The Door of Last Resort: Memoirs of a Nurse Practitioner

The Door of Last Resort: Memoirs of a Nurse Practitioner

by Frances Ward
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The Door of Last Resort: Memoirs of a Nurse Practitioner 5 out of 5 based on 0 ratings. 1 reviews.
tempepoolguy More than 1 year ago
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.