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Advanced practitioners span nurse-doctor gap

Trained at the master's degree level, ARNPs work with physicians and perform many of the same procedures.


© St. Petersburg Times, published March 4, 2001

Medical professionals usually have letters listed after their names. Some of the "alphabet soup" is easy to decipher: M.D. stands for medical doctor, RN for registered nurse, and so on.

What about ARNP? That is short for advanced registered nurse practitioner. The initials might not be immediately recognizable, but more and more people are coming to understand what these professionals do.

In Florida, advanced practice nurses are known by the state licensing term: advanced registered nurse practitioner, or ARNP. There are three kinds: nurse midwives, nurse anesthetists and nurse practitioners.

All told, 37 such professionals list a Citrus County address, according to the state Department of Health. That means they live here or work here or both.

Most advanced registered nurse practitioners are trained at the master's degree level and have specialty training beyond their initial nursing training. Simply put, they can do more than registered nurses but not quite as much as physicians.

For example, take Lucy Seijas, who owns and operates the Nature Coast Birth Center in Crystal River.

Seijas is a nurse practitioner and a certified nurse midwife, which means she can handle almost the full array of women's health services, including delivering babies.

However, she cannot prescribe controlled substances such as morphine.

Seijas went through a 14-month program at the Baylor College of Medicine in Houston, a time spent almost entirely "eating, sleeping, breathing nothing but ob-gyn," she said.

Other local ARNPs include Marybeth Nayfield, administrator of the Citrus County Health Department, whose specialty is pediatrics, and Sandra J. Verbosky, a nurse practitioner who specializes in adult psychiatric cases.

Verbosky maintains a private practice in Homosassa Springs and also works at the Health Department. She holds a doctorate in psychiatric nursing and serves as a visiting assistant professor at the University of South Florida.

Nurse practitioners work pursuant to approved guidelines and protocols that they have established with a physician.

State regulators don't require those physicians to be in the examining room, or even in the same building necessarily; rather, the doctor has consulted generally with the nurse practitioner and is available for consultation.

Seijas said many patients are beginning to choose nurse practitioners as their primary care provider "just because the type of care we give is not as hurried as a physician's care is."

Indeed, nurse practitioners are more likely than physicians to follow the nursing model, which emphasizes communication, partnership with the patient, health education and preventive medicine, according to Dr. Dee Williams, executive associate dean and associate dean for clinical affairs, at the University of Florida College of Nursing in Gainesville.

Williams said nurse practitioner programs grew nationwide during the 1990s, primarily in response to the need for more primary care providers in rural and urban areas that were underserved.

That's exactly how another Citrus ARNP -- Regina Epple -- got involved in the field.

In 1993, Epple participated in a federal program that selected nurses to become nurse practitioners. The program focused on people who worked in nonurban areas where there was a need for more experts in obstetrics and gynecology.

The government paid for Epple to spend a year studying at Emory University in Atlanta. After she finished training, Epple was obliged to spend at least one more year with the Health Department, where she was working at the time. She spent more than a year there and then moved to the Genesis Women's Center in Inverness, where she still works.

Epple performs routine examinations, Pap smears and cervical biopsies. She also can prescribe contraceptives and medications. She cannot deliver babies.

"I see between four and six new patients every day," Epple said.

Genesis patients also appreciate her presence. Some prefer a woman as a health provider. Others are just glad someone is there to fill in if the practice's two doctors, Steven Roth and Armando Rojas, are called away for an emergency or to deliver a baby.

"A lot of the public's perception (of nurse practitioners) depends on their one-on-one contact," Williams said. Once patients experience the care that nurse practitioners provide, whether in a doctor's office or in another setting, the practitioners "are widely accepted."

"It's just a matter of time before we get to be more accepted," Seijas said. "Our area here in Citrus County really needs to know that those options are out there."

CHILDREN'S HEALTH MEETING: "Discover Hidden Treasures," a half-day seminar for health providers and parents, will be held from 9 a.m. to 1:30 p.m. Saturday at Curtis Peterson Auditorium in the Lecanto school complex off County Road 491.

Health professionals and providers who work in pediatrics will set up displays and answer questions. Also on the schedule: talks from Joe Dillman, a Chicago pharmacist and national speaker who lectures on drug awareness.

Dillman is scheduled to begin speaking at 9:30 a.m. After an hour or so, participants will have a break and a chance to stop at the various displays. Dillman will resume speaking at 12:30 p.m.

Admission is free. The sponsors are the Citrus County Tobacco-Free Partnership and the Citrus County Children's Health Task Force.

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