Maxwell Miles

Every once in a while, this embittered online fight about who is superior between nurses and doctors resurfaces

While each person can provide valid sounding reasons as to why one or the other are on top, they are both wrong.

The problem is not about who is above or below. It’s about misunderstanding how the health system is structured.

➡️ Medicine and Nursing Are Different Professions

The first misconception is assuming nurses are part of a medical hierarchy.

We aren’t.

Nurses don’t fall under the medical ladder because nursing is not a branch of medicine; it’s an entirely separate, though interdependent, profession with its own theoretical foundation, models, and governing bodies.

Simply put, a nurse cannot further their studies and become a doctor because they are different jobs. If a nurse wants to become a doctor, they will have to be trained again from the start in medicine. Yes, some universities may reduce the study time by a year because of the existing overlap between the two roles.

Medicine operates on the medical model, which focuses on diagnosing and treating diseases.

Nursing follows the nursing model, which emphasizes holistic wellbeing addressing physical, emotional, social, and environmental factors that affect health.

So, while doctors make medical decisions, nurses make nursing decisions.

Both are essential, but they come from different scopes of practice.

➡️ Scope of Practice

Every health profession has its own scope of practice — the limits within which a professional is legally and ethically allowed to act. That’s where the real difference lies, not in value or worth.

For example:

1️⃣ It’s beyond a doctor’s scope of practice to determine what walking aid a patient needs. Even if the doctor knows the answer, that decision belongs to physiotherapy, because it’s a physiotherapy assessment and intervention.

2️⃣ It’s beyond a nurse’s scope of practice to prescribe regular medications for a patient (except nurse prescribers with extended rights). A nurse may know what the patient needs, but without a prescription, administering that medication would be illegal except in life-saving situations where some medication such as Oxygen or Adrenaline can be given under emergency protocols.

3️⃣ It’s beyond a doctor’s scope of practice to decide how much support a patient needs with feeding, mobility, or personal care. That’s a nursing decision, and only nurses are trained and authorized to make it.

So you see, these aren’t questions of “who is higher.” They are questions of who has the legal and professional authority to act in that area.

That’s how the entire healthcare system maintains safety, accountability, and quality of care.

➡️ Why Medical Decisions Often Take the Fore

Now, when people say “doctors make the final decision,” that’s only true in the medical sense because their decisions concern diagnosis, treatment, and medical management. Yes, it's the doctor who will determine what medications you will take, and for how long, because that is the scope of his practice.

But nursing is holistic, not just medical. To make a nursing decision, nurses integrate inputs from doctors, physiotherapists, occupational therapists, pharmacists, other allied health professionals and social workers before then making a final, patient-centered decision that encompasses all aspects of wellbeing.

Take discharge planning for example:
A doctor may declare a patient medically fit to go home.
But the nurse must ensure the patient is also functionally and socially ready.

That means confirming with:

Physiotherapy — Can the patient walk safely?

Occupational therapy — Can they manage daily tasks?

Pharmacy — Are their medications ready and understandable?

Social services — Do they have adequate home support?

Patient and Family — Do they have a means to get home?

Only after these inputs does the nurse make the final decision to discharge.

And yes, the nurse can decide to keep the patient in hospital if they are medically fit but socially unsafe to go home. I have kept patients in hospital uncountable times because of non-medical reasons that hold up their discharge.

That’s not subordination. That’s an interprofessional collaboration, each professional leading within their own scope.

Now let’s talk about the medical hierarchy, because it’s real, but it only exists within medicine.

Within the medical profession, decisions are stratified by seniority and experience:

A junior doctor can prescribe basic medications, order routine tests, and make day-to-day clinical decisions.

But for complex procedures, specialist interventions, or treatment escalations, they must get approval from their Registrar or Consultant.

The Consultant (senior doctor) carries the ultimate legal responsibility for the patient’s medical management.

That’s what hierarchy looks like, it exists within one profession. With each level up being able to make all the decisions as the one below it, and then more.

The same applies within nursing, where a staff nurse, senior nurse, ward manager, and matron each have their own levels of responsibility and decision-making authority.

But nurses don’t report to doctors in a hierarchical sense. They collaborate with them. As a staff nurse, my hierarchical senior is the ward manager, who tends to report to the matron, who also reports to the chief nurse.

In summary, hospitals aren’t single pyramids with doctors at the top and everyone else below.

They’re ecosystems made up of multiple professions, each with its own hierarchy and scope of practice.

The medical hierarchy governs medical decision-making.

The nursing hierarchy governs nursing decision-making.

Physiotherapy, pharmacy, radiology, occupational therapy, and social care all have their own professional hierarchies and authorities.

Healthcare only works when all these systems communicate and collaborate not when one tries to dominate the others.

So no, nurses aren’t below doctors.
They’re just different professionals doing different types of decision-making and when done right, both roles complement each other.

Collaboration isn’t subordination. It’s what keeps patients safe.

Ohh, and in my experience, you can tell how good a healthcare professional is at their job by how much they respect other healthcare professionals.

Ngong Laigha AJ

Eat healthy
Drink clean and sufficient amounts of water
Have adequate rest
Exercise frequently
Avoid stressors
Practice personal and environmental hygiene
Avoid unhealthy sexual practices
Limit alcohol, smoking, and drug use
Do regular health checks and screening
You have solved over 90% of your health problems

When I was doing my BSN, I had a roommate who noticed I was dating a doctor—now my husband. Unknown to me, she admired that and decided she also wanted to date a doctor.

One day, out of nowhere, she asked me: “How are you coping in your relationship?” I was surprised, so I asked what she meant. That was when she confessed she had started dating a doctor too, but she wasn’t enjoying it.

I asked her why: “Don’t you like him? Is he not into you?”

She laughed and said, “I like him o, but he’s a bookworm! Every time I visit him, he’ll start asking me about my grades, my studies, or he’ll give me books to read and say we’ll discuss them during the next visit.” 🤣🤣🤣

More importantly, she said she didn’t like the fact that he could always tell when she was lying—because he studied psychology. To her, he was doing “ITK” (I too know).

Meanwhile, he was just a fresh graduate who had barely finished his induction, while my own guy was already on the path to becoming a consultant.

I couldn’t hold my laughter 🤣🤣🤣 and told her, “Your boyfriend is still in nursery 1 and you’re already complaining. My own is already in university and I’m managing it!” 🤣🤣🤣

When I asked her the kind of man she truly wanted, she said: “A guy who will spoil me, take me out, buy me things, club with me, pamper me, blah blah blah…”

At that point, I knew she was still in her toddler stage of life. Because everything she complained about in her boyfriend was exactly what I loved about mine. 🤣🤣

I told her to do whatever makes her happy. She eventually broke up with him and found her peace.

But then she asked me, “Why are you still with your doctor?”

My answer was simple: “Because he inspires me. He fuels my dreams as a nurse. He pushes me beyond my limits and comfort zone. He is more intelligent than me, has leadership skills, and looks like the kind of man I’d want to build a future with.”

Today, 10 years later, everything I saw in him has played out in my life.

👉🏽 Your choice of a spouse is one of the most important decisions for your success as a woman. Don’t choose based on admiration or comparison—choose with vision, purpose, and alignment.

Obia’s Dynasty


゚