Medicine is medicine. And nursing is nursing. And that is the problem. This is the foundation of my essential rant on this topic: Nursing IS NOT medicine.
Physicians are trained differently because their focus is fundamentally different in some subtle ways that I think very few appreciate unless they have actively studied both disciplines. Physicians, how ever "holistic," are essentially focused on disease processes and their diagnosis and treatment... and further, they are focused to some extend on theory.
Nursing focuses on application and on the "human response to disease." It is NOT just watered down or simplified medicine. That is to say, at its core, nursing is about how the disease affects the patient and also the implementation of treatment plans. This is sometimes treated with less respect by physicians who imagine that their role is more indispensable, when the truth is that most intellectually honest physicians will readily admit that they may not actually know HOW to implement all of the orders they write.
Oh, sure, they might have an idea of how to place an IV or safely administer a drug or get someone off a bed pan without causing a skin tear or to perform a safe pivot transfer from a wheelchair to a bed or all the steps needed to arrange a transfer to another facility, etc, etc. But they don't always know the nuances that go into actually performing all the hands on care that their patients need. Those who think that they can learn all that it takes to be a nurse and to surpass the nurses in that specialized body of knowledge in the first few weeks of their internship are just as arrogant and just as wrong as the RNs who think they can learn to be a physician in a 20 month online NP program.
Nursing is an important discipline in the provision of care to patients. Medicine is another, separate discipline. And here is the thing... in theory, NPs never really study medicine. They study "advanced nursing." Advanced Practice Nurses, like CRNAs and NPs get a crash course in a bricolage conglomeration of nursing dressed up as medicine and medicine dressed up as nursing, which ends up being weaker than either discipline on its own.
In nursing school and throughout practice as a regular old RN, nurses are restricted from using medical diagnoses and have to instead use a ridiculous and convoluted system of diagnoses in order to avoid stepping on medicine's toes. Nursing notes can read like gobbledygook if you don't know the lingo, and physicians wonder why nurses write bizarre things like "Alteration of elimination, related to dietary intolerance, as evidenced by liquid malodorous stool, abdominal pain, and excessive flatus subsequent to consumption of dairy products," when everyone knows what they really mean is "lactose-intolerance induced diarrhea." If you read a formal nursing care plan, you will see example after example of these nursing diagnoses. It isn't because nurses are being deliberately obtuse. They just aren't permitted to say "The patient has diarrhea" because that is making a medical diagnosis, which they are not, as nurses, qualified to do.
Then you take that same person who learned all their clinical skills in that setting, and give them a year or two (*maybe* 3) of didactic and often no further required clinical education, a large part of which will be devoted, not to learning medicine, but to learning a slightly more detailed version of what they already knew, but letting them use medical diagnoses that make it sound like they are now practicing medicine.
They aren't. They weren't taught it. And that is the essential argument that must be made and made convincingly every time this argument comes up. Nurses don't perform well on tests of medical practice because they are practitioners of nursing.
If this point were fully appreciated, there would be no further question about how to cope with midlevel encroachment. No one who needs medical attention would be satisfied with nursing care alone... any more than they would get better if the physicians rounded on them and wrote orders, but without nurses available to actually provide the necessary care.
Both disciplines are harmed by role confusion. And most importantly, patients are terribly harmed by role confusion. There is absolutely a role for nurse practitioners on a physician-lead health care team. With physician supervision available, they can provide exceptional care... but unless they have attended medical school, they are not qualified to be physicians or to practice medicine. Full stop.
. Thank you if you are actually doing that..As leaders in medicine, it's so important that you (physicians) educate nurses too (yes, even despite political banter and differences) because ultimately it helps us both achieve our main goal, which is good and safe patient care..I too hope we can train more bright nurses. I actually do think we are already attracting a lot of bright people to our profession. I've met former lawyers, engineers, and doctors (from other countries) working as RNs. I've also met some of the most motivated and compassionate people I know in this profession.
