Bedside Nurse Practitioners

Specialties Advanced

Published

Specializes in Family Nursing & Psychiatry.

So this is just a thought... like many potential great ideas... :p

But just imagine a new advanced practice speciality, a bedside clinician acting as a registered nurse AND a nurse practitioner, the "Bedside Nurse Practitioner." They would be practicing in the ICU/stepdown units, taking care of very high risk complication patients. They would stay with the patients for 12hrs (regular shift) and will be able to assess, diagnose, treat and prescribe medications/treatments while at the bedside.

I know it's a far fetch idea (now)... but very interesting nonetheless. Thoughts?

Up Vote Up Vote ×
Specializes in Trauma-Surgical, Case Management, Clinic.

Interesting idea but it seems like there could be some kind of conflict of interest with being the primary nurse and diagnosing, treating, and prescribing treatments as the primary provider as well. I think the role of clinical nurse specialist in collaboration with a primary care provider is the best for these critically sick pts.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Why? Why would this be necessary? How would they be paid? Do you think that the facilities would advocate to pay a bedside "nurse practitioner" any more money? Do you think insurance companies would go for direct payor billing for each patient to pay the NP "What they are worth?" Do you think someone who has gone for an advaned degree wants to work at the beside in patient care and make what a bedside nurse makes? Do you think the MD community would allow thier jobs to be take away from them?

Do you know what a critical care nurse does at the bedside? Do you realize that they are highly trained individuals that make independent decisions? Didf you realize that many ICU have their own "hospitalist/intensivist" that work that 12 hour shift in the ICU that work with the ICU nurses and the patients on a 1:1 basis?

NO FACILITY will pay a NP big bucks to do patient care at the bedside. We will educate ourselves right out of a job.

Why would ANYTHING that only further raises the cost of healthcare be beneficial to the patient who ultimately will be footed with the bill?

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

You would lose an important check and balance there.

Up Vote Up Vote ×
Specializes in Psychiatric Nursing.

I don't see a conflict of interest since it is about patient care. Like everything else it would require getting used to. There may be other reasons care is divided the way it is. Would it be cost effective, for example??

Up Vote Up Vote ×
Specializes in oncology, MS/tele/stepdown.

Who checks that professional's decision? As a bedside nurse, I am an additional person that checks an order. I have caught things that pharmacy and the doctor missed. But, I have made mistakes too. I think the more eyes on the patient the better, and I don't see how this would necessarily be an improvement.

Up Vote Up Vote ×
Specializes in Family Nursing & Psychiatry.

Again, these are BOLD ideas for nursing (just like the APRN ideas 50 years ago). This idea came to mind when I'm I was working at the bedside one night and I needed a simple order for decreasing fluids and a breathing treatment. After 3 calls, I was not getting a reply and it was a bit annoying. The patient wasn't in distress or anything but I thought at that time wouldn't it be something if I were able to prescribe at the bedside.

This role I'm putting out there (however bold it is) are combining two already established nursing scopes of practice. Registered nursing and to an extent , advanced nursing as well, is at times seen as dependent on medicine. I know, know, we are an autonomous profession (blah blah blah) but I feel like why not push the role expansion even farther?

As far as oversight, there would still be a Nurse Practitioner available for collaboration PRESENT on the floor (as opposed to an MD or DO).

And of course I don't expect this to happen overnight. This kind of expansion may take decades (even generations) to become reality.

Up Vote Up Vote ×
Specializes in PICU.

As a former bedside ICU RN and now ICU APN, I agree with the others that it's not cost effective. As an RN, I took care of 1-2 patients. As an APN, I oversee the care of up to 12, our other ICU the APNs can have 16. I also agree that I enjoy the checks and balances that the MDs, pharmacists, APNs, RNs, and RTs bring to the patient's care.

As an aside, that's just wrong that you couldn't get a hold of someone. Glad it wasn't an emergency!

Up Vote Up Vote ×
Specializes in NICU.

You're right, it would be a lot more convenient to be able to write your own orders : ) but I do think it's safer to have more than set of eyes looking at the patient, especially in regards to an ICU patient. If a "bedside NP" does it all, then there's no one to double check her judgment.

Up Vote Up Vote ×
Specializes in Nursing Education, CVICU, Float Pool.

Even though it's a "stretch" I feel that it's a great concept in theory. I like the idea. I'm not sure what all the pro's and con's would be, but just taking the idea for what it is, I think it's creatively innovative to say the least.

Up Vote Up Vote ×
Specializes in Nursing Education, CVICU, Float Pool.
I don't see a conflict of interest since it is about patient care. Like everything else it would require getting used to. There may be other reasons care is divided the way it is. Would it be cost effective for example??[/quote']

Good points .

Up Vote Up Vote ×
Specializes in medical surgical.

I am a NP that practices as a prn Rn because I still enjoy it. There is no way the hospital would allow me to prescribe!

Up Vote Up Vote ×
+ Add a Comment