Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 30, 1993 TAG: 9306010206
SECTION: EDITORIAL PAGE: F-3 EDITION: METRO
SOURCE: JANET HARDY BOETTCHER
DATELINE: LENGTH: Medium
One way to improve health care for more people at less cost is to allow nurses more responsibility in health screening, assessment and treatment of "garden variety" illness.
It doesn't require 16 years of post-high-school education to treat an ear infection or sore throat. Nurses are quite capable of providing routine care and referring patients to a physician for problems that might require further testing or treatment. This would result in improved care, and would free up physicians to spend more time with those who truly need them.
Opponents of greater involvement of nurses must not realize how often people never see a doctor until serious health problems arise that could have been prevented with earlier treatment.
A good example is America's infant-mortality rate. It is 22nd in the industrialized world, behind most European nations, New Zealand, Singapore and Hong Kong. Research shows that 50 percent of low birth-weight babies could have been healthy, full-term babies with good prenatal care begun early in pregnancy.
These poor statistics are due to lack of access to affordable prenatal care, good nutrition, family planning, good hygiene, adequate housing and social support for the pregnant mother.
A recent study in one rural Georgia county calculated the long-term governmental costs resulting from low birth-weight babies. For example, if an instance of low birth-weight resulted in blindness, the cost of long-term special education was considered. In that county alone, special care of low birth-weight babies exceeds $5 million annually. So the question is: Do we pay for preventive health care for families or do we pay more for long-term care of sick children?
Some people don't even accept the existence of a health-care crisis in this country. They point to our frequently superior technology and to emergency rooms that treat all who request care, regardless of ability to pay. But expensive, technological treatments and emergency-room visits are no substitute for preventive care and early intervention.
The professional nurse, educated in a baccalaureate program for beginning practice, is a competent and collaborative member of the health team. Nurses at this level can assess the health status of an individual, provide guidance in self-care practices and refer for appropriate medical follow-up as needed.
Professional nurses who have received additional education can function in advanced-practice roles, and can do so as competently as physicians at a savings in cost.
This is not to say that nurses can replace physicians. Nursing is nursing and medicine is medicine; each profession is licensed separately by the state. When an individual needs medical care, licensed physicians are the appropriate providers.
However, the current arrangement primarily reimburses only physicians for all levels of health care, thus raising the cost and limiting accessibility.
Family nurse-practitioners, who are one type of advanced-practice nurse, can conduct regular health physicals for all family members. When problems requiring a medical specialist's attention are identified, the patient can be referred to the proper specialist and the nurse can make sure the patient and his family understand what is happening. Nurses are excellent communicators, and families can talk openly with them. The patient gets ongoing regular care from a competent health-care provider, personal attention and explanation, and early detection and proper referral.
This is also true of other advanced-practice nurses, such as pediatric nurse-practitioners, certified nurse-midwives, and obstetrics-gynecology practitioners. Certified nurse-anesthetists have been providing this level of advanced practice for many years in collaboration with physicians, hospitals and clinics.
Physicians specialize in health problems. That's what they're interested in, trained for and good at. The nursing perspective is holistic and can bridge the gap between expensive, specialized care and routine care.
The American situation today is grim: the costliest health care in the world, and steadily rising, with some of the poorest outcomes. If we keep what we've got and if we make decisions as a society based on professional turf as opposed to community needs, the people will pay. We're paying now and the price is getting steeper.
Florence Nightingale had to prove that nurses could alleviate pain and death in Crimea in the 1800s. Nursing stands ready to prove that the key to real health-care reform lies in recognizing and extending the nurse's role in health-care delivery.
Janet Hardy Boettcher chairs Radford University's School of Nursing.
by CNB