Читать книгу Start & Run a Medical Practice - Michael Clifford Fabian - Страница 14

The nursing profession goes hand in hand with medicine, and in many ways the two disciplines need each other to function. The nursing field has expanded in so many exciting ways, from an educational, research, and practice point of view. The duration of training has become longer in many parts of the world and the specialty options are immense.

Some nurses with advanced training and skills choose to set up an independent practice of their own, either alone, with a group of other nurses, or with other health-care providers. These nurses are referred to amongst others as Nurse Practitioners, Advanced Practice Nurses, Advanced Practice Registered Nurses, and Independent Nurse Contractors. In some areas in the United States and in Canada, these advanced nurses can set up their own independent practices, while in other areas they can open independent practices only with physician collaboration. In some states and provinces, the advanced nurses can also prescribe medication, refer patients to specialists, and even admit patients to health-care facilities. Note that not all states and provinces allow advanced nurses to practice independently. For more information talk to your local nursing association.

Clinical nurse practitioners in North America practice in some ways similar to, and together with, medical doctors. For this reason, the office setup of a nurse practitioner has much in common with that of a medical doctor.

While working up in Northern Canada’s isolated communities as a visiting doctor, I came across several nurse practitioners who performed amazing work in medically under-serviced areas. The nurses take care of the patients, do the necessary examinations, prescribe medications, and work closely with doctors. Nurse practitioners are an evolving profession, becoming more independent in the urban setting too, with different countries and jurisdictions permitting different levels of practice.

I will give you a concrete example of how this profession can function. Patient Zen was an infant in a remote area in Northern Canada who had recurrent ear infections in the first two years of his life. He needed antibiotics periodically, and if the clinical nurse specialist had not been practicing there, the complications as a result of untreated ear infections could have been significant.

One of the consequences of untreated ear infections is a condition known as mastoiditis (i.e., the infection spreading to the bone in the proximity of the ear), something that can usually be avoided by treating ear infections when needed. The nurse practitioner examined Zen’s ears and decided each time whether to give an antibiotic or not. When I arrived there for clinics, the nurse arranged for me to see patients that she felt needed further assessment by an ear specialist, and I would decide on the next mode of treatment. In the case of Zen, insertion of small tubes (known as grommets in some countries) into the eardrums was needed. I arranged for this to be done in the closest city that could do this procedure. Thank goodness for the nurse who was working in this community, contributing in a meaningful way to the care of Zen, avoiding untoward medical complications, and initiating the definitive treatment.

At every stage in my career, whether it is in the hospital setting, or outpatient setting, I have worked closely with nurses. Another example would be a family practice clinic where I worked for a few years. The nurse was the first contact, and did the initial screening and questioning of the patient. She also did part of the basic examination needed for any assessment including the measurement of the pulse, blood pressure, and body temperature. The nurse would give the injections and draw blood for investigations. She would accompany me and help out with some examinations and treatment that were carried out in the examination room. The nurse was a team member every step of the way.