1. Bartol, Tom APRN

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I was recently reading comments about an online article comparing diagnostic reasoning of physicians versus NPs. The comments quickly became caustic and sad to read from both sides of the issue. There was a lot of criticizing, defending, blaming, justifying, and rationalizing-all trying to prove the point of one side or the other. It was as if the goal was to cut down one profession to build up the other, and both sides were doing it.1

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Studies comparing NPs and physicians often lead to statements about who is better or worse, competent or not competent. The dialogue can become emotional and confrontational. It is easy to compare, to look at years of education, or who is better prepared. For NPs, our first instinct may be to defend and justify. Other NPs respond by selling themselves short, as "less than" physicians. However, the way we respond to criticism can be more powerful than the criticism itself. We are two separate professions with different philosophies and education structures even though we perform many similar roles.2


When discussions regarding physicians and NPs (or any different groups) arise, could we instead focus on how we might grow and learn rather than comparing and arguing? There may still be criticisms, judgments, and harsh words from some, but could we, as NPs, respond the way we respond to our patients: with compassion? Our response affects our image more than the critical words-especially in response to words that hurt.


The truth will prove itself

I believe that "the truth will prove itself." That has been the case for NPs over the years. I recently read testimony from over 20 years ago when the Maine legislature was considering legislation allowing for independent NP licensure. The testimony was full of messages of fear and emotion from the opposition. If NPs were licensed independently, they said, healthcare would suffer, people would die, tragedies would occur. The testimony contained many scary anecdotes and hypothetical situations.3 Twenty years have passed since that testimony and passage of the legislation establishing independent licensure of NPs in Maine. None of the scary stories have come to pass. Twenty years later, the truth has proven itself with NPs providing safe, effective, and compassionate healthcare.


Today, many of the same messages of fear are still spoken by NP critics. Some are subtle and others quite blunt. They are often hard to hear, and we are quick to respond, defend, justify, rationalize, blame, and compare. A different response will set NPs apart. First, our response must be through our day-to-day work with our patients. The compassionate care we provide, focusing on our patients, listening to them (beyond the medical and the technical), building relationships, and helping them see hope and purpose in life will define who we are. Without our actions of competent, compassionate care, our words about who we are really mean nothing.


Responding to the "why" and not the "what"

Next, we must avoid talking about those who criticize the NP profession the way they talk about us. We must not do to others what we would not want them to do to us. These issues are often so emotional that logic does not prevail. We must respond not to what is said but to why it is said.


When I feel upset, angry, and emotional, it is probably not the best time to: respond, meet with my boss, write a comment on a blog, send an e-mail, make a phone call, or even discipline my children. This is the time when I need to pause and take a time out, to listen, to broaden my perspective, to hear the "why" louder than the "what" of what is said. Defending, blaming, comparing, justifying, and rationalizing will only perpetuate conflict. They do not allay fear or reduce anxiety.


If I can pause before responding, collect myself, and open myself, I will then be able to respond in a more effective way. I can listen, inquire, and then acknowledge what is said even if I do not agree with what is said. It is a process of trying to see how the other individual might see things in a certain way. I respond to the "why" and not the "what" of the statement.


Acknowledging what is said

Consider first focusing on the positive traits of our colleagues who may make critical comments. We all have our flaws and weaknesses. What we do as NPs is an art, not a science. Physicians criticizing NPs have probably missed a diagnosis or regretted a past decision. It happens to all of us. Rather than responding by pointing out their inadequacies, we can look for their adequacies and highlight them. Find something about what they said to agree with. Rather than defending our educational process, agree that the educational processes are different for physicians and NPs and that they do put in many years of education. Share with them the benefit(s) you have received from working with physician colleagues. This changes the process from a conflict to a dialogue-a collegial dialogue. Acknowledging true statements along with the strengths of others does not weaken us. It lets others know that we are listening.


I use this strategy with my patients as well when they have conflicts in relationships. I suggest they eliminate justifying, rationalizing, defending, blaming, and criticizing. Instead, I encourage my patients to try to see the perspective of the other individual, to try to understand how another individual might think a certain way. I encourage my patients to try putting themselves in the other's shoes to see if they could see, from that perspective, how it might make sense to them. Then, they can acknowledge what was said before sharing opinions or ideas. Instead of defending, rationalizing, and blaming, they try to broaden their perspective, to understand the other. This takes practice, stopping the gut or automatic/emotional response, and listening to understand. The other person then feels heard and that there is nothing to fight against. This can transform relationships.


Fostering adequacy

The process of responding to words that criticize and hurt can become one, not of battling words, but of engaging another person. This is what we do with our patients. We do not tell them what to do and how to live, but we engage them in a process, listen to them, inquire, acknowledge their reality, and then share information and ideas. Some make changes more quickly than others, but they all feel heard and part of the process.


Positive words promote health and healing. When we build on adequacies rather than pointing out inadequacies, we all do better. Our patients, our colleagues, our children, and we ourselves all really want to feel adequate. The words that hurt (the critical comments that challenge our adequacy as individuals and as a profession) will hurt, and we should respond. We must not passively sit back-let the truth prove itself. How we respond is the key. Our responses can be healing or injuring, they can build up or tear down, they can create more conflict or bring harmony. The choice is ours. Words can hurt, they may challenge us, but through our responses, we can allow them to "polish" us, to help us to grow, to make us better at who we are and what we do.




1. NPs vs MDs: Diagnostic reasoning in complex cases. Medscape Nurses. [Context Link]


2. Bartol T. Nurse practitioners are not a consolation prize. Nurse Pract. 2014;39(11):10-12. [Context Link]


3. Legislative Record of the 117th Maine Legislature. Vol. 5; 1995:1304-1313. [Context Link]