Nursing Health Care

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Last week I asked Lucy, my 10 year old diabetic patient and a foster child, what she wanted to be when she grew up. No sooner were the words out of my mouth, than I realized I shouldn't have asked. Not like that.

Sure, by her age I knew I wanted to help sick people recover. But as a white, privileged science geek, there was only one word to embody my future self. "I want to be a doctor" was a sure win in the game of adult small talk. Now that I'm training at UCSF in what I wanted to do all along, though, I have other words for what I want to be: nurse and nurse practitioner. Perplexed acquaintances usually respond with questions, but never this one: "If the expansion of health insurance means greater access to health care, why aren't we talking about what nurses really do yet?"

Many of my patients proudly relate that their aunties or grandmothers were nurses too, and hope their children will follow suit. I notice they tend to be poorer, minorities from the Central Valley or Oakland. Such families, it turns out, have applauded nurses for generations. The same way mine has doctors.

You might say doctors and nurses do different things, but sometimes they don't. Nurse practitioners, for example, treat patients and prescribe medications under their own licenses. They may look and act like doctors. But their role has emerged from a profession relegated to the underclass, banished from the esteemed banter of more advantaged groups.

Last week, when Lucy replied impishly, "I don't know," to my regrettable question about what she'd be, I grinned. Having already been labeled 'foster kid,' maybe she'd had enough of being branded. "Smart," I recovered, "What do you like to do?"


It's time we started getting the questions right, and the answers. With the passage of health care reform there is an increasing need for primary care clinicians. Studies show nurse practitioners provide health care of equal quality as doctors. Nurses are already expertly treating many patients of different families, backgrounds and dreams. As a future nurse, that's what I get to do.

With a Perspective, I'm Loren Dobkin.