The Scoop: Medicine & Nursing

What’s the difference? IS there a difference? Are nursing school and medical school part of the same program? These are some of the questions I’ve encountered and figured would be prime content for it’s own dedicated blog post. I’ve partnered up with my friend and fellow healthcare professional, RNoire, to answer some of your questions. Whether you’re considering one or the other, hopefully our answers enlighten those who are simply looking to learn more!

My answers are blocked in yellow, and hers in gray.

1. Describe your training for medical/nursing school:

There are many types of nurses therefore many educational routes one can take to get into the field of nursing. Each level of nursing requires a certain level of education and specific licensure exam. You have your certified nursing assistant (CNA), licensed practical nurse (LPN), registered nurse (RN), and advanced practice nurse (NP, DNP, CRNA etc.) I know! It’s almost like alphabet soup. In my case, I am a registered nurse so that’s what we’ll focus on. In order to become an RN, one may choose to get an Associate Degree in Nursing (ADN) which is a 2-year program or a Bachelor of Science in Nursing (BSN) which is a 4-year program. ADN programs focus on clinical skills and can allow you to enter the workforce quickly whereas a BSN focuses on clinical skills and advanced nursing methodology and research and can allow you to advance the clinical ladder later down the road. After completing an accredited educational program, you have to sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN) which is the same exam across the U.S. This exam ranges from 75-265 questions and a maximum of 5 hours to complete. After passing the NCLEX-RN, you can apply for licensure in the state you would like to practice in. As a registered nurse you have to renew your license about every 2 years by maintaining a certain amount of continuing education hours depending on which state you’re licensed in.

The road to medicine is a bit nebulous to some, but it’s pretty straightforward: One first must obtain a Bachelor’s degree. In anything, really. A few programs may require a specific Bachelor’s but in my experience, most of them allow you to study pretty much anything you want. Some of my classmates majored in Dance, Psychology, Spanish, etc. However, you must take pre-med classes as a prerequisite for applying. Then, medical school itself is 4 years. The traditional structure is 2 classroom years, then 2 clinical years, yet there has been a shift in this model and what schools consider to be the best way to train. At the end of the classroom years (typically year 2), students must take USMLE (United States Medical Licensing Exam) Step 1—one of the most challenging exams on the route to physicianship. 3rd and 4th year consist of clinical rotations through the core clerkships and electives. During the 4th year, you apply to residency programs, and after graduation (when you officially have the MD and can be called “doctor”), residency begins. Residency programs can range from 3-5+ years depending on your particular field. Residents can opt to do a fellowship afterwards, which is a further specialization into the field. In the midst of all this, students take USMLE Step 2, and may opt to take a year off for research. Similarly, recertification exams occur every 7-10 years to maintain your board license.

2. What is the scope of your nursing/medical school education? What kinds of things do you learn?

The classroom years in medical school are largely focused on learning physiology and disease processes. Basically, how everything works normally, and the many ways in which these processes can go wrong. This ranges from the very basic cellular level all the way to the organ system level, so it covers A LOT and very quickly. Treatment and management of disease is also taught, although in my experience that is solidified much more in the clinical years when it’s more practical. There are also seminars and classes on psychosocial implications of disease, medical humanities, nutrition and other disciplines not often seen as “central” to medical education. In the dual degree program especially, we also take many public health classes like Research Methods, Health Policy, and Statistics to name a few. They equip us with the tools to conduct public health research and become involved in public health in many capacities. Third and fourth year are mostly in the clinical setting (hospital, community center, private clinic). During these years we typically work the same hours that a resident team or given physician would (and yes we still are expected to study, complete assignments, and take exams at the end of every rotation).

In nursing school, we are taught from the nursing model of care which focuses not only on the disease and treatment but also health promotion, disease prevention, health education, counseling, and advocacy. It’s a more holistic approach in comparison to the medical model which focuses more so on disease processes, pharmacology, anatomy and physiology. At least that’s how it’s been explained to me. In nursing school, you essentially have your coursework and hands-on clinical experience. Coursework includes subjects like pathophysiology, pharmacology, nutrition, microbiology, and health assessment. You’ll also have courses such as pediatric nursing, maternal and newborn nursing, adult and geriatric nursing, public health nursing, and psychiatric nursing with a clinical component attached. During your clinical rotations, you’ll be in the hospital setting for about one day a week taking care of 1-2 patients applying whatever you learned in the classroom. We also learn how to complete head to toe assessments, take vital signs, and many many many skills such as IV insertion, Foley catheter insertion, CPR, and how to transfer patients.

3. Can you specialize? What does it mean? How and when do you decide?

Yes! This is honestly my favorite part about nursing. Nursing is super flexible and allows you to move around in whatever specialty your heart desires. As a nurse you learn a set of skills that are applicable to all specialties such as how to assess a patient, medication administration, vital signs, and pharmacology. Therefore, there are no extra test or schooling required to change specialties. As a registered nurse you can work in an array of settings and with different populations: inpatient in the hospital, outpatient in a doctor’s office, in the community or even at a school. You can choose to work with children, adults, labor and delivery, in research, in the operating room, or even education. There are over 100 specialty options to choose from as a registered nurse. Most nurses usually get an idea of which specialty/field of nursing they want to get into through clinical rotations during nursing school. I personally remember starting my pediatric rotation and immediately knowing I wanted to work with children. After graduation, you apply for jobs in whatever you’re interested in and go through a unit-based orientation process that provides specific education and training for that specialty. You can become a certified nurse in every specialty. For example, I could become a certified pediatric nurse after working a specific number of hours and passing the certification exam. Many nurses change specialties at some point in their career due to change of interest, lifestyle, or even to avoid feeling stagnant.

Specialty is the name of the game in medicine. And similarly, there are so many to explore and choose from. Because medicine itself is so vast and complex, although not impossible (because I know many physicians who have had a career change mid-residency), I imagine moving between fields is not as simple as in nursing. There are always ways to get to where you want to be. In general, the idea is that after fourth year, you have a sense of what you’re interested in, complete training, and practice with certification in that field. That being said, there is much flexibility in choosing to (or not to) undergo fellowship training, choosing a workplace setting, target population, and so forth. Health policy, community and state health, hospital administration, medical education, global health, consulting, private practice, research…there are so many different career paths with an MD degree within a given field. I can’t imagine all the faces that medicine can take when you consider all the possibilities.

4. What is a typical day like in your program?

Given that I’ve started the “A Day In the Life” series for the clinical years, I’ll describe a typical day in the first 2 years of school for me: Lectures generally took place every day on campus. Sometimes 8a-12p would be scheduled, sometimes the afternoons, sometimes both. Monday, Wednesday, Friday we’d also have PBL (problem-based learning) small group sessions as part of our program, where we’d spend 2 hours reviewing a specific case, developing differential diagnoses, discussing ethical dilemmas, asking questions and clarifying concepts to one another. Some weeks we’d also have patient simulations where we’d practice our interviewing and physical exam skills. Generally my afternoons would be full of studying/watching lectures and I’d find a dance class or two for the nighttime.

Nursing school is a mix of classroom lecture, clinicals, and skills lab as is with most health professional programs. As a nursing student I had about three days of in-class lecture, one day of skills lab, and one day in clinical. For example, I’d be in classes Monday, Wednesday, and Friday from 8- 5pm with a 1-hour lunch. On Tuesday, I’d go to skills lab from 8am-12 pm where I would learn and practice a certain skill such as placing a catheter and getting checked off on previous skills learned. On Thursday, I’d go to clinical at the hospital from 7 am- 7pm. One to two days per week I’d have organization meetings or events for about two hours and the rest of my free time is spent studying and doing something fun, non-nursing school related.

5. In your experience what has been the relationship between nurses and physicians?

Ohh the infamous nurse and physician relationship. If you’ve watched any medical television show you’d think physicians scream at nurses telling them what to do and we argue like cat and dogs. And it actually used to be that way. But based on my experience I’d say nurses and physicians for the most part have a healthy working relationship. And of course, this relationship varies based on the individuals working together. Physicians, or providers as I like to call them, are the brains and the nurses are the hands. Providers assess, diagnose, and determine a treatment plan and the nurses carry out those orders while monitoring the patient. I’ve come across providers who are very hands-on with the patient and want input from the nurses and then there are some (very few) who basically ignore the nurses’ input. Being that I am at a teaching hospital, I interact with providers who are eager to teach and problem-solve with the nurses. There are plenty of times where the provider asked for my opinion and changed treatment plan based on my assessment/input. Although my experience has been positive for the most part, I would say that some providers often overlook the emotional/social aspect of patients and families that we nurses bring up especially with our long-term/chronic patients. At the end of the day, a healthy nurse-physician relationship is essential to providing quality patient care. Nurses have to be confident in their assessment and sharing that with providers and providers have to trust and respect the nurses input no matter how many times we may call lol.

Likewise, I can say I’ve seen healthy physician-nurse relationships, nothing like pop culture has normalized. Times have changed for the good. As a medical student, I interact with the nurses on a different level i.e. I lean on them for mostly everything I don’t know and am too embarrassed to ask the attending. If I don’t know where to find supplies, need help ambulating a patient, changing a dressing, updating the patient’s status, my go-to is the nurses’ desk. In my experience, students who dismiss the nurses will have a more difficult time adjusting to new clinical environments, and having someone, anyone, more experienced than me help me do what’s best for the patient is the most important thing. Mutual respect goes a long way and, in my humble opinion, is the bare minimum necessary to be successful in either field.

For years, there has been an “us” versus “them” when speaking of the nurse and physician relationship; however, the future of healthcare truly lies in collaboration and teamwork. With a rapidly expanding healthcare team, communication is key to keeping patients safe and achieving better patient outcomes. Furthermore, don’t be afraid to laugh together! Our responsibilities are heavy; we each have a role to play when providing patient care. Enjoying what we do is a small part of keeping the wheels turning and spreading good wherever we may go.

Peace & love (& nursing & collaboration & healthcare),

The IT Factor & RNoire

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