Updated August 19, 2021. The article was updated to correct minor grammatical errors and to update technical details.
Health care is an increasingly diverse field where many specialties interact to provide patient care, and the team approach to caring for patients includes many professionals performing a variety of specialized functions designed to meet the physical, emotional, and psychological needs of the patient. In the course of just one stay, a hospitalized patient may be cared for by an array of non-physician providers. For this collaborative approach to work, it is imperative that all health care professionals understand and respect the credentials, scope of practice, and function of each member of the health care team.
So who are these providers? This article will provide a brief introduction to the educational background and role of the different professionals a patient might typically encounter in a hospital. This list is by no means inclusive but is meant to be an overview of the major groups of professional practitioners currently found in large, comprehensive hospitals.
The Nurse Practitioner
Nurse practitioners (NP) are licensed registered nurses who have completed advanced academic and supervised clinical training beyond their registered nurse certification. Most have master’s degrees and many have doctoral degrees. Nurse practitioners provide a number of different health care services. They are trained to diagnose and treat a variety of conditions and can order and interpret diagnostic tests and procedures, perform health screenings, give immunizations, and may prescribe most medications. Nurse practitioners often focus on health promotion, disease prevention, and helping patients make healthy lifestyle choices. They treat patients in outpatient settings and in the hospital. Although most nurse practitioners focus on primary care, many train and practice in fields as diverse as OB/GYN, pediatrics, oncology, and dermatology. An NP-C is a nurse practitioner who has successfully completed a national certification exam for adult and family nurse practitioners. Scope of practice and autonomy for nurse practitioners varies state by state with most states requiring nurse practitioners to complete a collaborative care agreement with a physician who provides a specified level of supervision and oversight.
The Doctor of Podiatric Medicine
Doctors of Podiatric Medicine (DPM’s) earn a bachelor’s degree and complete four years of podiatric medical school followed by a hospital-based residency. Podiatrists are represented in private practice, on hospital medical staffs, in health care administration, on medical school faculties, and in the armed forces. Doctors of Podiatric Medicine are experts at preventing, diagnosing, and treating diseases and disorders of the foot, ankle, and related structures. DPM scope of practice varies by state but is generally restricted to the foot, ankle, or sometimes other lower extremity structures. They provide medical, surgical, and pharmacological treatments for a variety of foot conditions including diabetic foot care, sports injuries, wound care, and congenital abnormalities. Most states allow DPMs to prescribe a full complement of medications used to treat conditions related to the foot and ankle.
The Clinical Nurse Specialist
Clinical nurse specialists are licensed registered nurses who have additional training in nursing at the masters or doctoral level. Clinical nurse specialists are experts in specialized areas of nursing practice such as geriatrics, wound care, or psychiatric care. Many also work as administrators, educators, consultants, or case managers. In addition to providing direct patient care, clinical nurse specialists may work to improve patient outcomes through research, training, and bringing about improvements in health care delivery.
The Certified Registered Nurse Anesthetist
Certified Registered Nurse Anesthetists (CRNAs) are registered nurses who have masters and advanced training in anesthesia. Their clinical and classroom training lasts for 24-36 months and all graduates must pass a national certification examination. CRNAs provide anesthetics to patients in every type of practice setting and are the main anesthesia providers in two-thirds of all rural hospitals. They provide anesthesia in collaboration with other health care professionals such as surgeons, dentists, podiatrists, and anesthesiologists. They utilize a variety of anesthesia techniques and procedures for all types of surgery and obstetrics. As with other nurse practitioners, requirements for physician supervision of CRNAs vary by state.
The Certified Nurse-Midwife
Certified nurse-midwives (CNMs) are registered nurses who have been trained in midwifery. All have at least a bachelor’s degree and over 70% hold a master’s degree or higher. They must pass a national certification exam in order to be licensed to practice. Certified nurse-midwives provide health care for women including prenatal care, labor and delivery, post-partum care, routine gynecological services, family planning, menopausal care, health promotion, and disease prevention. Most certified nurse-midwives work in group practices with physicians and deliver babies in birthing centers or hospitals. CNMs can order and interpret laboratory tests and are able to prescribe most medications.
The Registered Dietitian
Registered dietitians have earned a bachelor’s degree in dietetics or nutrition with coursework that meets the requirements set forth by the American Dietetic Association. Dietitians complete an approved practical education program and must pass a national examination. The dietitian is the food and nutrition expert on the health care team. Dietitians help design food plans and educate and counsel patients to help them manage disease states such as obesity, high cholesterol, or heart disease. Many dietitians specialize in areas such as pediatrics, geriatrics, renal disease, or diabetes education. Dietitians are also involved in hospital food service management and clinical research.
The Recreation Therapist
Recreation Therapists have at least a bachelor’s degree with coursework in the sciences and in recreation theory, have completed a formal internship, and must pass a national certification examination. Recreation Therapists provide a wide range of interventions and therapy designed to improve patients’ functioning and keep them as healthy, active, and independent as possible. Recreation therapists incorporate patients’ specific interests into therapeutic activities to help the patient develop and maintain skills for daily living and promote physical, emotional, and social well-being. Recreation therapists work with clients of all ages and disease states.
Audiologists hold a master’s or doctoral degree from an accredited university-based graduate program. They can be found working in medical centers, hospitals, private practice, in schools, and in government health facilities. Audiologists are primary care providers for hearing health. They evaluate hearing and balance problems using a variety of specialized auditory and vestibular assessments. Based upon the diagnosis, the audiologist can offer a patient a variety of treatment options including hearing aids. Audiologists are trained to manage hearing health for newborns through elderly patients. When a patient’s hearing or balance problems require medical or surgical evaluation or treatment, audiologists are trained to make referrals to physicians for intervention.
The Physician Assistant
Physician Assistants (or simply “PAs”) are licensed health care providers who typically possess a bachelor’s degree and have completed a 24-26 month PA training program. They work alongside physicians to perform physical examinations, diagnose and treat illnesses, order and interpret diagnostic tests, prescribe medication, and assist in surgery. PAs are found in virtually all medical specialties, ranging from Family Medicine to each of the surgical sub-specialties.
Pharmacists earn the Doctor of Pharmacy (PharmD) degree after completing at least two years of undergraduate study and four years of pharmacy school. Pharmacists are medication experts, working with physicians (or PAs) to ensure new prescriptions do not interact with a patient’s current medications, that the right dosage for a particular medication has been prescribed, and to answer any questions patients may have. Pharmacists employed within the Department of Veterans Affairs (VA) have the authority to prescribe and change medications under collaborative care agreements with patients’ physicians. Pharmacist prescriptive authority is becoming more widespread as the benefits of having pharmacists involved in disease state management become more apparent. Additionally, pharmacists can complete postgraduate residency training to become Critical Care Pharmacists working in the ICU, Emergency Pharmacists in the Emergency Department, or a number of other possible specialties.
The Clinical Psychologist
Psychologists study the inner workings of the mind. A clinical psychologist’s aim is to reduce psychological and emotional distress and to promote emotional well-being. They often work in hospitals, clinics, or private practice settings. They work with individuals suffering from mental health problems, including anxiety, depression, adjustment to physical illness, neurological disorders, addictions, or behavioral disorders. Clinical psychologists complete four to five years of doctoral-level training and must complete a clinical internship prior to licensure.
The Speech and Language Pathologist
Speech and Language Pathologists evaluate, diagnose, and treat language, speech, or swallowing difficulties in patients in various settings. Education and licensure requirements vary by state, but virtually all Speech and Language Pathologists have completed a graduate degree and a clinical fellowship. They can be found in an array of settings, working with individuals suffering from mental impairments, recovering from strokes, or requiring rehabilitation therapy.
The Occupational Therapist
Occupational Therapists (OTs) work with individuals of all demographics to regain, master, or develop the everyday skills that enable them to lead fulfilling and independent lives. OTs possess a graduate-level degree in occupational therapy. They develop activities of daily living for individuals with mental or physical disabilities that inhibit their capacity to function independently. With time, routines may be developed which help equip these patients to pursue education and employment. OTs are most frequently found in the hospital or outpatient rehabilitation setting.
The Physical Therapist
Similar to OTs, a Physical Therapist (PT) works to treat individuals whose medical problems or other health-related conditions that impair their ability to move and perform activities of daily living. Treatment plans focus on preventing further disability, alleviating pain, and restoring function. Educational programs for PTs exist at both the masters and doctoral levels.
The Respiratory Therapist
Respiratory Therapists (RT) help evaluate and treat individuals suffering from respiratory ailments, injuries that involve the respiratory tract, need pulmonary rehabilitation, or require augmented or mechanical ventilation. They are all graduates of an approved college program in Respiratory Therapy, have completed their licensure requirements, and passed a nationally administered advanced practice examination. RT’s practice primarily in the hospital and long-term care settings, where they are an integral member of the patient care team.
The future of health care lies in successful collaboration among all of these disciplines. It is essential for medical and other health professional students to learn how to work with other clinicians in hospitals and other practice sites. Each of these professionals brings a unique skill set and viewpoint to the management of patient care. An environment of mutual respect and trust among health care providers will promote excellent care and improve patient outcomes.