Private-Practice Nurses

Like many nurses, Lucille Kinlein, 51, considered hospital work restrictive. Frustrated by lack of authority, she felt that a nurse functioned as a mere tool of the physician. Unlike most nurses, she decided to do something about it. In May 1971, she rented an office in suburban College Park, Md., and hung out her shingle as one of the nation's first independent nurse-practitioners.

Nurse Kinlein's practice is more limited than a doctor's. Because she is not a physician, she will not diagnose major illnesses or prescribe medication; nor does she read X rays or set fractures. But she can still bring the benefits of her training to those who visit her comfortable, informally furnished office, where she treats minor injuries, teaches patients to care for themselves, and helps them to decide when they should see a doctor. "I'm not focusing on disease, but rather on the person and his perspective of his own health," she explains. "I'm an extension of the client, not the doctor."

Other nurses are following in her footsteps. Complaining that hospital routines leave them too little time to minister to any but the patient's most immediate needs, they are turning in increasing numbers to private practice, offering their services directly to the public.

Though both tradition and regulations prevent nurses from performing many of the functions of physicians, the nurse-practitioners find plenty to do. Charles Koltz Jr., 29, a mustachioed male nurse, who together with another male and two female nurses recently opened an office in Bay Shore, N.Y., changes dressings and treats wounds, gives injections and teaches patients to inject themselves. He also draws blood, instructs diabetics and heart patients in proper dietary practices and provides post-operative care. Juanita Woods, 37, a Greenville, S.C., psychiatric nurse, offers even more specialized services. She works with a minister and a social worker to provide psychological counseling to patients who might not otherwise see psychiatrists or psychologists.

Cutting Costs. Many of the patients are elderly or chronically ill; without the independent nurse-practitioner they periodically would have to check into hospitals or visit doctors for treatment. Patients in rural areas or inner-city ghettos, who tend to be suspicious of doctors or hospitals, often find it easier to discuss their problems with the private-practice nurses.

Most independent nurse-practitioners continue to work closely with physicians. Koltz, for example, requires written instructions from a patient's physician before he will administer care. Most nurse-practitioners also depend upon physicians to refer at least some of their patients. A few doctors, doubtful of the nurse-practitioner's qualifications, will not make referrals. But many physicians seem to take a larger view, recognizing that the nurses can help make better health care available to more people.

There is no dispute about one point: nurse-practitioners can help to cut the costs of health care. The average nurse-practitioner charges $5 plus the cost of materials for an office visit and $10 for the house calls that constitute the major part of their practices. Most doctors charge at least $10 for office visits and do not make house calls at all.

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