What Is the Difference Between "Nursing" and the Rest of Medicine?

[Zenman1]

Pretending something is real, and comforting a patient by doing so, doesn't make it real.

Lol, well that was certainly well thought out....

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[Zenman1]

BS. I have also studied shamanism, of various flavors. I have lead rituals and taken my turn on ropes to erect a circle of standing Stones on sacred land. When I say voodoo, I am not being irreverent, because I have danced with the Loa and sung to my anscestors.

When I say that there is a role for priests, I mean it. That place is not a clinic.

Tell your patients and your employer that you are practicing magic, not medicine, and I will respect you. What I am offended by is that you try to dress one up as the other. That you have done so successfully enough to be granted some degree of credibility only proves that you are a skilled huckster and that those you exploit are inadequately informed.

Edit: I haven't ignored you yet because I don't like to just silence people I disagree with, unless their behavior invites it. Though, it may be the only way that I can stop wasting my time responding to your foolishness.

Chief of psychiatry here respects me, as do the staff, and he feels must of what we do is little better than placebo. I'll tell you what. Give me some time and I'll show you how myself and others are practicing shamanism in hospitals, clinics, etc.. and you might be surprised. It's perfectly fine if you want to strictly follow tenarrow path of medicine but what do you do when you've run out of options. I seem to have trouble getting an answer to that.

 

[el_duderino]

Lol, well that was certainly well thought out....

I could pretend that the Flying Spaghetti Monster is real, and a gullible patient who doesn't know better could find their anxiety and depression effectively treated by this.

Does that make the Flying Spaghetti Monster real? Of course not. Maybe if we name it the Flying Energy Aura it becomes real, since energy is in fact a real thing and we can tap dance around the issue.

You are apparently some kind of combination shaman/therapist/NP. What are you doing on a student doctor website besides stirring the pot?

 

[ChEMD]

Well at least this thread came with a new twist on the nursing vs. medicine debate, didn't see that one coming.

 

[Promethean]

...what do you do when you've run out of options. I seem to have trouble getting an answer to that.

One doesn't "run out of options" in medicine. You can always be present and support your patient through their trouble, even if you don't have a cure for it. That is an appropriate role for a physician or a nurse. You can help them learn coping strategies, or help them reframe the problem so that it is more manageable, etc. That is legitimate psychiatric care.

But if they want a priest, you should refer them to one, not try to take on the role yourself.

 

[TLCfromSC]

First, let me acknowledge that this will may lead to a flame war. That isn't my intention. With that said, I have a question I’d like to have answered by my nursing colleagues:


As one buddy said some time ago (and I quote loosely), “It’s basically a mix of fluff BS and indoctrination with some sensible practice related things at the heart of providing day to day care that physicians and other healthcare providers don’t have time or don’t care to be burdened with.”

I wanted the take of a few nurses. Is this true? If not, can you explain to me, in your own words, what is so distinct about “nursing” as compared to “medicine?” I wouldn’t even mind a block of text from a nursing book. I would ask that any commentators, including physicians or medical students, try to keep this professional. I think spirited debate is ok, but let’s try to keep this collegial.

A "textbook" definition of nursing: Nursing is the diagnosis, care, and treatment of HUMAN RESPONSES to actual or potential health problems, concerns, or life processes.

From the American Nurses Association:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

There are six essential features of professional nursing:

1. Provision of a caring relationship that facilitates health and healing,
2. Attention to the range of human experiences and responses to health and illness within the physical and social environments,
3. Integration of objective data with knowledge gained from an appreciation of the patient or group's subjective experience,
4. Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking,
5. Advancement of professional nursing knowledge through scholarly inquiry, and
6. Influence on social and public policy to promote social justice.

 

[Zenman1]

Well at least this thread came with a new twist on the nursing vs. medicine debate, didn't see that one coming.

You should always expect the unexpected.

 

[Zenman1]

One doesn't "run out of options" in medicine. You can always be present and support your patient through their trouble, even if you don't have a cure for it. That is an appropriate role for a physician or a nurse. You can help them learn coping strategies, or help them reframe the problem so that it is more manageable, etc. That is legitimate psychiatric care.

But if they want a priest, you should refer them to one, not try to take on the role yourself.

That's good, but do you realize how many times a physician might say, "I'm sorry there's nothing else I can do" and that's really all they can do? There's individual differences of course based on personalities or other life experiences. That's why I'm stirring the pot. Many don't realize, because they have one tool, that there is more you might do.

Where you getting this "priest" stuff from?

 

[Zenman1]

A "textbook" definition of nursing: Nursing is the diagnosis, care, and treatment of HUMAN RESPONSES to actual or potential health problems, concerns, or life processes.

From the American Nurses Association:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

There are six essential features of professional nursing:

1. Provision of a caring relationship that facilitates health and healing,
2. Attention to the range of human experiences and responses to health and illness within the physical and social environments,
3. Integration of objective data with knowledge gained from an appreciation of the patient or group's subjective experience,
4. Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking,
5. Advancement of professional nursing knowledge through scholarly inquiry, and
6. Influence on social and public policy to promote social justice.

I had some articles once on what was a nurse. Maybe I can locate them again.

 

[el_duderino]

That's good, but do you realize how many times a physician might say, "I'm sorry there's nothing else I can do" and that's really all they can do? There's individual differences of course based on personalities or other life experiences. That's why I'm stirring the pot. Many don't realize, because they have one tool, that there is more you might do.

Where you getting this "priest" stuff from?

Indeed, that's the time to send the patient to a priest or therapist and not pretend that shamanism is medicine.

 

[LiamNeesons]

 

[el_duderino]

Photoshop a prescription pad in there instead of a drum.

 

[Zenman1]

Then you might need these to go along with that pad.

 

[AnnoyedByFreud]

Do you like the Stahl prescriber's guide? I just saw that a new version came out recently. I'm trying to decide if I should buy it before starting my NP internship for the next year.

 

[fab4fan]

Wonderful, leave this forum and go to www.allnurses.com.

I hate to break it to you, but the "Clinicians Forum" is here for nurses, PAs, and the dreaded NPs to ask questions /discuss issues with their peers. Your poisonous attitude toward nurses is going to get you in trouble one day if you don't learn how to behave like a mature professional. For pity's sake, you're what...MS1, MS2? How much interaction could you possibly have had with nurses to have developed such a jaundiced attitude toward an entire profession?

 

[fab4fan]

Fantastic post, and THIS is the importance of great nurses. However none of this involves the "nursing theory", or "nursing diagnosis" fluff referred to earlier. That stuff was created by the nursing educator/nursing unions to create the divide between nursing/medicine.

Actually, nursing unions really have nothing to do with "nursing theory" or "nursing diagnosis." That claptrap came from nursing academia. It's only useful to teach students how to assess various diagnoses, and how to respond appropriately. Once out of school, they become basically irrelevant. Even if you're required to use them, most facilities have very formulaic nursing dx. that can be completed with checking boxes.

 

[fab4fan]

You should always expect the unexpected.

No one expects the Spanish Inquisition.

 

[Zenman1]

Do you like the Stahl prescriber's guide? I just saw that a new version came out recently. I'm trying to decide if I should buy it before starting my NP internship for the next year.

Yes, I like it. This is the latest edition, 5th. I like the way it is set up, quick and easy to review. Great if you're a visual person.

 

[Zenman1]

No one expects the Spanish Inquisition.

Historically they should have. Now, you better expect a different culture.

 

[fab4fan]

Whose culture?

 

[LiamNeesons]

For pity's sake, you're what...MS1, MS2? How much interaction could you possibly have had with nurses to have developed such a jaundiced attitude toward an entire profession?

I read the news. Reading influences my attitude. Sorry about that. Again, NP's, not nurses.

 

[AnnoyedByFreud]

I hate to break it to you, but the "Clinicians Forum" is here for nurses, PAs, and the dreaded NPs to ask questions /discuss issues with their peers. Your poisonous attitude toward nurses is going to get you in trouble one day if you don't learn how to behave like a mature professional. For pity's sake, you're what...MS1, MS2? How much interaction could you possibly have had with nurses to have developed such a jaundiced attitude toward an entire profession?

A lot of people seem to confuse things they read online with reality, especially on SDN. It seems there is a significant amount of med students (and even premeds - lol) who have decided they hate nurses, NPs, whatever... based off of what they have read on the internet. The internet. It makes me chuckle every time. I have a feeling those attitudes will become a bit more nuanced once these people get some actual work experience in a clinical setting.

 

[popopopop]

A lot of people seem to confuse things they read online with reality, especially on SDN. It seems there is a significant amount of med students (and even premeds - lol) who have decided they hate nurses, NPs, whatever... based off of what they have read on the internet. The internet. It makes me chuckle every time. I have a feeling those attitudes will become a bit more nuanced once these people get some actual work experience in a clinical setting.

This is the worst part about the forums for me.

 

[LiamNeesons]

A lot of people seem to confuse things they read online with reality, especially on SDN. It seems there is a significant amount of med students (and even premeds - lol) who have decided they hate nurses, NPs, whatever... based off of what they have read on the internet. The internet. It makes me chuckle every time. I have a feeling those attitudes will become a bit more nuanced once these people get some actual work experience in a clinical setting.

I read on the AANP website that NP's can practice independently in 19 states. I also read about the NP qualifications and curriculum. But since I read those things on the internet I guess they aren't reality. Rock solid logic. You must be a NP. Case and point.

 

[popopopop]

I read on the AANP website that NP's can practice independently in 19 states. I also read about the NP qualifications and curriculum. But since I read those things on the internet I guess they aren't reality. Rock solid logic. You must be a NP. Case and point.

No, I think AnnoyedByFreud is saying that SDN gives the impression to med students like you (and pre-meds) that NPs are this evil, militant group of people that are out to make money and steal your jobs. Most of this is paranoia and reinforcing stereotypes seen on these boards. I enjoy reading both sides of the discussion, but it's a lose-lose situation for the nursing side. If I try to fight every stereotype, I would have to defend the awesome DO's I've worked with and go over to the "surgeon dinguses" debate and defend all the cool general surgeons I work with. I can bet my life that the majority of us are decent people who are just trying to do our jobs as best as we can and go home to our kids and loved ones. I didn't even know about this NP movement until I started coming here. However, I don't disagree with SDN that NP school curriculums need to change. Every time I see an attack on nurses and NPs, I just wish the people behind the keyboards can appear in real life, go up to the wonderful NPs and physicians who hired them and say everything straight to their faces.

 

[LiamNeesons]

Etc.

 

[AnnoyedByFreud]

I read on the AANP website that NP's can practice independently in 19 states. I also read about the NP qualifications and curriculum. But since I read those things on the internet I guess they aren't reality. Rock solid logic. You must be a NP. Case and point.

NPs have been practicing independently in some states for over 20 years. What's your point? Also, there is a variance in NP training, it's true. This includes the existence of many excellent programs that train highly competent NPs. To carry a bias against an entire profession when you haven't even worked with any of these individuals in a clinical setting is asinine. I don't carry a bias against DOs even though I know the barriers for entry to DO school are less than those for MD school (lower GPA, MCAT scores, etc.) The vitriol on SDN is just not reflective of the reality of day-to-day practice, which I'm sure you will learn someday when you actually start practicing. In my experience, MDs/NPs/PAs get along just fine on provider teams. The anesthesiologist I work in research for recommends that people become CRNAs.

 

[LiamNeesons]

NPs have been practicing independently in some states for over 20 years. What's your point?

No problem. Quick recap:

You said it's bad when people read the internet because the internet is not reality.

I said I read news on the internet which is reality. Reality influences my opinion.

That was my point.

 

[oldiebutgoodie]

"No one expects the Spanish Inquisition."

Historically they should have. Now, you better expect a different culture.

Ummm... Zenman, that was a reference to a Monty Python sketch, not an invitation for more lecturing.

Oldiebutgoodie

 

[fab4fan]

"No one expects the Spanish Inquisition."



Ummm... Zenman, that was a reference to a Monty Python sketch, not an invitation for more lecturing.

Oldiebutgoodie

I have a feeling that pedants have their humor surgically removed, OBG. Glad you caught the reference.

 

[fab4fan]

View attachment 183867

Etc.

Have you ever read that book? Of course not. I have, and other than that line on the front of the book, you'd be hard pressed to find it full of nursing propaganda. I hope you don't use the same cursory method of studying that you use to prove that nurses are the enemy.

 

[AnnoyedByFreud]

Have you ever read that book? Of course not. I have, and other than that line on the front of the book, you'd be hard pressed to find it full of nursing propaganda. I hope you don't use the same cursory method of studying that you use to prove that nurses are the enemy.

Now now, stop using reason. Clearly taking the tagline off of a book written by one RN is all you need to write off the entire profession.

 

[fab4fan]

Yes, I should know better. Being reasonable is one of my major faults.

 

[LiamNeesons]

Have you ever read that book? Of course not. I have, and other than that line on the front of the book, you'd be hard pressed to find it full of nursing propaganda. I hope you don't use the same cursory method of studying that you use to prove that nurses are the enemy.

Great argument. Again, my point: I've read multiple perspectives on the internet which do reflect reality (news articles, books, national organization websites). I commend your recognition that a single statement doesn't necessarily represent an entire profession. That's great logic, and you're well on your way to critical thinking.

However, again, I am arguing that my gut feeling towards NP's is a culmination of researching reality. It's no different than someone agreeing with republican or democratic principles even though they have never been a US senator. I do not need "real world experience" to disagree with fundamental principles.

Moreover, I don't need to read a book to have an opinion about a statement on its cover, and I am not trying to prove that nurses are the enemy. I am stating my opinion about nurse practitioners, and believe me, I'm not alone. If you don't that like that fact, I'm sorry that you signed up for nursing, but that's not my problem.

 

[fab4fan]

Gee, thank you so much for that backhanded compliment about my critical thinking skills. Bless your pea pickin' heart.

BTW, why are you a plural Liam Neeson? Did someone else already have that screen name?

 

[LiamNeesons]

You're welcome.

http://www.cc.com/video-clips/xwnjlx/key-and-peele-liam-neesons

 

[Nasrudin]

But the AMA never did that because they didn't want to increase the number of physicians and risk lowering salaries, even in the face of a huge shortage. That is why NP/PA roles exist. I was having a discussion with another medical student on here who basically said that the NP/PA role is the AMA's fault for protectionism and allowing a huge shortage of docs in order to keep salaries high. They have refused to start training physicians faster and have clung to tradition, so other fields have sprung up. He stated that he thought it would make more sense to allow medical training to be more on a continuum where people can stop off and then get back on (ie: get some training and become a practicing PA, more and become a generalist doc, even more and then you're a specialist, etc.) Something alone those lines. The idea is that the current physician training model is outdated and inflexible. Others vehemently disagree with this line of thinking.

What I'm trying to say is that one really shouldn't blame NPs/PAs for existing when their existence could have been easily prevented had the field of medicine paid attention and opened more medical schools or tried to do something about the looming physician shortage. Perhaps more expedited training models would have helped. However, other people in medicine believe really strongly that by expediting anything in medical education you are cheapening the brand, so no change ever happens = awesome opportunity for NPs to step up. I am aware that there are a couple of 3 year training models being created for primary care physicians (NYU is one, if I recall correctly), but it seems like the cat is already out of the bag at this point. Plus, given the absolutely terrifying amount of student debt most med students take on these days, I completely understand why they avoid lower paying specialties like the plague. Unfortunately, this just keeps the shortage of PCPs going, which opens up more opportunities for NPs.

It would be a convenient moral scapegoat to blame the militant political agenda of NP expansion on the artificial demand orchestrated by physicians. But that is a total fabrication. One that assuages the inherent guilty feeling you must have when you assume the role of a psychiatrist with a fraction of the effort, sacrifice, and expense.

Aside from that you've made some good points. And I don't blame nurses for wanting to be NP's. I certainly would. And that's exactly what is driving this. Smart, energetic, ambitious people who want to expand their scope of practice and their salary. Period.

 

[Zenman1]

"No one expects the Spanish Inquisition."



Ummm... Zenman, that was a reference to a Monty Python sketch, not an invitation for more lecturing.

Oldiebutgoodie

Like I'd even store a Monty Python sketch in my hard drive....

 

[oldiebutgoodie]

Like I'd even store a Monty Python sketch in my hard drive....

It's not stored on my hard drive, it's on "the cloud". It's stored at Youtube. Just an FYI.

Although I do love that sketch so much, maybe I should store it on my hard drive.

Oldiebutgoodie

 

[oldiebutgoodie]

Oh well, Liamneesons has been banned. So much for erudite and thoughtful discussion on the function and role of the NP.

 

[Zenman1]

It's not stored on my hard drive, it's on "the cloud". It's stored at Youtube. Just an FYI.

Although I do love that sketch so much, maybe I should store it on my hard drive.

Oldiebutgoodie

No, no...meaning I wouldn't waste the space in my brain storing any info about Monty Python!

It would be a convenient moral scapegoat to blame the militant political agenda of NP expansion on the artificial demand orchestrated by physicians. But that is a total fabrication. One that assuages the inherent guilty feeling you must have when you assume the role of a psychiatrist with a fraction of the effort, sacrifice, and expense.

Aside from that you've made some good points. And I don't blame nurses for wanting to be NP's. I certainly would. And that's exactly what is driving this. Smart, energetic, ambitious people who want to expand their scope of practice and their salary, as well as increased knowledge in order to make a difference in their patient's lives. Period.

Fixed that for you.

 

[AnnoyedByFreud]

It would be a convenient moral scapegoat to blame the militant political agenda of NP expansion on the artificial demand orchestrated by physicians. But that is a total fabrication. One that assuages the inherent guilty feeling you must have when you assume the role of a psychiatrist with a fraction of the effort, sacrifice, and expense.

Aside from that you've made some good points. And I don't blame nurses for wanting to be NP's. I certainly would. And that's exactly what is driving this. Smart, energetic, ambitious people who want to expand their scope of practice and their salary. Period.

Haha, I just saw this reply. Honestly, nasrudin, I don't feel guilty at all, just pragmatic. The bolded portion captures how I feel to some extent, though I should add that I'm most excited about relieving people's suffering and specifically working with patients who are underserved, Spanish-speaking only, etc. That's the main driver for me. I feel bad for the med students who slave away, but then again they will make more money in the long run, assuming they don't attend an absurdly expensive DO/Carib school and then enter a specialty that compensates poorly. It was their choice to attend medical school and take out all that debt. They will have greater opportunities. Plus, NP school isn't all fluff and sunshine like it is often characterized here on SDN. Is it as difficult and challenging as medical school? Certainly not. But for going through that hell you have the opportunity to reap enormous benefits that NPs could never touch. Can you please explain how what I said is a fabrication? I have heard many physicians state frustration with the AMA and how they have placed limits on the number of physicians in order to keep demand and salary high. I'm interested in being corrected, if that's an incorrect assessment of the situation. I'm aware that the federal government limits funding for residency spots, but a significant number of those spots go to IMGs, no? Hasn't the AMA also been very reluctant to open new medical schools for decades, despite a shortage of docs?

 

[fab4fan]

Like I'd even store a Monty Python sketch in my hard drive....

Yes, because you're above humor and all that.

 

[Nasrudin]

It would be a convenient moral scapegoat to blame the militant political agenda of NP expansion on the artificial demand orchestrated by physicians. But that is a total fabrication. One that assuages the inherent guilty feeling you must have when you assume the role of a psychiatrist with a fraction of the effort, sacrifice, and expense.

Aside from that you've made some good points. And I don't blame nurses for wanting to be NP's. I certainly would. And that's exactly what is driving this. Smart, energetic, ambitious people who want to expand their scope of practice and their salary. Period. Except doing it by training like a pansy and expecting people to take you seriously.

Fixed that for me.

 

[Zenman1]

Yes, because you're above humor and all that.

Actually I'm a smarta$$ afflicted with genetic hiliarity, as are all my kin folks. Very rarely can anyone out-quip me.

 

[Zenman1]

Fixed that for me.

Quess that explains why my schedule is full....

 

[fab4fan]

Actually I'm a smarta$$ afflicted with genetic hiliarity, as are all my kin folks. Very rarely can anyone out-quip me.

It's a good thing you're so humble; statements like those might lead people to think you're arrogant as all get out.

 

[sarjasy]

I wanted the take of a few nurses. Is this true? If not, can you explain to me, in your own words, what is so distinct about “nursing” as compared to “medicine?” I wouldn’t even mind a block of text from a nursing book. I would ask that any commentators, including physicians or medical students, try to keep this professional. I think spirited debate is ok, but let’s try to keep this collegial.

Despite the predictable devolution of this thread, in response to the OP, the distinction between medicine and advanced nursing practice is more nuanced than what many posters have suggested. Most nurses and even most nurse practitioners don’t understand what “advanced practice nursing” actually means.

Ironically, the APN role was invented by a physician. In the late 1950's Dr. Stead (who later created the first PA program) had the idea of creating a new kind of health care provider by taking experienced nurses and giving them additional clinical training that built on the nurse’s previous education and experience, and hence advance and extended their knowledge, role, scope of practice, and skills for the purpose of handling routine medical conditions and chronic care that had previously only been handled by physicians. The first nurse to take on this role was Thelma Ingles, who was trained by Stead and other Duke physicians alongside medical students and residents. Ingles wrote “"[W]e came out with the idea that the nurse was qualified to do a great many things in patient care that had not been seen as part of her role. We even went so far as to project into the future that we were going to have our graduates in the master's program working in the clinic as responsible individuals in care, that patients would be told to come in and see 'the nurse.' And she would be paid a per-visit call same as the doctor. We thought that this was particularly relevant to patients with chronic disease. We saw her as having much greater input into the diagnosis and treatment and follow-up than had ever been done in the past. But we knew that we had to move slowly.” (emphasis mine).

Hence, the entire original, historical concept was to expand nursing scope of practice to take on roles that at the point were only performed by medicine. Hence the term “advanced practice nursing.” Duke via Stead and Ingles created the first MSN program for this purpose. It was, however, short-lived mainly due to the inability to gain accreditation. Stead held on to the basic idea, however, and went on to establish a program to create another kind of provider that didn't rely on training experienced nurses and expanding their scopes of practice. Instead he turned to providing training to military corpsmen and created the physician assistant.

Essentially, the entire NP profession was founded on the concept of advancing nursing practice with the intent of expanding nursing scope of practice to include things historically performed only by physicians, hence, those things historically part of medicine became part of nursing too. There was once a time that nurses weren’t allowed to take a blood pressure, or even take a temperature and read the result as these were the “practice of medicine” and not the “practice of nursing!” Advanced practice nursing simply means a broadened scope of practice for the nurse to include things once considered to be exclusively the practice of medicine.

 

[Zenman1]

It's a good thing you're so humble; statements like those might lead people to think you're arrogant as all get out.

Seriously? Statements like this is me telling you what is real. My Dad's funeral was this last Sat. and we had a hell of a fun time with all of us together. When we were pre-planning at the funeral home last week and were presented with the costs, my younger brother asked if they had a "lay-a-way plan" then burst out laughing. Fifteen years ago my Dad had a cardiac arrest in the doctor's office while telling the doc jokes. When I say something you can be sure I can prove it.

 

[Boatswain2PA]

....Hence, the entire original, historical concept was to expand nursing scope of practice to take on roles that at the point were only performed by medicine. Hence the term “advanced practice nursing.”....Essentially, the entire NP profession was founded on the concept of advancing nursing practice with the intent of expanding nursing scope of practice to include things historically performed only by physicians, hence, those things historically part of medicine became part of nursing too. There was once a time that nurses weren’t allowed to take a blood pressure, or even take a temperature and read the result as these were the “practice of medicine” and not the “practice of nursing!” Advanced practice nursing simply means a broadened scope of practice for the nurse to include things once considered to be exclusively the practice of medicine.

That's not quite accurate. Dr. Stead wanted to take the most experienced non-physician (ie: the nurse), and give them two years of training in MEDICINE, so that they could then practice MEDICINE under the supervision of a physician. He got the concept approved at Duke, but the ANA (aka the "nursing mafia") refused to let him use nurses because, in their domain, nurses practice nursing and doctors practice medicine. THAT is when he went to plan B and started the PA profession using military medics. Meanwhile the nursing mafia (the ANA and nursing academia) decided they liked the idea, but they weren't going to give up the political control of the nurse, so they created the Nurse Practitioner program in Colorado and labeled it "advanced nursing".