I suggest Gloria Gilbert Mayer consult nursing history before she urges other nurses to do so or charges nursing with failing to "take a leadership role" in bringing about needed change in healthcare (May 1, p. 38). Her miscast reference to nursing as a "medical" rather than a healthcare profession is only one example of the misunderstanding and misinformation that riddles her comments.
By saying that nursing has "historically narrowed its scope of practice," she suggests medicine has expanded its own through hospitals' use of 24-hour staff physicians who are "dealing with many patient problems that nurses once handled." Is she not aware of the many hospitals that are expanding nursing by employing advanced nurse practitioners to perform many duties once handled by medical residents? Has she forgotten the other ways advanced practice nurses have expanded nursing beyond the hospital to outpatient and home care, HMOs, clinics, schools and other community settings? If anything has narrowed registerd nurses' scope of practice, it is not nursing but the antiquated and unnecessary legal and regulatory restrictions that limit nursing's ability to practice at its full capacity.
Integrated systems hold promise as effective, cost-efficient models for patient care. But they are not solely the product of individual nurses, but of policies, conferences, publications and organized nursing advocacy that have helped to put these emerging systems in the forefront of everyday practice.
Instead of writing revisionist history that cites organized nursing as "whining" about the status quo, Mayer would do better to openly acknowledge the innovative and positive changes in healthcare delivery that nursing organizations have been pressing for, developing and instituting for years.
RACHEL Z. BOOTH
American Association of Colleges of Nursing