Q: “Shouldn’t doctors control hospital care?”
A: Absolutely not!
Sandeep Jauhar’s New York Times op-ed bemoans the decline in physician control of hospital care, arguing that business types have taken over, to the detriment of our health. He’s half right: health professionals should call the shots. But nurses are autonomous professionals who must, at a minimum, control their own care. And nurses are often a better choice for overall leadership, because hospitals exist mainly to provide skilled nursing.
October 10, 2017 – Today the New York Times ran an op-ed by physician Sandeep Jauhar headlined “Shouldn’t Doctors Control Hospital Care?” His basic point is that a generation ago, physicians ran many U.S. hospitals and exercised control over how care was delivered because of a “cultural perception of high minded knowledge,” but now they have been supplanted by business people, who have curtailed needed care because of a focus on the bottom line. We agree that health professionals should control hospital care. But nurses are autonomous, college-educated professionals with their own distinct scope of practice and their own management structure in hospitals. They must, at a minimum, control their own care. Jauhar seems to want more of the undue deference physicians have traditionally enjoyed. And his piece’s headline seems to be a rhetorical question, one based on the damaging misconception that physicians can, do, and should direct the work of all health professionals. Nurses also tend to be a better choice for hospital leadership because hospitals exist mainly to provide skilled nursing care. In general, if patients did not need nursing care, they could be treated at outpatient facilities. Nurses also have a long tradition of running hospitals, and some do today, although not nearly enough, given the prevailing assumptions that Jauhar’s op-ed reflects. In fact, nurses are well-qualified to serve as hospital CEOs and on hospital boards. Hundreds of thousands of nurses have graduate degrees in nursing, and their broad, holistic, and collaborative scope of practice makes them suited to overall hospital leadership. Nurses understand and coordinate well with the full range of health practitioners whose work is needed to restore and maintain health, including physical therapists, respiratory therapists, and social workers. Nurses focus on prevention and psychosocial factors, and they are open to alternative forms of care, including such as Qigong, acupuncture, and massage therapy. Increasing nursing leadership in hospitals could also address the crisis in nursing itself, since nurse leaders might be more willing to address the under-staffing and other resource shortages that have recently plagued the profession and taken many lives. Direct care nurses might then have more time for patient monitoring, education, and advocacy. That includes catching errors—the third leading cause of death in U.S hospitals—which nurses are the professionals most likely to prevent. Nurse leaders would also promote nursing autonomy, which would itself improve care. The one thing nurse leaders would be unlikely to do is publish an op-ed like this one, which discusses who should control hospital care without even mentioning the most numerous health professionals in those hospitals, i.e., nurses.
Tell Sandeep Jauhar what you think of his ideas on Twitter @sjauhar or email him by clicking here.
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