It’s time for another lesson on hospital personnel recognition. This time, it’s the nurses’ turn!

KINGDOM: Nurses

Nurses are one of the most important kingdoms in the hospital ecosystem. Amongst those in the Kingdom Nurses, there are several categories.

Phylum: Certified Nurses Aides/Licensed Practical Nurses

CNAs and LPNs are certified in specific nursing tasks. In the hospital, they may be found taking your blood pressure, setting up medical equipment, and assisting in other tasks.

Phylum: Registered Nurses

Likely the most common kind of nurse you’ll encounter in the exotic environment known as the hospital. They may work in any field, in any area of the hospital. As opposed to the previous phylum, registered nurses have degrees in nursing.

 

Phylum: Advanced Degree Nurses

Like exotic jungle birds, this group of nurses goes by a variety of different names: certified nurse practitioner, certified nurse midwife, certified registered nurse anesthesiologist, etc.

But they’re birds of a feather indeed: besides all being certified, this group of nurses have the ability to practice and prescribe at the level of a physician, with physician oversight. They tend to have smarty-pants degrees (Master’s and PhD’s) as well.

How To Recognize Nurses In Their Natural Environment

•  Clothing:

The line between nurses and doctors is a blurry one indeed, and nowhere can you see this better than in clothing. Doctors often wear scrubs. Nurses often sport white coats.

Those little white hats and aprons fetishized by men and Halloween costume makers alike? They definitely don’t exist any more. This isn’t the turn of the century, and this ain’t the Knick.

(And sorry to burst your bubble, but those short skirts and thigh high go-go boots: never happened, brah.)

How then can you tell?

Well, doctors tend to use the hospital-provided scrubs, scrubs clearly not created with the human form in mind. Forget Grey’s Anatomy:

Real hospital scrubs are lived in: dirty with all kind of stains.

Real hospital scrubs are tucked: the better not to let bodily fluids in, my dear.

Real scrubs are not fitted: one size does not fit all, but the manufacturers sure do try.

Real hospital scrubs are rolled up and scrunched awkwardly at the waist: because the crotch is far too low down.

Real hospital scrubs are worn up at the waist, Urkel-style: see the above.

Basically, your average resident physician is going to look a little unkempt and a little bit a mess. Note also the stress and chronic sleep deprivation on their face.

This is how nurses typically look in scrubs:

Note the fitted, free flowing top.

Note the stylishly flared pants.

Note the position of the crotch of the pants, where a normal human leg would begin.

Note the variety of colors and the possibility of prints.

This is likely a nurse.

(Note also the glossy hair and the smile.)

• Bedside time

Doctors are the ones waking you up at 5-6 am to poke and prod at you, and then again at 7-9 am, most likely in a Mongol horde complete with something we call a COW. They may then pop up spontaneously and individually throughout the day for a few minutes at a time, before a pager from the 90s goes off and the Pavlovian response to reach for a phone is triggered.

Nurses are the ones waking you up at 5-6 am to poke and prod at you, and then proceed to check on you at regular time intervals during the day, likely bearing something in their hands (butterfly needles or medication or apple juice and graham crackers) at all times. Their time with you tends to be counted in 15 to 30 minutes intervals.

• OR you could just try looking at their name tag for ‘MD/DO‘ or ‘RN.‘

 

Why Recognize the Difference Between Nurses and Doctors?

With all the faces that inevitably pop up at bedside, why should you try to recognize one or the other?

“Besides,” you might say, “didn’t you just write above that the line between nurses and physicians is blurring in our enlightened modern age?”

Touché.

However, the differences that do exist make a major difference to you as a patient.

• They’re the staff with whom you’ll probably spend the most time.

Your doctors tend to be running around from floor to operating room to emergency room, navigating their way through hospital obstacles and emergencies in a similar fashion to Mario in Donkey Kong.

Your nurses, however, are always on the floor, holding down the fort.

If a problem arises, they are the first line of defense.

If you have a question, they are Google.

• They’re the ones who perform important daily tasks that matter to you.

Generally, nurses are the ones who start IVs, who deliver the medications, who place urinary catheters. They do the absolutely thankless jobs of cleaning up bodily messes that inevitably happen. Without them, doctors would only be able to do 50% of their tasks, and half as well.

[Believe me, you don’t want your doctor putting in your IVs (unless she’s anesthesia); ask the experts, the nurses.]

• Their focus is on the patient first.

All of medicine is patient-centered. However, nursing is an area of medicine where the primary focus is holistic provision of care of the patient.

There’s a saying, “Doctors prescribe, nurses provide”: this is too simplistic a delineation. But it is true that nurses are taught to understand, empathize, and directly provide for a patient’s multifaceted needs. This doesn’t preclude physicians from doing the same – in fact, the sign of a good physician or nurse is the ability to understand and clearly communicate with those under their care – but physicians often approach patient care from a different, disease-and-organ-based perspective.

Neither approach is better than the other. Instead, let’s go with another saying: “see the forest for the trees.”

Think of doctors (and nurse practitioners) as the forest-seers, coordinating overall care of the patient as far as health and disease; think of the nurses as the tree-seers, coordinating the details of that care.

• Not recognizing each staff for their role can often stem from unrecognized rudeness or sexism.

Men and women can be nurses. Women and men can be doctors.

I’m not sure how many times I have spent significant time taking care of a patient, only to have them complain that the doctor never came in to see them. Or come in to round, and have the patient address the male medical student as doctor, and me as the nurse.

While I can’t deny that ego may be part of it – it comes with the debt and the long years of training! – this also reflects an unintentional sexism that continues to reverberate in the medical community.

In medicine, women on average still earn less than men in their field. Even if you compare incomes in the same field – for instance, my field, urogynecology – women earn less. Significant barriers continue to exist in research and academic medical success. And I happened to go to the last medical school to finally accept female students, so do I have a chip on my shoulder? Maybe. But I have earned the title of doctor as much as any other male colleague.

Additionally, especially in light of the growing presence of men in the nursing workforce, nurses are increasingly being asked, “You’re so great. Why don’t you become a doctor?”

Though nurses have as much medical background as doctors, and often more practical experience on the floors (and many have chosen to go on to become doctors as well!), nurses often choose their profession because of their personality and passion for working closely and one-on-one with patients. It’s rather uncouth to question their choice of profession, particularly as both professions are equally important.

Consider nurses and physicians as yin and yang: different, yes, but each a part of the other, and both necessary to complete the circle.

• When we specialize, we get more done.

Also, from a purely logical, economics standpoint, let’s consider the principle of division of labour and specialization, here described by David Hume:

When every individual person labours a-part, and only for himself, his force is too small to execute any considerable work; his labour being employ’d in supplying all his different necessities, he never attains a perfection in any particular art; and as his force and success are not at all times equal, the least failure in either of these particulars must be attended with inevitable ruin and misery. Society provides a remedy for these three inconveniences. By the conjunction of forces, our power is augmented: By the partition of employments, our ability en creases: And by mutual succor we are less expos’d to fortune and accidents. ’Tis by this additional force, ability, and security, that society becomes advantageous.

If you read that and didn’t fall asleep, you’re a better man than I am, Gunga Din.

So what does that mean, in modern grammar and English, and in the hospital environment?

While I may be able to get your medication for you (which, in fact, is not actually true at most institutions, as doctors don’t have access to the dispensary machines), and while a nurse may be able to stitch together your cut, we can get much more done if we are trained to efficiently perform specific skills, and leave other tasks to others.

Basically: In a hectic place like the hospital, this means that you win, I win, and we all win.

• The remaining difference

Finally, nurses and doctors often overlap in knowledge, skills, abilities, and communication, but there is one remaining difference: while both have responsibility to the patient, it is the physician who bears the final responsibility. Dr. Shirie Leng puts it beautifully in her post for KevinMD,

Because of our investment of time and money, and presumably because of the economic and social standing granted to us, we doctors bear this ultimate burden.  This is not to say that nurses don’t also have a responsibility to their patients and their field, or that they haven’t invested just as much time and money. I have been both a nurse and a doctor...But the law and society have laid the ultimate privilege and burden on the person that people call “doctor.”  That’s the difference.

So let’s applaud those who choose to devote their lives to patients, whether nurse or doctor, and let’s appreciate both for the different and complementary roles they play on the stage known as medicine.

 

Next edition: ORs and ERs and PAs, oh my!

cheers! /c

 

Related Links:

Practical ways to appreciate your nurses.

Ways not to piss off your nurse.

For perspectives on nursing and medicine from a doctor who has been both

Thank God nurses aren’t like this – but this is funny. Thanks Amy Schumer.