Beyond Bedside? Advanced Practice? Really?

[EGspirit]

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.

[BostonFNP, APRN]

My definition of "bedside" nursing is "direct patient care." Care...CARE. Nurses are in the profession of providing CARE. So, a school nurse is at the bedside when she is seeing students, a home health nurse is at the bedside when she is in someone's home--providing CARE.

By this definition, the vast majority of APRNs are doing "bedside nursing". Statistically more APRNs meet this definition than RNs.

Caring is the domain of nursing. Diagnosis and treatment is the domain of the MD.

So physicians don't "care" for/about patients?

Legally, diagnosis and treatment is not the "domain of the MD": that statement is just factually wrong.

So, only a special person is going to be able to see that because of the lower status, the nursing domain is greater.

I don't see that the "nursing status" is lower. You do?

And the whole profession is systemically bent that way, and so the advanced nurse is the more "doctorly" nurse. You even see this bias in the higher levels of nursing education and other areas of APRN.

How much experience do you have with the higher levels of nursing education and APRN practice?

A nursing school professor may have a Ph.D., but she's not an NP now is she?

A nursing school professor might be a PhD or a DNP. He/she might also be an APRN or not an APRN. PhD, DNP, MSNm BSN, ADN are academic degrees. NP or CRNA or RN or LPN are licenses.

[Rocknurse, MSN, APRN, NP]

Low level medicine? Are you kidding me? NPs use exactly the same clinical decision rules, treatment frameworks and prescribe the same medications as physicians. There's nothing low level about it. I've been a nurse for 28 years...I've paid my dues. Are you saying I shouldn't advance in my career just to satisfy some skewed idea of sainthood? I'm a critical care nurse but I'm also a nurse informatacist. Who do you think designs and builds your EMR? If it wasn't for people like me you'd all still be documenting on paper! I decided to become an NP because I have decades of knowledge and experience and it made absolute sense to keep climbing the ladder. Nursing is not the same job it was 28 years ago, and the physical and mental demands can break you. Until management get a clue and realize that nursing is an absolute miserable existence primarily because of their decision making, nurses will continue to leave the bedside for better opportunities, me included.

Let me clarify: NPs are NOT physicians's assistants. They are independent providers who work under their own license and work alongside physicians. They do NOT work under a physician's license nor are they the physician's handmaiden, anymore than a nurse is.

Saying "it's all about the patient" is a misnomer. If all you're doing is making sure they're comfortable and have fresh orange juice, you're doing them a disservice when you don't notice that they have a big anion gap and are getting acidotic. We're not servants. As I advance up the clinical ladder, I realize how much I didn't know before, and my education has given me such a better understanding of what's going on with the patient. I'm glad they're comfortable and have clean sheets, but I'd rather be knowledgeable enough to notice that their medication is increasing their QT interval.....that's more important than holding their hand.

I don't do my job for free nor do I have a halo. I strongly believe religion should be kept out of the professional arena. It is completely inappropriate to spout god stuff in this conversation. My job is based in science and science alone. This is a job. I get paid to do it and I do it well. I'm certainly not a martyr. This idea that nurses are saints who wipe the beads of sweat from a doctor's brow has to die....it's completely out of step with modern medicine. The BSN and NP nurses I know are smart, intelligent, precise and motivated individuals who deserve nothing but respect. Your original post smacks of jealousy and resentment. Quite honestly, your posts are excruciatingly inaccurate and embarrassing. You obviously do not understand the role of the NP at all.

[Oldmahubbard]

The OP apparently disagrees with the NP role. He or she thinks medicine should be left up to doctors. There are plenty of studies to refute this, but so what?

Something about the words "advanced practice" is also irksome to the OP. Strange how different semantics affect perception. For example, people are more receptive if you call something a "fee", versus calling it a "penalty"

At any rate, off I go to my PMHNP job where I have no help whatsoever from physicians, although I do collaborate with primary care providers, and I am expected to do everything a psychiatrist does.

[Oldmahubbard]

I am not sure where the OP works where NP's only have the easy cases. That model disappeared about 30 years ago.

[Rocknurse, MSN, APRN, NP]

I am not sure where the OP works where NP's only have the easy cases. That model disappeared about 30 years ago.

Exactly. The NPs I know completely run the ICU. The attendings are only there part of the time. It's NPs that are putting in central lines, and making clinical decisions. The post is complete nonsense

[BCgradnurse, MSN, RN, NP]

I am not sure where the OP works where NP's only have the easy cases. That model disappeared about 30 years ago.

Agreed. I'm sitting in this office as the sole provider, dealing with whatever and whoever is on my schedule. No one asks the patients "are you an easy case?" before putting them on my schedule versus a MD's schedule.. I deal with the most routine to the most complex in my specialty. The OPs ignorance about what NPs actually do is astounding.

[BCgradnurse, MSN, RN, NP]

The OP apparently disagrees with the NP role. He or she thinks medicine should be left up to doctors. There are plenty of studies to refute this, but so what?

Something about the words "advanced practice" is also irksome to the OP. Strange how different semantics affect perception. For example, people are more receptive if you call something a "fee", versus calling it a "penalty"

At any rate, off I go to my PMHNP job where I have no help whatsoever from physicians, although I do collaborate with primary care providers, and I am expected to do everything a psychiatrist does.

How many people would not have mental and physical health care if NPs (and PAs) were only allowed to be "assistants"?

[WestCoastSunRN, MSN, CNS]

The CNA who takes pride in their job and does the best they can each shift is still greater.

Because God is in the quanta of care. God is found in each and every moment when one human being feels compassion and does just a little more than they have to for the benefit of another one of God's creatures. This is most acutely present in ADL care--which is the domain of the CNA.

Again, this is just my opinion, and I appreciate the platform in this string to express it. Thank you for reading it.

Firstly, let me say that I also consider assisting a patient with ADLs holy work. It is so humbling for both the giver and receiver of such care. Some of my favorite times with patients is when I am giving that kind of care.

However, it is critical that I do not neglect the clinically weightier matters of their care. I am the ever-present eyes, ears and brain at my patient's bedside and inside their chart. I am constantly taking in and interpreting data during the shift, sometimes under the pressure of very high acuity. I have to know what needs to be done and by whom. I must possess both brains and brawn to do my job well. I must be able to marry compassion with the resolve to stay focused and effective on the clinical picture before me.... which sadly too often does not leave room or time for me to hold the hand of my very ill patient.

And you know what? God is in THAT too! He is not just the God of hand-holding care, but also of science, of clinical proficiency. I believe He is most glorified when we exercise ALL the gifts He's given us, wasting none! He is in the CNA work, yes, but my goodness, let's not limit Him!

This is the reality of bedside nursing as I've always known it to be. If I am "less than" because I am not a CNA, but rather a clinician capable of making life-saving decisions and performing life-saving interventions, than so be it.

I think you have it wrong. Not just about APRNs, but even about bedside RNs.

And I'll say, while I can understand some of your perspective on things, I am glad you don't make the rules for nursing. A lot of patients would suffer dearly if things were as you believed they should be.

[EGspirit]

Advanced practice is entirely different from the RN role; you can be an expert RN without being an APRN.

Indeed. So long as we don't confuse the two, that's all I ask.

I don't want to be a doctor. I don't want to pretend to be a doctor. If NPs are just as good as doctors--let the world use NPs. Then NPs will be the new doctors. Fine. Apparently, for a long time, it was assumed MDs needed 4 years of school after a pre-med bachelors, then a long residency to be competent. If the world says, "Sorry, can't afford all that. NPs are now all you get." Fine, whatever.

But you said it yourself, the RN and NP roles are not the same. You're in medicine. I'm in nursing. That's it.

When all the MDs retire and leave it to the NPs, the RN will still be the second half of health care. That's the half I'm in. So, I don't think your advanced to me. I think you are less to an MD.

Now...humph...you still like to come back to nursing for the halo society gives it, but you can't have both. An NP never works as a nurse. Unless they just don't do NP and take a staff nurse job.

Anyway. That's all I care about is that you recognize our roles are different. Don't mistake it as any other way...

Oh, and don't mistake my servility, extra-politeness, and willingness to help you any way I can when you come to the floor as me thinking I'm basking in the light of a superior nurse. Believe me that shtick--that's all for the patient. That's just me being my patient's advocate--trying to manipulate out of you what I can get for them.

[Rocknurse, MSN, APRN, NP]

Indeed. So longs as we don't confuse the two, that's all I ask.

I'm not sure what there is to confuse. One has an associates' or a bachelor's degree and the other a master's and an advanced license. They are two completely different roles.

[Toadette, MSN, RN]

Indeed. So long as we don't confuse the two, that's all I ask.

I don't want to be a doctor. I don't want to pretend to be a doctor. If NPs are just as good as doctors--let the world use NPs. Then NPs will be the new doctors. Fine. Apparently, for a long time, it was assumed MDs needed 4 years of school after a pre-med bachelors, then a long residency to be competent. If the world says, "Sorry, can't afford all that. NPs are now all you get." Fine, whatever.

But you said it yourself, the RN and NP roles are not the same. You're in medicine. I'm in nursing. That's it.

When all the MDs retire and leave it to the NPs, the RN will still be the second half of health care. That's the half I'm in. So, I don't think your advanced to me. I think you are less to an MD.

Now...humph...you still like to come back to nursing for the halo society gives it, but you can't have both. An NP never works as a nurse. Unless they just don't do NP and take a staff nurse job.

Anyway. That's all I care about is that you recognize our roles are different. Don't mistake it as any other way...

Oh, and don't mistake my servility, extra-politeness, and willingness to help you any way I can when you come to the floor as me thinking I'm basking in the light of a superior nurse. Believe me that shtick--that's all for the patient. That's just me being my patient's advocate--trying to manipulate out of you what I can get for them.

I see where you're coming from in terms of semantics. Expert nurses should be respected for their experience and knowledge and our healthcare system often disregards these nurses. Other than Senior Nurse, there really isn't a title designation to honor nursing years of service.

However, I don't know any nurse or other healthcare professional who "basks" in the presence of other more "advanced" healthcare professionals.

Your perspective of "manipulating" providers to get what you need for your patients is interesting. Healthcare is a team sport and the patient's care is the goal. We're all needed equally. I work WITH providers to care for our patients. We have a respectful and collaborative team and common goal. From the CNA to the social worker to the chaplain and to the Medical Director (and, yes, the RN, LPN, and APNPs too) we're all in it together.

I don't understand your designation of importance here. We all need to do different jobs to care for the whole patient. If everyone placed the highest value on personal care, there wouldn't be anyone advocating for more health clinics in the community, preventative care, or making health policies that impact our children and seniors.

[EGspirit]

I see where you're coming from in terms of semantics. Expert nurses should be respected for their experience and knowledge and our healthcare system often disregards these nurses. Other than Senior Nurse, there really isn't a title designation to honor nursing years of service.

Well, in my opinion, the RN has to take the bull by the horns on that. They can be certified in their area of practice, they can even become a CNS, if they have the money and time for a masters degree. They can do continuing education and that sort of thing.

They may even want to think about teaching when the demands of the job become too much--as they eventually do. That's up to them.

Your perspective of "manipulating" providers to get what you need for your patients is interesting. Healthcare is a team sport and the patient's care is the goal. We're all needed equally. I work WITH providers to care for our patients. We have a respectful and collaborative team and common goal. From the CNA to the social worker to the chaplain and to the Medical Director (and, yes, the RN, LPN, and APNPs too) we're all in it together.

I understand that. I was perhaps being a bit facetious.

I don't understand your designation of importance here. We all need to do different jobs to care for the whole patient. If everyone placed the highest value on personal care, there wouldn't be anyone advocating for more health clinics in the community, preventative care, or making health policies that impact our children and seniors.

Everyone has a role. God gives different purposes in life. But in NURSING, I believe the "advanced" nurse is the one who can provide the best bedside care for the most patients. They should get the most glory.

The world doesn't see it my way. I can live with that. But this is a discussion board, isn't it? So, here I can "discuss" what I think.