By Diana Mason. Two weeks ago, I got my hearing checked by a doctoral student in audiology at a faculty practice clinic at a university. The student was quite thorough. She advised me that she was not a physician and could not diagnose and treat hearing problems. Later on during the visit, her faculty supervisor repeated this mantra. I said each time, “Yeah, yeah…I know the spiel.”
I know it because for decades nurses were not allowed to say a patient was dead or bleeding or in congestive heart failure despite the obvious signs. Physicians were the only ones who could do these things. About 100 years ago, nurses didn’t even take blood pressures–or temperatures! As new technology was introduced into medicine and health care, the physicians claimed it as their purview–until they were bored with it. Then, they decided that nurses could be taught to do these things. Of course, in many states, including New York until last year, nurse practitioners still can’t pronounce a dead patient to be thus.
When she was the Associate Dean at the Yale Law School, Barbara Safriet (now at Lewis and Clark School of Law) wrote a classic article on the laws regulating medicine and other health care professions. She pointed out that state medical practice acts that govern the practice of medicine were written so broadly that they precluded other health professionals from doing most anything without the authorization and supervision of physicians. As such, podiatrists have fought endless battles to move from working independent of physicians on foot problems; optometrists, to do more advanced assessments of eye problems; chiropractors, to practice at all; audiologists, to use an otoscope to look in patients’ ears; and advanced practice registered nurses (APRNs), to be able to diagnose and treat common health problems.
The battle between APRNs–nurse practitioners, certified nurse midwives, nurse anesthetists, and clinical nurse specialists–and organized medicine is heating up because of the Institute of Medicine’s recommendation that all health professionals be able to practice to the full extent of their education and training and that the barriers to them doing so be removed. A very large body of evidence supports that APRNs provide high quality, safe care and produce the same or better outcomes as physicians. While some states already permit nurse practitioners and nurse midwives to practice without physician supervision or mandated collaboration, the majority of states continue to have restrictive laws and regulations that get in the way of APRNs being able to improve people’s access to affordable, quality, efficient care. (more…)