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While some people know at an early age exactly what kind of work they want to do, Elizabeth Gray, FNP-C (Class 188), MSN, is probably like many of us in that even upon graduating from college, she wasn’t sure where her next step would take her.

“I considered many different occupations,” she said. “I have a degree in history and had considered veterinary sciences, zoology, anthropology/museum sciences, and photography, amongst others. I ended up in nursing because I desired challenging, fulfilling work and the ability to work anywhere in the world.”

Currently, that place in the world is Boise, Idaho, where Gray works at the Boise Veterans Affairs (VA) Medical Center. A 2021 graduate of FNU, she joined the VA in August 2021 and completed their primary care nurse practitioner residency program before assuming her current full-time position in August 2022.

In her position treating military veterans, she has found the unique, challenging, and fulfilling work she sought. She splits time between the Women’s Wellness Clinic and working on building a new program that will manage lung cancer screening for all patients in the Boise VA’s care.

“Veterans are a very distinct population, as most of them have experienced either combat, extremely stressful scenarios, toxic exposures, and other military-specific situations,” Gray said. “As their provider, this presents particular challenges because it is not uncommon to see rare conditions such as multiple myeloma, cancers at young ages, and others. It’s important to keep these less common conditions higher in my differential process and always consider how military exposures could be impacting their long-term health.”

Gray said that there is also a high rate of chronic mental health conditions. These conditions, such as post-traumatic stress disorder (PTSD), impact all aspects of care.

“Particularly with the women’s population, there is, unfortunately, a notable prevalence of military sexual trauma (MST),” Gray said. “Many veterans have been through a great deal of hardship. It is so important to build a strong foundation of trust and ensure they feel seen and heard while engaging with the healthcare system.”

In the Women’s Wellness Clinic, Gray manages wellness screenings, chronic conditions, acute care needs, mental health conditions, and transgender healthcare. The scope of cases is broad and includes diagnosing and managing a wide spectrum of acute and chronic conditions in every body system. Commonly seen issues include coronary artery disease, diabetes, COPD/asthma, thyroid disease, family planning, hormone replacement, depression/anxiety, fibromyalgia, spine/ orthopedic issues, and others. Gray also provides access to specialty OB/GYN services for more complex women’s health needs and maternity care by way of early referral to obstetric or midwife services.

“I have a panel of primarily female patients and several transgender patients,” she said. “One great thing about the VA is that we have access to almost every specialty in-house, and there is a lot of opportunity to build great working relationships with the providers. I think this is really beneficial to providing high-quality care because if I have a complex patient or am unsure how comorbidity, say something like multiple sclerosis, could be playing into the symptoms I am evaluating, the specialists are very accessible.”

“FNU graduates are more motivated to take on the challenges of working with higher-risk and more vulnerable patient populations.”
– Elizabeth Gray, FNP-C, FNU Alumni

The other half of Gray’s responsibilities include working as a Lung Cancer Screening Coordinator. She is part of the start-up team that will be developing this program at the Boise VA. Once fully operational, it will involve identifying veterans who qualify for lung cancer screening following the United States Preventive Services Taskforce guidelines, then managing and tracking findings to ensure no one falls through the cracks. Gray will be part of the team that closely monitors identified lung nodules for suspicious changes and facilitates quick referrals to pulmonology or oncology as needed. She will also assist with bronchoscopy and lung nodule biopsy procedures.

Gray has quickly become an integral member of the team at the Boise VA – a group that consists of several fellow FNU alumni, including Elizabeth Ballweg, FNP (Class 158), Megan Fitzmaurice, FNP, DNP (Class 20), and Megan Simenc, FNP-C (Class 155). Gray said they also share her willingness to take on unique challenges in addressing patients’ healthcare needs.

“My impression is that FNU graduates are more motivated to take on the challenges of working with higher-risk and more vulnerable patient populations,” Gray said. “I think that the type of student FNU attracts are those who are not afraid to face settings that demand thinking outside the box and providing solutions for some of the greater issues in our healthcare systems.”

What unique challenges lie ahead for Gray are yet to be seen, but for now, she is embracing the fulfilling work she is doing at the VA.

“I am still getting miles and experience under my belt,” she said. “I intend to continue growing my career in the VA system, building my patient panel, and expanding my knowledge through additional specialized training. I am also now doing some precepting on the side for the VA’s nurse practitioner residency program and hope to become more involved with it down the road.”

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