Nurse practitioners can ease physician shortage
To the editor:
In response to your Wednesday article, “LV health care ailing,” which addressed Nevada’s physician shortage:
Throughout the country, advanced-practice nurses such as nurse practitioners have been recognized as a valuable resource to address the health care needs of our citizens. Nevada has been slow to recognize this potential workforce.
The statistics regarding the state of health care in Nevada are stark: There is an acute shortage of physicians in Nevada. A 2009 study from the University of Nevada School of Medicine found Nevada ranked 48th among states in doctors per patient. Nevada has 190 practicing doctors per 100,000 people. Nevada would need an additional 262 practicing physicians per 100,000 residents to post an average doctor-patient ratio. That’s an extra 5,240 new doctors.
The needs are high, and the workforce to address those needs is very small. Advanced-practice nurses can certainly help to ameliorate this situation, particularly in primary care and mental health services. Advanced-practice nurses are trained not only to diagnose and treat illnesses within their scope of practice, but also in managing and negotiating health care delivery systems. They are trained in research and evidence-based practice, skills that will be instrumental in the new model of care delivery under the Patient Protection and Affordable Care Act.
Additionally, advanced-practice nurses are more likely to work for underserved populations. In this regard, Nevada’s rural population and chronically mentally ill would be well-served by advanced-practice nurses.
Tapping into the potential of the advanced-practice nursing workforce will require examination of the current nurse practice acts that govern and in some instances limit the scope of their practice. In some states, including Nevada, advanced-practice nurses are limited and often provide care below the level of training they have received. In addition, physicians are currently charged with considerable managerial and clinical oversight and responsibility for advanced-practice nurses under Nevada’s practice act.
Yet Nevada’s current practice act can be a disincentive to physicians to collaborate with advanced-practice nurses. Substantive changes in the act could promote more collaboration. Particularly in psychiatry, changes to the nurse practice act are needed to allow more independent practice by advanced-practice nurses to address the anticipated increase in citizens seeking mental health care. Rural states such as Montana and Arizona have more expansive scopes of practice for advanced-practice nurses, which have served them well in the absence of sufficient physicians.
Advanced-practice nurses have been delivering comprehensive services that are largely comparable to those provided by physicians both in scope and medical outcomes. With the coming of massive changes in the way care is managed and delivered, the role of advanced-practice nurses in Nevada, particularly in mental health, should be reconsidered.
Mark A. Ackerman
Las Vegas
The writer is an assistant professor of mental health and psychiatry at Touro University.
Defending women
To the editor:
Regarding your Tuesday editorial on Nevada Rep. Shelley Berkley, “So much for the high road”:
I for one was glad Rep. Berkley called for conservative radio icon Rush Limbaugh’s firing over his hateful slurs against college student Sandra Fluke and his bizarre demand that he be able to watch her have sex on video.
Rep. Berkley’s criticism of her campaign rival, Republican Sen. Dean Heller, was also justified, given his vote for the Blunt amendment, which attempted to give employers the right to deny medical coverage for contraception.
If Sen. Heller doesn’t want to be lumped in with fellow conservative Rush Limbaugh, he should stop voting in ways that disregard and disrespect the rights of women.
Bart Atwell
Las Vegas
War is hell
To the editor:
In response to the reports about a U.S. soldier accused of killing Afghan civilians:
What are our so-called leaders thinking when they continue to send our troops into a war zone two to five times? I spent one year in Vietnam and still remember that time vividly — it was 43 years ago. I can’t fathom the possibility of going back into Vietnam two to five times, considering how much one tour stayed with me.
It is no wonder our brave troops are becoming disconnected from a normal life back home when they keep getting sent back multiple times to a country that doesn’t want us there or appreciate our help. I can’t imagine the mental stress those folks are going through.
Bring back the draft so everyone can participate in “winning the hearts and minds” of these people or get the hell out. Maybe then our troops won’t have to return multiple times to this sand pit.
If we don’t get fully in or get out, you will see more rogue soldiers venting their stress by killing all those they consider the source of their stress. All who are so quick to go to war should either participate or send their siblings in their place.
Ray McCann
Las Vegas
Protecting elections
To the editor:
It is a well-known fact that voter fraud occurs in every election. It is also a fact that some states have passed laws requiring everyone who wants to vote to have a legal voter ID card, similar to the one they use to buy many things. These legal ID cards are readily available and easy to obtain. If you want to vote, it is your duty to get the proper ID cards.
These laws should be upheld in order to minimize, or stop, people who are not entitled to vote, from voting. How in the world can you be against this? Instead of fighting to make such laws illegal, wouldn’t it be better to make sure that everyone in your group, town, or village actually obtained the proper ID?
But the Obama administration’s Justice Department is taking steps to prevent states from enacting new voter ID laws. Why? Does the Department of Justice intend to let anyone and everyone in our country, legal or illegal, vote? That’s what it looks like.
And the ACLU has a contingent in Geneva, at the United Nations, to discuss our voter ID laws! Who gave them the right to speak for me? On whose authority did they go?
Better wake up, American voters, before our republic is taken away from us. Inaction equals approval, at least for this bunch that governs us.
B. Wilderman
Las Vegas
