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I am writing to express my surprise and dismay at the front-page story titled "APA Opposes Expansion of Nurse Prescribing Privileges" in the January 16 issue. How ironic it is that just over a year ago one of my colleagues, who was then president of the American Psychiatric Nurses Association, was invited by the president of the American Psychiatric Association to write a guest editorial for the president's column describing the need for and value of enhanced collaboration between psychiatrists and psychiatric nurses.
As indicated by this most recent article, however, it is clear that to physicians "collaboration" with nurses really means "supervision" and that physician respect for the autonomy of nursing is espoused only if and when it does not affect physician income. As the article notes, physicians are objecting to nurses with prescriptive authority taking care of patients in managed care plans and other forms of medical insurance, but they have not been known to object to nurses with prescriptive authority taking care of indigent patients.
I am sorry to note that this article documents yet another example of how health care is being driven by economics under the thinly veiled guise of concern for patients.
What this cover story really reveals is the high level of anxiety psychiatrists have when confronted with the fact that master's-prepared psychiatric clinical nurse specialists with prescriptive authority provide high-quality and cost-effective care to patients and families. This fact can be attacked, distorted, or misrepresented, but such tactics do not make it any less true-as quietly but consistently confirmed each day by patients and families across the country. Indeed, it appears that psychiatrists "doth protest too much," and their time and energy might be better directed to examining the quality and cost-effectiveness of the care they deliver rather than attacking nurses. Which leads me to conclude with this observation: perhaps the medical order of the day should be "Physician, heal thyself."
Gail W. Stuart, Ph.D., R.N.M
Past President
American Psychiatric Nurses Association