So, on the cusp of Nurses Week, the week when Americans are encouraged to think about the value that nurses bring to health care, readers of the New York Times were treated to an op-ed written by physician Sandeep Jauhar. According to the byline, Jauhar is a cardiologist and the author of an upcoming memoir about his disillusionment as a physician. The title of the piece was “Nurses Are Not Doctors.” While the author makes sure to reassure us that he thinks nurse practitioners (NPs) have a valuable role to play in health care, he makes the usual charge that NPs are not qualified to practice primary care without physician supervision.
Jauhar conveniently ignores the many studies that have refuted this argument, while basing his case largely on weak anecdotes and one study from 1999 that showed NPs ordered more diagnostic tests. His conclusion: the NPs in the study ordered too many expensive tests because they lack the experience and knowledge of physicians (he concedes in passing that “there are many reasons the NPs may have ordered more tests”). I can’t help thinking that this piece’s publication was purposely timed to take some of the shine off Nurses Week.
I’m surprised that the Times published such a weak letter. First, along with other nonphysician health care providers who have earned doctoral degrees in their fields, many nurses are indeed doctors. “Doctor” is an academic title and is not exclusive to only those who’ve earned doctorates in medicine. Physicians should get over the fact that they do not own that term, just as they need to realize that medical care is only one aspect of health care. Nurses, too, need to use terms correctly—use physician, not “doctor,” when referring to a medical provider; use health care, not medical care, unless specifically talking about care provided by a physician.
Is one 15-year-old study all Mr. Jauhar can come up with? This author and many of his physician colleagues need to stop mourning an idealized golden age of American health care. Their arguments undercutting nursing in the public’s eyes and sowing doubt about nurses’ capabilities are without merit. To assume that nurses will venture to practice beyond their capabilities and training is akin to assuming that internists are likely to attempt heart surgery.
As I co-wrote in an editorial in 2006, these kinds of claims are “a misguided attempt to hold onto an antiquated and dysfunctional model of medical imperialism . . . [that] isn’t serving anyone but physicians.”
Many media outlets are looking for Nurses Week stories. Rather than using this opportunity for the denigration of the nursing profession, let’s use it to let the public know about nursing’s contributions. And there’s plenty of evidence we can cite, from a 2002 Cochrane metaanalysis showing that primary care by NPs is as good as and sometimes better than that delivered by physicians, to research supporting the safety of care provided by nurse anesthetists, to the more recent report from the Institute of Medicine on the Future of Nursing supporting a larger role for nurses in health care planning and delivery.
The bottom line: the public needs all nurses, not just NPs, to be able to practice to the full extent of their education and training.
(Reminder: This week, the entire May issue of AJN and most other Lippincott nursing journals will be open access.)