Filling the Gap 

Nurse practitioners increase health care access for patients in Northeast Wisconsin 

Five years ago, Anna Frederickson of Kaukauna had a change in her family’s insurance coverage. No longer able to afford the family plan insurance premiums, Frederickson was referred to Rachael Cabral-Guevara, a board-certified family nurse practitioner with Nurse Practitioner Health Services (NPHS) in Appleton.

Frederickson, whose four children had been seeing a family doctor until that point, noticed some differences at their appointments with Cabral-Guevara.

“I couldn’t believe the time she took, how thorough she was and I never felt rushed,” Frederickson says. “I liked [our family doctor], but along the way I started to feel rushed through appointments. I didn’t feel heard and I didn’t have time to collect my thoughts and ask questions when I was there.”

While NPHS is a direct health care provider that offers flat-rate health services, nurse practitioners can be found at all types of health care organizations from hospitals to community clinics to specialists’ offices.

Nurse practitioners (NPs) are registered nurses with advanced training and education. Because of their nursing backgrounds, many NPs take a holistic approach to patient care and focus on building relationships with each individual. Their schedules are often more flexible than those of physicians and allow for more time spent in patient consultations. For patients like Frederickson, the personal attention and feedback provided by a nurse practitioner were essential.

“I wasn’t expecting to get the level of care that we are getting,” Frederickson says. “I like how she guides you along and if it’s outside her realm, she makes a referral. She is willing to help you move to the next level in the best interest of her patients.”

Nurse Practitioners In Demand

According to the U.S. Bureau of Labor Statistics, there are currently about 300 NPs working in Northeast Wisconsin, with over 3,000 employed throughout the state. Overall employment of nurse anesthetists, nurse midwives and nurse practitioners is projected to grow 26 percent from 2018 to 2028. This is much faster than the average 5 percent growth expected for all occupations over that time period.

Cabral-Guevara is also an instructor at UW Oshkosh’s College of Nursing. She says of the recently admitted 90 nursing students, close to half want to become nurse practitioners.

“More and more nurses are getting into this field,” she says. “They want to do more than just straight patient care.”

Dr. Jennifer Frank, chief medical officer of the ThedaCare Clinically Integrated Network, says the demand for NPs is increasing throughout the Fox Cities.

“We are a growing community and we are always looking to grow our provider group at ThedaCare to meet the demands of our population,” she says. “[NPs] have become an increasingly essential part of our care team.”

Rapid growth in this field is expected for several reasons. First, there is an overall increased emphasis on preventive health care services, such as wellness visits, immunizations and screening tests. These services have traditionally been provided by primary care physicians, but nearly 90 percent of NPs are prepared in primary care and can manage 80 to 90 percent of the care provided by physicians.

This is good news, because there is an increasing demand for all health care services from an aging population and not enough physicians to meet that demand. According to the U.S. Census Bureau, the nation’s population is estimated to grow by more than 10 percent by 2032, with those over age 65 increasing by 48 percent. By 2030, the Association of American Medical Colleges predicts the United States could see a shortage of up to 120,000 physicians.

“There is a limited number of physicians available, so by adding NPs to the team we are able to expand the clinical care we provide to patients,” Dr. Frank says.

The educational requirements for NPs mean they can typically enter the workforce faster than physicians. While physicians must complete four years of undergraduate education, four years of medical school and three to seven years of residency, NPs complete four years of undergraduate study, typically work for several years, then complete two to fours years of additional schooling for a masters or doctoral degree.

As the practice of medicine becomes more complex with higher degrees of specialization, Dr. Frank says NPs are uniquely situated to help provide cohesive patient care at a time when it is most needed.

“Care has the potential to become more fragmented as it becomes more specialized, so we have to engage as a team because every person brings some special skill and knowledge to the table,” she says. “[NPs] bridge the world between physicians and nurses, having worked in both areas. They have the ability to balance out a team.”

Dr. Frank says NPs are well suited at onsite medical clinics where services are largely preventative or acute cases, such as the City of Appleton’s Connecting Care Clinic for employees and their families.

“Their scope of practice covers 99 percent of what is walking through the door each day,” she says. “NPs can become more of the fabric of those populations, going beyond the clinic walls into the community.”

Increasing Accessibility

Jessica Van Lannen is a nurse practitioner who has been with ThedaCare for 15 years. She has spent the last five years of her career at ThedaCare Physicians Appleton North.

Her days start at 7 a.m. and generally end at 5 p.m. Within that time, Van Lannen sees about 18 to 20 patients for everything from scheduled well visits and preventive care to acute visits for things like ear infections and sore throats.

“Our schedules are typically a little more flexible to see patients for preventive care visits. If the primary care provider is full, we don’t want to turn people away who want to be seen,” Van Lannen says. “Using NPs to have more access for preventive care is really important.”

The dynamic between physicians and nurse practitioners differs by organization and practice, but in Wisconsin, nurse practitioners are required to work with a collaborating physician. Some nurse practitioners work closely in tandem with a physician, while others operate more independently.

“As an NP I can practice very autonomously,” Van Lannen says. “The way we work here, we tend to bounce ideas off of each other. If I have concerns, there’s always a physician I can go to. It’s a really collaborative environment.”

Gabriela Van Eperen, APNP at Ascension Medical Group at Main St. in Neenah, says many patients are surprised to learn the extent of care that NPs can provide. Nurse practitioners assess, diagnose and treat many medical conditions. They can prescribe medication, order diagnostic tests and perform procedures.

“I see all my own patients and manage their preventive, chronic and acute care,” Van Eperen says. “I order my own labs and meds, my own follow-ups and referrals. From the patient’s perspective, they wouldn’t see any difference from an NP to a doctor.”

As a registered nurse, Van Lannen spent years in the labor and delivery unit where she developed skills in patient relationships and communication.

“As a nurse practitioner, you can take what you did as a nurse and use that to move forward,” she says. “I never had to learn how to talk to a patient about a diagnosis because I’ve been talking to them all along. That’s a big benefit.”

Cabral-Guevara says in addition to their educational backgrounds, the time NPs spend with patients is one of the notable differences between them and physicians.

“NPs emphasize education and the entire picture of healthcare,” she says. “Quite often, NPs schedule appointments that are 30 or 60 minutes so we can educate patients.”

The ability for increased patient interaction and education was a motivating factor for Van Eperen to pursue the career path.

“I really wanted to foster long term relationships, to be that educational support for patients and be their cheerleader,” she says. “In the hospital, you only see patients for a short time, so I wanted that longevity and relationship building experience.”

Patients may find that their NP will not only treat an illness, but will offer suggestions on diet, exercise and mental health care that can affect overall well-being and even prevent the illness from the start.

“I approach each patient individually and find out what their end goals are and we create a plan that fits them best and provides the best health care opportunities,” Van Eperen says. “I’m happy and open to work with patients within the Western model and a natural, holistic model. There’s lots of ways to achieve optimal health.”
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