Actually, neither. That is the emerging profession of nurse practitioner, a profession in which registered nurses with additional training and clinical experience are licensed to practice this profession. Certification as a nurse practitioner allows them to be primary health caregivers in many situations where a registered nurse would be required to call in a physician. The skills they have learned and the latitude they are granted by medical licensing bodies does make them, in a sense, “nurse doctors.”
How a Nurse Becomes a “Nurse Doctor”
A registered nurse with a bachelor’s degree may enter a program of study for nurse practitioner. These are master’s degree programs, generally, requiring two years to complete. Once certified, nurse practitioners provide basic preventive health care to patients, and increasingly serve as primary and specialty care providers. The most common areas of specialty for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and gerontology; however, there are many other specialties. In most States, advanced practice nurses can prescribe medications.
The American Nurses Credentialing Center is the central source for credentialing information for nurse practitioners. They are the credentialing arm of the American Nurses Association, a powerful national lobby with chapters in all fifty states. Their credentialing apparatus is recognized by the National Commission for Certifying Agencies. State Boards of Nursing are also looking into an accreditation process for advanced nursing practices; it is an evolving issue.
Finding the Appropriate Role
Some nurse practitioners simply hang out their own shingle. This is especially common in rural or underserved areas where MDs are reluctant to locate far from hospitals, labs or other support facilities, or from a large patient population. In situations such as these, nurse practitioners become replacements for the mythical and long gone country doctor.
More commonly, nurse practitioners seeking private practice will attach themselves to a doctor’s partnership as an adjunct member. Many groups of internists that practice general medicine will bring in a nurse practitioner to handle case overload and as a cheaper alternative than adding a bona fide MD as partner.
The same thinking holds true in hospital emergency rooms, where nurse practitioners have made inroads practicing primary emergency medicine. Emergency rooms are expensive to staff because they must be up to speed around the clock. Hospitals are discovering that they can cut back on physician coverage in the ER by bringing in nurse practitioners to handle the basic minor traumas and illness-related difficulties that walk in the door. In a hospital, there are always physicians on the floors that can be called for major cardiac emergencies or internal injuries that may require the attention of an MD.
Nurses Becoming Doctors
The extension of the nursing profession into primary medical treatment is continuing with the expansion of Clinical Nurse Specialists (CNSs) into additional fields heretofore reserved to the physician. The Nurse Practitioner is one example: an RN who has leveraged a position as a primary care giver. Other CNS areas of study may take nurses into primary care in psychiatry, in addiction medicine, in obstetrics - the entire concept is evolving. Providing validity to practitioners of a new healthcare delivery profession is a challenge in medicine, which is to a great degree a self-policing industry.
