Beyond Bedside? Advanced Practice? Really?

Nurses General Nursing

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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 his or her patient load, uses all their competency to care for real people in real beds.

But then the BSN comes along and wants to be manager, and that's considered "more professional." But that BSN isn't at the bedside anymore.

But then the BSN becomes an NP, and now they're practicing low-skilled medicine, which isn't nursing at all! But they are the "Advanced Practitioners?"

I understand nurses at the bedside. I understand, perhaps older nurses who can't do the physical stuff anymore, getting advanced degrees so they can teach nursing. And I get that someone on any unit, has to be the manager. But all of that focuses on the support and instruction of the bedside nurse.

Seriously, wouldn't technical nursing certifications like ACLS and CCRN (or the other specialty certifications) really be what makes a nurse "Advanced."

I mean if my name looks like this:

EGspirit, MS, APRN, ACNS-BC, CEN, FAWM, FAAN

am I even a nurse anymore?

Why can't caring be the profession and leave medicine and surgery to the doctors, and the Ph.Ds to the Nursing school professors? Wouldn't being really good at running a code or starting an IV, or even being really effective at feeding and bathing a patient be the definition of the advanced nurse?

Why in our profession are we always running away from the bedside? I mean, why be in the profession?

Just wondering and looking for opinions on the matter. :wideyed:

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
No one, no thing, and certainly no one else's journey takes away from who I am as a nurse.

Just be the best you and shape the perception of your practice by your practice.

Exactly!

Specializes in Trauma and Acute Care Surgery.

Hello EGspirit, RN ,

I respectfully have to disagree with your divisive statements in your original post.

Advanced Practice Nurses do not leave the bedside while working within the inpatient setting.

To state that Associate Degree Nurses (ADN) simply clock in and care for their patients is belittling; I think ADNs are like any other nurse, however educated at the Associate level. (I know some that run circles around their BSN coworkers)

Also, what do you mean by, "real patients in real beds?"

Do Baccalaureate Degree Nurses (BSN) not treat real patients in real beds?

Generally, BSNs do not seek to be managers, they just hope to increase their level of education to meet the ever changing needs of our demanding healthcare system. As well as to provide safe, and culturally competent care at the *bed side* to, "real patients," in "real beds."

The BSN is at the bedside.

The BSN may choose to pursue higher education and receive their Masters in Nursing, or may even pursue Nurse Practitioner studies.

Nurse Practitioners (NP) and Physician Assistants (PA) alike do not practice, "low skilled medicine." What exactly is, "low skilled medicine?"

NPs and PAs are advanced practice providers who are educated to provide care to patients in conjunction with a Physician; working as a team to lessen the load of the Physician and provide quality care. These providers provide diagnostic examinations, therapies, and interventions to patients in various settings. They do not practice, "low skilled medicine." NPs and PAs are at the bedside as well.

Yes, if your name has all of those educational degrees attached to it, you can still be a nurse :-)

Why? You may ask. Well, I will have you know that Nurses are educated healthcare professionals, and an integral piece of the healthcare team.

I suggest you try to achieve further education yourself, it may help you move away from utilizing the crooked, generalizing thought processes you may be accustomed to.

It sounds like you are one of those old veteran nurses who hates seeing any other nurses doing better than they themselves are - this is called, "Queen Bee Syndrome."

Nursing once, in the past, was more of a hospitality profession; simple tasks were delegated to nurses by physicians. I am not sure if you are aware of the fact we are now in 2018, yes, I said it, two thousand eighteen. Nursing is a profession based on science(Associate of Science in Nursing, Baccalaureate of Science in Nursing). We provide care that is based on scientific evidence.

There is no reason why we cannot be a caring profession.

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.

This is America, you are free to voice your concerns about nurses "taking away physician jobs."

It sounds like you may be a nervous physician or resident hiding behind the RN title on this forum just to direct some of your anger and frustration with the ever changing and elevating role of the educated nurse.

P.S.

Please enlighten me with the specialties you have listed as your own, "Cardiology, ICU, and Psych."

Let me know how learning to give patients a bed bath helped you achieve your goals of managing care for such critical patients. :-)

Just trying to understand your thought processes, if you have any. :-)

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
There are plenty of BSN RNs who are "bedside nurses."
And bedside RNs who hold an MSN as well.

Because your body is shot after a few years of lifting patients, walking miles down long hallways, etc., etc.

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.

Specializes in CVICU, MICU, Burn ICU.
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.

Specializes in Neurosurgery, Neurology.
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.

Specializes in CVICU, MICU, Burn ICU.
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.

Specializes in HIV.

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.

"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.

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?

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.

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.

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