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Barbara Dehn, MS, NP, RN, of Women Physicians OB/GYN Medical Group Inc. in Mountain View, CA, performs first trimester pregnancy ultrasounds, gynecologic ultrasounds, works with infertility cases and also does first pelvic exams for girls. Above, she conducts a medical examination on Deja Goodson.

Kristin Chaussee, MSN, FNP, RNCS, wanted a job with more responsibility, and she got it. The North Dakota nurse practitioner regularly detects sexually transmitted diseases such as genital warts in teen girls-a virus that can cause cervical cancer if not treated in its early stages.

Chaussee, who opened a teen clinic in Bismarck, N.D., is well-liked not only by her young patients, but also by parents who are grateful for a health professional who will take the time to teach their children about STDs. As a nurse practitioner, Chaussee is among a group of health care professionals that is quickly gaining popularity among patients as well as physicians.

For patients, nurse practitioners usually can offer more time than doctors to talk about a patient's health problems and explain the details of a condition. For doctors, NPs can ease patient load pressures by seeing certain types of cases, which frees up doctors to focus on cases that require their type of expertise.

Although the number of NPs has more than doubled nationwide in the past 10 years, nurses say that pioneering a new field has its challenges. One source of frustration is that rules about writing prescriptions and collaborating with doctors vary from state to state. NPs in some states are quickly elevating to the level of running their own practices, while in other states progress is slow, as NPs battle medical associations that are resistant to giving them more authority.

Even though nurse practitioners in some states are eager for more responsibility, most agree that the field has gained much ground since it began in the mid-1960s.

"People who graduate now have no idea what it was like in the 1960s or 1970s," said Susan Wysocki, NP, RNC, president and CEO of the National Association of Nurse Practitioners in Women's Health. "When I first was asked to attend an NP program, I literally did not know what an NP was."

Today, NPs are commonly seen in specialties such as women's health, family practice and pediatrics, although they are moving into more areas of medicine. In 1997, NPs won a major victory when the Balanced Budget Act passed. This legislation stated that Medicare would allow NPs to be reimbursed directly. Previously, Medicare billed the physician who collaborated with the nurse.

Now, 13 states allow NPs to prescribe drugs without physician involvement, and these states even permit nurse practitioners to prescribe controlled substances, according to an article in The Nurse Practitioner.

Victories such as these are possible in part because an increasing number of nurse practitioners in the field can lobby for more authority. About 88,000 NPs were practicing in the United States in 2000, compared to only about 43,000 in 1992, according to the National Sample Survey of Registered Nurses. Another powerful lobbying tool has been patient satisfaction ratings of NPs.

"We've had a long history of having to document our expertise and come up with the data to show that patients do accept us," said Joan Stanley, Ph.D., CRNP, director of education policy at the American Association of Colleges of Nursing. "Many of us have been involved in the movement for a long time. All the studies have shown patient satisfaction with nurse practitioners, and that the care provided is just as good or better than physicians'. None of the studies has shown dissatisfaction with NP practice."

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