Practice of Nursing vs Practice of medicine

VORB · Jun 16, 2009

I would agree with you, except that nurses operate only under the order(s) of a medical doctor. While a nurse may be able to make decisions within their scope of practice, it is always within those parameters previously defined by someone licensed in medicine. [As a nurse, you may be able to choose between two different pain meds for a patient, but you may not order them for the patient.] Though sometimes seemingly a gray area, that is not a matter of simple semantics. I know a court of law would not think so. Even when a flight nurse seemingly operates outside his scope of practice, he is doing so under the license of an M.D., and following his or her orders - whether standing orders or otherwise.

Whispera, MSN, RN · Jun 16, 2009

An advanced practice nurse does not operate under the orders of an MD. He or she writes orders and I think a CRNA would decide the meds without doctor input too. The line between advanced practice nurse and MD is surely quite gray.

JustMe · Jun 16, 2009

Yes, the lines between medicine and nursing are grey. But there are areas of distinction. Why is a patient admitted to a hospital? Because they need nursing care. Which professional is at the bedside 24/7 and which one makes a 5 minute visit per day? Nurses used to run the hospitals back in the day. Nurses used to deliver all the babies. It was when doctors (men) became more powerful that nurses (women) fell to the "position" of physician's handmaiden.

I think that when we understand the history of nursing and medicine that we understand the distinction. The lines are grey of course. There are tasks that cross lines just as there are tasks that cross lines within the nursing profession (i.e. RNs can insert foleys as well as LVNs).

As to the term "doctor" for a nurse: would you not refer to a university professor as anything but "doctor"? Anyone who attains that distinction should be able to use their title. It can be confusing if the doctoral nurse practices at the bedside, but most of them don't; they teach and do research. I'm more concerned about our society's propensity to think of men as the "doctors" and women as the "nurses". I work with male RNs and female MDs but they are often mistaken just because of their gender.

Nursing and medicine will continue to evolve as the technology advances. Watch what we will do in the future!

Just my :twocents:

2BSure · Jun 16, 2009

I am just getting stared down the Nursing career path but noticed some controversy over nurses who obtain terminal (doctoral) degrees in nursing being referred to as Doctor. while I understand that scope of practice is very important for everyone involved in patient care, the terms practice of nursing and practice of medicine are simply symantecs! We are all practicing "medicine". I just have a hard time with the boundaries we draw to protect egos. a CRNA performing anesthesia is practicing nursing but an anesthesiologist doing the exact same procedure is practicing medicine. What a load!

I agree about ego protection being a bit much.

It will be extremely interesting to see where we are in about 20 years with all of this.

RNperdiem, RN · Jun 16, 2009

Just read some of the threads about CMA's calling themselves nurses and you will understand the MD point of view.

Ego, image and turf boundaries do matter no matter how much we deny that they don't.

llg, PhD, RN · Jun 16, 2009

I have a PhD in nursing -- and have never taken a medical course in my life. I am an expert at nursing, both in its clinical practice at the bedside within my specialty and also as a teacher and researcher. My practice, teaching, and research are all based upon and within the discipline of NURSING ... and while I borrow non-nursing concepts from a wide variety of other disciplines (psychology, sociology, anthropology, biology, medicine, philosophy, etc.), I have never practiced as anything but a nurse.

When asked what I do for a living, I say, "Nursing." I would have no reason what-so-ever to say "Medicine."

llg, PhD, RN

keithjones · Jun 17, 2009

It just comes to mind, how many times has a nurse caught a doctor's med error and saved a life. In these cases it is the nurse's medical knowledge (limited as it may be compared to a MD) that saves the patient. Also notice how DR. title is already conferred on first year residents who need nurses to train them on even basic procedures. Who would you rather treat you a 20 year APN veteran or a Resident?

llg, PhD, RN · Jun 17, 2009

It just comes to mind, how many times has a nurse caught a doctor's med error and saved a life. In these cases it is the nurse's medical knowledge (limited as it may be compared to a MD) that saves the patient. Also notice how DR. title is already conferred on first year residents who need nurses to train them on even basic procedures. Who would you rather treat you a 20 year APN veteran or a Resident?

In the above med-error example, you are confusng "medical knowledge" with "pharmacology knowledge, physiology knowledge, etc." Not everything related to bodily functions is "medical knowledge." Like nursing, medicine is a practice discipline that utilzes the knowledge developed by scientists in a variety of other disciplines, such as pharmacology, biology, physiology, etc. Since all healthcare disciplines share the use of some of that basic knowledge, there are overlaps in the facts that we use as we engage in our practice. However, each disciplines uses those facts differently and has a practice with a unique focus. It's those differences that distiguish us from each other and define the various disciplines. I can administer oxygen, too, but that doesn't make me a respiratory therapist. I can look at the stars and identfy the Big Dipper, but that doesn't make me an astronomer. I know the basic parts of an atom, but that doesn't make me a physicist. etc. etc.

If your point is that all health care providers share some of the same basic factual knowledge about the human body and condition ... well then ... of course we do. But that doesn't make it "medicine" because medicine does not "own" all that basic science knowledge. In fact, much of it was not even developed by physicians, but rather by basic science researchers in biology, chemistry, physiologists, pharmacologists, etc.

elkpark · Jun 17, 2009

It just comes to mind, how many times has a nurse caught a doctor's med error and saved a life. In these cases it is the nurse's medical knowledge (limited as it may be compared to a MD) that saves the patient. Also notice how DR. title is already conferred on first year residents who need nurses to train them on even basic procedures. Who would you rather treat you a 20 year APN veteran or a Resident?

Nurses catch physicians' errors now and again, same with pharmacists, and nurses and pharmacists catch each others' errors, etc., etc., etc., because no one is perfect and we all work together as a team. Each discipline brings something different, necessary, and special to the party, and "the whole is greater than the sum of its parts," as the saying goes.

The title "Dr." is "conferred" on first year residents because they have completed their medical degree, passed their licensure exams, and are licensed physicians -- the title is earned, not "conferred." In the same way, new grad nurses who have passed the NCLEX and been licensed appropriately use the title "RN" even though they know comparatively little about nursing and still need supervision and assistance from more experienced colleagues to grow and succeed professionally -- often, it is the LPNs and CNAs (the people who are "below" them professionally) who help them get through a shift and grow as RNs.

I've been in nursing for a few decades now, and an advanced practice nurse for the last 15 years. I've had positive, collegial, productive relationships with colleagues both "above" and "below" me (professionally speaking) over all the time (with a few colorful exceptions! :)), and have been treated with courtesy and respect by most of my coworkers of all disciplines (again, with a few colorful expections, haha). Frankly, I just don't see the point of all the people here on allnurses (it seems to typically be students, often male students, and/or newer graduates, but that's just an anecdotal observation) who get all worked up about relationships between nurses and physicians, titles, who gets the most respect, who treats who better, who knows more, who's "better" than who, etc. Most of the nurses and other healthcare professionals I know "in real life" are too busy doing their jobs to worry about this stuff. Respect is earned. If you conduct yourself as a responsible, competent professional, the vast majority of your colleagues will treat you that way.

And I agree with what my buddy, llg, said (hey there, girlfriend!) -- in clinical practice as a child psych CNS, much of what I do overlaps and appears (to the untrained eye, haha) indistinguishable from what psychiatrists, psychologists, and social workers do. There are some aspects of the work that I do better than them, and some aspects that they do better then me. But I am definitely practicing psychiatric nursing; NOT medicine, NOT psychology, NOT social work. If I wanted to practice medicine, I would have gone to medical school.

Helping each generation of "newbies," of all disciplines, grow and learn is a professional responsibility within healthcare (for all of us). This is the way professional education has always worked. It's an integral part of all of us working together to provide good client care. Someone who really has a problem with this concept might not be v. happy in nursing. People who really want to practice medicine should probably go ahead and go to medical school -- they are probably not going to find nursing a v. satisfying career.

I think it's a shame that nursing education programs now seem to do very little to convey to students the full scope of what "nursing" entails -- carrying out physician orders is only one part of what nurses do, and, depending on what specialty area you choose, much of what you do in the course of a day may be entirely independent of physicians. Nurses work alongside physicians, not "under" physicians, and there is a great deal more to the differences between practicing nursing and medicine than "semantics" and egos.

llg, PhD, RN · Jun 17, 2009

I think it's a shame that nursing education programs now seem to do very little to convey to students the full scope of what "nursing" entails -- carrying out physician orders is only one part of what nurses do, and, depending on what specialty area you choose, much of what you do in the course of a day may be entirely independent of physicians. Nurses work alongside physicians, not "under" physicians, and there is a great deal more to the differences between practicing nursing and medicine than "semantics" and egos.

Love that post.