Care Beyond Doctors: Getting to Know Advanced Practice Providers

In 1925, the infant mortality rate in Appalachia was as high as anywhere in the world. In the rural woods, far from the nearest doctors, infant deaths accounted for up to 25 percent of all deaths.

Mary Breckenridge, the daughter of a wealthy and influential Kentucky family, founded the Frontier Nursing Service to help. Breckenridge and other FNS nurses rode to their patients on horseback. They rode alone in the woods. Guiding by remote riverbeds and crossing mountain trails, they safely brought the region’s babies into the world.

Today’s nurse midwives rarely reach their patients on horseback. But they still help expand available quality medical care beyond what limited numbers of doctors can provide. And they’re part of a growing number of advanced practice providers licensed to deliver all kinds of medical services.

Advanced practice providers

Advanced practice providers are health care providers with masters or doctoral degrees and advanced training. They’re certified and licensed for many specialized kinds of care. If you’re in a hospital, clinic or doctor’s office and someone in scrubs or a white coat who isn’t your doctor comes in, it may be one of these advanced practice providers:

• Nurse practitioner
• Physician assistant
• Nurse anesthetist
• Nurse midwife
• Clinical nurse specialist

Each of these providers has slightly different training and fulfills a different medical role. But they all help people get the care they need more easily.

Nurse practitioner

A nurse practitioner is a registered nurse with a master of science in nursing or a doctor of nursing practice. They also have advanced clinical training.

NPs now do a great deal of the primary care practiced in the U.S. And many are certified, trained and practicing in a broad range of medical specialties. These include pediatrics, family, emergency and psychiatric care. NPs are licensed to work independently and don’t need to be supervised by a doctor.

They can:

• Order, perform and interpret tests
• Diagnose and treat injury and illness
• Prescribe medications
• Manage care
• Provide counseling
• Educate patients on disease prevention and healthy lifestyle choices

Physician assistant

Physician assistants have master’s degrees. Their bachelor’s programs generally include basic and behavioral sciences. Many of them enter their master programs after thousands of hours working as paramedics, athletic trainers or medical assistants.

In some states, including Michigan, PAs are required to have a practice agreement with a doctor.

PAs often serve as a patient’s primary care provider. They can:

• Give physical exams
• Diagnose illness
• Create and manage treatment plans
• Prescribe medications
• Counsel on preventive care
• Perform some procedures
• Assist in surgery
• Make rounds in hospitals and nursing homes

Certified Nurse Anesthetist

Anesthesiology provides pain relief during surgery. And the anesthesiologist’s job is to keep the patient safe and comfortable. It is a far less risky business than it once was. In fact, the risks have dropped so much that nurse anesthetists can provide the same service as an anesthesiologist. And studies have shown they can do it just as safely. This is crucial in rural areas where there aren’t enough doctors. In these areas, CNAs often provide 100 percent of anesthesia services.

A CNA must have at least a master’s degree.

They may do:

• Anesthesia for many types of procedures
• Epidural, spinal, or nerve blocks
• Patient care before, during, and after anesthesia

Certified Nurse Midwife

CNMs are registered nurses with an advanced degree and are certified and trained in women’s health and newborn care. They practice in hospitals, clinics, free-standing birth centers and at-home births.

CNMs offer similar care to that of an OB-GYN doctor. They can:

• Manage labor and delivery
• Perform gynecological checkups
• Consult on family planning
• Provide prenatal care

They’re different from certified midwives.  Certified midwives may or may not be registered nurses but graduate from an accredited midwifery program.

Clinical Nurse Specialists 

Clinical nurse specialists have at least a master of science in nursing. They also have training and often certification in a specialty area. Many CSNs focus on nurse management or administration. But they also specialize in patient care areas such as:

• Populations, such as older adults or children
• Clinical settings, such as emergency rooms or critical care
• Medical specialty, such as cancer or diabetes
• Types of treatment, like wound care or pain management
  

Leaders in health care

Advanced practice providers fill vital needs for primary care and specialized services, including maternal care and anesthesiology. Like the frontier nurses, they work hard to deliver crucial services to medically underserved people and areas.

In addition to providing care, many APPs are educators, researchers and administrators. They’re on the front lines of medical practice. And many are leaders in their area of care and are helping to shape medical standards and public policy.

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