Differences in nursing ability influences physician decisions

Not all nurses have the same level of experience and knowledge. This disparity in education and experience can affect how well nurses are able to care for physicians’ patients. Some physicians find that they must tailor their patient care to accommodate for the nurse that will be implementing their orders; this is especially true when orders are given remotely based on a nurse’s assessment.

Differences Between Nurses

There are three main differences among nurses that can affect how they provide care and can cause physicians to adjust their approach to caring for their patients.

Education

Nurses vary in their level of education. Typically, nurses will either be licensed practical nurses (LPNs) or registered nurses (RNs). RNs will either have an associate degree or a bachelor’s degree.

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LPNs normally have one year of education and their education is more task-based. LPNs will not have the same level of knowledge that an RN will have and in most states are not able to independently perform an assessment. An LPN will provide care under the supervision of an RN, or in some situations, may provide care under a midlevel provider or physician. While LPN’s are licensed to perform similar care to an RN, their assessment skills and knowledge base will not be as strong as an RN.

RNs typically have an associate degree (ADN) with two years of nursing education, in addition to a year of prerequisite, or a four-year bachelor’s degree (BSN). The difference in the clinical knowledge and ability of these two levels of education are very small, and there is no difference in the scope of practice of an RN based on the type of degree they have. The main difference is that a BSN also includes courses focusing on subjects such as statistics, leadership, and education. While these areas do not significantly impact clinical practice, they do improve a nurse’s ability to advance in their professional careers. Many nurses in areas of leadership have a BSN degree.

Experience

Like any other profession, nurses with more experience will be better equipped to recognize changes in conditions, more familiar with standard treatments, and more able to efficiently perform nursing tasks. The disparity in nursing ability due to experience is most notable during the first one to three years. Nurses within their first few years of practice often have not been exposed to clinical situations that their more experienced counterparts have been. This can lead to nursing assessments that do not reflect the patient’s condition as accurately as a more experienced nurse’s assessment or in care that is not provided at the same standard that an experienced nurse would provide.

In addition to years of experience, the nurse’s clinical experience is also influenced by their specialty. A nurse who has just become a wound care nurse after working in an OB/GYN office, for example, will be much less familiar with their new role than an ICU nurse who is more frequently exposed to complex and chronic wounds.

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Certifications

Professional nursing certifications are awarded by professional organizations that provide certain professional standards and examinations that must be met to achieve that certification. A nurse who has a professional certification in a specialty may indicate their certification by including the initials of their certification after their name. These certifications indicate that the nurse has a high level of knowledge and experience in the specialty that they are certified in.

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How Differences Between Nurses Affect Physicians’ Decision-Making Process

The differences in education and experience among nurses should be taken into consideration by the physician and will play a role in the physician’s decision-making process. 

The Ability of the Nurse to Assess

Nurses who are less experienced or do not have a strong educational background may not initially provide a complete clinical picture or may inadvertently omit details that could be pertinent to a patient’s plan of care. When interacting with a newer nurse or a nurse with less experience in their area of practice, a physician should always be aware that they will need to ask more follow up questions and be sure that they are receiving the full clinical picture.

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The Ability of the Nurse to Understand What Needs to be Done

If a physician is not physically present, it is beneficial to the patient and to the physician for the nurse to be as autonomous as possible. This decreases the number of calls that the physician needs to field and streamlines patient care. Nurses who have less clinical knowledge or experience may require clear, detailed guidelines that indicate what they should call the physician for and in what areas they should act autonomously. By providing less experienced or educated nurses with clear, consistent guidelines, physicians can reduce the number of calls they receive and help the patient to receive more efficient care.

The Nurse’s Ability to Understand Orders

Nurses without much clinical experience may be unfamiliar with orders that seem routine. This can cause them to misunderstand certain orders and increase the risk of medical errors. Closed loop communication is the standard of care for all orders given, but careful attention should be given when providing orders to nurses with less experience. Orders for procedures or medications that are less common are especially important to clarify that the nurse has correctly received and understood. By using closed loop communication and requiring feedback from the nurse, physicians can help to avoid potential confusion and misinterpretations of their orders.

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Implications

Nurses are a vital part of the healthcare team, but have varied backgrounds, education, and experience. When physicians are aware of these differences between nurses, they are better able to adjust their decision-making process to include the ability of the nurse to provide the best care possible to their patients.

_{Japa Volchok, DO is a trained vascular surgeon and experienced wound care physician. He currently works as Vice President of Operations for Vohra Wound Physicians, the largest wound care specialty group focused on the post-acute market.}