MD vs RN

  1. This is the bottom line:

    MDs troubleshoot, diagnose and treat a pts medical problem (i.e., CHF).

    RNs troubleshoot, diagnose and treat a pts problems regarding care (i.e., how will this person with CHF use the toilet).

    When a person is sick--sick enough that they can't care for themselves--they have to have a nurse to provide that care. That is what a nurse does; that is our profession. We provide direct care, medication administration, pt education, and rehabilitation.

    The modern health care paradigm requires both MD and RN. When the modern healthcare paradigm falls apart, such as in some African countries, nurses ultimately become more useful than MDs. Then when the nurses all leave or die off, it reverts back to a "wild" caveman system of health care (see the NY times article today on the exodus of nurses from Africa).

    MDs cure people.
    Nurses care for people.

    There is no debate.

    MDs have NPs and PAs, allied healthcare workers and IAs as assitants--and thank God for them.

    Nurses have LPNs, IAs, CNAs, PCAs, housekeepers, laundry workers, and cooks for assistants--and thank God for them.

    Some MDs think that nurses are sub-doctor; they are idiots, because nurses are not MDs at all. We occupy the other side of the health care coin. And let's face it: most nurses are just as arrogant and consider what they do to be more important than what MDs do. But the two fields are completely different professions.

    Nurses should not seek to increase their status by becoming more like MDs. They should seek to provide more efficient and effective care for debilitated patients.

    When I call an MD because a pts cardiac rhythm has changed. I tell him/her the VS, the EKG interpretation, what the previous stips have read, the recent lab values (esp. K+) and the symptoms the pt is experiencing. I don't tell the MD "My patients potassium is low, she needs to go on the K+ protocol." It's not my job to tell the physician that, and I'm out of bounds if I do. It is the physicians job to tell me that. Implementing the potassium protocol is my job. It is not my job to dx a cardiac condition r/t low potassium, and frankly, I would be offended if a dietician came up to me and told me: "The patient is due for her potassium IV." So why would I do the same thing to an MD?

    I call MDs "sir, ma'am or Dr." But then I also call the houskeepers "Sir or Ma'am" And when my patient comes back from an x-ray and I call for a late lunch tray, I show more servile respect and undeserving gratitude to that kitchen worker on the phone than I ever show to MDs (But I should show MDs the same respect, and I'm working on that.)
    Last edit by OneRN on Jul 14, '04
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  2. 11 Comments

  3. by   zenman
    Very good. Just add that nurses help patients heal.
  4. by   Dixiedi
    Very well put with but one correction (IMHO), RNs and LPNs (all nurses) have IAs, CNAs, PCAs, housekeepers, laundry workers, and cooks for assistants--and thank God for them.
  5. by   OneChattyNurse
    Quote from dixiedi
    very well put with but one correction (imho), rns and lpns (all nurses) have ias, cnas, pcas, housekeepers, laundry workers, and cooks for assistants--and thank god for them.

    i caught that too. i am not here to start an rn vs lpn debate, i just want to be recognized as the nurse that i am!
    Last edit by OneChattyNurse on Jul 13, '04
  6. by   TMPaul
    Quote from OneRN
    This is the bottom line:

    MDs troubleshoot, diagnose and treat a pts medical problem (i.e., CHF).

    RNs troubleshoot, diagnose and treat a pts problems regarding care (i.e., how will this person with CHF use the toilet).

    When a person is sick--sick enough that they can't care for themselves--they have to have a nurse to provide that care. That is what a nurse does; that is our profession. We provide direct care, medication administration, pt education, and rehabilitation.

    The modern health care paradigm requires both MD and RN. When the modern healthcare paradigm falls apart, such as in some African countries, nurses ultimately become more useful than MDs. Then when the nurses all leave or die off, it reverts back to a "wild" caveman system of health care (see the NY times article today on the exodus of nurses from Africa).

    MDs cure people.
    Nurses care for people.

    There is no debate.

    MDs have NPs and PAs, allied healthcare workers and IAs as assitants--and thank God for them.

    Nurses have LPNs, IAs, CNAs, PCAs, housekeepers, laundry workers, and cooks for assistants--and thank God for them.

    Some MDs think that nurses are sub-doctor; they are idiots, because nurses are not MDs at all. We occupy the other side of the health care coin. And let's face it: most nurses are just as arrogant and consider what they do to be more important than what MDs do. But the two feilds are completely different professions.

    Nurses should not seek to increase their status by becoming more like MDs. They should seek to provide more efficient and effective care for debilitated patients.

    When I call an MD because a pts cardiac rhythm has changed. I tell him/her the VS, the EKG interpretation, what the previous stips have read, the recent lab values (esp. K+) and the symptoms the pt is experiencing. I don't tell the MD "My patients potassium is low, she needs to go on the K+ protocol." It's not my job to tell the physician that, and I'm out of bounds if I do. It is the physicians job to tell me that. Implementing the potassium protocol is my job. It is not my job to dx a cardiac condition r/t low potassium, and frankly, I would be offended if a dietician came up to me and told me: "The patient is due for her potassium IV." So why would I do the same thing to an MD?

    I call MDs "sir, ma'am or Dr." But then I also call the houskeepers "Sir or Ma'am" And when my patient comes back from an x-ray and I call for a late lunch tray, I show more servile respect and undeserving gratitude to that kitchen worker on the phone than I ever show to MDs (But I should show MDs the same respect, and I'm working on that.)
    Some nurses, by that I mean Nurse Practitioners, do what a MD does. I do not, however, consider myself an MD. I am and always will be an Advanced Practice Nurse.
  7. by   NP2BE
    why do you feel the need to compare? insecure about being a nurse? sheesh. How many threads are we going to have on MD vs RN. Its like a a 6 year old at the playground saying "rn is better rn is better wah wah wah wah"
  8. by   sharann
    I co-manage the patient with the MD. Today I called a Peds surgeon to clarify his incorrectly written order of Valium 5cc's for spasms (No ROUTE, DOSE)q 6 hours. After he apologised for forgetting the route (PO), I requested some Valium IV for the girl who needed it in PACU and was not on PO's yet. He said sure give her 5mg IV. I said "How about 1.25mg IV UP to 5mg as needed?" He said "that sounds great!". I also ask for K-riders and I CAN diagnose a low potassium...by interpreting the lab values.
    I respect most of the doctors, and they give me respect as well, for being an advocate for OUR patient and for showing him/her that I am not questioning them, but giving competent safe care to OUR patient. I love bedside nursing and if I had an advanced degree I would go into teaching clinical skills and critical thinking. That's nursing, plain and simple. The care and healing just naturally goes along with it in my opinion.
  9. by   nurseunderwater
    Nurse turned pre-med student.....

    Polarization doesn't help anyone. There are always a**h**** in every postion and every level. On the up side, there are those of us who "ROCK" and are fun to be around in general....

    From the let's play nice together team,

    XXOO
    Kate
  10. by   Tweety
    I don't overstep my bounds when talking to a physician. However, I would say "the patient's potassium is 2.5 and we have a protocol are you interested in me using that?".

    Asking the MD for what you need is part of the collaborative process.

    If I know phenergan relieves a patient's vomiting in the past why call an MD and say "the patient is vomiting" and have her order reglan. Why not say "I've taken care of this patient on previous admissions and phenergan works well, are you interested in ordering that?" I certainly wouldn't call and say "the patients vomiting and you need to order phenergan".

    I am the docs eyes and ears, and part of caring is being a patient advocate. I don't think that's arrogance or nursing trying to be doctors.

    Excellent post btw, respect for all persons in the process of caring for the patient is very important.
    Last edit by Tweety on Jul 14, '04
  11. by   OneRN
    Quote from Dixiedi
    Very well put with but one correction (IMHO), RNs and LPNs (all nurses) have IAs, CNAs, PCAs, housekeepers, laundry workers, and cooks for assistants--and thank God for them.
    I'm not going to turn this into an LPN vs RN discussion, but you are misinformed on the roles of the LPN. LPNs are the first line assistant to the RN. However, in LTC, I must admit, the roles are very similar between the RN and LPN.
  12. by   OneRN
    Quote from TMPaul
    Some nurses, by that I mean Nurse Practitioners, do what a MD does. I do not, however, consider myself an MD. I am and always will be an Advanced Practice Nurse.
    Most of the orders I need for my patients come from NPs. I am eternally grateful. But the NP, IMO, is no longer a nurse (obviously not a view shared by the greater nursing profession) If they were, then all nurses should strive to be NPs. But the education is too long and difficult for NP, therefore it would be impossible for that to workout in the healthcare paradigm. It's the same thing as suggesting that we do away with nurses altogether and everyone becomes a doctor. An NP is not an MD, but then they don't really do the job of a nurse either. However, they derive their status from being an AP RN, IMO.

    Like I said before, though, thank God for NPs!
  13. by   missmercy
    Quote from Dixiedi
    Very well put with but one correction (IMHO), RNs and LPNs (all nurses) have IAs, CNAs, PCAs, housekeepers, laundry workers, and cooks for assistants--and thank God for them.
    I sure understand where you are coming from -- however, in our state, the nurse practice act (as it applies to acute care settings) does put the LPN in a role to function with an RN directing the care of the patient. I know LPNs who have more experience and knowledge under their belts than I will ever have and believe me -- I thank God for them!!! But the nurse practice act seems to be a huge thing here and according to our "nurse practice act expert" an LPN has to have direction from an RN.:uhoh21:

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