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

Specialties NP

Published

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

Specializes in Outpatient Psychiatry.
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.

I agree with everything you've said. I remember being in undergrad nursing tell an instructor that their theories seemed like an attempt to legitimize the profession. I vividly recall saying "It's like nursing is stamping its feet screaming I'm a professional too." Of course, this same one tried quite hard to kick me out of school later.

The remark about SDN is spot on. I always find it quite interesting when a third year clerk makes such inflaming remarks. Of course, it's the internet generation, and they're prone to e-bullying.

Specializes in Outpatient Psychiatry.
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?

In my state, auxiliary police officers have a shortened length of training. Their role is to fill gaps for chores that it often doesn't take a regular police officer to do. It somewhat relates to midlevel roles. They can do anything on duty like a regular officer, but their purpose isn't to do everything. Off-duty, they can't do anything beyond what a private citizen can do. Their training is about 1/4 of what regular officers get EXCEPT someone realized somewhere that 1/4th of the firearms training would be a bit stupid. Relating that to NPs, there's a lot we can live without. There's a lot more we need, but somewhere there are some core things that shouldn't be diluted or overlooked. I'm a bit tired of my colleagues being content with 1/4th of the training.

Specializes in Outpatient Psychiatry.
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.

Productivity is the ultimate stimulus.

Specializes in Urology.

I really can't stand when NP's tout that physicians have a superior knowledge because of "Med School". Med school doesnt make the physician smart or competent to practice. They have yet to specialize and don't know more than a nurse with 4 years of experience (which is why they ask you what you would do). The only difference is they are thrust into the supervisory role and have to shoulder responsibility (which you also do as an NP). NP's need to develop more pride and be mindful of their experience and education. My advanced pharm teacher was an NP and blew MD's out of the water with her knowledge. She was wicked smart and very, very, good at her practice both as an NP and an educator. Most NP's have at least 6+ year of experience as a nurse prior to going to school. I think thats a fair amount of time in healthcare (its the same as some of the long residency programs) to have a solid foundation before going to learn advanced practice. Stop putting yourselves lower than a doctor because its what they want! The doc associations want control because they fear (and know) what is coming down the pipeline. They also have the money to lobby which nursing lacks (but is gaining ground on).

NP's can perform equal and in most cases better care than a doc for less. Of course if you were a doc would you want to take a paycut? I dont even think med school needs to be 4 years, it could easily be condesnsed into 2 years and residency programs could also be shaved down a bit. The whole thing is a big song and dance so they can say "we'll we put this much time in and are xxx better trained so therefor we are in charge". This just isnt the case anymore. Healthcare is too specialized and we cant expect to know everything about everything!! Long gone are the days where I give up my chair so a Doctor could sit in my seat. He can pull one right up next to me and roll his sleeves up just as he would expect from me. Grow a set NP's, become the future of medicine! You do practice that after all and not nursing theory!!

Docs have the edge on surgery, something that they are trained to do. I think NP/PA's are starting to crack this nut as well and are being allowed to perform minimally evasive procedures in some practices (cysto and derm for example). My vision of the future is NP's managing primary care with docs being specialist/surgeons.

Most NP's have at least 6+ year of experience as a nurse prior to going to school.

Do you have a source for this? With the huge popularity of the direct entry programs and the huge numbers of people going into nursing purely to become advanced practice nurses, I doubt v. much that this is the case these days.

Thank you for your post. I agree with you wholeheartedly. As NPs we need to focus on our strengths. Education is only part of it.

Specializes in Urology.
Do you have a source for this? With the huge popularity of the direct entry programs and the huge numbers of people going into nursing purely to become advanced practice nurses, I doubt v. much that this is the case these days.

The basis of my assessment on this is empirical. Of the 10+ nurse practitioners that I know the lowest is 6 years as an RN. So I cannot speak for the career as a whole. The AANP fact sheet does provide some interesting data though stating that NP's on average have been in practice for 10 years and the average age is 49 years as of 2014. This would imply that even an NP who has practiced for 10 years would be the age of 39 before starting practice. I think this echoes that most NP's probably had several years of nursing prior to entering advanced practice (I know my personal experience reflects that).

I will say that NP seems to be the new CRNA of a few years ago. Its quickly becoming the village bicycle, everyone wants a ride.

AANP - NP Fact Sheet

Nurse Practitioner vs. Physician Assistant

The basis of my assessment on this is empirical. Of the 10+ nurse practitioners that I know the lowest is 6 years as an RN. So I cannot speak for the career as a whole. The AANP fact sheet does provide some interesting data though stating that NP's on average have been in practice for 10 years and the average age is 49 years as of 2014. This would imply that even an NP who has practiced for 10 years would be the age of 39 before starting practice. I think this echoes that most NP's probably had several years of nursing prior to entering advanced practice (I know my personal experience reflects that).

I will say that NP seems to be the new CRNA of a few years ago. Its quickly becoming the village bicycle, everyone wants a ride.

AANP - NP Fact Sheet

Nurse Practitioner vs. Physician Assistant

We all know that our "own personal experience" means nothing. Look just around this site at how many people are posting about how they are only interested in nursing because they want to become NPs (or CNMS, or CRNAs -- fortunately, us CNSs are largely spared this phenomenon, since the general public doesn't know about us ...), asking about direct entry programs, or asking which graduate schools they can get into straight out of their BSN program. The direct entry programs are flooded with applicants, many of whom will never work a day as a generalist RN (or no more than absolutely necessary to fulfill whatever minimum requirements their school may have). Many, many people are going into nursing older, as a second career -- I don't think one can assume that, because numbers suggest that the average NP started practicing at 39 yo, that that means the "average" NP spent many years practicing as an RN prior to that. It might be true, but I would need to see some real numbers.

Specializes in Urology.
We all know that our "own personal experience" means nothing. Look just around this site at how many people are posting about how they are only interested in nursing because they want to become NPs (or CNMS, or CRNAs -- fortunately, us CNSs are largely spared this phenomenon, since the general public doesn't know about us ...), asking about direct entry programs, or asking which graduate schools they can get into straight out of their BSN program. The direct entry programs are flooded with applicants, many of whom will never work a day as a generalist RN (or no more than absolutely necessary to fulfill whatever minimum requirements their school may have). Many, many people are going into nursing older, as a second career -- I don't think one can assume that, because numbers suggest that the average NP started practicing at 39 yo, that that means the "average" NP spent many years practicing as an RN prior to that. It might be true, but I would need to see some real numbers.

I would wager the amount of people that are seeking rapid programs and are only interested in becoming and NP are a small portion of nursing as a whole and also a small portion of the NP community as well. Using that as ammunition isnt any better than my empirical approach to my views on the profession. I agree there are the ones that just want to get through as quickly as possible and this is what we see here on this site as evidence but Its a far cry away from reality. Just think how many NP's use this site to how many are actually in practice.

Specializes in Adult Internal Medicine.

In 2011, according to the AANP, the average nursing experience was over 10 years. I am not sure where they got their data on that one or if it's public, though I bet it has now changed a bit.

As of 2008 survey by ANCC for FNPs, average RN experience was >20 years.

http://www.nursecredentialing.org/documents/certification/rds/2008surveys/familynprds2008.pdf

As of 2011 survey by ANCC for FNPs, average RN experience was 21 years.

http://www.nursecredentialing.org/Certification/NurseSpecialties/FamilyNP/RELATED-LINKS/FamilyNP-2011RDS.pdf

As of 2014 survery by ANCC for FNPs, average RN experience was 19 years.

http://www.nursecredentialing.org/Certification/NurseSpecialties/FamilyNP/RELATED-LINKS/FamilyNP-2014RDS.pdf

Specializes in Psychiatric Nursing.

Re Nursing theory... I think there may have been a time when it was useful.. I loved the nursing model (assessment-nursing diagnosis- care plan) as an undergrad-- i think it gave me a theorectial framework for what I was doing. As an APRN, the medicai model is easier.. evaluation- diagnosis- treatment.... I think polictically it makes sense to stay with nursing.... I think nursing theories have helped us establish and advocate for our profession... Now aprn crosses over to medicine-- mds and aprns are all taking care of or treating patients... for psych, the decade of the brain in the 90's made us more biological and all those new psych meds came along... I was initially trained in psychodynamic psychotherapy (meds came later for me) and it was a great framework for psych.. The field, now called the industry, is evolving and now aprns and psychiatrists are mostly doing the same job...

In 2011, according to the AANP, the average nursing experience was over 10 years. I am not sure where they got their data on that one or if it's public, though I bet it has now changed a bit.

As of 2011 survey by ANCC for FNPs, average RN experience was 21 years.

http://www.nursecredentialing.org/Certification/NurseSpecialties/FamilyNP/RELATED-LINKS/FamilyNP-2011RDS.pdf

As of 2014 survery by ANCC for FNPs, average RN experience was 19 years.

http://www.nursecredentialing.org/Certification/NurseSpecialties/FamilyNP/RELATED-LINKS/FamilyNP-2014RDS.pdf

Yes, but it doesn't specify whether or not that includes the years as an NP. When I completed the ANCC role delineation survey as a CNS, I listed the total years I have been an RN, which includes the years I was a generalist plus the years I've been a CNS, because I've been an RN all those years. Isn't that how most nurses would answer that question (how long have you been an RN)?

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