Nurses are there to help and support doctors.... The place for nurses is with the doctors in our institutions.
Reading this statement from the president of Federation of General Practitioner of Quebec (FMOQ), you might think it was from years gone by. Unfortunately, it is a quote from January 2016 when Dr. Louis Godin made the comment in response to the FMOQ's decision to disallow registered nurses from owning their own businesses unless they were under the same roof as the physician.
We do not encourage self-employment or independent nurses. Nursing must be done in facilities where there are also doctors. They cannot work in silos, in separate clinics. This is not where we need nurses, we need them in our FMGs [family medicine groups] and in our clinics. (Translated from le Soleil, January 21, 2016)
It's hard to believe that this old school way of thinking is still in circulation today. Really? Our primary professional role is to support the doctors? We are not permitted to use the nursing process, which is the core of our nursing education, to be critical thinkers and apply this knowledge for the better of the patient?
While some physician colleagues might not view nurses as an equal on the health care team, the public has a definite high level of respect for the profession.
A Huffington Post survey in June 2017 found that nurses were tabbed as the most respected professionals in the country, with a 96% positive rating overall. And according to a Gallup poll in December 2016, 84% of Americans rated nurse honesty and ethical standards as "very high" or "high." Pharmacists were the next closest at 67%.
So why should a nurse not have his/her own business when the standards outlined by their colleges are being met, there is collaboration among the providers, and they are working within their scope of practice? The provincial nursing colleges encourage independent nursing practices and have established guidelines to assist nursing entrepreneurs. There is no evidence-based research to support the claim that a physician on-site will decrease complications or enhance the level of care provided to the patient.
A lack of respect continues to be a challenge for nurses, especially in the medical aesthetic industry. Or maybe it's just a lack of knowledge-about the extent of education an aesthetic nurse must try to acquire the knowledge, skill, and judgment to provide safe and ethical aesthetic treatments. Regardless, there is growing pressure being placed on aesthetic nurses by physician colleges to stop nurses from providing these services unless they are under the same roof as the physician.
The medical aesthetic industry has steadily increased in the number of procedures performed, as well as the number of providers performing these treatments. In the past, these treatments were done within a physician's office, under his/her "supervision." There is a growing trend for nurses with an entrepreneurial nature to open up their own practice while continuing to work within their scope of practice and collaborating with a trained physician. This has opened up opportunities for registered nurses, nurse practitioners, and physicians to work together to ensure that their practices are providing medical aesthetic services in an ethical and safe manner.
It works well and is widely accepted. Except by some physicians, it seems.
The concept of collaboration appears simple, but there are still several barriers that nurses are being faced with that need to be overcome to maintain the continual flow of care. Nurses are still bearing the burden of the "doctor-nurse" game. There remains the hierarchical and social structure of medicine where the physician is perceived as the primary decision maker and nursing knowledge is devalued.
Cleary, there needs to be a better understanding of the depth and breadth of the ongoing educational training that aesthetic nurses undergo to become a safe and confident provider. In return, nurses need to understand and respect the role of medical directors and their commitment to patient safety. This education of awareness may be the missing link. If physicians are unaware of the knowledge and skill it takes to become a proficient aesthetic provider, unaware of a nurse's scope of practice, and unaware of the standards and guidelines nurses need to adhere to for maintaining their license to practice, they will not be comfortable supporting nurses.
Increasing the collaboration between the nurse and the physician would make a difference, as each provider brings different perspectives on patient care.
To ensure a thorough approach to patient care, there must be an effective and open communication among the health care team providers. Neither profession can stand alone; therefore, collaboration with an understanding of each other's roles will promote safe patient care.
It is the combination of these differences-and respect-that can benefit patients and the care they receive.
Respectfully submitted,
Tracey A. Hotta, RN, BScN, CPSN, CANS, LNC
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