Alumna Dr. LaTonya Trotter Authors New Book on Nurse Practitioners
Health Services MPH (SBS) alumna (’06) Dr. LaTonya J. Trotter has authored a new book: More than Medicine: Nurse Practitioners and the Problems They Solve for Patients, Health Care Organizations, and the State, slated to hit virtual and physical book shelves by April of 2020.
In More than Medicine, Dr. Trotter investigates our health care crises through the case of the nurse practitioner (NP). Professional nursing has made the case -- to state legislatures, insurers, and health care organizations -- that NPs are part of the solution to our intertwined crises of cost and personnel.
In her book, Dr. Trotter chronicles the everyday work of a group of NPs on the frontlines of that crisis as they cared for 400 African American older adults living with poor health and limited means. Through her account, Dr. Trotter shows how this group of NPs expanded the medical encounter to include a mix of health, social, and coordination problems—illustrating the ways in which these providers are not just filling in for absent physicians, but are filling in for the absence of the state, in attending to the problems of poverty and unequal access to health care.
Dr. Trotter is currently an Assistant Professor of Sociology at Vanderbilt University in Nashville TN.
Check out this interview with Dr. Trotter to learn more about her work, and her journey from MPH student to Assistant Professor and published author!
[In your own words, what is the significance of these findings? What are the implications for practice or policy?]
“The NP is written about almost exclusively, as ‘filling-in’ for the increasingly absent physician. My book turns that story on its head. In finding that NPs are expected to provide *more* than medicine for patients, health care organizations, and state payers, my work reveals that the crisis in care is much more profound than the simple arithmetic of personnel, and that the saliency of the NP is as much a story of welfare state retrenchment as of economic utility. For practitioners and policy makers alike, my work raises important questions about the limits of applying professional, clinical solutions to the moral and political terrain of social problems. If we want to find answers to our health care crisis, we need to begin with a fuller view of the problem at hand.”
[How has your personal, professional, and academic journey influenced your decision to focus on these issues in your research?]
“I originally came to UW’s School of Public Health because I wanted to understand why African-Americans had worse health than any other group in the US. I wanted to understand how the intractable intersection of race and economics seemed to doom African-Americans to a worse quality of life. And I wanted to understand why even middle-class African-Americans like my own family had worse health than poor whites. There is no lack of research on this question. Health disparities research has become one of the fastest growing topics in public health and sociology alike. In my time at UW, I became a veritable expert of that literature, in part through the mentorship of Dr. Deborah Bowen, and through health services courses offered by Dr. Donald L. Patrick and Dr. David Grembowski. This grounding in the literature was critical. Yet, there seemed to be a critical perspective missing from much of it. The way that we study health disparities is at the level of the individual. We try to understand health disparities by counting up individual risk factors and looking at individual outcomes. Even when scholars theorize about the role of social context, the push for empirical testing inevitably lowers our gaze back down to the body and its habits. As a result, the study of inequality has increasingly moved to the laboratory—measuring hormone levels and stress responses. While that kind of work is invaluable in understanding how inequality manifests in the biological body, I began to realize that this was not the only body worth studying. The body politic and the policies it produces seemed equally worthy of scholarly attention. A health services course I took with anthropologist Dr. Janelle S. Taylor helped me to move toward a different line of questioning.
It was out of that questioning that I began to muse about the nurse practitioner as a particular kind of policy intervention. Because that is what they were. Not for African Americans in particular, but for a diverse population of those without reliable access to health care. A nurse and physician literally dreamed the nurse practitioner into existence, not to serve nursing, but to serve the nation and its intertwined problem of physician scarcity and rising costs. Yet policy solutions are rarely inert; they tend to generate unforeseen consequences. Even those consequences one intends have a way of reconstituting the problem in unforeseen ways. If nurse practitioners were a policy intervention to address access and cost of care, how might the work they do change our understanding of what care means?”
[How did you get involved in this specific project, and decide to write a book?]
“Believe it or not, through a friend. I began my PhD studies at Princeton University at the same time that a long-time friend was entering nursing school at Yale University. As I was learning to be a medical sociologist, she was learning to practice as an NP. That timing was fortuitous because it illuminated what was missing from the scholar’s view of the medical world. The literature I was reading on the health care encounter and the broader culture of medicine seemed to be describing a world in which nursing played no role…at least not one interesting enough to study. That invisibility contrasted rather sharply with what I was learning about nursing through my friend’s journey towards independent, NP practice. It was through comparing the world I could see with the world I was reading about that led me to write this book. I began to consider what we might differently learn about the problems and organization of health care by looking at how the particular solution of the nurse practitioner plays out in everyday practice.”
[What’s coming up next for you?]
“My work on the NP is part of a larger research agenda that explores the relationship between changes in the organization of medical work and the reproduction of racial, economic, and gender inequality. I am currently carrying out this agenda in a new book titled, New Forms of Home, New Forms of Work. In this book, I investigate the emergence of nursing home alternatives for older adults such as assisted living facilities, adult day care centers, and senior only retirement communities. Unlike nursing homes, these institutional forms are not expressly medical institutions; however, they remain sites of routinized, health care work. Through a comparative ethnographic analysis, this project investigates the organizational logics through which conceptions of work, identity, and responsibility are being reconstituted in these new forms of home.”
Learn more about Dr. Trotter's book: https://www.cornellpress.cornell.edu/book/9781501748158/more-than-medicine/
Or visit: https://www.latonyatrotter.com/