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.
Yes when I hit 20-25 a day I usually do more delegation lol. There are occasional days, though, where I may see 10. That leaves me with a bit of time. I need to remember to take my journals with me to the office! I do usually read my prescribers letter if there's a new one. But looking at a screen gets annoying after a while.

Just wanted to chime in again and say nothing is wrong with delegation and I see where y'all are coming from. Won't be long before someone misconstrues what I meant....

I just still like the easy stuff sometimes if appointments allow.

You are so positive and happy. You should come over to psychiatry.

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Specializes in Outpatient Psychiatry.
I do remember having to resist the urge to "help out" when I first graduated however I believe doing tasks a physician would never touch separates us from physicians and it is a slippery slope. It is confusing to the team and more importantly confusing to the patients. If it isn't a provider job I don't do it. Never. The phone could be ringing off the hook and I will never answer it unless it is ringing at my desk. I demand high end wages and function exactly the same as the psychiatrists.

Early in my NP career when the hospitals had just started using psychNPs there was the misguided suggestion that NPs should do psych patient placement in the EDs on weekends if a socialworker wasn't available. My medical director who pushed back on this ridiculous suggestion told me "Its medication management only, baby. If you start making insurance calls next thing you know they will expect you to take your own vitals. I'm not paying you $80 an hour to do that".

What are "vitals?"

Just kidding

Maybe.

Nah really, jk.

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You do realize that also until very recently most PAs entered their schooling with any number of years of healthcare experience. Many were paramedics or military medics. Others were RTs, RNs, and any other allied field. Kids don't really finish undergrad and jump straight into PA school the prerequisites for which surpass that of RN training. My wife's kid sister is trying to get into PA school. It's really hard.

I wasn't implying any criticism or denigration of PAs, and I'm generally familiar with the history of the PA role. I was referring to the other people one frequently encounters (often on this site) who try to make the argument that NPs are superior to PAs because all NPs have years and years of nursing experience before they go to grad school.

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Specializes in Outpatient Psychiatry.
I wasn't implying any criticism or denigration of PAs, and I'm generally familiar with the history of the PA role. I was referring to the other people one frequently encounters (often on this site) who try to make the argument that NPs are superior to PAs because all NPs have years and years of nursing experience before they go to grad school.

Oh, I see.

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Specializes in Cardiac, Home Health, Primary Care.
You are so positive and happy. You should come over to psychiatry.

NOOOOOOOOOOOOOOOOOOOOO.

I get just enough in primary care to have my fill.

You can keep your psych...... :no:

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Specializes in Family Nurse Practitioner.
NOOOOOOOOOOOOOOOOOOOOO.

I get just enough in primary care to have my fill.

You can keep your psych...... :no:

Plus PsychGuy we don't need any more positive happy people over here! The snarky, skeptical ones make the best clinicians in my experience. Wait a minute I resemble that remark. ;)

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If you haven't been to med school how do you know it can be condensed into two years?

i smell availability bias here. Esp when using one person you know as the standard for all nps.

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Specializes in Adult Internal Medicine.
If you haven't been to med school how do you know it can be condensed into two years?

i smell availability bias here. Esp when using one person you know as the standard for all nps.

The do have several three-year medical schools now.

They also have "associate/assistant physician" roles being legislated which do not require residency.

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I went to a well respected brick and mortar university and my education overall was rather poor, imo. It was heavy in therapy, which PsychNPs don't do, and light on pharmacology and diagnosing. I was fortunate to have had a strong background in my specialty and excellent psychiatrist contacts to help me navigate my way.

I think you mean that you don't do therapy but I use E&M plus psychotherapy codes for billing which may explain why I bring in double my revenue goals. But then, I am ZENMAN!

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Specializes in Family Nurse Practitioner.
I think you mean that you don't do therapy but I use E&M plus psychotherapy codes for billing which may explain why I bring in double my revenue goals. But then, I am ZENMAN!

It doesn't pay because we have therapists who make around $60,000 a year to do therapy. I'm on target to break $200,000 this year so I'm thinking my personal revenue goals are intact. ;)

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Specializes in Cardiac, Home Health, Primary Care.
Plus PsychGuy we don't need any more positive happy people over here! The snarky, skeptical ones make the best clinicians in my experience. Wait a minute I resemble that remark. ;)

I'm glad there are those of you who enjoy psych. I can't. One of my good friends worked on a geri psych unit and I'd hear her stories and say how I couldn't do it.

She'd hear my stories of cardiac patients and say how she couldn't do it.

I'm thankful for you guys. Really am.

Should I be more positive?

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Specializes in Family Nurse Practitioner.
I'm glad there are those of you who enjoy psych. I can't. One of my good friends worked on a geri psych unit and I'd hear her stories and say how I couldn't do it.

She'd hear my stories of cardiac patients and say how she couldn't do it.

I'm thankful for you guys. Really am.

Should I be more positive?

My hat is off to you because the heart is way tricky! I would guess psych is much easier as long as you have a good sense of humor and some street smarts.

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