Nursing specialty grows in popularity

(The Patients at Arrowhead Medical Center here sometimes call Marcia Hillman “doctor.” She understands the confusion, but gently corrects them.

She’s actually an advanced registered nurse practitioner, so she can see patients, diagnose and treat their maladies and prescribe medication — just as a family practice doctor.

Patients “can’t tell the difference,” Hillman said.

Advanced registered nurse practitioners usually come from a registered nursing background before going back to further their education. They can specialize in a variety of fields, just as medical doctors can.

“We know that we are not doctors, and we never pretend to be,” Hillman said. “We just enjoy working with our patients, and patients appreciate our tone.”

Advanced registered nurse practitioner is the second-highest nursing degree available, after medical doctorate.

In Iowa, becoming an advanced registered nurse practitioner means getting a master’s degree in nursing from one of five colleges in the state, including Allen College in Waterloo, where 37 nurse practitioners graduated this month — up six from last year.

In Iowa, members of the profession can work independently, but in larger health care organizations such as Wheaton Franciscan and Allen Memorial Hospitals in the Waterloo-Cedar Falls area, advanced registered nurse practitioners are assigned to a physician, who can double-check or sign off on their work.

Dr. Tim Horrigan, Allen’s chief medical officer, said that means advanced registered nurse practitioners become “physician extenders” in a sense, allowing for more patients to be seen and more personal care to be given.

“Their work in the hospital has grown exponentially,” Horrigan said. “Working with hospice programs, or their work within a specific physician practice, has exploded over the years.”

At Covenant Medical Center’s Convenient Care in Waterloo, patients typically are seen by an advanced registered nurse practitioner. But such nurses can also specialize in any medical field, whether it’s the neonatal intensive care unit, geriatric care, family practice or surgery.

The field has expanded nationwide, partly as a result of health care reform, said Kathy Weinberg, associate director of practice and education for the Iowa Board of Nursing in Des Moines.

The White House estimated that health centers nationwide have added 3,000 nursing positions, 800 of those in advanced practice, since health care reform passed in 2009.

In Iowa, after a drop of about 100 licensed advanced registered nurse practitioners last year, the number is up more than 300 today, to 2,230, according to the Iowa Board of Nursing.

“I think, at this point in time, (getting an advanced registered nurse practitioner license is) a common step the nurse may take,” Weinberg said.

Kristin Davis said she was encouraged to get her degree after she got a job in 2006 as a registered nurse. She graduated from Allen in 2009 with her advanced registered nurse practitioner degree and kept working at Arrowhead.

“You have completely different tasks” from RN duties, she said. “You are still comforting children, making sure mom’s got support. But instead of immunization and urine cultures, you’re doing splinting of fractures, putting sutures in.”

Davis, like Hillman and others, has “ARNP” on her hospital badge. To some patients, that’s a point in her favor over a medical doctor, she said.

“I think there’s a certain population that seeks to see nurse practitioners,” Davis said. “Nurse practitioners have a nursing background, and a nursing background is based on caring. … I learned how to care and talk to people first, and diagnose and treat second.”