Goshen News, Goshen, IN

December 8, 2012

WHOLE FAMILY: Advance-practice nurse an option to consider


— It’s another “Wish I had a nickel for every time someone asked me that” question: They’ve had their babies. Now they’re looking for a doctor. Do I have a recommendation?

Over the years, I would offer a few names or suggestions, share what other parents had said or suggest — if the clients were English — that they look online for referrals or reviews. If their insurance companies had a suggestion or requirement, it was obvious: Go with that.

Recently, though, when asked that question, I’ve taken a different tack, and I’m a little sheepish I didn’t think of it sooner.

First, I answer the question with a question or two myself: What is it you need? What are you looking for? If the answers are simple — “Oh, just wellness checkups, maybe” — I’ve begun telling them about nurse practitioners.

Nurse practitioners? Some people aren’t sure. Also wish I had a nickel for: “I don’t know. I just thought you’re supposed to have a doctor.”

No, no universal law I’m aware of says every person has to employ a doctor. Or a plumber, lawyer, baker or candlestick maker, for that matter. There are mandates within certain payor policies, for sure, and many people and organizations recommend you “have” a doctor — I think they mean “retain,” “visit” or “seek the advice of?” — but unless you have an affiliation that requires it, you don’t have to “have” a doctor.

Not that it’s a bad idea. I “have” a family doctor — sorta. I’m on her books, at least, a spot I’m not quick to relinquish since she’s such a cool doctor she has a long waiting list. But the truth is I haven’t seen her in a few years. I don’t think she even knows I had another baby. (Oops.)

I have been enjoying the care of advance-practice nurses (APRNs). In fact, now that I think of it, that last visit to my doctor a few years back? I actually saw the family nurse practitioner (FNP) working there.

Advance-practice nurses — certified nurse-midwives (CNMs) — helped me have a baby, of course, which included the prenatal management of borderline gestational diabetes as well as a referral to a specialist for complicated blood labs.  They assessed and treated me post-partum, and they served as my baby’s care provider until he was 6 weeks old. He’s nearly 2 years old now, and I still consider them my first call if I have any questions about his health — though, admittedly, I enjoy a bit of familiarity.

Should I tell you, then? My children, save the foster daughter born early to a sick mother, have not seen a pediatrician? Don’t worry. They’re fine. I’d take them to see a doctor the minute they needed to; it’s just they haven’t needed to.

IN THE UNITED STATES, APRNs fall into four main categories: nurse practitioners, clinical nurse specialists, nurse anesthetists, or nurse midwives. Within those categories, particularly the nurse practitioner category, APRNs may specialize. For example, a nurse practitioner (NP) might work with children, so she’s a pediatric nurse practitioner (PNP). CNMs, obviously, specialize in midwifery, so they focus on childbearing women and neonates.

APRNs are registered nurses who go on for at least a masters-degree level of university education and often have years of hands-on experience working with patients. Many go on for doctorate degrees, and many teach in nursing schools.

In general, APRNs can do much of what a doctor of medicine does. In Indiana, they can declare medical diagnoses, offer simple treatment — even minor surgeries — and can prescribe medications. They answer to a nursing licensing board and rely on a collaborative physician to review charts on a regular basis.

Most importantly, they’re experts in their fields. That means they know what they know — and they know what they don’t know. APRNs are quick to refer people OUT of their care when conditions or needed treatments warrant such. They enjoy collaborating with competent medical doctors whose expertise or scope of practice exceeds their own in any given specialty.

You probably caught on I’ve tiptoed around the multi-faceted elephant in the room: Nurses, really? Aren’t doctors better? Don’t we all need a family physician at least? And all children a pediatrician? Are APRNs competing with doctors for patients? And more, right?

Lots of questions to consider, for sure. For myself, I take them one at a time and answer them with science and logic.

Next week I’ll answer a few of those questions — tell you what the trends seem to be — and tell you about one FNP who enjoys a thriving family practice in Elkhart. In the mean time, you can read up on APRNs at the American Nurses Association’s web site content about them: http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses.

Goshen News columnist Stephanie Price is a wife, mother, teacher, childbirth educator, midwife’s assistant and nursing student from Elkhart. Contact her a¬¬t wholefamily@goshennews.com, 269-641-7249 or on Facebook at the page “Whole Family Column by Steph Price.”