ANA President Questions Gideon's Crossing Portrayal of Nurse Practitioners

After receiving numerous complaints regarding the insensitive and misleading portrayal of the nurse practitioner profession on a recent episode of the ABC-TV series Gideon's Crossing, ANA President Mary Foley wrote to the show's producers to voice ANA's concerns.

December 5, 2000

Paul Attanasio, Katie Jacobs, Eric Overmyer
Executive Producers
Gideon's Crossing, Touchstone Television Productions
Gideon's Crossing Supp. Building
5300 Melrose, 3rd floor, Room 306
Hollywood, California 90038

Dear Mr. Attanasio, Ms. Jacobs and Mr. Overmyer:

I would like to commend you for your sensitive and moving portrayal of what can happen when health maintenance organizations (HMOs) are allowed to control the utilization process in medicine ("A Routine Case," Gideon's Crossing, Episode 104, Oct. 24, 2000). Because of the cost-cutting measures imposed by HMOs, decisions regarding access to care and treatment often are made by HMO boards rather than by health care professionals, who formerly made all patient care decisions. As a result, patients in HMOs are frequently denied access to specialists, as this episode concerning a misdiagnosed leukemia patient attempted to demonstrate.

However, the episode made some very misleading portrayals, including a comment regarding a nurse practitioner (NP) made by the program's leading character, Dr. Ben Gideon, during a law office deposition scene. The American Nurses Association (ANA) finds this passing comment and the misguided assumptions that led up to it slanderous to the nursing profession and misleading to viewers (see p. 52 of the episode's script).

While it may very well have been an oversight committed by this individual nurse practitioner that led to the misdiagnosis of asthma in this fictitious instance, the overall message implied by the scene is that patients who go to nurse practitioners are likely to be misdiagnosed by incompetent individuals who are used by HMOs to cut costs.

The other message implied by the law office scene, and the newspaper account that was read in the scene after it, was that the HMO itself was being sued, when in reality, under federal law, HMOs cannot be held legally accountable for harm caused by the denial, delay or poor quality of care. Typically what happens in such instances is that HMOs get state malpractice lawsuits moved to federal courts, where the most plaintiffs can recover is the cost of care denied them. Thus, the only real recourse patients have is in suing their health care practitioners and the facilities in which those practitioners work. That is why a strong patients' bill of rights -- with clear language that would allow patients the right to sue their HMOs -- is now being debated in Congress, and why similar patients' bill of rights legislation has been passed in many states.

What is missing in the script is a more accurate illustration of the common problem of patients in HMOs being denied access to specialists, and further being denied the right to an internal and external appeals process. Also missing is the portrayal of health care professionals, nurse practitioners included, operating in a "mother-may-I" environment under the HMO practice of requiring permission before implementing a medical decision, a practice that has undermined the sanctity of the relationship between patients and their health care providers.

While the portrayal of a patient in an HMO going to a nurse practitioner is indeed an accurate one, the underlying assumption that such patients will receive an inferior quality of care is not. It is true that nurse practitioners are utilized in increasing numbers by HMOs. Today, more than 50,000 nurse practitioners provide primary care services, and given unprecedented demand by HMOs and others, the number of nurse practitioners has increased more than 200 percent over a span of 10 years. Furthermore, in 49 states and the District of Columbia, nurse practitioners have the authority to write prescriptions for their patients.

Contrary to the callous and prejudiced portrayal of nursing incompetence portrayed by "A Routine Case," nurse practitioners are highly skilled, highly educated and highly attentive health care providers. Not only do advanced practice registered nurses (APRNs) perform as well as physicians, but research demonstrates that in terms of quality care, patient satisfaction and cost-effectiveness, nurse practitioners are among the best values in health care. For example, a 1993 study by the ANA compared physician care with nurse practitioner care. It found that nurses delivered primary health care as competently as physicians, and for a lot less money -- 40 percent less per visit, to be exact.

The ANA study also found that nurses spend more time with their patients than doctors, 24.5 minutes versus 16.5 minutes, respectively. The nurse practitioners provided more health promotion activities than physicians, such as patient education and the writing of prescriptions. The patients of the nurses were more satisfied with their health care provider, more likely to comply with their treatment programs, and more knowledgeable about their own health status.

In communities across the United States from Appalachia to Cambridge, Mass., and Phoenix, Ariz., nurse practitioners provide care in clinics and other community settings that helps reduce the number of emergency room visits and keep frail elderly in their homes. Moreover, the majority of nurse practitioners do not require physician supervision or review of either their practice or prescriptive authority. All APRNs work in collaboration with one or more physicians --they are colleagues and work in partnerships with one another.

The Clinton Administration and Congress have seen the merits of nurse practitioners providing primary care services. In fact, in 1998 a law was passed to allow direct Medicare reimbursement payments to all nurse practitioners and clinical nurse specialists in all geographic locations, thus creating greater access to health care for Medicare populations who are most in need of services.

Given the increased demand by consumers for access to information about health and health care, ANA would like to explore the possibility of developing an ongoing relationship with Gideon's Crossing to share the expertise of RNs with your viewers. For example, RNs in a variety of specialty areas deliver high-quality, health-care services to a range of patient populations. RNs practice where nursing care is needed, including hospitals, homes, schools, workplaces, and community centers, as well as at some uncommon sites, including children's camps, homeless shelters, and tourist areas.

Furthermore, RNs conduct research, serve in policy roles on such issues as managed care reform, and are competent administrators. In addition, APRNs provide care to a growing population of all ages. According to a 1993 Gallup survey, a vast majority of Americans (86 percent) are willing to receive everyday health care services from an APRN.

I have enclosed some background information about nurses for your information and look forward to discussing the opportunity to develop an ongoing working relationship. If you would like to discuss this further, please contact Cindy Price in ANA's Communications Department at (202) 651-7038.

Sincerely,

Mary Foley, MS, RN
President
American Nurses Association

# # #

The American Nurses Association is the only full-service professional organization representing the nation's 2.6 million Registered Nurses through its 54 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

2000 press releases

Other past press releases: 1999 | 1998 | 1997 | 1996

Search	Contact ANA	Join/Renew Membership	Members Only	Online CE
NursingInsiderSpecial Offersnursesbooks.org © 2008 The American Nurses Association, Inc. All Rights Reserved Copyright Policy | Privacy Statement