Five days a week, Nurse Practitioner Melissa Clarke provides continuity to delivering health care at Riverside Tappahannock Hospital.
Clarke visits patients and makes diagnoses, formulates treatment plans, talks disease prevention with patients and takes a holistic approach to treating the sick and injured. While physicians at Riverside Tappahannock Hospital are caring for the most critical patients —those in the intensive care unit, for example —Clarke is treating the patients on the floor.
"I love being a nurse practitioner," Clarke said. "I wouldn't be doing it for 11 years if I didn't. I like taking care of patients, making sure that they get everything they need to be well."
Riverside Tappahannock Hospital celebrated National Nurse Practitioner Week the week of Nov. 8-14;highlighting the work of two nurse practitioners, Clarke and Linda Mitchell, as well as acknowledging Nurse Practitioners, Kathy Shea at Riverside Urgent Care in Tappahannock and Teresa Williams at Warsaw Medical Arts.
Nurse practitioners are licensed, expert clinicians with advanced education —most have master's and many have doctorate degrees —and extensive clinical preparation. They provide primary, acute and specialty health care services.
In addition to providing a full range of services, nurse practitioners work as partners with their patients, guiding them to make educated health care decisions and healthy lifestyle choices. Each year in the U.S., more than 916 million visits are made to nurse practitioners.
The first nurse practitioners program was established 50 years ago at the University of Colorado and there are more than 205,000 licensed nurse practitioners in the U.S., according to the American Association of Nurse Practitioners.
Mitchell, by her own admission, moves around quite a bit. During the week she works at three locations, including the office of gastroenterologist Dr. Waring Trible in Tappahannock, Riverside Callao Medical Arts and Riverside King William Medical Center in Aylett.
A nurse practitioner for 16 years, Mitchell obtained her undergraduate and master's degrees in nursing from Virginia Commonwealth University. 
"I like being able to help my patients reach their health care goals," Mitchell said. "Getting their blood pressure where it needs to be or getting their anxiety under control. I like being a family nurse practitioner because I can treat the whole patient and the whole family."
Mitchell also enjoys working as a nurse practitioner in a rural environment. "I like the extended family feeling," she said. "It's the grandma coming in bringing the grandchildren and sometimes the great-grandmother bringing the great-grandchildren. I love it. I get to have a wider patient base and if they can't see me in one place for some reason they will come see me in another place."
Clarke has spent the past 5 years working as a nurse practitioner at Riverside Tappahannock Hospital. Clarke obtained both an undergraduate and a master's degree in nursing from Virginia Commonwealth University.
"Working as a nurse practitioner entails a holistic model of health care to include the medical as well as social, religious and other aspects of healing," Clarke said. "Nurse practitioners have a lot more training in pathophysiology, or the disordered physiological processes associated with disease or injury," she said.
"In Virginia, there's no longer limitations on nurse practitioners," Clarke said. "We can write prescriptions, or do chest x-rays and take care of patients from the time they enter the hospital to the time they leave."
One area that is continually evolving in medicine regards criteria set by insurers on who can be admitted to hospitals. "Patients are a lot sicker now," Clarke said. "And they have a very short length of stay —the average stay is three days. So we have to prepare them to go home or to go to rehabilitation very quickly."
Medicine has seen many big changes in recent years, Mitchell said. "There's so many new medications coming out and there's so many more treatments for so many conditions," she said.
There's also a push to get 80 percent of the U.S. population to be screened for colon cancer —one of the most preventable cancers with early detection —by 2018. "So we're trying to get everybody in here screened for colon cancer," she said.
Being a nurse practitioner has plenty of rewards, Clarke and Mitchell said. Mitchell described how treatment for hepatitis C to eradicate it —left untreated it can lead to liver cancer —can cost $200,000. But prescription assistance is available and three of her patients have received the treatment for free. "That is very significant," Mitchell said.
The role of the nurse practitioner will be more important in the future of health care, especially when it comes to primary care. According to the American Academy of Nurse Practitioners, "NPs are a vital element of the primary care workforce with a major role in making high-quality, patient-centered health care available to the broadest possible range of consumers. In fact, NPs make up the most rapidly growing component of the primary care workforce."
Mitchell said nurses should take advantage of it. "I would like to encourage all nurses to go back to school to become a nurse practitioner," she said.