The Door of Last Resort: Memoirs of a Nurse Practitioner

The Door of Last Resort: Memoirs of a Nurse Practitioner

The Door of Last Resort: Memoirs of a Nurse Practitioner

The Door of Last Resort: Memoirs of a Nurse Practitioner

Synopsis

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

Excerpt

I was born a first-generation American to immigrant Scottish parents who settled in Kearny, New Jersey. From a diachronic perspective, my life as nurse and nurse practitioner was grounded in my early growth in this town. Maturing in a loving home shaped by the values of hard-working immigrant British parents, I enjoyed the luxuries of American higher education. As a student, I was a sponge. With education and experience, I immersed myself over time in unique events in distinct contexts, with dreams of an equitable health care system. Synchronically, certain tropes emerged in time, evidenced in behavioral outcomes; patterns of power relationships—equality, dualisms, reasoning, and valuing—evolved, invariably influencing what I live for. Perhaps more a blurred genre than either memoir or autobiography, my narrative recounts a life as a first-generation participant in the dismantling of medical autocracy in the United States—and the establishment of an alternative: the care of patients on their terms, in their context.

Over Time

The location of two Scottish manufacturers in Kearny—the Clark Thread Company and the Nairn Linoleum Company—cloaked the town in British values of hardiness, work productivity, and frugality. No one believed in the American dream more than my father. a highly skilled ship’s carpenter in Scotland, in his early years in the United States he was termed a “Mick,” mistaken as just another Irish immigrant looking for work. Once a member of the carpenters union, however, he had regular employment and benefits. Born in Dumbarton, Scotland, he was one of twelve children, completing the fifth grade in school. He married my mother, Frances, also from Dumbarton; but, as he wryly said, she was from the other side of the tracks. Also one of twelve, her family was engaged in the whiskey and liqueur trade; she completed high school and became a beautician. a British loyalist, she joined the Royal Army in World War ii, becoming a front-line jeep driver. When the war ended, they came to the United States and married, eager for a new life.

My sister, Maureen, was born in 1948 and I was born in 1950. Living in Kearny with Scottish values, we were a close foursome. Schoolwork came first; phones were for business, not idle chatter; no television on weeknights; dinner at 4:30 P.M. after my father came home from a construction site; and play was . . .

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