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Isabelle Amann speaks to Edna Manning's son, Greg Manning (not pictured), at Fredericksburg Primary Care.
Isabelle Amann is a nurse practitioner at Fredericksburg Primary Care. She is one of at least 93 nurse practitioners working in our region. Her main duties include treating patients and approving prescriptions refills.
Isabelle Amann approves or denies
Amann, who has a doctorate in nursing, writes a prescription. She has been in nursing for 20 years.
Amann inspects Ruth Hicks' throat. |
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.
"No," Hicks replied. "I've been trying to drink water, but that hurt, too."
Hicks, 27, had been miserable for four days with a fever, chills and aches. She had started to feel better, but her throat was still sore when she called Ferguson's office for an appointment.
Amann could see redness and tiny white pustules at the back of Hicks' throat. But a quick test for strep throat was negative.
Though painful, her condition probably was not serious, Amann told her. Gargle with salt water, drink fluids and take Tylenol or Motrin every four to six hours, she said.
"If you're not any better by Saturday, give me a call. I think you'll be all right, but the main thing is rest," Amann said.
OPENING UP THE SCHEDULE
Amann and fellow nurse practitioner Karen Swenor joined Ferguson last year. "There's just an enormous amount that both of them have taught me," Ferguson said.
Because of the two nurse practitioners, Ferguson was able to open his practice to more patients and reduce the time that patients wait for an appointment. He offers same-day appointments and extended hours, seven days a week.
"We can provide an availability that you just don't find other places," he said.
In addition, hiring a nurse practitioner can be more profitable for a practice than hiring another doctor, according to a report in Medical Economics magazine.
Amann works three days a week for Ferguson, averaging about 16 patients a day. A typical visit lasts about 15 minutes, not counting the mandatory paperwork that follows.
Amann usually works by herself, though two or three times a day she'll ask Ferguson to see one of her patients, or talk with him about what she has done.
"I'm not the physician," she said.
Ferguson said Amann's experience in cardiac care was an obvious strength when he hired her.
"But that's not why I chose her," he added. "I chose her because she's Isabelle. I chose her because of the person."
L. Timmes Ross, a nurse practitioner at the University of Mary Washington and a friend of Amann, added, "Isabelle's speciality is people."
For Amann that means teaching patients about their illnesses and listening closely to what they say.
"It's often that very last question, 'Is there anything else bothering you?' that you get the most information or the reason the patient really is there," she said.
Humor is also important, she said.
Recently, when a patient called to ask about the results of a lab test, Amann told him, "Your bad cholesterol was slightly elevated at 118."
Amann was content to let the man lower the "bad" or LDL, cholesterol number with diet and exercise.
"You're going to be slim and trim and gorgeous when you come in here," she joked.
But her patience had a limit.
She told the man that she wanted his LDL to be closer to 70. And if three months of diet and exercise didn't work, she wanted him to start taking medicine.
"Everybody has to try," she said. "If you contract with your patient, then they're more willing to try the medication. You have given them the opportunity to be in control."
Librarian Craig Schulin contributed to this story.
Jim Hall: 540/374-5433
Email: jhall@freelancestar.com
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 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, Studies show that they "We tend to be more involved with our patients |
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Amann became a registered nurse in Hawaii, then moved She earned a bachelor's 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
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