[NPInfo] Re: Medicine/Nursing/Healthcare

[Tracy Klein]

Framing the question as whether a nurse practices nursing or medicine  
really invites the erection of parallel fences. It generates a  
tremendous amount of legislative and statutory activity which some of  
you have posted here. It is the wrong question in my opinion.

Nurses practice nursing. Physical therapists practice physical  
therapy. Both use assessment and diagnosis in their work. Say what  
you will about "nursing diagnosis" (and I can hear the buzzing  
already) it was an attempt to capture what nurses do in a measurable  
way to validate their practice and remove it from invisibility. When  
that was less than successful, the next step was for nursing to  
engage in a fight to use "medical diagnosis". Meanwhile, nurses  
mocked each other for "stupidly" trying to define their practice in a  
measurable way that someone who counts insurance beans or whatever  
could understand.

While they were busy doing this, psychologists and social workers  
learned how to use DSM-IV, bill and get paid for it. Physical  
therapists set up their own practices, can do so without an MD order  
in our state anyhow, and happily use medical diagnosis and treat  
patients for what they see with modalities in their scope. Meantime,  
these folks seem to be able to educate themselves to establish a  
scope of practice, set up a business, ask for (and get) 100.00 or  
more dollars an hour, and are not being paid 35-45.00 an hour to  
clean their own floors (thanks, retail clinics).

Why can't we manage to do the same? Step outside of the paradigm  
which requires you to beg to be practicing medicine, using medical  
diagnosis, fighting every second to "defend" what you do. Start  
focusing on what you do and are educated to do, and don't apologize  
for it. But start working harder to describe, explain, define,  
professionalize, and support with real research that you do what you  
do. And much thanks to those who are busy engaging in such research  
and have taken more crap from nurses and nurse practitioners because  
they are not "real clinicians".

Tracy Klein, WHCNP, FNP
Portland, Oregon