Nursing Specialties

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A new book focusing on American nurses is nominally a book of portraits, intended for coffee tables. But a doctor writing in the New York Times, Abigal Zuker, found the the narrative to be the most affecting part, hitting her “in the solar plexus.”

For example, she appreciated the observation of a hospice nurse named Jason Short in rural Kentucky who has had a number of jobs, including auto mechanic and commercial trucker. He turned to nursing when the economy went under. This pragmatic decision turned into something more, and Mr. Short says he’s a nurse for good. “Once you get a taste for helping people, it’s kind of addictive,” he says in the book, called “The American Nurse.”

The book tells the stories of 75 nurses. Some of them wanted to be nurses from when they were very young, while others took Mr. Short’s more pragmatic approach. All of the nurses profiled exhibit the same “surprised gratitude,” according to Dr. Zuker.

The nurses profiled come from many different health care settings from many different places in America, ranging from large academic institutions like Johns Hopkins to very small places like the Villa Loretto Nursing Home in Mount Calvary, Wisconsin. There are administrators, home health care workers, emergency room nurses, military nurses, and much more.

All describe unique professional paths in short first-person essays culled from video interviews conducted by the photographer Carolyn Jones. Their faces beam out from the book in Ms. Jones’s black-and-white headshots, a few posing with a favorite patient or with their work tools — a medevac helicopter, a stack of prosthetic limbs or a couple of goats.

But even the best photographs are too static to capture people who never stop moving once they get to work. For a real idea of what goes on in their lives, you have to listen to them talk.

Here is Mary Helen Barletti, an intensive care nurse in the Bronx: “My whole life I’ve marched to a the beat of a different drummer. I used to have purple hair, which I’d blow-dry straight up. I wore tight jeans, high heels and — God forgive me — fur (now I am an animal rights activist). My patients loved it. They said I was like sunshine coming into their room.”

Says Judy Ramsay, a pediatric nurse in Chicago: “For twelve years I took care of children who would never get better. People ask how I could do it, but it was the most fulfilling job of my life. We couldn’t cure these kids, but we could give them a better hour or even a better minute of life. All we wanted to do was make their day a little brighter.”

Says Brad Henderson, a nursing student in Wyoming: “I decided to be a nurse because taking care of patients interested me. Once I started, nursing just grabbed me and made me grow up.”

Says Amanda Owen, a wound care nurse at Johns Hopkins: “My nickname here is ‘Pus Princess.’ I don’t talk about my work at cocktail parties.”

John Barbe, a hospice nurse in Florida, sums it up: “When I am out in the community and get asked what I do for a living, I say that I work at Tidewell Hospice, and there’s complete silence. You can hear the crickets chirping. It doesn’t matter because I love what I do; I can’t stay away from this place.”

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“Healthcare is political,” says a nurse quoted in this article on Nurse.com. The article looks at why some nurses have become politically active.

Pat Barnett was motivated to get involved in the legislative process in 1976, when she was a young nurse working for a state psychiatric hospital. At the time, deinstitutionalization was underway, with attempts by the state to move people from state facilities to the community. Barnett felt that she couldn’t just stand by and watch what she saw as a great injustice, as people were discharged from the state institutions but then had nowhere to go, and were given very little support. “So you would see people end up in the No. 1 institution for the mentally ill,” says Barnett. “Jail.”

She testified along with other nurses and they were able to get more funding for the mental health system, allowing some facilities to remain open.

Barnett points out that nursing is a highly regulated profession, which means that it’s especially important for nurses to be active and engaged politically.

The current state of healthcare and the upcoming presidential election add to that urgency, Barnett says. The points out that the Affordable Care Act alone has a great impact on nurses. If it stands, there will be 900,000 new patients in the state of New Jersey who will have new health coverage. Right now there are 1,400 too few primary care doctors — Barnett sees nurses as possible saviors.

“We have 5,000 advanced practice nurses, 80% of whom actually practice in primary care, and many of those take Medicaid and Medicare patients,” Barnett said. “So I think nurses need to be involved because the Affordable Care Act creates opportunity for nurses, whether or not they are advanced practice nurses. Also, there is money in the Affordable Care Act to create nurse-run clinics — and money for nursing education. That happened only because the American Nurses Association, other nursing associations and individual nurses lobbied the legislature and their individual legislators to make that happen.”

The Institute of Medicine weighed in on the importance of nursing input in its October 2010 report, “The Future of Nursing: Leading Change, Advancing Health.” According to the IOM, nursing is at a pivotal point.

“Nurses’ roles, responsibilities and education should change significantly to meet the increased demand for care that will be created by healthcare reform and to advance improvements in America’s increasingly complex health system,” the IOM announced after releasing its report.

Even as the largest healthcare profession, nursing’s voices often are silent or ignored, according to Vance.

“I believe our values and concerns should be heard to help our patients and our profession,” she said. “We have to decide whether we want to make our voices heard, [and have] input in the decision-making around our practice. Or, they’ll make these decisions without our input.”

Many nurses, like a number of Americans, think politics is a dirty word, according to Linda Parry-Carney, RN-BC, MA, education specialist at Hackensack (N.J.) University Medical Center.

Parry-Carney is a former president of the New Jersey State Nurses Association and the current chairwoman of the board for the New Jersey Collaborating Center for Nursing.

What nurses might not realize, she said, is they already are politicians, whether they’re negotiating with patients at the bedside, with employers, on hospital committees or as members of organizations.

Legislators don’t act alone. They make decisions based on what their constituents want, according to Parry-Carney.

“[As NJSNA president,] when I needed to talk to the Governor’s staff, an assemblyperson, senator or the commissioner of health, it wasn’t just me sitting in front of him,” she said. “He knew I represented the interests of all the people who were members of our organization, and, in fact, all nurses in New Jersey.”

One nurse sharing his or her perspective helps formulate strategies that groups use in an effort to influence policy and make changes.

“Every nurse should be a ‘political’ nurse because we are such a caring, large constituency for people,” Vance said. “We are important to society. We’re important to people. So we have to take our practice beyond the bedside, beyond the school, beyond our research, and set it in a larger way into community involvement, which means being an activist, being a volunteer, being an informed citizen.”

October 1st, 2012
Jenna Fischer

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This article on the Boston Channel website looks into the increasing popularity of nurse-midwives after a period of decline.

For example, a woman named Carla Tonks decided to switch to a nurse-midwife program when she was pregnant with her first child seven years ago. She hadn’t been impressed with her experience with the ob-gyn, especially the long waits at his office that resulted in actually seeing the ob-gyn for only 10 minutes.

She switched over to a nurse-midwife program and was much happier. She moved away from Massachusetts and became pregnant with her second child, and this time sought out a nurse-midwife in North Carolina, her new location. This experience went well too, and she kept up the trend with her third child after she returned to Massachusetts. In the article she pronounces herself “very happy” with nurse-midwives, and appreciates that they can spend more time with mothers-to-be.

Midwives, which were the rule until the mid-20th Century, are becoming more popular again. According to a report by the American College of Nurse-Midwives, 11.3 percent of vaginal births and 7.6 percent of all births were attended by either certified nurse midwives (CNMs) or certified midwives (CMs) in 2009. The number has risen each year since 1989. Certified midwives are not nurses but have Master’s degrees.

Anna Jaques offers nurse-midwives. Either type provides care to women during pregnancy, labor and birth, as well as during the postpartum period. They typically handle low-risk pregnancies.

“We do all the check-ups, all the prenatal care,” says Walsh, one of five nurse-midwives on staff at Anna Jaques. “If a complication arises, we consult with the physicians. They are always on call. If the patient needs a C-section, the physicians take over. But we are still in the operating room.”

Tonks said she did develop high blood pressure during her most recent pregnancy, but she decided not to transfer to a doctor’s care.

“The nurse-midwives can take on a lot more than you think,” she says.

Another plus was that over the course of her pregnancy, Tonks developed close relationships with all the nurse-midwives at the hospital, so if Walsh, for some reason, was unavailable at the time of delivery, Tonks would still know the person performing the delivery in her stead.

History has shown that physicians don’t always appreciate sharing with nurses.

The field of obstetrics, which was once dominated by midwives and lay midwives, has been a battleground for years, with physicians laying claim to the right to attend all deliveries. Physician’s groups in the past went so far as to say that women who were attended by midwives were putting themselves and their babies at risk, although statistically this notion was never proven to be a reality. Midwives fought long and hard and are only now attaining the respect they deserve as non-interventionists who are fully capable of handling low-risk deliveries. Ceding to midwives has been a hard pill to swallow for many physicians.

Some physicians are now uneasy with the expanding role of nurse practitioners. The Institute of Medicine recommended in 2010 that barriers to practicing to their full scope be removed so that nurse practitioners could help to ease the shortage of primary care physicians. To date, 16 states (plus the District of Columbia) have embraced more liberal laws to allow nurse practitioners to practice fully what they have studied and trained for. Other states, such as Nebraska, are currently considering such laws.

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One would think that easing the shortage of primary care physicians would be embraced wholeheartedly by physicians, but this has not been the case. What has been the major concern voiced by primary care physicians? It seems that some physicians are worried that nurse practitioners moving in on their turf will result in lowering of physicians’ incomes. Granted, many primary care physicians earn far below what physician specialists earn, so there may be some justification for their concern.

In the first study to assess the impact of nurse practitioners in states with liberal policies versus states with more restrictive policies, researchers from the George Washington School of Public Health and Health Services found no evidence that using nurse practitioners to their full scope of practice had an adverse effect on earnings of family physicians.

This is good news on two fronts: easing the physician shortage and expanding the roles of nurse practitioners. As of May 30th of this year, the Health Resources and Services Administration stated that there are 5,902 HPSAs (health professional shortage areas) serving 59.9 million people. At a ratio of 2000 patients for every one physician, this means that 16,349 practitioners are needed to meet the primary care needs of the population. Such a vast shortage seems to indicate that there is plenty of room for all, and that nurse practitioners can fill a rather large gap in healthcare services that is not currently being filled.

As with the obstetric field, it will take time before nurse practitioners are recognized for what they alone can offer, a unique set of skills and knowledge that can complement and enhance the skills and knowledge that physicians offer. As health care policy changes in the United States, nurse practitioners are entering into a new era, one in which they will be permitted to practice to the fullest extent possible.