I read sometime ago on a different site a ...

Roland,

Is it important to you what MDs prefer? I don't mean to be flip, but think about what you are really asking.

So what if MDs think theirs is the best way. Do YOU think its the best way?

This could lead to a huge philisophical debate. I know the prevailing view has been that "health care" means "medical care". But I think there is a difference. The most excellent of "health care" is interdisciplinary.

I am an advanced practice nurse, and I believe in the inherent value of nursing care. APNs are not "physician extenders". PAs are physician extenders.

APNs function autonomously on their own license. They are responsible for their own action, and accept the attached liability. PAs function only under the direction of a physician. The physician accets the responsibility and liability.

You can't really say which is best. We need both in the overall health care system. Which is best for you personally as a career choice depends upon which suits your own goals.

Of course there are other issues to consider besides personal philosophy. For instance, financial concerns. You could compare salaries in your area. CRNAs can do their own billing, form their own groups, etc. Which makes the earning potential large. But the other side of the coin is you are taking a greater risk and responsibility than if you work for someone else.

You raise many good debatable issues with your question. Maybe more than you intended <g> Good luck with making an informed decision.

loisane CRNA

Loisane,
How do you pronounce your name?j\w

Brett

Ah, yes---------research. A good word. How about another good word?----------theory.


I know-------groan. But it applies here. One of the reasons theory is important is to justify that what nurses do is "nursing" and not just "helping the doctor".

I believe the comment you noted, that started this thread, was really a veiled critisism that APNs are doing "doctor's work" or that they "want to be doctors". The person was implying that only physicians can do a real patient assesment. That patient assesment by a nurse is not as good, because it is grounded in nursing theory, not medical theory.

There is really another, even deeper level to this debate (Are you still with me?). What the person was actually complaining about is that APNs are not under the MDs control, like a PA is. And the biggest issue of all is money. APNs can bill independently (CRNAs can, and the others are making progress). Meaning they are in direct financial competition with MDs. PAs pose no such threat because their practice is dependent on the MD.

Now you might begin to see why your investigation into two types of assesment did not yield any results. It really is a bigger debate than patient assesment skills.

You are just beginning your entry into nursing. Much of this may be of little interest to you now. But tuck it away in the back of your brain. These are issues of great importance, that will affect you later.

But for now, know that all those theory and research classes are important, no matter how abstract they seem to you now. Learn all you can about NURSING. If you want to learn about medicine, make sure you are really doing what you want to do. (And remember that "medicine" is not all there is to "health care") If you learn all you can about patient assesment from all the books, instructors, experienced RNs, ICU nurses, APNs, etc then you will learn to perform excellent NURSING assesments.

Thank you for allowing me to use your quesstion to get up on one of my favorite soapboxes. I know I turned what you thought was a simple question into a philosophy exercise. But if even a few nurses in cyber-land stayed with me enough to at least give this some thought, I think it can help our profession.

loisane

Research, while absolutly required is not often viewed in the same light by all professions. Even if there were some objective peice of quatitative research there would be to many factors.
The independant variable would be easy ie. the doctor or nurses physical assesment. but, the dependant varible would be disgusting. you would have age, medical history, diagnosis, culture, relgion, sex, on and on and on. the research couldn't even be done in one project.
Say hypotheticaly there was peice of research like this (wich would cost millions and millions). and say that it yeilded an outcome that said doctors or nurses did the better assessment. The next one hundred years would be spent debating wheather the research was even valid. One group would obviously say it was good reseach while the other would fight it with all their power.
Would it change patient care? likely not. only one thing changes patient care and thats money. when it comes right down to it. The people really making decisions don't care about pateint outcomes. their priorties come in this oder 1 make money, 2 don't get sued, 3 look noble to the public.
there is group who makes decisons that does care about patient out comes and like it or not thats JCHO (Joint commision) and they have done a rescent study that shows the nursing shortage is causing bad outcomes. that is good for nursing.

O.K. I am going to open myself up to a massive flame here.
My entire nursing career I have thought of nursing theory as ridiculous.
We make up new names for old problems. We say we are treating a "different" aspect of the patients disease. We say that by doing so we are providing an infinately different, yet neccesary mode of therapy. We provide treatments which are clearly medical in nature yet call them by different names, while trying to lay claim to them as nursing interventions.
Originally nursing diagnosis and interventions were developed as a means to promote third party payment for nursing services. I don't think there is a third party payer out there that provides reimbursement for "fluid volume excess" and resultant interventions, or any other nursing diagnosis.
Most of the theory is psychosocial in nature and has limited value in the treatment of patients.
My belief has always been that by doing this we do a disservice to the profession of nursing. When we call CHF anything other than what it is we look ridiculous. When we talk about the theory of providing nursing care, from this psychosocial standpoint what are we acheiving? In my opinion we are conveying that we do not have the ability to deal with the intricacies of the disease processes and treatments, so we cover the superficial aspects of it. This is not true of most nurses, we can, and do regularly deal with medical problems from a medical standpoint and do so successfully.
Off my soap box here, let the flames begin!!

1. Physicians are generally not "being sincere." The fact is (as already mentioned) that a licensed PA still cannot practice unless under the direct supervision of a physician. Nurses, on the other hand, can hold a nursing license, and can practice nursing, without "benefit" of a physician. Hence, PA's are under the thumb of physicians, and cannot generally disagree with physicians. Nurses, on the other hand, practice independently of physicians, and their jobs (usually) do not depend on the good will of the physician. This simple fact has been a burr under the blanket of the AMA for years. Simply stated, most physicians want everyone in the health care community to be "under" them. Many long for the return of the day when nurses stood up when physicians entered the room. So, the question is flawed. The statement "Physicians prefer working with PA's trained in the medical school model of patient accessment instead of AP nurses trained in the nursing school model." may be better restated "Physicians prefer working with PA's whose licenses depend on physicians, and are therefore subservient to physicians, over nurses, who have independent licenses, and are therefore not under the physician's thumb."

2. Igvc and I are in agreement where nursing theory is concerned. Most nursing theory is merely an academically reworded statement of the obvious. The one glaring exception is Roger's theory of unitary human beings. This "theory" was obviously conceived while stoned on hash, and fleshed out in full at the height of an LSD trip. At best, it is more a metaphysical treatise rather than a scientific theory. That's the problem with many "nurse scientists." They cannot tell the difference between religious belief and solid scientific theory.

Feel free to flame.

Kevin McHugh, CRNA