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Prescription for Nurse Practitioners 

With more ARNPs, patients may be left wondering who should provide their care

click to enlarge In addition to working at the Spokane Valley CHAS clinic, Kathryn Sander is also president of the Nurse Practitioner Group of Spokane. - SARAH WURTZ
  • Sarah Wurtz
  • In addition to working at the Spokane Valley CHAS clinic, Kathryn Sander is also president of the Nurse Practitioner Group of Spokane.

Kathryn Sander can care for patients from birth to death. As a family nurse practitioner for CHAS Health, Sander treats patients with a variety of illnesses, focusing on management of chronic disease such as diabetes and hypertension.

Advanced Registered Nurse Practitioners like Sander may help cure the dearth of primary care providers sickening the nation's health care system. As the demand for nurse practitioners increases, patients making an appointment at their doctor's office might be given the option to see a nurse practitioner instead of a medical doctor.

That may leave many patients wondering what an ARNP is, and when it's OK to see one instead of a doctor.

"I think it really depends on two major factors," says Sander, president of the Nurse Practitioner Group of Spokane. "One is the type of practice. The second is patients' preference and what their comfort level is. "

The exact licensure requirements and scope of practice laws governing nurse practitioners vary state to state. Generally, an ARNP is an RN with a masters or doctorate degree in nursing, though there is a nationwide push to require a Doctor of Nursing Practice.

"It's pretty involved," Sander says.

There are three major subgroups of ARNPs: nurse practitioners, certified nurse midwives and certified registered nurse anesthetists. Nurse practitioners work in primary, acute and specialty settings, such as pediatrics, mental health and women's health.

While a nurse practitioner's role can vary widely depending on the setting, those providing primary care can do much of what a family physician can: assess patients, order and interpret tests, make diagnoses, develop and oversee treatment plans, make referrals and write prescriptions.

Despite the overlap in job functions, the education and training backgrounds of nurse practitioners and doctors are quite different. First of all, Sander says, they have distinct approaches to health care.

While the medical model is focused on disease diagnosis and treatment, the nursing model emphasizes disease prevention and health promotion, she says, adding, "Both are very important."

"Anecdotally, a lot of people like the holistic approach of the nurse practitioner," she says. "I think that nurse practitioners have a real strength in education and health promotion. I think patients appreciate that."

Nurse practitioners are skilled health care workers with an average of 12 years of experience as an RN before becoming a nurse practitioner, says ARNP Ken Miller, president of the American Association of Nurse Practitioners, and when it comes to picking a provider, it really boils down to choice.

"Patients can decide who they want to see and when they want to see them," he says. "The goal is really to provide them a choice as to who does their health care."

Medical doctors have four-year undergraduate degrees, four years of medical school, a residency lasting three to seven years, and three or more years in a fellowship for subspecialties. Nurse practitioners do not complete a residency.

In Washington and Idaho, nurse practitioners can practice independently of physician oversight.

The American Medical Association and the American Association of Family Physicians have opposed widening nurses' scope of practice, arguing that they cannot fulfill the need for a physician.

Regardless of their scope of practice, a large part of what nurse practitioners do is collaborate with other health care professionals and refer patients to specialists — often physicians — when needed, says Cynthia Fitzgerald, the interim associate dean of Academic Affairs at the WSU College of Nursing and an ARNP at the Mann-Grandstaff VA Medical Center.

"Nurse practitioners working in primary care settings make lots of referrals to physicians, specialty providers, who have access to a wider range of diagnostic testing, a wider range of therapeutic intervention, and really, frankly, a wider knowledge base by virtue or their education and experience," she says.

There are some procedures nurse practitioners do not perform.

"Nurse practitioners don't perform surgery," she says. "We also don't do complex procedures that involve, for example, the placement of equipment inside of a body: a Pacemaker, an intrathecal pump, an artificial heart, knee prosthesis, something like that."

But comparing the roles of nurse practitioners and medical doctors is like "apples and oranges," Fitzgerald says, and the focus should be on the ways they can work together, regardless of whether a nurse practitioner can practice independent of a physician.

"None of us can do this work alone," she says. "I think we are really going to find a solution to the nation's health care problem when we really focus on what contributions we can each make and how we can make those contributions as a team." ♦

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