Advanced Practice: Still nursing and holistic or medical model with nursing approach?

[WKShadowNP]

I read an article today for an assignment I have that stimulated my thinking regarding our role (my future role). It describes Watson's holistic model and goes on to say that the five domains of primary practice are connection, consistency, commitment community, and change. I find this interesting because I like being part of a team and don't want to have a divisive perspective that one is better than the other. Unless I go to medical school, I will not have their knowledge and experience. But I will be prepared, and am being groomed to fulfill a role—call it physician or nurse extender. I am to practice in an advanced capacity and sure I will rely on more knowledgeable persons (physician and NP or PA alike) to attain competency and excellence. I want to add that I don't know why it has to be one or the other. I've seen very caring and holistic physicians. They may identify the problems from a medical standpoint, but they still assess the person-in-environment.

So, I was interested in your opinions regarding the nursing model versus the medical model or anything in between and if this article aligns with your opinion.

Jules A, I'm particularly keen to see your response because I admire your wisdom here.

Medscape: Medscape Access

[Jules A, MSN]

An interesting theme that I see over and over in these posts is the feeling that NP education lacks. I believe it is up to the individual to fill in the gaps. I spent 100s and 100s of hours outside class studying and finding resources. It's the experience when we finally start learning. Education is where you learn to look for answers. One can learn from the good, bad and the ugly. I think as RNs and now NPs we need to stop comparing and focusing on our weaknesses and focus on our strengths and realize how we provide excellent care for our patients.

You make excellent points however why can't we expect to have both? A rigorous, relevant education with extensive clinical hours as well as continued, independent learning. My repeated theme remains that our education is lacking as compared to med school although not everyone agrees. I love the different perspectives even if I disagree.

[elkpark]

You make excellent points however why can't we expect to have both? A rigorous, relevant education with extensive clinical hours as well as continued, independent learning. My repeated theme remains that our education is lacking as compared to med school although not everyone agrees. I love the different perspectives even if I disagree.

Our education is supposed to "be lacking as compared to med school." Advanced practice nursing is not supposed to be a quicker, cheaper means of becoming a physician (or the equivalent). People who want a med school level education go to med school. The current model of nurse practitioner education has been turning out competent practitioners for decades now (although I share your concern about the flood of new, questionable NP programs).

[PG2018]

Well, I'm going to chime in having only seen the quotes that others have posted. I don't want to subject myself to the dogma. Such theorists and papers are merely an academic attempt to professionalize nursing and make it a legitimate partner in the psychosocial realms of psychology, sociology, etc. I think all of the nursing heads will know the body will never be held as an equal to the body of medicine. Should that day come, it will be in generations ahead.

Presently, nursing tries too hard to make itself appear educated and refined. To separate from the task masters, juice fetchers, physician lap dogs, and patient whipping boys we've developed "theories" and we conduct "research" and we "write papers." You know, if we were sociologists that would make sense. They do a lot of qualitative studies, write papers, and sit around and talk. Nurses, as a whole, are not afforded the opportunity to sit around and do anything, but we use academic methods to professionalize ourselves.

Here's the caveat! We work with medicine. We are medical professionals. Regardless of the NANDA, NOC, NIC garbage being pushed down the throat of nursing students and those so unfortunate to have to develop "care plans" we exist to carry out medical orders, monitor patients to see that they're getting better (or worse), and we assess. All of these activities are ordered by scientist physicians. They are scientifically educated, and instead of trying to level up the field and better understand the science behind these activities we concern ourselves with NANDA trash and psychosocial activities. I get it. Someone has to be present for the patient, but as we see nurses don't really fulfill the bedside hand holder role anymore so in my mind you may as well toss it in attempt to save the sinking ship. Quite frankly, I was led to believe, partially from these boards even, that nursing had developed into a biologically-oriented discipline, and I entered the field in search of that. I knew I'd have to wipe some butt here and there, but I knew general nursing wasn't in my life trajectory. However, I found that I was presented with little -ology and instead a lot of butts.

It doesn't really matter if the current education model is working. The "if it ain't broke, don't fix it" mentality is foolhearty. There is a lot to be learned, and I think those constantly beseeching for more education are definitely not the people who are looking for an education to be handed to them. Rather, these are the high achievers wanting to learn their trade craft. It is exactly the type of person who reads, subscribes to journals, attends conferences, and networks to learn even more. However, with a weak foundation it's rather hard to construct a lofty high rise. For those who tout that "nursing experience" should be the substitute for education I propose you go to work laying asphalt for a highway for ten years then decide you've got the experience to be the civil engineer that designed the road bed, slope, grade, overpass, expansion gaps, etc. necessary to build a major infrastructure. Sure, you could probably do some of it then attend some conferences and get even better at what you do, but I suspect your highway would degrade faster, become less safe, be replete with pot holes, however, the road would indeed lead to somewhere so by all means keep doing what you're doing and hope no one dies.

[synaptic]

If one of the anti midlevel mds saw this thread and posted it in sdn it would be equivalent to the second coming of Jesus in the Amas eyes.

Great thread tho

[PG2018]

If one of the anti midlevel mds saw this thread and posted it in sdn it would be equivalent to the second coming of Jesus in the Amas eyes.

Great thread tho

I love SDN!

[Dranger]

I love SDN!

I have been on SDN for years and while there is a lot of good info/posters to be found the forums reek of haughtiness and arrogance in many areas. Most of their understanding of what NPs or even RNs do is very very juvenile or snide in nature.

I agree with the other poster who said that nursing theory is bombastic, insecure and hollow. It almost seems like an attempt to validate profession as if a younger child is trying to prove something to their older sibling. I also find it insulting that nursing often assumes that it is only nurses that have the monopoly on caring and not MDs, techs, or any other health car employee. It is almost a essential right of passage that has become dogmatic and trite in every curriculum.

[Jules A, MSN]

Our education is supposed to "be lacking as compared to med school." Advanced practice nursing is not supposed to be a quicker, cheaper means of becoming a physician (or the equivalent). People who want a med school level education go to med school. The current model of nurse practitioner education has been turning out competent practitioners for decades now (although I share your concern about the flood of new, questionable NP programs).

I disagree that NP school should be lacking in content as compared to med school. I would concede the content has to be more far more focused but the depth of our education especially with regard to pathophysiology, diagnosing and prescribing absolutely should be comparable to physician's, imo. We are doing the exact same job, why shouldn't our knowledge in our specialty be comparable?

[Barnstormin' PMHNP]

I also lurk on SDN and I find that the posters that detest nurses and APRN's are usually the med students, or PGY's. The attending's with quite a few years under their belts are less threatened by APRN's, they have a better understanding of the RN role and NP role.

The third year med students on my unit exude this kind of attitude. Although, they are quite rude to the MD as well, they will barge into his office while he is dictating, or on a phone consult and sit there and wait for him to finish so they can ask questions.

I do agree with Jules in that I think that more medical and less nursing theory would be a good thing.

[anh06005, MSN, APRN, NP]

I just had to chime in:

AMEN!!!

[WKShadowNP, DNP, APRN]

I would like to extend gratitude for the discussion. It's given me plenty to consider and in many respects, summed some of my thoughts. Whereas yesterday I felt discouraged, today I feel more enabled and empowered.

Please, continue.

[SummitRN, BSN, RN]

This thread is hitting bulls-eye after bulls-eye

[Dogen]

Totally agree but have to say I know more than a few NPs who do things that clearly should be delegated to ancillary staff and I have actually been told "well if I don't do it who will?" Ummm "the secretary or perhaps the CNA?" My interpretation is that this was said as if its a martyr badge of honor that nursing seems to embrace. My strategy remains that I don't do anything a physician won't do.

Ugh, I still struggle with this. I get my own paper charts and put them away, while everyone else gives them to the MA. I feel like a dick asking someone to do grunt work. I'm working on it... By the time I'm being paid for productivity I'll have learned that it's okay to focus on tasks that increase my productivity.