I often receive a comment that, while meant as a compliment, annoys me to no end: “You’re so smart… why aren’t you a doctor?” Since people don’t really want to have a stupid nurse, it’s not that they are bashing nurses… they just don’t understand. Most people view healthcare as a hierarchy with doctors at the top and nurses beneath. This is further complicated by some of the language of healthcare: doctors give orders and nurses carry them out. It’s easy to understand why so many people think that the doctors are the nurses’ bosses. However, except in small medical clinics, nurses don’t work for doctors; they work with them.
There are differences between the field of medicine and the field of nursing. These differences are very important for knowing which medical professional you want to speak to about specific concerns. And, if you’re trying to decide between medicine and nursing as a career, it’s extremely important to understand these differences. (You wouldn’t want to spend years in medical school only to find out your degree doesn’t let you interact with your patients in a way that appeals to you!)
What Do Doctors and Nurses Have in Common?
Before we look at the differences, let’s consider what doctors and nurses have in common. We have the same patients and the same goal: we want the patients to get well. We work as a team to accomplish this goal.
In some hospitals, the nurses and the doctors work somewhat independently of the other. When I worked in a large teaching hospital, the attending doctors did not usually work with the patients on the floor, so they rarely interacted with the nurses. The interns and residents would do their assessments of the patients and submit their orders… occasionally they would ask the nurses for input, but normally they would just read their notes in the chart.
In other hospitals, notably small community hospitals, the lines between the roles of the doctor and nurse blur somewhat. The doctors are more present on a day to day basis and treat the nurses more as colleagues than just people who happen to work for the same hospital. These doctors tend to know a lot more about their patients as people, not just as diagnoses or conditions, and it shows in the amount of time and care they spend with their patients. However, in general, the differences that follow hold true.
(Note: Nurse Practitioners are a unique breed unto themselves, performing the role of the doctor with the mindset of the nurse.)
The Role of the Doctor
Doctors, for the most part, focus on illness, diseases, diagnoses, and conditions. They may see the patient for up to 20-30 minutes each day, and are available to the nursing staff by phone if the patient’s condition changes markedly. During that 20-30 minutes, the doctor is looking at the most critical issues facing that patient and deciding how best to deal with them. They diagnose (or at least try to diagnose… it’s trickier than it seems) what is causing those issues and try to fix the causes, if they can.
In order to do this, they write “orders”: for medications to treat the patient’s symptoms or underlying illness; for lab tests or diagnostic imaging to either attempt to determine an accurate diagnosis or monitor the effects that treatment is having on the progress of the disease; for treatments, such as wound care, special diets, or activity levels; and for consultations with other specialists, such as physical therapy, speech therapy, or occupational therapy.
The Role of the Nurse
Nurses, for the most part, focus on wellness. While the doctor attempts to diagnose a specific condition, nurses diagnose the effects the condition is having on the patient and design plans of treatment to help bring the patient back to his or her highest possible level of wellness. This requires time spent with the patient, but nurses have that time. While the doctor may get, at most, 30 minutes each day with a patient, nurses have him or her for the other 23 hours, 30 minutes!
During that time, nurses work to keep the patient safe and comfortable. Nurses administer the medications that the doctors order, but they also educate the patient (or family members) about the medications: what they are used for, how they work, what side effects they need to be aware of, etc. They also administer other treatments, depending upon the size of the hospital and how many other ancillary staff there are available. In smaller facilities, nurses may administer treatments that are normally delegated to respiratory therapists, physical therapsits or wound specialists.
Nurses don’t just blindly follow the “orders” that doctors give them, however. When administering any type of treatment that the doctors order, nurses work hard to anticipate and prevent any problems that the treatment might cause. For example, certain medications can cause the patient to be dizzy. Even though the patient may normally have no problems with getting up and around, the nurse is aware of this side effect and ensures the patient’s safety by making sure that there is always someone to assist the patient when he or she needs to get out of bed.
Nurses anticipate other risks to their patients as well, always looking for ways to minimize their effects. If a patient is bed-bound, the nurse knows that this causes a risk to the patient’s skin. The nurse will, therefore, turn the patient frequently from one position to another in order to minimize the amount of time that any one body part has pressure placed upon it. The nurse will also inspect the body frequently to ensure that there are no signs of impending skin breakdown. If there are, he or she will notify the doctor in order to get orders to treat the area.
Nurses also pay close attention to the effects that medications and other treatments have on their patients. Any medication or treatment can have unexpected (and unwanted) effects upon the patient and it is the nurse, not the doctor, who is available and watching to see if any such effects are beginning to occur. There are some things that a nurse can do immediately upon witnessing such effects, and as always, the doctor is available by phone if the nurse needs further orders.
Nurses have specific skills in performing procedures that allows certain treatments or tests to be done. For example, if a patient requires intravenous medications or fluids… the nurse needs to insert an IV. Similarly, nurses may insert nasogastric tubes, foley catheters, and a number of other devices that allow treatment to proceed. As always, the nurse is watching how these procedures or devices do or might effect the patient. He or she may request further orders from the doctor to deal with these potential or actual effects, such as sucrose for pain control for an infant receiving an IV line.
Nurses are patient advocates. With their greater contact and levels of communication with the patient, the nurse often has an understanding of the patient’s needs during and after their hospital stay that the doctor does not. Based upon this knowledge, the nurse advocates for the needs of his or her patient with the doctor, other nursing staff, case management, insurance companies, other departments of the hospital, etc. Nurses work with the doctor to ensure that the treatment plan ordered is based upon the individual patient’s strengths and needs.
Nurses are patient educators. They help patients to learn about their specific illness or condition. They teach patients and their families about specific warning signs and symptoms and what to do about them, or when to notify the doctor (or come to the hospital!) They teach specific skills to help the patient be as autonomous as possible, such as how to self-administer insulin or lovenox. They also teach critical thinking skills to help patients and their families build on the strengths they already possess and find solutions to any problems they may be dealing with.
Nurses are also skilled in the psychosocial aspects of health care. They build a relationship with the patient that allows the patient or family members to express their concerns, fears, and hopes within a nonjudgmental environmen. It is this relationship with the patient that draws most nurses to nursing. The satisfaction gained when a patient not only regains their health, but verbalizes a new level of acceptance/coping with the way that their disease is affecting their life is one of the greatest rewards a nurse can receive.