Cox News Service
WASHINGTON _ In Tucson, Ariz., nurses care for 15,000 elderly
people through clinics in trailer parks and apartments. In Ocala,
Fla., nurses paid by two hospitals treat 14,607 indigents. In
Atlanta, patients visiting Grady Memorial Hospital clinics will
be treated by nurses, not medical doctors.
They are specialists, known as nurse practitioners, who train
for two years after nursing school so that they can diagnose and
treat uncomplicated forms of such illnesses as hypertension or
Many hospitals and clinics began using primary-care nurses
more than a decade ago to cut costs. Now America wants to cut
costs, and leading health reform advocates view nurse
practitioners as one solution to the nation's toughest health
delivery problems: high prices and a shortage of primary-care
physicians, particularly in rural areas and inner cities.
"We have between 50 and 60 nurse practitioners at Grady, in
our satellite clinics," said Sue McConnell, a nurse practitioner
at Grady Memorial's outpatient psychiatric clinic in Atlanta. "In
the diabetes clinic, all our patients are seen by nurse
practitioners. The medical clinic has five nurse practitioners
with stable caseloads."
McConnell, whose patients are largely black, indigent,
inner-city residents, has worked in several of the clinics since
she joined the hospital in 1978. She regularly diagnoses and
treats hypertension, high cholesterol, diabetes, infection and
bronchitis. When she's confronted with a patient suffering from
dementia, she must determine whether the condition is a byproduct
of thyroid disease or advanced syphilis.
Few patients at the clinic complain when they discover that
their primary-care provider is a nurse.
"It would be very rare for a patient to say, `I won't talk to
you, I must talk with a doctor,' " McConnell said. "Very quickly,
they get the idea that this is a person who is going to be able
to help them with their problem."
The American Nursing Association estimates that 400,000 of the
nation's 2.1 million registered nurses are already delivering
primary care, some for high-quality health maintenance
organizations, which profit by keeping treatment costs low. "In
the future," one slogan goes, "your family doctor may be a
Also, more than 25,000 physician assistants nationwide
practice in virtually every health care setting and in every
specialty _ including surgery, according to the American Academy
of Family Physicians.
Architects of the Clinton Administration's health reform plan
say they view these health workers as a way to cut costs while
expanding access to care. First lady Hillary Rodham Clinton has
emphasized the administration's desire to expand the role of
nurses under the new plan, which is scheduled for release in
"We have every indication from the President and Mrs. Clinton
that there is much more that nurses could do than state
regulations allow," said Virginia Trotter Betts, president of the
American Nurses Association.
"If they bring 37 million uninsured into the medical system,
there will be too much work, for every group of providers, to let
archaic regulations limit the scope of our practice," Betts
Doctors, predictably, disagree.
Dr. Daniel Johnson, a trustee for the American Medical
Association, said "neither they nor anyone else should be able to
practice medicine independent of supervision of a physician."
"The nurse simply does not have the education to do that," he
said. "To compare the capabilities of a nurse who has four years'
education with someone who has 11 to 20 years of education simply
doesn't compute. It's not a question of turf _ it's a question of
quality of care."
"It's politics and it's turf," countered Arthur Caplan, a
medical ethicist at the University of Minnesota, who was a member
of the White House health reform task force. …