Nurse Practitioners
Daily Observer
The Advent of Nurse Practitioners
The New Nurses Seem Somewhat More
Liberated
“Harry
meet Eleanor C. Lambertson, dean of Cornell University’s New York Hospital
School of Nursing. Dean, meet
Harry.” I shook hands with the handsome
Ms. Lambertson. As we were guided by the
maitre d’ to our table I nudged S.Q. Lapius.
“What’s
the matter with you, have you forgotten my last name?”
“Shhh,”
said Lapius, “don’t be rude.”
There
is no point in describing the drinks, or the delicate oriental fare served up
to us that night, because the purpose of our dining out was so the Lapius could
renew an old acquaintance and badger Dean Lambertson about an article she had
written for Prism, the socio-economic magazine of the American Medical
Association.
“Well,
Eleanor, you haven’t changed. The last
forty years have been kind to you I see.”
“Ah,
Simon,” she smiled sweetly, “Gallant as always.
I remember even as a young man, whenever we went anyplace together, how
you slam doors in my face.”
“Tut
tut, Eleanor. That’s a canard. I never slammed a door in your face.” Lapius turned to me, “I’ll admit,” he said,
“that in my eagerness to escort Eleanor I often pushed through the portals
ahead of her and inadvertently allowed the door to swing shut before she had
gotten through, but slammed never.
That’s a very provocative statement, Eleanor. But, of course, you’ve always been
provocative. Now take that article, for
instance--.”
“You
mean on the expanded role of nurses in health care?”
“Precisely. Particularly the term ‘health care’. That’s the catch. Once medical care becomes health care, then
the services of the physician can be restricted to care of the ill, and nurses
will take over the rest of the so-called ‘health care’ and will make the
decision as to when the services of a physician are required.”
“Of
course, dear Simon. Why should so great
a man as you squander your talents on minor problems?” Her irony was not lost on Lapius.
“Because,”
said Lapius tartly, “only by being able to recognize the major medical problems
can one distinguish the minor problems.
Major illnesses often masquerade as minor illness. Nurses aren’t trained to make that
distinction.”
“But
nurses for the most part man (I hate that word) the coronary care units, and
make life saving decisions.”
“Of
course,” said Lapius, “Nurses do that after they have learned the criteria for
heart emergencies that have been established by the medical profession.”
“How
about the services nurses perform in community health programs, in nursing
homes, in chronic disease facilities, where they have to decide when or when
not to call a doctor? Surely you
physicians aren’t going to spend eight hours a day with the patients. Nurses do that, and gain a special sense of
expertise about their patient’s conditions, and they know damn well when to
call a doctor. They are really making
diagnoses. It would be a simple extra
step to prescribe an antibiotic.”
Lapius
was busy savoring a mouthful of leafy vegetables moistened in a beige sauce.
“As
a matter of fact, Eleanor, I agree with you.
Nurses can function at the lower echelons of medical practice, and do
admirably. I suggest that those that
would like to do so be trained as family practitioners be given a degree and
license that permits them to practice as nurse-physicians under the discipline
of the professional medicine.”
“Agreed
up to the last point, Simon. They will
practice as nurse practitioners under the discipline of the nursing
association.”
“Impossible,”
said Lapius. The American Nursing
Association has never established the uniform standards of education that the
American Medical Association has. Some
nurses have never gone to college. Some
have had two year courses, others three year courses. Some have baccalaureate degrees, some
not. It’s a hodgepodge. How would we know who is doing what. What objection do you have to nurse
appropriately trained, practicing under the discipline of medicine. It might help solve the doctor shortage.”
“Then
they wouldn’t be nurses, they would be doctors.”
“So
what?”
“I’m
not here to help preside over the liquidation of the nursing profession.”
“Well
then, establish some uniformity of educational standards for your nurses. Petition the state legislatures to issue
appropriate licenses for nurse practitioners, and then let the nurses assume
medical liability for their decisions.”
“I’d
like that.”
“Fine,”
said Lapius, peering under the pewter lids for more food, “Soon we’ll have four
professional groups vying for patients and responsibilities in the health
field. Physicians, osteopaths, nurses,
chiropractors, all with equal rights.”
“And
in the practice of health care you have forgotten a few others; social workers,
psychologists, practical nurses, and nurses aides.”
“And
under whose control will they be, Eleanor?”
“Ours
of course.”
“Then
they will all be fundamentally under physician control,” said Lapius, “since
traditionally nurses receive their mandate from the medical profession.”
“Oh,
but that’s where you are wrong, Simon.
Nursing is an independent profession.
We no longer are the handmaidens of the doctors.”
When
we left the restaurant Eleanor complemented Lapius. “You’ve learned something over the years,
Simon. I see you opened the door and
allowed me through first.”
“Only
so I wouldn’t be tempted, Eleanor--.”