Quote from RN4NICU
Nursing is holistic and focused on health whereas medicine is problem-based and focused on illness. Nurses are also charged with protecting the patient (if need be) from medical incompetence. No longer can a nurse have "MD orders" to fall back on - there is a responsibility to know and understand whether what is ordered will benefit or harm the patient. That is why nurses are EDUCATED and not TRAINED. That is why we are PROFESSIONALS and not TECHNICIANS.
Docs do not like this. They like to feel all-powerful. They expect to write an order and have nurses falling all over themselves to carry it out. They get defensive and pouty when nurses question their almighty wisdom (even if they are not as wise as they like to think they are). Not all docs are like this, of course - the best of them welcome input from nursing and value the professional nurse's assessment and opinion - but many docs do not like to admit that nursing even has a scope of practice, much less that nurses can exercise independent judgement about what is best for the patient: hence- the medicine vs. nursing battleground.
The above paragraph is so loaded that it is hard to figure where to begin. There is obviously an inferiority complex underlying this issue, otherwise nobody would feel the need to make statements such as the one above.
I believe that is the reason for the development of the nursing vs. medicine debate. In the traditional health model, nurses are below physicians, but "nursing theory" has evolved in order to give nurses a rationale for claiming that there is no subordination, just a difference. Rather than physicians being better educated and more advanced, the two are just different. This gives rise to semantical arguments such as "education" vs. "training", and "professional" vs. "technician", in an attempt to derive some superiority over other professions while simultaneously claiming to be on par with physicians in that both are educated professionals. People claim that nurses and physicians shouldn't be compared because they are different, but then they go and compare nursing to other professions to show that they are better. You can't have it both ways.
I believe this stems from years of maltreatment of nurses by physicians. Nurses got tired of going to school to be dumped on, and so they made a move away from medicine. Doctors make claims to knowledge, so nurses frequently make claims to "caring about the whole person", and some try to imply that the diagnosis and treatment of disease precludes a hollistic approach. I believe that the nursing model has developed in response to the conflict with medicine as opposed to any great ideological divide, or a legitemate historical claim to nurses using a different approach, and as such, the difference is once again semantics over substance. The Medicine/Nursing relationship has moved from one that was authoritative to one that is widely considered to be collaborative.
I think that "collaborative" is a good word to describe the relationship. Most nurses do not work for doctors. Both professions work together to provide care. Nurses have the duty and the obligation not to be complicit in providing treatment that would harm a patient. However, I think the burden on any nurse who decides not to execute a physician's order is fairly high. Refusing to provide treatment for a patient based on a physician's order because the nurse doesn't feel that is the best treatment is not a valid reason. That is a medical decision, and if you want to make those sorts of decisions, it is time to go to medical school. In order to withold prescribed care, the treatment must likely be harmful to a patient.
I am, quite frankly, worried that the practice of medicine will largely grow to be contingent on nurses giving their stamp of approval to every treatment before they carry it out, or else they will just refuse to do it. The intrinsic problem with this is that doctors and nurses are not on the same level with regard to education, even if they are both professionals. A physician's knowledge may make him comfortable with a treatment, while a nurse would not be comfortable because of a knowledge gap. You might say, "just let them do it themselves", but if you say that too many times, you quickly argue your profession out of the rationale for its existence- to implement prescribed treatments. I would support regulations that would release nurses from the burden of having to determine if a treatment is medically appropriate, since so many of you seem to be concerned about liability issues.
Let the flaming begin...