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Expanding care when the doctor is booked
If a patient has received medical care locally, chances are it was provided by a nurse practitioner like Isabelle Amann
Date published: 2/24/2008
BY JIM HALL
Edna Manning's feet were swollen and discolored, and Isabelle Amann, a nurse practitioner, was having trouble finding a pulse.
Amann spread gel on the top of Manning's feet and used a hand-held device, a Doppler, to listen for a pulse. Soon, the machine was beeping rhythmically.
"There you are," Amann said. "Hear it?"
Manning, 72, is a patient at Fredericksburg Primary Care, the office of Dr. Joseph Ferguson. She has been receiving care there for a variety of problems, including heart disease and diabetes.
This visit was a follow-up to an earlier one when her blood pressure was below normal. Her son, Greg Manning, was with her.
"It's surprising she was walking around the other day," Amann said to Greg Manning.
"I could tell something was wrong with her. She was slurring her words pretty bad," Greg Manning replied.
This time Manning's blood pressure was fine, and Amann pronounced her blood sugar "perfect" after a finger stick.
But she was troubled by the purple color and swelling in Manning's feet.
When she gets home, "we need to get those feet up," she told Manning.
To Manning's son, she said: "Prop her feet up on the coffee table. Then put a cushion underneath. That will get them up a little bit higher."
Manning's visit illustrates the care offered by advanced-practice nurses like Amann: They diagnose, treat, prescribe medications, and provide counseling and education.
The visit also symbolizes what has become a daily occurrence in the Fredericksburg area. Today there are at least 93 nurse practitioners in the region, working in family practice and internal medicine offices, but also in specialty areas such as pediatrics, oncology, surgery, geriatrics, women's health and hospice care.
Chances are that if a patient has been treated at a local clinic, hospital or doctor's office, a nurse practitioner provided some of the care.
NOW DOING SORE THROATS
For much of her 20-year nursing career, Amann has specialized in diseases of the heart. She has supervised stress tests and done EKGs, and has treated everything from cholesterol problems to heart failure.
However, in Ferguson's office, an internal medicine practice, she's just as likely to see a patient like Ruth Hicks, who had a sore throat.
"Are you eating?" Amann asked Hicks during a recent visit.
A nurse practitioner is a registered nurse with advanced schooling and experience. He or she must graduate from a nurse practitioner program and pass a national certification exam.
The job of nurse practitioner began about 40 years ago in response to a nationwide shortage of physicians.
Today there are about 145,000 nurse practitioners nationwide and about 5,300 in Virginia. About 3,000 of Virginia's nurse practitioners have gone through the separate licensing process that allows them to write prescriptions.
In the Fredericksburg area, the first nurse practitioner was Patty Sutherland, who began work at Pratt Medical Center with Dr. David Johnson about 30 years ago.
Nurse practitioners work in collaboration with physicians. Often they take care of acute illnesses or injuries, as well as the routine maintenance of patients with chronic diseases such as diabetes.
Studies show that they provide care comparable to what patients receive from doctors, and they're often better than doctors at interacting with patients.
"We tend to be more involved with our patients in terms of lifestyle changes and education," said L. Timmes Ross, a nurse practitioner at the University of Mary Washington.
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Amann became a registered nurse in Hawaii, then moved to Virginia and Stafford County with her husband, Duane.
She earned a bachelor's degree in nursing from Virginia Commonwealth University and a master's degree in nursing with a minor in the family nurse practitioner specialty from George Mason University. Last year she earned her doctorate in nursing from the Rocky Mountain University of Health Professions.
She is president of the local chapter of the Virginia Council of Nurse Practitioners.
Amman is also an experienced scuba diver and, along with her husband, a licensed pilot.
"I've been right seat for him for over 30 years," she said.
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Read more stories about Fredericksburg
Date published: 2/24/2008
Most recent reader comments:
NP anyday
(posted by
YankeeRN
, Feb. 24, 2008 1:19 pm)
I would rather have a Nurse Practitioner anyday!! They give you the attention and compassionate care much better than most MD's. For one, Doc's never took a bedside manner class until the last few years.
Doctor lite?
(posted by
busszz
, Feb. 24, 2008 12:36 pm)
...I;ve had 2-3 occasionas where I did a follow up meeting with a doctor only to find out the PA or NP had overlooked something. I'm sure the people doing these jobs are dedicated....I;m sure they have more medical education thatn me. But if I'm sick enough that I feel like I need medical attention....I want an MD.
Additionally...I'm sorry....but if I;m paying to see a doctor...I want to see a doctor. If I ge a Nurse Practitioner or a PA...I want to pay less.
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