Medical Model vs Nursing Model

[twixel]

Hello!

I have been skimming through many previous threads for information on MD/NP education and have often come across the terms of a "Medical Model" in regards to the MD route as well as a "Nurseing Model" as foundation for the NP route. As obvious as this may or may not sound, I was wondering if anyone could help me by elaborating on the two models and the ways in which they differ in regards to an MD/NP. Thanks so much!

---

Members don't see this ad.

 

[fort lincoln]

In a nutshell , the medical model deals with how to treat the disease(more science based) while the nursing model deals with the how to care for the patient(psychosocial ,emotional and patient education) with the disease.

 

[MacGyver]

In a nutshell , the medical model deals with how to treat the disease(more science based) while the nursing model deals with the how to care for the patient(psychosocial ,emotional and patient education) with the disease.

If thats true then why the hell do NPs feel they need to script drugs?

Reality is that there is "nursing" model is just a stupid catch phrase that nurses use to try and claim that they provide "different" and "better" care than doctors.

Its used as a ploy to increase nurses scope of practice. They try to claim that doctors have no say over what they do because they operate under a "nursing" model whereas doctors are on a "medical" model.

Its all a bunch of BS pandering and propaganda.

 

[ItsGavinC]

Actually, I think Fort Lincoln provided a solid and legit answer to the OPs honest question.

 

[Pediatron47]

The NP is a bunch of BS.

Case in point for those that understand medicine: A patient is hyponatremic. The patient has psychogenic polydysia and is admitted to the NP service for the hyponatremia. The NP checks an ADH level, which is of course low. She orders vasopressin. The patient becomes even more hyponatremic and crashes. She is than admitted to the MD service.

In my experince, NP are a joke. I spent an hour last week explaining to 2 NPs why we were taking care of a patient the way we are. NPs are here because not enough MDs want to do the crap work. But I will say, never, never try to question an MD, as you are almost always wrong.

 

[fab4fan]

As if there haven't been docs out there who have done things just as stupid.
No discipline is immune to having less than stellar practitioners.

How about the question that was posted on the allopathic forum a few months back when a female was asking about a heart condition. She said she went to see a NP at her student health center and the NP told her it could be caused by skipping breakfast and her heart muscle being broke down for energy

I'm guessing you posted this to prove your point. (Of course, you investigated this first to rule out the possibility that the pt completely misunderstood the NP, or that the situation was a total fabrication.)

 

[fab4fan]

But I will say, never, never try to question an MD, as you are almost always wrong.

Sorry, but my license requires me to question orders that may be incorrect. A good physician appreciates someone being a second set of eyes for him/her.

 

[southerndoc]

Sorry, but my license requires me to question orders that may be incorrect. A good physician appreciates someone being a second set of eyes for him/her.

Fab, thank you for doing that because I've screwed up before as a med student, and I'm bound to screw up again as a resident and physician.

 

[fab4fan]

Fab, thank you for doing that because I've screwed up before as a med student, and I'm bound to screw up again as a resident and physician.

No problem...we all learn from each other (at least, that's how it should be). I've been just as fortunate to learn things from med students/interns/docs.

 

[PACtoDOC]

I must say that this is the very first time I find myself agreeing completely with something MacGyver said!! The NP education and scope of practice is definitely propaganda. Psychosocial nursing issues are very important for patient care, but they are best left up to an RN carrying out the decisions of a physician. Simply furthering that psychosocial education does not make one capable of being an independent medical provider.

 

[sones]

I must say that this is the very first time I find myself agreeing completely with something MacGyver said!! The NP education and scope of practice is definitely propaganda. Psychosocial nursing issues are very important for patient care, but they are best left up to an RN carrying out the decisions of a physician. Simply furthering that psychosocial education does not make one capable of being an independent medical provider.

I think you all might be making blanket statements based on your experience with a few NPs. While NPs don't belong in some settings....there is a definite place for them where the ability to write scripts is helpful. I like going to my NP for my routine care. When it is something she feels she is not qualitified to handle...she requests assistance from a physician. She is able to write scripts for me and not bother the physician who is working with someone else...who is probably sicker than I am. As for the nursing model...I hate to admit this ...I think its basically total BS. (Yes...I'm an RN). I think there are some very important aspects of the nursing model that should be incorporated into practice...but to have a model...whatever. I think it is important for all practitioners to approach the patient as a whole person ...not just as a set of systems that need to be cured. Some physicians approach patients with a broad view and others approach the patient as a body to work on. As for questioning MDs...how dare you think you are so perfect that you don't make mistakes where an RN could help you...why the hell should I do anything to help you out....I suppose my job is to simply wipe butts and keep families away from your precious little rounds....NO!!! While I'll admit, you have the education to make the decisions about patient care...it is definitely my job to make sure you do your job correctly. There may be a day you forget to order something...that's where I remind you. Healthcare is a TEAM effort...there is no I in team. You really cannot do your job without nurses, if you think you can ha ha ha! Just don't kick in the knees of your support persons....they are part of what you depend on. Treat your nurses with respect, you'll be very glad you did.

 

[PACtoDOC]

If you read the my statement you quoted Sones, there was none of the stuff you went on to say about wiping butts and so forth. Relax a bit. I appreciate RN's to the nth degree, it is solely NP's that I have an issue with. I think RN's provide a very valuable service. Some people are just better in that sort of role, or for whatever reason don't want the added responsibility that comes with being a doctor. I agreed with you on your other post so stop freaking!!

 

[fab4fan]

I'm not surprised a PA would take issue with the NP role...there has been animus between these two professions from the beginning.

My experience with PA's has been less than encouraging, but I wouldn't generalize that and then say that all PA's are incompetent.

 

[PACtoDOC]

Your opinion about PA's is subjectives, however, what is objective is the fact that our training is unbelievably more intense than NP training. We had RN's in our class that struggled just like each of us, because being an RN is really not all that good preparation for true medical pathology. Maybe it is for the psychosocial nursing theory taught in NP school, but no one can argue the fact that PA training far exceeds NP training. The only credible argument NP's can make about PA's is that RN's might be ahead of the game on entry to midlevel training. Argue something substantial instead of your opinion, because everyone has an opinion. Trust me when I tell you that PA training is the absolute closest thing to physician training. NP training simply cannot compare hour per hour, credit per credit.

 

[FNP2B]

The whole NP vs. PA is overdone IMHO. For those pursuing PA...i want to say congrats. For those pursuing NP...again i say congrats. Here in the big state of Texas you will find job postings listed exactly in this format.......looking for a strong NP/PA.....I live in a city that has a little over 2 million and growing. the demand for NP/PA's is ever growing. the major hospitals dont request you go head to head, are compare hour for hour, or credit for credit when it comes to education. they just want to see that Masters behind your name. they know and understand that a PA has gone through just as much education as an NP and NP's have just as much as PA's. again this is just my 2 cents. i love texas and plan on staying here (of course i want that beach house in miami for the winters here in tx). i chose NP because of the nursing model and the pay ...for example my wife is an RN (going for her CNM,MSN) and she works in the NICU.there are two MD's and 3 NNP's. the NNP's are making a little over 90K. they are on call one week out of every month. On the other hand my wife and I know a PA that works in the express-Med in the same hospital and she is making a little over 90k as well. The university hospital here utilizes NP/PA very much. so again the NP vs. PA is over-rated. but of course there will be a response to my post from someone who feels superior to NP's, but thats ok their not the one's who are going to be the deciding factor over me applying the degree that i will have obtained. There is no secret, the demand for NP/PA is on a rise especially here in texas. so let the debating continue .....while i go an make my 10K/mo(with exp. of course). NP's will always be on the same level as PA's (that is the mid-level), you can type till your phalanges fall off and when you finally pick your fingers off the floor and get them surgically put back on. Flip through the job listing in your local paper or come on the internet and look for job postings.....and guess what...Hospital looking for strong NP/PA.

do what you feel....and feel what you do.

 

[UCLA_MSN]

Sorry to burst your bubble, but we didn't spend too much time on psychosocial or other nursing theories. The only time we had to slightly touch upon nursing theory was when we took our comprehensive exam. Thank goodness they warned us. Needless to say, I had to bust out my old nursing books and do some google searching because I had no clue what I would write about.

Your opinion about PA's is subjectives, however, what is objective is the fact that our training is unbelievably more intense than NP training. We had RN's in our class that struggled just like each of us, because being an RN is really not all that good preparation for true medical pathology. Maybe it is for the psychosocial nursing theory taught in NP school, but no one can argue the fact that PA training far exceeds NP training. The only credible argument NP's can make about PA's is that RN's might be ahead of the game on entry to midlevel training. Argue something substantial instead of your opinion, because everyone has an opinion. Trust me when I tell you that PA training is the absolute closest thing to physician training. NP training simply cannot compare hour per hour, credit per credit.

 

[zenman]

The NP is a bunch of BS.

Case in point for those that understand medicine: A patient is hyponatremic. The patient has psychogenic polydysia and is admitted to the NP service for the hyponatremia. The NP checks an ADH level, which is of course low. She orders vasopressin. The patient becomes even more hyponatremic and crashes. She is than admitted to the MD service.

In my experince, NP are a joke. I spent an hour last week explaining to 2 NPs why we were taking care of a patient the way we are. NPs are here because not enough MDs want to do the crap work. But I will say, never, never try to question an MD, as you are almost always wrong.

I was trained to question MDs on many issues, particularly in light of the over 100,000-200,000 people killed per year by them!

 

[zenman]

How about the question that was posted on the allopathic forum a few months back when a female was asking about a heart condition. She said she went to see a NP at her student health center and the NP told her it could be caused by skipping breakfast and her heart muscle being broke down for energy

Maybe this NP had assessed the patients level of education and was gearing her patient education so that the patient could understand it...we all know the sorry state of education these days!

 

[MacGyver]

I was trained to question MDs on many issues, particularly in light of the over 100,000-200,000 people killed per year by them!

link please.

I assume you are referring to the IOM study. Let me enlighten you:

1) IOM put the number at 70,000 deaths per year, not 100 or 200 thousand. Quit making up bull****.

2) That 70k number is ALL MEDICAL MISTAKES, not just those committed by doctors. It includes mistakes by PAs, NPs, RNs, technicians, EMTs, paramedics, CRNAs, AAs, and MD/DOs.

3) Most of hte mistakes were system wide errors. In other words, they couldnt be blamed on one specific individual. So for you to assign individual blame to the bulk of mistakes is just ignorant.

 

[MacGyver]

BTW, you will NEVER hear the nationwide leaders of the nursing profession claim that there is no difference between medical and nursing models.

The reason is because their current position on CRNAs and NPs is BUILT upon the proposition that MDs dont have the right to regulate them because its "nursing" and not "medicine."

If the leaders of the nursing profession admitted that there was no difference between "medical" and "nursing" models it would blow away their propaganda platform that MDs have no say in regulation of nurses scope of practice.

Each state has a state nursing board which is charged with the regulation of "nursing." If the nursing profession came out and said there is no difference between nursing/medical models, then it would ELIMINATE the need for a state nursing board, and would open the door for MDs to control the nursing profession. Obviously they would hate to see that happen, because then the artificial platform that NP/CRNA scope is built on would crumble.

 

[zenman]

link please.

I assume you are referring to the IOM study. Let me enlighten you:

1) IOM put the number at 70,000 deaths per year, not 100 or 200 thousand. Quit making up bull****.

2) That 70k number is ALL MEDICAL MISTAKES, not just those committed by doctors. It includes mistakes by PAs, NPs, RNs, technicians, EMTs, paramedics, CRNAs, AAs, and MD/DOs.

3) Most of hte mistakes were system wide errors. In other words, they couldnt be blamed on one specific individual. So for you to assign individual blame to the bulk of mistakes is just ignorant.

Do a search. Exact numbers are not available because many cases were hidden/covered up to keep lawyers at bay. 100,000 plus just in med errors alone; 102 million injured. Pretty neat system, eh?

 

[PACtoDOC]

Holy Holy Water Batman, I find myself in complete agreement with MacGyver. Perhaps Mac has come back to the mainstream or perhaps I have strayed out of it. Either way, Mac is right in what he says in that the nursing model is nothing more than propaganda to backdoor the practice of medicine without a license.

And hey Zen, watch out, the sky is falling the sky is falling. Your rationale on those medical mistakes must be off some plaintiff trial lawyers website. The cast majority of medical mistakes are not one person alone committing them but a "team" of errors per se in a hospital.

 

[Hope4Ava]

Your opinion about PA's is subjectives, however, what is objective is the fact that our training is unbelievably more intense than NP training. We had RN's in our class that struggled just like each of us, because being an RN is really not all that good preparation for true medical pathology. Maybe it is for the psychosocial nursing theory taught in NP school, but no one can argue the fact that PA training far exceeds NP training. The only credible argument NP's can make about PA's is that RN's might be ahead of the game on entry to midlevel training. Argue something substantial instead of your opinion, because everyone has an opinion. Trust me when I tell you that PA training is the absolute closest thing to physician training. NP training simply cannot compare hour per hour, credit per credit.

Oh yes, my training as an NNP consisted of so much psychosocial stuff.
Come on little baby you can make it. That's all I needed to learn was how to give a baby a pep talk. Yeah, it really works well on the babies. I just order x-rays cause I want to look at the pretty little picture on the screen. In the NICU I work in we truly do work as a team. Our neo's are very thankful to have us NNP's there. I don't pretend to know what the neo's know but I am very capable of doing my job and our neo's appreciate the job that we do.
I've been on both sides of the coin having had twins in the NICU, working as an RN in the NICU and now working as a NNP in the NICU. I appreciated the entire TEAM effort it takes to make the place run and the entire TEAM effort it took to save my son. When it came down to it, it wasn't about a MD vs NNP vs PA thing. It was about my son and my daughter (RIP AVA ). It was about all the people it took for my son to have a good outcome, from MD to NNP to nurse to respiratory therapist to physical therapists to nursing tech to the unit secretaries etc etc etc. It took All of those people for my son to have a positive outcome and I appreciate the education and dedication that each of them brought to the table.


To the person who said never question an MD . ......you have a lot to learn. Please don't let your ego get in you in trouble because that's exactly where you're headed.

 

[zenman]

And hey Zen, watch out, the sky is falling the sky is falling. Your rationale on those medical mistakes must be off some plaintiff trial lawyers website. The cast majority of medical mistakes are not one person alone committing them but a "team" of errors per se in a hospital.

Oh what's a few hundred thousand either way!

 

[JustaPA]

The whole NP vs. PA is overdone IMHO. For those pursuing PA...i want to say congrats. For those pursuing NP...again i say congrats.

Thanks FNP2B

 

[thehealingart04]

By Twixel

I have been skimming through many previous threads for information on MD/NP education and have often come across the terms of a "Medical Model" in regards to the MD route as well as a "Nurseing Model" as foundation for the NP route. As obvious as this may or may not sound, I was wondering if anyone could help me by elaborating on the two models and the ways in which they differ in regards to an MD/NP. Thanks so much!

To get an idea of what foundation the nursing model would have vs a medical one, take a look at NANDA (North American Nursing Diagnosis Association). This nursing organization has compiled nursing diagnosis into categories. This is the foundation of a nurses training and you will see that it is quite clearly 'unique'.

Scan the categories and get a feel for what you would think a person with medical training would have to say, then take a look at the nursing concerns.

Last time I looked there was even a diagnosis for "aura displacement", so take a thorough tour.

Then we can discuss the differences from a reference point of nursing's training that must be conducted to reach these conclusions.

This is the foundation of an NPs training and what puts the "nurse" in Nurse Practitioner. It's important to compare the two models with thier contrasting plans of care.

 

[JustaPA]

This is to the nurses in this thread. I came over here to just take a look at what goes on in your forum. I kind of had enough of the bickering that goes on in some of the PA threads. I'm sorry to see that one of the people that is envolved in the name calling in our forum is doing the same thing in yours. I'd suggest just ignoring him.

 

[KEC]

But I will say, never, never try to question an MD, as you are almost always wrong.

Wow Pediatron- you are arrogant!! what a jerk

 

[fab4fan]

By Twixel


To get an idea of what foundation the nursing model would have vs a medical one, take a look at NANDA (North American Nursing Diagnosis Association). This nursing organization has compiled nursing diagnosis into categories. This is the foundation of a nurses training and you will see that it is quite clearly 'unique'.

Scan the categories and get a feel for what you would think a person with medical training would have to say, then take a look at the nursing concerns.

Last time I looked there was even a diagnosis for "aura displacement", so take a thorough tour.

Then we can discuss the differences from a reference point of nursing's training that must be conducted to reach these conclusions.

This is the foundation of an NPs training and what puts the "nurse" in Nurse Practitioner. It's important to compare the two models with thier contrasting plans of care.

One of the things that makes me want to tear my hair out at work is "nursing diagnosis." True, some of the dx. can be helpful to guide your assessments and help map out how you plan to intervene in problems, but on the whole I think it's just a way for nurses to try to improve their collective self-esteem. Truth be told, I'm a manager, and it is very begrudgingly that I write out nursing dx's on my pts. I see hospice pts...I don't need to read "Alteration in comfort related to..." I already know my pt is uncomfortable; what I want to read are orders from the doc to adequately treat the discomfort.

Nsg. dx. may also be helpful to newer nurses who don't know all of the things that can be done to address pt problems, but for those of us who have been in nursing since the Paleolithic, it all seems a little silly, even pretentious.I highly doubt some overburdened staff nurse came up with this idea; this is straight out of academia, where those involved haven't done direct care since The Hundred Years' War. (Sorry, I exag. a bit there; I meant to say "...since the time of the French Revolution.")

A little less prose and a little more time for hands on care would make many of us, not to mention our pts., very happy.

 

[fab4fan]

This is to the nurses in this thread. I came over here to just take a look at what goes on in your forum. I kind of had enough of the bickering that goes on in some of the PA threads. I'm sorry to see that one of the people that is envolved in the name calling in our forum is doing the same thing in yours. I'd suggest just ignoring him.

Thanks!

 

[thehealingart04]

By Fab4Fan

One of the things that makes me want to tear my hair out at work is "nursing diagnosis." True, some of the dx. can be helpful to guide your assessments and help map out how you plan to intervene in problems, but on the whole I think it's just a way for nurses to try to improve their collective self-esteem.

These NANDA guidelines are also used to write the outlines for your plan of how you will intervene, right? I think you're talking about careplans, right?

To the OP: Careplans are an excellent point of reference between the nursing and medical model. Viewing a nursing careplan vs what you think would be appropriate concerns of any given disease process will give you an idea of what kind of education might suit you. NANDA guidelines, nursing diagnosis and careplans are a foundation of all undergraduate nursing education in preparation for mid-level training.

So, is this nursing model form carried over to training as an NP? It would seem reasonable that not only is the concept of NANDA guidelines but the use of them a basis of NP training. Since one must be trained as an undergraduate nurse in order to apply for postgraduate training as an NP, it makes sense that NANDA guidelines and careplans are the foundations of treatment in the nursing model as well as what is stressed in post graduate studies. How do NP schools get that into the same 2 year time frame with all the medical model training of a PA?

Many a proud nurse would proclaim that nursing and medicine are separate. One could then assume that NPs have a need for more clinical hours and a larger volume of didactic medical training than PAs Since the nursing model clearly doesn't require the same prerequisite preparation as the medical model and the foundation is psychosocial. A PA student with an undergraduate, in say, Biology or Medical Lab Sciences is preparing for the medical model of mid-level care. A BSN with clinical NANDA guidelines and careplans of holistic intervention as a foundation of training is quite clearly worlds apart from the other. How do NP programs fit in holistic care of an undergraduate nurse with the didactic and clinical medical model training of a mid-level in the same 2 year time as a PA program?

Perhapse some NPs on this board will tell us what clinical medical training and hours are in a typical NP program.

 

[sones]

By Fab4Fan


These NANDA guidelines are also used to write the outlines for your plan of how you will intervene, right? I think you're talking about careplans, right?

To the OP: Careplans are an excellent point of reference between the nursing and medical model. Viewing a nursing careplan vs what you think would be appropriate concerns of any given disease process will give you an idea of what kind of education might suit you. NANDA guidelines, nursing diagnosis and careplans are a foundation of all undergraduate nursing education in preparation for mid-level training.

So, is this nursing model form carried over to training as an NP? It would seem reasonable that not only is the concept of NANDA guidelines but the use of them a basis of NP training. Since one must be trained as an undergraduate nurse in order to apply for postgraduate training as an NP, it makes sense that NANDA guidelines and careplans are the foundations of treatment in the nursing model as well as what is stressed in post graduate studies. How do NP schools get that into the same 2 year time frame with all the medical model training of a PA?

Many a proud nurse would proclaim that nursing and medicine are separate. One could then assume that NPs have a need for more clinical hours and a larger volume of didactic medical training than PAs Since the nursing model clearly doesn't require the same prerequisite preparation as the medical model and the foundation is psychosocial. A PA student with an undergraduate, in say, Biology or Medical Lab Sciences is preparing for the medical model of mid-level care. A BSN with clinical NANDA guidelines and careplans of holistic intervention as a foundation of training is quite clearly worlds apart from the other. How do NP programs fit in holistic care of an undergraduate nurse with the didactic and clinical medical model training of a mid-level in the same 2 year time as a PA program?

Perhapse some NPs on this board will tell us what clinical medical training and hours are in a typical NP program.

While I cannot speak for NP training....my CRNA program ditches the nursing diagnoses. NOTHING...thank goodness.

 

[fab4fan]

These NANDA guidelines are also used to write the outlines for your plan of how you will intervene, right? I think you're talking about careplans, right?

Theoretically, yes. Practically speaking, no.

Here's an example. I saw a pt w/ terminal CA. His mouth was covered with apthous ulcers, and he also had some thrush for good measure. Now, did I think, "Alteration in skin integrity (oral mucosa) r/t immunocompromised state"?
No, I did not. I called his doc and said, "Hey, can I have an order for "magic mouthwash" and nystatin?" I didn't know to ask for that because of PANDA, NANDA, or whatever they're calling it these days. I learned what to ask for by taking care of patients, paying attention, and asking a lot of questions.

Call me a traitor to the nursing profession...I don't really care. The only reason I fill out those darned care plans is because I have to. I can only imagine what a physician would do if I called and said, "I think my patient has an aura displacement. Can you give me some orders?" (What in God's name is "aura displacement," anyway?)

We used to have to write this stuff out by hand and come up with the appropriate interventions and evaluations. At least there was some thought going into the process; now you just check everything off.

Sorry, I didn't mean to turn this into a diatribe about nursing dx. It's just a sore point for me, because I think it's one of the goofy aspects of nursing that makes other healthcare professionals take us less seriously.

 

[GeddyLee]

One of the things that makes me want to tear my hair out at work is "nursing diagnosis." True, some of the dx. can be helpful to guide your assessments and help map out how you plan to intervene in problems, but on the whole I think it's just a way for nurses to try to improve their collective self-esteem. Truth be told, I'm a manager, and it is very begrudgingly that I write out nursing dx's on my pts. I see hospice pts...I don't need to read "Alteration in comfort related to..." I already know my pt is uncomfortable; what I want to read are orders from the doc to adequately treat the discomfort.

Nsg. dx. may also be helpful to newer nurses who don't know all of the things that can be done to address pt problems, but for those of us who have been in nursing since the Paleolithic, it all seems a little silly, even pretentious.I highly doubt some overburdened staff nurse came up with this idea; this is straight out of academia, where those involved haven't done direct care since The Hundred Years' War. (Sorry, I exag. a bit there; I meant to say "...since the time of the French Revolution.")

A little less prose and a little more time for hands on care would make many of us, not to mention our pts., very happy.

OK...serious question here, for my own enlightenment...
What's the nursing assessment and diagnosis good for? I hate to sound like a jack*ss, but the other day I was in a hurry to see a patient and the nurse took like an extra 15 minutes finishing her assessment. I don't know about other docs, but I never read these things. Do the nurses make use of them on the floor? Or do they just read the doctors' assessment and plan??

 

[fab4fan]

First of all, that was rude. I may not give up my chair for a doc (well, I might if I like you), but I wouldn't hold up a doc who's rounding because I needed to finish my assessment. I am in no way saying that nurses' assessments aren't important or necessary, but there is always something else you can do for a few minutes. I have to say that in two decades of nursing, I've never seen anyone do what you describe...not even in the ED when we would be taking pts from the medics. Where do you work?

As for docs reading nurses' care plans... Maybe the notes...maybe, but care plans?

IMO, care plans are just another in a series of mind-numbing forms that have been shoved at us by our nursing "leaders" and by JCAHO and other regulatory groups.

Here's how bad it is: My pt's dose of OxyContin has been increased from 20mg BID to 30mg BID. Now, I may have writen the order on the physician's order sheet, changed it on the MAR (medication administration record), written it in my narrative note, and updated it in the on-call notebook. But heaven forfend if I do not remember to also go to the care plan (under the "Alteration in comfort r/t pain" problem) and change it there. Ye gods and little fishes! Because that will be the chart that my supervisor (or the DOH) happens to audit, and then I will get my hands slapped for not "updating the care plan in a timely fashion."

Never mind that the care plan is the last place I look for meds/treatments, etc. The long and short of it is I have to do it.

So, should I give the digoxin, or should I first make sure the care plan says, "Alteration in cardiac output r/t aura displacement." Sorry, I was exaggerating a bit there. The care plan should have read, "Alteration in cardiac output r/t asystole."



I'll be the first to defend nurses and their importance, but no one will convince me that care plans are nothing but a waste of valuable time that could be spent doing something productive...like actually caring for pts., not just doing it theoretically.

 

[thehealingart04]

To the OP,

As I queried in a previous post:

Perhapse some NPs on this board will tell us what clinical medical training and hours are in a typical NP program.

I did an informal search with the Vivisimo cluster search engine to quantify NP vs PA program credit hours and clinical real and credit hours. Unfortunately I didn't find an easily accessible scheme for presenting program information from most programs that I viewed. The programs didn't mind giving a timetable but the NP programs generaly gave them in real hous and PA programs in credit hours.

I also found,to my amazement that NP programs offer full AND part time participation while none of the PA programs, which were longer, even worked full timr through the summer.

The NP programs course descriptions didn't seem like they were delivering much medical model content for diagnosis and treatment of disease. It's just my impression but this would seem contradictory to the agreed concept of medical model diagnosing and treating and nursing model focusing on psychosocial treatment of disease. I would think that NPs would need MORE medical model training than nursing model training. Anyway, it's not what I expected.

NP schools train for one general practice and pa graduates are generalists that seek post masters training in specialties. There are some programs that I saw for neonatology,family and rural medicine for NPs.

Some random school stats:
365 real clinical hours at the Medical college of Georgia School of Nursing in a Family Nurse Practitioner program.
Penn State:
945 real clinical hours of the 56 credit hours for all classes in the program.

Clarion and Slippery Rock Universities joint program.
Family Nurse Practitioner. The Master of Science in Nursing program consists of 15 credits of theory courses and an additional 30 credits of combined theory and practical application course work for a total of 45 credits. The Clarion-Slippery Rock Family Nurse Practitioner program has 450 hours of didactic course work and 645 hours of clinical practice(real).

LSU Health Science center is 46 hours to FNP. No total clinical hours are given.

Sonoma State Univ. 40 credit hours. About 432 clinical hours to FNP

PA programs

Central Michigan Univ,
120 credit hours with 48 total credit hours in clinical alone. No estimation of total real hours in clinical was given but the credit hours total the average NP program hours that I observed.

University of Texas Southwest Medical Center
120 credit hours total, 4 didactic semesters, 61 clinical credit hours spread out between specialties.

Baylor College of Medicine
Clinicals consist of 50 real hours a week for a year, so 2600 real hours approx.

I got tired of weeding through extraneous information on all websites but my very informal survey points out some substantial differences between NP and PA programs. If one was to read the course descriptions in NP and PA programs, the nursing model vs medical model would become more clear. As far as what I found, there apears to be less focus on medical diagnosis and treatment in NP schools given shorter clinical,credit and real hours in medical model subjects.

Maybe if some NPs would care to post they could point out some items in thier course websites that would show otherwise but I think the whole point of separating nursing and medical models is the foundation of what the two professions seem to deem important.

 

[thehealingart04]

By Sones

While I cannot speak for NP training....my CRNA program ditches the nursing diagnoses. NOTHING...thank goodness.

Did you use nursing diagnosis through BSN? Is it a large portion of undergraduate training as a nurse?

 

[deleted6669]

Although pa and np programs have the same number of credit hours the focus is very different. np programs are more theory based while pa programs are more clinically based. typical pa program has > 2000 clinical hours encompassing 1 full yr including summer of year 2 while typical np program clinical hrs are<750 with many <500 often with the majority of hours spent in one specialty. my clinical yr was actually 54 weeks divided as follows:
surgery 5 weeks
inpt medicine 5 weeks
urban er/trauma ctr 5 weeks
obgyn( l+d/clinic/o.r.) 5 weeks
pediatrics 5 weeks
psych( inpt) 5 weeks
family medicine 12 weeks
community emergency medicine(elective) 12 weeks

as stated by a prior poster np programs generally have one clinical area of focus( ob, peds, adult medicine, etc.) while the pa degree is a general degree which allows the pa graduate to work at an entry level in any field of medicine. np's with an fnp(family np) certification have more ability to work in multiple fields as compared to their colleagues with more focused training. I have worked with several excellent fnp's who choose to work in emergency medicine.
not trying to start a flame war here just pointing out some differences in training philosophy. peace

 

[thehealingart04]

By Emedpa

Although pa and np programs have the same number of credit hours the focus is very different.

Maybe it was the way the different websites were set up but I actualy found that NP programs had less total hours. I thought I would find just the opposite to be true since diagnosis and treatment of disease is such a medical model sort of thing, but what do I know. It would seem improbable that a person with nursing model training in undergraduate school would be prepared for diagnosis and treatment of disease (medical model) after less total hours of program work and less generalized clinical training. Even more interesting is that the NP programs semm to incorporate nursing model themes in this time frame also. How do they do it?



It would be helpful to hear from some NPs on this thread about thier programs since they have firsthand knowledge. I'm sure there is something I'm not seeing from not actualy reading the programs right or something. I don't see how this small sample could represent the whole.

 

[hospPA]

Hello,
This is my first time posting in this forum, and had to give my take. I am a PA who was previously an RN, BSN. I had to decide whether to go to PA school or NP school about 6 years ago. NP school would have been much easier and cheaper for me given there being one or more programs in every major city across the nation. One of the main reasons I chose to go to PA school was the medical model. Frankly, and this is not meant to be a flame, nursing diagnosis is a joke. It is like trying to reinvent the wheel. I became aware of this the first day it was brought up in undergrad nursing school. I was thinking, what the heck is this trying to do? After further analysis, all I could think of was, "trying to reinvent the wheel". Why would one describe dehydration as alteration in hydration status as evidenced by poor skin turgor or whatever?
I have a lot of respect for nurses and the nursing profession in general, but nursing diagnosis and the explanation and reasoning given by nursing for it is laughable. There is no need at all for it. Just my humble opinion. Now a question to all you nurses and NP's, do you really believe in this stuff or is it just a way to justify your stance on independent practice? Seriously, I really want to hear. Most NP's I know and work with think nursing dx. is a bunch of bunk as well. In my experience, the one's who believe in it are in a university somewhere, never laying their hands on patients. Thanks in advance for your responses.
Pat, RN, PA-C, MPAS

 

[fab4fan]

I want to be clear that I am in no way saying that there is no place for NPs or that their education is inferior to a PA's education. I have my memories of working with PAs who had undergrad degrees totally unrelated to anything remotely medical (like accounting). It's already been explained before what is required to get an NP, so I'm not going to restate it.

I also have memories of working with NPs who had tremendous clinical skills and knowledge. I think the patients they care for would have something to say to those of you who sniff at their supposed "lesser" knowledge.

 

[sones]

By Sones


Did you use nursing diagnosis through BSN? Is it a large portion of undergraduate training as a nurse?

Unfortunately, we did use a lot of nursing diagnoses throughout the BSN training. YUCKY!! I, as a nurse, have never found something to be so much a waste of my time. I am not trying to discredit my profession in doing this, but other than a training activity for nursing training, I don't see the relevance! Thank goodness I have had none of that in my Master's training. I need to add that I felt that it was a very good activity for nurses to do in training. The diagnoses made the "front line troops"so to speak be able to differentiate what were some of the problems facing a patient (outside of the obvious medical ones) and come up with interventions to assist in accomlishing goals. It was a very good exercise in organization, thinking, and planning. After school, it's bullsh......t. Not all of our training was this however. In my training I took a great deal of science, pharmacology, nutrition, pyschology etc. My clinical classes consisted of some of the "nursing theory"by a lot of it was pathophysiology, assessment, physiology, anatomy, and various =clinical skills for tha particular patient population. My current training is all physiology, pharmacology, and anesthesia (chemistry, physics etc)

 

[hospPA]

Yep!

 

[thehealingart04]

By Fab4

I also have memories of working with NPs who had tremendous clinical skills and knowledge. I think the patients they care for would have something to say to those of you who sniff at their supposed "lesser" knowledge.

As long as you realize that you're disseminating between nursing skills and medical skills. In that case of the accountant and the BSN the two are going into graduate training with the same medical training. That would be ZERO. How could it be different given nursing's adherence to the nursing model throughout training? Some degree required patho or chem or similar classes do not pass for medical model training. Those BSN requisites may help prepare for functioning within it, but it is not medical model training. So, where do NPs get medical model clinical skills?

BSNs train in the nursing model, which shuns the thought of even being related to medical model to the point of inventing nursing diagnosis to prove its point. What I have found of the nursing model after having been exposed to it myself, is what others have already stated and the reason that it is granted its own little world with a BON as a distinct governing body. Why would graduate training, which is a logical extension of the nursing model, prepare a midlevel to function in both the nursing model and the medical model?


The aforementioned accountant would have to complete the science prerequisites with a GPA >3.5 and get relevent patient care experience to be competitive for most programs. That would mean that the accountant starting graduate work has just as much science as the BSN since the BSN would be required to complete a science core to satisfy degree requirements. So, what prepares the accountant to function in the medical model as a midlevel? Apparently, from a small random sample, 3xs the credit hours of graduate level work, 1000-1500 more real clinical hours in the medical model, generalist approach of being exposed to all medical disciplines, postgraduate residency, a national licensing exam that is all medical model and the expectation that the exam must be passed periodicly to keep that license. This is just as I would have expected from an NP program that is producing nurses that can diagnose and treat the same diseases. Woudn't you? I mean, if you weren't a nurse maybe a patient of thiers, wouldn't you expect the person licensed to diagnose your disease and recommending a treatment course to be exstensively trained in the medical model?


So, I wholeheartedly agree that by the time a BSN is completed, most are adequately trained in clinical skills. The NP has a vast amount of clinical knowledge with which to draw on in treating patients. As can be shown by the training in the nursing model (as evidenced by ) throughout undergraduate training, it is in nursing theory and in no way mirrors the judgement of a medical model clinician nor does it intend to.

So, where do NPs get the medical model training? What programs have we failed to review that make up for the agreed deficit in medical model diagnosis and treatment of disease?

I hate to be blabbing away without any NPs joining the discussion. The problem seems clear to me but it always does. Maybe some can relate thier experience and discuss how they feel about medical model training in thier school. Perhapse some can show programs that take the deficit of medical model training in undergrad to heart or BSN programs with more than nursing theory to offer.

Maybe, NPs don't care. They have what they want. What they don't know they can look up or ask the doc and they're comfortable with whatever they think they need to know. Maybe all that medical model training is more than they need to do thier specialty.

 

[thehealingart04]

By Sones

Unfortunately, we did use a lot of nursing diagnoses throughout the BSN training. YUCKY!! I, as a nurse, have never found something to be so much a waste of my time. I am not trying to discredit my profession in doing this, but other than a training activity for nursing training, I don't see the relevance!

I wanted to also make it clear that I'm not trying to make nursing model training seem irrelevent or discredit the profession either. I am only making the point that it isn't relevent to midlevel diagnosis and treatment of disease. It is very relevent to the discussion of nursing model vs medical model training, which is the goal of the thread's OP.

 

[fab4fan]

Maybe, NPs don't care. They have what they want. What they don't know they can look up or ask the doc and they're comfortable with whatever they think they need to know. Maybe all that medical model training is more than they need to do thier specialty.

Not taking the bait on this one.

 

[thehealingart04]

Bait?

Only if you think there's a hook in there somewhere.

There were multiple examples of real programs and intelligent rhetoric on the topic. There hasn't been much coming from the NPs however, and I guess that's because there is nothing to contribute in the way of new information that hasn't already been covered. I will assume then that the contrast between NP/PA and medical/nursing models that has been presented is accurate and the summary is fair.

Off to Miami tomorrow, then Key West for a week
Take care everyone!

 

[RnMd007]

So I'm a BSN student trying to decide between NP or MD for my further experience and practice; here is my two cents.

For the NANDA nursing diagnoses/care plans, it really is a bunch of crap. But for a student with little to no experience in a clinical setting recognizing problems from an assessment, it is actually helpful. Think about it. If my nursing diagnoses is decreased Cardiac Output r/t altered HR and stroke volume AEB tachycardia and HTN. That could tell me a lot. It basically teaches how to connect the dots when you might not know the pathology. Now I have a year of clinical experience, I do all of this in my head second nature just like practicing RNs, NPs, etc. Still doing all the paperwork showing the nursing Dxs = crap.

On the NP, MD, PA front, I'm still hung on the fence. I realize that NP and PA is similar ( I acknowledge there are differences). They are both mid-level. NP seems to build on the pathophysiology from the undergrad RN education. We are learning a lot of pathologies and the physiology, etiology, diagnostics, treatment, and patient education behind he pathology. For many programs I have researched, at least of two years of experience is required which means we are working in a clinical setting with these pathologies and the patients. Compare that to a PA student who probably does not have much practical clinical experience or education regarding pathologies and their 2000 hours of clinicals during school.

Trying to decide between NP and MD has been very difficult. Thus far, many NPs have taught me in the lecture courses and the clinical courses. I ask the instructor questions and they have no response that satisfies my question. I love learning about pathologies and pharmaceuticals on a much deeper level than we are taught. Nursing is an art and science and based on countless feedback, I have mastered the art. Now I want to master the science and TBH I'm terrified NP school wont be detailed enough. But am I ready to commit myself to another year of pre-reqs after graduation, four years med school, at least three for residency, and a possible fellowship?

 

[Zenman1]

So I'm a BSN student trying to decide between NP or MD for my further experience and practice; here is my two cents.

For the NANDA nursing diagnoses/care plans, it really is a bunch of crap. But for a student with little to no experience in a clinical setting recognizing problems from an assessment, it is actually helpful. Think about it. If my nursing diagnoses is decreased Cardiac Output r/t altered HR and stroke volume AEB tachycardia and HTN. That could tell me a lot. It basically teaches how to connect the dots when you might not know the pathology. Now I have a year of clinical experience, I do all of this in my head second nature just like practicing RNs, NPs, etc. Still doing all the paperwork showing the nursing Dxs = crap.

On the NP, MD, PA front, I'm still hung on the fence. I realize that NP and PA is similar ( I acknowledge there are differences). They are both mid-level. NP seems to build on the pathophysiology from the undergrad RN education. We are learning a lot of pathologies and the physiology, etiology, diagnostics, treatment, and patient education behind he pathology. For many programs I have researched, at least of two years of experience is required which means we are working in a clinical setting with these pathologies and the patients. Compare that to a PA student who probably does not have much practical clinical experience or education regarding pathologies and their 2000 hours of clinicals during school.

Trying to decide between NP and MD has been very difficult. Thus far, many NPs have taught me in the lecture courses and the clinical courses. I ask the instructor questions and they have no response that satisfies my question. I love learning about pathologies and pharmaceuticals on a much deeper level than we are taught. Nursing is an art and science and based on countless feedback, I have mastered the art. Now I want to master the science and TBH I'm terrified NP school wont be detailed enough. But am I ready to commit myself to another year of pre-reqs after graduation, four years med school, at least three for residency, and a possible fellowship?

Have you talked with MDs with years of practice? I've seen very few recommend their kids go into medicine but have seen them recommend PA/NP. When you all have to put up with a lot of bull from others, especially insurance companies, maybe spending less money and time on your education is a plus…maybe not.

 

[sarjasy]

For the NANDA nursing diagnoses/care plans, it really is a bunch of crap. But for a student with little to no experience in a clinical setting recognizing problems from an assessment, it is actually helpful. Think about it. If my nursing diagnoses is decreased Cardiac Output r/t altered HR and stroke volume AEB tachycardia and HTN. That could tell me a lot. It basically teaches how to connect the dots when you might not know the pathology. Now I have a year of clinical experience, I do all of this in my head second nature just like practicing RNs, NPs, etc. Still doing all the paperwork showing the nursing Dxs = crap.

OK, first. For some reason, your statement here annoys me. Can't quite put my finger on it. Perhaps its your "student" knowledge lightly seasoned with arrogance.

BTW, your "AEB" is physiologically incorrect (e.g. sinus tach increases CO), but I really don't care because no one does nursing dx's in the real world, especially practicing NP's. Furthermore, no one cares about nursing dx's except academic nurses, because normal people realize they are bunk. I will concede that they can be helpful for a student just learning nursing interventions to a certain degree, but in the end, they are nonsense.

NP seems to build on the pathophysiology from the undergrad RN education. We are learning a lot of pathologies and the physiology, etiology, diagnostics, treatment, and patient education behind he pathology. For many programs I have researched, at least of two years of experience is required which means we are working in a clinical setting with these pathologies and the patients.

Yes, NP is designed to build on all that and yes, prerequisite or concurrent experience should be mandatory, but unfortunately, it is not in many cases.

Compare that to a PA student who probably does not have much practical clinical experience or education regarding pathologies and their 2000 hours of clinicals during school.

That is one reason (but not all) why PA programs have more clinical hours that NP programs, as many basic/fundamental clinical skills taught in nursing school and/or already mastered by the RN need to be taught to many entering PA students.

Trying to decide between NP and MD has been very difficult. Thus far, many NPs have taught me in the lecture courses and the clinical courses. I ask the instructor questions and they have no response that satisfies my question.

Don't assume that they reason they don't know something is because they are NP's. I had many questions in my undergrad BSN and shortly after graduating that I could find no one to answer. E.g. why does the H&H drop in acute bleeds, when equal proportions of RBC's and serum/plasma are lost? Two NP's, a DO and two MD's could not answer the question. After I figured it out on my own, it was an ICU RN that confirmed it for me.

I love learning about pathologies and pharmaceuticals on a much deeper level than we are taught. Nursing is an art and science and based on countless feedback, I have mastered the art. Now I want to master the science and TBH I'm terrified NP school wont be detailed enough. But am I ready to commit myself to another year of pre-reqs after graduation, four years med school, at least three for residency, and a possible fellowship?

Three things. (1) The depth that you describe is theoretically taught in whatever school to lay the foundation of acquiring real-world, practical, day-to-day clinical knowledge, the utility of much of it, however, is debatable. The detailed molecular action of Xarelto on factor Xa is quickly forgotten by most after med school (if they even learned it in the first place). And I doubt there are many endocrinologists who could accurately sketch the Kreb's cycle in regard to its relevance to DKA. (2) The depth of what you learn in school entirely up to you -- your motivation and ability to accurately grasp it and retain it, regardless of where you go to school or what path you choose. (3) You have not mastered the art of nursing.

Having said that, if you are of traditional age or thereabout (I assume you are based on how your post is written), just go to med school. 7 years isn't much at your age in the grand scheme of things. Just suck it up and do it.