people who are not RNs,” says Dixie Brown, executive director of TNA’s disa patient has the right to expect any hospital “graduate nurse” or “staff nurse” to have proved his or her qualifications to the state, just as patients assume staff doctors have done so through the Texas Board of Medical Examiners’ license process. But requiring Texas licensure would nearly wipe out the nursing staffs of some hospitals. Take Harris Hospital in Fort Worth, which is heavily staffed with British nurses regularly recruited on one-or two-year contracts. Dorothy Haskins, director of nurses there, says “I don’t know how we could have offered care to our patients without these nurses. We just couldn’t get American nurses to work evenings and nights. Sure, the pay scale has something to do with it, but remember that the hours are not too entrancing to many, especially when you consider that most nurses are young women with families and the shifts are 2:30 p.m. to 11 p.m. and 10:30 p.m. to 7 a.m.” Claire Jordan, assistant director of practice at TNA, doesn’t believe unlicensed nursing care is better than no care at all. “It’s deceptive packaging,” she says. “People are falsely given the impression that they are getting professional nursing and, by the way, that’s what they’re charged for. We are not against foreign nurses coming in if they can pass minimum standards to practice. What we are addressing are those who come in and are not encouraged to take the exams or those who continue to fail their boards as many as 18 times but continue to work.” Existing regulations concerning minimum RN coverage in hospitals are not set by the nursing profession, but chiefly by the voluntary agency which accredits hospitals \(the Joint Commission on the Accreditation of Hospitals, representing physicians and hospital ment. Title 18 of the 1965 Social Security Act required hospitals receiving Medicare payments to offer 24-hour RN coverage, though this requirement is waived for some 25 isolated rural hospitals in Texas which must have an RN on hand for only one daytime shift. But according to U.S. Bureau of Health Insurance attorney Jerome Papke, who is charged with enforcing Medicare standards, the pressure to retain Medicare certification and the derivable incomeparticularly at a hospital that may very well be the major em ployer in its communityis so intense that hospital personnel have been known to falsify staffing pattern reports. A nurse at Mauritz Memorial Hospital in Ganado was convicted of making false statements to defraud Medicare two years ago. She stayed on as director of nursing, nevertheless. So it is understandable that one of the most controversial parts of the proposed Professional Nursing Practice Act \(to be introduced in the Texas House this year by Democrats Ben Grant of Marshall and pears in working draft, is that portion which would require licensing of all nurses. 0. Ray Hurst, president of the Texas Hospital Association believes elimination of the present exemptions would not only lead to a significant boost in hospital costs but also jeopardize the job status of doctor-trained office workers who are neither RNs nor licensed vocational nurses. Ace Pickens, legal counsel for the Texas Medical Association, says the TMA has the same concern. But, counters Dixie Brown, “We’re not telling doctors whom they can hire or what their office personnel can do. That would violate the Constitution of the United States. We’re just saying they shouldn’t pass them off as `licensed nurses’ if that’s not what they are.” Hurst’s refrain is the same as that of the Texas doctors and hospital administrators he lobbies for, namely the “overeducation” of the college-trained nurse who, it is alleged, is not as attuned to the care of the sick as the old hospitaltrained nurse was. “Campusology hasn’t replaced the laying on of hands,” says Hurst. “I think this was one of the reasons for the furor at UT because some of the regents felt the curriculum should be more clinical.” To wit: last March, The University of Texas regents moved to dissolve the UT to subordinate the six existing schools to the individual university health centers at Austin, El Paso, Houston, San Antonio, Arlington, and Galveston \(Obs., troversy set off by the regents’ decision seem to agree that these three questions were at issue: 1.Should the role of the nurse be limited to the hospital care of sick patients? 2.Is a nurse’s ultimate responsibility to patients or physicians? 3.Who should control nursing educationand thereby the profession? To the oldtime physicians accustomed to deference from hospital underlings, the nurse who questions orders is insolent and insubordinate. “If she wanted to be a doctor,” defensive doctors usually ask friends, “why didn’t she go to medical school?” Equal partners Doctors and administrators may yearn for the good gone days of hospital nursing schools, but hospital-based training is being phased out and replaced with baccalaureate and two-year associate degree programs. Today’s nurse usually looks back with distaste to an era when, she believes, nurses were “indentured” to hospitals and given little opportunity and reason to think. Luci Johnson Nugent, who chaired the UTSSN’s development board, told the regents last spring that by scrapping UTSSN they would be ignoring “the February 11, 1977 21 “To the oldtime physicians accustomed to deference from hospital underlings, the nurse who questions orders is insolent and insubordinate”
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