's a missing chapter because you're not reading the book. You
see where I'm going with that? What a wonderful way explaining it. Large deletions are like a missing chapter. And we didn't know about those in the early 2000s. But then technology has advanced, research has advanced. And I just want to go back Deborah, you had mentioned that there are competencies. Are those competencies readily available for anyone to to download to look at? Yeah, absolutely. Absolutely. And I can link the article that they were updated from. Okay.
This is put out recently by Dr. Calzone and her group and I will connect you to that. So we have competencies for every nurse and then we also have a set of competencies for those who do specialize in genomics at both the graduate and undergraduate level and that also was recently updated through the ANA and ISONG and we can link to that. Excellent. We'll make sure we add that
to this podcast. And again, what other resources, partnerships, continuing education opportunities would you recommend for faculty who want to kind of strengthen their knowledge about genomics so that they can incorporate that into their curriculum? There's a lot of good resources. I'm sure Deborah's going to give some. So, I'll let her start and if I think of anything she
doesn't say. Yeah. Yeah. No. One thing I will say is if you are a faculty member and you want to strengthen your no knowledge of genomics, you have friends because our group of genomic nurse educators is a incredible community and has done incredible work to make things easy for you. And a professional organization that I belong to ISONG, the International Society of Nurses in Genetics. It was named before we all started switching to genomics. Put online
a repository. So you can go to their web page and look for genomics education resources repository. And there are genomic nurse educators who spend their time looking for things that are helpful for teaching validating that the links work writing a brief description. In the column it says if it's free of charge or if it's if it costs and then they themselves have evaluated it and indicated if it's helpful for undergraduate,
graduate or research. And on top of all that, they categorized it based on this is helpful for teaching basic science, this is for cardiology, this is for cancer. There are resources linked on there like linkage. That's a free online little module hub that that nurses nurse educators can send their students to, but they can also go get access to educator only resources so that they have answers to case studies and things like that.
And then there's just a lot of the science based resources for clinical practice like Genetics Home Reference, which is now Medline Plus or Gene Reviews or OMIM some of those that that we use in our clinical practice. Another one for clinical practice is Jackson Laboratory. I think you were probably going to say that too Deborah but that's free. I mean that's a free place you can free is great. We'll make sure. Yeah, we are all about free and and linking and sharing and it's
a great community. Yeah, definitely resources for teaching are very important but and I know we're almost winding up but I would like to ask one more question which is very important. For example, we're overwhelmed with the science definitely especially for some of us who are not very familiar with the science of genomics. So what are the first steps that educators can take to begin integrating genomics in their courses without really overhauling the entire syllabus or
curriculum even however I handle that one. Yeah. So there's different models and it depends on who who you have at your college, right? We're not all experts in everything. So I find myself helping out faculty in in different courses. Sometimes I'll come guest lecture. Sometimes I'll help identify for them where they can call out concepts they're already teaching that are genomic based concepts. And that's very helpful.
But anything you teach, anytime you hit a disease or a sign or a symptom, you can go to one of these resources and look to see, oh, what's the genetic connection, right? Is there a heritable disease that presents this way? Let I would just say this. You know, understand that genetics is from
pedes to geriatrics. And so when you're looking at teaching the content, just like Deborah said, look to see what else is related to that condition or that or that time of life, you know, because there are more people taking biologics now, right? So we need to understand how does that work and just really kind of incorporating that into your everyday talk when you're teaching people. I think that's really important. Can I add one more
thing? You sure? One more thing on that question. I would just say it depends on if you want to dive in and get a lot of information or if you want to do it bit by bit and chunk by chunk because there are free resources for faculty members to take an online course that will provide them continuing education credit and is fully funded. We can link to that also fully funded by the NIH. Or just take one lecture at a time and and look for
the genetic connections. If you're talking about a family pedigree or sorry, a family history, I say pedigree, put a pedigree on the screen. So start exactly. Yeah, that's and hopefully in the future simulation resources, too. Yep. So it's come to an end. I mean I can go on for hours with this conversation. It's funny how fast 20 minutes can go by. But I do want to end on one
last question for each of you. If you could leave nurse educators with one key message or one pearl about why genomics matters in nursing education, what would it be? And I'll start with you Cindy. I just think that they need to understand that genetics, genomics, epigenetics, it's all part of who we are. how diseases impact us, how we age, you know, how we take medication, how the medications work with us. And I think it's just important to understand that and relay
those concepts to students. Excellent. Thank you, Sydney. And what about you, Deborah? What message you going to end us with? I would just say that national guidelines from the AACN Essentials to the ANA competencies already expect that nurses are going to be genomically literate. And so the question really isn't whether or not you should add it. It's how do we prepare students to meet
those expectations. Great. Well, I want to thank both of you for joining us on this episode of Nursing Edge Unscripted, brought to you by the National League for Nursing. A special thank you again to our guests, Dr. Himes and Dr. Snyder, for sharing your insights and expertise with us today. We appreciate your support, and we look forward to continuing this conversation about genomics and nursing education. So, thank you. Thank you. [Music]