Nurse practitioners entering field in
By Davis Bushnell, Globe Correspondent, 4/18/04
Hiring nurse practitioners may be one cure for hospitals and medical centers struggling to keep up with mounting patient caseloads.
Nurse practitioners, registered nurses who have master's degrees in nursing and are trained to perform many of the medical procedures doctors do, are coming into the field in rising numbers, according to the American College of Nurse Practitioners. The college reports the number of NPs nationwide has increased from 48,237 in 1992 to an estimated 115,000 currently.
One factor spurring the growth of this field is the restricted federal work rules for residents at hospitals with physician training programs. Residents, or physicians in training, now may work no more than 80 hours a week.
Nurse practitioners typically work alongside doctors. Duties range from physical exams and prescribing medications to performing some invasive procedures, such as bone-marrow aspirations.
''There's a growing recognition of how effective nurse practitioners are as skilled clinicians," said Dr. Peter Slavin, the president of Massachusetts General Hospital in Boston. ''They are a very important part of our team of care givers."
These specialists are in demand at area medical centers. Salaries can range between $50,000 to more than $100,000, depending on skills and experience, according to nursing administrators.
Mass. General, whose minimum and maximum NP pay scales are $54,059 and $116,054, had 10 such openings early last week, said Jeanette Ives Erickson, chief nurse executive.
The hospital, one of the first to hire NPs when the profession was born 40 years ago, now has about 200, Erickson said. Many work at MGH's five health centers in Boston, Revere, and Chelsea; others are on the hospital's acute-care floors, she said. The hospital has some 3,800 registered nurses.
There has been a sea change in attitudes concerning nurse practitioners, noted Dr. Jerry Younger, the clinical director of the MGH-Gillette Breast Cancer Center, who emphasized that NPs are expanding their capabilities beyond general nursing. He works closely with Nancy Schaeffer, an NP for nine years.
''Nancy and I practice as a team," Dr. Younger said. ''She carries out treatment plans to the extent that I may not see a patient for two or three months. But we talk daily, morning and night, so that I'm aware of what's happening."
Dr. Younger said he could never handle the patient volume without Schaeffer and the four other NPs working at the breast cancer center, which logs in 1,100 new cases a year while overseeing 20,000 patient visits annually.
''I didn't want to leave patient care and become an administrator," said Schaeffer of her decision to become an NP. Schaeffer, who has been a nurse for 32 years, has bachelor's and master's degrees in nursing from Salem State College and the MGH Institute of Health Professions, respectively.
She relishes her many different tasks, which include admitting patients, drawing up treatment plans, doing physical exams, ordering CT scans and MRIs, and writing prescriptions. But ''giving emotional support" to the patient is behind all of these duties, she said.
Schaeffer, 53, of Natick, juggles many responsibilities and may meet with up to as many as 10 patients a day. The first oncology nurse practitioner at the hospital, she said the main benefits for her are ''really liking what I do and making a difference in someone's life."
Jacqueline Cantone, who has been battling breast cancer for 20 years, praised the support she has received from Schaeffer. ''Without people like her, I never would have gotten through the 20 years," said Cantone, 72, who lives in Boxford. ''She and others help me get fighting again."
Leslie Clark, 44, who works in the MGH acute-care cardiac access unit, said being a nurse practitioner for 15 years has afforded her many ''learning opportunities" and satisfaction from ''having made some impact on patients and their families."
Also, she has flexible hours, resulting in more time to ''assume family responsibilities," said Clark, who admits cardiac patients and manages their daily care. She and her husband, Bob, have three children, ages 9, 11, and 13.
Mass. General and four other large Boston hospitals, Beth Israel Deaconess Medical Center, Boston Medical Center, Tufts New England Medical Center, and Brigham and Women's Hospital, collectively employ about 600 NPs. Boston Medical is tied with Mass. General at the top of the list, while Beth Israel Deaconess and the Brigham each have 80. Tufts has 39 nurse practitioners. They work in clinics, emergency rooms, intensive-care units, and specialty areas from dermatology to orthopedics.
Besides the master's degree requirement, all NPs depending on their specialties must be certified by either the American Nurses Credentialing Center, the American Academy of Nurse Practitioners Certifying Board, or the National Certification Corp. before being licensed by a state. Two-year master's degree programs specially tailored for nurse practitioners are offered by Boston College, Simmons College, Northeastern University, the University of Massachusetts, Regis College, and the MGH Institute of Health Professions, among others.
In Massachusetts, there are 4,970 licensed nurse practitioners, up from 3,798 in 1999, according to the state Department of Public Health, a rise of 31 percent. The state ranks fifth nationally in the number of nurse practitioners, said Margaret Fitzgerald, a nurse practitioner and principal of Fitzgerald Health Education Associates, a North Andover consulting firm that assists with the NP credentialing process. California heads the list, followed by New York, Florida, and Pennsylvania, Fitzgerald said.
Physician assistants serve in similar capacities as nurse practitioners, but there are major differences between the two disciplines. For instance, NPs are licensed by the state, as are doctors, but PAs operate under the licenses of the doctors for whom they're working.
What NPs can do ''is still very much a work-in-progress" because of the new medical areas they're getting into, said Kathleen Davidson, vice president of nursing at Boston Medical Center.
Nurse practitioners like Schaeffer, for example, ''are now very involved in clinical trials, an opportunity for them to advance in their fields," said Dr. Younger. A current project he and Schaeffer are working on, he said, involves investigating a drug ''for lessening nausea during chemotherapy."
Overall responsibilities of nurse practitioners will only increase as the population ages and "people get sicker and sicker and go in and out of hospitals more frequently," said Fitzgerald, the North Andover consultant. "And nurse practitioners will continue to be the glue that holds the process together."