Understanding Just What It Is That The Doctor Orders

Nurse Practioners Communicate As They Treat Patients

March 08, 1992|By Anne Haddad | Anne Haddad,Staff writer

The next time you find yourself wishing your doctor could spend moretime with you, think about calling a nurse.

A growing trend in the last decade, nurse practitioners are registered nurses with additional training to handle routine medical care and patient education. They work in tandem with doctors.

Pediatric nurse practitioner Sandra Wildisan was part of the trend before it was even recognized as such. The children know her as "Miss Sandy," and Wildisan said she makes a point of remembering all thechildren's names, too.

"I really try to know all the kids in the family, so if they all come in together, I can call everybody by name," said Wildisan, 53, from Washington Heights Medical Center. She works with pediatricians Karl Green, Michael Scobie and Charles Ashburn.

Mary Madrinan, 34, practices in the Billingslea Building in Westminster as a general nurse practitioner for adults, treating minor ailments such as ear infections, screening for breast and cervical cancer and other diseases, and educating patients about chronic conditionssuch as high blood pressure.

Madrinan also works with her husband, Dr. Reynaldo Madrinan, a urologist, educating patients and checkingon those in the hospital recovering from surgery.

Often, she willstop in to see a patient after the doctor has just given a diagnosisand some directions for follow-up care.

"When I go back to say, 'Did you understand what he said?' you'd be surprised how many times they say no," Madrinan said.

"I think they're more intimidated by the physician. Especially older people. They come from the old school that you do everything the doctor tells you and you do not question."

Doris Bauerlein, 70, agreed.

"I trust what Mary says because Iknow she's got the doctor by her," said Bauerlein.

Madrinan has treated Doris' husband, Caspar, 80, and daughters Barbara Bauerlein, 33, and Deborah Long, 38.

Barbara is brain-damaged and has requiredspecial patience and skill when she is in pain, her mother said. Madrinan has even visted their home when it was difficul;t to get Barbara to the office.

Wildisan works mostly with children coming in for"well" visits -- scheduled appointments for immunizations and exams to make sure the child is developing well.

Ryan Groft, 2, has asthma and often sees the doctors. But his mother, Diane, said Wildisan has been helpful in teaching her to manage the condition.

Last Christmas, Ryan had an attack. Over the phone, Wildisan helped Groft use the right terms so that medical people on call could assess the severity.

"Never have I asked a question when I got the message or bodylanguage from her that it was a dumb question," Groft said. "I like the fact that she is also a mother. She's been up nights with her children."

Wildisan said some mothers in the practice feel more comfortable asking her more questions, especially about breast feeding, than they might of the doctors.

The education required of nurse practitioners hads changed in the 25 years the specialty has been around.

In 1972, Wildisan already had 12 years of registered nursing under her belt and had had completed another six-month program at the University of Maryland and a two-year internship under a doctor. She already was working with Green.

Since 1979, the American Nursing Association has required nurse practioners such as Wildisan have a bachelor of science degree in nursing, two years of experience and a master's degree. However, nurse practitioners such as Wildisan were grandfathered in.

Although there are none in Carroll County yet, certified nurse-midwives are another category who work with doctors to assistpatients with pregnancy anddelivery care.

Carroll County General Hospital does not have provisions for nurse-midwives, but hospitals and birth centers in Baltimore and Howard County do have them on staff.

Both Wildisan and Madrinan said if they were starting over just out of college, they would still choose to be nurse practitioners rather than doctors.

"I don't think I'd ever be happy being a doctor," Wildisan said. "There's just something special about nursing. I like caring and being able to administer to people."

Madrinan said the carin aspect of the job suits her as much as it does the needs of her patients.

"Many of the behaviors that I have as a nurse-- in terms of nurturing, taking time and caring -- you'd have to give yp to be a doctor," she said. "If you don't, you'd never get through the day seeing everybody."

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