sealPurdue News

February 1999

The nurse is in

Nurses' roles, education expanding (Indiana Version)

WEST LAFAYETTE, Ind. -- "Do you want to see the doctor or the nurse practitioner?"

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It's a question more and more Americans are hearing when they call their primary health care provider, and the trend is growing. That's because advanced practice nurses -- those who have education and clinical practice experience beyond that required of a registered nurse -- are taking on new roles that put them on the front line of primary and preventative health care.

The reason goes directly to the bottom line.

"The skyrocketing cost of health care has changed the focus of medical practice to that of health promotion and wellness," explains Sharon Wilkerson, assistant head for graduate studies at Purdue University's School of Nursing. "That's where the advanced practice nurse can really make a difference as a provider -- and the numbers we see indicate that the nation currently needs an additional 100,000 primary care providers to meet desired levels of care."

The American Nursing Association estimates that between 60 percent and 80 percent of primary and preventative care traditionally done by doctors can be handled less expensively by a nurse.

"It's not because the quality of care is different, but because of the basic economic factors involved," Wilkerson says. "Doctors have much higher overhead in terms of equipment and facilities, liability insurance, and the cost of their education."

Financial beneficiaries of the nurse-practitioner trend include the health care provider, who can pass the savings on to consumers indirectly, according to Priya Rajagopalan, visiting assistant professor of economics at Purdue.

"The patients or their insurance companies will generally pay the same amount for an office visit whether they see the doctor or the nurse practitioner, so the patients won't see the savings on the front end," she says. "But by containing its costs on services for minor illnesses and injuries, the provider can use the savings to cross-subsidize other programs to keep them more affordable."

Wilkerson says the potential cost savings is not the only benefit to patients.

"For the most part, a physician's income -- particularly that of a general practitioner -- will fluctuate depending on the number of patients seen," she says. "So it's in the doctor's best interest to treat as many people as possible. But a nurse practitioner receives the same salary no matter how many people are seen, and this can translate into patients spending less time in the waiting room as well as more time for discussion between the nurse and the patient."

There are four types of advanced practice nurses: certified nurse midwife, certified registered nurse anesthetist, clinical nurse specialist and nurse practitioner. All have advanced educational and clinical practice beyond the two to four years of basic nursing education required of all registered nurses.

Clinical nurse specialists usually concentrate on a general area such as mental health, cancer care, gerontology or neonatal health. Nurse practitioners are qualified to handle a wide range of health-related issues including the diagnosis of common minor illnesses and injuries. In many states they can prescribe medications, order and interpret laboratory tests and X-rays, and counsel and educate their patients.

Annual salaries for advanced practice nurses vary according to the health care setting, but in 1997 they ranged from $43,386 in college health clinics to $60,000 in emergency departments and surgical facilities. The most recent national figures list the average salary as $52,532, compared to $36,400 for an RN.

Wilkerson says the field has a number of rewards in addition to higher salaries.

"Advanced practice nurses have a lot more flexibility when it comes to the kind of work they do and when they do it," she explains. "Many RNs work in the acute care setting of a hospital and only see a patient when there's a crisis. But a nurse practitioner, for example, can delivery primary health care across the life span of a patient, and usually during regular office hours."

The career field is expected to continue to grow, especially in the area of primary and preventative health care services. To help meet the demand, Purdue has begun offering two graduate-level nursing courses on the West Lafayette campus that previously had been available only at its Calumet campus in Hammond. And starting this semester, the school began offering a graduate-level nursing course in pharmacology via a distance education classroom that links the two campuses through two-way interactive video.

But even with the additional courses, Wilkerson says there is still a waiting list.

"Because of the very intensive clinics involved, we can take only 15 to 20 students at a time in the traditional classes, and they fill up immediately," Wilkerson says.

Similarly, enrollment in the pharmacology class is at capacity with 40 students. Plans call for a Web-based nursing research course to be launched this summer that will allow working nurses to take the class on their home computers.

"We're responding to what the industry is telling us it needs," Wilkerson says. "Advanced practice nurses have more versatility in terms of the kinds of care they can provide, and that benefits both the nurse and the employer."

Sources: Sharon Wilkerson, (765) 494-4013; e-mail,

Priya Rajagopalan, (765) 494-4436; e-mail,

Writer: Sharon Bowker, (765) 494-2077; e-mail,

Purdue News Service: (765) 494-2096; e-mail,


As health costs soar, advanced practice nurses are providing more of the routine medical care once handled by doctors. Kellie Lohrman-Kozma is a certified family nurse practitioner in Lafayette, Ind. Here she monitors the fetal heartbeat for a pregnant patient. Nurse practitioners handle a wide range of health-related issues, including the diagnosis and treatment of common minor illnesses and injuries. (News Service photo by David Umberger)
Color photo, electronic transmission, and Web and ftp download available. Photo ID: Wilkerson.njobs1
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