Published: April 06, 2008 10:54 pm         

Nurse practitioners may be answer to lack of doctors in some rural areas

Less wait time and easier and better access to treatment. These are things nurse practitioners can provide for patients and doctors.

In fact, they are skilled enough in the medical profession to even have their own practices.

With the decrease in the number of primary-care doctors in rural areas of Oklahoma, nurse practitioners, or mid-levels, may just be the answer to increase access to medical treatment. More mid-levels could help alleviate the need for more primary-care doctors in underserved areas and could help with the influx of people going to emergency rooms for non-emergency issues.

“We are not basic nursing, but we are not quite doctors,” said Cheryl McFadden, a nurse practitioner from Enid. “We learn every day from what we see in hospitals and clinics.”

Nancy Cooper, a nurse practitioner at Intergris Bass Baptist Urgent Care Clinic, said the clinic has two doctors who take appointments. If another patient needs to get in to see someone, mid-levels can step in. She said this is a major benefit of being in a rural area.

“For the patient, it is beneficial because they don’t have to wait three weeks to get in to see a doctor,” Cooper said. “A lot of times, we get to work more independently.”

Nurse practitioners are re-quired to be registered nurses before they become mid-levels. The difference between physician assistants and mid-levels usually comes down to education. Nurse practitioners generally have a more specific educational background in medicine. They are required to have a master’s degree studying medicine. Typically, mid-levels will work as registered nurses for two or more years before they can become nurse practitioners. They can obtain a doctorate of nurse practice, which will help them to expand on their clinical capabilities.

Most mid-levels are trained to diagnose, treat and monitor chronic diseases and treat injuries, illnesses and infections. This allows them to prescribe medications and physical therapy and perform health care maintenance, like annual physicals. They essentially will provide the same kind of care as a physician while working in conjunction with them.

Cooper said if there is a situation or symptom she doesn’t completely understand, she will go to a doctor, but she is not required to get doctor approval for anything she does at the clinic.

“I’ve been doing this long enough that they are more resource people,” she said. “If there is a chest X-ray I’m not sure of, I will have them look at it, or if there is something different that I have not seen, I will talk with them about it.”

Cooper said mid-levels always are having to learn as they go. New medications, new procedures and new clinical information keep her learning more about her profession.

“We not only have to have continuing medical education, we also have to have continuing pharmaceutical education to be able to prescribe medication,” she said.

McFadden said she believes nurse practitioners have a tendency to treat from a different perspective than physicians. She often finds herself not only treating the patient but the patient’s family as well, spiritually and physically. She said a physical ailment for one person often can be stressful on the rest of the family.

Nurse practitioners can go into just about any part of the medical field, depending on their field of study. McFadden said, in addition to family practice, she has seen adult and pediatric practitioners, wo-man’s health, clinical specialists and psychiatric practitioners. Cooper said family nurse practitioners pretty much encompass treatment of all ages.

Mid-levels also can go into advanced pathology, neurology, pharmacology or physical assessment, and McFadden said they often serve nurse mid-wives to pregnant women. It all depends on the level and field of study.

Northwest Oklahoma al-ways is in need of more mid-levels, Cooper said. She works at several clinics in the area and has seen a great need for more in the area.

“We provide greater accessibility to care,” she said. “They are very much needed, and there is a lot of opportunities. There is a need for primary care, and mid-levels can help with that.”

McFadden had her own practice in Covington before she moved on to work in Oklahoma City. She said one of the problems she had with her practice was with insurance companies accepting the role of nurse practitioners as primary care provid-ers. She sees this as an issue of acceptance from the medical profession in general. She said this has led to educational opportunities in Oklahoma being somewhat scarce. Only the University of Oklaho-ma offers classes for nurse practitioners, she said.

“My personal hope is that we can gain the respect and trust having proven that we are safe providers,” McFad-den said. “The most important thing is taking care of patients, and you have to look at the whole big picture in looking at comprehensive health care.”

Cooper has been a mid-level at Bass for about 12 years. She said anyone interested in going into the field should know there is time for family. She is one of four mid-levels at the hospital and has found the hospital to be considerate in working around her family schedule. Basically, she would want any future nurse practitioners to know it is not all work, although she enjoys what she is doing and likes to work as much as she can.

“They try to keep it as stable as possible and work really hard with us,” she said. “They are real family friendly.”