The title of this article might sound like a simple question; however, the answer is not so cut and dry. In some states, the right to practice as an NP hinges on the fact that the NP is practicing "nursing" and not "medicine." Legal definitions of medicine universally include the authority to diagnose and treat, whereas nursing definitions include holistic care of patients and implementation of medical orders. NPs across the country assess, diagnose, and treat patients every day. In doing so, are they practicing medicine?

A Unique Perspective

During the first part of the twentieth century, medicine practically defined itself and carved out the whole of healthcare. Next, it was proclaimed that only those licensed to practice medicine could supply medical services. As a result, other healthcare providers have had to chip away at the medical definition in order to define themselves. Nursing skirted the issue by defining itself in ways to exclude medical diagnosis and treatment. However, by the nature of our practice, NPs cannot eliminate the fact that medical diagnosis and treatment is used as part of the care they deliver. We have defined ourselves as nurses first, but have also incorporated parts of medical practice into the profession. This has produced a new healthcare professional that is a meld of both nursing and medicine: one that delivers medical care, but from the unique perspective of nursing.

Recently, advanced practice nursing leaders and organizations have become more vocal in their call for legislative changes that would grant full autonomous practice to advanced practice nurses. According to recently published summaries of state laws concerning NP practice, more than 20 states grant autonomous practice, but only 14 grant autonomy in both practice and prescribing.1 NPs who want to increase professional autonomy and clarify their legal authority to diagnose and treat should eliminate collaborative requirements.2 Moreover, the National Council of State Boards of Nursing called for fully licensed practitioners to be independent practitioners.3 The American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties both call for autonomous NP practice with the implementation of the Doctor of Nursing Practice as the degree for entry into practice.4

A Continuing Battle

Clearly, reimbursement for NPs is dependent on the ability to provide autonomous healthcare services. In states where NPs are designated primary care providers and licensed independent practitioners, reimbursement is facilitated but is not a foregone conclusion. In states where NPs are required to practice under physician supervision, the battle for recognition and reimbursement is uphill.

So, do we practice medicine? The answer is yes. Medicine is defined as the diagnosis and treatment of illness. We posses the education and skill to diagnose, treat, and use medicine to deliver care to our patients, but we are also nurses that practice nursing. We must work to change state laws to allow for autonomous NP practice and the full recognition of all that we bring to the healthcare arena.

References