Can you tell me who controls the scope of practice for nurses; medicine or nursing?
Nurses control the scope of practice for nursing - as defined by the law. Medical doctors control the scope of practice of medicine as defined by the law. Again the legal definition (as set in place state to state by legislators and the governor) is the key...make that THE key. So creating a definition of medicine that prohibits nurses from performing the exclusive features is what needs to be done. Its still possible at this time to make the treatment of visceral disease the sole domain of medical doctors.
Diagnosis can be done by chiropractors, etc. Treatment of patients with musculoskeletal disease or dental disease is not the sole domain of MD's. If the treatment of visceral disease is written as the EXCLUSIVE domain of medicine, then nurses could only TREAT visceral disease under the auspices of a medical doctor.
I am realizing that people here do not grasp the way a law is written. There is an old SCHOOL HOUSE ROCK that describes it on a Federal level called how a bill becomes a law (I am a bill, I am only a bill, sitting here on capitol hill....) - but this is similar to how it functions on a state level too. Maybe Law2doc could do a better job of explaining this. But if a legal statute is passed defining something exclusively as the domain of medicine, nurses cannot do it independantly. The key is to capture exclusive rights to something - and I think that needs to be the treatment of visceral disease (heart, liver, colon, pancreas etc).
A licensing board is not a sovereign entity operating under their own controls - they operate under the office of the Governor and are subject to states and rules passed into law. *sigh*
You know..
If I had a patient (call him "Angry Old Man") and I was doing a colonoscopy on him and I twisted around a lot trying to see all the dark angle to see what polyps he could have at odd angles hidden that are potentially cancerous.... I would make the patient hurt and even though I saved his life when finding a near impossible to see polyp, he would think I suck!
If I had a patient (call him "Who cares Guy") and I went in and out, didn't care to look at all angles or twist around for fear of perforating the guy... He would not be in pain and he would think I kick ass cause I did a good job and saved his life from potential polyps.
These two studies are BS.. heck the more the patient is dissatisfied with the colonoscopy, the more I know I did a good job twisting around and seeing ALL angles to evaluate sessile polyps and hidden tumors at odd angles. But the nurses wont understand that.
PATIENT SATISIFACTION IS NOT EQUAL TO A GOOD JOB ALL THE TIME!
No, you are right, patient satisfaction is not equal to a good job, but patient satisfaction is a huge part of CUSTOMER satisfaction. Customers pay our bills.
I will look for it but a similar study was done (maybe in the peer reviewed JMPT) regarding the treatment of musculoskeletal injuries by MD's and DC's (chiropractors). Patients reported greater satisfaction with the DC's. One of the reasons was determined to be simply being touched. Patients liked to be touched - where as many times an MD came in and performed an H&P and wrote a prescription with minimal or no contact. Even simply putting a hand on the patients shoulder improved the patients feelings of satisfaction.
So my questions is what are the nurses doing that increases satisfaction - we can still do a thorough painful job - but I also want a satisfied customer base because I want to get paid.
I had one of the largest rural chiropractic practices in my state in the 1990's (as measured by gross collections - money collected - actual money in the door - using the statistics compiled by Morgan and Quitno publishing on State Health Care statistics). I am an ***-hole, but I did all sorts of things as a routine : I called patients the same day as their first appointment to ask how they were doing (this took 5 painful minutes for me - but patients loved it), I sent birthday cards, if they referred someone in to me I sent them a thank you letter, I looked through the local paper and looked for reasons to send letters of congratulations to people who were celebrating a big anniversary or made the school honor roll (many of whom I had never met before), I went to a few birthday parties I was not too keen on etc..
My practice was in a town with roughly 3,000 people and the county had roughly 6,000 people - I had over 3000 inidividual patient files in my 7 years of being there when I sold it (it was counted and documented by the broker who sold my business and this fact was affirmed by the person buying my practice). Consider that roughly 11% of the population sees a chiropractor, in that town only 300-400 people should even see a chiropractor - and there was one other chiropractor in town and 2 DO's that did spinal manipulation. One of the DO's ONLY did spinal manipulation exclusively. One of these DO's was my patient. Of course quite a few of my patients came from surrounding counties, and I had patients who regularly drove over an hour one way to see my from other states. I had articles about me and what I did published in several professional journals as an example of a "successful" business and these articles can be still found online in e-form. I had a friend who was in another nearby (and bigger) town - who was in business with a DC who had been in business several decades ; my business was bigger than theirs (in terms of money collected). According to what he told me they collected, I as one person actually collected more than the BOTH of them collected - as one sole proprietor in a town half the size of theirs - as the new guy, whereas one of them had been there decades.
I am not saying this to brag - but as a point - I did the same thing as other chiropractors, but I had more patient satisfaction as indicated by their willingness to return, drive by many other DC's to get to my office and most importantly PAY ME. I say this to motivate you and others to value patient/customer satisfaction - customer satisfaction translates into more green.
I never had collections under 90% - and if you are doing even just $200,000 a year in total business - going from 90% collections to 80% means $20,000 more in your pocket each year. I never took a patient to small claims court and never used a collections agency. I expected people to pay me, billed fair fees, and made sure patients liked me. I want to be a good person, but am not naturally nice. That may be an understatement. I practiced many years as a DC, and was very successful because I was GREAT at
appearing to care (through calling patients to see how they are doing etc - how many medical doctors call a patient to see how they are doing - not have a staff person do it, how many doctors themselves call? Patients love that - patients go to who they love - patients pay who they love - love me and show it by paying me). I am hoping medicine will save my soul by helping me be truly caring and have a heart full of love. But if not, I want to know how to make my customers satisfied because it could mean the difference of retiring in 10 years or not because of the hundreds of thousands of dollars difference collected in 10 years time.
