Beyond Bedside? Advanced Practice? Really?

  1. 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.
    Last edit by Brian S. on Jan 17
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  2. Visit EGspirit profile page

    About EGspirit, RN

    Joined: Dec '17; Posts: 212; Likes: 348

    114 Comments

  3. by   Flatline
    I believe the "Advanced" is in reference to the enlarged scope of their practice and nothing more.

    Nursing is more than the bedside, always has been unless you are going to start calling Nightingale a fraud. Advanced Practice Nurses are nurses with an elevated scope of practice, they are not lesser doctors. The distinction is subtle but important.

    The point of nursing is to care for our patients and be their advocate, patient centric always. We do not benefit our patients by pigeonholing ourselves into a single role.

    The bedside is important, APNs are important, leadership is important, education is important, regulatory is important.

    We are all nurses doing nurse things.
  4. by   EGspirit
    Quote from Flatline
    I believe the "Advanced" is in reference to the enlarged scope of their practice and nothing more.

    Nursing is more than the bedside, always has been unless you are going to start calling Nightingale a fraud.
    I'm not calling anyone a fraud. Maybe it's a bit telling that you bring in that term to this discussion, because I didn't even think it until you said it.

    Florence Nightingale was an educator and social reformer. I'm not sure what that has to do with my point that today we tend to think of all the "advanced" positions as being away from the direct care of patients. Back in her day, nurses just did nursing. A poem was written about her being on the floor late at night nearly floating from room to room (hence the term lady of the lamp), so yeah, I'd say that's what I consider a super-nurse. I would say she was an "advanced" nurse if patients were writing poems about her.

    Clearly advanced degrees are needed to teach in nursing colleges, and teaching future nurses has to be considered part of the continuum of care--globally speaking.

    I'm not calling anyone a fraud (and you know you're just baiting with that). I'm calling into question our ideas of what makes someone an advanced nurse.
  5. by   kakamegamama
    An ANP follows a preventive medicine model, the nursing model. Yes, we diagnose and prescribe, but we provide patient education about their disease, education about good health practices, etc. It's not all "pill pushing". Several ANPs are still at the bedside, in the role of acute NP, doing bedside education for staff and patient alike, depending on their job description at their area.

    What do YOU think advanced nursing practice should be about/is about?
  6. by   Cat365
    Would you rather we change the terminology from Advanced practice to expanded practice? That's probably more correct, but doesn't sound as good.

    NP do have advanced degrees, so they are referred to as advanced.

    I agree with the first poster your original post does sound very negative and kind of off-putting on the subject of nurses with higher degrees and yes, they are nurses. Why should nurses and nursing not have multiple levels? I don't notice you growling about the difference between LPN and RN.

    Not all nurses (even the "lower levels") work bedside. Are nurses that work in schools, public health, offices, and case management not nurses? That in my opinion is the wonder of nursing. There is an area, a specialty for a wide variety of nurses.
  7. by   llg
    In order to be successful in most of those non-bedside nurse roles, the nurse must have the basic nursing nursing knowledge learned in his/her pre-licensure nursing program AND ALSO additional knowledge learned by completing a higher-level educational program. Preferably, that advanced-practice nurse also builds on his/her previous direct patient care experience, whether that experience was gained at the bedside or in some other health care setting.

    We are still nurses in that we continue to use our basic nursing education in our current practice. We have added to our original education and expanded our focus by expanding the services we offer to patients ... or we take responsibility for providing care for large groups of patients (a whole patient care unit, whole hospital, whole community, etc.) ... or we take responsibility for developing the nursing knowledge base and passing it on to a new generation of nurses. We are still using our nursing expertise to help people manage their health -- we just don't do it in the same way as a bedside nurse taking care of a single patient.

    Nursing hurts itself when individual nurse fails to appreciate that those nurses in jobs other than his/her own are also working hard to help provide nursing care to patients. We need to support each other in our multiple roles, not tear each other down.
  8. by   Susie2310
    Quote from EGspirit
    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?"
    Or the NP is practicing under standardized procedures (as RN's do), with a physician supervisor. But they are now "Providers."
    Last edit by Susie2310 on Jan 15
  9. by   Susie2310
    [QUOTE=EGspirit;9696617
    Why in our profession are we always running away from the bedside?

    [/QUOTE]

    Ego often plays a big part. Chasing the following: PROVIDER status. More money. Better benefits (actual or perceived). Better working conditions (away from the nasty bedside). Better working hours. The desire to associate with a better class of person (please note I am being sarcastic in using the word "better"). Better (actual or perceived) social opportunities. Better (actual or perceived) networking opportunities. Being upwardly mobile.
    Last edit by Susie2310 on Jan 15
  10. by   Jedrnurse
    I agree with some of what you said. Particularly as it pertains to direct entry APNs- they've never been nurses, so how can they practice an advanced form of it? It's just another form of Physician's Assistant with a different method of licensing.
  11. by   mmc51264
    I am certified in my specialty, climbing the clinical ladder and have completed an MSN program (non-cinical) I don't really want to leave the bedside but rather mentor the new nurses that are being pushed through orientation too fast (in my opinion) we have a clinical team lead, but her duties keep her away from the unit doing a lot administrative stuff.
    I find the ADN nurse have lots of clinical experience, BSN students, many times, don't feel prepared to be turned loose.
    The NPs and PAs that I work with on the ortho floor where I am, they are hands-on as much as they can. As the floor nurse is having to wear more hats, so do the NPs. I work in a teaching hospital and they do a lot of resident clean up.
    I think it is best for everyone to have respect for one another's scope and work together. I have an affinity for EPIC and lots of experience with diabetes (I have 2 T1 kids). I can offer those experiences. We have one nurse with a LTC history, she is great with our older, sometimes confused, population.
    We all have something to offer.
  12. by   elkpark
    FWIW, Florence Nightingale did very little hands-on nursing over her lifetime. She was, as you noted, an educator and social reformer. Her great contribution to nursing was the creation of a discipline and practice, not what a great bedside nurse she was. Her first nursing position, on returning from her education in Germany, was as director of nursing at a hospital in London. If you read up on her work at Scutari, you will learn that her role there was primarily hospital administrator, while the nurses she brought with her did the actual nursing care. At night, after the other nurses had gone to bed for the night, she would go about the wards with a lamp and check on the sickest clients herself, which is how she got the nickname and the poem was inspired. But that was after a day of managing the hospital while the other nurses provided the actual nursing care.
    Last edit by AN Admin Team on Jan 22
  13. by   EGspirit
    Well, I don't mean anything by my post. I don't know why I should expect the world to turn in some direction it's never turned in before. People are ambitious. They always will be. Maybe they should be. I just bought the line in nursing school when they said, "Our profession is caring." And not emotional caring, but doing things for people who cannot do them for themselves for whatever reason that might be. There are MDs there are Registered Nurses and there are assistants to both. 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 don't care how the world spins. I don't care if I'm wrong or right. It's just an opinion. Just breath on the wind.
  14. by   kakamegamama
    Quote from llg
    In order to be successful in most of those non-bedside nurse roles, the nurse must have the basic nursing nursing knowledge learned in his/her pre-licensure nursing program AND ALSO additional knowledge learned by completing a higher-level educational program. Preferably, that advanced-practice nurse also builds on his/her previous direct patient care experience, whether that experience was gained at the bedside or in some other health care setting.

    We are still nurses in that we continue to use our basic nursing education in our current practice. We have added to our original education and expanded our focus by expanding the services we offer to patients ... or we take responsibility for providing care for large groups of patients (a whole patient care unit, whole hospital, whole community, etc.) ... or we take responsibility for developing the nursing knowledge base and passing it on to a new generation of nurses. We are still using our nursing expertise to help people manage their health -- we just don't do it in the same way as a bedside nurse taking care of a single patient.

    Nursing hurts itself when individual nurse fails to appreciate that those nurses in jobs other than his/her own are also working hard to help provide nursing care to patients. We need to support each other in our multiple roles, not tear each other down.
    Said much better than I!

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