Group From Clinic Wants Nurse Practitioner Referrals
By Erin Nicholes, The Montana Standard, Butte
Oct. 14–A dozen people picketed St. James Healthcare Thursday out of frustration over rules that restrict nurse practitioners at the Butte hospital.
The group wants St. James to allow nurse practitioners to order diagnostic imaging, such as MRIs, without a doctor’s supervision.
“The doors of your hospital are where I go for treatment,” protester Brian Devon said. “I don’t need to know the politics.” The group’s members — wielding signs saying “we deserve patient care”– are patients of Gold Street Clinic. The clinic is run by nurse practitioners Shari Healy and Vicki Thuesen.
The patients organized after Dr. Jesse Cole, chairman of St. James’ radiology and pathology section, wrote a letter to Gold Street on Oct. 5 stating that he would not accept referrals for imaging other than routine X-rays made without physician supervision.
“I do not believe that a nurse practitioner … has the training, education or experience to independently act on my consults,” Cole said. “Why wouldn’t you want to have a doctor involved in some of this stuff?” But Healy pointed out Montana law allows nurse practitioners to work independently of doctors.
Nurse practitioners hold master’s degrees in nursing and certification by national and state nursing boards. They can examine, diagnose and treat patients and write prescriptions.
“Legally we shouldn’t have to have physicians sign anything for us,” said Healy, who did not picket but said she appreciated her patients’ support.
Despite the law, the hospital’s doctor-written rules require nurse practitioners to have physician sponsorship to admit patients and order imaging, said James Kiser, chief operating officer.
“It has always existed in the medical staff by-laws that a non-physician has to have a sponsoring physician,” he said, adding that many nurse practitioners in Butte do business at the hospital under physician sponsors.
Butte’s three radiologists, including Cole, work together at St. James and will follow the by-laws, meant to protect the hospital from liability, he said.
But nursing advocates and patients chafe at the rules.
“Statute clearly states what a nurse practitioner is and what they can do,” said Eve Franklin, president of the Montana Nursing Association. “I have never seen this degree of self-righteousness and blatant ignorance.” And patients say they’re caught in a power struggle.
“This hospital is dictating who these people’s health care provider is going to be,” said picketer Fred Boyer.
“Patient care isn’t what’s coming first; I think it’s corporate greed and politics,” certified nurse midwife Cindy Kaiser said.
But quality of patients’ care, Cole said, is the heart of the issue.
“They can be assured when they come in and have a physician treating them, or seeing them … they are achieving a higher standard and quality of care by having physician involvement,” he said.
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