The discrimination against nurse practitioners must stop


I have been a neonatologist for 30-plus years. Throughout my career, nurses and neonatal nurse practitioners (NNPs) have guided me, assisted me and comforted me through difficult patient care issues that arose. Even more importantly, they allowed me to leave the neonatal intensive care unit (NICU) without worrying about how my patients were being taken care of.

I am writing this because our profession (MDs and DOs) continue to devalue these professionals despite the quality care they provide to our patients in our absence. I have personally witnessed during my tenure practicing in the hospital setting how physicians poorly treat nurses, speak condescendingly to them and often demean them amongst themselves, telling off-color jokes or making lewd comments about their appearance.

Nurses and NPs are not medicine “lite.” The vast majority, especially after the 1990s, did not go into their respective professions because they couldn’t get into medicine or used their nursing careers as stepping stones to enter medical school. That may have been a more common phenomenon a few decades back, when women in medicine were a rarity and nursing was seen as a pseudo-profession. This is obviously not the case anymore.

Now, both men and women, decide on a career in nursing because it is their passion. Those that choose a nursing career understand the difference between how physicians and nurses practice and what both professions offer to patient care. Essentially and simply put, doctors mostly diagnose while nurses administer care. Yes, one could say that without physicians, nurses could not administer care. However, without the nursing profession, patients would not get the care the physicians’ order.

It is the above experiences that I have personally witnessed, which drives me to explain why this continues to happen and how we, as physicians, can and should change the culture.

I believe that the origin of treating nurses as inferior to doctors resulted from, in the distant past, nurses practicing without needing a bachelor’s degree. Students were allowed to go to nursing school after high school, graduating with a degree in nursing. This has completely changed over at least the last 30 years. Nurses not only are required to have a bachelor’s degree, but many are encouraged to pursue a masters. Those nurses that go on to receive an advanced practice degree now receive a doctorate, either as a PhD or as DNP (doctorate nurse practitioner). The past discrimination against the nursing profession due to what some believed to be “inadequate” education can no longer be used to discredit this noble profession. Yet the stigma of “poorly educated” continues to be used as a trump card.

I believe that the elitism that continues to be taught in medical school feeds this discriminatory pattern of interaction with nurses, despite the common knowledge that nurses now practice with at least a bachelor’s degree if not more.

It is imperative that we as physicians be tasked with assisting nurses to become empowered within their profession. By empowering nurses to be an equal partner in the health care team, studies have shown that nursing job satisfaction rises, leading to improved patient care. Isn’t that what we, as physicians want?

So how do we stop this type of discriminatory behavior and elitism? How can we help support the nursing profession so that they begin to be treated as the equal partners of a health care team that they truly are? That, of course, is a difficult question to answer as it requires a change in culture, which requires the perpetrators of poor behavior to change said behavior. More importantly, those who require changing their behavior need to acknowledge and accept that their behavior is wrong before they can accept the need to change it! Education is the key to change.

I believe educating new physicians in training — whether in medical school and/or residency — of the value nursing brings to the health care team, will be the key to help them understand and treat nurses with the equal respect they deserve. Furthermore, it needs to be emphasized to these young doctors, that the knowledge nurses possess include not only how to care for patients but also their understanding of the pathophysiology behind the disease process and treatment plan. Moreover, the skills they have are as important towards the healing of a patient as are those of the MDs.

To assist physicians who are in the middle of their career or even later, to learn how to treat nurses as their equals within the health care team, the education needed to accomplish this may be more difficult to impart. Many may not understand that their perception, and therefore treatment of nurses is wrong and needs to change. This particular group’s mindset is that they, the physicians, can talk down to the nursing staff because of their continued belief that nursing training is inferior to theirs. How could nurses ever be considered as equal members of the health care team?

These group of physicians, will require intense new education, education not too dissimilar to learning about EMRs, HIPAA, IRBs, etc. Learning may need to be accomplished through CME courses and should be required by health care corporations as well as hospitals so that physicians can be allowed to continue to practice. Certainly we, as physicians, put limitations on our own profession, when standards for safe practice are not met. Why would learning how to interact appropriately with nurses be any different? After all, if nurses are treated poorly — patient care suffers.

Therefore, I would like us, as a group, to begin the journey towards understanding the strengths that nurses within the health care team possess. Let’s celebrate these strengths daily. In this way, patient care can be impacted positively, and outcomes improve across the board.

Originally published:

Cristina Carballo-Perelman is a neonatologist and can be reached at her self-titled site, Cristina Carballo-Perelman, and on Twitter @ccperelman.

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