Colorado is facing a shortage of 197 family doctors ñ a shortage that’s expected to double in three years, as reported in The Gazette June 27, 2011.In response to impending shortages, the Colorado Legislature revised the state’s Nurse Practice Act in 2010. The revised act allows advanced practice nurses (also known as nurse practitioners) to diagnose, treat and write prescriptions for patients without a formal agreement with a physician.In the past, such agreements were required by law, so most nurse practitioners were employed in doctorsí offices, clinics and hospitals.Given the shortage of primary care givers projected nationally as well as in Colorado, care provided by advanced practice nurses, especially in rural areas will be key, said retired physician Tom Davis, former chief medical officer for Penrose-St. Francis Health Services in Colorado Springs.ìJust as with physicians, knowing the limitations of one’s ability and when to seek the knowledge and assistance of specialists is key,î Davis said.Colorado is one of at least 23 other states that in recent years have given nurse practitioners more autonomy, including the ability to open their own practice, according to an article published in the ìLos Angeles Timesî March 29, 2011.Karen Migliaccio, who has worked as a nurse practitioner for 12 years, opened her own family practice, Prairie View Family Care, in Falcon’s Safeway shopping center last year.There are just not enough primary care physicians, and that’s where nurse practitioners can have a big impact, Migliaccio said.When the Colorado Legislature revised the Nurse Practice Act, it created the State Board of Nursing, which now licenses nurses in Colorado.According to the State Board of Nursing’s Web site, a nurse in Colorado who wants to become a nurse practitioner must hold an active registered nursing license in good standing issued by Colorado or by one of 22 other states participating in the Nurse Licensure Compact; hold an active advanced practice registration or license from another state with proof of active practice in two of the last five years; or hold a national certification.Nurse practitioners must also earn an advanced degree from a recognized nursing program in a specialty, such as women’s health, neonatal care, pediatrics, adult care, family practice or mental health; and have a professional liability insurance policy.If they write prescriptions, nurse practitioners must have 1,800 hours of prescribing experience under a physician mentor and complete graduate-level courses in physical assessment, pathophysiology and pharmacology.Migliaccio is an example of an emerging trend for nurse practitioners.She attended Beth-El College of Nursing and Health Sciences at the University of Colorado, Colorado Springs, where she received her undergraduate degree and masterís degree in nursing. She is currently enrolled in a three-year doctorate of nursing program in Denver; she has one year left to finish. Getting a Doctor of Nursing Practice degree is the next level of commitment to the profession, she said.There are some differences between the medical doctorís practice and the nurse practitioner.Nurse practitioners are trained to listen and see the whole patient in the context of the whole family, Migliaccio said.ìWe’re trained from a philosophy of listening and caring instead of just diagnosing,î she said.She cited an example. If a child with a swollen toe is brought into the office of a nurse practitioner, the NP will consider the impact the injury has on the childís life and help the parent work around the toe in terms of activities and something simple like shoes.Prairie View Family Care accepts certain forms of private insurance as well as Medicare patients, said Dawn Sutherland, Migliaccio’s medical assistant and office manager.Medicare has been reimbursing nurse practitioners for Medicare Part B services that would normally be provided by physicians since 1998 but at a reduced rate: 85 percent of a physicianís pay for the same service, according to the Centers for Medicare and Medicaid, the federal agency that administers Medicare.ìAs our population ages, access to primary care physicians may prove to be even more challenging than at present, and the ability for the well-grounded advanced nurse practitioner to provide such care is welcome,î Davis said.ìWe’re starting to feel people know we’re here and understand us a little better,î Migliaccio said. ìThere’s a learning curve and we understand that. We’re starting to grow.î
