Nurse practitioner Sandy McCoy, left, watches as Gracie Hood rings a bell for being a good patient after her examination at a practice in Dallas, Texas. McCoy works with three surgeons where she prescribes drugs, performs physicals and handles post-operative care.

If doctors no longer can meet the growing demand for basic medical care, specially trained registered nurses are poised to fill the gap.

Advanced-practice nurses have slowly been taking over primary-care functions as fewer doctors seem willing to perform these basic services. When the doctor is busy, the nurse is ready.

“A nurse practitioner can do 80 to 90 percent of what a primary-care doctor can do in the office. But it depends on their skill level,” said Sandy McCoy, a nurse practitioner who has treated patients in the Dallas area for 19 years.

For the past two years, she has worked with three surgeons who run the Baylor Weight Loss Surgery Center in North Dallas. She starts most days visiting post-surgical patients at Baylor University Medical Center before a full day of patient visits at the offices she shares with the doctors.

With nary a doctor in sight, McCoy will take medical histories, monitor vital signs, write prescriptions, manage chronic conditions and keep the patients happy.

“She gives patients her private cell phone number and tells them to call her with any concern,” said Judy Knight, the office’s patient advocate. “She’s just fabulous.”

From McCoy’s perspective, the easiest solution to the primary-care crunch would be to allow advanced RNs to have stand-alone practices that provide basic medical care for patients who have no doctor. Anything complicated would be referred to a physician, she said.

“Many nurses would work in rural areas if the state would relax some of the restrictions on their practices,” said McCoy, who also serves as president of Texas Nurse Practitioners, a statewide organization representing the interests of about 8,000 RNs.

Currently, 19 states allow nurse practitioners to work independently of doctors. An additional 20 states allow some lesser form of collaboration between the doctors and nurses. Eleven states, including Texas, require physician supervision for nurse practitioners.

Some physician groups assert that nurse practitioners might not have the judgment to recognize when a patient’s ailments are beyond their expertise. But studies have shown about the same patient outcomes whether the provider is a nurse or a doctor.

In recent years, Texas has loosened the reins enough to allow doctors to delegate to nurse practitioners the authority to prescribe drugs and diagnose ailments. “Before, every time I saw a patient, I had to stop, run and find a physician to sign the prescription,” said McCoy, 62, who recently was named nurse practitioner of the year by the American Academy of Nurse Practitioners.

Studies show that specially trained RNs, who are paid less than doctors, could cut national health care expenses by billions of dollars. Such nurses include RN anesthetists, certified nurse midwives, certified clinical-nurse specialists and nurse practitioners.

They also might do things differently than doctors. After a recent office visit with McCoy, a patient who had shed 126 pounds was encouraged to ring a bell in the waiting room. Several people within hearing distance applauded as the patient smiled proudly.

“This is what we do when a patient has done something really well,” McCoy said. “It’s my way of saying, ‘Good job.’”