Yes. There's a real need for skilled services in the home, particularly in my specialty -- care of the chronically ill elderly. Not only is it more humane to provide care in the patient's own home, it's also cost-effective.
I don't practice medicine. I practice nursing. I have seven years of academic qualifications and 30 years of clinical experience in my field. I believe such a background qualifies me for independent nursing in the community, as a complement to the work done by physicians.
At the turn of the century, nurses had a primary role in providing health care in their communities. Now, given patients' needs and the emphasis on cost-containment, the trend is once again toward nurses giving care directly.
The claim that we lack needed skills and may even be a hazard to patients is just not true. Physicians in hospitals depend on nurses to make nursing assessments continually and judge whether a physician is needed. Why should it be any different in a community setting?
The focus of health care today is the office and the institution. But for many of the chronically ill elderly and the homebound, access to these locations is limited or nonexistent. Without access, there is no health care unless the providers go into the home. That's what we do.
We advertise locally, and most of our patients are self-referred. We never lead a patient to believe we're any more than our name states.
We are providing a quality health-care service well within the scope of current nursing practice. In our seven years, we've never had a malpractice suit.
We're a legitimate organization, fulfilling a real need. We plan to stay and to grow. -- Jean Sweeney-Dunn, RN Community Nursing Services for the Elderly, Elmira, N.Y.
No. Neither nurses nor other allied health professionals should be allowed to practice independently unless they have training equal to that received by physicians.
The nurse's role is as a part of the whole health team. Nurses' training doesn't prepare them to act independently. When nurses or other allied health professionals act independently, they may jeopardize the well-being and health of the patients they're trying to help. How can a nurse, with limited training, make a medical judgment call equivalent to a physician's?
Even their role in follow-up requires supervision. Symptoms that don't appear complicated initially can suddenly and very dramatically become critical. I don't think it's fair to patients for nonphysicians to determine what's minor and what's major.
The same argument can be applied to the monitoring function nurses provide. I have no objection to nurses gathering information. That role has been appropriate for them for a long time. But when medical judgment occurs independently without the physician, then I take strong exception.
Use of independent nurses is viewed as a move toward cost-containment. But this is short-sighted.
The quality-of-care issue will become significant in the next two years or so, and this will switch the emphasis back to the physician.
Finally, the medicolegal issue is a tremendous one that may alter independent practitioners' behavior more than anything else will. Once they're forced to pay the kind of liability insurance fees physicians pay, I suspect they won't be able to sustain their practices.
I hope the quality issue, liability and public expectations of the best possible medical care will reverse this trend toward independent practice. -- Richard C. Inskip, MD Former President, American Academy of Family Physicians