Nurses Step to the Front
In hamlets and high-tech hospitals, nurses are taking on bigger roles
Looking at the whole patient is critical for oncology nurse Ann Welsh. As a senior nurse in the chemotherapy division at the University of Pittsburgh Medical Center's Hillman Cancer Center, she is doing more than she could have imagined when she graduated with an associate's degree in nursing from Northern Virginia's Marymount University in 1973. At that point, she was given a little white nurse's cap and went to work on the National Cancer Institute's pediatric ward. "Early on, I was the liaison between the doctor and the patient," she explains. But through the 1980s, as more cancer treatment moved to an outpatient basis, her responsibilities grew to coordinating most aspects of her patients' therapy regimen. With her understated manner, Welsh, 51, gently administers chemo to hundreds of patients. Though she closely collaborates with Hillman's oncologists, there's nary a doctor in sight while she sets up complicated webs of intravenous drips for folks like Mario Urlini, a hearty 83-year-old who's getting his last treatment for non-Hodgkin's lymphoma. While Welsh connects the clear tubes, Urlini's wife, Grace, looks on and says: "I went through two major operations, and I never found a nurse like Ann."
Welsh also trouble-shoots problems with patients, such as sorting out whether an older man with worrisomely low blood counts can undergo needed cataract surgery. Patients call Welsh, not their physicians, with day-to-day concerns. "I know them inside and out, so I can assess if there is a big change," she says. "We can take better care of our patients if we use our own judgment, provided we know them and fully understand the course of their disease." As for that nurse's cap? "I wore it for a few months," says Welsh. Then she threw it out.
Balancing act. The ability of nurses to balance complex elements of long-term care while acting as counselors has made them a good fit as case managers. They work as the primary contact for patients, like the elderly, who have complex treatment plans. They can help eliminate frustrating redundancies among various doctors' offices and keep a constant record of detailed medical regimens. In San Francisco, gerontology expert and nurse Monika Pettross started her own case-manager business four years ago. One year into the venture, she began working with an elderly woman whose family found a suicide note in her home. Pettross, 32, discovered that some of the patient's medications could badly interact and lead to depression. After suggesting changes to the woman's prescriptions, she helped place her in a therapy program and counseled the family on how best to offer support. After two months, the woman was looking for a part-time job. Pettross still works with her today. "This work is so important I can't take off a badge in my free time and walk away from it," says Pettross.
Pettross is on to something. As people live longer and the nation's 78 million baby boomers approach retirement, more nurses are taking on elder care. The federal National Institute of Nursing Research is devoting millions of research dollars to the topic. One project explored the effect of delivering education and follow-up care at home to older patients hospitalized for heart trouble, says institute director Patricia Grady. Home delivery decreased the number of visits to the hospital, saving $4,845 in Medicare expenses per patient.
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