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


 

 

Can nurses really speak out too much?

This article caught my attention from the Nursing Times (a monthly magazine for the nurses of the United Kingdom). I had to do some homework to learn about The Queen’s Nursing Institute and its function.

Healthcare policy is a key activity for The Queen’s Nursing Institute. The QNI works to influence decision makers across England, Wales and Northern Ireland on health care policy including primary care, public health, nursing education, regulation and skill mix and issues such as services for homeless people and reducing health inequalities. To do so QNI contributes to stakeholder meetings, responds to national consultations, takes up issues raised by local projects where it appears they may have wider significance, and provides examples and information to policy-makers.  Wikipedia

At the annual conference of the QNI held in London last week, Dame Donna Kinnair, chief executive of the Royal College of Nursing, was told by government representatives that “nurses voices are too loud.”

Read her response below. 

 

 

Let’s Shout Together for Community Nursing

27 SEPTEMBER, 2019 BY  KATHRYN GODFREY 

Nurses at the annual Queen’s Nursing Institute conference held this week in London were told about the government response to hearing the views of nurses.

Dame Donna Kinnair, chief executive of the Royal College of Nursing, told delegates that she had been told by government representatives to bring her membership “under control” so that the voice of nurses would not become “too loud”.

“Nurses do need to speak out about key workforce issues such as safe staffing”

This conversation occurred at a government meeting, but Dame Donna reassured the audience that she would ensure the nursing voice would be heard and in fact “amplified”.

But can nurses ever speak out too much? As a profession they have traditionally been known for getting on with their essential work and not shouting about policy and resource issues. It is therefore good to hear that there is concern that their voices are getting louder.

Nurses do need to speak out about key workforce issues, such as safe staffing as well as more specific issues that affect the patients that they care for. For example, patients who are incontinent are often not provided with adequate supplies of pads to manage their condition. It is big issues like staffing and more specific issues like incontinence resources that affect the care nurses can give and the quality of life patients experience.

Nurses who do speak out can feel like they are speaking in a vacuum and that it is hard to get their message to the decision makers.

Now Dame Donna is asking nurses to share their experiences with her so that she can amplify and communicate to government the concerns of all nurses.

She said: “What I want to do is make sure your voice is amplified through my voice and I can’t do that unless you share your voices and stories with me.

“So that every time I look around, every time I speak to a minister I have got the basics of that conversation, so I am truly representing how nurses feel,” she told attendees.

“This is a crucial time for nurses to raise their voices and have their points heard”

“My pledge to you is that I will continue to amplify your voices and in return I ask you to share your voices and your stories with me, so that we can collectively be a unified profession.”

These are difficult times. We hear little other than Brexit in the news, which means key issues for the health and welfare of the population are being neglected. This is a crucial time for nurses to raise their voices and have their points heard.

The new advertising campaign We are the NHS is timely. The video about nursing is an excellent showcase for the many and varied jobs nurses carry out. It is a great illustration of how highly skilled and essential a workforce nurses are, the glue that holds the NHS together. So the more we hear from them the better. Let’s hope that those who need to listen don’t put their fingers in their ears.

nursing times

I wish our fellow nurses across the pond every success in making their voices heard.