What Is the Difference Between "Nursing" and the Rest of Medicine?

[deleted480308]

Don't think that because you are the top dog means that you are the top dog. Meditate on this for a week or so and get back to me.

we both know that's not happening, but I wish you well in your journey

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[Placidius]

Imagine if you will a board of archery and a board of firearms. both can accomplish simple things like shoot that deer at 20yrds. But, by the time you are shooting a rabbit at 100yrds, a board of firearms trained hunter is all but required. now imagine a few archers realized there wasn't always a board of firearms hunter around when they needed one, so they buy a few rifles and try to teach themselves how to use them. eventually they say they are just as good at shooting that rabbit at 100yrds and they want to do so, they call themselves advanced practice archers or archer practitioners. The board of firearms gets upset and says you don't have the approved training from the board of firearms. The archer practitioners (with gunpowder residue on their fingers) says they aren't under the board of firearms because they are archers. They just practice "advanced archery".

I don't care how advanced your archery is, if you are using a .30.06 rifle.....you are in board of firearms territory.

In some sense I think you are right, and it's unfortunate that we have to obfuscate what we say in order to avoid regulatory scrutiny. To extend your analogy, though, consider what happens as archers develop more advanced bows that, while not competing with firearms in their entirety, certainly get past 20 yards. Or we twist the analogy a little further and consider that the archers are in better proximity to more targets. This is what I think is happening in medicine. We have a lot of people who are capable of doing more than what they are doing. We have a lot who aren't. We have people who are over-educated for the role they actually play, and we have people who are under-educated.

I'm an RN, and in some situations my formal education was not adequate even for the nursing role, the uncontroversial role that most medical doctors agree is appropriate. It's not because my education was poor, solid biological/social sciences and two years of kick-ass clinical education. It's because the situations are complex and fast moving. Things happen when I don't have a physician to hold my hand. Six years after graduation, with some clinical experience and continuing education under my belt, I routinely ask for orders for issues that believe I am qualified write, such as changes in the dose or route of a medication (one that I know well and that has already been prescribed). I also recognize situations in which I am not qualified to make the decision at hand. Sometimes I'm not sure.

Nurses, as they advance education and experience, get better at clinical judgement, not just the accomplishment of tasks. Clinical judgement relates strongly to diagnosis and treatment of disease, but the two terms are not interchangeable. The nurse routinely makes unofficial diagnoses when evaluating patients. I'm not talking about nursing diagnoses, which I see as a way in which nurse educators have worked around this practice of making unofficial medical diagnoses. I mean saying "These symptoms look like heart failure." We have to make the diagnosis because, whether we like it or not, we have to formulate a framework for what information we gather, what we do in the moment, how we communicate with a physician, and just how urgently we approach the situation. It would be unwise to just turn the whole ship over to a person who isn't formally educated to operate it, but what operations of judgement can we turn over safely? This is not an easy question and the answers are going to need to be guided by evidence.

How interested is the medical profession in determining a graduated approach to clinical education vs. scope of practice, or is the medical profession more interested in maintaining only two roles: MD and RN? What do we do if the board of firearms does not recognize the middle range between 20 and 100 yards and has no interest in the regulation of that range in face of a growing rabbit infestation?

 

[deleted480308]

When your lobby is pushing for private practice and pay equity, you don't get to imply that doctors are the ones being unreasonable

 

[Placidius]

A

When your lobby is pushing for private practice and pay equity, you don't get to imply that doctors are the ones being unreasonable

I didn't think I was. I thought I was just saying that they aren't pushing for some things that really need to be done. And sorry about my lobby, they just do whatever they want.

 

[Placidius]

But its so much easier to go to online archery school where you learn feather theory, and practice hitting virtual targets. Then, if you want to reach the pinnacle of archery and become a Zen-archer, you can study the flight patterns of the birds whom the fletching feathers come from. As a true zen-archer-master, you can then look down with disdain at those silly barbarians who limit themselves to simple firearms.

Then there are nurses who really do value science and who want to learn more medicine. We even respect medical practitioners. But maybe we want to take a more holistic approach, still based on science, but taking advantage of some of the softer sciences as well. I'd like to find a balance in which I can help a patient as part of a transformative process. That's an important role that I think isn't really filled and is the source of a lot of frustration for us all. I'll be damned if I know how that opinion relates to archery and firearms, but nurses aren't limited to those who conflate energy (the ability to do work) with some kind of mystic mumbo jumbo.

 

[Boatswain2PA]

Placidius - of course not. Most nurses are amazing, highly capable, incredibly caring, hard working folks who perform the majority of actual care for our patients. Unfortunately there is a vocal minority of nurses who drive the politics (and education) of the profession, and they are driving it further from actual nursing....and then there are the occasional looney one who sits around in the lotus position all the time meditating on how they can fix the Zen of their patients with ESRD.

 

[Mad Jack]

Nursing isn't medicine. That's the difference.