In recent years, medical directors and other physicians practicing in post-acute care settings have recognized the benefits of aligning with advanced practice nurses working in these settings. Physicians benefit by having a clinical partner participating in the medical management of their patients. Academic nursing has hailed this partnership in hopes that advanced practice nurses will help to elevate the nursing practices of nursing services offered in these settings.

Another opportunity between medicine and nursing exists that needs to be recognized, nurtured, and developed. That is, the natural partnership between the medical director (MD) and the director of nursing (DON). While Title 22 (22CCR 72305) refers to the MD as a consultant to the DON “in matters related to patient care services,” the DON regulation ( 22CCR 72327) makes no mention of a partnership. However, it is possible that both persons have opportunities to learn from one another. In fact, it is likely that such a partnership exists among some of our members. However, for this to become commonplace, existing barriers and challenges to establishment and maintenance of this partnership need to be addressed over time. 

This partnership is more likely to develop over time if both partners realize that it is in their mutual self-interest to commit to fostering this relationship. The possible benefit for medical directors is that they will learn more about the routine operations of nursing services, some of which are not helpful and are entirely within the scope of practice of the DON to modify. Alternatively, the useful and helpful practices of nursing services may be better understood. 

The DON benefits by having a clinical and operational partner with whom to advocate facility and corporate administration more effectively for practice changes that may initially be perceived as too risky or too costly. Although their advocacy may not always result in desired practice changes, success becomes more likely when the key clinical professionals are united in their requests. 

I suggest that development of this partnership is just as important as that which has emerged between physicians and advanced practice nurses practicing in the post-acute setting.