Dr. Collins F. Kellogg glanced at an award hanging on the wall at his office on Public Square and recalled how its impetus caused a stir in Watertown's medical community more than a decade ago.

The American Academy of Nurse Practitioners honored him in 1997 for promoting its profession by hiring his first nurse practitioner in the early 1990s.

"A lot of area physicians said, 'Oh my God, how can you do that?'" said Dr. Kellogg, who operates Watertown Internists. "Like anything new, it raised a few eyebrows. But many of those doctors who raised the biggest eyebrows now have nurse practitioners."

With the federal government terming the north country "medically underserved," nurse practitioners — registered nurses with advanced education and clinical training — are helping to apply a tourniquet to stop the hemorrhaging occurring from a lack of primary care doctors and specialists.

"The services they provide ensure access to health care for many individuals, especially when the nation and the local community is experiencing a shortage of primary care providers," said Krista A. Kittle, spokeswoman for Samaritan Medical Center.

The local increase of NPs reflects a nationwide trend. According to the U.S Department of Health and Human Services, between 1992 and 2000 the number of nurse practitioners grew 240 percent.

The first nurse practitioner training program in North America opened at the University of Colorado in 1965. The American Academy of Nurse Practitioners notes that approximately 6,000 nurse practitioners are prepared each year at more than 325 colleges and universities.

Nurse practitioners can write prescriptions and order and interpret tests.

"If we see a patient in trouble, we can keep them out of trouble until they see a doctor," said Margaret A. "Peggy" Quinton,president of the Thousand Islands Chapter of the Nurse Practitioner Association of New York State and the sole nurse practitioner at North Country Orthopaedic Group, 1571 Washington St.

NPs say that while they can't replace doctors, their being trained initially as nurses gives them a distinct approach to patients.

"Most nurses are taught to listen to the whole person; it's the holistic approach," said Ms. Quinton.

"Theirteachingemphasizes theteachingof patients," said Dr. Kellogg.

REQUIREMENTS

Legislation allowing nurse practitioners in New York was approved 20 years ago, according to Barbara Zittel, executive secretary for the state boards for nursing and respiratory therapy.

That law requires a nurse practitioner to be a registered nurse; have five years' experience; graduate from a state-approved nurse practitioner program; have a master's degree and pass a national certification exam.

"We think a lot in terms of prevention, prevention, prevention," said Ms. Quinton. "Doctors think a lot about treatment."

For example, Dr. Kellogg said that if a patient is diagnosed with diabetes, he can sit down with that patient and describe the disease and symptoms in "broad brush strokes." However, a nurse practitioner can "micromanage" such a patient by discussing proper diet and how to record blood sugar levels.

"It enables me to see a lot more patients than I could by myself," Dr. Kellogg said.

His four nurse practitioners specialize in the fields of diabetes, cardiac care and anti-coagulation medicine, dermatology and Alzheimer's disease.

Dr. Kellogg said their training is ongoing.

"We send them all over the country for all sorts of conferences," he said. "They get a tremendous amount of job satisfaction because they're taking care of patients and managing their care."

Ms. Quinton said that her interaction with doctors is key in making their partnership thrive.

The group's associated North Country Endocrinology, also at 1571 Washington St., has two nurse practitioners, according to an Orthopaedic Group spokeswoman.

KEY AT SMC

Samaritan Medical Center has 25 nurse practitioners, said Ms. Kittle.

Ten nurse practitioners work at the Woman to Woman health center at 1575 Washington St., the Samaritan Family Health Centers and SMC's Employee Health department.

Nurse practitioners also work in community medical offices in the fields pre-admission testing, cardiology, gynecology, family practice, internal medicine, oncology, anesthesiology, orthopaedics and more, Ms. Kittle said.

She added that many nurse practitioners began their careers as registered nurses. Today as NPs, they are prescribing medication, ordering testing and performing diagnostic procedures.

"Many nurse practitioners have an extensive patient following and work side by side with physicians and other health care professionals in the hospital and clinic setting," Ms. Kittle said. "Their skill and compassion is invaluable to the physicians, staff and community."

Laura C. Shea, spokeswoman for Claxton-Hepburn Medical Center, Ogdensburg, said physician assistants and nurse practitioners play a big role in providing health care for the hospital and its seven community health clinics in St. Lawrence County. The hospital employs three nurse practitioners and about 10 physician assistants.

"They certainly do help with the physician shortage," Mrs. Shea said. "They definitely fill in the gaps."

TEAMWORK ESSENTIAL

"We do a lot of collaborative work together," Ms. Quinton said about working with doctors. "Sometimes a doctor will come and consult with me and ask, 'What do you think about this?' It makes the group function better."

Ms. Quinton is a 1986 graduate of the nurse practitioner program at Community General Hospital in Syracuse. She has worked in orthopaedics and neurosurgery and at the Osteoporosis Center at Upstate Medical Center in Syracuse. She later opened five rural health clinics staffed by nurse practitioners in Louisiana that are still providing care.

"I have the backup of a team that makes me as good as I am and I won't work for just any group," Ms. Quinton said. "We have a very good handle on a lot of different things. But you need a team of good people."

She said situations in which unruly patients demand to see a doctor and not a nurse practitioner have become rare.

"First, I would say they do need to see the doctor," Ms. Quinton said. "I don't see that a lot now. There's not a lot of patients who don't know what a nurse practitioner is."

She predicts the ranks of nurse practitioners will continue to grow: "I think it'll only get bigger because there's a need for them and they work well."

INDEPENDENT PRACTICES

Nurse practitioners can work independently of doctors' offices, but under New York state law, they must have an arrangement with collaborating physicians.

Joan D. Hawthorne and Catherine M. O'Brien opened their practice at 26495 Route 3, town of LeRay, in 2004. Their collaborating physician is Dr. Charles Moehs.

He reviews patient charts monthly and is available for regular consultations.

Mrs. Hawthorne and Ms. O'Brien, who call their practice Northern Nurse Practitioners, specialize in skin care and said their business has been growing. The two treat chronic and acute conditions including acne, psoriasis, eczema and warts. They can also take biopsies of suspected skin cancers to send for testing.

"A majority of doctors do appreciate we're here and do send us patients," Ms. O'Brien said. "I think a rural area is a great area for nurse practitioners to work with doctors. It fills a great void."