What's the difference between medicine and nursing?

[Livinstrong85]

I was reading a post recently where several people seemed to be agitated that someone called something in nursing "medical." I understand the fields are different, but really, are they THAT different from each other? You are both providing clinical care to a patient. Nurses spend more time with the patient and provide a lot of the direct care, but other than that, what's the huge difference?

[GilaRRT]

*** I don't know about where you work but in the hospitals I have always worked at nurses practice medicine by proxy all the time. I have always worked in teaching hospitals. Our interns and residents will ask us "what do you want", or "hmmm, what do you usually do", or "what would you suggest" or "what do you think we should do". In the ICUs I have worked at we take it for granted that we always know exactly what it is we need ordered before we call the physician, especially if it is a covering physician who doesn't really know the patient. When we call or have a physician at the bedside to deal with a problem, or during rounds we are fully expected to offer suggestions. They are not always followed but if not we get an explanation why not. In code and emergencies our word goes. We ICU nurses deal with dozens of codes a year over many years of a career, the on call resident may see 2 or 3 codes while s/he is on call for the few years they are in residency. There are there to learn, not run the code.

I think the quote was a response to some "interesting" CHF management suggestions.

[vindy]

Nurses and DO's perform holistic care...MD's perform allopathic care

[Rexie68]

Doctors carry pagers. Nurses do the paging. I once came up with why that was really profound, but I'm not in the mood for profound right now and can't remember off the top of my head

I'm an RN on the IV team......and I carry a pager, as do many nurses these days!:)

[Rexie68]

to nerdtonurse: if you think that the few sentences in quotes you spouted off is something that you are qualified to do given your licensure and education level, i'm scared of you, and i'm more scared of any physician that would listen to any of what you said without examining the patient.

without commenting on the specific advice nerdtonurse gave, i do agree with her point that we're often the ones making "suggestions" to the doc when we call. in fact, the hospital i work in has implemented sbar for nurses to follow when we phone the doc....situation, background, assessment and recommendations. this is especially helpful for those 3am conversations!

[anggelRN]

Pts go to the hospital to receive nursing care...

[grandmawrinkle]

without commenting on the specific advice nerdtonurse gave, i do agree with her point that we're often the ones making "suggestions" to the doc when we call. in fact, the hospital i work in has implemented sbar for nurses to follow when we phone the doc....situation, background, assessment and recommendations. this is especially helpful for those 3am conversations!

and my point is that making suggestions or recommendations is not practicing medicine, which is the original point of this thread.

we have all had periods in our career when we will suggest medications based on knowledge of how disease processes are usually treated and our own patient assessment. i am personally not one of those that spouts off a dosage regime for the physician to copy into the chart. i am not the provider that did the complete history and workup on the patient and i don't know past events with the patient that might contribute to medication intolerances. that is why physicians do what they do, and why nurses don't do what physicians do. and why would you cheat your patient out of a physician assessment by telling them everything you want ordered before they even have time to give it a second thought?

if i was a medical provider, i would think it was very presumptuous and would be offended if a nurse called me for orders and laid out everything she wanted without asking what i wanted first and seeing if i was going to come evaluate the patient myself. i mean, who holds the right to diagnose/prescribe in that situation? it's not the nurse.

also imo it should be unnecessary to practice "medicine by proxy" in teaching hospitals. there is a physician in house available for concerns. why would you set yourself up for making huge errors by taking on the prescriptive role of the physician?

[traumaRUs, MSN, APRN]

The difference between medicine and nursing is subtle - yes they are different disciplines but both work together (or should work together) for the good of the pt.

I'm an advanced practice NURSE. I carry a pager, I assess, diagnose, treat and analyze the treatment/tests I've ordered. I consult with a physician when necessary.

Personally, for the most part, I like my job.

[Flying ICU RN]

Medicine determines the medical plan of care, Nursing implements it and provides a feedback loop!

Boy is my job easy!

[PMFB-RN, RN]

If I was a medical provider, I would think it was very presumptuous and would be offended if a nurse called me for orders and laid out everything she wanted without asking what I wanted first and seeing if I was going to come evaluate the patient myself. I mean, who holds the right to diagnose/prescribe in that situation? It's not the nurse.

Also IMO it should be unnecessary to practice "medicine by proxy" in teaching hospitals. There is a physician in house available for concerns. Why would you set yourself up for making huge errors by taking on the prescriptive role of the physician?

*** We do it because we are advocates for our patients and want them to have good outcomes. Of course it depends of who the physician is. If you are talking to an attending or 5th year resident who really knows what s/he is doing then my job is to provide a clear picture of what is going on and the problem and allow them to deal with it. On the other hand if the problem is, lets say reddened area under an abdominal fold, and the attending is a neurosurgeon who very like will have no idea what to order then I will just tell them what they should order.

I will give you an example. Last week I responded to a rapid response call from a med-surg nurse. Her patient had had a jaw resection. The attending doctor, and resident where all dentists. Her patient started to have ST segment elevation and chest pain. When I got there I found an attending dentists and 4 dental resident standing around outside the room talking amongst themselves but issuing no orders. After a quick assessment I walked up to them and recommended they consult the cardiology service and in the mean time I wanted to do X, Y, & Z. Is that cool with you? They look relieved that a person with experience with cardiac problems was there. The attending readily agreed to X,Y & Z and headed off to make the consult. I don't know how long it would have taken those dentists to take some positive action but they had already been there a while without doing anything to help the patient.

My bet is that every experienced RN on this board can tell many similar stories.

[Rexie68]

and my point is that making suggestions or recommendations is not practicing medicine, which is the original point of this thread.

indeed, you are correct that we don't practice medicine, as the physician has to give the orders.

and why would you cheat your patient out of a physician assessment by telling them everything you want ordered before they even have time to give it a second thought?

i suppose every facility has different expectations of their rns. the physician isn't assessing the patient unless i tell him i need him to come to the floor to do so (or during their routine rounds, of course) or if i am uncertain of my findings. certainly the doctor can decide that he would rather order something other than what i've suggested or to come assess the patient himself.

if i was a medical provider, i would think it was very presumptuous and would be offended if a nurse called me for orders and laid out everything she wanted without asking what i wanted first and seeing if i was going to come evaluate the patient myself. i mean, who holds the right to diagnose/prescribe in that situation? it's not the nurse.

again, our phone call to the physician follows sbar...and the doctor can always decide not to follow our recommendations, but 9 times out of 10 he is in agreement and very much appreciates the rn suggestions.

also imo it should be unnecessary to practice "medicine by proxy" in teaching hospitals. there is a physician in house available for concerns. why would you set yourself up for making huge errors by taking on the prescriptive role of the physician?

yes, there is a physician in house.....and that doctor is responsible for doing all patient admissions, dealing with any/all critical lab/xray/test results and responding to all pages. (i work in a 312 bed hospital). if the rn is uncertain in her assessment or has that "uneasy" feeling then that is what she tells the physician. the docs respond quickly when an experienced rn requests their presence. (and i have no problem, for example, asking the doc for lasix 40 mg iv push in a patient who is experiencing an acute exacerbation of chf). as previously stated, we are expected to make recommendations to the physician unless we are unsure or in need of a physician stat, such as if a pt is crashing. we are frequently the "eyes and ears" of the doc. it works for us, and, since we're not asking the doc to physically come to the unit to assess a patient every time we request orders, he responds quickly when we ask him to do so. (inexperienced rns are expected to consult with a more experienced rn before requesting orders.)

i'm sure every facility has different expectations of their nurses....this is just what works for us!

[grandmawrinkle]

Being a patient advocate also means ensuring that patients get an appropriate physician assessment before medications are prescribed (that is what I am talking about specifically -- nurses making med recommendations to doctors.) I believe if you don't do that, you are shortchanging your patient. I'm not arguing with you about the validity of the points you lined out above, PMFB. I think that you are thinking that I'm making a much broader point than I am.

[PMFB-RN, RN]

What's the difference between medicine and nursing?

*** $200k per year