NOT JUST PLAYING DOCTOR AS THE BABY-BOOM GENERATION AGES, NURSE PRACTITIONERS STEP UP TO A LARGER ROLE IN HEALTH CARE.

Byline: Mariko Thompson Staff Writer

Sharon Poncher climbs on a step stool and examines her patient's ears. Jose Garcia came to Kaiser Permanente Medical Center in Panorama City complaining of pain inside his left ear and Poncher suspects a bacterial infection.

``I'm going to give you ear drops,'' she says, stepping down and scribbling on a prescription pad. ``Check back in five to seven days and we'll look at that ear again.''

Stethoscope draped around her neck, Poncher looks and sounds like a doctor. But Poncher is a nurse practitioner, which means she has undergone an advanced level of training allowing her to diagnose, treat and prescribe medications.

Four decades ago, nurse practitioners emerged during a shortage of primary care doctors. Today, nurse practitioners still fill the gap, but often in collaboration with physicians; nurse practitioners handle common and chronic health problems, which frees up doctors for more complicated cases.

As baby boomers approach retirement and their numbers strain the health-care system, some predict nurse practitioners will become even more valuable. The baby boomers are accustomed to having their demands met. As seniors, they'll expect a health system that not only treats illnesses, but provides preventive services and wellness care, says Denise Link, clinical associate professor at Arizona State University's College of Nursing.

``That's the cornerstone of the nurse practitioner practice,'' says Link, also secretary of the American College of Nurse Practitioners board of directors.

Without enough doctors in primary care or geriatrics, physicians will be looking to team up with nurse practitioners to meet the increased caseloads, says Dr. Marc Hoffman, assistant chief of service for family medicine for Kaiser Permanente in Panorama City. Already, doctors are finding that they can accommodate more patients by using nurse practitioners for routine care, he says.

That's good from a business standpoint. A nurse practitioner typically costs less than a primary care physician. They allow doctors to expand their practices, seeing more patients in the same time frame. And the emphasis on preventive care should save money by reducing the need for more costly services in the long run, experts say.

For the patient, that means getting into the doctor's office more quickly and getting chronic health problems under control.

``The real benefit is to the patient,'' Hoffman says.

In the 1960s, nurse practitioners gravitated to rural areas with little access to health care. Over the decades, the use of nurse practitioners has spread to a number of specialties, including women's health, geriatrics and mental health. Cost-conscious managed-care organizations also began to find nurse practitioners attractive. Even so, the nurse practitioner ranks remain relatively small, just over 102,000 compared to an estimated 2.2 million registered nurses nationwide.

To become a nurse practitioner, a registered nurse must complete a graduate-level program. Because of the current nursing shortage, registered nurses have little financial incentive to leave the bedside and pursue the advanced degree. Those who enroll in advanced-practice nursing programs are drawn by the promise of more autonomy and new intellectual challenges, says Lynn Doering, associate professor at the UCLA School of Nursing.

``We're torn,'' Doering says. ``There aren't enough nurses however you slice it.''

Colleen Bogdanich spent 15 years as a registered nurse before she decided to become a nurse practitioner. Through her hospital work, she discovered an interest in working with people suffering from chronic conditions. Five years ago, she completed her advanced degree at UCLA. Today she splits her time between primary care and a diabetes management program at Kaiser Permanente in Santa Clarita.

For the diabetes program, Bogdanich is part of a team that includes a doctor, a registered nurse and a dietitian. They hold classes once a month and handle routine check-ups, which include an eye exam, a foot exam and lab tests.

``We're not here to take the place of the doctor,'' Bogdanich says. ``We work with the doctor in giving patient care. There's a lot of autonomy, and there's also a lot of collaboration.''

Like Bogdanich, Poncher spends part of her time helping patients with chronic diseases. She meets regularly with pulmonary patients suffering from lung diseases such as asthma and emphysema. The rest of the time, she helps with primary care, doing physicals and seeing patients with flu, ear infections and other common complaints.

A petite woman who wears her long honey-colored hair pulled back in a braid, Poncher previously worked as a registered nurse doing discharge planning and quality control. Longing to return to patient care, she enrolled in Kaiser Permanente's nurse practitioner program.

Over the last 14 years, she's had her share of gratifying moments. In the medical center parking lot, a former patient stopped to thank her for persuading him to quit smoking. Another time, Poncher spotted an odd freckle on the heel of a female patient. A dermatologist later determined that the growth was cancerous.

``It's my job to find these things and know that,'' Poncher says.

On a day packed with patient visits, there's little time to reflect on past achievements. Poncher sends Garcia to the pharmacy for his ear drops. Grabbing another patient chart, she hurries to the next exam room.

Mariko Thompson, [phone]

mariko.thompson(at)dailynews.com

CAPTION(S):

3 photos

Photo:

(1 -- cover -- color) ON THE COVER: Registered nurse practitioner Sharon Poncher listens to the lungs of patient Eva Rounsavall. Their images were reflected in a mirror for this photograph.

(2) Sharon Poncher, a nurse practitioner at Kaiser Permanente in Panorama City, examines patient Jose Garcia's ear for signs of an infection, then prescribes eardrops and orders a recheck in five to seven days.

(3) Among the gratifying moments during her 14 years as a nurse practitioner, Sharon Poncher recalls a former patient stopping to thank her for persuading him to quit smoking. Another time, she spotted an odd freckle on the heel of a female patient; a dermatologist later determined that the growth was cancerous. Says Poncher, ``It's my job to find these things and know that.''

Charlotte Schmid-Maybach/Staff Photographer