The Door of Last Resort: Memoirs of a Nurse Practitioner

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

86 Protection of the Public or Creation of a Guild? Chapter 4 Helmets down, lancets up! According to a colleague, here is an apt motto for nursing, complete with medieval associations. Experiences with boards of nursing hardened me to nursing’s own brand of inquisition. A national model—termed LACE (Licensure, Accreditation, Credentialing, and Education)—emerged in 2008 in an effort to unify and standardize requirements for nurse practitioner practice across states. Despite the emergence of this model, however, self-oppression continues, just as social philosopher Michel Foucault hypothesized. Unique forms of discipline include special rules by boards of nursing, aimed at compliance or subsequent punishment, to dictate clinical education ratios of faculty to students, circumscribe curricula, specify faculty requirements, and define program resources with no regard to institutional context. Even as nursing ’s so-called bone and sinew, the registered nurse, practices under a single license that denies scope of practice based on educational levels , nurse administrators with advanced education remorselessly advocate for diploma-prepared nursing workforces. Here is a nightmare in which workforce needs trump the value of education and the future of the individual.Yet even as nursing’s subtle mistrust of its own plays out in mandates, individuals move hopefully forward, championing special causes. My experiences with school-based wellness centers illustrate such advocacy.Anticipating correctly the Supreme Court’s 2012 endorsement of the Patient Protection and Affordable Care Act, my Philadelphia nursing colleagues established nurse practitioner school-based clinics at two charter schools in 2010–2011. With nurse practitioners in place, Protection of the Public or Creation of a Guild? 87 the absenteeism rate plummeted at the end of year one, heralding the value of the effort and forecasting success of some components of the health care reform law. Hardiness is necessary but not sufficient to buffet nursing’s own culture; resilience coupled with hopefulness for future change is also required.The story of Joe at Mary Howard Health Center highlights this resilience. One patient–one provider haughtiness takes time to cultivate. * 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 bells hanging from the large pine Christmas wreath on the main hospital door jingled loudly as Irene entered the building. A young graduate of the Cooper Hospital Training School for Nurses in Camden, Irene walked briskly to the nurses’ quarters. Nurses had gathered in the large, impeccably clean and scantily furnished main hall, seated comfortably around a large spruce tree, decorated with strings of popcorn and homemade ornaments. Excitement and anticipation were in the air. The nurses’ goal, as noted in the minutes of that meeting: to organize the New Jersey State Nurses Association for the purpose of securing legislation that would lead to the betterment of the nursing profession. Efforts of this New Jersey group were watched vigilantly by members of the Nurses Associated Alumnae of the United States and Canada, created in 1897 with three goals, as documented by Susan Reverby in Annual Conventions, 1893–1899: The American Society of Superintendents of Training Schools for Nurses (1985): to establish and maintain a code of ethics , to elevate the standard of nursing education, and to promote the usefulness , honor, and the financial and other interests of nursing. Like its colleague organization, the American Society of Superintendents of Training Schools for Nurses, the alumnae association germinated in the period surrounding the 1893 Chicago World’s Fair, a period when teachers, engineers, and others crafted professional identities through organizational structure and shared goals. The date marked the entrance of the United States as a leader within the international community. By the end of that December evening, Irene had been elected president of the new state organization by its 112 charter members. Her first charge as president was to secure state registration of nurses, an action considered tantamount 88 The Door of Last Resort to self-preservation, eliminating unqualified quacks from practicing the profession . Lobbying tenaciously, Irene and her fellow officers of the NJSNA secured friends in the legislature, galvanizing positive votes for the Nursing Practice law. In April 1903, the act to license graduate nurses was signed into law by Republican governor Franklin Murphy...