Clinton's Health Plan : Health Plan: A User's Guide : For Care Givers and Businesses. . .There Are Reasons to Hope and Fear : NURSES : 'Pay, challenge and job security are pulling them in'

Under President Clinton's health reform plan, nurse Joanne Bercier doesn't see a lot of bedpans in her future.

Instead, she's looking forward to the role her profession has sought for decades: fuller partnership with doctors in deciding how to treat the complex medical problems of hospital patients today.

The plan's cost control features give nurses more leverage than they have had in the past. As spending limits force doctors and hospitals to manage patients more economically, nurses are positioned to inherit tasks once considered exclusively in the doctors' domain.

Indeed, the opportunities inherent in health reform and salary improvements resulting from a nationwide nurse shortage have combined to significantly boost the number of applicants to nursing schools. Locally, USC's Department of Nursing reports a record freshman class of 100, 15% of whom are men.

"Pay, challenge and job security are pulling them in," says Linda McDermott, an assistant professor of clinical nursing.

Bercier, who has specialized in caring for critically ill patients, foresees a day when nurses will routinely be able to diagnose and treat certain medical conditions without having to wait for a doctor's approval. Currently, that authority is held on a limited basis by a few specialized nurse practitioners, midwives and anesthetists, and varies from state to state.

Bedpans, bed-making and other housekeeping duties, Becier hopes, will in turn fall to staff who haven't spent four years in college studying the biological sciences.

"I think there's a lot more potential for nursing as an exciting career," said Bercier, 30. "We are well-educated and sometimes our skills have been under-utilized."

For Bercier, health reform has been as hot a topic at family gatherings as it has in staff meetings at the 165-bed Medical Center of North Hollywood, where she is director of nursing operations. Her mother, sister and a brother are all nurses, and two other brothers are married to nurses.

Besides the professional opportunities the reform plan would open for nurses, Bercier also applauds its goal of providing insurance to the 37 million Americans who currently lack it.

Her first job out of nursing school--at Los Angeles County-USC Medical Center--gave her a first-hand look at what happened when the uninsured put off medical treatment until their problems became critical. The hospital, one of the busiest in the nation, serves many of Los Angeles County's 2 million uninsured residents.

As an impressionable young trainee in County-USC's coronary intensive care unit, Bercier was shocked by the neglect these patients had suffered before landing desperately ill at the hospital's doorstep. "Even more heartbreaking," she said, was the number of times many of them returned with new crises because they were unable to afford preventive care or medication.

One middle-aged man with a young family became a regular in her unit, Bercier recalled. "It was pretty much a revolving door. We'd fix him up and then he'd be back again," never able to enjoy for long the health she and others had labored to give him.

Clinton is promising universal health insurance, including preventive care.

Bercier left County-USC in 1988 for the challenge of nursing AIDS patients in a special unit at Medical Center of North Hollywood.

That assignment convinced her that nurses have a valuable role to play in teaching patients about their illnesses. Health reform, she believes, will make patient education even more vital as shorter hospital stays and greater reliance on lower-cost outpatient and home-based care force patients to take a larger role in their own recovery.

Bercier is putting all these experiences and insights to work as she prepares to lead her hospital's 409 nurses into health reform. With more than half the patients at Medical Center of North Hollywood already in some form of managed care, the Clinton proposals are seen by many nurses on the staff as accelerating changes in their role, rather than revolutionizing it.

"We are trying to prepare the staff to be as flexible as possible to be ready for the changes ahead," Bercier said.

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