Beyond Bedside? Advanced Practice? Really? - page 8

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   EGspirit
    Quote from Toadette
    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.
  2. by   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.
  3. by   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.
  4. by   Farawyn
    Quote from 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.
    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.
  5. by   Matt8700
    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.
  6. by   Matt8700
    So many mis-spellings. Sorry guys
  7. by   Horseshoe
    Quote from Matt8700
    It makes the RN look "less educated" in the eyes of the patient......after all, they don't have "advanced" in the title.
    The RN **IS** less educated. That's a fact. Those of us who haven chosen not to further our education (and that would be me, too) have to own our choices. It does NOT mean the bedside RN is incompetent, but let's not pretend that those who went on to pursue and obtain advanced degrees haven't learned a good deal more than what an associate's or bachelor's degree can teach you. Experience counts, of course, and advanced certifications reveal additional expertise on the part of the RN, so those of us who have continued to delve into our specialties should be able to feel good and confident about that without denigrating others who have advanced their education and scope as well. It's not a contest.
  8. by   JBMmom
    Quote from Horseshoe
    The RN **IS** less educated. That's a fact. Those of us who haven chosen not to further our education (and that would be me, too) have to own our choices. It does NOT mean the bedside RN is incompetent, but let's not pretend that those who went on to pursue and obtain advanced degrees haven't learned a good deal more than what an associate's or bachelor's degree can teach you. Experience counts, of course, and advanced certifications reveal additional expertise on the part of the RN, so those of us who have continued to delve into our specialties should be able to feel good and confident about that without denigrating others who have advanced their education and scope as well. It's not a contest.
    At my hospital, on your name badge it also identifies BSN/MSN etc (along with our first and last name, which I'm not a fan of). When I was still in orientation, a patient noticed my name tag and made a comment about what a great nurse I must because because I have my MSN. I did mention that my MSN is in management, and doesn't really improve my ability to provide their care, but I hope that they would be happy with the care I could provide either way. It surprised me that someone would really zero in on the letters on my badge and quickly make assumptions about my competence. That's too bad because there are some nurses on my floor without an MSN that can run rings around me, I hope to some day be as good as they are. It's not about alphabet soup after your name, it's providing the best care.
  9. by   squishyfish
    Quote from EGspirit
    So why nursing? Why not business or finance or law? But whatever. I've worked around nurses who won't even give PRN pain meds when they're due, because it means they will have to chart it. I've watched many nurses ignore patients stewing in their own sh.. and pi.. , and nothing I say is going to change the world. And I'm sure not going to do it with this post. But for the love of God, why not go into insurance or teaching high school?
    Because I like science and medicine, and I like helping patients. I enjoy being a nurse, I don't mind getting my (gloved) hands dirty. I'll jump right in and change a patient, make sure they are clean and comfy, and help other nurses pass meds. But maybe I don't like being chronically understaffed and mistreated. It takes its toll on a person after awhile. To those nurses who have worked bedside for decades, I absolutely respect you. I know it's not something I'd want to do for a long period of time. We need nurses who work in insurance review, home healthcare, pediatric offices, advanced practice, dialysis, case management, etc, in addition to bedside. None of those jobs are easy, but they may appeal to nurses who have different strengths.
  10. by   brandy1017
    Honestly most doctors I've worked with are decent, smart and treat the nurses and staff with respect. I've only encountered a few arrogant ones over the years or ones that need anger management.

    I have great respect for doctors, they work long hours, and have spent many years in school. I had no idea how hard it is just to get chosen for the specialty you want and the years after med school. There are more med students then residencies available so some aren't accepted and our left in limbo.

    Plus something as simple as CP has a differential diagnosis of 5-7 different things. That is a lot of responsibility, it can occasionally even be a sign of cancer. Who knew?

    I really haven't encountered arrogant NP's, although many are newer grads and exude more self confidence than I did when I was a new grad. I remember working with one of the first RN's to become an NP and listening to her thought process about a patient's diagnosis after she was in school and I could see the difference in knowledge. I respect NP's and studies have shown their care is as good as a primary care doctor.

    NP's were started as a way to provide medical care to under served areas in the country and the PA programs were developed to help medics transition from the military and use their skills. It's true doctors and PA's have more clinical hours than NP's, but usually NP have been working as RN's so have some relevant on the job experience.
    Last edit by AN Admin Team on Jan 22 : Reason: quoted edited/removed post
  11. by   opalbee
    Quote from squishyfish
    Because I like science and medicine, and I like helping patients. I enjoy being a nurse, I don't mind getting my (gloved) hands dirty. I'll jump right in and change a patient, make sure they are clean and comfy, and help other nurses pass meds. But maybe I don't like being chronically understaffed and mistreated. It takes its toll on a person after awhile. To those nurses who have worked bedside for decades, I absolutely respect you. I know it's not something I'd want to do for a long period of time. We need nurses who work in insurance review, home healthcare, pediatric offices, advanced practice, dialysis, case management, etc, in addition to bedside. None of those jobs are easy, but they may appeal to nurses who have different strengths.
    This was perfect. We all have different strengths and weaknesses, so why are nurses getting attacked for finding something within the field that works better with their personality? For instance, I'm a more quiet person and I don't build relationships easily. I personally don't think I would be a good fit in a nursing home because from my clinical experiences, it seems as though the elderly seem much more at ease with people who are friendly and can easily see them as family because... Well, they kind of are their new "extended" family now.

    But I don't think that means that I shouldn't be a nurse. I absolutely love science and human physiology, and I'd love to be challenged and I think it's important for me to have a career that's mentally stimulating. I think that I have certain qualities that would prove to be beneficial in the field of nursing, even if it's not always at the bedside.

    And if I have it in me to want to further my education so that I can find a better niche in nursing (as there are many) then you better believe I'm going to and not hold myself back because some random person has a pre-conceived and ignorant notion of what he thinks I should be doing with my life to fit his own image.
  12. by   brandy1017
    Quote from EGspirit



    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.

    There are ways to improve morale and keep more nurses at the bedside. A no lift environment which the VA has achieved with ceiling lifts. Safe patient ratios with adequate nurses and ancillary staff such as CNA's, transporters, IV nurse and stat nurse and a hands on supervisor.

    I remember when we used to have good staffing and resources, the only thing we didn't have was a no lift environment. Patients have gotten heavier over the years where 300-500 pound patients are much more common now whereas they were rare when I first became a nurse. We finally have hover mats, but have lost all the other resources and now have higher patient ratios with increased acuity due to new treatments, meds, technology that keeps people alive longer and sicker.

    More nurses would stay at the bedside if working conditions were improved such as a good strong union can help with or mandated staffing ratio's like CA.
    Last edit by AN Admin Team on Jan 22 : Reason: quoted edited post
  13. by   Matt8700
    The RN and APRN are two very different roles. It does not mean that the RN is less educated than the APRN. You can have an MSN and not be a practitioner. APRNs, in my opinion, do not provide nursing services, they provide medical services, and we are lucky to have them to do so. The fact remains, however, that the core of nursing was never meant to include writing prescriptions and making medical decisions-that was left to the physician staff. When APRN practice began, they shifted from practicing nursing to practicing medicine. I agree that there is a difference between an RN and APRN, but disagree in the titles, and the statement that they have more education, because that may not always be the case. In fact, if you had a certified wound care RN discussing a patients plan of care with an ER APRN, the RN would be the more advanced clinician here. They would have more working knowledge of the situation than most ER APRNs, so the fact that the APRN has "more education" to me is an invalid point......their education is different. I think most APRNs would agree that they are practicing medicine, not nursing. Nursing is at the bedside for hours during the shift (the NPs are usually only at the bedside for a few minutes). Additionally, the RN staff is coordinating procedures, meds, etc, which the APRN is not doing......instead they are writing admission and discharge orders, consulting with cardiology, etc......which are all aspects of practicing medicine, not nursing.

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