Beyond Bedside? Advanced Practice? Really?

Workitinurfava, BSN, RN · Jan 16, 2018

Whatever works for a person, let it. If you want to be at the bedside so bet it (stick with it and do your best), otherwise high tail it away from it and don't do like the Freddy Krueger movie (where the person looks back constantly and trips on a tree branch on the ground). Really book it.

EGspirit · Jan 16, 2018

Because bedside nursing sucks and not everyone wants to be miserable in the name of "compassion."

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?

EGspirit · Jan 16, 2018

Whatever works for a person, let it. If you want to be at the bedside so bet it (stick with it and do your best), otherwise high tail it away from it and don't do like the Freddy Krueger movie (where the person looks back constantly and trips on a tree branch on the ground). Really book it.

I guess that's true. If a person won't give good care, and finds no glory in it, but only finds humiliation and resentment, then I guess it's good that there are other avenues that will take them from the bedside. The bedside is where nursing is distilled to its finest, only the finest should be there.

brandy1017, ASN, RN · Jan 16, 2018

I used to have high ideals, not an par with an angel, just helping others, but the working conditions have gotten so bad over the years I now only look forward to retirement. I work my 3 shifts, do the best I can and I don't do extra. They call almost daily so if it were just about money I could makes lots of OT. The extra money isn't worth the stress and I refuse to be guilted into working extra when management refuses to hire enough nurses. That's on them!

I do believe you are wrong that bedside nursing is all that counts. In fact the future is away from the hospital setting as more care is outpatient. The irony is my hospital has half as many beds as it used to and yet one thing never changes there is a perpetual nursing shortage given managements refusal to hire enough nurses and the majority of nurses which leave once they see the working conditions.

It seems that you are romanticizing bedside nursing and will end up being a martyr rather the "angel" you aspire to be. Personally I don't like when management starts the nurse as angel routine, nominate your angel. It is a marketing gimmick to them and creates unrealistic, even impossible expectations. I don't think nurses should be put on a pedestal as we are only human. Management is quick to forget that we have needs such as safe staffing, adequate resources and time to eat and take a break, simply time to think!

Best of luck of to you!

EGspirit · Jan 16, 2018

I used to have high ideals, not an par with an angel, just helping others, but the working conditions have gotten so bad over the years I now only look forward to retirement. I work my 3 shifts, do the best I can and I don't do extra. They call almost daily so if it were just about money I could makes lots of OT. The extra money isn't worth the stress and I refuse to be guilted into working extra when management refuses to hire enough nurses. That's on them!

Perhaps you could go into teaching nurses, CNA's, something like that. If you read my OP, that's the exception. Nurses have to teach nurses or we won't have any, so it's the place to go when the physical demands get to be too much for us later in life, or supervision if that's possible. The greatest glory is at the bedside, but once we are not able to do it anymore, if we don't want to retire, we could move into teaching or some supportive role.

My contention is when those supportive roles get praised as more "advanced" nursing than just some lowly bedside nurse. I say let the first be last and the last be first.

I do believe you are wrong that bedside nursing is all that counts. In fact the future is away from the hospital setting as more care is outpatient. The irony is my hospital has half as many beds as it used to and yet one thing never changes there is a perpetual nursing shortage given managements refusal to hire enough nurses and the majority of nurses which leave once they see the working conditions.

I think the Missionaries of Charity have the same problem in Calcutta.

It seems that you are romanticizing bedside nursing and will end up being a martyr rather the "angel" you aspire to be.

Well, I have been once. I should tell that story some time. But it's a painful one for me, and all I would get is the vultures swooping into my post to pi.. on it.

Personally I don't like when management starts the nurse as angel routine, nominate your angel. It is a marketing gimmick to them and creates unrealistic, even impossible expectations. I don't think nurses should be put on a pedestal as we are only human. Management is quick to forget that we have needs such as safe staffing, adequate resources and time to eat and take a break, simply time to think!
Best of luck of to you!

I absolutely agree with that. :yes:

allnurses Guide · Jan 16, 2018

Call me naive, but maybe someone could explain something to me:
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?"

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"?

Seriously, wouldn't technical nursing certifications like ACLS and CCRN (or the other specialty certifications) really be what makes a nurse "Advanced."

What makes an APRN "advanced" is the advanced scope of practice (based on advanced education, advanced knowledge base, etc). Specialty RN certifications demonstrate expertise at the RN level but they do not change the scope of practice.

I mean if my name looks like this:
EGspirit, MS, APRN, ACNS-BC, CEN, FAWM, FAAN
am I even a nurse anymore?

Do the semantics really matter?

On that topic, there is a semantic issue with the term "bedside" as well. What is your definition of "bedside"?

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?

Again, the role and the scope (and everything that goes with it) is much different between RN and APRN.

Farawyn · Jan 16, 2018

Meh. I like bedside nursing. I'm certainly no angel. Whoever said it sucks, don't do it. I'll take care of your dad when he has CHF just the same.

allnurses Guide · Jan 16, 2018

I'm not sure what that has to do with my point that today we tend to think of all the "advanced" positions as being away from the direct care of patients.

The vast majority of APRNs are involved with direct patient care.

allnurses Guide · Jan 16, 2018

Particularly as it pertains to direct entry APNs- they've never been nurses, so how can they practice an advanced form of it?

They go to graduate school and complete the same curriculum and clinical requirements as student NPs with prior nursing experience (and often they pause along the way to work as RNs while going to school part time). Then they pass the same national board certifications just like those with prior RN experience. Then then enter practice as a novice just like those with prior RN experience.

elkpark · Jan 16, 2018

Nor is it new that many nurses start in a bedside role and decide to move on to something else which is their prerogative. Nurse Practitioners have been filling their roles since before anybody on this post was born. I think this is how its always been and probably is at it should be.

(Just a minor historical correction, the NP role was initially developed in the mid-1960s. Plenty of folks here have been around a lot longer than that.)

Libby1987 · Jan 16, 2018

No one, no thing, and certainly no one else's journey takes away from who I am as a nurse.

Just be the best you and shape the perception of your practice by your practice.

allnurses Guide · Jan 16, 2018

(Just a minor historical correction, the NP role was initially developed in the mid-1960s. Plenty of folks here have been around a lot longer than that.)

By mid-70s I hope they can "escape the bedside"! Those transfers must be brutal!