Nurse Practitioners


“Harry meet Eleanor C. Lambertson, Dean of Cornell University’s New York Hospital School of Nursing.  Dean, meet Harry.”  I shook hands with the handsome Ms. Lambertson.  As we were guided by the maitre d’ to our table I nudged S.Q. Lapius.


“What’s the matter with you, have you forgotten my last name?”


Shhh,” said Lapius, “don’t be rude.”


There is no point in describing the drinks, or the delicate oriental fare served up to us that night, because the purpose of our dining out was so the Lapius could renew an old acquaintance and badger Dean Lambertson about an article she had written for Prism, the socio-economic magazine of the American Medical Association.


“Well, Eleanor, you haven’t changed.  The last forty years have been kind to you I see.”


“Ah, Simon,” she smiled sweetly, “Gallant as always.  I remember even as a young man, whenever we went any place together, how you slam doors in my face.”


“Tut tut, Eleanor.  That’s a canard.  I never slammed a door in your face.”  Lapius turned to me, “I’ll admit,” he said, “that in my eagerness to escort Eleanor I often pushed through the portals ahead of her and inadvertently allowed the door to swing shut before she had gotten through, but slammed never.  That’s a very provocative statement, Eleanor.  But, of course, you’ve always been provocative.  Now take that article, for instance--.”


“You mean on the expanded role of nurses in health care?”


“Precisely.  Particularly the term ‘Health Care’.  That’s the catch.  Once Medical Care becomes Health Care, then the services of the physician can be restricted to care of the ill, and nurses will take over the rest of the so-called ‘Health Care’ and will make the decision as to when the services of a physician are required.”


“Of course, dear Simon.  Why should so great a man as you squander your talents on minor problems?”  Her irony was not lost on Lapius.


“Because,” said Lapius tartly, “only by being able to recognize the major medical problems can one distinguish the minor problems.  Major illnesses often masquerade as minor illness.  Nurses aren’t trained to make that distinction.”


“But nurses for the most part man (I hate that word) the coronary care units, and make life saving decisions.”


“Of course,” said Lapius, “Nurses do that after they have learned the criteria for heart emergencies that have been established by the medical profession.”


“How about the services nurses perform in community health programs, in nursing homes, in chronic disease facilities, where they have to decide when or when not to call a doctor?  Surely you physicians aren’t going to spend eight hours a day with the patients.  Nurses do that, and gain a special sense of expertise about their patient’s conditions, and they know damn well when to call a doctor.  They are really making diagnoses.  It would be a simple extra step to prescribe an antibiotic.”


Lapius was busy savoring a mouthful of leafy vegetables moistened in a beige sauce.


“As a matter of fact, Eleanor, I agree with you.  Nurses can function at the lower echelons of medical practice, and do admirably.  I suggest that those that would like to do so be trained as family practitioners be given a degree and license that permits them to practice as nurse-physicians under the discipline of the professional medicine.”


“Agreed up to the last point, Simon.  They will practice as nurse practitioners under the discipline of the nursing association.”


“Impossible,” said Lapius.  The American Nursing Association has never established the uniform standards of education that the American Medical Association has.  Some nurses have never gone to college.  Some have had two year courses, others three year courses.  Some have baccalaureate degrees, some not.  It’s a hodgepodge.  How would we know who is doing what.  What objection do you have to nurse appropriately trained, practicing under the discipline of medicine.  It might help solve the doctor shortage.”


“Then they wouldn’t be nurses, they would be doctors.”


“So what?”


“I’m not here to help preside over the liquidation of the nursing profession.”


“Well then, establish some uniformity of educational standards for your nurses.  Petition the state legislatures to issue appropriate licenses for nurse practitioners, and then let the nurses assume medical liability for their decisions.”


“I’d like that.”


“Fine,” said Lapius, peering under the pewter lids for more food, “Soon we’ll have four professional groups vying for patients and responsibilities in the health field.  Physicians, osteopaths, nurses, chiropractors, all with equal rights.”


“And in the practice of Health Care you have forgotten a few others; social workers, psychologists, practical nurses, and nurses aides.”


“And under whose control will they be, Eleanor?”


“Ours of course.”


“Then they will all be fundamentally under physician control,” said Lapius, “since traditionally nurses receive their mandate from the medical profession.”


“Oh, but that’s where you are wrong, Simon.  Nursing is an independent profession.  We no longer are the handmaidens of the doctors.”


When we left the restaurant Eleanor complemented Lapius.  “You’ve learned something over the years, Simon.  I see you opened the door and allowed me through first.”


“Only so I wouldn’t be tempted, Eleanor--.”