Oh boy that’s an interesting question. Having worked on both sides of that “fence” now, you’d think I could articulate an answer but I fear I may lapse into jargon… I will try not to.
I think Bill gave a good response. Nursing is about those actions that will help restore a person to health or maintain a person’s health. In the hospital setting, such actions might include: assessing a person’s response to medication (e.g. pain med), taking blood pressure (how did he respond to the new BP med?), talking to find out what aspect of a person’s hospitalization is most challenging for him, explaining a person’s treatment to a family member, checking a comatose patient’s response (via monitor readings) to ventilator settings, etc. etc. etc. The knowledge base required for performing in this setting includes knowing the normal parameters of body functioning and human response - for example, knowing normal heart rate and blood pressure; knowing the abnormal functioning that accompanies illness (e.g. normal heart rate of around 70, heart rate with a fever could be 90 or 100). You need to have a basic understanding of the physiology underlying the patient’s body’s response to illness, surgery, medications, treatments.
The physician needs to look at a person and diagnose the problem, prescribe the treatments that will hopefully treat the problem, and assess the person’s response to those treatments. There is definitely some overlap.
In the hospital, nurses are the ones who are in charge of the minute-to-minute care of patients. They carry out care that is prescribed by the physician as well as care that does not need to be addressed by the physician but is also integral to the patient’s well-being and recovery. For example, while the physician may prescribe a cardiac diet, the nurse will be the one to determine that the patient doesn’t understand the menu choices, and explain to him how he needs to choose his menu selections. Or, the physician may prescribe Lovenox (low-molecular-weight heparin for anticoagulation) but the nurse teaches the patient how to inject this himself so he can go home. Or the nurse reports back to the physician that the patient isn’t going to be able to perform this skill and will need some other sort of treatment.
You’ll read a lot of people on other boards (cough - SDN! - cough) trash the nurses because their job is “to follow my orders.” That’s a decidedly inaccurate view of nursing. Nurses are educated in anatomy and physiology and much more. They aren’t robots who just blindly do what someone else says. Doctors can prescribe wrong meds, wrong treatment and nurses have a responsibility to make sure the patients they care for get the RIGHT drugs and RIGHT treatments.
You may recall the story some years ago about the patients who died at Dana Farber Cancer Institute in Boston when they were given an inappropriately mixed experimental chemo agent. Among the health professionals found liable in that investigation were the nurses who did not ask the right questions about the chemo they gave.
Oh, finally I gotta say that it’s the nursing programs that really care about this. While I heard about “the medical model” all the time in nursing school, and had it drummed into my head all the ways in which nurses did NOT practice “the medical model,” I don’t believe I EVER heard the term while in medical school nor have I heard it in residency. You can’t get away from hierarchies and regretfully I have observed that the field of nursing has a big collective chip on its shoulder about the status of nursing, which I theorize leads them to need to come up with phrases like “medical model” and “nursing model.”
Hmmmm I already said “and finally” once but one last comment: I LOVED being a nurse. I loved caring for patients, loved what I did. Nurses are great in my book, and have a really tough job. I am not so keen on nursing education, which I think has spent way too much time justifying its existence. OK 'nuff said.
Dunno if this helps!
Mary