Mary Mundinger, dean of the Columbia University School of Nursing, was just a young nurse when she learned a lesson in medical hierarchy. She was working in an intensive care unit when a patient seemed to take a turn for the worse in the wee hours. "He didn't look right to me," recalls Mundinger, 61. "So I called his physician." Instead of advice she got a dressing down. The doctor, irate because he thought he had been needlessly awakened, contemptuously dismissed her observations. Mundinger called another doctor who confirmed her fears and treated the patient. But the disillusionment lingered. "It was," she says, "a humiliating experience."
Over the years, Mundinger channeled her outrage into a quest to win greater respect for nurses. Last fall she achieved a watershed goal: She opened Columbia Advanced Practice Nurse Associates (CAPNA), a clinic on Manhattan's Upper East Side where four nurse practitioners, not doctors, tender what she considers a more personalized type of medical care. Says Mundinger: "We wanted to prove that people will choose us even though there are more than enough doctors around."
CAPNA's nurse practitioners, who have two years more training than registered nurses, offer such services as diagnosing illnesses and writing routine prescriptions. In complicated cases, the nurse may refer the patient to a specialist. In 1996, the 2-million-member Oxford Health Plans agreed to pay CAPNA nurses the same as physicians for primary care—a first. Other HMOs followed suit. "We were following our philosophy to deliver the best care to our members," says Oxford medical director Richard Petrucci.
Predictably, physicians are edgy. "Serious conditions could go undetected by someone with half the training of a doctor," warns Charles Aswad, vice president of the New York State Medical Society.
"You lose nothing by coming to a nurse practitioner," counters Mundinger, noting that her nurses have up to 16 years of experience. She also believes that nurses are more likely than doctors to focus on preventive care, which can theoretically help lower medical costs because patients are encouraged to adopt healthier lifestyles. So far the medical community isn't buying the financial argument. "My guess," says Nancy Dickey, president of the American Medical Association, "is that we will not find huge surprises in cost savings."
In only one year, the number of patients served by CAPNA has grown to nearly 300. Most seem drawn to it by the buzz about the staff's personal touch. "We talked about things I wouldn't think of talking to a doctor about," says Luwana Hart, 48, recalling the relief she felt discussing the stress of caring for a son with cerebral palsy. "It was like talking to a friend."
That kind of connection is what originally drew Fredonia, N.Y.-born Mundinger to nursing. "Everything you do is a comfort, a healing measure," she says. The eldest child of canning-company executive Thomas O'Neil and his wife, Dorothy, a teacher, she graduated from the University of Michigan in 1959. Soon after, she wed Paul Mundinger, now 63 and a biology professor at Queens College. The couple, who live in Rye, N.Y., raised four children as Mary juggled parenting with nursing. Says daughter Elizabeth, 33, a lawyer: "She always made me feel I was a top priority."
As her kids grew up, Mundinger kicked her career into higher gear, earning a doctorate in public health policy and administration at Columbia. She took the helm of the nursing school in 1986 after a year of advising Sen. Edward Kennedy on healthcare reform. Soon afterward, when Columbia-Presbyterian Medical Center was short of doctors for its inner-city clinics, she offered up her faculty to help. Their practicing led to CAPNA. Mundinger, who moonlights as a commentator on FOX TV's Good Day New York, believes that CAPNA could seal a healthy future for nurse-practitioner clinics. "If you can do this in New York, where there are more excellent doctors than any place in the world," she says, "you can do it anywhere."
Sophfronia Scott Gregory
Julia Campbell in New York City
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