Are doctors really better than nurses? Will This War Ever End?

It remains one of the most baffling questions I have ever been asked. In an attempt to answer, I spoke with colleagues and friends. I called a nurse friend in Ghana with the main goal of discussing the same question, during my daily rounds, I stopped more often to chat with nurses, I tried to tap into a largely non-existent experience from dating nurses and I brought it up for discussion among my doctor colleagues. I realized the need to understand the many perspectives there are to this issue and finally I sat down to write albeit briefly on the ‘war’ between doctors and nurses.

There is a war, an unspoken one between two great professions; nursing and medical practice, and thankfully, it is one problem that is not peculiar to Nigeria but global in nature though manifesting in various forms in different regions and countries. It is also a perennial war. It has been before now and many feel obliged to pass on the enmity to upcoming generations. It is like those ancient stories of great enmity between two respected families that continues down generations irrespective of what version of the cause of such animosity a descendant gets to hear. Or like in the world of soccer, the feeling of responsibility to hate that a Liverpool FC fan has towards Manchester United FC. 

By agreeing to be a Liverpool FC fan, he naturally also accepts the duty to hate 
and wish all kind of ill luck towards Manchester United FC. The same applies to the Manchester United fan regarding Liverpool FC. All who come into either of the nursing or medical profession also naturally get drafted to continue the war. 

I know of doctors married to nurses, a benefit or hazard depending on your perspective of the nature of both professions, yet this is one war that years and generations of intermarriage has not helped to bring to an end.

This is not an open war. It is not one of swords, guns, bayonets and bombs in the literary sense – it is a cold war. It is only once in a while you run into an outright confrontation between a nurse and a doctor but these few confrontations are only small battles in the bigger war between doctors and nurses. It is a war that subtly shows in the way the young house officer greets the matron of the ward or the way the nursing staff address the doctor and in the way the doctor and nurse document about the other in their respective reports. Only the naïve in mind and the uninitiated would argue there is no such conflict. And I am often asked, why the war?

JUST WHO IS THE GREATER?

Where lies the origin of this war? I read about the history of both professions in search of answers and went online in search of reports of cases of conflicts between doctors and nurses so I could answer this simple yet complex question but I only succeeded in coming up with more questions.

Firstly, does this conflict have anything to do with the fact that the medical profession is traditionally male-dominated while the nursing profession is, still, female-dominated? Could it be that the medical profession traditionally, and subsequently passed down generations of doctors, feel superior to their female ‘assistant’ – nurses? And could it be that the clamour for more equality/independence of the female-dominated nursing profession has something to do with the ongoing global demand for female liberalism? I know that both sexes are represented in both professions but is it that the traditional thinking of the founding fathers pervades the current thinking of both professions?

Related to the above is the nursing profession’s perceived preferential favorable treatment of doctors by the health care system. For example, in many centres, a newly graduated medical doctor earns more than many senior members of the nursing staff who have been working for years before the young doctor was admitted at medical school. The average doctor thinks ‘why not?’- why can’t he earn more than a nurse, he also wonders if ‘those nurses’ can in their most horrific nightmare ever understand what it took to pass through medical school. 

In response, the nurses think, ‘what do the young doctors know’?

A superimposing factor on the aforementioned is the attitude of individuals – it eventually comes down to this. I know rude doctors just like I know irritating nurses. Yet, I sense that in many, irrespective of their attitude a sense of belonging to one side of the divide. I could go on but will stop postulating for now. This doctors-nurses conflict would not have mattered if it had no dire consequences.

WHEN TWO ELEPHANTS FIGHT

As the saying goes, when two elephants fight, the grass beneath suffers. In this case, the grass is the patient. And this is reality. There are instances where a patient had been mismanaged simply because of this conflict. For example, where a nurse does not inform the managing doctor of a patient’s complaints because she wants to watch and see if the all-knowing doctor would elicit the complaint himself only for the patient to develop serious complications later, likely avoidable if the doctor had known of the complaint. Or less serious effects like a patient not getting medications regularly because the medical intern would not administer a drug he felt was the nurse’s duty to give.

The patients suffer. Only on few occasions has this been put into consideration as a possible contributing factor in cases of patient’s mismanagement. The conflict however continues. Nurses are clamouring for more academic trainings and qualification even here in Nigeria and while that should translate into better patient care, one often gets the feeling that it is part of the catching–up-with-doctors’ aspiration. The question still begs for answers; will this war ever end?

We have here two noble professions with the same goal of restoring health, who need each other and who must work together yet, are perennially at war with each other. Will the war ever end? And I am tempted to answer ‘Yes’ but careful enough to add, in the words of that man who saw tomorrow, ‘only if men come to reason’. What do you think?