The Power Not The Glory Changes In Nursing Responsibilities Merely Reflect Realities Of Today's Health Care.

Posted: March 22, 2000

When some people go in for a checkup, their stay in the waiting room ends when the receptionist announces, "The nurse will see you now."

Is the doctor out to lunch? No, actually, the presiding physician may be a telephone call or e-mail away, while the hands-on care is offered capably by an advanced practice nurse.

For growing numbers of patients, particularly in rural and low-income urban settings, it's such nurses who put everyday care within reach - because there aren't enough primary-care doctors to meet the need.

In Pennsylvania, 7,500 advanced practice nurses minister to basic needs and dispense medicine under a doctor's supervision - which often comes at arm's length.

A recent study gives advanced practice nurses high marks for primary health care.

But in Pennsylvania, advanced practice nurses regard their status as second-class. That's why, the other day, the Harrisburg Capitol rotunda was packed with white-coated nurses rallying for legislative remedies.

One fix is obvious. That's to give advanced practice nurses the authority to write prescriptions. Pennsylvania is one of the few states that doesn't do this. It should, borrowing from other states the best practices on how to handle this expansion of some nurses' powers.

Even so, physicians' groups grumble about giving nurses the right to puzzle pharmacists with their handwriting. The doctors' view is that the quality of care will suffer.

Yet doctors themselves have blunted that risk by virtue of a compromise on another issue that they worked out with State Rep. Patricia H. Vance (R., Mechanicsburg), chief sponsor of the nursing bills.

Rather than calling for free-standing nursing practices without a doctor on call, nursing advocates have agreed to language that would insure medical doctors' oversight. Rep. Vance says advanced practice nurses are willing to continue under collaborative agreements with doctors, to train in pharmacology, and to beef up malpractice insurance as needed.

Why, it's a legislative miracle cure.

One issue still unresolved may not mean much to folks in the waiting room. But advanced practice nurses see it as a matter of professional dignity. They want to be regulated by the state nursing board alone, rather than the present dual oversight by the nursing board and the physicians' medical board.

Largely symbolic? Perhaps. The nurses' proposal "makes no change in the scope of practice" for advanced practice nurses, says University of Pennsylvania nursing professor Melinda Jenkins. Still, physicians' groups object that the change would make it easier for nurses to expand their practices beyond appropriate limits.

Compromise should also be possible here. Endless quibbling over the fine print would begin to look like a bid to protect turf - not patient care.

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