On the Doctor-Nurse Relationship

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The modern process of the health service, especially in the more economically developed countries, has not only substantially changed the Doctor-Patient relationship, but also the Doctor-Nurse relationship. At the forefront in the patient’s care and assistance, these two latter professional roles are identified by their specific activity as an essential benchmark – to the point of separating these two roles from all the other health care professional roles (like technicians and diagnostic staffs).
The MD’s role is indubitably present in the medical culture and practice since the very beginning. Always been responsible of the preservation of health and life, prevention and therapy of the diseases, the MD has also been able to consolidate his social status, starting by the XIX century, with the establishment of the clinical medicine. The acknowledgment of the efficacy of medical actions, founded on a deeper scientific, self aware and technological culture, gave birth to a model of physician with an enormous and exclusive power on the Patient. All this sprung off a supremacy built on the scientific culture, on some kind of a surreptitiously hierarchical prevalence and on a certain functional hegemony based on the exclusive responsibility of the Physician in the diagnostic and therapy decisions, nonetheless on the very same practical supervision of the Patient. The MD seemed to claim as well for himself the power over the other health professional operators who used to collaborate in various ways in the Patients treatments. Particularly, Nurses were considered as subordinates, also on a merely cultural level. They were seen as mere executants who passively do what was ordered by the MD, following a generally acknowledged hierarchical scale which implied that the MD had an undisputed predominant role.
At the beginning of the ‘90s of the last century – it sounds like long time ago, but in fact only a few years have passed – several regulations and the reorganization of the National Health Care System have progressively changed – to all intents and purposes – the Doctor-Nurse relationship.

It is our intention, here in this issue, to remind the conversion of the Schools for Health Care Professionals in College Bachelor’s Degrees, and especially the evolution and maturation – from a simple Nurse merely executing the tasks bore by the job description – of the professional role in itself during the course of the years. In other words, where in the past Nurses used to be bound to complete only three categories of tasks (autonomously, under prescription, under medical control), now they actively participate to the clinical process with their intervention, cognition of the causes and effects and, more important, with more self-awareness of their role and competences.
If sometimes, when emergency strikes and the time and chance to cooperate and share decisions fail to be the first approach possible, it is precisely that specific kind of self-awareness of clinical skills and consequentially clinical actions that allows Nurses to play this new role with new specific clinical responsibilities. Self-awareness built with a new cultural and more articulated professional educational path.

Even the national laws and regulations, during the recent past years, have been progressively adapted to the changes of the time and the knowledge. In Italy, by the Law 42/1992 through the DDL 739/1994, new regulations have been sketching the new Nurse profile as a fully responsible professional operator, together with what can be also found in the Deontological Code which defines the current, not just regulatory, sought-after of this Nurses’ new professional profile.
The modern Medicine, which with its complexity forces its operators to find within their range of abilities all the knowledge and possible actions, has been undergoing in the past 10-20 years a deep cultural and operative transformation, especially for those professional roles working at different levels, technologically, diagnostically and therapeutically. Then again, the growing relevance and diffusion of chronic pathologies and the progressive increasing of the average age of the Patients, have consequentially modified the modality of approach to the Patient – both at a communicational level and for the quality of services. There are no doubts that the Doctor-Nurse relationship needs to aim at a more tight and deep cooperation, respectful of the two different institutional roles, and from now on, endeavoring to allow Nurses toward a pivotal role, useful to draw and built new welfare plans and new clinical paths.

In this editorial opening the 4th number of the Pain Nursing Magazine I would like to conclude with the most intense greetings for the proximity of Christmas and New Year Festivities. As Editor-in-Chief, I wish to express my best and affectionate good wishes of serenity and peace to the Nurses, the Doctors and all their Families.

Also available in : Italiano