Miller Jason E
Highmark Inc., Pittsburgh, Pennsylvania, USA.
Medscape J Med. 2008;10(11):253. Epub 2008 Nov 4.
The distinction between doctor and nurse has been historically visible to patients, and the scope of practice for each healthcare provider has been clearly marked by a wall of separation rooted in state law. In fact, even the titles by which these providers have been addressed have remained constant, with the term "doctor" being reserved for reference to physicians. With the advent of the new doctor of nursing practice degree, however, the clear distinction between doctor and nurse is in jeopardy. Moreover, accompanying the push toward a practice doctorate for advanced nursing practice is a call for the expansion of the scope of advanced nursing practice. The urgent questions at hand are the following: First, is a practice doctorate necessary or even appropriate for advanced nursing practice? Second, should the scope of advanced nursing practice be extended at this time? In addition to the increased educational requirements placed on aspiring advanced practice nurses and the associated increase in costs of obtaining the requisite education, requiring a practice doctorate for advanced practice nursing risks blurring the line between doctor and nurse and creates a potential for patient confusion. A true need for requiring a practice doctorate for advanced practice nursing has not been demonstrated. Moreover, the states should tread carefully when considering expanded roles for advanced practice nurses to avoid creating conflict within the medical community. Considering the level of qualification of today's medical school applicants, perhaps we should be training more physicians to meet the demand head-on rather than creating a separate practice doctorate to fill the gap.
医生和护士之间的区别在历史上患者是能够明显看出来的，而且每个医疗服务提供者的执业范围都由基于州法律的一道分隔墙清晰地划分开来。事实上，甚至这些医疗服务提供者的称呼都一直没变，“医生”这个词一直专指医师。然而，随着新的护理实践博士学位的出现，医生和护士之间的明显区别受到了威胁。此外，在推动高级护理实践获得实践博士学位的同时，也有人呼吁扩大高级护理实践的范围。当前迫切的问题如下：第一，实践博士学位对于高级护理实践来说是否必要甚至合适？第二，此时是否应该扩大高级护理实践的范围？除了对有志于从事高级实践护理的人员提出了更高的教育要求以及获取必要教育的相关成本增加之外，要求高级实践护理具备实践博士学位有模糊医生和护士界限的风险，并有可能让患者产生困惑。尚未证明对高级实践护理要求具备实践博士学位存在真正的必要性。此外，各州在考虑扩大高级实践护士的角色时应谨慎行事，以避免在医学界内部引发冲突。考虑到如今医学院申请者的资质水平，或许我们应该培养更多的医师来直接满足需求，而不是设立一个单独的实践博士学位来填补缺口。
