Nurse Practitioners
“Harry meet Eleanor C. Lambertson, Dean of
“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 any place 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--.”