Should Nurses Be Trained and Licensed to Perform Procedures Currently Done Only by Physicians?

As a healthcare professional with experience in both nursing and veterinary care, I have often observed the critical roles that nurses and technicians play in patient care. This observation has led me to reflect on the scope of practice for nurses and whether it should be expanded to include procedures that typically require the expertise of a medical doctor (MD).

Nurses' Abilities to Recognize Critical Situations

It is well-established that nurses and veterinary technicians can recognize when a patient may need specific interventions, such as endotracheal intubation, just as effectively as their doctor counterparts. In situations where a patient's life is at risk due to respiratory distress, the ability to act quickly without delay can be the difference between life and death. For instance, the ability of a nurse to perform endotracheal intubation can save a patient's life in mere minutes, making immediate intervention crucial.

The Distinction Between Physicians and Nurses

While it is true that nurses and allied health professionals can be trained to perform specific procedures, it is crucial to understand the fundamental distinctions between their roles. The depth of knowledge, training, and judgment required to perform complex medical procedures extend beyond the training of a nurse. Physicians undergo extensive medical school training, residency programs, and regular continuing education to ensure they can provide the comprehensive care that patients require. Nurses, on the other hand, are trained primarily in patient care, assessment, and support functions.

For example, an experienced nurse can teach a doctor how to perform certain tasks more effectively, but this does not negate the need for the doctor's specialized training and judgment. A doctor's role is to diagnose and treat, while a nurse's role is to support and care for the patient. This division of labor ensures that both professionals can contribute their unique expertise to the patient's care.

Advanced Training and Scope of Practice

Nurses can be trained to perform specific advanced procedures, such as intubation, or take on roles like a flight nurse or advanced practice registered nurse (APRNs). In these cases, the training and experience of the nurse are paramount. However, not all nurses will have the training or experience to perform every procedure that an MD can.

A good example is ICU physician assistants, who can be trained to perform thoracentesis with ultrasound-guided techniques and central line placements. This specialized training allows them to handle specific procedures that are both diagnostic and therapeutic. However, the decision to have an allied health professional perform a procedure should not be made lightly. It requires careful consideration of the patient's specific circumstances, the availability of other alternatives, and the nurse's or technician's level of training and experience.

Caution and Specificity in Expanding Nurse Roles

Expanding the scope of practice for nurses to include more complex and critical procedures is not a one-size-fits-all proposition. While some straightforward diagnostic or therapeutic procedures may be suitable for allied health professionals, others may require the unique judgment and experience of a medical doctor. For instance, procedures that do not have a large number of alternative options or those that do not require a lot of subjective interpretation based on the entire clinical context may be more suitable for nurses and other allied health professionals.

It is important to carefully evaluate each procedure and determine whether it can be safely performed by an allied health professional with adequate training. This ensures that patients receive care from professionals who can make the best judgment calls based on the specific needs of each case.

In conclusion, while there is value in expanding the scope of practice for nurses to include certain advanced procedures, this should be done with caution and specificity. The role of the nurse, the background and judgment of the professional performing the procedure, and the patient's specific needs are all critical factors to consider when determining which procedures can be assigned to allied health professionals.