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

[PG2018]

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 agree. You really need cynicism to fend off all the lies and exaggeration. Plus some people haven't the mettle to look another in the eye and say no, i.e. no I'm not refilling your Xanax.

I was thinking she'd fill a therapist role well.

[PG2018]

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?

I couldn't be a staff nurse on a pych unit. They're too disorganized in my limited experience. On the clinic side, nurses have to run too much interference. I'm more of a do the thing and move on with life. The minutiae of nursing drove me nuts. I have no regard for the quality of one's poop.

[synaptic]

If we want total authorita then we need to make NP school 12 years long with a 8 year residency in your specialty where you work 25 hours per day and only get to sleep while dictating. we would be the ultimate 1337 ubersauce of the universe then and mars would be fully colonized by the year 2025 due to our godliness.

The only thing that makes less sense than my post is the nursing education model. And maybe our government.

[Psychcns]

it is not about sense , it is about politics. we have full authority over our scope of practice. MD's had control over everything for a long time.. there was a time psychologists couldn't do therapy, only MD's..there was a time only MD's could use a blood pressure cuff.. Everyone none MD has fought forever for authority to practice in their area to the extent of their education and training.. Nursing has done a good job for us..

[synaptic]

either that or they where like "hmm if i delegate this to others i can make more dollars by seeing more patients"

[BostonFNP, APRN]

I absolutely agree: this has very little to do with the patients getting quality accessible care and everything to do with money. If it were about NP/PAs providing quality care then physicians wouldn't hire them. Physicians are more than happy to have an army of NP/PAs working autonomously FOR them because they generate revenue. They are not keen on PA/NPs working autonomously for themselves.

[matthewandrew, NP]

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.

Well said, I completely agree. :)

[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.

I'll bet you don't have a max of 12 patients a day either which is what I'm busting $200k on

[zenman]

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.

As a former Level 1 trauma, nurse, helicopter flight nurse, ICU, etc., etc., I can say that psych beats them all. Opening the airway and stopping up leaking holes is nothing compared to the human psyche. Everyday is so interesting I can hardly stand it. Oh, did I mention the boring 6 months I spent in the OR with Denton Cooley?

[PG2018]

I absolutely agree: this has very little to do with the patients getting quality accessible care and everything to do with money. If it were about NP/PAs providing quality care then physicians wouldn't hire them. Physicians are more than happy to have an army of NP/PAs working autonomously FOR them because they generate revenue. They are not keen on PA/NPs working autonomously for themselves.

This. They're merely protecting by trying to place doubt in the minds of the politicians who regulate us.

[anh06005, MSN, APRN, NP]

As a former Level 1 trauma, nurse, helicopter flight nurse, ICU, etc., etc., I can say that psych beats them all. Opening the airway and stopping up leaking holes is nothing compared to the human psyche. Everyday is so interesting I can hardly stand it. Oh, did I mention the boring 6 months I spent in the OR with Denton Cooley?

Yes! I need logic. I love logic and puzzles that I CAN piece together. Psych patients often aren't logical.

[Jules A, MSN]

I'll bet you don't have a max of 12 patients a day either which is what I'm busting $200k on

Close, I average 12-15 per day but for me to break $200,000 a year it also includes some call, holidays and weekends.

If your yearly income actually is over $200,000 as a NP working for the military my hat is off to you!