Beyond Bedside? Advanced Practice? Really?

[EGspirit]

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.

[elkpark]

Well, in my opinion, the RN has to take the bull by the horns on that. They can be certified in their area of practice, they can even become a CNS, if they have the money and time for a masters degree.

But ... But ... But ... The CNS is (gasp!) an advanced practice role and many CNSs work away from the bedside. Some of them have doctoral degrees and get referred to as "doctor." Shouldn't you be looking down on them, too? They're not fulfilling your Christian ideal of martyrdom and servanthood!

[Farawyn]

Well, in my opinion, the RN has to take the bull by the horns on that. They can be certified in their area of practice, they can even become a CNS, if they have the money and time for a masters degree. They can do continuing education and that sort of thing.

They may even want to think about teaching when the demands of the job become too much--as they eventually do. That's up to them.

I understand that. I was perhaps being a bit facetious.

Everyone has a role. God gives different purposes in life. But in NURSING, I believe the "advanced" nurse is the one who can provide the best bedside care for the most patients. They should get the most glory.

The world doesn't see it my way. I can live with that. But this is a discussion board, isn't it? So, here I can "discuss" what I think.

You can, and we can keep telling you why your thinking is not logical.

[BCgradnurse, MSN, RN, NP]

Your perspective of "manipulating" providers to get what you need for your patients is interesting. Healthcare is a team sport and the patient's care is the goal. We're all needed equally. I work WITH providers to care for our patients. We have a respectful and collaborative team and common goal. From the CNA to the social worker to the chaplain and to the Medical Director (and, yes, the RN, LPN, and APNPs too) we're all in it together.

I don't understand your designation of importance here. We all need to do different jobs to care for the whole patient. If everyone placed the highest value on personal care, there wouldn't be anyone advocating for more health clinics in the community, preventative care, or making health policies that impact our children and seniors.

It is a very interesting perspective. It really shows a lack of understanding of the needs of the patient, and the role and value of the entire health care team in caring for the patient. It also sounds a bit pathological to me.

"Bedside" RNs don't have a monopoly on being caring. Caring is shown by the housekeeper who works to ensure a new admit has a room that is clean and sanitary. It's also shown by the pharmacist who is meticulous in mixing IV solutions and TPN for patients, and who calls the floor or office when orders don't make sense. It's shown by social workers who try to find a good placement for a patient who has nowhere to go after discharge. It takes an entire team from different disciplines to provide complete care. No one is more or less important than the other. Bedside and non-bedside nurses are an integral part of that team. I don't see what's so hard to understand about that.

[EGspirit]

But ... But ... But ... The CNS is (gasp!) an advanced practice role and many CNSs work away from the bedside. Some of them have doctoral degrees and get referred to as "doctor." Shouldn't you be looking down on them, too? They're not fulfilling your Christian ideal of martyrdom and servanthood!

They don't have to. It's up to them. Maybe CNS is a waste of time in that case.

[EGspirit]

You can, and we can keep telling you why your thinking is not logical.

Logic, huh? There's nothing logical about any of this. It's my opinion. It's what I feel should be true. But I'll tell you what's not logical but what is sad, is that NPs want to make big bucks, get away from doing direct patient care, get away from the bedside, but they still want to be considered "nurses." Because they know that MDs are not a particularly well-liked group. But nurses are held in very high regard by society. But that regard is, and always has been, generated by the experience people have with bedside care.

Don't talk to me about logic.

[Toadette, MSN, RN]

Well, in my opinion, the RN has to take the bull by the horns on that. They can be certified in their area of practice, they can even become a CNS, if they have the money and time for a masters degree. They can do continuing education and that sort of thing.

They may even want to think about teaching when the demands of the job become too much--as they eventually do. That's up to them.

I understand that. I was perhaps being a bit facetious.

Everyone has a role. God gives different purposes in life. But in NURSING, I believe the "advanced" nurse is the one who can provide the best bedside care for the most patients. They should get the most glory.

The world doesn't see it my way. I can live with that. But this is a discussion board, isn't it? So, here I can "discuss" what I think.

I appreciate the response. As a non-religious person, I don't have a full appreciation for the glory that you're speaking of, but I can see how important that one on one care is to you - it's the most spiritually rewarding.

As a nurse manager, all the thank you cards to my team come to me first. The cards are always addressed to the direct care staff - CNA, SW, LPN, RN, chaplain, nurse practitioners, and doctors. I find reward in passing along the recognition and knowing that my team is out there making a difference.

I'm also certified in my specialty and I'm currently finishing up an MSN program for nursing informatics. I'm not seeking more recognition or a feeling that I'm better than anyone else - it's a feeling of personal achievement for me, that is rewarding. In my career, I want to help as many people as possible. I won't be a direct caregiver, but supportive in a way that will allow the best care for many patients.

Thanks for sharing your perspective and allowing me to discuss mine. í ½í¹‚

[EGspirit]

"Bedside" RNs don't have a monopoly on being caring. Caring is shown by the housekeeper who works to ensure a new admit has a room that is clean and sanitary. It's also shown by the pharmacist who is meticulous in mixing IV solutions and TPN for patients, and who calls the floor or office when orders don't make sense. It's shown by social workers who try to find a good placement for a patient who has nowhere to go after discharge. It takes an entire team from different disciplines to provide complete care. No one is more or less important than the other. Bedside and non-bedside nurses are an integral part of that team. I don't see what's so hard to understand about that.

I know all about the TEAM. And I recognize your need to fall back on that. But I'm not talking about the team. I'm talking about what constitutes a truly "advanced" nurse, not what constitutes a pharmacist or a social worker or a housekeeper.

An article I recently read in a nursing magazine. The editor wrote, and I paraphrase: "Nurses start at the bedside, but some choose to increase their professional abilities by becoming an advanced practice nurse, or even a DNP." And of course, this editor had all the initials after her name.

So, I got to thinking about what really was a professional nurse, what was a nurse, and why is it that everyone you talk to is either going or planning on going to NP school.

I know the answer: Nursing is hard. But take out the hard and it's not great anymore.

[EGspirit]

I appreciate the response. As a non-religious person, I don't have a full appreciation for the glory that you're speaking of, but I can see how important that one on one care is to you - it's the most spiritually rewarding.

Yes.

As a nurse manager, all the thank you cards to my team come to me first. The cards are always addressed to the direct care staff - CNA, SW, LPN, RN, chaplain, nurse practitioners, and doctors. I find reward in passing along the recognition and knowing that my team is out there making a difference.

Great.

I won't be a direct caregiver, but supportive in a way that will allow the best care for many patients.

Well, it's unfortunate for you, but thank you for supporting those who do give direct care.

Thanks for sharing your perspective and allowing me to discuss mine.

You're welcome. And thank you back.

[Oldmahubbard]

Although I have less education than physicians on paper, I take the time to listen to patients. I am intellectually curious about my specialty, and love to learn. I nearly always come to work, unless I am in bed, and I feel morally obligated to work during the hours my employer is paying me. I answer pages and the phone. My paperwork is done.

English is my native language and although I listen to patients, I don't believe everything they say, especially when there is a significant motive to lie or misrepresent. I don't hand out antipsychotics to everyone who claims to hear voices.

I strive to balance compassion with the realities of the environment. I consider risk/benefit ratio extensively before prescribing.

In working with a largely African American population- yes, sadly, this is the prison population in my state- I make a special effort to understand how cultural factors impact diagnosis, treatment and care.

As a result of the above, there was no comparison between me, as a Psychiatric NP, and the mostly foreign Psychiatrists I worked with for many years in the corrections setting, and continue to work with in the community.

Countless times, patients, staff, and even primary care physicians have approached me to say "you are so much better than Dr So and so!"

My response is "thank you, but that isn't much of a compliment."

The moral of the story is that more education on paper sometimes is meaningful. Sometimes it is not.

[TruvyNurse]

I am currently 11 months away from *hopefully* earning my FNP. Will I be an advanced practice nurse? Yes. But in that title I will always be a NURSE. I will never turn my nose up at emptying a bedpan or any bedside task for that manner. I plan to take the bedside manner with me..not forget it.

[Farawyn]

I am currently 11 months away from *hopefully* earning my FNP. Will I be an advanced practice nurse? Yes. But in that title I will always be a NURSE. I will never turn my nose up at emptying a bedpan or any bedside task for that manner. I plan to take the bedside manner with me..not forget it.

I don't think anyone is turning their nose up at that. At least, I hope not. Three are many ways to care for a patient, to advocate, and to treat.

[Matt8700, RN, EMT-B]

I think that it is very confusing to patients when a nurse walks in the room and tells them they will be the nurse providing their care, then comes the NP and explains to the patient that they are the advanced nurse. It sore of does make the bedside RN look less competent. I think that NPs are really providing more medical services to patients, not nursin services and I think it takes away from both professions to refer to NPs as advanced nurses. It makes the RN look "less educated" in the eyes of the patient......after all, they don't have "advanced" in the title. It also lessens the importance of the NP role because patients equate them to being "just a nurse." In my setting (ER), patients being cared for by an NP often ask when they will see a doctor. When I explain that they have seen an APRN, they seem confused and will sometimes question why they have only seen a nurse? The provider status is not there in the title of "nurse practitioner." If you think about, any level nurse, be it LPN, RN, BSN, is a practitioner of nursing. I think APRNs need a title change, maybe something like Advanced Clinician or something of the sort. The nursing profession has become very confusing with the role titles. As I said, anyone that is a nurse is technically a practitioner of nursing. I think to preserve respect for both professions we need a title change. Also, I feel that APRNs do not really offer expanded nursing services, they offer medical services. Nursing was never about prescribing medications and ordering CT scans, so to equate that to expanded nursing practice is not very accurate.....those are medical services. I think the APRN is very important, just as the RN is as well, however I do agree that at times it does seem like that to refer to an APRN as the advanced nurse is a bit of put down to the RN staff.