Not second-best.

It happened again: a raft of compliments from a patient and her husband, with the husband taking me aside and speaking seriously about what a pity and a waste it was that I didn't go to medical school. The implication is that I'm too smart, or too hard-working, or too marvelous overall to be a nurse; that I'd be doing the world more good as an MD.

This time I didn't scream. I didn't blow my top. I didn't even feel insulted. (Well, okay, I did. But I didn't let it affect my response.)

I went to nursing school not because I was too old or too tired to become a doctor, but because I wanted to be a nurse.

Doctors, by virtue of their training and specialization, focus on the disease process. Nurses focus on the person dealing with the disease process. (A lot of the narrow focus of doctors' work, unfortunately, is born of the medical system, with its emphasis on CYA shotgunning and rule-outs.) A nurse will view her* patients holistically, take the time to discover weird little underlying causes, and educate her patients about whatever's wrong with them and how to live with it. Because of the contraints under which doctors operate, if a doc does that, it gets him a book deal and a spot on NPR. Nurses do it every day.

Nursing and doctoring are equal professions. I predict a lot of flak from that, mostly coming from residents (grin), but listen up: I may not know the pharmacological profile of gentamycin like the back of my hand, but most doctors don't know how to deal with a clogged central line. I don't do as thorough a clinical neurological assessment as my neuro MD colleagues, but my neuro assessment will tell me (and them) more about how the patient is able/unable to operate in his or her daily life. I can't read an MRI reliably yet, but I have a gut feeling, honed through years of paid and volunteer work, that is pretty near infallible.

My two main foci as a nurse are assessment and education. It's because I'm a nurse that my assessment skills are more detail- and change-oriented than those of my medical colleagues: after all, they're in surgery or clinic all day, while I'm dealing with the same people for twelve hours at a stretch. When something minor changes, the nurse is often the first to notice--or the only one to notice--not just because she's there, but because she knows the patients better.

I also have time to educate. One of the biggest parts of nursing is translating what's just happen or what's about to happen into English. This can be worrying or reassuring, depending on the situation; it's up to me to deal with the patient's emotional and mental reactions. It's also my job to teach the patient how, for instance, not to rip the Harrington rods right out of his back immediately post-op. Doctors know the general outlines, like "do not lift anything heavier than ten pounds or do strenuous activity", but most can't translate that into "don't pick up anything heavier than a gallon of milk or vacuum your carpets." (It's worth mentioning that two-thirds of the education I do consists of putting instructions into fourth-grade reading-level form. This disturbs me on many levels.)

Doctors and nurses are two parts of a big symbiotic critter. Our skills are different, our education levels are different, our training is different--but we are equal despite those differences. I can't do what the folks on the neuro service do to brains, but they don't know how to mobilize their own patients, or prevent pressure ulcers, or treat the side effects of some medications without drugs. The healthiest nurse-doctor relationships (and I'm proud to say that, despite the current weirdness at L'Hospital Schwankienne, our professional relationships are top-notch) are those that recognize the inherent differences in skill and focus and give credit where credit is due.

I'm not a helpmate. I'm not a handmaiden. I'm certainly not a failed, frustrated doctor-wannabe. I'm a carefully-trained, careful-thinking, observant clinician with a wide range of disparate skills and some strange little tricks up her sleeve. You really can't compare the two professions; our tricks and skills are too different.

And my profession is certainly not second-best.



*Yes, I'm using "her" here, since most nurses are female.