SIMI NURSE TAKING NEW STEP FORWARD.

Byline: Gloria Gonzales Daily News Staff Writer

After 11 years of following the doctors' orders, Kathryn Steffen is moving up the nursing ranks and looking forward to a little independence.

``Nurse practitioners are doing much more diagnosing and many now provide direct patient care,'' said Steffen, who has worked as a registered nurse at Northridge Hospital Medical Center since 1986. ``They can work more independently - in private practice or in group clinics - and their decisions aren't subordinate to the decisions of the doctor or the hospital.''

Steffen, a longtime Simi Valley resident and mother of three, has returned to school at age 40 to find that independence through a new UCLA program designed to encourage midcareer registered nurses to become nurse practitioners - one of the fastest-growing medical professions.

Steffen is one of four students in the new accelerated program at UCLA, one of the top nursing schools in the nation. The intensive, three-year program is designed to train nursing professionals to meet the growing demand for community-based nursing.

Nurse practitioners - or advanced practice nurses - work under their own license in collaboration with a physician. However, the physician does not need to work in the same location, thus allowing nurse practitioners to set up their own clinics, said Kay Barker, associate dean of student affairs at the UCLA School of Nursing.

Nurse practitioners can provide routine gynecological care, health screenings and they can also manage a patient's serious illness even through hospital admission and discharge, Barker added.

Nurse practitioners hold the equivalent of a master's degree in nursing, as compared to registered nurses, like Steffen, who are licensed to assist doctors after receiving an associate degree in nursing.

Steffen, who earned a bachelor's degree in sociology and Spanish from Indiana University in 1979, went on to earn an associate degree in nursing from Pierce College in 1986. Soon after, she began working at Northridge Hospital Medical Center.

``I've wanted to go back to school and earn an advanced nursing degree for about six years, but my kids were still too young,'' said Steffen, whose youngest son turned 7 this year. ``Now the youngest is in school all day, so it's a little easier. . . . I just felt I had so much capacity that I wasn't using, and I also wanted to broaden my knowledge.''

Intensive three years

The new program will take Steffen three years complete. UCLA has had a nursing program since 1971, but it normally takes a total of four years of college and two years of graduate-level course work to complete a bachelor's and a master's degree in nursing.

Like Steffen, students admitted to the school's regular four-year BS/MSN program in nursing have already completed an associate degree.

The new program, dubbed Advancing Nursing, Bachelor of Science, Master of Science, allows nurses with associate degrees and professional experience to complete the course work necessary for both degrees during an intensive three-year course.

After her course work is completed, Steffen said she hopes to work in an outpatient clinic environment in eastern Ventura County or in Oxnard.

``Whether I work in a group practice or independently - I'd like to work in the Simi Valley/Moorpark or Oxnard area,'' she said. ``I want to work with a clientele that I know and see on a regular basis.

``I expect to be hanging my own shingle. . . . People would be coming for primary and preventive care. There would be wellness checkups for kids, immunizations, gynecological checkups for women and specialized gerontology services.''

All are services nurse practitioners are licensed to provide in outpatient clinics operating independently of hospitals, and all are services that are in high demand, Barker said.

``Most nurses learn little about community-based health care, and because most everybody is moving out of hospital-based care, there's a high demand for advanced practice nurses,'' Barker said.

Nurse practitioners can focus in high-demand areas such as elder care, wellness and prevention, or, as Steffen dreams of doing, providing all those services under one clinic roof. And because she is bilingual in English and Spanish, Steffen hopes to provide services to the area's Spanish speakers.

Culture and care

Her language skills, and her knowledge of Latin American cultures, will be a plus in an increasingly diverse region, according to program directors who list cultural diversity as an important area of education for all nurses.

``I have a certain allegiance to the Hispanic community because my husband is Peruvian and we lived in Peru for three years. I always say I was Hispanic in another life,'' Steffen said. ``So I'm well enmeshed in Hispanic culture, though I say that recognizing that there are, in fact, many Hispanic cultures, with a wide range of issues and beliefs.''

Steffen's field work has included encouraging visits to community-based clinics that are better funded and staffed now than they were a decade ago.

``When my husband and I were new in California with a young family, we had to use the clinic system at times, and the clinics were generally old, small, dirty and noisy,'' she said. ``It's been a real eye-opener to see nurses working now in the community clinic setting that's so different, and to see what good care people can get at clinics.''

CAPTION(S):

Photo

Photo: (Color) Registered nurse Kathryn Steffen of Simi Valley is enrolled in a three-year course at UCLA to become an independent nurse practitioner.

Evan Yee/Daily News