Full-Text Friday: Nursing Is Not a Lesser Included Profession

I am on my way to Argentina, but wanted to leave you with a new full-text post before I jet off. This week’s offering is actually a law review article, and I post it because it’s an important perspective from the legal profession about a conversation we should be having more of (or really, just having since I don’t know that I’ve ever heard the topic mentioned in any formal way). Click through for details:


Citation: Gerova-Wilson, T (2013). Nursing is not a lesser included profession: Why physicians should not be allowed to establish the nursing standard of care. 16 Quinnipiac Health Law Journal 43.

Why this article? First, let me make this clear–I don’t post this with any disrespect to my physician colleagues. I post this because we frequently allow nursing to be subsumed by medicine, as if the two aren’t separate and distinct professions. Look at any state’s requirements for licensure and the distinction should be clear, and yet we often see physicians formally commenting on nursing practice and standards. Although this law review looks at the issue from the civil, malpractice side of things, it’s an important conversation to be able to have in the forensic world, as well. There is a role for both professions, but it is important to make sure nursing is more than just physician-light. To have that happen, nurses need to be able to discuss our role in nursing terms, understanding and articulating nursing regulations, licensure, and standards. It also means stepping up our game in court so that these distinctions are proactively made (in anticipation of the, isn’t it true you’re not a physician theme of cross, as well as to simply establish the healthcare nature of the role)–something I feel like I talk about tirelessly, but which never becomes less true.

I also want to say this: I don’t love all of the author’s conclusions, but it doesn’t negate the importance of the issue. This would be a great article for journal club, because there’s a lot to discuss and debate.

Key quote:

Despite the fact that the scope of nursing has expanded substantially throughout the years and currently certain nursing responsibilities overlap with physician’s, it is clear that being a nurse and being a physician are still two sharply distinguishable professions. Each of them requires different training and licensing, and the majority of the responsibilities of those professionals are not the same. Even where nursing and physician activities do overlap, it is not always reasonable to presume they would be performed at the same level of competency by a physician and by a nurse. Therefore, allowing a nurse to testify as to physician’s standard of care, or vice versa, carries the risk of establishing an erroneous standard. (p. 13)

{Note: I had someone comment that this quote assumes that nurses cannot perform tasks as competently as physicians, which I do not believe is an accurate interpretation. I think there are some things nurses do far more competently than physicians and vice versa. The point here is that allowing one profession to comment on the other assumes a baseline level of interchangeability that is unreasonable. Period.}