NURSES MOVE INTO NEW ROLES IN MEDICAL SCHEME

Debbie Sutherland, left, a nurse practitioner at St. Francis Medical Center, issued discharge instructions for Angela Varner of Tamms, Ill.

Doug Bell of Eureka, a student at Southeast Missouri State University, reacted to a probe of his ear by Cathy Young, a family nurse practitioner who works at Crisp Hall.

The traditional role of nurses in the medical scheme has been to monitor a patient at a hospital's bedside and do the hands-on types of treatments and exams physicians don't have time for.

A new breed of nurses, called advanced practice nurses, is moving that traditional role outside the hospitals and into the forefront of managed health care.

"The family nurse practitioner is going to be the main primary care provider for the future. That is a growing market all across the United States," said Dr. A. Louise Hart, chairwoman for the nursing department at Southeast Missouri State University. "It is really an exciting opportunity for nurses to use their whole gamut of skills that they're taught."

The university's master's program in nursing has doubled over the last few years, Hart said.

Jennal Johnson, a nurse practitioner and coordinator for the diabetes center at St. Francis Medical Center, said there are opportunities for advanced practice nurses in the Cape Girardeau area and the potential for the growth in that field may coincide with the growth of managed health care.

"It all depends on the physicians' reception," Johnson said. "We have a collaborative agreement, we don't do this all on our own. It could become a very nice partnership. Nurse practitioners can bring a lot of value to a physician's practice."

Nurse practitioners are different from physicians because of the complexity of the ailments they treat. "We will see people who have some limited diseases or minor chronic illnesses," she said.

"One other thing that I think does differentiate us from physicians is that we spend more time at a visit than a physician can afford to because generally they see a higher number of patients than we do," Johnson said, adding the length of time a nurse practitioner spends with a patient can be twice as long as what a physician can schedule. "They also have much more of a disease focus and we have more of a wellness focus."

The ability to educate patients in preventative care and monitor their every day treatment is what makes nurse practitioners valuable additions to a physician's practice.

"What we provide as nurses is, we manage those patients that the physicians have already developed a plan of care for," said Kathy Blevins, a women's health nurse at East Missouri Action Agency Family Planning Clinic. "We keep seeing the patients and we make sure the patients are doing well with their medication. If anything comes up out of the ordinary or if the problem keeps getting worse, then the physician takes over again."

Blevins can manage about 90 percent of the cases she sees without a physician's referral because the majority of her work is routine health care for basically healthy females.

"Scope of practice is the key word," she said. "My scope of practice is women's health so anything that's not within my scope of practice that I'm not real sure about is someone that I would refer."

Dolores McDowell, a nurse family practitioner at Cape Girardeau County Health Department, said her practice does a lot to free up the hospitals' emergency rooms from unnecessary visits.

"Many people were using the emergency room as their primary care center," McDowell said. "The emergency room is a costly avenue for treatment, especially when many of the people going there shouldn't be. Nurse practitioners take the place of the emergency room diagnosis and referral, or treatment."

McDowell said both St. Francis Medical Center and Southeast Missouri Hospital employ advance practice nurses. The field has branched out over the last decade from just a few nurses to nearly 30 and they include nurses at the university, satellite clinics and specialist offices.

"That's another thing that's very specific to nurse practitioners, we're more into teaching and preventive care, management of care, versus what physicians do which is acute care," she said.

Blevins said nurse practitioners lower medical costs by heading off expensive medical treatments that can be prevented through education.

"The type of preventative care we provide and the health teaching saves medical dollars," she said. "If we prevent unintended or unwanted pregnancies at my clinic we've saved about $6,000 for each pregnancy and that can probably be done for $50.

"That's what cost-effective means. Whatever we're doing in the preventative way is saving dollars down the line."