What are the differences between Doctors and Nurses?

I’m in Nursing school right now and a lot of questions arise in the difference between Nursing responsibilities and Doctors.

It seems that we work in collaboration. Doctors are obviously in charge and give out the orders, and we carry them out. But the line seems to be a bit blurry at times.

I know that Doctors work on the medical scientific end, and we work more on the human response. But I feel like I’m studying a lot of the same things that doctors are. I have to understand the conditions, the drugs and what they do, and just general management of a sick individual.

But I’m still pretty new to this, as I’m only in my second semester. If someone could point out what the major (and even minor) differences are I’d really appreciate it.

At this point in your training the biggest difference is the depth of the material you are studying. You are taking classes with the same names, like anatomy and physiology, but you are likely not being taught the material at the same level as your counterparts in medical school.

My wife is a nurse. One big difference is that a doctor can prescribe a course of treatment and a nurse can’t. For example my wife must have an order from a doctor before giving a pain medication. Sometimes there are standing orders, but orders all the same. If my wife thinks a patient needs a medication, she much call the doctor first and request permission to give it. On the other hand she has many times questioned a doctor’s orders and withheld medications until the matter is clarified. She’s saved more than one doctor’s ass doing that not to mention saved a patient from severe problems.

So in one respect, the Doctor is the Boss and the Nurse is a highly skilled Employee. Things get strange with the nurse works for the hospital and the doctor is in private practice and uses the hospital. Then there’s Nurse Practitioners who can prescribe drugs and treatment.

The “doctor as boss” mentality in health care has been linked to problems in the form of nurses failing to speak up when they notice a doctor doing something dangerous. In recent years, there has been a real effortto get nurses to take more of a collaborative role.

I’ve worked for a couple of hospitals and feel confident in saying that if you want to know what’s really going on with a patient, ask a nurse.

The concept of getting nurses to take a more collaborative role strikes me as backwards. Where I worked, and this was some time ago, the power differential between doctors and nurses was obvious. Although we gave lip service to the team effort it was evident that some doctors were intimidating to others on the team.

I’ve seen doctors ask a nurse for a patient’s chart while standing in the chart room. Others expected nurses to bring them a cup of coffee when they came to do their rounds even though the staff room was well-equipped and self-service. The implication of this is that the nurse existed to meet the needs of the doctor.

Unless this unspoken assumption of superiority has changed I would find it more appropriate to suggest that doctors make an effort to take a more collaborative role. The team effort with the adjunct of at least weekly team meetings to discuss patient care in an atmosphere of openess and cooperation works well if all members are capable of it.

I may as well add, if there’s any time to do it. I think that’s a large part of the problem.

I’m not dissing doctors here. They come in all stripes. And perhaps the world has moved closer to the ideal than what I have observed.

The level of training for one.

Doctors can diagnose, nurses can’t.
Doctors can prescribe medicine, nurses can’t.

Oh… about a hundred k a year.

ba-dum tish.

This sounds a lot like the concept of crew resource management, which has been implemented with great success in commercial aviation, firefighting and other areas where effective cooperation can minimize the risk to life and limb. The nurse/doctor relationship sounds like exactly the sort of situation where the tenets of CRM can be helpful, providing clear techniques for nurses to effectively voice their concerns without fear of reprisals/repercussions.

Truth. Medics and nurses perform a number of routine tasks, but even these are dictated by the hospital’s SOP and has a doctor’s name on the bottom line. If the SOP isn’t up to date, or includes errors, the doctor that signed off on it is to blame.

This is true of RN’s, but NP’s can diagnose, write prescriptions and work independently.

I don’t think NP’s are equal to physicians when it comes to training, but there is some cross over in their scope of practice (depending on specialty). NP’s are educated by the nursing model and are regulated by the Board of Nursing. Physicians (and PA’s) are educated by the medical model and regulated by the Board of Medicine. There can sometimes be turf wars (CRNA’s, for example), but I generally think collaboration between the two should be encouraged with optimal patient outcomes always the goal, rather than getting caught up in egos and silly turf wars. Patient safety should always take precedence.

I would equate NP’s more with PA’s, except in many places PA’s are required to work under the license of physician, while I believe a NP works under their own license.

Are we talking legally, philosophically, work duties, training or what?

Training for a nurse is much shorter than training for a doctor; I think we all know that. I became a nurse after a 2 year Associate in Applied Science degree (which required another 2 years of prerequisites, but they still consider it a 2 year degree.) Some (probably most, these days) nurses have a Bachelor’s Degree, but their nursing license and what they can do is identical to mine. We’re encouraged these days to get Master’s Degrees, at which point many, but not all, of us become Advanced Practice Nurses.

Legally, a doctor and an advanced practice nurse (“nurse practitioner”) can make MEDICAL diagnoses, while a Registered Nurse can make NURSING diagnoses. We spend a lot of time in nursing school learning the difference and beating medical diagnoses *out *of student’s brains. :smiley:

Medical Diagnosis: Asthma

Possible Nursing Diagnoses we might see if someone is having an Asthma attack: Ineffective Airway Clearance, Impaired Gas Exchange, Ineffective Breathing Pattern, Fatigue, Activity Intolerance, Anxiety.

If a person isn’t currently having an asthma attack, but has in the past and is likely to in the future, we can put “Risk For” in front of any of those: “Risk For Ineffective Airway Clearance”. This isn’t just any old jargon, it has to be specifically approved and formulated jargon approved by NANDA, The North American Nursing Diagnosis Association. It’s based on very specific observations, signs and symptoms gathered during the nursing assessment process.

Generally speaking, you need the Medical Diagnosis for billing. Nurses use the Nursing Diagnosis to develop a Care Plan, but we can’t bill under Nursing Diagnoses.

Philosophically, it’s a tricky thing to generalize. GENERALLY speaking, doctors treat diseases, while nurses treat patients. That’s pithy, but not entirely accurate. Still, it does sum up the idea that doctors tend to focus on what’s wrong with the patient and how to treat the disease process, while nurses tend to take a gestalt view - not just the disease, but the environment, the family dynamics, the diet, activity, the mind, body, and (for lack of a better term) spirit of the patient. We’re interested in not only what’s wrong now, but what could go wrong down the road (those “at risk for” diagnoses.)

A doctor is needed to identify that a patient needs a cast for a broken leg and to order physical therapy. A nurse is going to want to know how many stairs are in your home, what you do for a living, if you’ve got adequate child care while you heal, how to relieve the itching from the cast and teach you nonpharmeceutical pain relief techniques, as well as make sure you know how to take your medicine, when, why and what you need to know to take it safely. She may teach you how to use those crutches (at least until you can see your physical therapist.)

Some of this is specific to the kind of nursing you’re talking about. A nurse in a dermatologist’s office is sometimes not much more than a receptionist and a hander-of-instruments during procedures. A hospital nurse on a med-surg floor is often a medicine-passer-outer and does a lot of “charting” in the computer tracking the patient’s condition each shift.

In my particular line of nursing (home health care) I have to be very independent, and my work is much more like what we learned of nursing in school - the work of an independent professional. While I need to have a physician’s order for nearly everything I do, the practical matter is that I visit the patient, figure out what he needs, then I write the orders, call the doctor and say, “here’s what I suggest”. She says, “Sure, sounds good, FAX it to me and I’ll sign it.” Or, much more rarely, she says, “Hmm…how about three visits a week instead of two?” or makes other suggestions, and I make the appropriate changes before I FAX her the order for signing. And that’s the best doctors. Many of them don’t even want to talk to me, and just have their receptionist or nurse tell me to FAX the orders and they’ll sign them, so I never actually talk to them. So while, on paper, I’m “following the doctor’s orders”, in reality, I’m actually calling the shots - although the doctor has to agree to sign.

Home health nurses are often the ones who do the care coordination (in the hospital and in a few home health companies I’ve heard of, this is often done by a medical social worker, but sometimes by a different nurse). I’m the one who calls the Physical Therapist to see how their visits are going and if we need to get an order to continue PT, for example. I make sure supplies the patient needs are ordered (although we have another person to do the actual ordering with the medical supply company, I have to tell him what the patient needs and get the doctor to sign the order for it.) I contact the doctor at least once every 60 Days to let her know how the patient is doing and if we need to continue home health or not, and get a new set of orders to her for signing.

I also do hands on care and teaching. I show people how to give themselves insulin or other shots, how to run IV’s and work their feeding tubes and pumps. I do wound care, changing dressings and cleaning out wounds. I do a LOT of teaching. Tons. That’s probably my biggest job - teaching people about their health condition, what it means, how it’s diagnosed, what to do about it and how to slow or reverse the progression of the disease. I teach caregivers and family members, as well as the person who is the patient.

This is what a GOOD nurse does. That is, I’m good for a new nurse, as evidenced by better than average patient outcomes and doctors and patients alike who request me by name and recommend me to other patients. I’m still learning, and hope to get better. There are also BAD nurses, who come, take vitals and push a piece of paper at the patient to be signed and then leave. We hates them, we does, precious. They gives us a bad name. :mad:

I hope this helps a little. I’m afraid I can’t be as specific about doctors, because one of the drawbacks of my line of nursing is that I don’t see them very much. They’re voices on the phone and signatures on the FAX to me, by and large. :slight_smile:

WhyNot

I’d like to know mostly about the duties and how Doctors and Nurses interact. Legal and training differences is important now too. Whatever you think would be helpful at this point in school as many questions on the tests pertain to these issues.

Regardless, thank you for your thorough and informative post.

One important thing for the test, as well as real life, is that you are responsible for what you do. You. Not the doctor. Even if you have an order, if it’s a lousy order and you have a poor patient outcome, you are responsible. Professionally, ethically and, yes, legally.

Doctor didn’t put the order in the computer to hold the Metformin the morning of a CT scan? Guess what, if that patient goes into lactic acidosis and your name is on the chart as the last one to hand him his Metformin, it’s your license on the line. Doesn’t matter that you still have an order for it. *You *have to know what the current recommendations/ contraindications are.

For nursing school, it’s a common test question and the answer is you hold the metformin. (In real life, it depends on comorbidities: if they have normal renal function and no other health conditions involving the liver or kidneys, the ACR says you can give them their metformin. If they may have or do have impaired renal function, you hold it.)

If you get an order that you think is a bad idea, what do you do? First, you grab your reference materials, check the date, and see if your worry is a current valid concern. Then you talk to the doctor and express your concern and make your recommendation. What if the doctor won’t listen?

(That’s a common test question.)

Then you go to your charge nurse and tell him what’s up. Calmly, rationally, nurse to nurse. He’ll either back you up, or he can update your education, or he can fill the order himself. What if the charge nurse won’t listen?

(That’s a common test question, too.)

Then you go to the nurse in charge of the floor or department. Then you go to the Head of Nursing. You chase the chain of command as far as it goes, until someone higher up than you is willing to put their license on the line instead of yours.

Notice who is NOT in that chain of command? A doctor.

Nurses do not answer to doctors. Doctors do not supervise nurses. Nurses supervise nurses, and doctors supervise doctors. That’s a HUGE part of the test questions. Remember, nurses write these tests. Old battleaxe nurses who are proud professionals write these tests.

Similarly, they like to ask test questions about deteriorating patient condition. Almost always, the answer is to assess. Sometimes, it’s a nursing intervention. Only very rarely is the correct answer, “Call the doctor”. Nurses are proud. Nurses on tests can handle almost anything.

In real life, we’re more collaborative and even deferential sometimes. On tests, we are nearly sovereign. :smiley:

The basic difference is in the amount of training. Most nurses spend 2-4 years getting a degree, with some of that time being practical training. They then can spend 1-2 years extra doing essentially subspecialty training which in many cases lets them practice fairly independently, but usually with the ability to have a supervising doctor they can go to with complex problems. Doctor have a minimum of 6 years of combined college and medical training (although most do a full 4 year college degree to get the prerequisites and then a full 4 years of medical school of which two are purely book learning and two are more practical training). Then most states require an additional minimum of 3 years residency training to get a license. So, in short training after high school is 2-6 years for nurses (average ~ 4), 9-14 years for doctors (average probably ~ 12).

Things that Doctors can often do that nurses cannot:

-Diagnose complex or unusual cases
-Prescribe medication including choosing the correct medications especially when there are multiple medications, or difficult problems, such as allergies, side effects, etc
-Perform surgeries and invasive procedures
-Analyze complex results such as knowing when what looks like a normal test is really dangerous, or what looks abnormal is really normal for that patient

Things Nurses do better than Doctors

-Know the nuts and bolts of administering medications such as which can go in the same IV or which can be crushed and which cannot
-Analyze subtle changes in one patient over time
-Carry out non-invasive treatments like giving medications, injections, treating wounds
-Do much of routine preventative care

As far as pay goes, let’s just say I would be ecstatic to make what an ICU nurse makes at my local hospital-they currently take home about 50% more than I do with much better benefits and they are worth every penny.