Ramblings on Expanding Nursing Practice

 

 

I asked Martha Barry who worked with me at the Erie Family Health Centers in the early 80s, to remind me if the Certified Nurse Midwives delivered babies.

 Here’s what she said:

The model for the Certified Nurse Midwives (CNM) when I arrived was outpatient care only. The CNM did all of the New OBs and sorted out the high-risk patients and cared for the other patients throughout their pregnancies, post-partum and follow-up gyn care. Prenatal care was intense case management. (We took) a lot of care and time to be sure no one fell through the cracks and got “lost to follow up.” Luckily, we could utilize the community health RNs to help find patients who did not show up for a visit. At the beginning, Medicaid was not widely available to all low-income pregnant women and especially not to non-citizens. The patients would be on a payment plan and would need to pay by “7-months” and it was a deal that included their prenatal, postnatal and delivery costs. I remember patients bringing their money stuffed in their bras to pay up at that 7-month mark. Deliveries were at Ravenswood Hospital. I wish I could remember the cost. The consulting OB physician would come to Erie for a few hours each week.

I also remember a few patients who worked at the live poultry plant and they said that although they had no health insurance, the boss would pay their delivery fees! 

I was preparing for my talk to the first class of AdvancingPractice, a one-year fellowship to develop quality care and nursing leadership at the clinic I had worked in over 30 years ago and written about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.

I read Martha’s words to the group of eight APRN Fellows especially showing the generosity of the poultry plant employer. Then I told the Pigeon Lady story from my book that ends with a neighborhood funeral home director footing the bill for the wake and burial of one of our patients. He then turned around and donated that amount back to the clinic. (It’s complicated) I wanted to stress the interrelatedness of the surrounding community on the health care clinic. 

Part of my presentation was to discuss the historical context of the advancement of nurse practitioners and nurse midwives (collectively labeled Advanced Practice Registered Nurses, APRN).

One of the handouts for the class (Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013) plunged me back to the time I and other new APRNs in the Chicago area were struggling to justify our right to practice to the full extent of our training.

How much had I forgotten—maybe wanted to forget. For example, back in 1957 the American Nurses Association developed a definition of nursing that would retard the advancement of nursing practice for decades: nurses were neither to diagnose nor prescribe. And some groups of nurses called us “little doctors” and didn’t support developing educational programs in nursing colleges.  

I hope the new Fellows I spoke to learned from my presentation something about the historical context of the role, the significance of the role in the community setting and the potential of the APRN career choice. 

I close with a quote from the NACHC fact sheet:

An expanded role for nursing is an idea deeply rooted in nursing’s past and from it, much can be learned for today. Indeed, nurses should take this historical opportunity to think creatively about recycling elements of past practice for today’s unique context—perhaps initiating state-of-the-art nurse-run clinics in rural and inner city areas; reaching others by telenursing; and collaborating with designers in technology firms to create Apps and other high tech solutions to bridge gaps that exist in healthcare today. To do so, they must first read and understand the impact of the historical antecedents, cornerstone documents, and legislative acts that contribute to the nursing profession’s rich history. 

 

Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013, Page 9


 

 

Book tour in Chicago

Saturday, June 1, 2019

I am scheduling this post to publish on Wednesday, June 5, 2019. That day, I will be in Chicago talking about my book to the Advanced Practice Nurses at Rush University. I have three other venues scheduled before I head home on Monday. In between events, I will spend time with old friends. I’m having lunch with one woman that I haven’t seen in over 20 years!

Frank Lloyd Wright Home and Studio, Oak Park, Illinois

On Sunday, I will be reading at the Oak Park Library, Oak Park, Illinois. My daughter and 15-year-old grandson will have flown from Raleigh to join me. Afterwards, my daughter will show her son where she grew up. Maybe we’ll visit the Frank Lloyd Wright Home and Studio where, to get a change from nursing, I volunteered in the gift shop. I learned so much about Frank in particular and architecture in general. I always wondered if my involvement with the FLW Foundation had any influence on my daughter’s choice of a career—architecture.

So, think of me in the Windy City as you read this.

 

The Eric Hoffer Award

I am pleased to announce that Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers is a 2019 Eric Hoffer Award Finalist.

Nurses Week–Here We Go Again

Here we go again. It’s Nurses Week and we are still battling a misguided perception of nurses.

This isn’t just a week to celebrate nurses for all that we do to keep patients well and safe, not only in hospital settings but on the world stage, and to remind ourselves that for 52 weeks a year we need to be vigilant and proactive to maintain our autonomy.

This time a politician shows her ignorance regarding nursing practice in hospital settings. The following is an excellent response by two nurses to the offensive comment:

Nurses aren’t sitting around playing cards, they’re working to fix global health

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Nurses aren't sitting around playing cards, they're working to fix global health

© Getty Images

Washington State Republican Sen. Maureen Walsh’s recent comment  that nurses “working at hospitals in rural regions probably play cards for a considerable amount of the day” is offensive to nurses regardless of nursing role or practice setting.

While Walsh has apologized and many nurses have expressed their disgust for her statement, voicing their disdain on social media, via emails, letters and even sending  1,700 decks of cards to Walsh, nurses can seize this moment to educate Walsh, policymakers and citizens on the role and contributions of nurses who daily care for individuals and communities worldwide to help people achieve health.

As nurses with decades of service to the profession, we know firsthand the tremendous work that our colleagues do as clinicians, researchers, educators and policy advocates. On a daily basis, we work alongside and in collaboration with very talented, educated and committed individuals who consider it an honor to serve in this capacity.

Whether in rural or urban areas, the demands associated with providing quality care require that we spend our working hours doing just that, not engaging in activities that do not lead to better outcomes for those we serve. To do otherwise would be disrespectful to the profession and would violate nursing’s contract with society.  

We do not take the distinction of being the most trusted profession lightly. For 17 consecutive years Gallup poll results revealed that more than four in five Americans, or 84 percent, rated nurses’ honesty and ethical standards as very high or high compared to 20 other professions.

Yet, the misrepresentation of nurses is not new.

For years the profession has worked to elevate the image of nursing and reverse the stereotypical images depicted in the media. Sandy Summers and Harry Jacobs Summers, authors of the 2009 Saving Lives: What the Media’s Portrayal of Nurses Puts Us all at Risk  provide examples of  the dangers of inaccurate portrayal of nurses.

As a profession, nurses have made progress highlighting the tremendous role nurses play in caring for those need of health care services. This month, Oprah magazine featured  five nurses who “just might save the world”.

Globally, nurses such as Dr. Sheila Tlou, a former UNAIDS Director for Eastern and Southern Africa and former Minister of Health in Botswana, raise awareness of the critical role nurses play in health policy. Tlou used her expertise as a nurse to develop and lead a nurse-driven intervention to decrease the maternal mortality rate due to HIV/AIDs in the region from 38 percent in 2004 to 9 percent in 2008. These interventions reduced  mother to child transmission of HIV from 40 percent to less than 4 percent within four years.

Members of the British monarchy have recognized the contributions of nurses in protecting human health and wellness. The Duchess of Cambridge, Kate Middleton, helped launch the campaign Nursing Now. The campaign is based on the triple impact report identifying the need to develop  the profession of nursing in order  improve health, promote gender equality and support economic growth.

Nursing Now, recently launched in the U.S., is committed to elevating the status of nursing globally and helping people understand how important it is to have the expertise of nurses in their communities and in positions of decision making on health care initiatives.

It is time to erase the inaccuracies and re-examine the prevalent image of nurses in this country. The opportunity to elevate the conversation extends beyond our elected officials. Everyone could benefit from knowing our commitment to advancing a nation’s health.  

This is not a game to us.

Janice Phillips, RN PhD, is an associate professor at Rush University College of Nursing and the Director of Nursing Research and Health Equity at the Rush University.  Medical Center. Colleen Chierici BSN, RN is the president of the nursing staff at Rush Oak Park Hospital and working towards her doctorate in Family Nurse Practice.  Both are Public Voices fellows through The OpEd Project. 

Barriers to Advanced Practice Registered Nurses

In the April 2019 AARP Bulletin there is an article discussing the restrictive laws in North Carolina that control Advanced Practice Registered Nurses.*

North Carolina is where I now live. While I no longer practice as a nurse practitioner, I’m always on the lookout for the latest restrictions or advances in APRN practice. And I am saddened with this particular write-up. Why? Because the story shows that the years of research proving that APRN’s give the same level of safe, quality care as physicians in similar settings is totally disregarded. Therefore, limiting the use of APRN’s has caused the following:

Many rural North Carolina counties face severe provider shortages. Three have no primary care doctors, 26 counties have no OB-GYN, and 32 are without a psychiatrist, . . . .

North Carolina:

  • Ranked 35th for overall health care
  • Ranked 41st for infant mortality
  • 56% of low-income children don’t have a doctor

(Michelle Crouch, Bridging the Health Care Gap, AARP Bulletin/Real Possibilities, April 2019. p 44.

In 2017, a bill to expand APRNs practice was defeated. Both the NC Medical Society and the NC Academy of Family Physicians opposed this bill, in spite of the fact that “moving restrictions on APRNs could save the state $400 million to $4.3 billion in health care costs annually” and, could increase the number of APRNs to correct the health care shortage.

I have almost 40 years’ experience in watching the struggle to limit APRNs practice. I know many physicians who work alongside nurse practitioners, nurse midwives, and mental health nurses who promote their role in keeping our communities healthy. From my viewpoint, it’s the efforts of organized medicine that disregards putting patients first and values only its own economic growth.

A new bill to remove barriers to APRN practices is expected to be introduced this year. I will be following this closely. It is my dream that in the near future, all states will give APRN’s full practice authority.

See how APRN practice varies from state to state.

*Advanced Practice Registered Nurse

  • Certified Nurse Practitioners
  • Certified Nurse Midwives
  • Certified Nurse Anesthetists
  • Clinical Nurse Specialists