Beyond Bedside? Advanced Practice? Really?

Nurses General Nursing

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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. :wideyed:

Yeah Society can take that "halo" and park it up it's butt. I don't want to be looked at as an angel but as a compassionate, highly trained & educated medical professional regardless of title. I agree with the poster above who basically stated that this whole "halo" nonsense and lead to unrealistic expectations from employers, patients and most of all from ourselves. This "halo" stuff also leads to a devaluing of our services. After all angels work for free. I don't have the delusion or ego frankly to place myself in the rarified air of angel-dom. I'm very human and rejoice in that fact. I don't work for free or anything close to it. I expect to be well compensated for excellent professional medical care delivered. Sound like an angel? Nope, just a very human part of a medical team who expects something back for his efforts besides putting a smile on the big guy's face in the sky.

Specializes in Tele, ICU, Staff Development.

Nurses who practice hands-on nursing should be given more respect. Let's call them clinical practice nurses rather than bedside nurses (credit: AMSN)

Specializes in allergy and asthma, urgent care.
Yeah Society can take that "halo" and park it up it's butt. I don't want to be looked at as an angel but as a compassionate, highly trained & educated medical professional regardless of title. I agree with the poster above who basically stated that this whole "halo" nonsense and lead to unrealistic expectations from employers, patients and most of all from ourselves. This "halo" stuff also leads to a devaluing of our services. After all angels work for free. I don't have the delusion or ego frankly to place myself in the rarified air of angel-dom. I'm very human and rejoice in that fact. I don't work for free or anything close to it. I expect to be well compensated for excellent professional medical care delivered. Sound like an angel? Nope, just a very human part of a medical team who expects something back for his efforts besides putting a smile on the big guy's face in the sky.

THIS^^^^

I also love what I do, but it's not a religious calling and I am certainly not superior to someone who has chosen another field. And, yes, I do it for the money. Bills have to be paid, children and animals need to be fed. I get to utilize my love of science and helping others, and be well compensated for it.

I'd like to know what the OP defines as bedside. Does that include school nurses, employee health nurses, infusion nurses, etc? I think they're pretty important. Apparently APNs, and I assume CRNAs are not providing direct patient care. What about midwives? What do you think we do all day???

Nurses who practice hands-on nursing should be given more respect. Let's call them clinical practice nurses rather than bedside nurses (credit: AMSN)

I don't care what you call me. Just pay me.

Specializes in Medicine, Geriatrics, Ambulatory Care.
Because bedside nursing sucks and not everyone wants to be miserable in the name of "compassion."

Amen.

When I was a young nursing student, I couldn't fathom the idea of "nursing burnout" and ever leaving the bedside. I just couldn't. Six years of bedside later, I understand too well now when experienced nurses in clinicals would used to asked me "Why did you ever choose nursing?" Simply put, there's a better way to earn a decent living that doesn't cost your sanity and humanity and if I stay, i know I will lose both.

Low-skilled medicine? Please, enlighten us, what is the different legal standard that NPs have for the practice compared to physicians? What are the different quality of care measures? What is it exactly about NP practice that is "low-skilled"?

My guess is that the OP may be referring to the vast difference between physicians medical education and training versus that of a NP. Physicians are trained in the Medical Model and are uniquely qualified to practice medicine, hence the credential "Doctor of Medicine." NP's do not have the level of education and training a physician does (and anyone who disbelieves this can research for themselves the significant differences in Medical School versus NP School admission requirements, course content, years of education/training, clinical practice hours, etc.). This is simply a fact. So a NP, by virtue of their education and training compared to a physician, does not practice at the level of medical expertise a physician does.

Specializes in Adult Internal Medicine.
My guess is that the OP may be referring to the vast difference between physicians medical education and training versus that of a NP. Physicians are trained in the Medical Model and are uniquely qualified to practice medicine, hence the credential "Doctor of Medicine." NP's do not have the level of education and training a physician does (and anyone who disbelieves this can research for themselves the significant differences in Medical School versus NP School admission requirements, course content, years of education/training, clinical practice hours, etc.). This is simply a fact. So a NP, by virtue of their education and training compared to a physician, does not practice at the level of medical expertise a physician does.

Susie, why don't you share with everyone the outcomes studies that have examined quality of care of physicians vs NPs? Or explain to us the different legal standards of care between physicians and NPs? Or tell us about how quality measures used by MCOs are different for NP directed care vs physician directed care?

Specializes in PDN; Burn; Phone triage.

There are a lot more non-bedside positions than management and advanced practice and teaching? Who is supposed to coordinate case management for medically complex patients or run infusion clinics or manage a hapless surgeon's schedule/clinic?

I DO think there is a problem with nurses getting their year or two of direct patient care and than leaving -- generally because non-bedside care is seen as less stressful and the hours are generally better. I'm not sure if it's because people think that non-management/NP/CRNA roles are more superior to bedside nursing. In fact, you often hear of people transitioning to clinic or case management and complaining that they feel like "less" of a nurse and they sometimes have problems trying to find bedside roles down the road because their experience is often seen as less than that of a nurse with recent bedside experience.

I think mandated ratios and appropriate nurse-assistant staffing would help stem some of the exodus. Rebranding bedside nurses as saintly mini-Jesus', probably not. Although nursing has historically always had a pretty high turnover rate even when it was basically the only career pathway for women interested in medicine.

So why nursing? Why not business or finance or law? But whatever. I've worked around nurses who won't even give PRN pain meds when they're due, because it means they will have to chart it. I've watched many nurses ignore patients stewing in their own sh.. and pi.. , and nothing I say is going to change the world. And I'm sure not going to do it with this post. But for the love of God, why not go into insurance or teaching high school?

Are you being serious right now lol? Is that seriously what you're going with? So if a nurse is being over-worked and not respected at the bedside, instead of choosing to further their education or work in a different area (that needs help), that nurse should completely leave the profession because YOU dislike that they're leaving the bedside to fill roles that are needed in different areas?

"To speak without thinking is to shoot without aiming."

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. :wideyed:

Because your body is shot after a few years of lifting patients, walking miles down long hallways, etc., etc.

1 Votes
Specializes in Adult Primary Care.

It just sounds like the OP is mistakenly threatened by others who have chosen to get more education!

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

Because your body is shot after a few years of lifting patients, walking miles down long hallways, etc., etc.

Exactly! I left the bedside because I couldn't walk due to a blown back. But, I wanted to continue to take care of people, in the nursing profession. So, NP was the right direction.

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