Dec.23, 1997
                                               Contact:  Katherine Jackson
	                                                 (804) 924-3629    


              Acute-Care Nurses Fill New Health-Care Role
              BRIDGING THE GAP BETWEEN MEDICINE AND NURSING

	A small but growing cadre of advanced-practice nurses is
enhancing health-care delivery for acutely ill patients by offering
high-quality diagnosis and individualized lifelong treatment.
	"It's a new way of delivering medical care that I expect
to continue into the next century," said Dr. Mark Robbins, who
works with advanced-trained nurses at the University of Virginia.
	Robbins heads U.Va.'s Lung Transplant Program coordinated
by two acute-care nurse practitioners (ACNPs) trained through a new
program at U.Va.'s School of Nursing.  Since 1996, 12 U.Va. nurses
have completed advanced training allowing them to practice with
physicians caring for acutely ill patients.
	Nurse practitioners (registered nurses with master's
degrees) must complete at least 18 months of study in advanced
clinical practice and nursing science to be qualified to take the
acute-care nurse practitioner national certification examination.
Once certified, these nurses typically work with a select group of
acutely ill patients such as transplant patients or patients with
congestive heart failure.  Like primary-care nurse practitioners,
ACNPs work in collaboration with a physician and are skilled at
physical evaluation, diagnosis and treatment.  Their approach to
health care involves coordinating feedback from patients, families,
nurses, physicians and other health care providers.  ACNPs follow
their patients over an extended period of time to meet families and
patients' lifelong nursing needs. 
	Nurse coordinators Vonda Reel and Beverly Ryan work with
Robbins at U.Va.'s Lung Transplant Program, the largest in the
state.  (Since its inception in 1990, about 100 single and double
lung-transplants have been performed).  Reel and Ryan prepare patients
for transplant procedures, counsel, teach and provide a significant
amount of the post-operative care, including hands-on care.
	"The value of having ACNPs working with transplant patients
is increased because we deal with very complicated and complex issues.
Physicians alone would not have time to meet all the challenges
presented by these patients.  Following surgery and after discharge
from the hospital, our patients are monitored for the rest of their
lives for reactions to medications.  We review medication problems and
decide what needs to happen," Reel said.  Reel completed U.Va.'s
advanced acute nursing program in August.  
	"The nurses are always available for patients," added
Ryan, who completed the acute-care nursing program in 1996.
"Because patients can call us directly, we are more accessible than
physicians."
	Although nursing roles are expanding and evolving, nurses are
not trying to replace physicians.  "We want to help expedite
patient care efficiently," Reel said.  "I'm not trying to win
an award.  I'm trying to meet the needs of a patient population by
providing basic care in a way that will improve patient
satisfaction."
	"Nursing care has come a long way from the days that nurses
were not permitted to perform the simplest procedures such as blood
pressure readings," Ryan said.  "Today, their roles continue to
evolve to include diagnosing and treating many illnesses," she
said.
	"Using nurse practitioners in this expanded role is very
forward-thinking," Robbins said.  "Physicians can use other
health care professionals to provide more thorough care.  Nurses can
assist in comprehensive care." 
	Nurse practitioners initially provided comprehensive expanded
services in primary care settings and recently have moved into
acute-care settings, noted Arlene Keeling, director of U.Va.'s ACNP
program.  ACNP programs began in the United States in 1990; there are
about 50 programs nationally today.
	"The use of ACNPs in tertiary care is steadily increasing
throughout the country due to redesign of the workforce," Keeling
said.  "Medical residencies in subspecialty areas are
decreasing," she said.  "The ACNP can step in to provide
continuity of medical and nursing care, allowing physicians more time
for patients with more complex medical needs." 
	Keeling says the ACNP role could bridge the gap between
medicine and nursing.  Nurses and doctors are educated and trained
quite differently, she noted. But they do have a common goal: a
favorable outcome for their patients.
	Like nurse practitioners in other disciplines, ACNPs are
board-certified and in most states have the ability to prescribe
medications. Since its inception in 1977, more than 250 registered
nurses have completed U.Va.'s primary-care nurse practitioner
program.
	Nurse practitioners are employed within several specialties
other than acute care, including neonatology, nurse-midwifery,
pediatrics, school health, family and adult health, women's health,
mental health, home care and geriatrics. 
	Beginning in January, all nurse practitioners and clinical
nurse specialists can receive direct Medicare reimbursement.  
                             ###

	For more information about the U.Va.'s acute-care nurse
practitioner program, call Arlene E. Keeling at (804) 924-5906 or Dr.
Mark Robbins at (804) 924-9687. Television reporters should call our
TV News Office at (804) 924-7550.



         U.Va. news lines:  http://www.virginia.edu/topnews/