12570 ~: EXTENSIONS OF REMARKS April 2·7, 1977 EXTENSIONS OF REMARKS THE NURSE PRACTITIONER A nurse practitioner should not be con­ lowing one-hour intervals, allowing one hour fused with a physician's assistant or physi­ for physical exa.mina tions. cian's extender. Nor is she a. mini-doctor. "A 'Ihe husband-wife relationship in the team physician is disease-oriented rather than co-practice creates no unusual problems. The HON. GOODLOE E. BYRON health-oriented," said Mrs. Frizzell. "The ones they have are "routine and minor," ac­ OF MARYLAND physician is not trained, for instance, in nu­ cording to Dr. Frizzell. trition or psycho-social counseling." Nor is authority a problem. "The limits are IN THE HOUSE OF REPRESENTATIVES Serious ;:;elf-discipline and stringent train­ pretty well defined using a jointly prepared Wednesday, April 27, 1977 ing is required to become a certified nurse protocol. If anything, it makes us doubly practitioner. A nurse practitioner must be careful." Mr. BYRON. Mr. Speaker, the Fred­ a registered nurse, licensed by the State Protocol in the medical sense is not ex­ erick News-Post recently contained a Board of Examiners of Nurses, having pre­ actly diplomacy. A written protocol is an es­ feature article on the outstanding work sented credentials and met criteria estab­ tablished plan of therapy for treating the of Mrs. Jean S. Frizzell, a nurse practi­ lished by the Board. Generally, after two parameters of a certain disorder. The protocol tioner. Along with her husband, Dr. years' practice as an RN, she then must outlines specific treatment accorded acute, James Frizzell, she renders outstanding attend a formal Nurse Practitioner program episodic and long-term management of in an academic setting. chronic diseases and disorders such as diabe­ service to the Frederick community and Most stat.es require a year's internship tes and h igh blood pressure. Protocols are both of them are to be congratulated. functioning as a nurse practitioner, fol­ usually m u tually established between the I think this article does an excellent lowed by an exam to show evidence of clini­ healt h care practitioners utilizing them. "For job of describing the important contribu­ cal competence. If passed satisfactorily, meet­ instance," said Mrs. Frizzell, "if I recom­ tions of Mrs. Frizzell and other nurse ing other criteria as determined by the indi­ mend a certain pharmaco therapy, diet or practitioners. I feel that this article vidual state board, the nurse practitioner activity for a patient, Jim and I must agree." might be of interest to other Members of IS certified. Evidence of continuing educa­ A nurse practitioner at the present time, tion and practice in agencies, hospitals, the cannot legally sign a prescription. Congress by helping to provide an insight U.S. Public Health Service, university infirm­ Mrs. Frizzell described a typical first ses­ into the increasingly important role aries. Planned Parenthood clinics, to name sion with a patient. "I take a complete his­ nurse practitioners are playing in the de­ but a few, JS required at the end of each tory and perform a physical examination. If livery of health care services. year. Private practice or co-practice with an the patient is a woman, I teach her how to This is particularly relevant, because established physician is rare. self-examine her breasts. I take a Pap smear, of pending legislation which would en­ Mrs. Frizzell's credentials are impressive. which doesn't have to be done by a physician. able greater participation by nurse prac­ She was graduated from the University of you know. We talk about female anatomy, titioners in the care of patients using Vermont in 1968 with a BS in Nursing. From birth control, diet and weight control. De­ Catholic University, Washington, D.C., she pending on the patient's age, we may talk medicare and medicaid. I would, there­ received her MS in Nursing in 1972. She about menopause. If the patient iS over 40, I fore, like to include the article in the was certified an Adult Nurse Practitioner may su ggest a cardiogram and cancer detec­ RECORD at this point: in 1974 after having attended the Northeast tion program." BEYOND THE RN-THE NURSE PRACTITIONER Regional Medical Program at the University "We talk about health based on the pa­ (By Pat Sikes) of Vermont. Mrs. Frizzell has supplemented tient's history, comparing h.ealth care needs and continued her education since 1970, ex­ as perceived by the patient and her family, The nurse practitioner is new to Frederick, panding her knowledge in specific areas re­ and the extent to which these needs are be­ but not to the medical coxnmunity. lating to her practice : respiration, diabetes, ing met. The patient is guided to ask herself, So what is a nurse practitioner? cardiology, alcoholism, stroke, nutrition, 'Should I be doing more or should I be doin g A nurse practitioner can be an attractive weight control, digestive disease. Her profes­ less?' young woman with modishly styled blonde sional experience includes hospital staff .. I test for glaucoma which is usually the hair who speaks medical jargon a mile a nursing, medical-surgical instruction, admin­ realm of the ophthamologist. If there are minute. istration, primary care perception and re­ teens in the family, there may be drug-re­ That's only a thumbna.U sketch of JeanS. search. Since 1973, Mrs. Frizzell has co­ lated problems which need counsel. The wife Frizzell, A.N.P., who is a member of a small practiced with a physician as an adult nurse and her husband may need marital counsel­ but growing profession presently numbering practitioner, the last two and one half years ing. If the patient is a smoker, and wishes to approximately 2500 in the U.S., with nearly with her husband. Dr. James A. Frizzell. stop smoking, we outline a program to help. 250 in Maryland. They are graduates of some Technically speaking, a nurse practitioner "If tests reveal a gastrointestinal disorder , 100 programs established over the U.S. to is an RN functioning in an expanded role as Jim may see the patient next. If there is an train the nurse practitioner. Only the Uni­ a health appraiser. In so doing, the nurse elevation of cholesterol and triglycerides an­ versity of Maryland and Johns Hopkins Uni­ practitioner elicits and records a comprehen­ other appointment is scheduled with me for versity provide the prescribed prozram in sive health care history traditionally asso­ nutrition counseling. If any time during the the State of Maryland. ciated with the p'hysician. She performs a physical I find anything that is not within Besides the nurse practitioner, nurses are complete physical examination using such my realm, I call Jim over. serving in two other expanded roles--the skills as "auscultation, perc•.lSSion, palpation "We schedule a daily telephone hour for nurse midwife and the nurse anesthetist. and inspection." (To medical illiterates, that the convenience of patients who have ques­ The concept of a trained person who could means listening, tapping, touching with tions or are anxious to hear lab results." perform basic physical and psycho-social as­ trained hands and the tools of the medical The role of the nurse practitioner doesn't sessments originated in the early 1960's. Dr. trade. As Mrs. Frizzell demonstrated, a nurse stop with her daily office practice. She iden­ Henry _Silva and Dr. Loretta Ford of the practitioner has to be able to talk in physi­ tifies problems in the clinical area that re­ University of Colorado proposed that there cians' language.") She subsequently initiates quires study, and works independently and/ was a need in the area of preventive medi­ appropriate screening and diagnostic proce­ or in collaboration with others in seeking cine for well-baby health care. "A mother dures, recommending x-ray and lab tests, if answers to these problems. She continually with a well baby has lots of questions," said indicated. evaluates the role of the nurse practitioner Mrs. Frizzell, Frederick's only adult nurse In the co-practice of Frizzell and Frizzell, in terms of consumer, self and colleague sat­ practitioner. the doctor in the house views Mrs. Frizzell's isfaction. It was further proposed that the need contribution as a nurse practitioner as in­ Mrs. Frizzell is a membe·r of the Maryland could be served by someone other than pedi­ valuable. ''A physician's assistant would not Nurses' Association. She belongs to a sub­ atrician. Such a person was needed, for in­ be able to do what she does," said Dr. Frizzell. group, Primary Care Special Interest, com­ stance, to perform a routine physical ex­ "The physician's assistant would not have posed strictly of nurse practitioners special­ amination, in the school systems, to oversee the background and training for taking case izing in the areas of pediatrics, adults, ob­ out-patient care. histories.·• stetric-gynecology, school, family. Most mem­ But the registered nurse was not the com­ Competent comprehensive case histories bers of the sub-group are ped1a.tric and adult plete answer. To protect the public, ad­ are extremely important to the Frizzells. practitioners. In sub-group sessions mem­ vanced training would have to be required. Said Mrs. Frizzell, ..Jim Bnd r share the same bers dialogue on-going practice, comparing A pilot study was conducted to determine philosophy that you can't take care of a toe problems and rewards, discussing inter­ professional and patient response to the if" you don't know what it's attached to." related audits, sharing news of others in idea. It was highly favorable: In fact, the Doesn't finding out ''what it's attached to" their field within the state.