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An E.D. Doctor Who’s Not an M.D.

Posted on Mon, Jan 14, 2013

An EmCare-Affiliated Doctor of Nursing Practice Provides Insight into Her Growing Field


mileypic.jpg“Hi. My name is Dr. Miley, I’m one of the Nurse Practitioners. What brings you to the ER?” That’s how I start most of my conversations with patients. Most patients are there for medical care and don’t think much about the introduction, but some ask “What does that mean?”

It’s a great conversation that I enjoy having. I am one of a growing number of nurse practitioners who holds a Doctorate of Nursing Practice (D.N.P.) degree. The D.N.P. is widely considered the penultimate training for clinical nursing education. After graduating with my master’s degree as a Family Nurse Practitioner, I felt like there was more to learn. I wanted more knowledge. I admit I should have probably gone to medical school, but my opportunities for a medical degree seemed limited.

My first degree program was in pre-pharmacy. I really thought I wanted to be a pharmacist. However, I was swept off my feet and married. I didn’t just pick an “Average Joe,” I married an Air Force Airman.

I always enjoyed the adventure the military offered. I got a new house every few years. I got to decorate, unpack, settle our four kids in school and, oh yeah, find a new job. My pre-pharmacy degree was not much help. So after we moved to Georgia, I decided the kids were old enough and I needed to go back to school. During my first semester, though, I found out child number five was on his way with his expected arrival during my schooling. Despite this unexpected (but welcomed) arrival, my husband remained supportive and somehow I made it through nursing school. I graduated with my associate degree in nursing.

This degree offered lots of flexibility. I no longer had to worry about what career I would work in. Nurses remain in great demand.

Even though I was working and raising children, a friend convinced me I should join her in earning a bachelor’s degree. The next year I graduated with my Bachelors in Science-Nursing.

But still, I felt the need to do more. While working in Interventional Radiology, I began to notice the nurse practitioners (N.P.s) with whom I worked. I noted that one N.P. in particular was able to insert central lines, work on clotted dialysis ports, complete biopsies, and perform various other procedures. He worked independently and was able to care for some of the more critical patients.

I decided to go back to school for my Master in Science Nursing-Family Nurse Practitioner degree. One big difference between working as a physician assistant and nurse practitioner is the degree that is required. I stayed in the emergency department as a nurse practitioner. After all, the majority of my nursing experiences were based in the emergency department. The E.D. just feels like home to me: total managed chaos. There is something about the excitement that starts and ends just as quickly that keeps me in the emergency room.

When asked to be in the inaugural class of my alma mater’s Doctoral of Nursing Practice (D.N.P.), I was thrilled. More knowledge, more information, more understanding in the medical field, and better resources - all good things to have in this ever-changing field of medicine. When asked what I wanted to complete as a capstone project, I knew it had to be something emergency-room based. I studied “chest pain in the young adult (under age 40) who presents to the emergency room.” My study has been accepted and is pending publication in the Journal of Emergency Nurses.

In today’s clinical environments, where the rapid expansion of scientific knowledge is only outpaced by the demand for health care services, it is imperative that clinical practice experts master additional competencies,” says Dr. Susan Eley, chair of the Department of Advanced Practiced Nursing at Indiana State University.

I have earned a doctorate much like those in business, pharmacy and education can earn. There is this misunderstanding that I wanted to complete the degree so I could use the doctor title. Quite frankly, you can call me Kathy for the rest of my life - it has worked for the first 38 years and I will still answer to it without hesitation. Truth be told, I am sometimes caught off guard and don’t answer when I hear “Dr. Miley.”

I continue to assist with bedside and clinical care. Of course, I’ve been approached to teach and I do this in my spare time (limited to one or two classes a semester). But my passion is still bedside care. I still find it rewarding to help others despite all of the changes and difficulties in health care. Nurse practitioners often work side by side with a team of medical providers in the emergency rooms. Each hospital is set up differently in terms of the types of patients I see, but no matter what I enjoy what I do. Having the doctorate degree only offers me more knowledge and a personal sense of accomplishment.

“The expectation of the D.N.P. prepared nurse practitioner is congruent with other professions and demonstrates additional and expanded knowledge and skills consistent with those of other clinical based professions, such as podiatrists, optometrists, pharmacists, and physical therapists,” says Dr. Eley. “No longer can the advanced practice nurse remain in the mid-level role. Nurse practitioners’ skills and knowledge place them in a role of top performers and the attainment of the Doctor of Nursing Practice degree reflects those qualifications.”

Emergency rooms are often considered a “catch all” for the underinsured or uninsured and they continue to be the point of entrance for access to medical care. Physicians are vital in this environment. However, for those times when the physician line is large and wait times for non-critical patients (those without life-threatening conditions, the physician extender can assist.

“Extenders ‘extend’ a physician’s ability to see each patient as need without sacrificing the level of quality and attention given to them,” says Chris Loman, M.D., Medical Director of Emergency Medicine at Major Hospital in Shelbyville, Ind.

If patients don’t hear my introduction, it is easily visible on my name tag: Dr. Kathryn Miley, Family Nurse Practitioner. I’m not here to mislead anyone. I’m here to help alleviate the congestion in the emergency room.

A Board-certified nurse practitioner can perform both routine and acute care, including ordering lab work, wound care and diagnostic workups. This specialized care affords patients a number of benefits including shorter wait times, attentive treatment and management, great coordination of care, continuous access to a medical professional, and accurate diagnosing with necessary treatment(s) or referral to appropriate medical care.

“Extenders are a key resource within the E.D. at Major Hospital, both for physicians and patients,” Dr. Loman says. “Simply put, they fill a role to deliver health care more quickly, efficiently and compassionately than can be done by physicians alone.”