| Summary: |
Uninsured and underinsured urban residents receive primary care in
starkly contrasting health facilities—from
expensive, state-of-the-art
hospital emergency departments staffed by hospitalists to neighborhood
health centers staffed by nurses. In the latter, nurse practitioners
use basic diagnostic tools to offer primary care services. The focus is on
patient context. Here, I take my stand. Through narratives of my experiences
as an adult nurse practitioner in both an urban emergency department
and in rudimentary nurse-managed urban health centers, I give
voice to the scope of practice of a nurse practitioner. Such stories reveal
how nurse practitioners think. Beyond cognition, the stories help me
describe the intricate network of relationships that exist among providers
in various community-based organizations. This web of relationships
sustains the financially fragile yet critically needed safety net that binds
us together in the service of a common humanity. The stories offered
in chapter 1 establish questions that will be explored further in other
chapters: Who owns the language of health care? Is health care patient
centered or provider centered? And, with their focus on the patient’s context,
just how disruptive are nurse practitioners in a health care system
that reimburses for the singular cost of illness?
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