Mary Beth Alder, Ph.d., A.P.R.N., A.A.H.I.V.S.
The clinic where I get my HIV care is a really great place and I am very happy with my doctor there. Sometimes when I go for my routine visits, and also on some occasions when I have needed something quick or when I was actually really sick with a flu, I was seen by the clinic nurse practitioner. The NP is great; he is also an HIV Specialist, and he seems to be as knowledgeable about things as my doc, but can you tell me, what is the real difference between my doctor and the NP who sometimes sees me?
This is a great question, and we hear it often. I'll describe what an NP is in a moment, but for starters, there are many levels of nursing care, and each is differentiated by education and responsibility. For example, a Licensed Practical Nurse, or LPN, is trained to perform basic medical tasks and usually requires a certificate from a one- or two-year program following high school. A Registered Nurse, or RN, must obtain a Bachelor's degree at an accredited university. An RN has an understanding of anatomy, physiology, and disease processes. RNs employ greater critical thinking skills and are able to apply nursing concepts to individual patient problems. An RN cannot make medical diagnoses though, and by law cannot prescribe medications or order medical interventions.
A nurse practitioner, or NP, is an RN with a graduate degree in advanced practice nursing. Licensed by both the Departments of Medicine and Nursing in most states, an NP requires a minimum of a master's degree education. They are licensed to provide a broad range of health care services, including taking a patient's history, performing a physical exam, ordering lab tests, and making clinical decisions on medications and other treatments. Nurse Practitioners are also able to diagnose, treat and manage diseases, provide prescriptions, and coordinate referrals to other health care providers. In some states, NPs work completely independently, while in others they are required to work with an MD. In short, your nurse practitioner can often provide the same level of medical care as an MD.
In a lot of ways, nurse practitioners are ideally suited to the type of care that HIV disease calls for. A much higher frequency of visits, and the fairly concise nature of HIV specialized care, make your NP the ideal provider to provide very high quality and competent care for almost anything related to your health and well-being with HIV. Moreover, the nursing scope of practice differs somewhat from the medical scope of practice in that it centers around a holistic approach to patient care. This holistic approach recognizes the impact of social and psychological factors that affect one's health. Social and psychological factors are extremely important in HIV care, and so receiving the benefits of this aspect of care likely benefits your health in indirect ways. Nurse practitioners often take the time to ask about things like your medication "compliance," non-medical factors in your life that may be affecting that compliance, your sexuality, social support, stress, mental health, family, finances, career, and relationships. Looking at your life and your person as a whole can greatly impact the success of your medical care, and may ultimately help you feel better about your body and your life in general.
Best wishes for good health, and please share this response with your own NP. He may be able to offer even more insight into the way our profession offers an additional aspect of care for a healthy life with HIV.
Mary Beth Alder, Ph.d., A.P.R.N., A.A.H.I.V.S., is with Capital Medical Associates, Washington, D.C.
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