Advanced Practice: Still nursing and holistic or medical model with nursing approach?

cayenne06, MSN, CNM · Oct 4, 2015

I really, really hate the trope that NPs provide holistic care while MDs are simply pill pushers, so I am glad to see you reject that out of hand. I think MDs and APRNs alike are (as a general rule) devoted to their patients and try very hard to care for them in a compassionate and holistic way. Unfortunately clinicians (MD, PA or APRN) are overworked and constrained by time and administrative burdens.

My (admittedly brief, as I am a new grad) experience as a CNM has been overwhelmingly one of teamwork and a shared goal of promoting positive outcomes. My honest reaction to that article was a big eye roll. Fluffy nursing theory about "the practice of loving-kindness...being authentically present." Etcetera. Come on now.

The profession needs to reaffirm that NPs are nurses who are acting in an expanded role, not nurses who practice medicine.

Look, I get it that nursing and medicine are two very different professions. I also understand that nurses have been historically marginalized in health care ( it's a female dominated profession, you know) and there is a very real need for nurses to protect their professional autonomy. However. Nursing and medicine are inextricably intertwined, and when you are talking advanced practice nursing, you are indeed talking about the practice of medicine AND the practice of nursing.

As a CNM, I could not possibly care less about whether I am practicing under some half baked theory of "caring" vs simply using my knowledge base to implement medical care as appropriate, based on my skill and knowledge. I find a lot of the "nursing theory" research to be an embarrassment to the profession. I don't see RTs devoting huge chunks of their professional publications proposing essentially identical theories about the "respiratory theory of caring and authentic presence."

The transformation from nurse to the advanced practice role of NP involves development of advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health, preventing disease, and helping patients make changes in their lives.

The articles makes it seem like this is unique to nursing. Every physician I have had the pleasure of working with was JUST as devoted to holistic care as I am.

I practice midwifery. However, I would never try to make the case that midwifery does not incorporate the practice of medicine, nor would I argue that my physician colleagues cannot practice "the midwifery model," because it is nothing more than holistic, patient centered care under another name.

Methinks the authors of that article doth protest just a liiittle too much.

WKShadowNP, DNP, APRN · Oct 4, 2015

Thank you, Cayenne. It sounds odd, perhaps, but I was thinking my philosophy would be considered sacrilege to nursing. We have the same goals, I would assume (we meaning providers of every ilk), and why does one have a corner on the market over another. I like the collaborative model in that each brings their talents and knowledge to the table for the betterment of their patient.

Don't get me wrong, I love nursing and the history behind it, but to move beyond that limited scope is indeed necessary, not because I'm moving to advanced practice, but because nursing as a whole as grown so very much.

Dogen · Oct 4, 2015

As a CNM, I could not possibly care less about whether I am practicing under some half baked theory of "caring" vs simply using my knowledge base to implement medical care as appropriate, based on my skill and knowledge. I find a lot of the "nursing theory" research to be an embarrassment to the profession. I don't see RTs devoting huge chunks of their professional publications proposing essentially identical theories about the "respiratory theory of caring and authentic presence."

During a break I was talking to a faculty member and she pulled out an early psychiatric nursing textbook. They'd eschewed DSM diagnoses in favor of nursing diagnoses, renaming recognizable disorders as things like, "Disorders of emotion requiring reflection from the nurse." It really drove home how hard the field has tried to make itself appear distinct from medicine.

Jules A, MSN · Oct 4, 2015

My dear WKShadowRN you might not want to hear my take on this topic so bear with me as I've been on call all weekend and rounded on 24 patients today. My brain is a bit sluggish and my normal air of decorum is likely a bit reduced, lol. Quite simply this article horrified me and as I looked for something ridiculous to quote as evidence of the ridiculousness I realized I would have to copy/paste the entire first page which is only as far as I got before I was ready to enter the witness protection program so no one would think I'm a member of this deluded group.

I agree with cayenne06's response and will further expand to say I find this kind of self-inflated faux finish embarrassing not only that two educated nurses took the time to write this dribble but also that someone else actually felt it worth publishing. Nurses haven't cornered the market on empathy and to act as if this is the foundation of my knowledge and practice is insulting. I strive to be an empathetic, skilled diagnostician and prescriber which should go without saying. If our education wasn't so deficient we wouldn't have to constantly pound this drum that sounds to me as if they are asserting "we might not be as competent or educated as physicians but we sure can hold a hand and mop a brow". :banghead:

WKShadowNP, DNP, APRN · Oct 5, 2015

Nurses haven't cornered the market on empathy and to act as if this is the foundation of my knowledge and practice is insulting.

I think you hit the nail on the head and for us to think we have is what holds us back. We few who know better must be the pioneers to catch the rest up with us.

I'm discouraged a bit today, not by your input, which I am glad you gave especially as I asked for it. But because I desire more than what I am getting (in the way of education) but know it will be up to me to get it.

By that I mean that much of my learning will occur only in clinical or after I am boarded. (Which to a small degree is how it was in nursing school, but now the stakes are much much higher.)

Jules A, MSN · Oct 5, 2015

I think you hit the nail on the head and for us to think we have is what holds us back. We few who know better must be the pioneers to catch the rest up with us.
I'm discouraged a bit today, not by your input, which I am glad you gave especially as I asked for it. But because I desire more than what I am getting (in the way of education) but know it will be up to me to get it.
By that I mean that much of my learning will occur only in clinical or after I am boarded. (Which to a small degree is how it was in nursing school, but now the stakes are much much higher.)

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.

There are times when I feel as if I have come to terms with being a NP because I have managed to distance myself from the NP angst and have aligned with physicians but it is articles like this that slap me right in the face with the fact that so many of my actual peers value a totally different skill set if that is what you want to call it.

Jules A, MSN · Oct 5, 2015

I can't speak for anyone else's experience, but I feel like there's a self-consciousness in nursing that drives programs to tell us, "Nurses are leaders... please believe us." I was a scientist before I was a nurse, and scientists don't become leaders by taking classes on leadership. You want to work in a lab? Get your BS. You want to run someone else's lab? Learn more science and get your MS. You want your own lab? Learn even more science and get your PhD. Instead of actually earning respect (by being trained more thoroughly as clinicians), we're learning the theory of earning respect and hoping that amounts to the same thing. It bugs me.

Well said and although I stole this from another thread I feel it applies beautifully here also.

Barnstormin' PMHNP · Oct 5, 2015

I view my nursing theory classes as a necessary evil that have to be taken in my program. I don't know of a single NP or student that cares about it and uses it in their practice. Nursing theory just sounds so insecure and bombastic, I feel that there is a "nuts and granola" feeling to these theories. It is ridiculous as well to pretend that MD's are not holistic or caring and that nurses have a special gift for empathy.

Jules A, MSN · Oct 5, 2015

I view my nursing theory classes as a necessary evil that have to be taken in my program. I don't know of a single NP or student that cares about it and uses it in their practice. Nursing theory just sounds so insecure and bombastic I feel that there is a "nuts and granola" feeling to these theories. It is ridiculous as well to pretend that MD's are not holistic or caring and that nurses have a special gift for empathy.[/quote']
Totally agree but have to say I know more than a few NPs who do things that clearly should be delegated to ancillary staff and I have actually been told "well if I don't do it who will?" Ummm "the secretary or perhaps the CNA?" My interpretation is that this was said as if its a martyr badge of honor that nursing seems to embrace. My strategy remains that I don't do anything a physician won't do.

WKShadowNP, DNP, APRN · Oct 5, 2015

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.
There are times when I feel as if I have come to terms with being a NP because I have managed to distance myself from the NP angst and have aligned with physicians but it is articles like this that slap me right in the face with the fact that so many of my actual peers value a totally different skill set if that is what you want to call it.

That's makes sense. I do feel like I am learning so much now that I am in my core classes. (Did I really need another theory, policy, or informatics class?) I was so relieved and excited to get to advanced assessment, advanced pathophysiology, and advanced pharmacology. But like a PP said, they were a necessary evil. My program needs a skills lab, though. It would make a world of difference. I have good preceptors but I know not all of my cohort can say the same. I have two acquaintances who are teaching me not related to work or school so I am blessed. But my future is in MY hands, MY control, so I have to work harder to attain the ideal and hopefully garner respect as a peer.

Nursetk4 · Oct 5, 2015

An interesting theme that I see over and over in these posts is the feeling that NP education lacks. I believe it is up to the individual to fill in the gaps. I spent 100s and 100s of hours outside class studying and finding resources. It's the experience when we finally start learning. Education is where you learn to look for answers. One can learn from the good, bad and the ugly. I think as RNs and now NPs we need to stop comparing and focusing on our weaknesses and focus on our strengths and realize how we provide excellent care for our patients.