As I continue to monitor the movement toward advancing the NP profession, I can’t help but think we are going about this the wrong way. In the push to achieve higher levels of independence, nurse practitioner organizations are presenting NP’s as equivalent to physicians, the difference between the two professions often stated as a “Nursing Model” rather than a “Medical Model” approach to patient care.
In a recent CSPAN story, Susan Apold, board member of the American Association of Nurse Practitioners, was asked about the difference between nurse practitioners and physicians. She stated that nurse practitioners can diagnose, treat and prescribe medications similarly to physicians however “we also bring a nursing model to the patient care situation…we are taught to take care of the whole patient”. Similarly, a KevinMD feature “What is so special about a nurse practitioner?” written by NP Kim Sakovich, noted that while physicians employ a disease-based approach to patient care, nurse practitioners do more. She argues that not only do NP’s diagnose and treat, they take a nursing-based approach focusing on the patient and their environment as a whole.
If nurse practitioners hope to establish greater respect and independence as medical professionals, our representatives must drop the “nursing model” as the benchmark for quality. Do we not think physicians take into account “the patient as a whole”? Of course they do. I work in an emergency department treating a largely low income population. If my physician co-workers did not prescribe generic medications to accommodate patient’s financial constraints, the number of pharmacy callbacks would be insufferable. Intuitively, they consider “the patient as a whole” in diagnosis and treatment.
Rather than arguing a “medical model” vs. “nursing model”, nurse practitioners must differentiate themselves from physicians based on acuity. An acuity-based distinction does not devalue from the NP role or diminish professional dignity. Rather, it represents reality. An argument that nurse practitioners are “lower than” or “unequal to” physicians is not meant as a personal attack but is reflective of an educational distinction.
As a nurse practitioner, I enjoy my place in the middle. My role is different than that of a nurse while I am not qualified to treat the highest acuity patients or perform certain procedures. This doesn’t mean I don’t work hard, my work ethic is solid. This doesn’t mean I’m not smart, I could have gone to medical school. My “midlevel” status simply refers to the acuity of patients I treat. I stick to diagnosing cases of abdominal pain but I don’t perform the appendectomy. My training prepared me to treat bronchitis, not do thoracotomy.
If nurse practitioners want respect from physician groups and greater independence in practice, reformulating our arguments is in order.