Nurses need more power

finger-pointingThe state of Michigan is considering a bill to give advanced practice nurses, such as nurse practitioners, the right to prescribe medications without the consent of a doctor.

Some in the medical community balk at giving nurses this much power, but I don’t think that the bill goes far enough.

Not that I am saying that we should do away with doctors, but the idea of nurses in general having more power makes sense.  PRN medications and standing orders give us some power that we didn’t have before, but how many times have you literally told the doctor the order you wanted?

Actually, there are quite a few good reasons for nurses to have more power.  Certainly advanced practice nurses can be trusted with some of the responsibilities of the doctor, but even bedside nurses could handle more power in patient outcomes.

Presence at the Bedside

Nurses are always at the bedside, and doctors are not.  Often, we can see what they can’t, assess what they are unable to, and are better equipped to make decisions regarding medications or procedures.

Doctors only see patients for a limited window, but nurses spend whole shifts with the same patient.  Why isn’t a nurse just as qualified to prescribe a medication based on their observations than someone on the phone who may not even know which patient you are talking about.

Nursing Process

Like doctors, nurses have a process by which to diagnose patients.  Although it doesn’t seem like we use it on the floor, subliminally, it probably impacts our approach to patient care.

With this diagnosis-treatment-evaluate paradigm, we are on par with what doctors do when they treat patients.  For lower level diagnoses of patient problems, the nursing process can be just as effective in allowing us to treat a patient correctly.

Knowledge of Medicine

Nurses don’t have the vast knowledge of medicine that doctors have, but we are trained in the basics.  Most of the knowledge we have, though, comes from our observations of patient conditions.

Does it really matter that we never took organic chemistry?  Does it matter that we didn’t major in biology?  Many times, the nurse knows far better than the doctor does what is wrong with the patient, and it is our observations that determine care.

If we are already the eyes and ears for the doctors, why can’t we take the step beyond that and become the ones who call some of the shots?  This isn’t to say we should usurp the role of doctors, but we can certainly handle more power than we are currently given.

Experience with Patients

Some doctors, especially residents, don’t have the experience with putting eyes on patients.  And they are the ones making decisions about how to treat patients with high acuity?

It doesn’t make sense that a person who is just learning and just seeing patients to make life altering decisions when a nurse of twenty years is the one placing the call.  Shouldn’t we have some say in what direction the treatment takes based on experience alone?

Of course, everyone has to learn and not all nurses have the experience to make those decisions for patients.  We all have to make decisions about when to call, but we could make decisions affecting patient care depending on our experience with patients

Advanced Practice Standing

Advanced practice nurses deserve the power to be able to act independently of doctors.  They have taken the additional classes to prove that they know medicine and know patients.

I propose that an intermediate standing also come into use.  We already have certifications based on experience and further study, but they don’t confer power over patient outcomes.

If nurses with ten years’ experience and a certain amount of continuing education hours could be given the ability to make decisions about non-narcotic medications, non-life threatening treatments, and other lower level decisions, I believe nursing and medicine could benefit the patient more effectively than the current paradigm allows.

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