NURSING EXPERTISE

Editors, Vineyard Gazette:

I am writing in response to your June 3 article about the hospital emergency room (ER) staffing, specifically concerning comments about nurse practitioners (NPs) and physicians assistants (PAs).

It is wonderful that the hospital wishes to improve wait times in the busy ER. However, a quote attributed to hospital CEO Tim Walsh — “nurses [referring to nurse practitioners] do not order tests and PAs do,” — is unfortunately an inaccurate statement. I have spoken to Mr. Walsh, who assures me that it was a misquote and that perhaps there was some confusion. As an active nurse practitioner, I wish to provide clarification so those in the community will better understand the role and value of nurse practitioners and physicians assistants within any health care delivery system.

Both work side by side with physicians in practice settings or in consultation with them when they are not directly on premises. Both operate under written guidelines with a physician or facility — PA supervisory guidelines are filed with the state’s board of medicine, NP guidelines with the board of nursing.

Both order lab tests and diagnostic work-ups, interpret results, consult with and refer to specialists when needed. And both develop treatment plans appropriate for each patient and regularly assess and reevaluate to ensure the plan is working meeting the patient’s needs.

Nurse practitioners complete a four-year undergraduate program and earn a bachelor of science degree in nursing. They then complete a two or three-year postgraduate program, obtaining an advanced practice degree. Some go on to a doctorate degree program. There are many specialties within the NP field, as in the medical field. Nurse practitioners may specialize in primary care (either family or adult practice), acute care, OB/GYN, gerontology, pediatrics, anesthesia, psychiatry, cardiology — the list goes on.

I applaud the hospital’s decision to use PAs in the ER, and they have made an excellent choice in hiring Anthony Piland in that role. Also commendable is the hospital’s past practice (2001-2004) of using NPs in the ER during the busy summer months.

Nurse practitioners and physicians assistants provide exceptional health care, here on the Vineyard and across the country, and are increasingly more valuable as primary care providers in a national climate where severe shortages exist. Nurse practitioners can now choose to become “designated” primary care providers in the state of Massachusetts and recognized as such by health insurance companies. Many of us will gradually move in this direction and we will clearly be a vital part of high quality health care into the future.

Carol Forgione

Vineyard Haven

The writer is an acute care nurse practitioner who works for Vineyard Medical Service and Island Health Care.

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PEACE AMONG NATIONS

Editors, Vineyard Gazette:

It was indeed helpful for the Vineyard Gazette to present a clear picture of the present Martha’s Vineyard population in its May 20 issue. Thank you, Mike Seccombe, Gazette senior writer. This article encouraged me to do a little research on the beginnings of the uneasy relationship between many Brazilians and many longtime residents of Martha’s Vineyard.

On the Internet I found some surprising answers in an article written by Daniela Gerson, a journalist specializing in immigration issues, entitled How Migration Transformed Martha’s Vineyard, published in the Financial Times, on August 15, 2009. She writes that in 1986, when Ronald Reagan was President, Congress announced an amnesty for immigrants pending new, forthcoming legislation. Today we know that no new legislation was ever enacted and to this day no new legislation has ever been made into laws. This matter has caused innumerable tensions in many parts of our country. Apparently it is assumed that immigrants who stay in our country will apply for full citizenship, but a door was left ajar for those who do not do so. President Obama, in spite of his campaign promises, has done nothing to correct this wrong to our country — a wrong which has caused mass confusion, anger and downright hardships to everyone. On the Vineyard, a great deal of pain and suffering has been felt by all who call this our home. We should be very proud of how Vineyard schools, hospitals, businesses and social services have risen to this bewildering situation over some 25 years, but I also feel a sadness that many of our friends live in a limbo.

Vineyarders have expressed their dissatisfaction with this situation in a number of ways. Brazilians have lately responded by becoming stronger as a group. There has definitely been poor frank dialogue between the two groups. Many of us have good friends among Brazilians. A lot of time has gone on, though, and not many of our leaders have really faced the situation with us. What I fear is that this new Brazilian organization will drive us further apart or into more dissent. What I hope is that our selectmen, our town officials, our clergy, our teachers, our leaders, will not let the situation grow worse. Changes may well be in the wind and they won’t be the right ones for everyone. We need support for those changes and we need honest solutions emanating from what are now two different groups — what I call the power elite from the old Vineyarders and the power elite from the Brazilian community.

The true culprit behind this is once again, big government. I hope that our Martha’s Vineyard power elites are very sensitive to both sides of this thorny issue and remember that all of us, I hope, all the smaller people, just want a working solution and peace again.

I look forward to open, well-advertised, public forums, which include the presence of both groups fighting for a solution to one common problem.

Roberta Mendlovitz

Oak Bluffs

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NSTAR SOCIETY

Editors, Vineyard Gazette:

During a recent storm, a high, heavy branch toppled onto the power line leading to our home. The limb didn’t break all the way off the tree, but the next good wind will finish the job, dragging live wires into the road. When I alerted NStar, I was told there would be a 14 to 28-day response time. Why? Because we still have power. When I pointed out this might change at any moment, causing inconvenience and a hazard to anyone using the road, I was told: “Well then it will be an emergency and we’ll come right out.”

This, in capsule, is how our society so often operates, whether it’s health care or climate change or public services. Rather than take an ounce of preventive action, we wait until the problem is acute and expensive to fix — or the mess is too great to clean up at all.

Tony Horwitz

West Tisbury

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DOGS GONE

Editors, Vineyard Gazette:

Sarah Piazza, who I grew up with in Edgartown, is exactly right when she said, “Dogs don’t belong on a bathing beach,” and she said it a lot nicer than I did.

The Bend in the Road is supposed to be dog-free but for the past three years I have been trying without success to get the county and Sheriff McCormack to enforce the no-dogs-on-the-beach bylaw from the lifeguard stand toward Oak Bluffs on State Beach, which the county controls. Actually many people park at the lifeguard stand and walk their dogs toward Oak Bluffs.

I have written letters, talked to Sheriff McCormack several times, and my wife and I went to the county commission meeting last April to get it on the record concerning their non-enforcement. That bylaw clearly says no dogs on the beach 24/7, period, between April 1 and August 31.

They have not and say they cannot enforce that bylaw because they have no money! I still have no clue why the county exists. One hundred per cent of the violators that I have personally experienced, reported to the police and testified about are all tourists!

Hopefully I have toned this letter down enough notches to be published and get the county’s attention.

Woody Williams

Vineyard Haven

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NEW OSPREY DIGS

Editors, Vineyard Gazette:

The following letter was sent to NStar:

My thanks and gratitude for your support and efforts with the installation of an osprey nest pole on the Edgartown Gardner Property on Chappaquiddick. As our town and island are transformed back to the 1929 era, Chappy returns through the efforts of NStar Electric, Bay State Piping and their subcontractors, to its earlier life. The trials of this project will be in everyone’s mind for decades to come. Phone wires to fuel tanks to do-overs, this historic transformation will forever change Chappy living and her opportunities for the future.

Thanks to your cooperation, hopefully a pair of osprey will find this project to be worthy of occupying the new, affordable, seasonal residence now overlooking the greatest harbor on Martha’s Vineyard. Thanks again to NStar Electric for its support of osprey habitat on the Vineyard.

Bob Gilkes

Edgartown

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PLAY BALL!

Editors, Vineyard Gazette:

What makes Chilmark Softball keep going after some 75 years? It started in the back lots of Menemsha in the 1930s, traveled to Toomey’s in Chilmark, took a respite in West Tisbury, and now flourishes in Chilmark at Flanders Field again. Is it the quality of play? Perhaps, but that has varied over the years. No — what I think brings seniors, men and women and stray canines together every Sunday in the summer at 8:30 a.m. is the fun that takes place while playing softball. It also brings the community together — Islanders and summer visitors alike. The joyful chatter on the sidelines matches the friendly competition between the baselines. There are no stickers and you can’t tell a corporate executive from a day laborer. Come out and play or sit on the homemade box seats and heckle. I guarantee it will put a smile on your face. The first game of the season begins Sunday, June 26. It’s rumored that Julie Flanders will throw out the ceremonial first pitch after Howie Wall plays Take Me Out to the Ball Game on his bagpipes.

Bill Edison

Menemsha

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THE HIGH LIFE

Editors, Vineyard Gazette:

Taking advantage of this public forum, this is to give notice to our friends on the Island that Paulette and I have been elevated to super-executive status.

It is true that a quick peek at our bank account (thanks to online access) shows the same modest number of digits to the left of the decimal point. A glance out of the window shows no Cadillac in the driveway — only the middle-aged Volvos, although these are bedecked in the latest fashionable Island pollen patina.

Our attire owes more to Dumptique and Thrift than Macy’s, although we do sport an occasional touch of Brickman’s and Laughing Bear. Our garden, though becoming (in its third year) delightfully prolific and colorful, is far from the well-tended elegance and manicured precision of the Edgartown look.

The attributes of the rich and famous have been thrust upon us — or, more accurately, upon Paulette — via the U.S. mail by a company looking to elevate us to jet-setter status with the use of the luxurious amenities of their diverse fleet of aircraft.

Perhaps they read of Paulette’s modest sale at Featherstone as a harbinger of worldwide fame and fortune.

Perhaps we have gone shopping without changing after laying pavers or painting the bedroom, and John Steinbeck’s, “You have to be rich to go out looking like that,” has come to the minds of observers.

Whatever flattering misinterpretation prompted this generous invitation to dramatically change our lifestyles, we have, after careful consideration, decided to decline the opportunity.

To be frank, the benefactor’s claim that the aforesaid Diverse Fleet “can meet any budget” has to be mistaken. Our budget might meet a timeshare in a secondhand skateboard, but a Gulfstream V is out of the question.

The clincher, though, is the offer of “Work to Weekend In 30 Minutes.” Right now my work-to-weekend journey is about five minutes — this could double at the height of summer — but Paulette’s is 12 stair steps up from her basement workshop — even less if she steps outside directly.

So to those who mailed the invitation, thanks for the kind offer but we are doing fine as we are. In fact, to be frank, I do not think we could possibly be any better off.

Nick Mosey

Vineyard Haven

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RESEARCH HEAVEN

Editors, Vineyard Gazette:

The following letter was sent to the Edgartown Library:

Words cannot express how grateful I am to have had your support, advice, assistance on my research, guidance on my editing and your overall customer service while I was writing my thesis for the past six months. All of you made me feel right at home serving coffee, tea, popcorn, snacks such as home-baked muffins and breads, cookies too occasionally! As all of you know, there were many evenings when you had to alert me it was time to close for the night.

You offered me so much respect and friendship; how fortunate we are to have this library in Edgartown. The good news is that my thesis is being bound and I graduate on July 10 with a master’s of education, in environmental science for middle school students.

This goal of completing my thesis would never have happened if I did not have the Edgartown Library to come to daily to write and research.

Kathleen H. Smith

Edgartown