Listen, you can take this as far as you want and argue till you're blue in the face...but the only point I want to make is that this movement is basically marginalizing doctors and sending us the message that our education, training, and hard work are not appreciated. The issue currently dominating this thread is the role and value of nursing research. I'm not seeing anyone here making claims that the hard work, training, or education to become a physician is unappreciated. If anyone is okay with sending doctors that message, fine, keep defending the expansion of midlevel scope. Explaining what nursing research is to someone who is completely ignorant of it (i.e. AegriSomnia) is a separate issue from expanding midlevel scope. If you feel that doctors should not be receiving that message, join us and voice your opinion. As for the concerns that you raise, I personally do not have an opinion on what the limits of midlevel scope of practice or level of autonomy should be. If I were to have an opinion about it, it would be based on the comparison of outcomes rather than just simply comparing number of years of education and/or comparison of curricular content. To illustrate my perspective on this particular situation- cause I love illustrations- Let's say I spend all day making Julia Child's boef bourguignon. I've done this and let me tell you, it is time consuming and a lot of work. Then Rachel Ray comes around and says her 30 min burgundy beef stew is just as good if not better. I'm sure my kneejerk reaction would be to tell her to get the hell out of town. There's no way my culinary masterpiece that I lovingly labored over could be trumped by some crazy upstart's wham bam thank you ma'am dinner. But what if 9/10 people report that they prefer Rachel Ray's stew? Well, I guess I'd be forced to re-evaluate my assumption that slaving over dinner is absolutely neccessary to make a delicious meal. To bring this back to the example of midlevel v. physician outcomes- I am open to the possiblity that midlevel outcomes may be equal to physician outcomes in certain populations and settings. I haven't read or evaluated any studies that support one or the other. Sure, I will certainly read whatever comes my way, but frankly I'm not motivated enough to do a literature search and review. This issue really has no bearing on my current or future professional endeavors at this point. But it is interesting, to say the least, to follow how this issue has been debated and discussed and yet, very little if any meaningful evidence is offered in this forum (at least that I've seen) to support either side. So on this issue, I'm content to be noncommittal and read from both sides with an open mind.
Now when it comes to someone saying that nurses don't integrate the science of medicine in their practice or have any place in research, then I'm definitely stepping up to shut down that fallacy.
Just know that I worked really hard to get into medical school (yeah yeah yeah I know you worked hard to get into nursing or DNP school or whatever but hear me out I'm hearing ya). I worked hard in medical school to be the best, most knowledgeable, most patient-centered doctor I can be. I mortgaged myself to the hilt (over a quarter of a million dollars in student loans), worked my arse off, and have taken my licking with a smile because I was hoping some day, I'll be able to treat patients, be a specialist in my field, be valued and respected by the team I lead. Everyone wants their hardwork, expertise and dedication to be acknowledged and appreciated (and compensated!). That is normal and reasonable. My perspective is to look beyond the emotion tugging sentiments to what the reality of best practice is. There is no denying that an education in medicine is very rigorous and of greater scope and depth than in a PA/NP/DNP education. But does it always translate to better outcomes in every healthcare setting? That is the ultimate question. I don't automatically assume that longer and harder= better. Though,hey maybe it is 😉. And yeah, I need to make a decent living (and honestly, I think we're valuable and deserve a good living considering what we offer society and how much financial and personal risk and sacrifice we offer). I completely agree. One would think that a person's value to society should reflect their salary. However, you only need to compare a teacher's income to that of Lady Gaga to know that we can't assume that value correlates with compensation. Obviously other priorities drive market forces.
And yeah, I expect (eventually) to lead a team. Not the dictator, but the leader. Yes, I respect and want input from everyone on the team, and I delegate and utilize the skills of everyone on the team as appropriate. In fact, the more you can do for the patient and the team, the less work for me. That dynamic you describe isn't quite accurate (members of the "healthcare team" actually function a bit more independently than you describe)- unless you're talking about a private practice and whoever is under a physician's direct employment. Taking an acute inpatient hospital setting for an example (and for simplicity, limiting it to two disciplines): The attending physician is responsible fpr admitting a patient, obtaining an accurate health and social history, review of systems, physical examination, ordering and evaluating diagnostic tests, arriving at the correct diagnosis(es), formulating treatment plans, and performing therapeutic procedures as appropriate to their training and policy/legislation, and for coordinating the patient's care and consulting with other specialists as appropriate. The attending physican and physician consultants (as appropriate) generally make rounds daily to evaluate the progress of the patient toward the anticipated outcomes, discusses the patient's progress with the other healthcare disciplines, and adjusts the treatment plan as indicated. The amount of face time with a patient/family is (usually) quite brief and face/phone time with RNs, RTs, PTs etc is (usually) brief if applicable as well and the quality and collegiality of those interactions vary widely upon the individual personalities and style. The nurse's role is to assess and treat patients with respect to the medical diagnosis and treatment prescribed by the physican. The nurse understands (to a lesser degree) the pathophysiologic profile of the patient and the science of the prescribed therapy, implements it and evaluates response to treatment- adjusts treatments accordingly (that may or may not include consulting with the physician). While the physician is the one with the diagnostic and prescriptive responsibilities, that's not necessarily a strong "leadership" dynamic. Ideally there is a high degree of respectful interaction and collaborative attitude, but regardless, the physician is managing the patient, not the RN/RT/PTs. And that's the same deal with RN/RT/PTs. They manage patients in the capacity that is appropriate and to varying degrees collaborate and coordinate with other disciplines.
It's just hard to hear these devaluing, ambitious, and frankly scary messages that sound an awful like what I'm afraid will happen. We take on all this debt, we work so hard, and we sacrifice so much to become doctors and now society is telling us they don't care. Medicare cuts 21%. Doctors are characterized as being greedy rich doctors while the rest of the un- or under-insured country suffers. Midlevels are saying they do the same stuff and their training is just as good. What the hell? What are we supposed to say to all that?
