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The Door of Last Resort

Memoirs of a Nurse Practitioner

Frances Ward

Publication Year: 2013

Having spent decades in urban clinical practice while working simultaneously as an academic administrator, teacher, and writer, Frances Ward is especially well equipped to analyze the American health care system. In this memoir, she explores the practice of nurse practitioners through her experiences in Newark and Camden, New Jersey, and in north Philadelphia.

Ward views nurse practitioners as important providers of primary health care (including the prevention of and attention to the root causes of ill health) in independent practice and as equal members of professional teams of physicians, registered nurses, and other health care personnel. She describes the education of nurse practitioners, their scope of practice, their abilities to prescribe medications and diagnostic tests, and their overall management of patients’ acute and chronic illnesses. Also explored are the battles that nurse practitioners have waged to win the right to practice—battles with physicians, health insurance companies, and even other nurses.

The Door of Last Resort
, though informed by Ward’s experiences, is not a traditional memoir. Rather, it explores issues in primary health care delivery to poor, urban populations from the perspective of nurse practitioners and is intended to be their voice. In doing so, it investigates the factors affecting health care delivery in the United States that have remained obscure throughout the current national debate

Published by: Rutgers University Press

Series: Critical Issues in Health and Medicine

Title Series Info

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p. 2-2

Title Page

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p. 3-3

Copyright Page

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p. 4-4


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pp. 5-6


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pp. vii-8

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pp. ix-xviii

I was born a first-generation American to immigrant Scottish parents who settled in Kearny, New Jersey. From a diachronic perspective, my life as nurse and nurse practitioner was grounded in my early growth in this town. Maturing in a loving home shaped by the values of hard-working immigrant British parents...

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1. Bread Is Not Sugar

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pp. 1-24

I arrived early at the health center. The large plastic clock with the drug name Protonix written in yellow and blue across its face reported the time as 7:30 a.m. While patients did not typically arrive earlier than 9 a.m., today was different. Darlene, my petite thirty-five-year-old African American patient with hypertension and Type 2 diabetes mellitus, left a message the day before that she wanted to see me today...

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2. Health Care: Perspectives from the Street Level

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pp. 25-63

As I walked down South Broad Street in Philadelphia in August 2010, wide sidewalks steamy with heat, I felt light, sure, confident. I had an appointment with Tine Hansen-Turton, JD, chief executive officer of the National Nursing Centers Consortium (the Consortium for short), an organization of nurse-managed health centers serving vulnerable...

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3. Nurse, Are You a Doctor?

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pp. 64-85

Scrub the area, Marta barked at me. The area was a 2.5-centimeter laceration over the left eyebrow of a twenty-three-year-old male patient. He had been struck in several locations with a baseball bat in a gang fight at the intersection of Springfield Avenue and Irvine Turner Boulevard in Newark. Brought in by the police, he remained feisty even after...

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4. Protection of the Public or Creation of a Guild?

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pp. 86-120

Head down against the wind, a dark brown woolen scarf wrapped tightly around her neck, Irene Fallon marched confidently on the icy street toward Newark City Hospital in Newark on December 4, 1901. Set against the crisp, deep blue evening sky, the hospital was a formidable four-story red brick structure, first occupied in 1890. The bright golden...

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5. Context, Data, and Judgment: When is Enough, Enough?

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pp. 121-153

In early spring of 2001, on a beautiful day, an unusual tableau of individuals sat together in the New York City office of Ambassador Joseph Mutaboba, permanent representative of Rwanda to the United Nations. As members of a health mission team going to Rwanda in May 2001, my colleague Carolyn and I had questions...

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6. Barriers, Opportunities, and Militancy

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pp. 154-184

From my recliner chair facing the head of Miss Millie’s bed, I anticipated that her twenty-second apneic period would be followed by a pattern of crescendo-decrescendo alteration in tidal volume—Cheyne-Stokes breathing, a pattern of breathing often noted in those with severe cerebral brain injury. As her respiratory depth increased in each...

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pp. 185-192

Within the particular context of nursing practice, to lead is to be disruptive. The act of leading disrupts a status quo, invigorating context, welcoming change. When enacted by a marginalized group, leading disrupts. This relationship between leading and disrupting is not linear, but rather pan-dimensional and...


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pp. 193-200

About the Author

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pp. 201-222

Available Titles in Series

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pp. 203-224

E-ISBN-13: 9780813560540
E-ISBN-10: 0813560543
Print-ISBN-13: 9780813560533

Page Count: 224
Publication Year: 2013

Series Title: Critical Issues in Health and Medicine