[Tammy79, RN]

Is prescribing medication, as an example, a function that is exclusive to medicine? When a M.D./D.O. gives a prescription it is well established that this is practicing medicine; when a dentist does the same it is the practice of dentistry.

I know that practicing medicine without a license is a crime. I also know that I can't lend someone else my driver's license so they can drive a car, just like probably an NP can't work under the license of an MD as much as rules specify and call for collaboration in the form of supervision and/or protocols. I also know there are vast differences between nursing theory and models versus the medical model.

So, from a professional and technical perspective, when a NP prescribes, is it a function of advance practice nursing or is the APN considered to be practicing medicine?

Just curious on your thoughts.

-T

[pinoyNP]

It depends on who you ask and where you live. ANCC who certifies some NP specialties and CCNA who certifies CRNA's are specialty boards that are accredited by the National Boards of Nursing Specialties. Technically, the standards set on what minimum level of competency is required via certification is established by a nursing board in this case. One can then assume that the acts performed by NP's in this case, whether they are the same as the ones physicians perform, still fall into a nursing specialty and are thus, within the confines of advanced practice nursing and not medicine.

However, state to state rules vary. There are states where professional practice acts and legislation give the BON the sole responsibility of regulating the practice of NP's. In these states, NP's practice within the confines of nursing in an advanced role achieved by virtue of the NP's advanced training and specialty certification. In some states, both the BON and BOM regulate NP practice. Technically, these states confirm that some acts performed by NP's fall into the practice of medicine, hence, the oversight by the BOM.

In recent developments, the proposed certification exam for DNP's is one that is developed by the American Board of Medical Specialties, a group that represents the medical profession. One can interpret then that this is a validation of the fact that many NP roles fall into the practice of medicine, or at least, the proposed roles a DNP certified NP can perform per the group that is offering this new DNP certification.

As a practicing NP, I have the opinion that a vast majority of the day to day acts I perform in my role fall into the practice of medicine. I have to admit that I do not formally utilize or adhere to a particular nursing theory in my current practice. I know, I admitted it and I could just hear my nursing professors growling in disappointment right about now. However, many of my medical decision-making are highly influenced by my nursing background and knowledge of theories of human responses to illness, stress, and human ability to cope which I learned in nursing school.

Since you asked for a personal opinion, the above is what I can offer as far as your question. Some may agree or disagree.

[forpath]

Originally Posted by Tammy79, RN

Is prescribing medication, as an example, a function that is exclusive to medicine? When a M.D./D.O. gives a prescription it is well established that this is practicing medicine; when a dentist does the same it is the practice of dentistry.

I know that practicing medicine without a license is a crime. I also know that I can't lend someone else my driver's license so they can drive a car, just like probably an NP can't work under the license of an MD as much as rules specify and call for collaboration in the form of supervision and/or protocols. I also know there are vast differences between nursing theory and models versus the medical model.

So, from a professional and technical perspective, when a NP prescribes, is it a function of advance practice nursing or is the APN considered to be practicing medicine?

Just curious on your thoughts.

-T

One question, which I think relates directly to this topic, is what journals do NPs/DNPs read to stay up on the latest diagnostic/therapeutic advances? The Journal of Advanced Nursing (I flipped through a few month's worth) did not seem, at least to me, to have much practical stuff that would help the busy NP/DNP. Are there others out there that I don't know about? I would love to hear about some.

[traumaRUs]

To answer the OP's question, I too think that I practice medicine far more than nursing...that said, I utilize my nursing experience daily in order to make decisions that then lead me down the road to practicing medicine.

forpath - I'm in nephrology so I read specialty journals. I did once subscribe to an APN journal but since it wasn't specialized, I didn't get the info that I needed.

[pinoyNP]

Originally Posted by forpath

One question, which I think relates directly to this topic, is what journals do NPs/DNPs read to stay up on the latest diagnostic/therapeutic advances? The Journal of Advanced Nursing (I flipped through a few month's worth) did not seem, at least to me, to have much practical stuff that would help the busy NP/DNP. Are there others out there that I don't know about? I would love to hear about some.

The best way to go about finding the most authoritative and up-to-date information on patient management is to look through the pages of Tier 1 Medical Journals such as The New England Journal of Medicine and The Journal of the American Medical Association. Like traumaRUS also pointed out, some peer reviewed specialty journals are also excellent resources as far as medical management in specialty fields. I would also like to point out that just because these are journals that represent the medical profession doesn't mean that only physician-generated articles and research are published. Many of the articles approved for publication in these highly respected journals actually involve the work of a multidisciplinary team of health care professionals including non-physician providers such as nurse practitioners.

It may also come as a surprise to some that many of the well-respected nursing journals are also referenced and read by medical professionals because they actually appear when an Ovid/Medline search for an article is performed. For instance, not too long ago, one of the intensivists at work distributed copies of an article on Airway Pressure Release Ventilation published in a critical care nursing journal so that resident physicians during their ICU rotation can familiarize themselves on this emerging mode of mechanical ventilation.

[jjjoy]

In my opinion, most NPs practice medicine. I'd consider nursing practice to be those things that assist the patient in dealing with their disease - eg determining the most appropriate treatments for symptom management - as opposed to prescribing meds to cure the ailment - eg antibiotics. Yes, there's overlap there... as in dentists prescribing meds practicing dentistry or medicine? Presumably the dentist will keep their practice only on dental-related issues and refer other issues to an MD as opposed to treating it themselves - even if they know exactly what it is and what should be done. The more widely accepted definitions of nursing tend to *exclude* diagnosing and treating disease directly while describing activities to assist the patient in maintaining a quality of life and avoiding preventable deterioration.

If nursing truly wants to have its own domain (eg assisting patients in getting through and/or living with disease processes) then it can't try to claim all roles someone with a background in nursing might take. Thus, a nurse might do well functioning as a 'physician extender' diagnosing and treating disease processes, but they are not practicing nursing. If they then go on to develop a plan of care to cope with the disease process (eg antiemetics and pain control in a cancer pt), then they would be practicing nursing. Perhaps, then, an MD who takes up such care could be said to be crossing over into the realm of 'nursing care'?

My thoughts aren't well developed here, but just some thoughts on defining the differences between 'practicing nursing' and 'practicing medicine.'

[Joan Z]

I think of medicine as dealing with disease; nursing is dealing with response to disease. I like to think that as an NP I will be practicing health management. The domains are pretty blurred. I am concerned legally and usually say what I do is described by my license and by the state BON.

[christvs]

I will be soon practicing as a Hospitalist NP and when I shadowed 2 of the current Hospitalist NPs I could see quite clearly that they were practicing medicine, in my opinion. I think this because they spent their time examining patients, ordering diagnostic testing and labs, prescribing meds, and admitting patients in the ER and writing their admission orders. However, that being said, I do agree with others who have responded to this post: I think that I will be mostly practicing medicine as a Hospitalist NP, but also I will be using my nursing background to help me consider all the needs of my patients (emotional, psychosocial, spiritual) and not just focus on trying to "cure" them all as fast as possible. I am the kind of nurse who loves taking the time to answer patients' questions, address their concerns, give support, and I like to think of this as my nursing side. So this is how I believe I will be practicing as an NP-both medicine and nursing.

[JDCitizen]

Originally Posted by christvs

I will be soon practicing as a Hospitalist NP and when I shadowed 2 of the current Hospitalist NPs I could see quite clearly that they were practicing medicine, in my opinion. I think this because they spent their time examining patients, ordering diagnostic testing and labs, prescribing meds, and admitting patients in the ER and writing their admission orders. However, that being said, I do agree with others who have responded to this post: I think that I will be mostly practicing medicine as a Hospitalist NP, but also I will be using my nursing background to help me consider all the needs of my patients (emotional, psychosocial, spiritual) and not just focus on trying to "cure" them all as fast as possible. I am the kind of nurse who loves taking the time to answer patients' questions, address their concerns, give support, and I like to think of this as my nursing side. So this is how I believe I will be practicing as an NP-both medicine and nursing.

Practice medicine? Its all in the eyes of the beholder. As a NP I am allowed to diagnose, order test, interpret test, order medications, etc...
Am I practicing medicine or advanced nursing???

The way one gets to practice is directly controlled by the one writing the paycheck. Ones ideals of of exactly how it should be/could be will be warped by necessity.

I practice advanced nursing in a world governed by medicine.

Vague explanation I know; sorry....

[hypocaffeinemia]

This totally depends on how you define practicing medicine. The party line is that NPs practice advanced nursing, but common sense indicates there is a substantial overlap in scopes of practice between practicing medicine and practicing advanced nursing.

Of course, there's substantial overlaps in areas such as optometry and ophthalmology, dental surgery and ENT surgery, and podiatry and foot and ankle orthopedic surgery as well. I guess if we say such specialists practice optometry, podiatry, and dentistry, respectively, instead of practicing medicine the same should be said for NPs. The confusion comes from the fact NPs often share the exact same job roles as PAs who do practice (supervised) medicine, so it all comes down to how you define medicine.

If you go with a specific definition of medicine, you can argue against it, but if you go for a less anal and more generalized definition, then you can argue for it.