Nurses, after long neglecting their political health, are suddenly out of their professional sickbed and looking to a strong recovery. Two recent successes are the reason.
This past year, the threat of malpractice suits moved the major insurer of the American College of Nurse-Midwives to discontinue coverage. The college's 2,500 members, who are 85 percent of the profession, were justified in feeling insulted. Their malpractice rate is low. Only 6 percent of all nurse-midwives have had suits filed against them. While it is true that most deliveries are low risk, another reason for the rarity of suits is that nurse-midwives are known to give generously of themselves, professionally and personally. With that kind of bonding, a lawsuit is the last thing on the agenda of the mothers and families being served.
After the Mutual Fire, Marine and Inland Insurance Co. of Philadelphia withdrew its policies, the nurse-midwives were rejected by every other carrier they appealed to. They turned to Congress for help. The politicians, world-class baby-kissers, were sympathetic but said no anyway. Times are tough, even for motherhood.
At this low point, the nurse-midwives, in the spirit of the old Frontier Nursing Service, unwallowed themselves and came up with a solution. They formed their own insurance company. By April of next year, the nurse-midwives, each paying approximately $2,000 for $500,000 worth of coverage, expect to be rid of a problem that other medical professionals -- wealthier and seemingly better organized -- find too hard. Obstetricians, between blaming lawyers for the malpractice crisis and having an inability to discipline the incompetents who help drive up rates, are abandoning the profession. A survey by the American College of Obstetrics and Gynecology finds that 12 percent of the polled obstetricians are not delivering babies as a result of the risk of malpractice. Two years ago the figure was 9 percent. More than 23 percent said they were decreasing the number of high-risk deliveries, up from 17 percent. Perhaps the obstetricians should make an appointment with the nurse-midwives to learn the art of solving problems through group solidarity.
The second success occurred last month when a national center for nursing research was put into law at the National Institutes of Health. President Reagan, who on leaving the Bethesda Naval Hospital following his cancer surgery effusively praised his nurses and criticized the media for not appreciating the profession, originally vetoed legislation for the center. The Senate voted 89 to 7 and the House 380 to 32 to override the veto. The nurses' lobby had been sophisticated in making the case that a research center was needed.
One of the persuaded was Sen. Orrin Hatch, the Utah Republican who is chairman of the Labor and Human Resources Committee. The center, Hatch said on the Senate floor, "will cost only $5 million -- money which . . . is already included in the appropriations bills. The veto message tells us that even this relatively small sum, compared with the almost $5.5 billion budget of NIH, is too much. This is preposterous. A proposal for nursing research to have one one-thousandth of the NIH budget is too much? My fellow senators, don't you believe it. It is high time that nursing research took its rightful place in those NIH halls of ivy."
Wise shoppers in the medical marketplace know that nurses often provide the kind of low-cost care and services that physicians or hospitals have often monopolized at high prices.
It was nursing research that led, in part, to the increase in home patient care. The savings to families have been large. A 1982 study found that when home care for children dying of cancer was coordinated by nurses -- and doctors served only as consultants -- the costs were 18 times as low as for a hospital setting.
It was nursing research that informed the public that nurse-midwives can deliver babies at safe and efficient birthing centers at a cost 60 percent less than the customary hospital obstetric services.
Patient-care research is often best provided by those who are most involved with the patients. These are nurses. No group of health-care providers is larger. Despite that, the need for nurses increases. The Department of Health and Human Services reported in 1984 that in five years the nation will need 358,000 nurses with graduate education but will have only 118,000. Of the 1.4 million nurses currently working, less than6 percent have advanced education. It has been documented that the master's and doctoral nurses are responsible for many of the innovations in occupational-health, critical-care and medical administration.
The new center at NIH is expected to provide the kind of research base that the nurses deserve. If they know how to start their own insurance company and can persuade Republicans to spend money on them, they should be up to standing on their own at NIH.