Is there a Doctor (of Nursing) in the house?

I recollect one day, several years ago, at a then-small, rural community/junior college where I began my higher education, while walking across a parking lot, that I greeted an administrator whom I saw.

“Hello, Dr. Gudger!,” I cheerily greeted him.

“Good morning!,” came his reply.

Just then, another student, unknown to me or Dr. Gudger, called out, “Doctor! Oh, doctor! I have a question about my mama’s ...”

“I’m sorry I can’t help you. I’m not that kind of doctor,” replied Dr. Gudger, as he turned and looked the student in the eye.

At the time, I thought it rather odd, then quickly considered that the fellow – likely from a very rural and poor background – was there to obtain an education. And so in part, he was schooled that day.

However, interesting stories aside, as healthcare goes, our nation is experiencing a significantly decreasing interest in rural healthcare practice, as well as family practice, followed by internal medicine.

Now, I realize that some would pooh-pooh lawyers and blame law suits (everybody hates lawyers… until they need one), claiming that sue-happy folk are to blame for the problems. However, while law suits may have a role – albeit an insignificant one – insurance companies are probably more to blame for increased costs of healthcare and rationing the delivery of health related services.

It’s really rather easy to understand: Anytime anyone gets in between you and the checkout stand, you’re gonna’ pay more. From a fiscal perspective, that’s essentially what happens.

Now, while I could drone on and on about the hows and whys that the insurance industry is (in my opinion) corrupt (the federal government has also bailed them out, along with banks – which, along with stock brokerage houses enjoy an incestuous fiscal orgy), and has corrupted whatever thing their hand touches, I shall confine my remarks toward the more germane and problematic topic at hand, which is the shortage of healthcare delivery to rural areas, and among the poor.

I was inspired to write this entry after having read an article written by Carla K. Johnson, AP Medical Writer, entitled “Doctor shortage? 28 states may expand nurses’ role,” and which was published online April 13, 2010 at http://news.yahoo.com/s/ap/20100414/ap_on_he_me/us_med_dr_nurse.

As a Registered Nurse, my interest in healthcare began to emerge when I traveled with a friend’s dad one day – he was a owner/operator truck driver and itinerate circuit-riding preacher – and along the way to visit a sick church member saw a rural Alabama hospital in northern Alabama that had closed down. Emergency healthcare would be critical, I realized, and then began to dream of utilizing GPS in helicopters to find scenes where farm accidents may have occurred.

Later, my interest in health and healthcare began to flourish as an adjunct with a woman whom I dated briefly, but really intensified sometime later with a dear, close friend whom shared my vision. Ernie and I were making plans to attend OUCOM – Ohio University College of Osteopathic Medicine, but he later lost his life in a tragic hiking accident.

I have liked the osteopathic model of healthcare delivery over and above the allopathic model, which is employed my M.D.s. Osteophathic physicians, of course, have the letters D.O. – Doctor of Osteopathy – after their name. Essentially, the osteopathic model differs from the allopathic model – and I write most abbreviatedly – because the osteopathic model not only treats the symptoms, but seeks to ameliorate or eliminate the underlying cause. It encompasses a teaching element.

After Ernie’s death, I lost heart, motivation, and to some extent, vision. I didn’t attend OUCOM.

Events later transpired in my life – graduate school, loss of employment, followed by divorce, homelessness, and relocation – and I subsequently entered into Nursing School in a different city.

My entry into Nursing School was, I believe, very much guided by Divine intervention. I say that because there wasn’t anything I could do to obtain entry, and the doors of opportunity were opened for me. At the time, Nurses from throughout the nation had converged upon Washington, D.C. and in symbolic demonstration, had placed thousands of white shoes on the steps of the Capitol building. Various Professional Nursing organizations along with nurses from all 50 states were there to testify before Congress of the coming Nursing Shortage. The news and photographs of their testimony, demonstrations and symbolic shoes were all over every news media outlet – radio, television, newspaper, magazine – including the then brand-new Internet.

Researchers from throughout the Nursing Profession, in academia and within and without the Profession, have all identified that a Nursing Shortage is now in effect. It’s not anticipated to become any better anytime soon.

Toward that end – of meeting our nation’s people’s healthcare needs – leaders from within Nursing Academia then began to strategize about how they might best address the nation’s healthcare needs. Recognizing that further advancing Advanced Nursing Practice was the best route possible, educators began to embark upon creating Doctor of Nursing Practice, or Doctor of Nursing Science programs in universities.

Research has continually demonstrated that the healthcare services delivered by Advanced Practice Nurses equals that of healthcare provided by physicians. And, they do so at reduced cost, and increased efficiency.

As beneficial as that may seem – and it is – the practice of Nursing is regulated by the states, and there are a plethora of states – Alabama included – that do not allow Nurses with Specialized and Advanced Education and Training to practice independently. While Advanced Practice Nurses all earn Master’s Degrees and have National Standards and Board Certification for the various specialty areas, along with Continuing Education requirements, and professional regulation, some states don’t allow them independent practice. In Alabama, for example, physicians must oversee a Certified Registered Nurse Practitioner, are limited to having two on staff, and are required by law to by physically present at least 10% of the CRNP’s practice time.

From a 2004 report prepared by Nurses, Universities, Practitioners, State Regulators and others to an Alabama Legislator to more fully utilize Nurse Practitioners in rural areas, it was discovered that 60% of Alabama’s population resides in rural areas, and are experiencing serious health care shortages of Primary Care Practitioners (family practice, internal medicine, pediatrics, and obstetrics/gynecology), whom also provide health care for low-income populations. However, fewer than 20% of the state’s physicians practice in Alabama’s rural areas.

As of November 13, 2003, there were 1227 Certified Registered Nurse Practitioners (CRNP) in collaboration with physicians in Alabama. Six educational institutions in Alabama provide Nurse Practitioner programs that provide 10 different types of Nurse Practitioner programs in Alabama, and have graduated 1283 from their Nurse Practitioner programs in the past five years (1998-2003). However, as of November 13, 2003, there were 1227 Certified Registered Nurse Practitioners (CRNP) in collaboration with physicians in Alabama. The report said that “the fact that the number of nurse practitioner graduates produced by Alabama schools in the past five years is greater than the number of certified nurse practitioners indicates that a subtantial number of nurse practitioners are either not practicing in that role or they are no longer in the state.”

Although the Alabama legislature places other shackles upon Advanced Nurse Practitioners, thereby effectively harming the health of all Alabamians, there doesn’t seem to be any indication that the powerful medical lobby or others, like Pharoah, will “let My people go” get healed.

So when the various voices cry out about the state and quality of healthcare – and there are numerous voices – recall that at least, in Alabama, our legislature stymies us.