The pursuit of a career that aligns with one’s passion, intellectual curiosity, and sense of fulfillment is an aspiration for both medical students and physicians, yet it often remains elusive. Preparing for a career in medicine means confronting numerous obstacles and making multiple decisions, some clear and practical, others deeply personal.
It’s often the quiet, internal challenges we face that lead us to shift our career paths, or, in the current vernacular, to “recalculate our route.” The same challenge applies to healthcare as to all paths we follow.
The relationship between a registered nurse (RN) and a medical doctor (MD) is often viewed as a symbiotic one behind the scenes, where both nurse and physician work together to ensure comfort in times of illness, provide better patient care, achieve improved outcomes, and gain trust in the healthcare system.
This view of the symbiotic relationship between physician and nurse may illicit the preconception that a nursing background provides an ideal path to becoming a physician. This assumption oversimplifies the profound differences in training and clinical responsibility that define each role. As an indication of the distinct roles of nurses and physicians, fewer than 2% of nurses choose to pursue a career as a doctor.(1)
Once inside the walls of hospitals and clinics, another fate unfolds, and those closest to both professions know that blending them is difficult. Their duties and guardrails are so rigid that neither discipline offers educational reciprocity. However, the nurse–physician relationship is imperative to the successful health outcomes for patients, and there is an opportunity for physicians and nurses to learn from one another.
CHANGES IN PERSPECTIVE AND APPROACH
The low transition rate from nurse to physician highlights the unspoken truth that entry to a career in medicine, even from a starting point in nursing, requires traversing a chasm of training that is difficult to close. The small percentage of nurses who make the journey from RN to MD often share a common understanding that this path requires dedication and modification to one’s professional identity.(2) A change in perspective is necessary to face new challenges and the intensity found in medical training.(2)
Nurses must shift their stance from providers of care outlined in care plans to primary caregivers and decision-makers.(3) This transition calls into question long-held professional viewpoints and further necessitates the adoption of new clinical theories and leadership roles.(2) As a result, the RN-to-MD pathway is more than just learning new skills along the way; it is about altering the professional mindset to reflect a greater level of responsibility, autonomy, and impact within the health system.
While registered nurses and physicians share the common goal of delivering patient care, their approaches to clinical decision-making differ. Physicians acquire their initial physical examination skills through classroom instruction and simulation-based training.(4) Nurses refine these skills through clinical practice at the patient’s bedside. This real-world experience enables nurses to develop a keen sensitivity to subtle patient changes, thereby enhancing their efficiency and accuracy in clinical assessments.(2) Incorporating experienced nurses into medical education provides a valuable complement to traditional physician training by bridging theoretical knowledge with practical application.(2)
Nursing education emphasizes interdisciplinary collaboration, patient advocacy, and a nuanced approach to bedside care.(2) Communication skills are essential to the practice of medicine, as they foster a holistic understanding of patient care, enhance clinical decision-making, and underscore the importance of empathy in clinical care.(2,5-7)
Healthcare professionals don’t understand the value of good bedside manner until they’re exposed to face-to-face and hands-on encounters with patients; however, many medical students don’t see a patient until their third year.(8) In contrast, the nature of the nursing profession involves early face-to-face interactions with patients in their training, giving them opportunities to hone their communication skills. These communication skills not only strengthen the therapeutic patient–physician relationship, but also build confidence in the healthcare provider.(9) This cultivates opportunities for shared competencies, such as bedside communication and a more comprehensive approach to patient care, encompassing the psychological, emotional, and social aspects of the patient’s background.
When physicians work alongside nurses, they have the opportunity to incorporate competencies nurses learned during their training and apply them in medical practice. Physicians who are better communicators and show increased capacity for empathy make better caregivers.(5,7) As Silverman posits, “The accomplished doctor has a bedside manner that is humane and compassionate, empathetic and supportive.”(10)
There must be a pause when caring for patients, a pause that has been deemphasized because of technological advances. Human behavior is a complex interplay of cues that are not always apparent to the observer. Recognizing why a patient presents in a way that deviates from textbook expectations is fundamental to clinical practice and reflects the core of what it means to be a physician.
One of us (CH) has encountered new residents in the Intensive Care Unit (ICU) who order diagnostic tests or imaging studies to guide their next steps and find clarity through these tests and procedures. This mentality among new residents may limit communication between healthcare providers and nurses, dismissing the patient-centered interactions that nurses use to achieve optimal care.
When rounding with new residents, CH, a registered nurse, has been able to assist them in managing patients’ treatment because he had been with the patients over several shifts and was familiar with the patients’ medications and medical history. For example, the new residents often prescribed medications to adjust the patients’ blood pressure; however, they omitted the specific parameters indicating when to notify the physician if the blood pressure crossed a threshold. This overlooked task, once corrected by the new residents, helped create a plan of care and prevented unnecessary calls to the residents.
As a nurse at the patient’s bedside for extended periods, CH has cared for patients who are reluctant to share pertinent information during the doctor–patient encounter because they perceive a lack of interest by the physician, often resulting from time constraints that limit engagement with the patient. Patients who exhibit this hesitation or unwillingness in reporting information are at an increased risk, as effective communication between physicians and patients is strongly associated with improved accuracy of diagnosis and clinical outcomes.(6,11)
Medical residents often defer to experienced RNs to learn about patients’ feelings, concerns, and psychosocial backgrounds that the physician may not glean during the traditional history and physical examination. RNs augment patient care by spending more time with patients at the bedside.
EMBRACING PATIENT-CENTRIC CARE
The medical model is shifting toward embracing technology; as a result, compassion, empathy, and listening to the patient are no longer part of the delivery of care.(6) As physicians, we must strive for a patient-centric approach to care and seek to improve our awareness of a trend where bedside manner and communication skills have taken a backseat to technology.
Bernard Lown emphasizes this in his book The Lost Art of Healing, in which he states, “now the doctor, by virtue of accepting science so totally, creates a total imbalance, forgetting the art of healing, forgetting the art of engagement, forgetting the art of listening, forgetting the art of caring and ceasing to invest time with the patient.”(12)
If we do not return to the basics of patient-centered care set forth by Hippocrates, Galen, and Osler — listening to patients and looking at them rather than a computer screen — we will have surrendered our role as trusted healers to the computer, artificial intelligence (AI), and technology.
Lown has endeavored to bridge the scientific commonalities between the two roles of nurse and physician, such as the study of anatomy and physiology, in which physicians and nurses can both be known for their complementary bedside rapport and emphasis on the patient rather than merely the disease for which they seek a cure.
One of us (NB) had a patient with terminal cancer and accompanying bone pain requiring strong analgesic medication. NB was planning to suggest a program of chemotherapy that had reported results of minimal improvement. The nurse, who knew the patient well, shared that the patient had made peace with his disease and did not want any additional therapy. Therefore, NB’s plan of action was to assure the patient that he would be made comfortable with pain medication and that no further treatment would be instituted.
If NB hadn’t received this feedback and information from the nurse, he might have tried to persuade the patient to try a long-shot therapy. Instead, he had the opportunity to work in a complementary fashion with a nurse, enabling him to provide the best care for the patient.
A TRUE PARTNERSHIP
Reflective practice, defined as the assessment, evaluation, and intervention, highlights the importance of self-awareness and learning from past experiences.(7,13) This is a skill that nurses use to achieve better outcomes by quickly processing information gathered in these settings, which informs care decisions. The nurse must anticipate the need to titrate an intravenous drip, manage equipment attached to the patient, and adhere to established protocols.(14) These skills strengthen the ability to detect small, but essential changes in vital signs related to patients’ assessments.
Nurses learn to coordinate their skills with other members of the healthcare team, thereby developing a working knowledge of the patient’s care progress and recognizing when other care teams are needed to provide effective clinical management. Nurses have navigated the health system and have a unique understanding of thinking outside the box. The use of these communication skills is the foundation of nursing training.
A nurse spends 12-hour shifts in proximity to several patients, and the communication skills developed help the nurse understand the multifaceted indicators in patients’ behaviors, which in turn increases trust between the nurse and patient.(15,16)
According to a 2023 study, “patients’ trust in nurses was positively associated with the quality of nursing care, indicating that increasing trust in nurses could positively affect patients’ perception of the quality of nursing care.”(13) Patients who had more trust in their health care provider reported better health behaviors, fewer symptoms, and a higher quality of life, as well as more satisfaction with their treatment.(16,17)
Abraham Flexner detailed the inferior quality of the American medical education system over the previous 100 years, which led to the development of streamlined and radically improved methods of physician training.(18,19) This offers insight into why medical training lacks basic core communication skills such as those found in nursing. Medicine became so standardized that it prioritized biochemical and pathological constructs of disease, resulting in the loss of the humanistic approach.
The evolution of modern medicine must include patient-centered care, and medical training cannot grow with the times without a well-thought-out collaboration and integration of the strengths found in nursing as a complement to the training received during medical education. We need not reject the advancements Flexner defined as creating a new era of healthcare providers; yet we must seek a different standard of care that includes a technological approach to align with patient-centered care. All patients who encounter a physician with training to treat diseases and also a keen sense of obligation to look into a patient’s eyes will experience the patient-centered approach and receive the new, improved standard of care.
BOTTOM LINE
Nurses and physicians share a commitment to ethical patient care. While the two professions serve distinct roles, their values and patient advocacy are the same. A nurse’s experience adds a meaningful dimension to a future built on a stronger foundation in healthcare. Effective patient care requires bridging the professions and embracing an experienced nurse with skills and competencies acquired over years of practice.
Medical care is enriched by patient-centered insight and wisdom gained from hands-on experience, which helps build a better healthcare environment. The traditional path to a career in medicine may benefit from a new approach that combines the best aspects of both nursing and medical training.
The road less traveled to a career in medicine should be viewed through the lens of merging the two disciplines. Nurses contribute to this future by understanding patient behavior and by having the unique perspective on the healthcare system afforded to them by the extended presence at the patient’s bedside.
References
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