The recent article on nurse-physician collaboration11 was excellent for identifying the difference between case knowledge (the physician model) and patient knowledge (the nursing model). As an administrator over intensive care units (ICUs) for more than 10 years, I have not seen much progress in nurses with respect to feeling that their input is valued by medical staff. I agree that if a patient is being monitored for a specific illness with expected variances, collaboration is strong. Interventions are predictable and expertise in skills is valued.

With more chronic patients or with unidentifiable disease progression or behavior decompensation, however, nurses are left to figure out what to do. At times they must manage an unmanageable situation. Physicians tend not to want to be bothered with nurses’ vague interpretations. This makes nurses frustrated; they’re left feeling like handmaidens.

As...

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