This year, as AACN’s National Teaching Institute & Critical Care Exposition (NTI) celebrates its 50th anniversary, we honor our commitment to continuing education. Among NTI’s most popular session facilitators is Douglas Houghton, DNP, APRN, ACNPC, NEA-BC, FAANP. For 25 years, Houghton has presented a broad range of topics, including antibiotics and infection, ethics, APRN leadership and more. In this interview, we explore Houghton’s NTI experience and how he has embraced the roles of a lifelong learner, educator and leader.
Please introduce yourself.
My name is Doug Houghton. I'm the associate chief nursing officer for advanced practice at the University of Miami Health System. I've been an NTI presenter for 25 years.
That's amazing! You’ve presented at half of our NTIs. Tell us about your personal nursing journey.
I became a nurse about 40 years ago. I started at 17 as a nursing assistant in a nursing home, a part-time job to put myself through prelaw. I saw what a huge difference nurses make in the life of a patient or in the day of a family member. It was that human impact that inspired me to bail out of prelaw and go to nursing school. So I became an RN and graduated in 1987. Yes, I know I'm speaking to audiences now at NTI where many of them were not yet born when I graduated. I have fun with that and embrace it.
How did you choose critical care nursing?
After completing all my rotations through nursing school, I knew I didn't want to work in the operating room. Back then — and probably still today — you'll hear the advice to go to medsurg for a year or two to get some experience first. And I said, “Oh, heck no, I'm not doing that.” I want to work in critical care. That's my passion. I just love the intensity of critical care. The acuity of the patients drew me, because it emphasizes the critical role that a nurse can play in the life of the patient.
When did your leadership career begin?
I would call myself an unintentional leader. I never had any aspirations to be one of those people with the suits, looking over people's shoulders. But here I am. How did it happen? It happened little by little, and it started by leading from a clinical perspective.
One of the things that I tell every new nurse and every new nurse practitioner is that this is not labeled a leadership position, but patients look to you for leadership. Other providers will look to you for leadership. Patients’ families look to you to lead the way and guide them in the right direction. I think that clinical leadership is where it all starts, and every nurse should be capable of doing that. To mentor a new graduate, I don't think you need to have 20 years of experience.
How did you start as an NTI session facilitator? Did you have a mentor?
The mentor who inspired me to start presenting at conferences was a trauma surgeon and a critical care intensivist. He said, “You're smart, you can do this.” So I submitted an abstract to NTI. First year, boom, I got that one accepted. That was in 2000, and it was called “Super Bugs vs. Super Drugs.” We were starting to recognize how overuse of antimicrobial agents was leading to the creation of all kinds of multidrug-resistant bacteria. I was super excited with my first NTI. I wish I had gone much earlier in my nursing career when I was a bedside nurse, because it's so motivating and so inspirational to be at NTI and feel that energy, the group, the team, the spirit. It's just a great experience that I recommend to everybody.
Your NTI sessions are very popular. Tell us about what you’re presenting this year.
APRN leadership in critical care is a new topic for me, although experience-wise, it's certainly not new. Now that I've been in APP [advanced practice provider] leadership for a number of years, I thought I would share some of the lessons that I've learned — first in critical care and then in the broader sense of hospital leadership. APRN onboarding for critical care is a key factor because I think that if you set people up properly, your chances for success in retaining that person are going to be much, much better. We're going to go over best practices, mentorship and productivity. How do you decide how many patients is the right number for an APRN in critical care?
The second session is tracheostomy, something I have spoken on in previous years in different ways. Personally, I've been performing tracheostomies independently for more than 20 years. I teach tracheostomy through the percutaneous method in the intensive care unit environment. While this is not a hands-on session, I've noticed that tracheostomy management can often leave a lot to be desired. That's what this session's about: how to know when to do it, how to do it, what patients need what care, and then how you follow up with each patient.
My other session is my first love, which is on antibiotics and infection, an update on the evidence for 2024. We will review the latest trends in multidrug resistance in the common organisms that you find in a critical care environment. We'll also discuss best practices for diagnosis of infection, because that's a key point. You have to make sure that you're diagnosing in the best and most accurate way possible so that we're not overusing antibiotics. We've also learned a lot about how antibiotic failure can occur in critically ill patients, especially people who are very third-spaced, very swollen, very edematous patients, who lose antibiotics into the tissues. So I'll be sharing some newer information looking at different ways to dose antibiotics in those types of patients.
Will you have time for learning or SuperSessions?
I love the SuperSessions because of the energy! You leave there renewed and refreshed and like, wow, there are so many people that are doing this work. It's just super energizing. I always make a point to get to as many SuperSessions as possible. And yes, indeed, I do still go to as many CE sessions as I can, especially on the Advanced Practice Institute (API) track. And pharmacology credit — that's always what I'm hunting out. Like most other advanced practice nurses, you need that pharmacology credit to maintain your certification.
The development of the advanced practice content within the NTI [curriculum] has been a really valuable, smart move on the part of AACN, because they have kept pace with the growth in advanced practice. As we were able to demonstrate how beneficial advanced practice nurses could be in the critical care environment, the API has been a very valuable part of helping to keep us going in the right direction.
What advice do you have for those who would like to submit an abstract and present at a future NTI?
My advice to anybody who hasn't presented yet is to only submit abstracts for topics you can really get excited about, that you know, and that you feel you'll be successful presenting. If you have that passion and knowledge and experience, share it.
I enjoy it. Engaging with the audience to me is the best. That energy is truly gratifying. It's been such a valuable experience for me. I've grown so much as a person and as a professional through having the opportunity to present. I will mentor anybody who wants a mentor.
What would you say to a nurse who has never attended NTI?
You have to do it. The most valuable thing that I've done in my career as a critical care provider and as a critical care nurse is to start going to NTI. It just helps you grow so much. It is worth every dollar. I feel strongly that this is something that should be reimbursable by every organization. And I make every effort to support people where I have the opportunity to, because that investment in sending your nurses to NTI will be recouped by the organization by coming back with fresh ideas, new innovations, passion and just a refreshed perspective on their own job and their own role in that critical care unit. It is, to me, a career-changing experience. And I think it's something everybody should do. I just wish I had done it earlier.
Join Us at NTI 2024 in Denver
NTI 2024 in Denver marks NTI’s 50th anniversary. Do you have a great memory from your first NTI? We want to hear it. Submit your story idea today.