andersenpa Posted August 5, 2009 Share Posted August 5, 2009 This issue has been getting under my skin lately. I have been reading the coverage of the recent articles from CNN and Time that we discuss here, in particular the responses on allnurses. Of course I have to provide my PA disclaimer.....I work with NPs.....about a dozen of them at my institution. I have never had a negative experience with any of them, and have no need to write a "hit piece". We confer, they give medical feedback, I give surgical, etc....collegial and pleasant. That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc..... I really don't see this as NP bashing, but I see these comments as somewhat elitist....or at least "leading the argument". The NPs I work with practice the same medicine (!) as the rest of us, PAs, MDs, etc. Their preop cardiac workups look just like any other. And they're good. A clinic NP treating OM...are they really offering that much of an edge over a non-NP due to their nursing background? What does the nursing backgroud teach about listening, empathy, and thinking about interdependent body systems that our medical model education does not? This all seems like a phoney selling point that is SO subjective that there is no way to argue it, putting NPs in a position which is easy to defend and impossible to refute. Thoughts? Do you feel like you treat your patients any less holistically b/c you were trained in the medical model? Link to comment Share on other sites More sharing options...
SilverPA Posted August 5, 2009 Share Posted August 5, 2009 I work with an NP who was not well trained, and I see her spend 30 minutes with a child presenting with a cough and runny nose. As I have never been in the exam room with her, I don't know exactly what she does, although in meetings she presents herself as "thoroughly educating" a patient before she lets them go home. The problem is that she prescribes antibiotics 90% of the time and decongestant meds to toddlers under 2 ALL THE TIME!!! Ultimately, I don't care if you think you're more touchy/feely than those trained in the medical model because if you practice bad medicine, then you are doing the patient a disservice. Oh but then I forgot, she is practicing advanced nursing and not medicine. Perhaps that's where I go wrong. Perhaps in nursing the evidence shows that everyone does better with antibiotics no matter what the cause of the illness. Not NP bashing - really! This is simply one nurse practitioner who was obviously poorly trained. I get on other providers, including PAs and MDs, who do the same thing. The proof would be in the pudding though. I have much better outcomes with my diabetic patients than the NP because I spend time educating my patients so that they understand their disease process and can self-treat their disease. So which is better? I don't believe this particular NP has the understanding of pathophys enough to clearly educate her patients - no matter what she contends. Just my opinion. Link to comment Share on other sites More sharing options...
dfwpa Posted August 5, 2009 Share Posted August 5, 2009 The treating the whole patient/holistic approach is something DOs have claimed since the beginnings of osteopathic medicine. Yes, it irks me as I think about nutrition and emotional well being in my patients all the time....but I'm not going to take out an add in the local paper saying so....the Chinese herbalist/accupuncturist/chiropracters in the area spend big money doing that already. Here's a link from the AACOM website explaining the history of the osteopathic profession. Sounds like the NPs are just rehashing parts of this for their own purposes: http://www.aacom.org/about/osteomed/Pages/History.aspx Link to comment Share on other sites More sharing options...
brookspa Posted August 5, 2009 Share Posted August 5, 2009 Sounds like a nursing school mantra to me. Been there -got the T shirt , mostly female profession and that is their claim to fame. (maternal, caring, thoughtful; kind blah blah ) This is just carried over to the NP side of the program. Just a thought.. for the uninformed as to what really happens in the trenches...nurse pt ratios, seeing 40 pts a day and doing it well. occasionally the fine points of social graces suffer but not our compassion or professionalism. Link to comment Share on other sites More sharing options...
jmj11 Posted August 5, 2009 Share Posted August 5, 2009 About a year ago I was leading a meeting in Boston that was made up of about 1/3 physicians, almost 2/3 NPs (with one other PA besides me). I went around the room having the provider talk about their practice. In that setting, the PA made the statement that while PAs have shorter training than MDs, they offer better care because they are much better at treating the “whole patient.” I honestly felt embarrassed. None of the physicians said anything, but I could only imagine what they were thinking. Yes, I too think it is rhetoric. Link to comment Share on other sites More sharing options...
jdenning Posted August 5, 2009 Share Posted August 5, 2009 Any good clinician treats the "whole patient" - they do their homework, they listen, they do good follow up, and most of all they convey a sense that they actually care about what happens to the patient. There is no way on earth that nurses are the "only ones" capable of doing it. And it doesn't matter at all what model you were trained in. It's just good patient care. Link to comment Share on other sites More sharing options...
Febrifuge Posted August 6, 2009 Share Posted August 6, 2009 I'm just starting out, so I was kind of hoping I could treat, say, the left side of patients on even days, and the right side on odd days. Obviously I'd have a colleague work with me to cover the other half, so the whole patient would be cared for at some point or another every day of their stay in the hospital. Treating the whole patient sounds like a lot of work! ;) Link to comment Share on other sites More sharing options...
roman6163 Posted August 6, 2009 Share Posted August 6, 2009 That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc..... Do you feel like you treat your patients any less holistically b/c you were trained in the medical model? I remember seeing a poor 40-year old Navy Chief who came in to see me for excruciating testicular pain for 3 days. His scrotum was the size of a cantaloupe. He came to sick call three days earlier for testicular pain and was seen by a Navy NP. She diagnosed him as having a touch of epididymitis and sent him on his merry way on ABX without getting a scrotal US. The poor guy ended up loosing his left testicle on top of a week of unnecessary horrible pain and discomfort all because this Navy NP didn't know how to practice medicine. But I'm sure she was a great nurse and was good at coddlying and pampering patients. If I were a patient, I want a provider who knows MEDICINE and can address my medical problem. I've never seen a PA miss something this obvious and certainly never seen a doctor miss something this big either. I know anyone could and everyone makes mistakes. But this nurse cost a Navy chief his testicle. Just my personal experience. Link to comment Share on other sites More sharing options...
dfwpa Posted August 6, 2009 Share Posted August 6, 2009 I remember seeing a poor 40-year old Navy Chief who came in to see me for excruciating testicular pain for 3 days. His scrotum was the size of a cantaloupe. He came to sick call three days earlier for testicular pain and was seen by a Navy NP. She diagnosed him as having a touch of epididymitis and sent him on his merry way on ABX without getting a scrotal US. The poor guy ended up loosing his left testicle on top of a week of unnecessary horrible pain and discomfort all because this Navy NP didn't know how to practice medicine. But I'm sure she was a great nurse and was good at coddlying and pampering patients. If I were a patient, I want a provider who knows MEDICINE and can address my medical problem. I've never seen a PA miss something this obvious and certainly never seen a doctor miss something this big either. I know anyone could and everyone makes mistakes. But this nurse cost a Navy chief his testicle. Just my personal experience. I've got a 28 yof patient who's a widow.....a local doctor kept telling her late husband....who was 24 at the time that his testicular pain was nothing to worry about. After 3 visits where the doctor told him the same thing and not to worry about it (and not ordering a sonogram), the deceased ignored it for another 3 months before having shortness of breath that brought him to the ER. His CXR showed extensive cannonball mets....he died a couple of months later. This local doctor prides himself and even brags to drug reps that he sees 50-60 patients a day. I've had patients who used to see him say he'd literally walk in a room, ask 2-3 questions, occasionally look or touch, and walk out....rarely spending more than 3 minutes with each patient. Just goes to show you anyone can be a bad clinician....doesn't matter what letters follow you name on your white coat. Link to comment Share on other sites More sharing options...
Joelseff Posted August 8, 2009 Share Posted August 8, 2009 I told a family member of a pt of mine that I was going to start PA school in the fall. She happened to be a nurse. She said "So you only see patients as diseases???" I asked her what did she mean and she said "Well if you want to treat the whole patient you would be a NP." I told her jokingly that if I wanted to treat the WHOLE pt, I would be there for hours. She smirked and said "well nothing beats being a nurse." I just smiled and went back to work all the while in my head thinking "she actually believes this crap." I worked with NP's actually one wrote me an LOR, I never observed her "treating the whole pt." That concept is so intangible it's ridiculous. They must learn it in school... Link to comment Share on other sites More sharing options...
brookspa Posted August 8, 2009 Share Posted August 8, 2009 like i said , mantra, they do teach it in school Link to comment Share on other sites More sharing options...
EsperPA Posted August 8, 2009 Share Posted August 8, 2009 They cram and cram and cram that crap down our throats while in nursing school. Some buy into it, and even fewer buy into it when they are in the real world. I've only met a few nurses (usually MSNs or DNPs i.e. educators) and not a single nurse practitioner that believes in that deception. It really is a rare occurrence. We even have a name for them called "Ivory Tower Nurses." Nurses (usually in education) looking down upon on the little peasants below passing out judgement on their lack belief in a bullcrap ideology. Link to comment Share on other sites More sharing options...
Iain1028 Posted August 8, 2009 Share Posted August 8, 2009 That "Holistic Nursing Theory" NP stuff is a bunch of crap. They treat pt's exactly as anyone else does. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 8, 2009 Moderator Share Posted August 8, 2009 I'm just starting out, so I was kind of hoping I could treat, say, the left side of patients on even days, and the right side on odd days. Obviously I'd have a colleague work with me to cover the other half, so the whole patient would be cared for at some point or another every day of their stay in the hospital. Treating the whole patient sounds like a lot of work! ;) HEEEEE HEEEEE HEEEEE that made me laugh 1/2 way through a 12 hr shift... thanks Link to comment Share on other sites More sharing options...
istat2 Posted August 8, 2009 Share Posted August 8, 2009 Psyops at its finest :cool:! It does show one thing if we are having this discussion. Look at the propaganda for both professions. Its fairly obvious the Nurses are smoking the AAPA. Link to comment Share on other sites More sharing options...
roman6163 Posted August 8, 2009 Share Posted August 8, 2009 I guess a Nurse Practitioner could never work in Podiatry then............ Link to comment Share on other sites More sharing options...
rcdavis Posted August 9, 2009 Share Posted August 9, 2009 Several of my attendings, when I was a snuffy PA, taught me to present in rounding patients in a slightly different manner;presenting the social history right after the chief complaint: Professor Smith is here for evaluation of her abdominal pain. She is a 45 year old college english professor who lives locally in the city,, has a daughter who visits her daily, drinks no alcohol, but consumes a pack of cigarettes a day and has for 20 years, and rides horses every weekend at her small farm in the country. She started having this pain...(continuing on with the traditional HPI, PMH, expanded SH, etc) The attendings feeling were that starting each presentation with a little bit of "who the patient is" immediately forces you to start considering her circumstances as you consider the data. Infact it worked, immediately I noted that everyone on the team would start thinking of the patient as who she was, not what she had. I guess that is sorta holistic. Works for me, and I am a pretty scientific guy. BTW, the attendings were surgeons. v/r davis Link to comment Share on other sites More sharing options...
Joelseff Posted August 9, 2009 Share Posted August 9, 2009 I agree RC but isn't taking a social hx part of a complete hx and would this not be in a way "treating the whole pt?" I mean I guess I should ask them to quantify their statement next time it comes up. Link to comment Share on other sites More sharing options...
picupnp Posted August 9, 2009 Share Posted August 9, 2009 As a practicing NP, I can tell you that this holistic crap that some NPs are pushing is just a load of crap. Anybody that is human has the capability to render holistic care! I agree with the Ivory Tower theory. This crap about treating the whole person is just a tag line that some NPs are using to further divide the PAs and NPs. I work with PAs daily and they could care for me or my family. These elitists need to get on with their lives. Link to comment Share on other sites More sharing options...
PADad Posted August 10, 2009 Share Posted August 10, 2009 Great discussion item! I have had this conversation several times in the last few months. I used to think that nursing was supposed to be holistic. Now, I am hearing more and more about nursing specialization in the hospital. Advanced skills are not made, they are very good. But, the incidence occurs in nurses explaining what they do and don't do. Example: ICU nurse transferring pregnant patient to high-level antepartum service after almost 3 weeks on step-down, "I don't know here pregnancy status. That is not my specialty." Example: LDR nurse floating to GYN floor: " I don't do patient education. That is not my specialty." Example: ED nurse with 33 week pregnant patient in ED. "I called for an OB nurse because I don't do fetal heart rates. That is not my specialty." I am seeing this type of "specialization" and lack of holistic attention more prevalent among large, ANCC Magnet Hospitals. It is common among new RN grads and increasingly among the older RNs. I see and believe and majority of floor nurses do provide care in a holistic manner. But, I am concerned about an increasing trend among nursing education and administration towards less-integrated and holistic and some perverse attempt to gain recognition and respect. :cool: Link to comment Share on other sites More sharing options...
rcdavis Posted August 10, 2009 Share Posted August 10, 2009 Great discussion item! ...... Example: ED nurse with 33 week pregnant patient in ED. "I called for an OB nurse because I don't do fetal heart rates. That is not my specialty." QUOTE] would be given an opportunity to become educated, or a letter of reference to her next job... because she is not working in my ED with that attitude and incapacity. In ANY ED, at ANY level of RN (RN, CEN, CEPN, etc) FHT are part of the business. (as you all know, I am just reacting to the absurdity of that statement) v/r davis Link to comment Share on other sites More sharing options...
tigerlily Posted July 28, 2012 Share Posted July 28, 2012 Perhaps in nursing the evidence shows that everyone does better with antibiotics no matter what the cause of the illness. No, not really. I'm just a LPN and even I know the negative the risks of antibiotic overuse, and effects of antibiotic resistance. It sounds like she has a problem. Link to comment Share on other sites More sharing options...
tigerlily Posted July 29, 2012 Share Posted July 29, 2012 Hmmm, that's no bueno Link to comment Share on other sites More sharing options...
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