doi: 10.1111/nup.12081
Editorial
If nurses nurse, why don’t doctors doctor? It is a curious feature of the English language that permits nurses to engage in nursing but is disinclined to allow doctors to engage in doctoring – for doctoring carries connotations of nefariousness with which doctors are not normally, and nor would they wish to be, associated. Assuming no historical or present cunning plan to keep nurses in line and while wishing to avoid accusations of paranoia, this limiting feature of the designation ‘nurse’ extends beyond mere curiosity into the realm of perceptions, stereotypes, and myths regarding the description of the roles of nurses and doctors. Perhaps this language feature is no accident after all? Nurses are nurses, right? Doctors can be physicians, surgeons, paediatricians, geriatricians, pathologists, radiologists, family (or general) practitioners, and so on while nurses can be, well, nurses. In those countries that have a strong association with the British medical system, doctors who are surgeons can be conferred with the title Mr or Mrs or Miss or Ms on obtaining specified qualifications, reflecting a level of expertise beyond that of regular surgical doctors – a badge of honour and status apparently even though each of those titles of Mr or Mrs or Miss or Ms is readily available to non-doctors. Confusingly, at least to outsiders, doctors need not be medical doctors at all; doctors can be doctors of philosophy by virtue of doctoral study leading to the award of a doctorate. And then there are clinical doctorates, professional doctorates, and various forms of course-based doctorates to add to the general confusion of what it means to hold the title doctor. And there are, of course, nurses with doctorates, which make them both nurses and doctors. In some countries, notably North America, the term physician is commonly used to describe medical practitioners and more generally is used sometimes, but not always, to distinguish between the practice of medicine (physicians) and the practice of surgery (surgeons). Thus, doctors may or may not be medical doctors; medical doctors may be physicians or surgeons; and physicians may be surgeons. Further, doctors may be house officers, senior house officers, registrars, interns, residents, consul-
© 2015 John Wiley & Sons Ltd Nursing Philosophy (2015), 16, pp. 75–76
tants, and so on. In North America, doctors might be dentists. And all the while nurses are, well, nurses. Admittedly, there are some titles that nurses can aspire to – matron and sister spring to mind but by and large, most nurses are known as nurses. Titles available to nurses rarely stray from the root word nurse. The title registered nurse reflects a specified level of qualification and is legally protected in many countries. Staff nurse is commonly used as a job title for a registered nurse, and a staff nurse working in a surgical unit might consider himself or herself to have a specialty although that specialty is not reflected in any generally accepted nursing title. But in some countries, staff nurse might merely mean a nurse who is on the staff of an organization as opposed to a nurse who is freelance. There are some titles for nurses with specialist expertise such as nurse practitioner, advanced practitioner, and consultant nurse but notice how few of these titles do not feature the word nurse or some derivative of that word. In contrast, there are a number of meanings of the word doctor. One meaning of the verb to doctor implies corruption. To say that a document has been doctored would be to say that that document has been altered so as to mislead the reader; often for the purpose of practising deceit in a such a way as to obscure unfavourable outcomes. An accountant accused of doctoring the books would be understood as attempting to show a healthy bank balance where one did not exist for the purpose of personal financial gain. A researcher accused of doctoring data would be understood as seeking to fabricate results to fit a hypothesis or to maintain a reputation. Similarly, a nurse accused of doctoring patient records would be understood as attempting to falsify events so as to cover up an error or an omission. There are a number of meanings of the word nurse but as a verb, to nurse does not lend itself to the kind of negative connotations that can be associated with the verb to doctor. Thus, to say that nurses nurse is not open to the kind of negative interpretation available when saying that doctors doctor and this may go some way to
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explaining why common parlance permits doctors more words for practice than allowed to nurses. Doctors practise medicine whereas nurses practise nursing. Doctors do not, on the whole, practise doctoring. The negative connotations attached to the idea of doctoring are not consistent with the professed values and intentions of doctors despite the attempt by Mol (2008) to rehabilitate the term doctoring to describe work for health based on a logic of care rather than a logic of choice. There is, however, no reason for nurses to become smug with the recognition that the word nurse remains relatively immune from the negative associations to which the word doctor can be subjected for, as outlined above, this same feature of language restricts descriptions of nursing in ways that doctors can tran-
scend with ease – albeit with an associated danger of confusion and imprecision.Thus, linguistically at least, it is truer to say a nurse is a nurse is a nurse than it is to say a doctor is a doctor is a doctor. Whether or not this linguistic limitation has been translated into a clinical constraint for nurses will likely forever remain an open question. Derek Sellman University of Alberta
Reference Mol A. (2008) The Logic of Care: Health and the Problem of Patient Choice. Routledge Taylor & Francis Group, London.
© 2015 John Wiley & Sons Ltd Nursing Philosophy (2015), 16, pp. 75–76
Copyright of Nursing Philosophy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Editorial
If nurses nurse, why don’t doctors doctor? It is a curious feature of the English language that permits nurses to engage in nursing but is disinclined to allow doctors to engage in doctoring – for doctoring carries connotations of nefariousness with which doctors are not normally, and nor would they wish to be, associated. Assuming no historical or present cunning plan to keep nurses in line and while wishing to avoid accusations of paranoia, this limiting feature of the designation ‘nurse’ extends beyond mere curiosity into the realm of perceptions, stereotypes, and myths regarding the description of the roles of nurses and doctors. Perhaps this language feature is no accident after all? Nurses are nurses, right? Doctors can be physicians, surgeons, paediatricians, geriatricians, pathologists, radiologists, family (or general) practitioners, and so on while nurses can be, well, nurses. In those countries that have a strong association with the British medical system, doctors who are surgeons can be conferred with the title Mr or Mrs or Miss or Ms on obtaining specified qualifications, reflecting a level of expertise beyond that of regular surgical doctors – a badge of honour and status apparently even though each of those titles of Mr or Mrs or Miss or Ms is readily available to non-doctors. Confusingly, at least to outsiders, doctors need not be medical doctors at all; doctors can be doctors of philosophy by virtue of doctoral study leading to the award of a doctorate. And then there are clinical doctorates, professional doctorates, and various forms of course-based doctorates to add to the general confusion of what it means to hold the title doctor. And there are, of course, nurses with doctorates, which make them both nurses and doctors. In some countries, notably North America, the term physician is commonly used to describe medical practitioners and more generally is used sometimes, but not always, to distinguish between the practice of medicine (physicians) and the practice of surgery (surgeons). Thus, doctors may or may not be medical doctors; medical doctors may be physicians or surgeons; and physicians may be surgeons. Further, doctors may be house officers, senior house officers, registrars, interns, residents, consul-
© 2015 John Wiley & Sons Ltd Nursing Philosophy (2015), 16, pp. 75–76
tants, and so on. In North America, doctors might be dentists. And all the while nurses are, well, nurses. Admittedly, there are some titles that nurses can aspire to – matron and sister spring to mind but by and large, most nurses are known as nurses. Titles available to nurses rarely stray from the root word nurse. The title registered nurse reflects a specified level of qualification and is legally protected in many countries. Staff nurse is commonly used as a job title for a registered nurse, and a staff nurse working in a surgical unit might consider himself or herself to have a specialty although that specialty is not reflected in any generally accepted nursing title. But in some countries, staff nurse might merely mean a nurse who is on the staff of an organization as opposed to a nurse who is freelance. There are some titles for nurses with specialist expertise such as nurse practitioner, advanced practitioner, and consultant nurse but notice how few of these titles do not feature the word nurse or some derivative of that word. In contrast, there are a number of meanings of the word doctor. One meaning of the verb to doctor implies corruption. To say that a document has been doctored would be to say that that document has been altered so as to mislead the reader; often for the purpose of practising deceit in a such a way as to obscure unfavourable outcomes. An accountant accused of doctoring the books would be understood as attempting to show a healthy bank balance where one did not exist for the purpose of personal financial gain. A researcher accused of doctoring data would be understood as seeking to fabricate results to fit a hypothesis or to maintain a reputation. Similarly, a nurse accused of doctoring patient records would be understood as attempting to falsify events so as to cover up an error or an omission. There are a number of meanings of the word nurse but as a verb, to nurse does not lend itself to the kind of negative connotations that can be associated with the verb to doctor. Thus, to say that nurses nurse is not open to the kind of negative interpretation available when saying that doctors doctor and this may go some way to
75
76
Editorial
explaining why common parlance permits doctors more words for practice than allowed to nurses. Doctors practise medicine whereas nurses practise nursing. Doctors do not, on the whole, practise doctoring. The negative connotations attached to the idea of doctoring are not consistent with the professed values and intentions of doctors despite the attempt by Mol (2008) to rehabilitate the term doctoring to describe work for health based on a logic of care rather than a logic of choice. There is, however, no reason for nurses to become smug with the recognition that the word nurse remains relatively immune from the negative associations to which the word doctor can be subjected for, as outlined above, this same feature of language restricts descriptions of nursing in ways that doctors can tran-
scend with ease – albeit with an associated danger of confusion and imprecision.Thus, linguistically at least, it is truer to say a nurse is a nurse is a nurse than it is to say a doctor is a doctor is a doctor. Whether or not this linguistic limitation has been translated into a clinical constraint for nurses will likely forever remain an open question. Derek Sellman University of Alberta
Reference Mol A. (2008) The Logic of Care: Health and the Problem of Patient Choice. Routledge Taylor & Francis Group, London.
© 2015 John Wiley & Sons Ltd Nursing Philosophy (2015), 16, pp. 75–76
Copyright of Nursing Philosophy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
