AUSTIN, Texas – Algunas organizaciones de Texas dicen que las necesidades de atención a la salud en las comunidades rurales sería mejor si al personal de enfermería se le permitiera tratar a los pacientes aplicando todo el conocimiento adquirido durante su capacitación.

En Texas hay más de 300 comunidades con un servicio médico insuficiente, y algunos grupos afirman que pudieran ser mejor atendidas con un cambio en las normas.

El personal Registrado de Enfermería con Práctica Avanzada (“Advanced Practice Registered Nurses”), conocido como APRN por sus siglas en inglés, tiene total capacitación para tratar y diagnosticar enfermedades agudas y crónicas, y aplicar los cuidados primarios completos. Pero las normas de Texas les impiden ofrecer estos servicios al máximo de su capacidad y entrenamiento profesionales.

Elizabeth Ellis es una profesional de la enfermería con nivel doctoral (DNP), Enfermera Registrada (RN), Practicante de Medicina Familiar (FNP-BC) y propietaria de una clínica en Bedias. Explica que hay una norma de supervisión que limita el campo de práctica de los APRN porque les exige tener un contrato con un médico colaborador.

“Texas es un estado tan grande como sus necesidades de atención a la salud y sus necesidades rurales de salud. Debemos ir con el futuro y ofrecer una práctica independiente a nuestro personal capacitado y con experiencia en enfermería.”

Texas ocupa el lugar número 46 entre los estados en cuanto a cantidad de médicos que practican en áreas rurales. La AARP, la Asociación de Negocios y la Fundación de Política Pública de Texas están entre los grupos que apoyan una mayor cobertura de su práctica.

Investigaciones del Diario de Practicantes de Enfermería (Journal of Nurse Practitioners) muestran que para los pacientes atendidos por practicantes de enfermería, el resultado en términos de salud es el mismo o mejor que por un médico.

“Estamos teniendo que pagarles y en mi caso desviar fondos de mi clínica que podrían usarse para tener servicios o equipo adicionales, para poder pagarle a un médico que sea mi proveedor colaborador (Collaborating Provider).”

Algunas organizaciones de médicos argumentan que los doctores tienen capacitación y experiencia más amplias en el cuidado de pacientes, y dicen que se necesitan reglas para garantizar la seguridad. Pero Ellis responde que cambiar las normas no acabaría con la colaboración entre profesionales médicos.

“Todos tenemos nuestras propias limitaciones y visión, así que si eres un buen practicante sabes cuáles son tus limitaciones y siempre acudirás a tu colega para garantizar el tratamiento apropiado para tu paciente cuando lo necesites.”

Más de 20 estados más permiten a los practicantes de enfermería trabajar en toda su área de capacitación sin un contrato de supervisión, y el Departamento de Asuntos de Veteranos (Deparament of Veterans Affairs) también les dio autoridad para una práctica ampliada.


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Farmworkers in South Carolina and across the U.S. face scorching heat with little protection at the federal and state level. However, the Farm Labor Organizing Committee is taking steps to enhance worker safety.

The group is ramping up heat protection guidelines for migrant workers in the South through an existing rule. Originally negotiated in 2006 with the North Carolina Growers Association, the rule aimed to address heat-related incidents. Now, it is being strengthened to improve conditions for more than 9,000 farmworkers.

Baldemar Velasquez, president of the committee, believes the efforts are key in safeguarding workers where legal measures do not.

"The problem with legislation, whether it's the federal or state, it takes forever," Velasquez asserted. "Enforcement is always an issue because we're not talking about big factories with a lot of workers. We're talking very remote labor camps, isolated, and so it's important that workers know how to take action on their own."

He noted under the new guidelines, workers who are a part of their union take heat safety into their own hands. The rules say if it is getting close to 85 degrees and workers have symptoms such as dizziness or nausea, they should take a break in the shade and drink water, no matter what the boss said. When it hits 95 degrees or more, breaks are supposed to happen every couple of hours.

According to the Centers for Disease Control and Prevention, 67 people died from heat-related deaths from 2016 through 2020 in South Carolina.

Mario Vargas, lead organizing development coordinator at the Campaign for Migrant Worker Justice, shared his 15 years of firsthand experience. He vividly depicted the challenges faced by workers, such as tall crops blocking the wind and constant pressure from employers.

Recognizing the urgent need for change, Vargas and his organization are teaming up with the committee to go beyond guidelines. They are prioritizing education.

"Because if you say, 'Oh, we got another 100 feet to go so we can finish the row,' you might not make it to the end of the row," Vargas pointed out. "You need to stop and find some shade and drink some water. We let them know their rights, that they have a right."

The group will be teaching farmworkers about the new guidelines, signs of heat stress, how to stay hydrated and when to seek medical help. Vargas added they will also have support channels to report issues or pushback to ensure their well-being is not compromised.

Last week, Walmart became the latest major retailer to retreat from providing direct health-care service by announcing closures of all its health clinics and virtual health-care operations.

However, Florida's health centers say they are ready to fill the gap.

Florida is home to most of the soon-to-be-shuttered health centers - 23 of the 51 centers are now winding down operations in the Sunshine State, where they offer various services, including medical, dental, and behavioral health care.

Benjamin Browning - vice president and COO of the Florida Association of Community Health Centers - said many have tried to figure out the complexities of delivering health-care services, which doesn't always work.

He said the current concern is ensuring displaced patients, often in rural underserved areas, can still access care.

"Fortunately," said Browning, "the community health centers are positioned throughout the state to be able to welcome those patients, to encourage those patients to come and visit and receive their primary-care services."

In a statement, Walmart cited the challenging health-care reimbursement landscape and rising operating costs as reasons for the closures.

Additionally, Walgreens is closing 160 VillageMD clinics, Amazon is cutting jobs at One Medical and Amazon Pharmacy, and CVS Health plans to shutter dozens of pharmacies in Target stores.

Browning said their model of providing care is embedded in their name - building community.

When a patient enters their facility, they might also be connected to additional services. He said the model is financially challenging, but they've been working to perfect it.

"There is a level of streamlining," said Browning. "There is a level of efficiency that is maximized to the extent possible, within the health centers to provide for those patients that can and cannot afford to pay the full bill."

Walmart expects the closures to occur within three months and will now focus its health business on its nearly 4,600 pharmacies and more than 3,000 vision centers across the United States.

Community Health Centers are in all of Florida's 67 counties, serving patients in more than 800 locations - including dozens of mobile units and school-based sites statewide.

Michigan farmers are responding to the new Avian Flu "Extraordinary Emergency" order from MDARD, Michigan's Department of Agriculture and Rural Development.

New safety guidelines must be in place by this Wednesday that affect all dairy and poultry operations in the state.

The guidelines include the designation of a biosecurity manager, establishing a perimeter that limits access to livestock, and implementing cleaning and disinfection procedures at those access points.

Chief Medical Executive for the state of Michigan, Dr. Natasha Bagdasarian, said the most severe cases of the Bird Flu seem to be in poultry.

"Poultry don't recover well from this virus," said Bagdasarian. "This is a highly pathogenic virus in poultry and the dairy cows do tend to recover, even though their milk production is slowed down."

M-DARD first detected Avian Flu in Michigan dairy cattle on March 29 of this year. The disease has since been detected in more dairy herds and commercial poultry flocks in 7 counties.

The emergency guidelines also include farms maintaining a record of vehicles and people who cross access points.

Regarding the health risks for humans, Bagdasarian said there is some positive news amidst the crisis.

"We had a number of workers who had been exposed, but very few have been symptomatic," said Bagdasarian. "And no one who has been symptomatic and tested for the virus, had tested positive. So, that's really good news. "

The Food and Drug Administation continues to advise against drinking raw milk and recommends that the dairy industry does not manufacture or sell raw milk or raw milk products.



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