Interview with Dr. Christine Hart Kress, DNP

Dr. Christine Hart Kress DNP, a leading women’s health nurse practitioner, discusses her journey in the healthcare field, achieving a Doctorate in Nursing Practice (DNP) to enhance her leadership role as a Chief Nursing Officer, the challenges of bedside nursing, and what led her to specialize in Mid-life and Menopause Telemedicine Care.

Charlotte: Good morning Dr. Kress, thank you again for taking my interview. If you’re ready, I can start with the first question. What originally inspired you to pursue a Doctorate in Nursing Practice (DNP) instead of another nursing pathway?

Dr. Kress: Okay, so my advanced practice nursing degree is as a women's health nurse practitioner. A doctorate (PhD) is a terminal degree for nurses, and I was in an executive leadership role, and at the time that I was pursuing my degree, because I was the senior nurse, I was the Chief Nursing Officer, and I felt that that gave me a greater seat at the table with the physicians and the administrators, by showing that I had attained that terminal degree for nursing. So for me, it was about showcasing my expertise.

Charlotte: How did your expectations of nursing compare to the reality once you began practicing?

Dr. Kress: So I realized really quickly that I liked bedside nursing, but that it was often a struggle when I was working with residents and junior attendings, because my education was quickly outpacing the providers that were ultimately responsible, and so it became really apparent to me that I knew more than the people in charge, and that I needed to keep accelerating my degree so that I had more autonomy as a nurse. And so then I decided to become a nurse practitioner. And in I think it's 25 states, nurse practitioners are autonomous, meaning that we have achieved the academic milestones and the certifications and the number of required hours in Virginia, it's 5000 hours of care in order to apply for an autonomous practice. I don't work under the supervision of a physician, and so I don't think that I really expected to feel so challenged when I was initially a nurse, I thought I would be a bedside nurse forever. I started calling the residents later to deliveries than I probably should have but they were so not helpful. So that's when I decided that I really needed to pursue my advanced degrees.

Charlotte: That's really interesting, what has been the most meaningful moment in your career so far?

Dr. Kress: Working specializing in mid-life and menopause care, I think it is one of the most under-recognized, under-valued specialties. You know, when I was a young nurse practitioner, I was all about OB, and I found that, as I have aged, my interests have changed and moved with me. And so when I was a younger nurse practitioner, I did the breastfeeding certification and the lamaze certification, and then as my kids aged, I was doing colposcopy certifications. And so here I am in my mid 50s, and I'm now certified as a menopause practitioner. I think so many women are gaslit by their providers, because women have a 10% chance of finding a provider who is well versed in mid-life care, hormone therapy, and so I get a lot of patients that are at their wits end, they have been searching for months or years for answers to all of their symptoms that don't really make sense, but when you look at them under the context of hormonal changes, they make tons of sense, but we have not taught medical students, residents, attendings. It's not in any of the very little education, as in any of those programs, maybe an hour, maybe two hours, in an OB GYN residency, and then in continuing education, whether it's a conference or something that you're doing virtually up until the last two years, there was not any information on midlife and midlife care hormone therapy, because of the WHI (Women’s Health Initiative) people stopped talking about it and so it is more complex than providers realize and it takes a lot of time, so a lot of providers are not wanting to do hormone care. So by the time a woman gets to me, not only has she been gas lit, told her labs were normal, but yet she still feels terrible. She is probably on one to four medications for chronic conditions that could have otherwise been prevented by just replacing, moderately replacing, the hormones that she is losing or lost since she entered into menopause or while she's transitioning into menopause.

Charlotte: Wow, I didn't know that it's so hard for a woman to find a good provider.

Dr. Kress: Most providers won't treat or they will say it's just aging, or you should go on an antidepressant, or you go on a birth control pill. I've been practicing for a long time, since before the WHI and so when the WHI was published, for the next five years, we told women, you know, you can't be on hormone therapy. It's going to cause breast cancer, you're going to have a stroke, you're going to have a heart attack. And so what we would do is we would put people on birth control pills, because the number one presenting symptom is usually some kind of anxiety, depression, mood changes and so and then, of course, the first symptom that someone's going through menopause is period changes. So if you put them on a birth control pill, you stop the bleeding, which means they stop coming in, and then you levelize out their mood changes and which means they stop coming in. And you hope that all of their other symptoms, which most providers don't realize are from hormonal fluctuations, will go away. So in an insurance based system where you're expected to see a GYN patient every seven and a half minutes, it's the quickest way to get through your day.

Charlotte: What inspired you to start your mid-life and menopause telemedicine practice?

Dr. Kress: My own difficulty finding care and realizing that it didn't have to be this difficult for women, but then it really has evolved, because hormones are just one piece of the puzzle and the level of support require. The level of support women need means you need time. And so new visits are an hour. Follow up visits are 30 to 45 minutes, which is the time that you need. Because not only are you looking at their hormones, you're looking at the chronic conditions that they've already have amassed. You're looking at their vitamins and minerals, which, if that foundation isn't good, it winds up impacting their hormones. It impacts their gut. It impacts their metabolic flexibility, which then ties into all their chronic conditions. But women also, the nutrition is different, the exercise is different, sleep is different. The things that they need to do to optimize their health for the next 40 years is a much different trajectory than we ever knew. And so for me, it's very comprehensive and holistic. And I think the greatest thing for me is seeing women. All of my patients have come off their blood pressure medications. All of my patients are reversing or improving their osteopenia, their bone loss, and most importantly, they feel great and they're back to who they were. All of those symptoms are minimized, if they're there at all, and it's improving their quality of life. And women are saying, I finally feel joy again. I actually enjoy the people that I live with, I have the resiliency to deal with being caught in a generation where you have aging parents and kids in school and high power jobs and seeing women be like, I can do my job again. I can sleep again. I don't hate my family again, I think is all very rewarding, and I think it's the first time in my career where I actually see that the work that I'm doing really is changing women's lives. And it's just so rewarding, because to me, it's so simple, and it's such a shame that other providers don't have the training that I have in order to make those impacts.

Charlotte: That's really inspiring. I just have one last question, how do you balance clinical responsibilities with those of running a practice?

Dr. Kress: It's a full time job all the time. I have a network of providers that we all started our businesses about the same time. And what we realized is we all need to do the same things, and we are licensed in other states. These are other women across the country, and we don't all have to do that one thing. We all need an intake form, we don't have to have 10 different intake forms. And so we work together to create the things that we need for our practice, whether it's a lab guide for a patient or a menopause insights guide or something about fiber, or we want to do webinars monthly, or we need to do newsletters or blogs. And so we have all gotten together, and we have just force multiplied by splitting up the work and sharing, which I because we're not each other's competition. There's, you know, billions of women entering menopause every day. There's plenty of people for all of us. And so by working together, we have shaped and developed our practices to get the outcomes that women are needing. And I think that has really been the way that I get a lot accomplished to develop my practice with still protecting some of my own time, because you still have to see the patients, but then you also have to develop the programs that create the outcomes. And then, of course, I think the other thing that I have learned really quickly is, when you're a new entrepreneur, you just have to do all of the things because you're not established, you're still making your money, so to speak. But then once you start having an active practice, it is outsourcing it like I am not a good bookkeeper, I am not a good CPA. I don't want to do the social media, so it's really putting, like one of my friends says, aces in their places, hiring the people that can make your life easier so that you can get your time back. Because at the end of the day, I'm not just a clinician, I'm not just a practice owner, I'm a mom and a wife and a dog owner, and I like to do things because I'm also a mid-life woman, so I have to eat the fiber, eat the protein, do all the stuff, so there has to be some space in that.

Charlotte: Okay, well, this has been really informative. I've learned so much from our interview. Thank you again for your time.

Dr. Kress: You’re welcome.