ROLE OF NURSES SHIFTING WITH CHANGES IN TECHNOLOGY

The stereotypical image of a nurse is the person who checks your IV in a hospital or gives you a shot in a doctor's office. But nursing has increasingly become a profession of specialists.

"There's been an expansion of nursing into a multitude of settings," said registered nurse Bobbi Morris, a nurse practitioner at Southeast Missouri State University and president of the District Nurses Association. "Medicine has also become much more technical. It's easier to be an expert if you focus on one area."

"There are so many directions a nurse can go in," said registered nurse Lou DesPres, a certified registered nurse anesthetist at Southeast Missouri Hospital and president of the Missouri Association of Nurse Anesthetists. Most require education beyond the bachelor's degree earned by registered nurses.

DesPres administers anesthesia to surgery patients. Registered nurse Melindi Abner is a flight nurse at St. Francis Medical Center, providing care to patients on medical helicopter flights. Other nurses at local hospitals specialize in such fields as pediatrics, labor and delivery, emergency, surgery and intensive care.

One reason most specialize is because continuing developments in technology, pharmaceuticals and research change medicine almost daily, Morris said.

DesPres gave his job as a nurse anesthetist as an example. Certified registered nurse anesthetist do everything anesthesiologists do except prescribe anesthesia, which a doctor can do for the anesthetist.

DesPres said his job has become very technical, especially in the monitoring of patients.

"Fifteen years ago, there were few ways to monitor patients," he said. "Now we analyze their blood with every beat."

Advances also have been made in types of anesthesia and how they are administered.

"There is more fast tracking now," DesPres said. "We put patients to sleep quicker, and because there is better monitoring we can use less anesthesia and they wake up quicker."

Things has changed just as much outside of hospitals. There are now more nurse practitioners, Morris' specialty, diagnosing and managing illnesses in an ambulatory care setting. There are also nurses that provide home care, that work in schools and public health centers and that provide hospice care. And there are specialties within each of those areas, Morris said.

In many of these areas, nurses are becoming increasingly autonomous in delivering patient care.

Morris, for instance, has a collaborative arrangement with a physician, but as a nurse practitioner, it is Morris who sees the patients, diagnoses their problems and manages their treatment.

"Studies have shown that nurse practitioners can provide care equal to a primary care physician in 90 to 95 percent of patients in an average office setting," Morris said.

Plus patients tend to be more satisfied with the care they receive from nurse practitioners, she said.

"Physicians are educated to look at the disease," Morris said. "Nurses are educated to look at the human response to the disease."

It's a more holistic approach, she said.

In Missouri, nurse practitioners can prescribe all medications except controlled substances. Morris doesn't have hospital privileges, though she could. When her patients need a controlled substance, which would include pain medications, diet aids and tranquilizers, or hospitalization, she refers them to a doctor.

She expects the number of nurse practitioners to continue to rise because of the decreasing number of primary care providers, especially in rural areas.

"Nurse practitioners are a cost-effective, quality mechanism to provide quality health care at the primary level," Morris said.

Abner also has a lot of autonomy in her job as a flight nurse.

Physicians give flight nurses protocols, procedures they use and medications they give in specific situations, which can range from accident injuries to heart attacks to strokes to gunshot wounds. But it is up to Morris to assess the situation and decide what protocol to use.

"Your medical director has to have a lot of trust in you," Abner said.

Abner said she likes the ability to make decisions on her own and the fast-paced atmosphere of emergency medicine.

"In emergency medicine, you do the initial treatment for a patient. What you do makes a difference throughout the rest of their treatment," Abner said.

While medical technology is changing and nurses are specializing, DesPres said, what hasn't changed is the compassion with which nurses approach their job.

"We offer the same compassionate care but with a technical flare," he said.

Abner said she's seen the public perception of nurses change in the last few years.

"The public realizes it's not just bedpans and shots. There's a lot more to it," Abner said.

An advantage of specialization is that nursing is become more lucrative," said DesPres, who noted the average salary for registered nurses is $25,000 to $30,000 and those with specialties often make much more than that.

Besides the salary, Morris said there are less tangible benefits to a nursing career.

"To me, it's the best career you can have," she said. "Having patients tell you that you made a difference in their lives is a phenomenal feeling."

NURSING WEEK

National Nurses Week began Saturday, National Nurses Day, and ends May 12, the birthday of Florence Nightingale, founder of nursing as a modern profession.