The once personal relationship between a physician and their patient is no more. Doctors are under intense pressure to squeeze as many patients and appointments into their busy day in order to generate enough revenue to keep their practice open. This evolution of the doctor-patient relationship has placed greater emphasis on the nurse-patient relationship.
Significance
Once thought of as doctor's assistants, nurses today not only command more responsibility, but more respect in their communities. Nurses are the first line of defense that patients frequently come into contact with when they are ill. As the nurse performs an assessment, they listen, gather information, make nursing diagnoses and later also make recommendations to the doctors for the care of the patient. Experienced nurses know more than new medical interns when it comes to patient care, disease pathology and treatment. Once a nurse becomes trusted by a physician, the nurse may frequently request what she wants for the patient in the form of treatment and medication, and the doctor will then prescribe it. It has been often said that nurses treat the patients, and doctors treat the disease.
Function
Because most nursing time is not billed outright, nurses have more time to spend with patients and listen to their concerns. In the case where the time is billed, such as that of a nurse practitioner, their rate is much lower than the doctor's and they are still able to spend more time in the care of the patient. As patients are armed with more health information from the Internet, print and television sources and come to their appointments and hospital visits with a stack of printouts, the extra time that a nurse spends going over the material fosters a relationship of trust between the nurse and patient.
Features
As health care becomes more specialized with different types of doctors needed for different diseases, it has become increasingly important for the nurse to coordinate interdisciplinary care among many different health care providers including allied health personnel such as physical, occupational and respiratory therapists. Having a central person such as the nurse whose job it is to review the chart, complete with lab work and reports from all caretakers of the patient, is more important than ever especially when the patient presents several health issues. Without the nurse acting as the coordinator of care, patients could receive double treatment from doctors or too many medications for the same disorder. It is not unusual for a patient to show up with two large plastic bags of medications for an appointment with the nurse to help them sort it all out. At this point, a nurse becomes a bit of a private investigator in order to ferret out the reasons the patient is taking all that medication.
Considerations
As the rising cost of malpractice insurance has forced many physicians into early retirement or simply retiring from patient care and moving into another aspect of health care, nurses have a higher demand for services placed on them. To offset a need for better-educated nurses, the National Council of State Boards of Nursing constantly changes the licensing exam for nurses and raises the minimum passing standard every four years. Nurses who received their license 15 years ago would probably find it difficult to pass the licensing exam today as the nursing school curriculum has become more rigorous through the years. Continuing education credits are required of every nurse before license renewal in order to stay abreast of changes in health care.
Expert Insight
A great deal of autonomy is available to a nurse who wishes to practice more than the typical bedside nursing found in hospitals. In many states, nurses are able to set up their own primary-care practices and write prescriptions with a simple checkoff by a physician. Two of the emerging fields in nursing are genetic counseling and research. Nurses now conduct family planning and genetic counseling sessions with people who have concerns about inherited diseases and disorders. Nurses are the great problem solvers and frequently have more creative solutions to the patient's problems than the doctor simply because they have had to do far more with far less authority and resources for a long period of time.
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