Beyond Bedside? Advanced Practice? Really? - page 9

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   elkpark
    Quote from 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.
    I have never, in my >30 years of nursing, heard anyone introduce her/himself to a client as the "advanced nurse." It is always (in my experience) "nurse practitioner," "nurse anesthetist," "nurse midwife." Not "the advanced nurse." For all the time and effort people here spend fretting over these kinds of issues, this and whether or not advanced practice nurses with doctorates should be able to be referred to as "doctor" so-and-so in the clinical setting, I haven't run into any actual clients who have difficulty figuring out who is who and what the different individuals' roles are.
  2. by   SpankedInPittsburgh
    Yeah I agree the whole "advanced nurse" title seems to be an issue with nurses and nobody else.
  3. by   BostonFNP
    Quote from EGspirit
    There's nothing logical about any of this. It's my opinion. It's what I feel should be true.
    This about sums up the issue.

    Its not about what is true or not true, its about what the OP feels should be true . Facts, evidenced based practice, ethics, the scientific process yields to individual beliefs, as ungrounded in reality as they may be.
  4. by   EGspirit
    Quote from BostonFNP
    This about sums up the issue.

    Its not about what is true or not true, its about what the OP feels should be true . Facts, evidenced based practice, ethics, the scientific process yields to individual beliefs, as ungrounded in reality as they may be.
    Exactly. And where are we? Are we writing policy for the state legislature? No. We're in a social media forum.

    But I wouldn't be so quick to denigrate my "feelings" on the subject, for as long as nurses "feel" punked by MDs, they will continue to try to pretend they are "just as good as" MDs and will debase themselves as they seek MD approval. And THAT is the worst possible path the nursing profession can walk.

    There is no shame in leaving nursing to become a PA. There is no shame in leaving nursing to go to medical school. But there is a real shame in feeling that nurses are "less than" doctors just because they take "medical" orders from doctors. Nurses are the profession of caring. MDs are the profession of applied science whereby they diagnose and prescribe or perform treatments. But when nurses try to play catch up to MDs they are admitting that their profession is less than the MD profession, and absolutely nothing could be further from the truth.

    In fact, medicine will always fail. People will all die eventually. Nursing, the care we give for those who cannot care for themselves, never fails. MDs have to act like asses to nurses and pretend to be superior, because deep down they know they cannot give people what they promise. They know they cannot save a life.

    We should not have NPs in the nursing profession. They should should be a completely separate profession on the side of medicine.

    Because remember, there are two elements in healthcare, two primary actors: the MD and the RN, and everyone else is an assistant to one or the other.
    Last edit by AN Admin Team on Jan 22 : Reason: quoted edited/removed post
  5. by   Dodongo
    Quote from EGspirit
    But I wouldn't be so quick to denigrate my "feelings" on the subject, for as long as nurses "feel" punked by MDs, they will continue to try to pretend they are "just as good as" MDs and will debase themselves as they seek MD approval. And THAT is the worst possible path the nursing profession can walk.

    There is no shame in leaving nursing to become a PA. There is no shame in leaving nursing to go to medical school. But there is a real shame in feeling that nurses are "less than" doctors just because they take "medical" orders from doctors. Nurses are the profession of caring. MDs are the profession of applied science whereby they diagnose and prescribe or perform treatments. But when nurses try to play catch up to MDs they are admitting that their profession is less than the MD profession, and absolutely nothing could be further from the truth.

    In fact, medicine will always fail. People will all die eventually. Nursing, the care we give for those who cannot care for themselves, never fails. MDs have to act like asses to nurses and pretend to be superior, because deep down they know they cannot give people what they promise. They know they cannot save a life.

    We should not have NPs in the nursing profession. They should should be a completely separate profession on the side of medicine.

    Because remember, there are two elements in healthcare, two primary actors: the MD and the RN, and everyone else is an assistant to one or the other.
    I'd be willing to bet your views are in the minority.

    I didn't enter the nursing profession to be a bedside nurse. I didn't particularly enjoy being a bedside nurse. I was "just putting in my time" to move on to what I actually wanted to do. Which, I guess, according to you, is to "debase myself" and pander to, or "seek approval from MDs". Believe it or not, everyone entering the nursing profession doesn't want to remain a bedside RN. For many it's just a hoop to jump through so that they can go on to doing what they actually want.

    And I think it's utterly ridiculous for you to say that there are nurses and physicians and all other health care providers are there to assist these two groups. There are many distinct professions in healthcare and none are better than any other. Climb off your high horse.

    At the end of the day you have some serious issues you need to work through. People can choose to be whatever they want to be, and no one gives two craps what you think about it. You want to be a bedside nurse, be a bedside nurse. Worry about yourself rather than what everyone else is doing. No sense in worrying about something so very out of your control.
    Last edit by AN Admin Team on Jan 22 : Reason: off-topic
  6. by   BostonFNP
    Quote from EGspirit
    Because remember, there are two elements in healthcare, two primary actors: the MD and the RN, and everyone else is an assistant to one or the other.
    What healthcare system do you work in that has no pharmacists, case managers, social workers, physical therapists, occupational therapists, EMTs, medics, etc.

    Good luck with your MSN...that's a Master of SCIENCE in Nursing...
  7. by   FNPOwlGal
    I read through all the comments and OPs rambling, almost incoherent statements. And I sincerely hope that most bedside nurses are nothing like the OP. I want to work with professionals. Professional nurses who value science and know their "stuff". It's great to sponge bath patients. I'm glad the OP is all for that. But I want to work with nurses who can evaluate labs, know their medications inside and out (or at least utilize technology to look up these medications, so they don't kill someone), and who can evaluate the (vital) members of the healthcare team. They don't view NPs and physicians as competition or devalue the contributions of pharmacists, PT, OT, and social workers.

    Really, all of these ramblings have me wondering in what venue the OP works. It appears that he/she doesn't have a firm grasp of science, the field of medicine, or of nursing. That's scary.

    And if you cannot see anything other than the person in the bed in the hospital, then you are doing your patients and community a huge disservice. The real ability to impact patients is when they are out in the community, living their lives -- screening and prevention; early detection and management of diseases and risk factors. And in order to effectively treat our patients and communities, we need all the players to be on their game -- NPs, physicians, nurses, nurse managers, quality, etc, etc, etc.

    You seem so ill-informed, that I almost don't believe that you are a practicing nurse.
  8. by   EGspirit
    Quote from FNPOwlGal
    I read through all the comments and OPs rambling, almost incoherent statements. And I sincerely hope that most bedside nurses are nothing like the OP. I want to work with professionals. Professional nurses who value science and know their "stuff". It's great to sponge bath patients. I'm glad the OP is all for that. But I want to work with nurses who can evaluate labs, know their medications inside and out (or at least utilize technology to look up these medications, so they don't kill someone),
    What in the world are you talking about? Seriously, that doesn't even justify a response. What exactly do you think bedside RNs do?

    You seem so ill-informed, that I almost don't believe that you are a practicing nurse.
    Fortunately, it only matters what my board of nursing thinks--and the hospital I work for.
  9. by   FNPOwlGal
    I know what bedside nurses do (at least the good ones), but the way you describe your practice and interactions with physicians and NPs (not to mention pharmacists, social work, and therapists) along with your dreadful lack of knowledge regarding the role and training of NPs (that you started a thread to criticize) leads me to believe that there are probably some professional nursing skills lacking. If you start a thread to complain about other nursing roles without any understanding of what those roles entail, and then admit that you can barely tolerate working with any of the care team (who, by the way, are tasked with caring for the same patients you are), then you open yourself up to a bit of scrutiny.

    You seem to base many of your thoughts on feelings rather than facts -- and I can't help but think that puts your patients at a disadvantage.

    And, I guess that we should all be glad that you are proud to be practicing at the bare minimum that your state deems necessary to maintain licensure?
  10. by   SpankedInPittsburgh
    Quote from EGspirit
    What in the world are you talking about? Seriously, that doesn't even justify a response. What exactly do you think bedside RNs do?

    Fortunately, it only matters what my board of nursing thinks--and the hospital I work for.
    Bedside Nurses apply scientific evidenced based processes to helping their patients. In opposition to operating on the "principal" of this is how I think it should be based on my preconceived notions from who knows where.
    Opinions on NP Roles, Nurses leaving the bedside, How every other nurse should work in support of the bedside nurse as in opposition to helping the patient, Nurse Titles..... are all determined and bestowed by regulatory agencies and hospitals not by the self-proclaimed ruler of the internet who in his mind determines all that is right in nursing. Any opposing view point to the status quo which has been developed by years of evidence based practices and backed up by countless studies leading to helping many, many patients better be backed up by serious, robust evidence and be much better than the "argument" of "but I don't like it that way."
    Last edit by AN Admin Team on Jan 22 : Reason: off-topic
  11. by   traumaRUs
    Closed for review

close