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The Door of Last Resort

The Door of Last Resort: Memoirs of a Nurse Practitioner

Frances Ward
Copyright Date: 2013
Published by: Rutgers University Press
Pages: 224
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  • Book Info
    The Door of Last Resort
    Book Description:

    Having spent decades in urban clinical practice while working simultaneously as an academic administrator, teacher, and writer, Frances Ward is especially well equipped to analyze the American health care system. In this memoir, she explores the practice of nurse practitioners through her experiences in Newark and Camden, New Jersey, and in north Philadelphia.Ward views nurse practitioners as important providers of primary health care (including the prevention of and attention to the root causes of ill health) in independent practice and as equal members of professional teams of physicians, registered nurses, and other health care personnel. She describes the education of nurse practitioners, their scope of practice, their abilities to prescribe medications and diagnostic tests, and their overall management of patients' acute and chronic illnesses. Also explored are the battles that nurse practitioners have waged to win the right to practice-battles with physicians, health insurance companies, and even other nurses.The Door of Last Resort, though informed by Ward's experiences, is not a traditional memoir. Rather, it explores issues in primary health care delivery to poor, urban populations from the perspective of nurse practitioners and is intended to be their voice. In doing so, it investigates the factors affecting health care delivery in the United States that have remained obscure throughout the current national debate

    eISBN: 978-0-8135-6054-0
    Subjects: History, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xx)
  4. Chapter 1 Bread Is Not Sugar
    (pp. 1-24)

    I arrived early at the health center. The large plastic clock with the drug name Protonix written in yellow and blue across its face reported the time as 7:30 a.m. While patients did not typically arrive earlier than 9 a.m., today was different. Darlene, my petite thirty-five-year-old African American patient with hypertension and Type 2 diabetes mellitus, left a message the day before that she wanted to see me today. Her phone message was tremulous, halting, and almost fearful in tone. She would come over to see me in the morning right after her shift at work. Sorting bed linens...

  5. Chapter 2 Health Care: Perspectives from the Street Level
    (pp. 25-63)

    As I walked down South Broad Street in Philadelphia in August 2010, wide sidewalks steamy with heat, I felt light, sure, confident. I had an appointment with Tine Hansen-Turton, JD, chief executive officer of the National Nursing Centers Consortium (the Consortium for short), an organization of nurse-managed health centers serving vulnerable people across the country. The Consortium, headquartered in Philadelphia, is housed on the eighteenth floor of the Atlantic Building at 260 South Broad Street, just two blocks from City Hall. (A neighboring historic building—the Bellevue-Stratford, built in 1904—houses the Independence Foundation, a private, not-for-profit philanthropic organization also...

  6. Chapter 3 Nurse, Are You a Doctor?
    (pp. 64-85)

    Scrub the area, Marta barked at me. The area was a 2.5-centimeter laceration over the left eyebrow of a twenty-three-year-old male patient. He had been struck in several locations with a baseball bat in a gang fight at the intersection of Springfield Avenue and Irvine Turner Boulevard in Newark. Brought in by the police, he remained feisty even after sedation. On the outside corner of his right eye, he had a tattoo of a teardrop, a symbol, he told me, that he had scored one for his gang in the recent past—his present street battle a retaliation fight for...

  7. Chapter 4 Protection of the Public or Creation of a Guild?
    (pp. 86-120)

    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...

  8. Chapter 5 Context, Data, and Judgment: When Is Enough, Enough?
    (pp. 121-153)

    In early spring of 2001, on a beautiful day, an unusual tableau of individuals sat together in the New York City office of Ambassador Joseph Mutaboba, permanent representative of Rwanda to the United Nations. As members of a health mission team going to Rwanda in May 2001, my colleague Carolyn and I had questions about licensure and regulation of nursing practice in that country. Would we be allowed to provide primary care in Rwanda? Should we carry with us any documentation authorizing us to provide health care in Rwanda, given that we had not been educated or licensed in that...

  9. Chapter 6 Barriers, Opportunities, and Militancy
    (pp. 154-184)

    From my recliner chair facing the head of Miss Millie’s bed, I anticipated that her twenty-second apneic period would be followed by a pattern of crescendo-decrescendo alteration in tidal volume—Cheyne-Stokes breathing, a pattern of breathing often noted in those with severe cerebral brain injury. As her respiratory depth increased in each cycle, her neck muscles contracted, pulling her head to the left with such force that her mattress shook. For nine hours, my husband and I waited for Miss Millie’s pain to ease, pain associated with a large sacral decubitus ulcer, pneumonia, depression, and the sheer exhaustion of breathing...

  10. Epilogue
    (pp. 185-192)

    Within the particular context of nursing practice, to lead is to be disruptive. The act of leading disrupts a status quo, invigorating context, welcoming change. When enacted by a marginalized group, leading disrupts. This relationship between leading and disrupting is not linear, but rather pan-dimensional and perhaps best symbolized by the mathematical operator: ↔. The symbol, however, is context specific.

    Memoirs, and the narratives contained in them, are like that as well. Ben Yagoda, who has written a fine book about the history of the memoir, tells his readers that the genre is to be understood as a factual account...

  11. Index
    (pp. 193-200)
  12. Back Matter
    (pp. 201-204)