[Anxious Patient]

"As the shortage of primary-care physicians mounts, the nursing profession is offering a possible solution: the "doctor nurse."

rest of article here:

http://online.wsj.com/article/SB1207...s_Most_Popular

[Salesman217]

I think docs and nurses have spent way too much time and energy convincing themselves that they operate in different realms. They say medicine is about illness and nursing is about human response to illness. What kind of semantic twisting gobbledy-gook is that?

Nursing is the hands on practice of medicine. If we wanted to we could look at nursing as a sort of medical apprenticeship. We nurses certainly learn a lot from docs. And if docs spent as much time with patients during their education as we do during our practice they'd be a lot better practioners for it.

Since ADNs like myself are practicing alongside BSNs and getting the same pay as if we know the same thing then perhaps it's time to put some more umph into the BSN degree. Why not retool the BSN to make it a premed degree (or at least make that an option) where they take biochemstry and higher level pharm or whatever pre-meds study?

If nurses want to practice like docs the let them become docs. Why does all this healing practice have to be so segregated? Let's lump us all together.

This artificial wall between docs and nurses is not based on any sound objective reality about the difference in what docs and nurses do. It's based on the old gender role seperation of the past that said women were not smart enough to be docs but they could be docs handmaidens. How about nurses as docs assistants and de facto apprentices?

Then you have a vast pool of individuals already in the medical profession who might move on to higher levels of practice.

As it stands now, if a nurse decides to become a doc they're looked at like they are somehow switching to the dark side.

Why are there both there NPs and PAs? PAs exist because men without the time, money, or ambition to pursue an MD choose to attain to a mid level medical profession without having to do "women's work" (nursing). NPs exist so nurses can attain to a higher level of medical practice without abandoning the sisterhood.

If you asked me it's nuts.

Here's my suggestion:

Level 1: current ADN would be - Medical Rehab Technician I - MRT1
Level 2: current BSN would be - Medical Rehab Technician II - MRT2
Level 3: current NP/PA would be - Medical Master - MM - Your primary care providers
Level 4: current MD/DNP would be - Medical Doctor - all of whom would be specialists including specialists in nursing who would be experts on developing and improving the delivery of direct cares

That's just some preliminary rethinking of the situation.

My ultimate point is that the idea that docs and nurses are not both in the same line of work is ludicrous. Let's start merging the profession. Giving BSNs a pre-med track option would be a good start.

[Alex_RN2b09]

Salesman217 I really like your ideas. I too agree RN's and MD's have spent too much time and energy separating themselves and trying build up this wall between professions. Maybe someday we can tear that down but it's gonna be one hell of a job.

[elkpark]

Many of us nurses do not want to "practice like docs." Nurses who do are welcome to go to med school.

[llg]

I've known a lot of nurses who used their BSN's as a pre-med degree. It's very possible to do now under the current system.

... and there are a whole lot of us who want to focus on the practice nursing and develop the nursing knowledge base -- a body of knowledge that is based on a separate and distinct tradition from the discipline of medicine.

Yes, there are overlapping functions and overlapping areas of knowledge. But that doesn't make us the same. There are nuances, shades of differences, etc. that distinguish the varying health care disciplines. If not, why not combine ALL the fields (pharmacy, PT, OT, RT, Radiology, Lab, etc.)? No, the real world is more complex than that.

Overlaps do not make things identical. That's just bad logic.

llg, PhD, RN

[oldiebutgoodie]

Salesman217,

It's refreshing to see someone actually doing a little original thinking. Thanks for your ideas.

And I do like your comment about the PAs not wanting to become nurses. Very insightful.

Oldiebutgoodie

[jjjoy]

On the other hand, nurse practitioners ARE filling the exact same role as PAs... and such mid-levels are practicing MEDICINE. While NPs may have a foundation in nursing, their FUNCTIONAL role as a NP in most places is no different than PAs and again, at that point, they are practicing medicine and not nursing. Some would argue nurses are more holistic, but the reality is that some are and some aren't. Same with PAs and MDs. The good ones WILL see their patients as more than a diagnosis, will take the time to educate and address psychosocial needs to the extent possible in their role.

In regard to non-advanced practice, a good percentage of most nurses' work IS assisting with the medical therapy - administering medications, intravenous therapies, monitoring for side effects, monitoring physiological indicators, etc. The 'nursing' side of nursing is often primarily carried out by unlicensed assistants... that is feeding, toileting, turning, ambulating.

Yes, the licensed nurse is responsible for these being carried out, but the reality is that these are but a small part of the responsibility of licensed nurses and, while unquestionably important, often are of the lowest priority compared to other responsibilities - that is, immediate medical needs take priority over many basic nursing functions. So a patient may be left in a wet bed with an increased risk for skin breakdown if another patient is crashing. And in such a scenario, the nurse will take care of the crashing patient while an unlicensed aide will take care of the wet bed.

So, essentially, maybe the nursing assistants are the ones practicing "pure" nursing while professional nurses practice some kind of hybrid of nursing and medicine.

Just some thoughts...

[elkpark]

Originally Posted by Salesman217

As it stands now, if a nurse decides to become a doc they're looked at like they are somehow switching to the dark side.

Why are there both there NPs and PAs? PAs exist because men without the time, money, or ambition to pursue an MD choose to attain to a mid level medical profession without having to do "women's work" (nursing). NPs exist so nurses can attain to a higher level of medical practice without abandoning the sisterhood.

Do you have any documentation or evidence to support your assertions, or is this just your own, personal theory? Have you actually read anything about the historical development of the NP and PA roles? On what do you base these sweeping generalizations?

[StudentNurseBean]

I plan on doing this. I learned about it when living in NYC. I went to an educational session about it at Columbia last year. I like the emphasis on "preventive" care

[pinoy_guy]

Originally Posted by llg

I've known a lot of nurses who used their BSN's as a pre-med degree.

how about nurses who used their MD's as a pre-BSN degree?

ask around--a lot of doctors from the Russia, India, and Philippines had taken up Nursing as a way to a better life in the US.

the training is very different: Medicine mashes your face into the nitty-gritty of a dead man's chest cavity as an introduction to Human Anatomy. that's in the 1st Semester.

Nursing focuses less on the Theory and more on the Implementation of the Healing Arts without necessarily understanding the Fundamental Bases of why the Doctor wrote that order (like focusing on dose calculations).

neither one is better, they're just...different.

now a very seasoned nurse with more than 10 years under his/her belt will learn to anticipate what the Doctor will probably order in a certain situation...but since Medicine delves into the basics, Doctors are more equipped to detect the 1 in a million aberrancy.

for example: since the Philippine Government is providing enough funds (sarcasm implied) for Government Hospitals, some Government Obstetricians are encouraging Normal Births to go to a Midwife--and the Obstetricians tend to accept only the complicated cases.

another point: Nursing Diagnoses are designed so differently from Medical Diagnoses that they're akin to oil and water.

anyway, it will be interesting what the outcome will be.