As the future of health care professions becomes increasingly interdependent and boundaries between physicians and nurses blur, it is important to explore medical and nursing functions and roles. By better understanding these, health care professionals can enhance patient care.
Because of my role as a nursing educator, patients, friends, family, and students have all asked me, “Why nursing? Why not medicine? What is the difference?” For me, the difference is simple. Medicine focuses on treating disease, whereas nurses treat the patient’s response to disease. Thus, through careful collaboration, we partner to meet patient needs. So, how do the medical and nursing avenues parallel one another?
The science behind nursing began with Florence Nightingale. During the Crimean War, physicians were overburdened with an onslaught of injured soldiers. The surgeons set about their job of repairing these wounded men through surgical interventions. However, Florence Nightingale discovered a significant number of soldiers were dying of malnutrition and infections frequently unrelated to the initial injury. Therefore, her work centered on nutrition, cleanliness, and the emotional aspect of patient care. Florence Nightingale, her nurses, and the doctors worked in tandem to meet the soldiers’ various health care needs. Though the roles have since evolved, this is how I see our collaboration.
In the hospital setting today, doctors and nurses work in partnership. Through this careful collaboration, the overall patient needs are met. Doctors assess patients and orchestrate medical care. They diagnose and order needed tests, treatments, and medications. Nurses implement the physician’s orders, assess patients, and perform nursing interventions. Bedside nurses also develop deep relationships with patients and strive to meet countless emotional and educational needs. The following clinical experience exemplifies my perception of nursing care.
I was working in maternal–child with students from the University of San Francisco. We were working with a typical postpartum family. Mom was holding the baby and Dad was in the chair looking adoringly, yet longingly, at his newborn son. It was a beautiful scene, but I had a hunch that Dad was uncomfortable. This clinical grasp, intuition, whatever you call it, cannot be denied. I do not know how I knew something was wrong; I just did.
I asked Dad if he wanted to hold the baby, and he stated he needed to take a shower first. I asked him if there was anything I could teach him, and he said, “No, I have paperwork to fill out.” However, he kept looking at his son and wife achingly. It turns out, he had yet to pick up his son. He was afraid.
A few minutes later, my student left the room to ambulate with Mom. I then asked Dad again if he wanted me to show him how to hold the baby. He looked at me and stated, “OH, YES!” This man was afraid of his son and did not want to tell his wife. He stated, “She would lose respect for me if she knew.” This poor man, on one of the best days of his life, was miserable.
So, we picked up the baby and put him down. We did this again and again as his confidence rose and he became assured in his ability to pick up the baby. I then spent the next few minutes teaching him how to diaper and swaddle his son. His comfort level continued to grow. Next, I demonstrated how to burp the baby. Mom returned from her walk just as the baby emitted a quite impressive burp.
She looked at her husband, holding their son for the first time, and asked, “What was that noise?” He nonchalantly said, “Oh I’m just burping him.” Mom stated, “I haven’t been able to do that yet; I don’t know how.” Dad replied, “That’s okay, I can teach you.” He was beaming ear-to-ear at that point. In my short time with him, this new father had expressed his fears, his jealousy of his wife’s ease with their baby, and his feelings of inadequacy as a parent. Thirty minutes later, I left a very different man. He was confident and assured in his role as diaper changer, swaddler, and official baby burper.
To me, this is nursing. We teach, we respond to emotions, we help families overcome crisis, and we direct their path. Though we cannot work without our physician partners, nor would we like to, the collaboration between physicians and nurses augments the treatment of patients to achieve well-rounded quality of care.