Role of Nurse Practitioners

* In response to “Nurses Have Had It With Sexism,” by Suzanne Gordon and Judith Shindul-Rothschild, Commentary, Dec. 7:

I have had the privilege in the last six or seven years to have worked with a number of nurse practitioners. I have seen the American Medical Assn.’s and the California Medical Assn.’s escalating war against increasing the scope and authority of the nurse practitioners. The sayings that they are “only nurses,” that they “lack the basic theoretical foundations of medicine” are slogans that obscure the reality. The nurse practitioners I have observed give more care, more teaching and more warmth than the majority of physicians.

Instead of clashing with this profession, we, as physicians, should learn from them. Our tarnished image might be better served and the patient’s needs better met. These practitioners truly spend time with their patients, they teach again and again the needs of preventive care, they deal with the families, with lifestyles as well as with disease. Study after study has shown that patients, given the choice, prefer the nurse practitioner to the physician. Maybe that is why the AMA and CMA are so vehement and frightened.

J. GARY DAVIDSON MD

Northridge

* While the AMA may be attacking the nursing profession, it’s too bad this article was not written by a female nurse and a male nurse. The authors offered many valid points to support the nurse’s role as a valuable professional. Rather than being caught up in their shorts on feminism-converting metaphors as female only, they should gear their written performance to the level of professionalism they ardently profess. I am not a physician, but I am married to a registered nurse administrator who practices at the professional level advocating professional issues.

JOHN BETHE

Huntington Beach

* Suzanne Gordon’s and Judith Shindul-Rothschild’s claims of physician sexism toward nurses are outrageous, inaccurate, and finally, sad. When did nurses and physicians, who have always worked together in the noble profession of medicine, become enemies?

First, organized medicine has not opposed social legislation, as claimed, but has been promoting it. The AMA proposed its reform plan, Health Access America, in 1989. Last year the CMA attempted to reform insurance and expand health care coverage to workers and their families, an effort that was actively opposed by organized nursing.

Second, physicians have always advocated that a team of trained health professionals care for patients. And while physicians have been tireless in efforts to prevent quackery and protect the public from bogus practitioners, their efforts have never been directed at nurses.

Third, nowhere are nurse anesthetists sole providers. In rural areas where no anesthesiologists may be available, registered nurse anesthetists work under the supervision of non-anesthesiologist physicians. Those cases account for about 8% of all surgical procedures each year. The 85% figure quoted in the article is misleading.

Fourth, allowing nurses to prescribe drugs and practice independently raises serious questions of patient safety, for the education gap between nurses and physicians is substantial. Nurses receive two to four years of college education. Advance-practice nurses must complete an additional nine months to two years of training, which does not necessarily include any study of pharmacology. On the other hand, to become a physician requires four years of college, four years of medical school, and three to seven additional years of residency training.

Physicians are aware that health system reform may include an expansion of the role of non-physicians. We support the care team approach with each member practicing within the scope of his or her education and training.

MARIE G. KUFFNER MD

Immediate Past President

Los Angeles County Medical Assn.