Nurse/Attorneys Look at Future of Health Care : More Specialties, Responsibilities Discussed at San Francisco Convention

Imagine, say five years from now, hospital patients with computer terminals next to their beds linking them to their nurses, physicians and their families at home. Any of these people can tap into the computer system, monitor the patient’s status or merely be sure he swallowed his medication on time. Then, after he goes home, the hospital can continue to check the patient’s progress--instantly, electronically.

Or picture this. Hospitals of the future finally do something about the disruption in sleep cycles many patients endure because Medicare doesn’t pay for a hospital stay the night before surgery. Such patients typically rise at 4 a.m. or earlier so they can arrive at the hospital in time to be prepped for 7 a.m. surgical appointments.

“One of these days, the patient will probably demand we change our behavior. We could start the operating room hours from 10 a.m. to 7 p.m. instead of starting them at 7 a.m.,” said Carolyne K. Davis, the nurse and former federal agency administrator who was describing these future scenarios at the annual national meeting of the American Assn. of Nurse Attorneys last weekend.

The nurse/attorneys had come to San Francisco to hear Davis, former administrator of the Health Care Finance Administration, the agency that runs Medicare and Medicaid, and others discuss upcoming models of health care--and the roles nurse/attorneys can expect to play in them. (There are now about 750 nurse/attorneys in the nation and 325 of them are members of TAANA, which was founded in 1982.)

At this meeting, the focus was on how nurse/attorneys can best assist their nurse/entrepreneur clients (nurse/midwives, nurse/anesthetists, nurse/practitioners and others). Such “expanded role nurses” frequently hire other “expanded role nurses,” namely nurse/attorneys, to help them set up or expand their practices in areas where there may be no legal precedents. (But not all nurse/attorneys specialize in representing other nurses; many work for malpractice firms, hospitals, or allied health organizations and some practice law in areas unrelated to health care.)

Davis, who is also a professor of health administration at Cornell University, emphasized to the gathering of about 60 TAANA members that many changes in health care dictated by federal cutbacks and other financial curtailments may bode well for nurse/entrepreneurs offering alternative systems of health care delivery.

For example, many more patients will likely be receiving care in the home than in the past, she suggested, referring to an area in which some nurse/entrepreneurs already have a head start. (One of them, Mary Baker of Sacramento’s Chicken Soup, Plus, a home heath-care firm with 30 employees, was a convention speaker.)

Davis, who now spends 60% of her time as a consultant on health care to the international accounting firm of Ernst & Whinney, said that many HMOs (health maintenance organizations) are already dependent on nurse practitioners for chronic patient care and for wellness care.

And she observed that as institutions and insurance companies become increasingly concerned with both the bottom line and the quality of health care, more money will be spent to analyze what is medically and financially most viable.

In other convention sessions, there were these reports concerning the future of nurse/attorneys and nurse/entrepreneurs:

--Jo Ann Smith, a nurse/attorney who represents and advises nursing homes for Beverly Enterprises in Pasadena, told the group that 19 states have passed laws allowing nurses to prescribe drugs. In most cases, Smith added, the nurse prescribing drugs must have physician supervision, is limited in the types of drugs which can be prescribed and must be a nurse/practitioner, nurse/midwife or other type of nurse with advanced training.

--Respect for the contributions of expanded-role nurses seems to be on the upswing, according to several TAANA speakers. One of them, Sharon Gedan, a Los Angeles psychiatric/mental health nurse licensed to provide mental health counseling, described an enormous change: “What I was called then (when she opened her practice in the 1960s) was a troublemaker. Twenty years later I’m called an entrepreneur.”

--Nurse/attorneys may be more frequently sought after by clients who don’t have actual legal needs but request advice “on how to negotiate the medical system.” Sacramento’s Baker, the owner of Chicken Soup Plus, told of several such cases, one in which two attorneys who were married to each other sought her help when one spouse was suddenly dealing with cancer. “They had HMO coverage and were faced with a catastrophic illness,” Baker said. “They came to me to brainstorm how to deal with the medical system.”

--Nurse/entrepreneurs are increasingly requesting and sometimes winning hospital privileges, both admitting privileges and attendance privileges. Ann O’Connell, an attorney with McDonough, Holland & Allen in Sacramento, said she had helped several nursing groups win such privileges, but cautioned that they are still difficult to come by, particularly admitting privileges. She recommended nurse/entrepreneurs (or their nurse/attorney representatives) do the homework for the hospitals--provide them with precise information on what privileges will be exercised and which standardized procedures will be involved, among other things. She discouraged litigating for hospital privileges because even if the litigation is successful, “You’re going to have to go ahead and work with the hospitals you’ve just sued. The relationships aren’t going to be good.”

After the convention adjourned, TAANA President Mary Kelly took a moment to assess what had been accomplished and what was next on her organization’s agenda.

“I think we made substantial progress toward our goal of teaching our members how to help nurses set up independent practices,” said Kelly, a Los Angeles nurse/attorney in private practice who recently co-authored a forthcoming book on legal issues in nursing.

As for the upcoming work of her group, Kelly concluded that the national meeting had helped clarify that, too: “Many of us have been in the trenches as staff nurses and administrators. We think we have a perspective that would be useful in formulating policy. Our biggest issue--what our membership told us during this meeting--is becoming influential in health-care policy making on a national level. That’s where we really want to put our efforts over the next few years.”