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Why physicians lack confidence in nurses

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For those readers who follow me on Scrubs, or if you found me via social media circles, you know how big of a nurse advocate I am. I consistently praise and endorse our profession. I hold in very high regard the brave souls who work the trenches every day and every shift. Our job is not an easy one and not everyone can do it. Quite honestly, not everyone has the cojones for nursing.

But there’s an inherent problem with the performance and responsibility of our fellow professionals: No two nurses have the same function. I’m not talking about a “good” versus “bad” nurse–I’m referring to the expectations of a nurse as a healthcare professional.

The only way I can explain myself is by making a comparison. Unfortunately an equal comparison to another profession does not exist. My problem becomes exponential due to the very nature of the qualifications, education and training differences that exist among newly registered nurses.

This argument is further complicated by simple nomenclature, since the very word nurse translates into many different definitions, depending on the reference. Nurse can refer to a CNA, an LPN or an RN. And even then, things get fuzzy–an RN can have a 2-year diploma degree, a 2-year associate’s degree or a 4-year bachelor’s degree. Are you still with me so far?

This is what is wrong with nursing: the inaccuracy. Only those who work with nurses can truly understand the difference between the above vocations. Oh, wait. That brings up yet another source of confusion: Is nursing a vocation or a profession? A vocation is an occupation that does not require advanced education or specialized training, while a profession requires specific training, education and continuing education. Nursing seems to suit both these needs and definitions.

Are you confused yet?

Good–so is everyone else who is NOT a nurse. This includes most healthcare professionals, especially physicians! I can tell you from experience that most physicians do not have a firm grasp of what the requirements are to become a nurse.

After all that garbled discussion, I still have to explain what is wrong with nursing. Now back to my original point. No two nurses function the same. In essence, when you depend on the nurse to perform their responsibilities to their fullest, the outcome of your expectations is entirely dependent on which person is on shift at the time. During one shift everything may get accomplished or addressed, while on another shift the infamous ball inevitably will be dropped.

This is a major source of disdain among coworkers and is THE source of physicians’ lack of confidence in our wonderful profession. I’m not sure why it happens, or how it happens, but many nurses lose the ability to cognitively navigate through a problem. Instead, most will reflexively react to a result.

They pound this little concept called critical thinking into our brains as basic nursing students. We have to develop the skill over time, with experience and guidance. Yet we lack the consistency to see it develop. It seems to be spread out like Swiss cheese throughout our profession–and it’s that “Swiss cheese” that I believe is the problem with nursing.

I’m still trying to figure out how we as a profession can solve this problem and fill the Swiss cheese holes–but so far I’m coming up empty-handed. Anyone care to weigh in?

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4 Responses to Why physicians lack confidence in nurses

  1. alhansen32 RN

    Awesome article, Sean Dent!
    I wrote an paper on this same topic for one of my nursing classes.
    We, as a profession, are annoyed that we garner little or no respect for who we are and what we do – but until we address such discrepancies of training, and use of title, I believe we will continue to be “dissed”!
    I believe that a BSN is the only way to go (based on the literature) but until we find a way to fill the “black hole” of long term care with workers other than RNs, we will not be able to move forward.
    AACN has a great, comprehensive position paper at
    http://www.aacn.nche.edu/publications/position/bacc-degree-prep
    Thank you for your thoughts, Sean. We need a profession-wide conversation about this. (And, yes, I believe we are professionals, nursing is not just a vocation.)

  2. ceilcherry RN

    This just demonstrates how in our profession so many times it is a case of “we have met the enemy and it is us”. Nurses have been debating the entry level since the 60’s (at least). Are we any closer to coming to a consensus than we were 40 years ago? Not that I can tell. (When I was in a master’s program I had a surgeon ask me what was the “difference between a master’s degree nurse and a two-year nurse”). No wonder other healthcare providers are confused about the educational preparation for nurses when nurses can’t agree on what it should be!

  3. RNSCHANGETHEGAME

    I think blanket statements are mostly false. I have worked w/ physicians in “very intense” areas in healthcare systems. Some are confident in our anticipations, and assessment skills, and some are not. I’ve found myself extremely anxious w/ regard to, certain doctors, as they lack certain skills, and are not aggressive when the pts. Dx, Px, and over all clinical pathway merits it. They do not all perform exactly the same, or “accurately”. I am not only speaking of interns either. One thing I would like to see change, is the entrance into Professional Registered Nursing. You are correct in the difference in vocational nursing as compared to professional nursing. If you ask 2 doctors or 2 lawyers how they became lawyers, they could tell u each others experience for the most part. There are far too many gateways into nursing. Every nurse is not a Professional Registered Nurse ♥

  4. Belasko RN

    I believe part of the problem in regards to the “critical thinking” is I have yet to really hear a good definition of it or how it’s supposed to work. Over my 10 years since I obtained my bachelors of science in nursing I’ve slowly come to my own definition. Experience. It is learning to anticipate and prepare for in advance. This can be as simple as having all the equipment ready for a procedure to knowing the side affects of a medication and how they will affect the other medication the pt is getting and how that will affect the pt and their vitals then adjusting things before a situation degrades. As it sits now I feel nursing is expected to do more and contribute more to the overall pt care. Yet they are still only 2-4 year degrees (for RN’s). And a huge amount of that is classroom time that is completely needed. The best answer I can see for this issue is turning the RN into a masters degree and using that extra time for more hands on, intensive clinicals. I know I learned a lot more my first full year as a new grad than I did my whole time in nursing school!

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