When I graduated from nursing school, I thought I was all that.  I was so smart and sassy, on top of the world.  So when I got compliments from my patients like “you are so smart you should be a doctor”, I saw that comment as a validation of myself.  Though now that I have matured in understanding my self-worth and self-confidence, that comment is really offensive to me.

Well, the comment probably had a little more to do with just perceived intelligence.  This isn’t a knock on physicians, but if I were to scale the most intelligent professions out there, physicians aren’t on the top of my list.

Yes, they went to school for 4 more years than I did as an undergrad, but I spent 15 years in graduate school post-BSN to obtain a masters in business, 3 masters in nursing and a PhD.  However, no matter how many years of school and specialization I receive, I can never seem to make up for those 4 additional years that physicians got in med school.  So yes, the comment that I’m so smart I should be a doctor is no longer a source of pride, I find it obnoxious and degrading.

What is interesting to me is that no one ever said I was so smart I should be a bench scientist, a microbiologist or a nuclear physicist, so why does a physician have a monopoly on epitomizing the concept of “being smart” in the healthcare space?

As an entrepreneur, I have new found interest in this question, because the branding and marketing of a profession is extremely powerful.  Medicine has always had that air of otherworldly-ness and mystery.  Their ability to craft the story that they can solve medical mysteries is extremely powerful.

I bought into this story myself, believing that those 4 extra years the physicians received were somehow a transformational experience unlike any other.  But really the first two years they study physics, cell biology, and chemistry.  This doesn’t explain why people would associate being physicians with being “smart”, particularly when the guy in the lab has a PhD in cell biology, compared to that one class the medical students took.

What I do think is an essential take away point though from the physicians is that the art of the narrative is extremely powerful.  The way the story is told and how it is told will be what is remembered.

Physicians have claimed the storyline that they smart, rich and powerful.  Maybe at one time, this was true, but it’s not really in line with the ongoing reality of today.   This idea of physicians being rich is so pervasive that the everyday person (and maybe even nurse) believes that this is true, despite the fact that physicians don’t earn nearly as much money as they used to.

On the general spectrum of wealth, compared to other industries, the average physician makes a paltry salary.  That is not to suggest that physicians make a bad salary.  They make a respectable living for sure, don’t get me wrong, but when you compare them to other industries where bankers, insurers and entrepreneurs are earning millions and tens of millions of dollars, the medical field doesn’t exactly feel like a rich space.

In fact, many experienced nurse practitioners and nurse anesthetists are starting to close the gap in pay differentials, which almost makes going into medicine seem not so smart.  The average pediatrician makes $185k, primary care physicians earn on average $195k, yet they work 55–65 hours a week.  Nurse anesthetists make $170k and only work 3 days a week.  Nurse Practitioners with lots of experience can even expect to pull in $130k.   On an hour per hour basis this doesn’t work out well for physicians.

Primary Care Physicians–Average $195k/year, work 65 hours per week = $57/hr

Pediatricians–Average $185k/year, work 55 hours per week = $64/hr

CRNAs–Average $170k/year, work 36 hours per week = $90/hr

Nurse Practitioners–Average $130k/year, work 36 hours per week = $70/hr

These numbers are based on average pay an average work hour for example: (195k/52 weeks/65 hours per week vs. 170k/52 weeks/36 hours per week).  It doesn’t take into account call, which physicians take after hours, overnight, during weekends, holidays, etc.  Even nurse practitioner pay at the low end of $130k still works out much better and you could argue they have a much better quality of life.

Part of the running storyline in nursing is that becoming a nurse is a great way to marry a rich doctor.  In reality, you would be better off marrying a rich CRNA or NP.  But that story doesn’t carry quite the same oompf if you will.  Why because no one has said that ever… And why not?

As nurses emerge as a smart and rich profession, this storyline should evolve with it.

The last part of the physician storyline was power.  Physicians have typically held significant power over the hospital, how it was run and health care policy.  This too has diminished remarkably as lawmakers are looking for alternative solutions by engaging with nurse practitioners to address the growing healthcare problem, CEOs are now businessmen and women (33 hospital CEOs are now nurses) and physicians have less and less control over how units are run.  In fact, a temper tantrum by a physician these days is likely to end up in anger management classes instead of a roomful of scurrying nurses.

But the perception of being smart, rich and powerful remains.  And this is something remarkable that I think nursing as a profession can and should take note of as we continue to build our profession and take it into the future.

Our ability to make people believe in our potential comes from within us.  We got started on the right foot.  Florence Nightingale, even though technically not a nurse, is considered the mother of the nursing profession.  She recognized the foundations of preventing the spread of infectious disease without any background or any real scientific support.  She was able to conduct clinical trials and show without a doubt, her common sense method of providing care could trump pretty much the effects of any surgical procedure.  After all what good is having surgery if the person develops gangrene and dies?

From the height of nursing beginnings came a precipitous fall to the role of the obedient handmaiden who served at the will of the physician.

It’s taken several centuries since then but nursing has managed to wrangle itself out of the grasp of the medical association for the most part. We still have some stragglers and outdated laws that are a nuisance, but nursing has re-exerted its independence and is climbing back up to where it started.

Unfortunately, our brand and our mindset remain that nursing is a subordinate role. For some unknown reason, this brand is perpetuated by nurses who seem to have adopted the medical model as a superior concept and then measure themselves against it.

You will often hear nurses exclaim that they don’t know as much or they aren’t as smart as the physicians. Even my nurse practitioner students are full of angst because as they go through their master’s program they realize it’s not a medical school and they aren’t receiving a med school curriculum. How can they compete with the physicians or know as much as they do?

These situations completely miss the point that nursing needs to stop comparing themselves to physicians and that we need to focus on our own storyline. Part of telling our own story is understanding our strengths and valuing our expertise.

When I ask nurses what their expertise is in, I get several kinds of vague responses such as “I don’t have an expertise, I’ve worked in a couple of different specialties” or “I worked in neuro for a bit” or “My expertise is cardiology.”

To me, none of these responses reflect the expertise of nursing. And furthermore, I would argue that they do nursing a huge disservice because the emphasis is stressed on the medical model. Your expertise is not the service you work on. For instance, your expertise is likely not cardiology.

If you go head to head with a cardiologist on expertise, I’m going to wager on behalf of the physician.  Why? Because physicians have always been very clear on their story of what their expertise is.

But who would I rather get my care from?  Well, to be honest, I’d rather talk to the nurse practitioner about my cardiac care for a number of reasons.

The nurse practitioner talks to you like a human being, don’t throw jargon at you, doesn’t assume you know the latest guidelines in cardiac care and gives you more than a 5-minute evaluation.  What nurses are good at is breaking down subject matter, helping people to understand, making the patient feel heard, and seeking solutions to real problems.

Yes, weight loss is a great way to treat diseases, but it’s not enough to prescribe a 25-pound weight loss. Nurses would take into account that the person is working two jobs, has 3 kids, is taking care of a demented parent and has no support.  Similar to Florence Nightingale, the intervention of weight loss is useless if the aftercare isn’t there. There is no point in prescribing weight loss if it can’t be done without additional resources and tools. For sure this ability to get patients to lose weight is expertise and must be recognized as such.

We need to begin to craft a new storyline, one that builds off the strength of nursing.

The other very powerful tool nurses have is that they have been rated the most trusted profession for almost 15 years.  Americans know, like and trust nurses. Our patients believe that we are here to help and do good by them. Our role isn’t to name that mystery disease or make recommendations on the type of treatment plan the patient should be on. I’m sure you could probably do it in many instances, but it’s not nursing’s expertise, and it shouldn’t be where we focus the narrative of our story. Instead, nursing’s expertise is in empathy, therapeutic communication, and active listening.

Nursing has a very high level of emotional intelligence and we always have, because we are trained to empathize.

The concept of emotional intelligence has emerged as a major predictor of personal success. In fact, many medical schools are considering adding emotional intelligence as a marker of medical school admission (because well let’s face it physicians are not known for their active listening skills). The soft skills of nursing have long been mocked by the medical field (and nurses) or dismissed, but ironically, it’s being discovered they are exactly what medical schools are lacking.

Interestingly enough, the concept of empathy has emerged in the area of entrepreneurialism as well. The role of the entrepreneur is to provide solutions to problems. And the only way to discover problems is to actively listen and empathize with a person who is willing to give you the scoop. So the best schools in business and entrepreneurialism are teaching soft skills like empathy, therapeutic communication and active listening as a way to make lots of money!

So all of a sudden, nursing has an opportunity to teach what it has always known, and has always been its expertise.

In no other time in history could nurses say they were smart, rich and powerful all at the same time.  And now it’s true! This is a new phenomenon and one that nurses need to harness.

It is my perception that the expertise of nursing has a very powerful position in the entrepreneurial space and could easily define a storyline here.  Imagine the ability of nursing to transform its expertise into a value.

Getting buy-in from the nursing community on the importance of this storyline is going to take a huge grassroots movement, but is so essential!

We can change the perceptions of our profession and thereby change the profession just through repeating and telling the stories of the expertise of nursing.

And maybe we aren’t so far away from the little old lady in Room 101 telling the physician, “you seem so smart, you should become a nurse.”