To doctors' dismay, health-care reform reportedly would give nurses bigger role

April 08, 1993|By Boston Globe

WASHINGTON -- Nurses, historically relegated to a secondar status in the world of medicine, would assume a more significant, independent role in providing health care under the White House health-care plan, specialists and administration sources say.

But doctors say they would fight efforts to give nurses more independence.

The Clinton health plan, with its emphasis on preventive care, would call for greater reliance on services that nurses already are trained to perform. And a shortage of doctors who practice general medicine means highly trained nurses probably will be called upon in greater numbers when the government offers health care to the nation's 37 million uninsured.

President Clinton's health advisers are leaning toward measures that would increase the number of advanced-practice nurses -- those trained to write prescriptions, for example -- in its health-care overhaul.

The advisers are considering offering states incentives to waive regulations that bar advanced-practice nurses from roles traditionally reserved for doctors, as well as increasing federal funding for nurse training, sources said. Similar measures are being considered to boost the ranks of physician assistants, also trained to give general medical care.

"I think the '90s will be the decade of nursing," said Virginia Trotter Betts, president of the American Nursing Association.

"When you have 37 million uninsured, somebody has to offer the primary care," said Anne Elderkin, head of the Somerville, Mass., health department and the president-elect of the American Academy of Physician Assistants. Physician assistants are trained differently than nurses, although their skills are similar. By law they must work under a doctor's supervision.

But physicians argue that even advanced-care nurses do not have the education and experience to practice primary care without a doctor standing by.

Advanced-care nurses include nurse practitioners, certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists.

"Are they adequately trained? The answer is no," said Dr. M. Roy Schwarz, senior vice president of the American Medical Association. "They haven't gone through the necessary training that teaches clinical judgment, like when a referral to a specialized provider is necessary."

The Clinton Task Force on National Health Care Reform has not made any final decisions.

Soaring health-care costs would be curbed under the plan by moving care out of hospitals and back into community settings such as school-based clinics.

Yet at a time when only 30 percent of all doctors are generalists, there will not be enough doctors to perform community-based medical care when the additional patients flood the health-care system.

And that is where nurses and physician assistants say they can come in.

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