I argue that nurse does not equal doctor even after 30 years of clinical experience, anymore than a doctor equals a nurse after 30 years of doctor experience. There are some who believe otherwise. It has been an excellent interaction, I think, even though I disagree with those who feel compelled to practice medicine without a license, and tell the whole world about how great they are at it.
My position is that for us to delivery great care to a patient we need specialists of all types. Doctors, nurses, respiratory therapists, wound care nurses, cath lab nurses and on and on and on. Clinical experience by one professonal group will never equate to certification status in another, no matter how many years of clinical experience you have or pockets of knowledge garnered during your life.
Great thread at Guitar Girl, and I have to say, that your initial comment was spot on.
ReplyDeleteMuch of the interaction in hospitals is stuff we all should have learned in kindergarten-- treat others with respect, what goes around comes around, etc.
I'm not sure the purpose of GG posting the vignette of how she showed up some intern twice in front of a patient, except maybe to add her magnanimous apology. Gads.
Some people simply should not work in a teaching hospital... and that goes as well for doctors being around nursing students.
Everybody has learned skills; a MD is not a nurse just like a nurse is not an MD. Either could learn the others trade. But neither of them have the same learned skills. It would be tough to perform a case with no RN's and just MD's.
ReplyDeleteI don't think that you're arrogant. You're just right. Sometimes being right makes you look arrogant.
ReplyDeleteI know this because I'm usually right. :-)
Why some nurses continue to insist that 2 years of nursing school is equal to 7 years of med school is beyond me. I've done nursing school. A turnip could pass nursing school. You'll have to tell me if a turnip could pass med school or not.
Anyway, you're dead on in what you said. We each serve different purposes. I couldn't do your job, you couldn't do mine. End of story. No clue why everyone is so annoyed about it.
Nurses who believe themselves to be equivalent to doctors in their scope of knowledge and believe that they are educationally equivalent and capable of being doctor on even ground are practicing medicine without a license.
ReplyDeleteNurses who believe they are great nurses for makings clinical suggestions and offering opinions are great fricken nurses.
There is a huge difference between being a great nurse and believing because one is a great nurse they are also a doctor. The assertion is ludicrous, any more than me saying I am a great nurse. I would fire myself if I was assigned responsibilities commensurate with a nursing degree.
Why is this so hard to understand?
I have to say that the hospitalists that I have worked with (very few as I work in the Heart and Lung building at my hospital) have not always been the nicest when I have called to politely suggest perhaps some hydralazine for the 200/100 BP or holding one of the TID doses of Lantus when a patient's BS was 42 (for overflow patients on my floor). It is very nice to see your comments and I just wished you worked at my hospital! (I have always equated hospitalist with dickish but now I have to take that back!) I also agree with MG as I don't think a nurse will ever be a doctor unless he/she goes to med school. I go insane when other nurses act like they know more than the MDs.
ReplyDeleteDickish=hospitalist. That has been my experience. But I kid...
ReplyDeleteYeah, I agree with you, HH. It's not only the length of education, it's the focus. But I don't think nursing school was a walk in the park. My class started with 65 and graduated 31 two years later, and we picked a few up along the way. One student quit the first day. Anyway, med school teaches critical thinking skills (or at least I hope it does), while that's not really the purpose of nursing school. I am not qualified to diagnose, nor do I want to.
ReplyDeleteI guess my experience with physicians is different from the other nursies here. I've had trouble with nasty docs, but they're almost always older. I guess they miss their glory days when we had to stand when they entered the room. And I've never been yelled at, ever, by doing an extra accucheck on a symptomatic patient.
TID Lantus? There's more problems there than a 42 bg.
ReplyDeleteMG- A turnip, eh? Your nursing school must be quite different than mine was.
I read with interest the extended comments section on the linked article and decided I was most likely to not get flamed if I responded on your blog.
ReplyDeleteI think that you are correct.
I started in health care as a nurse (RN), and am now in medical school (just finished MS1).
Having done both nursing school (at a top 25 university) and now medical school (top 25) I can tell you that the differences are monumental.
I can also tell you that I have 5+ years of med-surg and triage nursing under my belt and the belief that increased patient exposures as a nurse equals knowledge of medicine is commonly held among nurses. I can also tell you that once you experience the difference between what you learn in medical school and what you learn in nursing school it is apparent that this belief is wrong and it damages the nurse's credibility (and the earned trust) that are essential in successful team-building.
Your comments about these beliefs being dangerous are valid as well. While an attentive and smart nurse can identify mistakes and save a patient's life, there are many nuances to medicine that are way beyond the cookie-cutter templates, standardized order forms, or the PDA Rx programs. An unusual dose of medication should be discussed and double-checked, but that doesn't mean it's wrong. With new interns, perhaps triple check...but that doesn't mean it's wrong.
Thanks for your blog and thanks for listening.
the nicest when I have called to politely suggest perhaps some hydralazine for the 200/100 BP or holding one of the TID doses of Lantus when a patient's BS was 42 (for overflow patients on my floor)"
ReplyDeleteAberrant RN .. I think the problem here is that you feel compelled to provide the solution( hydralazine) and yeah that Lantus tid ( which certainly did not pass under the pharmacists radar) demonstrates the whole point
I'm looking to hire nurses that can do a doctors job for a nurses salary. I still haven't figured out whether you'll have to pay nurse's or doctor's malpractice insurance.
ReplyDeletekcalohagirl said
ReplyDelete"Why shouldn't the nurse offer a suggestion as to possible treatment?
Becuase there may be more than one choice and this rush to prescribe may not entirely be appropriate. Nurses who make these suggestions then get offended if their advice is not followed. My main question is with how much basic science education are you making your suggestions. Or do you think mere familiarity with use is sufficient expertise.suggesting colace is one thing. I once had a scoial worker( any science background there?) suggest ativan for a patient she "diagnosed " as withdrawing.So now you have the whole team momentum towards protocol based medicine which is what we constantly have to fight. Bad enough to have patients get information without context from the internet, now you have a smattering of trained health care workers assume that since they have been so close to the driver's seat, they MUST be as good drivers too.
HAHA....Love those comment from nurses such as this:..."holding one of the TID doses of Lantus when a patient's BS was 42...".
ReplyDeleteOh wow. Um, so you're a nurse and don't know that Lantus is only given once a day (in most Type 2 (also known as insulin resistant diabetes) diabetics, or at most twice a day (in a split dose) for many Type 1 (autoimmune diabetes) diabetics?
Also, why the heck would you withhold a BASAL insulin with no peak for a patient with a low BG? It has nothing to do with the treatment of the patient's low BG. Hello?
You would treat the low BG immediately, perhaps reduce or delay the rapid insulin (I.e. Humalog) until after the patient's next meal (if required to do so depending on follow up BG), and *ask the MD* about the possibility of *adjusting* the Lantus dose for the next while on a trial basis if the patient is having *constant* and repeated low BGs, especially when fasting.
It's not hard. No one is asking you to even know anything about the chemistry or kinetics of the drug.
Sorry, but Lantus is a very common basal insulin used all the time. A real nurse should know this.
And if you really are a nurse, that IS downright scary. It's when nurses like this one think support the "nurses can function in the same realm as doctors" ideology.
Bottom line, the smart nurses (some on here) know full well their limitations without question.
Nursing school is a cakewalk compared to an MD program. Anyone who has the intellectual and academic ability to be an MD could likely do a nursing program in their sleep and get 100%. No hyperbole.
To be an RN, you need 1 year of basic watered down science courses, including basic chemistry and "Microbiology for Nurses" (note that bio and pre-professional majors cannot take this course for credit). People who complain that these basic courses are "hard" could never even make it through *pre* med classess...
Then you have 2 years of nursing skills courses, with applied theory. You learn how to give baths, insert catheters, change dressings, do assessments, start IVs, meds, etc. Mostly technical skills.
Then you have 1 year of advanced nursing theory, which is really 'airy fairy' compared to what med students are doing in their later years.
That is a nursing degree in a nutshell.
You have NONE of the theory that MDs do. You are trained to act, not think, aside from a standard "critical thinking" imaginary flowchart. It's nothing against nurses, it's the limitations of your scope of training as a nurse. If you were meant to diagnose, treat, etc. you would have graduated with an MD.
All of that said, I know nurses are valuable. They do bedside care for the patient, they advocate for them, they educate them about post-op care, they do great nursing skills. And many advanced practice nurses (ICU, ER) are very knowledgeable and intelligent.
Nobody disrespects nurses other than when nurses disrespect themselves. And some of the comments made by "knowledgeable" nurses who don't have a clue at how little they know about medicine (because they're not trained in it) are downright scary. They may know a correct dose of a drug (or not), but this is a shining example of how little they know about how to USE that drug and why.
Some docs are clueless (try packing 4 years of insane amounts of material into your head), some are great. Same for nurses. What bothers me is that RTs, EMTs, interns, etc. usually know the limitations of their role. For some reason, nurses are prone to forget that important detail...
It's cliche, but if you really think you can do better all of the time than your typical MD, go back to school and become one. Obviously you're NOT happy as a nurse role, or you wouldn't be trying to always expand it.
Flame away
I'm going to nursing school in about 2 months fresh out of highschool. I'm 18 y/o STRAIGHT!!! male. This is gunnna suucccckkk..... At least i don't have it as bad as med students.
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