The Door of Last Resort: Memoirs of a Nurse Practitioner [NOOK Book]

Overview


Having spent decades in urban clinical practice while working simultaneously as an academic administrator, teacher, and writer, Frances Ward is especially well equipped to analyze the American health care system. In this memoir, she explores the practice of nurse practitioners through her experiences in Newark and Camden, New Jersey, and in north Philadelphia.

Ward views nurse practitioners as important providers of primary health care ...
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The Door of Last Resort: Memoirs of a Nurse Practitioner

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Overview


Having spent decades in urban clinical practice while working simultaneously as an academic administrator, teacher, and writer, Frances Ward is especially well equipped to analyze the American health care system. In this memoir, she explores the practice of nurse practitioners through her experiences in Newark and Camden, New Jersey, and in north Philadelphia.

Ward views nurse practitioners as important providers of primary health care (including the prevention of and attention to the root causes of ill health) in independent practice and as equal members of professional teams of physicians, registered nurses, and other health care personnel. She describes the education of nurse practitioners, their scope of practice, their abilities to prescribe medications and diagnostic tests, and their overall management of patients’ acute and chronic illnesses. Also explored are the battles that nurse practitioners have waged to win the right to practice—battles with physicians, health insurance companies, and even other nurses.

The Door of Last Resort
, though informed by Ward’s experiences, is not a traditional memoir. Rather, it explores issues in primary health care delivery to poor, urban populations from the perspective of nurse practitioners and is intended to be their voice. In doing so, it investigates the factors affecting health care delivery in the United States that have remained obscure throughout the current national debate
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Editorial Reviews

National Nursing Centers Consortium

“A wonderful personal story of what it means to be part of a disruptive movement that changed healthcare in the United States, making nurse practitioners the future of primary care.”

— Tine Hansen-Turton

National Nursing Centers Consortium - Tine Hansen-Turton

“A wonderful personal story of what it means to be part of a disruptive movement that changed healthcare in the United States, making nurse practitioners the future of primary care.”
University of Pennsylvania, School of Nursing - Barbra Wall

"Ward makes a convincing case for a view of health care that relies on clinical skills and diagnosis with sensitivity to the differences among groups—against one that pursues only curing at the expense of thorough diagnosis and caring."
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Product Details

  • ISBN-13: 9780813560540
  • Publisher: Rutgers University Press
  • Publication date: 3/14/2013
  • Series: Critical Issues in Health and Medicine
  • Sold by: Barnes & Noble
  • Format: eBook
  • Pages: 224
  • Sales rank: 840,436
  • File size: 2 MB

Table of Contents


Preface

1. Bread Is Not Sugar
2. Health Care: Perspectives from the Street Level
3. Nurse, Are You a Doctor?
4. Protection of the Public or Creation of a Guild?
5. Context, Data, and Judgment: When Is Enough, Enough?
6. Barriers, Opportunities, and Militancy

Epilogue
Index
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Sort by: Showing 1 Customer Reviews
  • Posted October 15, 2013

    more from this reviewer

    I'm a registered dietitian and professor of nutrition at a very

    I'm a registered dietitian and professor of nutrition at a very large university. Through the years, I've met LPNs, RNs with a diploma, RNs with a bachelor's degree, nurse midwives, nurse practitioners, and individuals with a Doctor of Nursing Practice (DNP) or a PhD in Nursing. As a society, we use the word "nurse" to refer to all of the above, plus more I haven't listed, and that has led to a lot of in-fighting in the profession. Toss in certified nurse's aides, who sometimes call themselves nurses too, and you have the makings of a toxic environment within the discipline.
    That might surprise people, whose paradigm of nursing invokes Florence Nightingale and the Red Cross, but Nursing tends to be very territorial and hyper vigilant about their place in health care. Dr. Ward notes this too -- although, as a nurse herself, she seemed to do so without a second thought -- when she documents that Nursing is different from, but not subservient to, Medicine. Nursing has volumes of theories and a lexicon that nurses cling to to underpin their approach to health care. But by and large, a doctor's "orders" are what must be done. There's some seething in the health care hierarchy.
    (There are exceptions, such as nurse practitioners who are licensed to work in states that permits autonomy and collaboration with -- but not mandatory oversight by -- physicians. They can practice advanced-care Nursing, which looks a whole lot like MD-style medicine, especially in the states that permit nurse practitioners to prescribe and dispense medications with autonomy. These nurse practitioners have liberated themselves from doctors' "orders.")
    Dr. Ward records her experiences, including obstacles constructed by fellow nurses, as a nurse, a professor, a nurse practitioner, and an academic administrator. She has captured perfectly the jealousies within Nursing and with physician assistants (PA-C) as she led the charge to legislate the primary care scope of practice, including diagnosing and prescription-writing, for nurse practitioners and physician's assistants in New Jersey. As I figured she would, Dr. Ward faced strong opposition from physicians and nurses who weren't nurse practitioners. She had to swallow her pride (commendable) and partner with physician assistants, who were seeking similar additions to their scope of practice. She knew they would either get an extension of their licensure together or neither discipline would get legislation passed at all. She soon found herself defending physician assistants and serving as their advocate, which she acknowledges was novel for a nurse to do.
    Dr. Ward's biography, focusing on her professional successes and occasional shortcomings, is interesting to read, even for those of us who are not nurses. Primary care affects all of us, but states differ in how nurse practitioners and physician assistants can legally practice. Reading this book might make you an advocate for non-physician primary-care providers, despite doubts that continue to be voiced about the capabilities of those who don't put MD (or, to a lesser extent, DO -- because there are still allopaths [MD] who look down on osteopaths [DO]) after their name. This is frequently seen when nurses who have a doctorate (PhD, DNP, DrPH [Doctor of Public Health]) refer to themselves as Dr. ______ in the health care setting. That upsets the medical hierarchy, but it's fun to watch.

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