Nurse practitioners are the future of health care

Premature Baby Delivered By Same Doctor And Nurse As Father

Have you seen a nurse practitioner yet for your health care needs? Chances are you will in the future.

This mid-level provider role has been steadily growing since the mid-1960s when it was developed to relieve a physician shortage. Nurse practitioners (NPs) are advanced-practice nurses, trained at the master’s or doctoral degree level to deliver the same care as your primary care physician. Because research shows that they provide care equal to better than physicians and at a lower cost, their role is expanding rapidly. There are now about 140,000 NPs in the US compared to 106,000 in 2005, according to the American Academy of Nurse Practitioners.

Additional programs, especially at the doctoral level (DNP), have launched in response to the 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.” It recommended that “the health care system needs to tap into the capabilities of advanced practice nurses to meet the increased demand for primary care.”

HRSA (Health Resources and Services Administration) projects a shortage of 20,400 physicians in 2020, but notes that the shortfall could be reduced to 6,400 with effective integration of nurse practitioners and physician assistants (mid-level providers trained under a medical model) into the system.

Increasingly, health care administrators and the public understand and accept the role. In Georgia you’ll find nurse practitioners practicing under physician supervision in hospitals, doctors’ offices, specialty clinics, emergency rooms, urgent care sites, public health centers, nursing homes and home health agencies.

We’d like you to meet two Georgia nurse practitioners with very different practices.

Patti Thomas, RN, MSN, FNP-C

Family Nurse Practitioner with Gwinnett Emergency Specialists at Gwinnett Medical Center and instructor at the Byrdine F. Lewis School of Nursing and Health Professions at Georgia State University

A nurse since 1981, Patti Thomas earned her master’s degree to become a family nurse practitioner in 1995. She wanted to offer her patients a broader range of care and work in the emergency room. “As a nurse, you’re not taking care of all patient needs, only pieces,” said Thomas. “As an NP working under the supervision of an attending physician in the ER, I’m responsible for every aspect of my patients’ care. I take histories, perform assessments, order diagnostic tests, interpret those tests, make a diagnosis and order treatment.”

She enjoys the challenge of a constant variety of patients and conditions. “I like the autonomy of providing every aspect of care to my patients, but I also appreciate having the backup of a physician when I need help,” said Thomas. “They have more training, but I can diagnose and treat about 90 percent of what a physician does. Sometimes one will run something by me.”

Unable to find a job in an Atlanta emergency room in 1995, Thomas worked in a Griffin hospital for 12 years, before coming back to the city.

“The role is much better known and accepted now than it was when I graduated, and NPs are needed in rural and semi-rural areas,” she said.

She’s seen nurse practitioners move into many more settings and specialties. “When I started going to the American Academy of Nurse Practitioners annual meetings, there were no classes for emergency room NPs. Now there are five days of sessions, and I meet NPs practicing in cardiology, dermatology, oncology, pain management, diabetic foot care, nephrology and plastic surgery—if the role isn’t there yet, you can develop it.”

She expects that changes in health care and higher demand for services will drive the need for nurse practitioners in the future. “There are so many benefits to having mid-level providers deliver primary care,” she said. “It gives more people access to high-quality, lower-cost health care [NPs are reimbursed at a lower rate under Medicare],” she said. “And studies show increased patient satisfaction as nurse practitioners spend more time taking histories, giving physicals, and explaining things to their patients.”

Assessment, critical thinking, listening and teaching were skills she learned as a nurse and hones daily in her practice. “My greatest satisfaction is having the ability to provide quality health care to my patients,” she said.

Lori Hudson, RN, FNP-C

Owner of Temple Medical Clinic in Temple, Georgia

Lori Hudson was a nurse when she encountered her first nurse practitioner. She asked to shadow the NP and saw her attending to the needs of the whole patient, not just addressing the particular illness. “She worked for a large medical practice, but she also had her own sign,” said Hudson. “I decided then that I wanted to have my own sign someday.”

She does in front of Temple Medical Clinic, her own practice located in a refurbished 1930’s house. She had been working in a large practice as an NP, when a physician offered her the practice in Temple, Georgia 10 years ago. “It was a gift, so I held my nose, closed my eyes, trusted God and jumped in,” said Hudson.

Her patients range from ages three months to 92, and present with everything from sore throats to skin diseases, to chronic illnesses or depression. A doctor in Carrolton supervises her practice, but not the running of her business. She’s planning to expand and add another NP to her practice.

“It has been awesome. I’m not rich, but that isn’t why I got into this. I can pay my people and my bills and I was able to bring my last two babies to work with me, so I got it all –the empowerment, the authority and being able to practice medicine as I want,” she said.

She tells every new patient that she is a nurse practitioner. “They don’t always understand the role, but if you give me five minutes with them, I’ve got them,” said Hudson. “I see my job as being safe, taking time to listen and being human. I just want to help people.” She sees about 20 patients a day, with a goal of forming a relationship with each one.

“Health and wellness are a growing part of my practice. I’m not going to tell a diabetic patient to just take a pill; I’m going to tell him 10 other things he needs to do to get better, and I’m going to follow up with phone calls to check on his progress.”

The affordability of her office visits and her approach to care draws patients from Alabama, and Paulding and Douglas counties. “Waiting three hours to see a doctor for five minutes is not a relationship, and it’s not my idea of taking care of people,” she said. “About 95 percent of what I see, I can manage, but I know when to refer someone to a doctor or specialist, and do that often,” she said. “Everything I do is evidence-based and built on a nursing foundation which emphasizes compassion, education, listening, motivating and empowering the patient.”

She believes that there is more to practicing medicine than prescribing medicine. “I see happier people, because they pay less, wait less and get more. My greatest satisfaction is changing and improving lives.”

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