Nurses Step to the Front
In hamlets and high-tech hospitals, nurses are taking on bigger roles
Over time, as the hours and roles of medical residents and interns changed, many nurses with master's degrees who specialized in fields such as pediatrics were called upon to perform tasks once reserved only for the med-school set. Rowell, a pediatric nurse practitioner, remembers hearing of her colleagues in infant intensive-care units being allowed to insert breathing tubes down the throats of delicate babies. "It was an incredible thing," she says. These trends are continuing today as residents' exhausting schedules are further cut back--for reasons of patient safety.
As nurses are asked to do more, they are also trained to do more. In 1980, 60 percent of nurses received their basic education through on-the-job training courses in hospitals. That number was cut in half by 2000. During that same time, the share of nurses earning associate's degrees more than doubled, to 40 percent. The number of nurses pursuing master's degrees and doctorates has tripled over the past two decades--by 2000, one in 10 registered nurses had made the leap. And the number of doctoral programs nationwide has grown from 52 in 1990 to 93 today. By 2015, the American Association of Colleges of Nursing wants all nurses doing advanced practice work that now requires at least a master's degree--this includes nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists--to hold a doctorate of nursing practice.
Nurses already have rigorous training. Most undergraduate nursing schools require students to take a variety of courses, from statistics to biology, before they can even enter the nursing program. Once in a program, students' classes include anatomy and ethics, and they must complete several practicums. After earning an undergrad degree, every student must pass a nationally standardized test before officially becoming a nurse.
Rules governing what nurses are allowed to do with this training vary by state. "You sometimes push for 15 years, so hard, just to take one baby step," says Marie-Annette Brown, a nursing professor at the University of Washington who helped lobby to give nurses in her state more power to prescribe medication. Before such efforts, nurses could not prescribe controlled substances like morphine without doctors' supervision. That's still the case, though, in 37 states that demand a doctor's sign-off. But 27 states allow nurses to open their own private practices without a doctor in the house. Many nurses still have trouble, however, persuading insurance companies to reimburse them for their work.
Whole-patient care. But more than the ability to prescribe drugs, nurses are pushing to practice a breed of care that bears their unique imprint. "More so than doctors, we focus on health promotion, the strategy of teaching our patients how to live healthier lives," Brown explains. This means helping patients manage their symptoms and chronic conditions and avoid health pitfalls like poor diets. "If I have a child with diabetes, I try to teach him to self-regulate his condition," says Rowell. "But I also tell him to . . . engage in after-school activities; don't be afraid to live a normal life."
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