A few years ago my daughter informed me that she was considering a career in health care and was trying to decide between nursing school and medical school. She wanted my advice. I thought about her strengths and interests and where she might fit best in the health care system. As I prepared to respond, I realized that many of my comments would probably be based upon roles and functions that had changed considerably since I had trained. Nurses now have options to become nurse practitioners, nurse anesthetists, intensivist nurse practitioners, and nurse executives. Teams are replacing the model in which doctors write the orders and nurses carry them out, doctors make the decisions and nurses do assessments. How was I to provide useful advice about such an important decision?
All of this prompted me to ask our community to look at the evolving roles of doctors and nurses through the Question of the Year, which comprises two questions this time: What is a doctor? What is a nurse? Responding to this question might help us understand what the transformations in the health care delivery system mean about the present and future functions, descriptions, training, and ultimately identity of doctors and nurses and others as members of interprofessional teams. This team model will certainly grow, since evidence is accumulating that teams improve patient outcomes. Recently, the Community Preventative Services Taskforce of the Centers for Disease Control and Prevention analyzed 77 studies of health care professionals working in teams and found team-based care produced better outcomes for blood pressure control in complex, high risk-patients than did physicians working alone.1
Having doctors and nurses as the dyad for this Question of the Year should in no way limit our thinking about the roles of the other members of the health care team—physician assistants, paramedics, technicians, pharmacists, social workers, physical therapists, nutritionists, dentists, and others. As you consider a response to the question, please be as inclusive and expansive as you feel is appropriate.
I have asked my colleague Liana Orsolini-Hain, RN, PhD, a nurse—who participated on the Institute of Medicine’s committee on the future of nursing2 and is currently serving on the institute’s new Global Forum on Innovations in Health Professional Education—to assist me, the editorial board, and the journal’s professional staff in identifying and analyzing the responses that best envision the rich possibilities of our evolving health care workforce. We will select a group of the responses for publication in Academic Medicine, and a subset will be chosen for presentation at the 2013 AAMC annual meeting.
Some guidelines and instructions: I encourage responses from all members of health care teams and the academic medicine community as well as members of the public. I am particularly interested in the ideas of students and residents. An individual may be an author or coauthor of more than one response. To determine eligibility for authorship, please consult the journal’s “Complete Instructions for Authors” at http://journals.lww.com/academicmedicine/Pages/InstructionsforAuthors.aspx. Responses should have no more than four authors. The deadline for submitting responses to the 2013 Question of the Year is May 1, 2013. Responses should be essays with a maximum of 750 words, no more than three references, and no tables or figures (please note that accepted essays may be edited to fit on a single page of the journal). All essays must be written in English and submitted through the journal’s Web-based manuscript submission system (www.editorialmanager.com/acamed/). “Article Type” will be the first field on the submission form; please select the category “Response to 2013 Question of the Year.”
In conclusion, it is clear that solutions to our workforce problems and our current fragmentation in health care will require new ways to take advantage of the unique training and skills that all members of the health care team can bring to the patient encounter and to the community. We can start this process by asking fundamental questions and engaging our communities in frank reexaminations of our past, present, and future. I look forward to the collective wisdom of our community in helping envision the evolving nature of our professions.
2. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine.The Future of Nursing: Leading Change, Advancing Health.. 2010 Washington, DC National Academies Press