Beyond Bedside? Advanced Practice? Really? - page 5

Call me naive, but maybe someone could explain something to me: Why, in our profession, is it considered advanced NURSING practice to leave the bedside? The ADN goes in, does a shift, cares for... Read More

  1. by   WestCoastSunRN
    Quote from Farawyn
    Many of us are. Shot, I mean. After 20 years I made the shift. I miss it every day. I loved the bedside, the hands on, being part of that team, the collaboration. I hated the short staffing that eventually leads to being burnt, physically and mentally.
    When I see a seasoned bedside nurse at the top of her game, it makes me smile.
    This. It's a beautiful thing, isn't it? Many times the reality of this work is that it is not sustainable for the length of a nurse's career. I can understand nurses who want to get into the next phase of their career with time enough to grow, flourish and succeed in it, like they did at the bedside. I'm one of those nurses. I keep trying to figure out how to stay at the bedside at the same time as I advance in my career and I'm not sure the two can really both happen.
    There's nothing wrong with young nurses leaving the bedside early on (though there's lots of good reasons not to), but there's something to be said for the nurse who did all the things, became an expert and then moved on to the next thing.
    Last edit by AN Admin Team on Jan 22 : Reason: quoted edited post
  2. by   MurseJJ
    Quote from WestCoastSunRN
    This. It's a beautiful thing, isn't it? Many times the reality of this work is that it is not sustainable for the length of a nurse's career. I can understand nurses who want to get into the next phase of their career with time enough to grow, flourish and succeed in it, like they did at the bedside. I'm one of those nurses. I keep trying to figure out how to stay at the bedside at the same time as I advance in my career and I'm not sure the two can really both happen.
    There's nothing wrong with young nurses leaving the bedside early on (though there's lots of good reasons not to), but there's something to be said for the nurse who did all the things, became an expert and then moved on to the next thing.
    It's interesting, I work with a nurse that has around 8 years experience, all on our unit, has two masters, two certifications, presents at conferences, chairs a hospital committee, clinical ladder, and is a permanent charge and preceptor, and she has no desire to leave the bedside and go into leadership or anything else. She likes her 3 12s and the flexibility that offers. She just did the last level of the clinical ladder, and is happy with that (the ladder is specifically stated to be for those that want to advance in nursing but remain at the bedside, and it does offer pretty substantial pay raises).

    We also have nurses that have been on the unit for 18+ years, some as permanent charges, others taking patients, and i really don't know how they do it.
  3. by   WestCoastSunRN
    Quote from MurseJJ
    It's interesting, I work with a nurse that has around 8 years experience, all on our unit, has two masters, two certifications, presents at conferences, chairs a hospital committee, clinical ladder, and is a permanent charge and preceptor, and she has no desire to leave the bedside and go into leadership or anything else. She likes her 3 12s and the flexibility that offers. She just did the last level of the clinical ladder, and is happy with that (the ladder is specifically stated to be for those that want to advance in nursing but remain at the bedside, and it does offer pretty substantial pay raises).

    We also have nurses that have been on the unit for 18+ years, some as permanent charges, others taking patients, and i really don't know how they do it.
    If the work environment is good (staffing, adequate professional support, recognition/pay, etc), then it can make a lot of sense to stay bedside. That said, the physicality of bedside nursing is no joke. Your 8-years-in coworker is smart. If an injury takes her out (hopefully not!), or the general wear and tear on her body becomes too much ... she's got options. Lots of them, given that she's obviously a highly engaged go-getter. In the meantime, she's making good money doing what she likes to do with the flexibility she likes to have. Smart.
  4. by   mushyrn
    First of all, there are plenty of nurses who never touch a patient. To equate nursing with cleaning incontinence and inserting feeding tubes is an insult, really.

    Nurses are more than task managers. We have knowledge and skills to do our jobs. We have researchers and scientists. We are advancing our profession and you are part of the resistance, it appears.

    Also, "advance practice" nurses are so called advance due to their advanced education and capabilities. A solid NP/CRNA program will teach you much more advanced knowledge than a bedside RN has (from their professional nursing education).

    Don't get upset because some people strive for more.
  5. by   maji2002
    "But the patient is what it's all about. Not the staff meetings, not lobbying Washington, not scientific papers, none of that. I understand nurses will do all of those things. I just think NPs should be doctor's assistants, or solo practitioners, whatever, and "advanced practice" should mean advanced clinical skills within the scope of a registered nurse in the profession of caring."

    I must respectfully disagree. We, as nurses, are not only care for physical and emotional needs, but we absolutely must be advocates in all areas including being the "squeaky wheel" to our legislators. So many issues affect our patients and nurses, who have a unique perspective to what real-life needs of our patients really are, we can also affect positive change in policy and programs as well as the government policies that affect our practice, and take us away from the beside. I feel it is as much our duty as bedside hands-on care to be informed and advocate to our managers, administrator, and legislators. To remain silent is akin to malpractice in my opinion.
  6. by   Oldmahubbard
    I am an APRN, and I am at the patient's bedside regularly in my Psych NP practice. Hoping to find an empty chair in their room, so I can sit down comfortably, and discuss their mental health issues.

    That being said, many Nursing jobs away from the bedside offer better pay, better hours, no holidays or weekends, and much less physical labor. Can you blame people from wanting to escape those conditions?
  7. by   EGspirit
    Quote from BostonFNP
    Susie, why don't you share with everyone the outcomes studies that have examined quality of care of physicians vs NPs? Or explain to us the different legal standards of care between physicians and NPs? Or tell us about how quality measures used by MCOs are different for NP directed care vs physician directed care?
    I just have to say this, and I SHOULD PUT IT IN ALL CAPS. NPs are not MDs. They don't compare. They are a physician's assistant. They are nurses taken from nursing care and used primarily to assist a physician. They work under the supervision of a physician. When I go to the doctor, sometimes I see the MD, sometimes I see the NP. There is an obvious difference.

    I will tell you this, and make no mistake about it: when nurses leave nursing, there is no longer anything about them that is special. But again, it's just my opinion on things. Nursing boards call NPs advanced nurses. The nursing profession, hails the NP (cuz they're just about like doctors!).

    I don't compete with doctors, personally. Personally, I totally respect them and consider myself far less educated and incapable of doing what they do. But as a nurse, I also know that I do things they cannot do--or will not do. And that's my domain. I am with the patient. I care for them; I advocate on their behalf, and I do for them what they cannot do for themselves. I educate them, and I make for them an environment where they can become healthy again or be as comfortable as possible if they can't. I follow the MDs orders and I make nursing diagnoses and perform interventions on those diagnoses.

    I'm not in competition with anyone. I don't feel lesser than anyone. And I'm not going to try to play catch up to MDs. The modern healthcare model must have an MD and an RN and everyone else is an assistant to one of them.

    But, hey, go be an NP and make as much money as you can, and enjoy what you do. Just don't think you're the same thing as a bedside nurse. Feel superior to the bedside nurse if that makes you happy. Feel superior to me if you need to. Just make sure when you leave the patient's room you give me the orders I need. That's all I care about in our relationship to one another.
  8. by   Susie2310
    Quote from EGspirit
    I just have to say this, and I SHOULD PUT IT IN ALL CAPS. NPs are not MDs. They don't compare. They are a physician's assistant. They are nurses taken from nursing care and used primarily to assist a physician. They work under the supervision of a physician. When I go to the doctor, sometimes I see the MD, sometimes I see the NP. There is an obvious difference.
    This.
    Last edit by Susie2310 on Jan 17
  9. by   EGspirit
    Quote from mrcleanscrubs

    If you want to provide personal care, you can always go to school to become a Certified Nurse Assistant (CNA); this is a great path. I have a tremendous amount of respect for CNAs.
    Not true. I tried to go back to being a tech. The closest I felt to God was when I was a CNA in the dungeon of a nursing home where I first started. But I've been told by two different hospitals in my area that they will not hire a nurse as a tech--they say they can't.

    And I take that as a sign that the calling I received to be an RN is something I have to live up to whether I want to or not. But I envy the CNAs. Or at least I envy their position in the spiritual scheme of things.

    In my opinion, a CNA who works at the same pace I do for my patients is better than me. You won't ever understand that. It's lost on you, I know it. I'm not judging you for that--it's just a fact.
  10. by   EGspirit
    Quote from Oldmahubbard
    I am an APRN, and I am at the patient's bedside regularly in my Psych NP practice. Hoping to find an empty chair in their room, so I can sit down comfortably, and discuss their mental health issues.

    That being said, many Nursing jobs away from the bedside offer better pay, better hours, no holidays or weekends, and much less physical labor. Can you blame people from wanting to escape those conditions?
    No, I can't blame them. I fully understand it. But even you, in this post, make it clear that you ARE at the beside of your psych patients. And that's my whole case in point. Let us give the most respect where the most respect is due. The more direct the patient care, the more the honor and glory should be. And frankly, I think that should be the rule with doctors and social workers as well. But those aren't my fields, so I can't really make a statement about them.
  11. by   EGspirit
    Quote from NurseBeans
    And because I am a leaver-of-the-bedside, because it was that or leave the only profession I know, I would like to know how you suggest the world fill all the non-bedside nursing positions?
    There's no such thing. Anything not at the bedside can be done by non-nurses, and probably better. WITH THE EXCEPTION (as I mentioned in the OP) of the unit manager or the nursing school teacher, but both of those roles are in direct support or manufacturing of the bedside nurse. And those should be reserved for the older or less physically capable nurses.
  12. by   EGspirit
    As for me being judgmental. I'm not judging any individual in here. This is a discussion post about a broad subject matter. So, don't try to impugn my Christianity for the case I'm trying to make in this post as if somehow that will shame me into shutting up.

    Individuals are individuals. I judge no individual. I'm talking about the broad concept of what is or is not an "advanced" practice nurse.

    Besides, God knows there are much better reasons to believe I'm a bad Christian (pun intended).
  13. by   BostonFNP
    Quote from EGspirit
    I just have to say this, and I SHOULD PUT IT IN ALL CAPS. NPs are not MDs. They don't compare. They are a physician's assistant. They are nurses taken from nursing care and used primarily to assist a physician. They work under the supervision of a physician. When I go to the doctor, sometimes I see the MD, sometimes I see the NP. There is an obvious difference.
    You can put it in ALL CAPS or bold or italics but you are still absolutely wrong. NPs are not MDs nor are they PAs nor do they exist to "primarily assist" a physician. If you want to underline your ignorance, feel free, but it doesn't make it true.

    Quote from EGspirit
    I will tell you this, and make no mistake about it: when nurses leave nursing, there is no longer anything about them that is special. But again, it's just my opinion on things. Nursing boards call NPs advanced nurses. The nursing profession, hails the NP (cuz they're just about like doctors!).
    Nursing (and medical) boards license NPs as APRNs along with CNM, CNS, and CRNAs. If you are unsure what licensure is, there are excellent resources available via Google.

    As for not being special anymore, you are entitled to your opinion on that, I am sure as someone who has left nursing a few times you understand that.



    Quote from EGspirit
    I don't compete with doctors, personally. Personally, I totally respect them and consider myself far less educated and incapable of doing what they do.
    Professional respect is a good thing, but in this case I am not sure how it applies as you don't have the education or experience (or license) to be capable of acting in the provider role.


    Quote from EGspirit
    But as a nurse, I also know that I do things they cannot do--or will not do. And that's my domain. I am with the patient. I care for them; I advocate on their behalf, and I do for them what they cannot do for themselves. I educate them, and I make for them an environment where they can become healthy again or be as comfortable as possible if they can't. I follow the MDs orders and I make nursing diagnoses and perform interventions on those diagnoses.
    You are an RN and you practice within the RN scope. Just like APRNs practice within the APRN scope.

    Quote from EGspirit
    The modern healthcare model must have an MD and an RN and everyone else is an assistant to one of them.
    NPs see more than 1 billion visit per year and in 22 states they are fully independent providers. Moreover, most outpatient clinics don't have an RNs or LPNs on staff, with your "bedside" blinders on you miss the fact that the majority of healthcare happens outside the hospital.


    Quote from EGspirit
    But, hey, go be an NP and make as much money as you can, and enjoy what you do. Just don't think you're the same thing as a bedside nurse.
    Define "bedside" for us.

    And thanks, I love my job. For what its worth, and so you understand what the role outside of the "bedside" is, I am responsible for the health of more than 2500 people as a PCP and I spend 8+ hours a day standing next to an exam table doing my best to keep people out of the hospital, healthy, happy, and alive.

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