Nurse practitioner Irene Stuart runs a clinic for the homeless out of a Skid Row rescue Mission in Los Angeles. Call her a heroine--a fighter in the struggle to deliver health care to the homeless. Or just call her by her title, director of clinical services. All those fit.
Just don't compare her to a doctor.
"Nursing isn't doctoring," said Stuart, an ex-Navy nurse who runs the UCLA School of Nursing clinic at the Union Rescue Mission.
Nursing is redefining itself, and Stuart is contributing to the new definition.
So are nurses such as Georgina Garcia, whose specialty is high-tech coronary care; or San Francisco-based nurse practitioner Susan Shea, who specializes in the treatment of AIDS, or Mary Ann Barnes, a registered nurse who is the administrator of the Kaiser Foundation Hospital in Harbor City.
Along with running clinics on Skid Row and using innovative technology to keep patients alive far longer than would have been possible a few years ago, many nurses are returning to medical schools. They are seeking advanced degrees and positioning themselves for a role as primary care providers in the health care reforms being sought by the Clinton Administration.
Nurses, at least in California, still must work within guidelines set by doctors. But the medical world is beginning to accept the notion that advanced-practice nurses, with master's degrees and special licenses in fields such as pediatrics, family medicine and obstetrics, can do as much as 80% of what a physician can do.
"They (advanced-practice nurses) have had more training than an intern right out of medical school," said Dr. J. N. Sarian, a radiologist who puts in four hours a week at the rescue mission clinic run by Stuart.
These days, nurses are starting their own practices with minimal supervision from doctors and are able to furnish or dispense drugs to patients. In corporate medicine, many registered nurses are leapfrogging over doctors and administrators into top executive jobs. Nursing schools are at the bursting point, with room for only one of every three qualified applicants in top schools.
But with all the gains come growing pains.
Registered nurses are finding more and more health care providers standing between them and their patients. Cost-conscious insurance companies and health maintenance organizations are putting the squeeze on hospitals, and they in turn are putting the squeeze on nurses. RNs are being replaced by a variety of unlicensed hospital workers who have less training but also cost less.
With industry analysts agreeing that the nursing shortage of a few years ago is over, nurses have gone from being chased and courted with bonuses and write-your-own-ticket jobs to the possibility of being laid off.
Today, nurses will find jobs, but the jobs may be on a night shift, in a specialty that wasn't their first choice or even outside an acute-care hospital, in a long-term care facility or an in-home treatment program.
Stress is also high. As a result of cost-cutting, patients these days are in hospitals for shorter periods, being treated for more acute illnesses. As a result, ward nurses are likely to be wearing track shoes and beepers, all the better to keep them running from one patient to another. The Service Employees International Union, which represents registered nurses and licensed practical nurses in the female-dominated profession, released a survey earlier this year showing that nurses suffer significantly higher rates of such stress-related diseases as colitis, ulcers and depression than do women generally.
Nurses also say they have a continuing struggle to gain respect.
They point to a budget proposal by UCLA Chancellor Charles E. Young to eliminate the university's undergraduate nursing school, ranked 15th in a nation in a recent national survey. It has three qualified applicants for every slot that opens. Outraged nurses believe that they are still suffering from gender bias, since the faculty at the nursing school is 98% women, roughly the proportion of women to men in the nursing ranks.
"Even today, nursing is considered less academic than other fields. We question why nursing is viewed as less academic than engineering. . . . We think it is a gender thing," said Kathleen Dracup, a professor at the nursing school.
Linda McDermott, a nurse practitioner and a faculty member of the USC School of Nursing, went through a similar fight three years ago when USC administrators tried to close the nursing school there.
"I don't think it bodes well for anyone that two nursing programs have been threatened in the last three years. No one ever talks about closing medical schools, even though it is a fact that you can educate five nurse practitioners with advanced degrees for the cost of one doctor," she said.
Still, although nurses are far from satisfied, they seem pleased that after years of playing what one said was an invisible role in the health care system, they are beginning to get their due.
