It's hard to imagine Larry Kerschner in his first profession.
Now a nurse practitioner, Kerschner was first employed in a plywood mill.
An injury landed him at home on worker's compensation; after boredom
set in, he decided to make a drastic career change.
"My wife was a nurse working in a hospital, so I took a job there as an
orderly. I enjoyed the work, found it very satisfying, so I decided to go
back to school and train to be a nurse."
Kerschner completed a two-year program to become a registered nurse and
landed a job in a rural hospital. For several years, he worked in a medical
surgical ward, then in the labor and delivery unit, which is an unusual post
for a male nurse.
His decision to return to school to become a nurse practitioner was based
on several factors, not the least of which was a sense of powerlessness. "There
was some frustration, because there were many times I knew what needed to
be done but didn't have the credentials to do it."
He got his bachelor's and master's degrees and returned to a
hospital setting. Eventually, he opened his own practice in a rural community
outside Seattle.
Kerschner has not looked back. Although some people might find it a big
leap to go from a plywood mill to a hospital, Kerschner says the adjustment
has not been that hard. "This work involves much more human interaction. It
is far more suited to me."
The job is a very satisfying one, marred only by paperwork and government
bureaucracy. He says dealing with health insurance companies and Medicare
has taken some of the enjoyment out of the work.
"I've been working in the same practice for seven years, so my original
newborns are now seven, and my seven-year-olds are now teenagers," says nurse
practitioner Linda Jones.
Jones says it's the long-term relationship with patients that she
finds so rewarding. "Nurses working in hospitals only see people when they're
in the hospital. It's not the kind of relationship you see when you're
involved in a family practice."
With a certificate in registered nursing, a bachelor's degree in nursing
and a family nurse practitioner certificate from the University of Southern
California -- almost six years of education -- Jones is sometimes asked if
she wouldn't rather be a doctor. But Jones says she has no plans to establish
her own practice, and she has never thought of herself as a physician.
"I'm really committed to nursing. I like the part about nursing that
is more supportive, and I like being able to spend more time with people."
Jones points out that although she performs some of the same tasks as physicians,
her role is unique. "By working in the community, you're really working
with what determines health, which is social relationships, education, economic
status -- all those things that influence health."
Jones' part in community health care stresses overall health and prevention
of illness. This means providing a lot of lifestyle counseling -- covering
areas like stress management, nutrition, tips to help people stop smoking,
grief counseling and birth control. Her focus doesn't stop there.
"I have about 400 clients in my practice, and I do everything from wellness
care for adults, to baby care, child and adolescent exams, treatment of short-term
illnesses like sore throats and earaches, and treatment of recurring problems,
such as high blood pressure," says Jones. "For many clients, I serve as their
family physician."
Jones says that when it comes to diagnosis and treatment, she uses her
judgment and places what's best for the patient above all else. "I refer
and consult with the physician on staff when I run out of knowledge."
Jones considers herself lucky in her working environment because
she's treated as an equal part of a team, a luxury not all nurse practitioners
enjoy.
"Some physicians see nurse practitioners as a threat to their role, and
there are a lot of nurse practitioners out there who aren't being properly
utilized because physicians are fearful. I think there are a lot of unhappy
partnerships out there."
Jones is grateful this is not the case with her. "I'm an equal partner.
The physician's not the head of the team; it's an equal partnership."
According to Jones, this partnership also serves the patient best. "We
share the clients. I see a pregnant woman until her 28th week, then she's
seen by the physician. After the physician delivers the baby and the baby
is examined, the mother and her child come back to me for well baby care.
"It's a very smooth and efficient system."
This spirit of equality and cooperation is necessary to run a successful
practice, says Jones. "You need the spirit of cooperation from the physician.
If you don't get it -- if they throw obstacles in your way or insist
on checking everything you do -- it defeats the whole purpose."
After years of neglect, says Jones, the career of nurse practitioner is
finally starting to become recognized as an important profession.
"Nursing has been poorly utilized in the area of primary health care. Now
governments and nurses are coming up with ways to increase the role of nurses."
Jones says the profession has succeeded because of dedicated nurses who
obtained training and persisted, despite obstacles like a lack of training
programs and physician resentment.
"Nurse practitioners love and believe in the role, so we've been willing
to keep pushing forward."
The struggle is nowhere near over for Jones, who quietly battles for respect
and recognition in her job.
"Every time we bring in a new doctor, I have to be rediscovered."