DiversityNursing Blog

Once A Nurse, Always a Nurse

Posted by Pat Magrath

Mon, Sep 26, 2016 @ 03:33 PM

Medical_Student.jpgCongresswoman Lois Capps of CA is committed to helping people improve their daily lives through better schools, quality health care, and a cleaner environment. During her 20-year tenure as a Nurse and public health advocate, she felt her education and background was needed in Congress to help improve health care in the US and strengthen our Nursing workforce across the country.

This week, the U.S. House of Representatives Energy and Commerce Committee unanimously passed the Title VIII Nursing Workforce Reauthorization Act (H.R. 2713), bipartisan legislation I authored with Representative David Joyce (OH-14) to strengthen the nursing workforce and improve access to health care. While this is an important step forward for the millions of nurses and aspiring nurses in our country, it is particularly poignant as my 18 years in Congress draw to a close.

When my late husband, Congressman Walter Capps, passed away in office, I was not a politician. I was a public health nurse working in our local schools. And while some said that I couldn’t be a Member of Congress because I was “just a nurse,” it quickly became clear to me that the work I did every day was exactly what Washington needed. 

As nurses, we often wear many hats. We spend much of our time listening to our patients and their families to find the root cause of their ailments and truly understand their needs. We are advocates, navigating a complex system to ensure that our patients receive the best care possible, while gaining valuable insight to our health care system’s strengths and weaknesses as a whole. And we are consensus builders, rolling up our sleeves to do whatever is needed to help our patients stay healthy. Simply put: nurses have a critical voice that must be heard. 

So when I came to Congress, it was clear to me what I had to do. And I never stopped being a nurse.

That is why one of the first pieces of legislation I championed was the Nurse Reinvestment Act, a bipartisan effort signed into law by George W. Bush in 2002 to expand our nation’s federal nursing workforce training programs. I also founded and continue to co-chair the bipartisan House Nursing Caucus, the first caucus established to highlight the critical role nurses play in our health care system. And for the past nine years, I have led efforts to improve nurse staffing numbers in hospitals to help ensure better care for patients and protect against nurse burnout.

Nursing issues were also a key component of the Affordable Care Act. When it became law in 2010, our nation took its first steps toward moving our health care system from one that only focused on those who were sick to one that also emphasizes wellness and prevention. In this law I spearheaded efforts to continue nursing workforce programs, as well as expand access to care through school-based health centers for students, nurse-managed health clinics for primary care in underserved areas, and nurse home visiting programs to support new moms and babies. It also included a Graduate Nurse Education demonstration program to explore ways to give more clinical experience to Advanced Practice Registered Nurses, like nurse practitioners. More broadly, the law highlighted the importance of our health care system working in collaboration as a team while helping patients be more active participants in their care. 

Thanks to the Affordable Care Act, more Americans than ever have health insurance. That has made the need for nurses at all levels of care even clearer. Our country has an increasingly dire shortage of primary care physicians. This shortage is especially problematic among rural and vulnerable populations. But nurses, especially graduate-level prepared Advanced Practice Registered Nurses, have the training and expertise to help fill this gap. 

And that is why getting the Title VIII Nursing Workforce Reauthorization Act into law is so important. First enacted 50 years ago, Title VIII programs have helped make it possible for more nurses to deliver high-quality care as demand has increased. The bill bolsters nursing education at all levels, from entry-level preparation through graduate study, and supports institutions that educate nurses to help open spaces in nursing school programs. It helps nurses repay student loans in exchange for working in underserved areas or for going into academia to teach the nurses of tomorrow. And it places a special focus on ensuring nurses are ready and able to care for our nation’s aging population. 

As anyone who has received medical care can attest, nurses have a powerful presence in medicine. They are caring, attentive and integral members of the health care team. As we look ahead to looming nursing shortages, reauthorization of these critical programs is more important than ever to help bring more nurses into the field, better educate them for the needs in our communities, and keep them in the profession, providing high-quality care to communities across the country.

We know that the important work of strengthening our health care system is not yet done — it’s far from it. But legislation like this will help get us there.
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Topics: healthcare, health laws

Doctoring, Without the Doctor

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 02:59 PM

By 

www.nytimes.com 

26NEBRASKA master675 resized 600There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy.

It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.

“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”

But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.

“I was like, ‘Oh, my gosh, this is such a wonderful victory,’” said Ms. Osburn, who was delivering a calf when she got the news in a text message.

The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away.

“The situation could be viewed as an emergency, especially in rural counties,” said Jim P. Stimpson, director of the Center for Health Policy at the University of Nebraska, referring to the shortage.

Groups representing doctors, including the American Medical Association, are fighting the laws. They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the A.M.A., said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”

Dr. Richard Blatny, the president of the Nebraska Medical Association, which opposed the state legislation, said nurse practitioners have just 4 percent of the total clinical hours that doctors do when they start out. They are more likely than doctors, he said, to refer patients to specialists and to order diagnostic imaging like X-rays, a pattern that could increase costs.

Nurses say their aim is not to go it alone, which is rarely feasible in the modern age of complex medical care, but to have more freedom to perform the tasks that their licenses allow without getting a permission slip from a doctor — a rule that they argue is more about competition than safety. They say advanced-practice nurses deliver primary care that is as good as that of doctors, and cite research that they say proves it.

What is more, nurses say, they are far less costly to employ and train than doctors and can help provide primary care for the millions of Americans who have become newly insured under the Affordable Care Act in an era of shrinking budgets and shortages of primary care doctors. Three to 14 nurse practitioners can be educated for the same cost as one physician, according to a 2011 report by the Institute of Medicine, a prestigious panel of scientists and other experts that is part of the National Academy of Sciences.

In all, nurse practitioners are about a quarter of the primary care work force, according to the institute, which called on states to lift barriers to their full practice.

There is evidence that the legal tide is turning. Not only are more states passing laws, but a February decision by the Supreme Court found that North Carolina’s dental board did not have the authority to stop dental technicians from whitening teeth in nonclinical settings like shopping malls. The ruling tilted the balance toward more independence for professionals with less training.

“The doctors are fighting a losing battle,” said Uwe E. Reinhardt, a health economist at Princeton University. “The nurses are like insurgents. They are occasionally beaten back, but they’ll win in the long run. They have economics and common sense on their side.”

Nurses acknowledge they need help. Elizabeth Nelson, a nurse practitioner in northern Nebraska, said she was on her own last year when an obese woman with a dislocated hip showed up in the emergency room of her small-town hospital. The hospital’s only doctor came from South Dakota once a month to sign paperwork and see patients.

“I was thinking, ‘I’m not ready for this,’ ” said Ms. Nelson, 35, who has been practicing for three years. “It was such a lonely feeling.”

Ms. Osburn, 55, has been on the plains her whole life, first on a sugar beet farm in eastern Montana and more recently in the Sandhills region of Nebraska, a haunting, lonely landscape of yellow grasses dotted with Black Angus cattle. She has been a nurse since 1982, working in nursing homes, hospitals and a state-run psychiatric facility.

As farming has advanced and required fewer workers, the population has shrunk. In the 1960s, the school in Wood Lake had high school graduating classes. Now it has only four students. Ms. Osburn and her family are the only ones still living on a 14-mile road. Three other farmhouses along it are vacant.

The isolation takes a toll on people with mental illness. And the culture on the plains — self-reliance and fiercely guarded privacy — makes it hard to seek help. Ms. Osburn’s aunt had schizophrenia, and her best friend, a victim of domestic abuse, committed suicide in 2009. She herself suffered through a deep depression after her son died in a farm accident in the late 1990s, with no psychiatrist within hundreds of miles to help her through it.

“The need here is so great,” she said, sitting in her kitchen with windows that look out over the plains. She sometimes uses binoculars to see whether her husband is coming home. “Just finding someone who can listen. That’s what we are missing.”

That conviction drove her to apply to a psychiatric nursing program at the University of Nebraska, which she completed in December 2012. She received her national certification in 2013, giving her the right to act as a therapist, and to diagnose and prescribe medication for patients with mental illness. The new state law still requires some supervision at first, but it can be provided by another psychiatric nurse — help Ms. Osburn said she would gladly accept.

Ms. Nelson, the nurse who treated the obese patient, now works in a different hospital. These days when she is alone on a shift, she has backup. A television monitor beams an emergency medicine doctor and staff into her workstation from an office in Sioux Falls, S.D. They recently helped her insert a breathing tube in a patient.

The doctor shortage remains. The hospital, Brown County Hospital in Ainsworth, Neb., has been searching for a doctor since the spring of 2012. “We have no malls and no Walmart,” Ms. Nelson said. “Recruitment is nearly impossible.”

Ms. Osburn is looking for office space. The law will take effect in September, and she wants to be ready. She has already picked a name: Sandhill Behavioral Services. Three nursing homes have requested her services, and there have been inquiries from a prison.

“I’m planning on getting in this little car and driving everywhere,” she said, smiling, behind the wheel of her 2004 Ford Taurus. “I’m going to drive the wheels off this thing.”

Topics: mental health, AANP, health, healthcare, nurse, medical, patients, medicine, patient, treatment, psychiatrist, psychiatric nurse, health laws

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