- The Washington Times - Monday, February 20, 2006

Some forms of professional health care these days can be bought on the spot in a retail store. Others are only a telephone call away.

MinuteClinics that offer walk-in health care in selected CVS and Target stores have a reassuring slogan: “You’re sick, we’re quick.” It offers the promise of little wait time, treatment prices for various conditions posted upfront, and the guarantee that a family nurse practitioner is in charge.

So-called tele-health centers usually are open 24 hours a day to dispense advice or give physician referrals.

Both are staffed by registered nurses, or RNs.

All well and good — except how many callers or walk-in customers know exactly what a nurse practitioner is and why he or she is qualified to write prescriptions and administer care?

Or what the difference is between a licensed nurse practitioner, who may specialize in a field such as family nursing, and a licensed practical nurse?

And when someone calls a tele-health center, such as the one at Anne Arundel Medical Center in Annapolis, why does it matter that an experienced registered nurse answers the phone?

The public understandably can be confused about titles and relevant duties of professionals in the medical and health care fields. For the most part, consumers are asked to take on trust the competence of the person giving guidance or hands-on care unless they take the trouble to research the meaning of the acronyms printed on diplomas, badges or uniforms.

In general, a nurse’s rank depends on the type and number of years of training and college education he or she has received.

Nursing assistants have the least amount of schooling. When trained to take blood and handle machinery — usually in a hospital, they may become certified nurse technicians. Practical nurses take an 18-month program, usually at a community college, which gives them an associate degree. This AA degree qualifies them to take a state licensing exam and become a registered nurse.

The associates may go on later to obtain a bachelor of science in nursing, or BSN, normally a four-year program. Nurse practitioners are RNs with advanced training in a specialty and usually have a master’s degree or MSN. They are certified to administer care and write prescriptions in any number of fields, such as family, women’s health, pediatrics and anesthesiology.

Recent data shows there are better outcomes — decreased infection rate and even lower mortality — among patients cared for by a nurse with a bachelor’s degree, according to Marianne Lyons, RN, MSN, and Colleen Norton, a registered nurse who holds a doctorate in nursing science. Both are on the faculty at the Georgetown School of Nursing and Health Studies.

It’s important to note, too, that a nurse who works in a primary care physician’s office is trained separately from a physician’s assistant, or PA, although they sometimes perform similar duties. The PA works directly under a doctor and has a different credentialing system from that used in the nursing world.

“Nurses usually have several years experience before they go into a nurse practitioner program and typically see three or four patients an hour as part of a health team,” says Mary Jo Golsby, director of research and education for the American Academy of Nurse Practitioners that has 110,000 members. “More and more have doctorates, because of the increasing complexity of health care.”

A majority practice with physicians, she says, but 4 percent have their own panel of patients, such as those manning the MinuteClinics located in a number of area stores.

Donna Helfferich, an administrator at Anne Arundel Medical Center where she oversees some 700 nurses, says the subject of titles can be “tricky” since they often depend on the requirements of the state in which they train. “We have advanced practice nurses in different categories under the Maryland Board of Nursing — nurse midwife, nurse practitioner, and those in clinical settings. As an RN, once you take the exam you are licensed here, but some states require periodic updates.”

Advanced education for nurses in clinical settings is more important than it was 30 years ago, Ms. Lyons and Ms. Norton say. The trend reflects more complicated problems faced in patient care, such as people acquiring multiple diseases as they live longer.

Even so, they both support tele-health and walk-in clinics for less critical medical needs as a way of helping control rising health care costs.

The savings to the consumer are considerable. Walk-in clinics, which generally limit their basic services to minor short-term illnesses only, charge about half what it costs to be treated in a physician’s office or an emergency room, and they generally accept insurance. The nurse on duty will refer someone to a physician in more complicated cases or when a patient needs continuing care.

The telephone triage nurses on duty in the Anne Arundel tele-health center (443/481-4000 or 1-800-MD NURSE) receive an average of 5,000 calls a month from a service area covering 600,000 to 1 million people. All are seasoned registered nurses. Janet Henery, 55, who has 30 years’ experience, alternately answers phones and works in the hospital’s outpatient clinic.

She sits at a desk surrounded by reference books and works from what she calls a protocol — guidelines that scroll before her on a computer screen whenever a call comes in.

The call might be as simple as “a person reading what happens when taking Tylenol and wanting a second opinion. I think they just like to hear information from a person. We do not diagnose or prescribe, but we can make certain conclusions based on symptoms — assumptions based on circumstances.”

A panicky woman who called in late one morning complaining of having abdominal pains and bleeding was urged by Ms. Henery to have someone take her to the emergency room. The interview and recommendation took barely seven minutes, with Ms. Henery making careful notes as she calmed the woman, talking her through a number of steps regarding her medical history and present condition.

“We can get something as emergent as chest pain or as simple as diarrhea and vomiting. Diarrhea and vomiting can be simple, and we can offer some home care so they don’t have to go to the emergency room right away.”

Trish Hughes, a family nurse practitioner with a doctorate in education and 31 years’ experience, is D.C. metro manager of operations at area MinuteClinics. “We do get a lot of questions about what can we do, and patients even will say ‘When you know what is wrong with me, do I have to go back to my doctor?’” she reports. Flu season is their busiest so far. “For many people we were the only option.”

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