Professor Frances Ward

I'm a registered dietitian and professor of nutrition at a very large university. Through the years, I've met student nurses, LPNs, RNs with a diploma, RNs with a Bachelor's degree, nurse midwives, nurse practitioners, and individuals with a Doctor of Nursing Practice (DNP) or a PhD in Nursing (or another discipline but maintain their licensure and registration as a nurse). The word "nurse" refers to all of the above, plus more I haven't listed, and that has led to a lot of in-fighting in the profession. Toss in certified nurse's aides, who sometimes call themselves nurses too, and you have the makings of a toxic environment within the discipline. That might surprise people, whose paradigm of nursing invokes Florence Nightingale and the Red Cross, but Nursing tends to be very territorial and hyper vigilant about their place in health care. Dr. Ward notes this too -- although it seemed she did so without a second thought, as a nurse -- when she documents that Nursing is different from, but not subservient to, Medicine. Nursing has volumes of theories and a lexicon that nurses cling to to underpin their approach to health care. But all along, a doctor's "orders" are what must be done. There's some seething in the health care hierarchy.

Dr. Ward records her experiences -- including obstacles constructed by fellow nurses -- as a nurse, a professor, a nurse practitioner, and an academic administrator. She has captured perfectly the jealousies within nursing and with physician assistants (PA-C) as she led the charge to legislate the primary care scope of practice, including diagnosing and prescription-writing, for nurse practitioners and physician assistants in New Jersey.

As I figured she would, Dr. Ward faced strong opposition from physicians and nurses who weren't nurse practitioners. She had to swallow her pride (commendable) and partner with physician assistants, who were seeking similar additions to their scope of practice. She knew they would either get an extension of their licensure together or neither discipline would get legislation passed at all. She soon found herself defending physician assistants and serving as their advocate, which she acknowledges was novel for a nurse to do.

Dr. Ward's autobiography, focusing on her professional successes and occasional shortcomings, is interesting to read, even for those of us who are not nurses. Primary care affects all of us, but states differ in how nurse practitioners and physician assistants can legally practice. Reading this book might make you an advocate for non-physician primary-care providers, despite doubts that continue to be voiced about the capabilities of those who don't put MD after their name. (Osteopaths [DO] are full-fledged physicians too, but, in my experience and speaking very broadly, they often are more collaborative in providing health care than SOME -- I'm not implying all -- MDs who consider both DOs and nurse practitioners to have a weaker education.) Nowadays, this attitude is increasingly seen among physicians when nurses who have a doctorate (PhD, DNP, DrPH [Doctor of Public Health]) refer to themselves as Dr. ______ in the health care setting. That upsets the medical hierarchy, but it's fun to watch.… (més)