All this talk of professionalism and being respected by doctors makes me sick.
I am a professional. I am a nurse. My job is to diagnose and treat human responses to illness (care for the sick). I also educate patients, assess their physical condition, and rehabilitate them. Society considers an RN a professional position, so I am a professional. I am not a doctor, I don't work for a doctor; I am not a doctor's assistant. I work for my hospital and my nurse manager.
A doctor is an academically prepared individual who diagnoses and treats medical problems in human beings. We use doctors in caring for patients who have medical problems. We need their medical orders (orders for the patient--not orders to us as in "ordering" us to do something), because we can't legally administer medical interventions without them, why? because we are nurses not doctors!
I'm in the profession of caring for people, especially sick people, and in my case especially sick people with cardiac conditions. So, naturally I have problems with the nurse practioner being considered an "advance practice nurse." In reality they are a doctor's assistant. Our professionalism does not come by being more like a doctor but by being more of a nurse.
I respect doctors, but then I respect patients as well, and I respect strangers on the street. Doctors are not nurses, and I feel they are missing out on the greatest spiritual vocation available. If they think they are above me, professionally, then they are as misguided as the nurse who thinks he's not a professional if he can't write a prescription for amoxacillin.
I'm in the profession of caring for people, especially sick people, and in my case especially sick people with cardiac conditions. So, naturally I have problems with the nurse practioner being considered an "advance practice nurse." In reality they are a doctor's assistant. Our professionalism does not come by being more like a doctor but by being more of a nurse.
I respect doctors, but then I respect patients as well, and I respect strangers on the street. Doctors are not nurses, and I feel they are missing out on the greatest spiritual vocation available. If they think they are above me, professionally, then they are as misguided as the nurse who thinks he's not a professional if he can't write a prescription for amoxacillin.
OK, I'm done:)
I was with you until you got to this part. You seem to have a bit of resentment towards NPs and for sure you have no clue what they actually do if you think they are a doctor's assistant.
The truth is that a nurse practitioner is exactly an advanced practice nurse. They provide primary care just as a physician does but using a nursing model of care which focuses on prevention and a holistic method of care as opposed to the medical model of care which is to diagnose and push as many pills and expensive medical procedures at a patient as they can. In many states they are able to practice completely independently of physicians and hopefully the day will come when that is in all 50 states. Cetainly they have an advantage over PAs who can never practice independently of physicans and who do not have their own model of care as do the NPS.
Nurse practitioners are not physician-extenders, doctor assistants, wannebe docs, or junior doctors. And it both shames me and pains me to read comments like yours from a nurse who really should know better about your profession.
Personally I utilize the services of an advanced practice nurse whenever possible. I've had two children, one delivered by a CNM and one delivered by a physician. I can assure that the CNM was much better than the supposedly better trained, well educated physician.
P.S. I would disagree about nursing being a "spiritual" vocation also. That is the type of talk that is keeping many smart, dynamic people away from the profession who don't feel the "calling".
I was with you until you got to this part. You seem to have a bit of resentment towards NPs and for sure you have no clue what they actually do if you think they are a doctor's assistant.
The truth is that a nurse practitioner is exactly an advanced practice nurse. They provide primary care just as a physician does but using a nursing model of care which focuses on prevention and a holistic method of care as opposed to the medical model of care which is to diagnose and push as many pills and expensive medical procedures at a patient as they can. It's true that some aspects of the medical model of care are incorporated into the care provided by NPs but overall their focus on diagnosis and treatment is not exactly the same as physicians. In many states they are able to practice completely independently of physicians and hopefully the day will come when that is in all 50 states. Cetainly they have an advantage over PAs who can never practice independently of physicans and who do not have their own model of care as do the NPS.
Nurse practitioners are not physician-extenders, doctor assistants, wannebe docs, or junior doctors. And it both shames me and pains me to read comments like yours from a nurse who really should know better about your profession.
Personally I utilize the services of an advanced practice nurse whenever possible. I've had two children, one delivered by a CNM and one delivered by a physician. I can assure that the CNM was much better than the supposedly better trained, well educated physician.
P.S. I would disagree about nursing being a "spiritual" vocation also. That is the type of talk that is keeping many smart, dynamic people away from the profession who don't feel the "calling".
I know we in nursing have formal roles and certifications that differentiate us from medical diagnosticians. Personally, however, I believe that the *best* doctors are also instinctively nurses and that the *best* nurses have medical instincts in addition to all the standard skills. Why not give nurses who are more interested in the medical aspect of nursing the right to pursue their interest in their own unique position? I am confused as to why you apparently feel threatened by that. NPs aren't a statement against the traditional values and roles in nursing, just a brilliant way to expand them beyond tradition.
I know there is a poor relationship between nurses and doctors due to power imbalances, tradition of abuse, etc- but can't we maybe try to forge an alliance on equal terms instead of cutting each other down?
H: Whoa, I sense some hostility toward an uppity NP perhaps? Maybe you should print this out and leave it in her mailbox.
P: Then you're mistaken. I have no issues with any NP. But an NP is a nurse who has become an assistant to a doctor. There are some states where they practice pretty independently, and in that case, they are even more like a doctor than a nurse.
Well, I'm not the only one who came to that conclusion then, perhaps we are all mistaken.
H: NP's are advanced practice nurses. They are still diagnosing human response to illness and working under the supervision of a doctor.
P: That doesn't make any sense. I see what they do.
Can you be any more vague? What is it that you see them doing that does not include diagnosing responses to human illness. If anything, that makes them better than a doctor b/c they diagnose the illness and recognize the response and how important that is as well.
H: They went the extra mile for the time, expense, and trouble of advancing their degree (something I am not willing to do, since usually the compensation is not adequate,) so I think they deserve the title.
P: Perhaps you are not able to separate what a physician is and a nurse is. If that is the case, you will always consider nurses "less" than a doctor. I see them as completely separate animals.
How, pray tell, did you come to that conclusion?? LMAO. I had a CNM deliver my child, and take my children to PNP's, what is it that I don't recognize exactly?? I do not consider nurses OR NP's less than a doctor, but different from a doctor.
H: Even hospitals have medical directors, and yes, you are in a round-about way functioning under there supervision as well.
P: In that case, I'm working for the stockholders and the Board of Nursing, too. But the bottom line is I don't have a physician as a supervisor.
OK, I'll give you that if it means so much to ya
H:If you are craving more autonomy, I suggest home health, if you can tolerate the paperwork.
P: I'm as autonomous as my profession allows, and I work for a hospital that sets forth rules and regulations for my practice while under their roof. My job is to care for people who are sick. That's my profession. The law allows me to do medical interventions in aid of that task if there is a physicians order for it, because they are the medical professionals. I am a nurse. My profession is to "care" for sick people who couldn't otherwise care for themselves.
I don't care how autonomous you are in the hospital, home health nurses have more autonomy, but I guess you'll have to take my word on that.
The truth is, most people think caring for the sick is a dirty, low job. Just last night at a banquet a man told me his wife was going to nursing school, and then he quickly added that she isn't going to be "wiping butts" or anything, she wants to do something other than work in the "hosptial." I replied that for me, wiping someones butt who can't wipe it for themselves is glory and honor. It is an extreme power. Of course, he didn't see it that way.
My point is that nursing is nursing and medicine is medicine, and almost every nurse I encounter has dreams of one day not working at the bedside, and I think that's a shame, because that's where the meat of the profession is. We need NPs, we need nurse supervisors, we need nursing school instructors and nurse lawyers and nurse consultants and CRNAs, et al ad nauseum, but the bottom line is that our profession is nursing, and that means caring for sick people who can't care for themselves.
To do that, we have to have a great working knowledge of medicine, anatomy and physiology, physical assessment pharmacology, psychology, educational techniques, and most of all, an exceptional ability to comfort human beings in distress--whatever that entails. Our degree is the ADN/BSN. MSNs are for teaching and DNSc is for research. Physicians are professionals as well as nurses, and together we form the core of an endeavor to alleviate human suffering.
Seems to me that the real problem is that you[/i] think that anyone who is no longer at the bedside isn't a real nurse. I left the bedside b/c my back couldn't take the work anymore, esp since we had no support staff, they were cut, no unit secretary, no aides, just us, we even had to unpack boxes from central supply and stock the supply cart in our "spare time" that wasn't what I considered "real" nursing anymore. So, I looked for something less labor intensive. I am still a real nurse. Even when I do phone triage when I am weekend supervisor, I am able to help people, and they appreciate me.
Your final paragraph makes no sense to me. You talk of being a core and working together, but you see the NP as outside of this? MSN's are for teaching? So the NP who must be a MSN has no place in your world of healthcare?
This is a wonderful quote. It is posted in our callroom above the phone. Someone posted it there and i take it as a gentle reminder as i am answer pages to keep mindful of my attitude and words over the phone at times i feel impatience coming on.
Nice job!
I might have to actually add this at the bottom of my posts...why did't i think of it before!
You are most welcome.
Please do! I am sure Plato and Plato will have no problem with that! It is a good quote, and one worthy of my remembering on a daily basis as well.
I just wanted to say that I can kind of see what he is saying about NP's. I'm sure it depends on where you work.
I'm sure that in some places NP's are independent from MD's and approach things from the Nursing model of care. I'm also sure that I have never seen one. I live in small but not too small city so maybe that has something to do with it. Here all NP's and CNM's work for MD's. The Np's round on the patients the docs want them too, see the "easy" patients in the office and pretty much do what ever the MD tells them to do. Now they do have some autonomy in how they choose to treat patients but because they work for the MD they have to handle things the way he wants them too.
This was not the way NP's were supposed to work but it is the way it has turned out because in order to get the legislation passed words like Medical collaboration and consulting physican had to be added. The AMA has huge dollars in lobbing and for obvious reasons could not allow any discipline other then medicine to be seen as truly independent.
It is sad because I honestly believe that the nursing model of care is better for all except the patients who need an MD to cut them open.
I also have to say I'm not really sure why everyone is ragging on Plato.
The parts of his post talking about a nurses role are perhaps idealistic but also very well thought out and beautiful.
What he talks about is the reason that many of us became nurses
but got burned out or sidetracked. Many nurses have forgotten how great our profession is and focus on the lack of respect and bad treatment. I don't think anyone went into nursing for respect or high pay.
I think although he may not have been trying too, He has in fact described what really makes nursing a profession onto it's self and if we were able to communicate this to the public and doctors we might finally be able to show them we are more then just the doctors hand maidens.
I just wanted to say that I can kind of see what he is saying about NP's. I'm sure it depends on where you work.
I'm sure that in some places NP's are independent from MD's and approach things from the Nursing model of care. I'm also sure that I have never seen one. I live in small but not too small city so maybe that has something to do with it. Here all NP's and CNM's work for MD's. The Np's round on the patients the docs want them too, see the "easy" patients in the office and pretty much do what ever the MD tells them to do. Now they do have some autonomy in how they choose to treat patients but because they work for the MD they have to handle things the way he wants them too.
This was not the way NP's were supposed to work but it is the way it has turned out because in order to get the legislation passed words like Medical collaboration and consulting physican had to be added. The AMA has huge dollars in lobbing and for obvious reasons could not allow any discipline other then medicine to be seen as truly independent.
It is sad because I honestly believe that the nursing model of care is better for all except the patients who need an MD to cut them open.
I also have to say I'm not really sure why everyone is ragging on Plato.
The parts of his post talking about a nurses role are perhaps idealistic but also very well thought out and beautiful.
What he talks about is the reason that many of us became nurses
but got burned out or sidetracked. Many nurses have forgotten how great our profession is and focus on the lack of respect and bad treatment. I don't think anyone went into nursing for respect or high pay.
I think although he may not have been trying too, He has in fact described what really makes nursing a profession onto it's self and if we were able to communicate this to the public and doctors we might finally be able to show them we are more then just the doctors hand maidens.
Are you sure that the NPs and CNMs work "for" the physicians and not "with" the physicians? Because they collaborate with the physician, does that mean they automatically defer to them? No. When one physician collaborates with another, does that mean they are working for them or with them? No.
I think that the reason that some are not receiving Plato's post well is because he/she started out talking about nurses being professionals and ultimately ended up tearing down NPs. As a professional who respects all members of the nursing profession, I find that irritating......and not very professional.
I realize that there are good nurses and bad nurses, compassionate nurses who are bad at their job and cold, unfriendly nurses who are great at their job. I really wish I could come across more of the good. I'd really like to be proud to be a nurse.
Ashley Kay, this is an excellent post. And you can be proud already, even as a student, in that you can see the evil in front of you. If you don't want to become evil, you won't become evil. Just don't do what you hate, and you will be a good nurse. You have to stay the course, or there will be one less "good" nurse out there.
please don't assume that you know squat about why an np is an np. you must have went into nursing because you failed at being a nurses aide right?
whatever
in my state no matter what you think of me i still have the authority to diagnose, treat and prescribe without a doc stuck up my butt. i choose this route after 15 years of critical care nursing because i wanted to apply my nursing skill with the ability to make more decisions in illness and wellness.
]so, you've gone from being a nurse to some form of physician. that's it.
i rely heavily on the knowledge the nurses have about the patient so we can mutually care for the patients. if they are compassionate it's certainly a bonus.
i am held in high regard by the nurses in my hospital and many times work as a nursing advocate. ask these nurses if they think i failed as a nurse....
i don't have to ask them; that is my opinion.
your post sounds jealous and i think that your attitude sets nursing back another 20 years. your thinking draws an imaginary line in the sand between nursing and medicine. [/quote
nursing is nursing; medicine is medicine. i really am not going to have a conversation with you, because i don't consider you a nurse, and i'm here to discuss with nurses. that's my opinion, and it may not be the majority opinion, but it should be. jealous? of what? what makes you think that all nurses want to be you? it's that arrogance and low professional esteem, i assure you, that made you abandon nursing and play physician.
SharonH, RN
2,144 Posts
I was with you until you got to this part. You seem to have a bit of resentment towards NPs and for sure you have no clue what they actually do if you think they are a doctor's assistant.
The truth is that a nurse practitioner is exactly an advanced practice nurse. They provide primary care just as a physician does but using a nursing model of care which focuses on prevention and a holistic method of care as opposed to the medical model of care which is to diagnose and push as many pills and expensive medical procedures at a patient as they can. In many states they are able to practice completely independently of physicians and hopefully the day will come when that is in all 50 states. Cetainly they have an advantage over PAs who can never practice independently of physicans and who do not have their own model of care as do the NPS.
Nurse practitioners are not physician-extenders, doctor assistants, wannebe docs, or junior doctors. And it both shames me and pains me to read comments like yours from a nurse who really should know better about your profession.
Personally I utilize the services of an advanced practice nurse whenever possible. I've had two children, one delivered by a CNM and one delivered by a physician. I can assure that the CNM was much better than the supposedly better trained, well educated physician.
P.S. I would disagree about nursing being a "spiritual" vocation also. That is the type of talk that is keeping many smart, dynamic people away from the profession who don't feel the "calling".