I introduce myself to the patients as a nurse practitioner (NP), but they still call me a doctor. Even worse, some of the staff refer to me as “doctor.” I imagine they do so out of respect, but no matter how many times I correct them, the erroneous title lives on. The reason I ask not to be called doctor is not because I have not earned my doctorate nor because I did not go to medical school; rather, it is because I want to be called a nurse. I do not want to be confused with a physician, as the title in this situation confers. I would want to be called a nurse even if I had my doctorate in nursing or my doctorate in medicine. I want everyone to know that I am of the breed of Florence Nightingale, Lillian Wald, and Walt Whitman—not of Lister, Fleming, and Hippocrates.
A nurse is incorrectly viewed as a subordinate to a doctor, and “doctor” has incorrectly been tied to “physician.” Enter the 21st century: physical therapists hold a doctorate and can thus be called “doctor,” and a dietitian is a provider and can have a doctorate as well. Shall we speak of chiropractors? But the most confusing medical role belongs to nurses, who range from a licensed individual restricted to giving medications to a specialized doctorate-prepared clinician who prescribes complex regimens and wears a white coat.
To the outside world, the actions of an APRN and MD/DO are identical. Our specialties learn the same science and work with the same language of medicine. But just as math is the language for both physics and statistics, the two disciplines are different and respectively play an integral role in our world. The same is true for nurses and physicians or for those attempting to deceptively be perceived as one or the other: a nurse trying to be a physician is the same as a physicist attempting to explain physics with statistics—it does not work.
As nurses, and those who go by the title of nurse practitioner, we should be more cognizant of the unique experiences and wisdom that we bring to our patients and clinics. We should realize and show our patients that what we have is a unique set of skills and experiences that will be valued as much as, if not more in some instances, than that of a physician. A nurse is made up of our modern schooling (19th/20th century as opposed to the 10th), is a member of the United States’s most trusted profession, and each individual is composed of vast and nimble experiences ranging from months to decades in every unit, office, and community one can imagine.
There are unique experiences of a nurse that differentiate us from a physician: nurses work as social workers and case managers, as CNAs or LPNs, or even as managers of a unit or a clinic. Individuals become nurses as a second or third career. Nurses typically work in several units over their careers and see the continuity of care closer than other professionals, as they can easily go from the ED to mother and child, to pediatrics, to oncology, and then to palliative care. In all fairness, physicians enjoy this experience during rotations to some extent, and even a few physicians change their specialty, but for a nurse, a change in specialty is normal and expected. Our time in specialties lasts far longer than a medical school rotation, giving us greater opportunity to learn the nuances that are so important to patient care and healing. Furthermore, there are places where physicians do not go but where nurses are indispensable: have you ever heard of a grade-school physician? No, because it is the nurse who sits with the children and watches bullying, malnutrition, and poor home lives that put children on a trajectory to become future patients. Also rare is a home-care physician without concierge in their title, but a nurse, in their various roles, often sees patients in their homes, in their environment, in their milieu, which is as much a product of the patient as the patient is of it. A physician does not usually have the opportunity that a nurse has to sit at the bedside with patients for hours on end, engaging in deep conversations that reveal the inner workings of their minds and learning the life cycle that got them into that hospital bed in the first place. The RN learns that it is in these conversations where the secret to caring, curing, and healing is often revealed.
Collectively, these roles, experiences, trust, and care create an entity in health care unlike any other. This entity is called a nurse. These experiences yield the unique knowledge and wisdom that make nursing a specialty unto its own that is awaiting its members to claim the pride it deserves. The NPs who continue to be nurses first are the ones who often do not wish to be called doctor. Aside from the subordinate nature of the title, physicians would rightfully pine over the title of nurse.
As jurisdictions grapple with the role and practice limits of NPs, the profession will amplify itself by embracing the essence of being a nurse. It will stand on its own, practice independently, be respected, and be held equally by our medical colleagues. Should the profession continue to attempt to be “doctors,” it will hit a ceiling—and perhaps rightfully so.
As nurse Walt Whitman put it:
“Nothing can ever diminish my admiration for our heroic doctors. Oh, how they did work and wrestle with death! Each case had its peculiarities, and needed some new adaptation. The typical good doctor of the army united rare sacrifice with deep emotional, sympathetic qualities—would adapt himself to conditions—was never a medical dogmatist. The young surgeons of the army—such a power!—and so philosophic, too—with minds so open and free—with hands fit for any emergency! They would not resent advice, even from me. They would be apt to say—well, that is new, and it will not hurt to try. I learnt thus a good deal of hospital wisdom, welcomed by the surgeons as by the soldiers—very grateful to me. The doctors would most times leave the boys absolutely in my hands.”
Joseph Lanctot is a nurse practitioner.
