Valley Voices

Nurses are neither doctors nor handmaidens

The Fresno Bee

I know you know this, but it bears repeating: nurses are not doctors.

We are not physician wannabes. We are not handmaidens. (And please don’t think this of the great nurses who happen to be men.) We are healthcare professionals with a distinct theory base and scope of practice.

Indeed, there are overlapping functions between nurses and physicians. How the two intersect became a Fresno court matter last month. Who should have been injecting Botox in a medical spa where the service was rendered? What was the role of the nurse in that office? What was the role of the physician?

I don’t have much patience for medical spas. The industry preys on our collective insecurities. But as a nurse, I also believe that your body is your own, a concept mirrored in feminist thinking. How you treat your body is your decision.

In California, registered nurses, licensed vocational nurses, and physician assistants can administer Botox injections, but only under the direction of a physician. While it may not be illegal for a doctor to order such injections without examining a patient first, it’s shoddy practice if they don’t. All healthcare professionals have an ethical responsibility to understand and properly respect the boundaries of their practice.

No medical procedure is without risk. Botulinium toxin, the key ingredient in Botox, is a neurotoxin produced by bacteria that can be used to paralyze droopy facial muscles in the forehead and around the eyes that can make us look old. Moreover, some physicians administer Botox for off-label purposes not approved by the Food and Drug Administration.

This “cosmetic” (so benignly identified in the manufacturer’s literature) also has the potential to seep into your general circulation. The risks associated with this seepage are listed in a black-box warning. Granted, the risk is small. Yet the risk is there and must be managed.

You can teach almost anyone how to perform a basic clinical procedure. But it’s the trained professional who can see a patient within the larger picture. That same professional must understand the scope of their work and the associated limitations. A nurse doesn’t practice medicine. A surgeon doesn’t practice psychiatry. Where gray areas exist, critical thinking is essential.

Many years ago I worked as a camp nurse at a typical New England summer camp. This was paradise in the woods, a place where kids lived for eight weeks each summer on the edge of a glistening lake and the Milky Way grazed our shoulders each night. If a child or counselor experienced a health issue, they’d walk up the hill to the infirmary where I served as head nurse and surrogate mother.

One evening, a boy about nine years old walked through the screen door to tell me he wasn’t feeling well. As I spoke to him, I noted a heaviness in his breathing. He seemed to have a flare of asthma – or maybe the start of a cold. My stethoscope confirmed slight wheezing.

For reasons I can’t remember, the camp physician wasn’t available. This left me with a decision: Do I drive this otherwise healthy child to the emergency room 45 minutes away or do we ride out the night?

I gave the boy a can of Coke. I reassured him. I tucked him into an infirmary bed where I could check on him periodically. I knew I could change my game plan at any time.

The caffeine in the soda opened his airways ever so slightly, a small insurance policy. He slept through the night.

Was I practicing medicine that evening or was I being a good triage nurse? Perhaps the question could be argued either way. But for all the options I could have chosen, never did I consider grabbing an inhaler from our stock medication shelf and administering it. That would have been crossing the line.

I suspect the boy grew into a man who is slaying lions somewhere around Manhattan these days. The nurse honed her skills and now directs various risk management activities at a hospital here in town. She collaborates with physicians on a daily basis. She advocates for the use of nursing protocols.

Occasionally, she taps out a few thoughts on her home computer, her brow furrowed like the Mississippi.

That’s what happens when you age. That’s what happens when you think.

She’s OK with that.

Danielle R. Shapazian is a nurse and writer who lives in Fresno. She can be reached at