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A new kind of nurse.

Almost 900 Nurse Practitioners Supplement the Medical Industry in Arkansas

WHEN PATRICK STERN moved from Cleveland to Little Rock in 1981, he came with a special request.

The behavioral pediatrician at Arkansas Children's Hospital and associate professor of pediatrics at the University of Arkansas for Medical Sciences asked to have a nurse practitioner in his office.

"They were an invaluable resource," Stern says of the nurse practitioners he knew in Cleveland.

There were few, if any, nurse practitioners at Children's Hospital then. But Stern got one. In fact, he now has two. Today, there is a nurse practitioner in almost every section of the hospital.

"They're not replacing physicians," says Linda Hodges, dean and professor at the College of Nursing at UAMS. "They work in collaboration with physicians to make health care more accessible, particularly to underserved populations in rural areas."

Nurse practitioners treat commonly seen problems of all ages. Training dictates what a practitioner can handle, but family planning and obstetrics are two popular areas.

In Stern's office, the practitioners conduct histories and physical exams.

"There's a lot of repetition in doing histories and physical exams that can be done very well by trained people like nurse practitioners," Stern says.

"It allows me to focus my medical work into the more complicated parts of the work with the patients and families rather than having to do some of the routine things that other well trained people can do."

Skill Levels Vary Widely

Every state has a legislative act that dictates what a nurse practitioner can legally do.

Arkansas is one of only two states that actually administers a license from the State Board of Nursing.

But the skill levels of practitioners vary widely.

Just this year the UAMS campus started its first master's degree program for practitioners.

"We feel like that's the level nurse practitioners need to be prepared at," says Janice Dean, who is a family nurse practitioner and a clinical instructor with the UAMS program.

"Our focus is primary care," Dean says. "There is a need for our services, and there's a place where we can fit into the health care service nicely."

But that place is still being defined.

There is a debate over Arkansas' Nurse Practices Act.

It defines management but does not clearly outline prescriptive privileges.

Some physicians oppose practitioners being able to prescribe medicine. Others do not.

"It's just critical that a person has the training clinically and in knowledge if they're going to be the ultimate person responsible," Stern says. "I don't think they necessarily have to become a doctor to do it."

Dean says there are some rural health clinics that are basically run by nurse practitioners and seldom have the benefit of a physician. If the practitioners can't prescribe medicine for some basic conditions such as an ear infection, the patient may have to drive 50 miles for it.

There are 828 nurse practitioners in Arkansas. That's up from 753 last year and 683 in 1991.

The Arkansas Department of Health is the largest employer of the practitioners.

Not everyone likes them, though.

"It's probably as varied as how people feel about chiropractors," Dean says. "Some people like them and some people don't."

But, in Dean's and Stern's experience, most people are comfortable being treated by nurse practitioners.

"It's probably because they interface with them a bit more frequently," Stern says. "Over time, they almost prefer the nurse practitioner to the doctor."
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Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Health Care Update; nurse practiciioner skill levels
Author:Rengers, Carrie
Publication:Arkansas Business
Date:Apr 26, 1993
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