Nurse Practitioners on The Rise

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Advanced registered nurse practitioners can see patients, diagnose and treat their problems, and prescribe medication. So it’s not that surprising that sometimes they’re called “doctor” by their patients.

Marcia Hillman, a family practice ARNP, gently corrects her patients when that happens. There isn’t a lot of difference, it’s true. But there are some differences.

ARNPs usually come from a registered nursing background before they go back to school to get further education and certification. Just like doctors, ARNPs specialize in a variety of fields. But in addition to those skills and qualifications they bring what this article on WCFCourier.com calls “the standard nursing compassion” to their work.

“We know that we are not doctors, and we never pretend to be,” Hillman said. “We just enjoy working with our patients, and patients appreciate our tone.”

ARNPs are one of the highest nursing degrees a person can obtain, second only to a medical doctorate.

In Iowa, getting to be an ARNP means getting a master’s degree in nursing from one of five colleges in the state, including Allen College in Waterloo, where 37 nurse practitioners graduated this month — an increase of six from May 2011.

In Iowa, ARNPs can work independently, but in larger health care organizations like Wheaton Franciscan and Allen Hospital, ARNPs are assigned to a physician, who can double check or sign off on their work.

Dr. Tim Horrigan, Allen’s chief medical officer, said that means ARNPs become “physician extenders” in a sense, allowing for more patients to be seen and more personal care to be given — meaning ARNPs are more valuable to an organization.

“Their work in the hospital has grown exponentially,” Horrigan said. “Working with hospice program, or their work within a specific physician practice, has exploded over the years.”

If you’ve ever walked into Covenant Medical Center’s Convenient Care, you were probably seen by an ARNP. But ARNPs can also specialize in any medical field, from the neonatal intensive care unit to geriatric care and from family practice to surgery.

The field has expanded nationwide, and part of that is due to health care reform, said Kathy Weinberg, the associate director of practice and education with the Iowa Board of Nursing in Des Moines.

The White House estimated that health centers nationwide have added 3,000 nursing positions, 800 of those in advanced practice, since health care reform passed in 2009.

In Iowa, after a slight drop of about 100 licensed ARNPs last year, the number is up more than 300 today, at 2,230, according to the Iowa Board of Nursing.

“I think, at this point in time, (getting an ARNP license is) a common step the nurse may take,” Weinberg said.

Kristin Davis said she was “encouraged” to get her degree after she got a job in Convenient Care in 2006 as an RN. She graduated from Allen in 2009 with her ARNP and kept working at Arrowhead.

“You have completely different tasks,” from RN duties, she said. “You are still comforting children, making sure mom’s got support. But instead of immunization and urine cultures, you’re doing splinting of fractures, putting sutures in.”

Davis, like Hillman and others, has “ARNP” right on her hospital badge. To some patients, that’s a point in her favor over a medical doctor, she said.

“I think there’s a certain population that seeks to see nurse practitioners,” Davis said. “Nurse practitioners have a nursing background, and a nursing background is based on caring. … I learned how to care and talk to people first, and diagnose and treat second.”

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