Ed itoria1 A Call for Action, The Challenge of Collaboration

The fact that the lead article in this issue highlights a psychiatrist may cause s m e nurses concern. In our early struggles to achieve separationlindiduation as a pmfession frm medicine, we turned from the physician as teacher. We had to overcome the fact that, at one time in our history, most all of our teachers were MDs. We were

deeply embroiled in the ”professionalizationof nursing’’in having nurses, not physicians,accountablefor the education of nurses. A noble and necessary goal, to be sure! However, we have long since proven our adequacy in this regard. We have achieved enough autonomy to value knowledgefor its own sake, even if it doesn’t come from ”oneof our own.” Valuing the contribution of a psychiatrist does not automatically s m e to devalue or negate the contribution of nurses. If so, we aren’t as individuated as we claim. Our independencedoes not require the devaluation or rejection of thosefrom whom we have separated. Rather, if we are to tackle the healthcare mess we’re in, we need to join forces with the psychiatristlphysician in order to empower the psychiatric profession as a whole. This is a good time to forge such a collaboration,for physicians are feeling increasingly beleaguered by outside forces that are eroding the autonomy they have so long enjoyed, but to which nurses have only aspired. Such loss of autonomy is the common “enemy”for both professions. We have never had a high degree of control of our practice because we have tended to practice in institutions where administrators, not nursing standards of practice, dictate what financial resources will be allocated for nursing personnel. On the other hand, while nurses are well-qualified to

function in a private practice setting in which they can achieve autonomy of practice,fm health insurers are willing to reimburse nurses for the smices they provide. The bottom line in our struggles within nursing has always Perspectivesin Psychiatric Care VOL28, NO.3, July-Sept,1992

been economics. Our practice is shaped by the financial resources allocated to us by institutions and health insurers. No wonder we sometimes feel like the underdog! Likewise, health care in this county is not shaped by the health needs of consumers, but by the policies of co&mte entities and government bureaucrats who decide which health smices will be paid for and which will not. Such policy decisions have begot a healthcnre system that denies reimbursementfor preventive health care such as breast exams, but will provide liberal reimbursementfor a radical mastectomy. Something is drastically wrong with a system that denies reimbursementfor mental health nursing services provided in areas where psychiatrists flourish, but one which reimburses nurses in geographical areas where the psychiatrist does not wish to practice. We must deal with a system that has emptied out state hospitals,flooding the streets and prisons with the mmtally ill in order to protect clients from the negative effects of institutionalization. A system that points with great pride to the fact that these lucky individuals have been spared the ravages of such a fate. No, in terms of hedfh are we have not become a ”kinderand gentler nation.” We, in fact, seem to be heartless. The real tragedy is that we havefailed to use the resources at hand in our master’s and doctorally prepared nurses to expand the provision of mental health sentices in a costqective manner. It was due to the vision ofJohn E Kaznedy that nurses in the ’60s were helped to obtain

advanced education so that needed mental health pmfessionals would stand ready to tackle the enormity of healthcare needs projected for the ’90s.In particular, stipends were made available to encourage and support nurses to seek a master’s akgree in psychiatrik/mentulhealth nursiqq. The government paid my full tuition and allocated $350 a month for me to live on while I pursued my master‘s 3

Editorial

degree in mental health nursing. More support was forthcoming from NIMH for my doctoral research on misguided entitlement, as 1 pursued my PhD in nursing. Finally, the long years of study culminated in a well-educated, clinically experienced PhD mental health nurse. Oh, but here’s the rub! Blue CrosslBlue Shield of Kansas won’t reimburse my services. Why? Because 1am a nurse. What if health care were not viewed as synonymous with medical care? What if the central value in our healthcare system was to promote wellness and prevent illness? And what if nurses were paid to do so? Would this philosophy be too great a threat to the industry that generates billions of dollars from people being sick, rather than well? Certainly some would have us believe that to reimburse nurses for promoting wellness and preventing illness would bring our nation to the brink of economic collapse. Nurses and doctors are in the same boat. Other people are making decisions-bad decisions-abou t the provision and reimbursement of healthcare services. These decisions, not professional judgment, are dictating healthcare policy. If it is bad for nurses to lack autonomy of practice, it is bad for the physician as well. We need to join forces, and resources, to do battle with our insane and inhumane healthcare system.

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Perspectives in Psychiatric Care VoL 28,No.3, July-Sept,1992

A call for action, the challenge of collaboration.

Ed itoria1 A Call for Action, The Challenge of Collaboration The fact that the lead article in this issue highlights a psychiatrist may cause s m e n...
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