The role of the nurse practitioner has evolved since nurse/professor Loretta C. Ford and pediatrician Henry K. Silver started the field's first master's degree program at the University of Colorado in 1965. The original thrust was to provide primary health care services to underserved populations. Today, NPs operate independent clinics in rural and urban areas and serve in public health capacities, but many also practice in private physician offices, hospitals, emergency rooms, jails and other health care settings.
As a whole, nurse practitioners say their advanced practice roles bring more career choices and tremendous satisfaction. In Georgia - the only state where NPs don't have authority to write prescriptions - it can also bring frustration. "It's time for this legislation to pass," said Nancy Buist, RN, MN, CS, a certified nurse practitioner for almost 30 years. Buist graduated from a pioneering nursing program at the University of Arkansas in 1978.
"It was a five-and-a-half year combination BSN and NP certification program. I wasn't even sure what being a nurse practitioner meant; I just knew that I wanted to be the most educated nurse I could be in order to give the best care," she said. The role allowed Buist to work in a variety of settings. She worked in a cardiology collaborative practice in Arkansas, where she treated patients in the emergency room and intensive care unit. She also has been a transplant coordinator for Emory Healthcare, a cardiovascular nurse researcher and a patient outcomes manager.
"Every physician I've ever worked with said that he respected me because I knew what I knew and what I didn't. They could trust me to tell them when I needed help," she said. "Doctors, patients and other nurses bene?t from what we do. We need to do a better job of communicating that." As an NP in a private OB/GYN office in south Cobb County, Lynn Kunkel, CNP, gives physicals, performs procedures, diagnoses problems and educates patients.
"Some will ask for me. They've learned that I have more time to spend with them than the doctors," she said. "I always loved nursing in labor and delivery, but I wanted more. Being an NP gives me more autonomy to use my skills. Now I truly know I've helped someone at the end of the day."
Deborah Miller, MSN, APRN, BC, is thrilled to work at the Kimani Clinic in Atlanta, alongside two physicians - one who specializes in pulmonary medicine and the other in internal medicine. Patients there don't always understand her role.
"When I'm doing rounds in the hospital, patients will ask me if I'm studying to be a nurse or when I'm going to become a doctor," she said. "Nurses sometimes confuse us with physician's assistants, but having to explain is minor compared to having more options and getting to see the direct results of my practice."
Miller said that she couldn't have made it through the steep learning curve of two specialties without good physician collaboration.
A team approach is a high-quality, costeffective way to give more people access to care in today's overburdened health care arena. Chris Gisness, CRN, MSN, CEN, FNCP, sees it work well in the emergency room at Grady Memorial Hospital in Atlanta.
"I work in the fast track and we see the less critical patients so that the doctors can get to the more acute patients quicker," she said. "I love working in ER because I never know what I'll be seeing. A shoulder pain might be a deep vein thrombosis, a laceration to the head, a gunshot wound. You're learning all the time.
"We diagnose and treat about a third of the patients, and even when someone needs a doctor's attention, I can start the work-up, order the labs and IV, so that the patient is getting help sooner." What Gisness likes best is the one-onone interaction with patients. "We're nurses at heart. It's the nursing part of us that cares about the person, not just the disease," she said.
Like most of her fellow NPs, Gisness doesn't understand not having written prescriptive authority.
"It's silly not to have it," said Karen Schwartz, MS, WHNP. "I do every step of the process with my patients - assessing, diagnosing and prescribing - everything up to signing my name on the prescription pad. The doctors who sign it don't ask questions about my prescription, and if I choose, I can call it in to the pharmacy using the physician's DEA number."
Schwartz works in a private OB/GYN practice in Dunwoody and is chair of the United Advanced Practice Registered Nurses of Georgia's grassroots committee to pass prescriptive authority in the state. She's also the past chair of the Georgia Nurses Association Legislative Public Policy Commission.
"I don't deliver babies or do surgery in the hospital, but I do everything else," she said. "Occasionally, patients will say that they don't want to see the NP, but if she gives me a chance, I can change her mind."
Schwartz and others have been working behind the scenes to get two prescriptive authority bills, House Bill 935 and Senate Bill 313, out of committee and onto the oor for a vote in the 2006 legislative session. They've called all advanced practice registered nurses in Georgia and asked them to contact their legislators by letter and phone.
This is the eleventh attempt to get a prescriptive authority bill passed in Georgia.
Proponents face the Medical Association of Georgia, which has lobbied against prescriptive authority for nurse practitioners, citing nurses' liability issues and possible lost income for doctors.
"We keep fighting because this issue is in our face every day," Schwartz said. "It takes time to track down a physician to get a prescription signed, especially if the doc is off site."
Schwartz, who worked in Columbus and commuted to Georgia State University to earn her graduate degree, isn't about to give up.
"I get such satisfaction when patients thank me for taking so much time with them, for helping them understand their condition," she said. "Having written prescriptive authority would mean that we can function to the full capability of our training and keep pace with the rest of the United States."