NURSING CARE IN DEMAND; NURSE PRACTIONERS DISPENSE PATIENT CARE

Clad in a white coat with a stethoscope around his neck, Paul Mackey looks like another hospital emergency room doctor.

But Mackey isn't a doctor. He is a nurse practitioner who deals with everything from ear and sinus infections to strains and sprains at St. Francis Medical Center.

He sees Convenient Care patients in the hospital's emergency room. Convenient Care deals with minor health emergencies.

Mackey is one of a growing number of nurse practitioners in the region.

A nurse practitioner since 1996, Mackey treated patients in rural northwest Iowa before taking a job with St. Francis Medical Center last February.

St. Francis has six full- and part-time nurse practitioners on its staff, including three in the emergency room.

As a boy, Mackey wanted to be a doctor. He attended medical school in the 1960s, but had to quit because of lack of funds.

But he never lost his love for medicine.

Mackey, 54, ended up going back to school in recent years, receiving a master's degree in the nurse practitioner program from the University of Illinois-Chicago.

Nurse practitioners have been around since the 1960s, dispensing medical care in many cases in rural health clinics where there are few local doctors.

"We are known as the folks who go places that nobody else wants to go," he said.

"In a lot of ways, you are like old Doc Adams in `Gunsmoke.'"

In Iowa, he often received gifts of sweet corn from the families of patients that he treated.

Patients who see Mackey at St. Francis don't realize that he is a nurse practitioner.

But when they call him doc, he corrects them and insists they just call him "Paul."'

Most nurse practitioners are women and salaries vary nationwide.

Mackey said some nurse practitioners make six-figure salaries while others receive less than $50,000.

Mackey is one of 37 nurse practitioners in Cape Girardeau and the surrounding region extending from Perryville to Sikeston, and Marble Hill to Charleston.

The number continues grow, boosted in part by Southeast Missouri State University's nurse practitioner program.

Southeast's nursing department began offering a master's degree program to train people as family nurse practitioners in 1997.

To date, 14 people have graduated from the program.

The university is on its third class of nurse practitioner students, who must have a four-year nursing degree to enter the program.

The students must complete a year of course work and obtain 760 hours of clinical experience to graduate with the advanced degree.

Nurse practitioners can treat patients as competently as doctors when it comes to routine illnesses, said the university's Bobbi Morris,

Morris is one of two nurse practitioners who teaches the nurse practitioner program at Southeast and treats students at the campus health center.

"Family nurse practitioners can competently and safely care for 90 percent of what family physicians see in their offices," she said.

Regulations vary from state to state. Nurse practitioners have prescribing privileges in 36 states, including Missouri.

In Missouri, nurse practitioners can dispense drugs, except for narcotics. They don't do surgery either.

"We cannot practice independently," said Morris. Nurse practitioners must have a collaborative agreement with a physician.

But that doesn't mean nurse practitioners can't have their own practices and patients.

Nurse practitioner Debbie Sutherland practices with Physician Associates in Cape Girardeau.

Sutherland sees patients in family practice just like the doctors in the medical group.

Like many nurse practitioners, Sutherland worked as a regular nurse for years before becoming a nurse practitioner.

"I have my patients that I see regularly. My youngest was 2 weeks of age. My oldest is 97 right now," she said.

The profession is growing rapidly, she said.

The profession began in Colorado in the 1960s as a way to assist pediatricians in such things as health promotions and screenings.

Patients generally like nurse practitioners' bedside manners.

Morris said there's good reason why patients feel that way. "We are nurses first," she said.

"Historically, I think physicians treat disease and nurses treat the human response to that disease," she said.

Sutherland agreed. "We're taught those extra communication skills," she said.

Morris said nurse practitioners know their limitations and will send patients to doctors when the medical problem is beyond the scope of their training.

Many doctors initially didn't welcome nurse practitioners. But Morris and others said times are changing.

But Mackey said there are doctors that have yet to put out the welcome mat. "There are still a lot that see us as competition."

Nancy Mosley has seen the profession grow. A nurse practitioner since 1982, Mosley has worked in Cape Girardeau since 1988.

Early on, there were few nurse practitioners in the area.

Mosley worked for a local pediatrician for years. Today, she works at the Cape Girardeau Public Health Center, treating the low-income children who visit the clinic.

She said her profession is more accepted by doctors today.

"We are not in competition with them," she said. "We are not there to take their patients."

Said Mosley, "I think they have finally realized that we are partners in health care and providing care for the patient."

NURSE PRACTIONER

A nurse practitioner is a registered nurse with advanced education and training.

In Missouri, a nurse practitioner can:

* Obtain health histories

* Perform physical examinations

* Order and interpret laboratory and diagnostic studies

* Diagnose health problems

* Develop treatment plans

* Order therapy

* Make referrals

* Provide counseling and teaching

* Prescribe medications