Medical model vs. nursing model

[crobe]

"keeping them alive" strikes me strange. Supporting the patient with an overall improvement in their quality of life seems to be a more well rounded end goal. Anyone can stick a tube in every orifice and put you in a virtual suspended animation. That's easy (comparatively). I think the trick to quality medical care is patient satisfaction with the end result. Getting there via a nursing model versus a medical model is really patient dependent. Different people will respond in their own way to different care providers.

 

I think it was more like "doctors prescribe and treat, but I am the one that keeps the patient alive," and truly if you are a nurse who is part of an ER that is understaffed and over capacity that is what you do. However, in that circumstance, the nurses are also patient and PA/MD advocates. Obviously, nursing in its most ideal form has an end goal of improving the patient's quality of life; my mother was just explaining how she sees her role in comparison to a medical practitioner. Rest assured Just Steve, she isn't just running around jabbing tubes into people treating them as if they aren't real.

 

 

 

@JoelSeff Its cool, no need to apologize!

[Just Steve]

I think it was more like "doctors prescribe and treat, but I am the one that keeps the patient alive," and truly if you are a nurse who is part of an ER that is understaffed and over capacity that is what you do. However, in that circumstance, the nurses are also patient and PA/MD advocates. Obviously, nursing in its most ideal form has an end goal of improving the patient's quality of life; my mother was just explaining how she sees her role in comparison to a medical practitioner. Rest assured Just Steve, she isn't just running around jabbing tubes into people treating them as if they aren't real.

 

 

 

@JoelSeff Its cool, no need to apologize!

 

First, I did not say anyone was actually treating patients with indifference and just jamming tubes in holes. My point was that the statement struck a strange cord... I drew nothing from that as a reflection of what is really going on. Second, after many years as a field paramedic getting teased with statements such as "how do you drive with your super hero cape flapping around so much" I have learned that the perception of what people have can be a long ways from the reality of what is going on.

 

Third, the team of providers is essential. Everyone is counted on from the neuro surgeon to housekeeping. If not for housekeeping the infection control rate would be abysmal and no amount of nursing or "doctoring" would be worth a darn. Similiarlyn if medical providers didn't write orders the nursing staff wouldn't have any direction to follow. everyone counts on each other. For a nurse to claim that they are the sole person who keeps patients alive strikes me strange.

[crobe]

First, I did not say anyone was actually treating patients with indifference and just jamming tubes in holes. My point was that the statement struck a strange cord... I drew nothing from that as a reflection of what is really going on. Second, after many years as a field paramedic getting teased with statements such as "how do you drive with your super hero cape flapping around so much" I have learned that the perception of what people have can be a long ways from the reality of what is going on.

 

Third, the team of providers is essential. Everyone is counted on from the neuro surgeon to housekeeping. If not for housekeeping the infection control rate would be abysmal and no amount of nursing or "doctoring" would be worth a darn. Similiarlyn if medical providers didn't write orders the nursing staff wouldn't have any direction to follow. everyone counts on each other. For a nurse to claim that they are the sole person who keeps patients alive strikes me strange.

 

I never said that she claimed to be the only one keeping patients alive. I'm pretty sure she has a lot to do with it though, because not only does she clean up people's piss, puke and poop, she administers medication, cleans wounds/changes bandages, draws blood, feeds patients along with a bunch of other stuff for 8-10 people. She's talking about her generalized perception of her role as an ER nurse in a hospital, she wasn't thinking of service techs, central suppy, nurse techs, house keeping, PAs, etc, because that's not what I had asked her. Since it seems to bother you, I'll inform you of the context of her response. At the time, I had been hearing from quite a few pre-med students that nurses were too dumb or lazy to become doctors, and I asked her how she felt about that and whether she had seen similar attitudes in doctors that she worked with. That was her response. Wouldn't you think it would be a little grandiose to for a RN would think that he/she was SOLELY responsible for keeping a patient alive? Sorry she didn't mention everybody in the hospital in relation to her role.

 

I think its a pretty accurate explanation given that I am often surrounded by various ER staff and I see what they do individually, I thought I'd share a nurse's opinion. What do YOU think the difference between the medical model and nursing model is?

[winterallsummer]

To the above poster - your mistake was in asking a pre-med for their opinion. The only thing pre-meds care to talk about is themselves, or didn't ya know that?? ;p

[Just Steve]

medical model: evidence based approach to the treatment of diagnosises based upon the gathering of a history and physical. Concurring re examination guide the success or failure of approach and guide the re direction if needed.

 

Nursing model: holistic approach to pt improvement via an overall, inclusive examination of patient's mental, emotional, and physical needs.

[crobe]

To the above poster - your mistake was in asking a pre-med for their opinion. The only thing pre-meds care to talk about is themselves, or didn't ya know that?? ;p

 

Ah no, I never asked for any of the pre-meds opinions. I suppose I wasn't clear, I was asking my mother, a nurse how she feels about pre-meds and doctors that might assume certain things about other kinds of medical providers.

 

And thank you Just Steve, I feel as though that's what I said.

[Just Steve]

I never disagreed with anything said here except when words got put in my mouth. A recalled statement, written a degree or two removed from the original speaker, struck me strange. I commented that I found it strange..and things when down a weird route. It's the internet...we don't all have to agree on everything all the time. If we all had the same thoughts all the time, the place would be boring.

[mrssmith1017]

I am just a plain ole nurse here. I work in an understaffed, overflowing level II trauma hospital. I work in the intensive care units.

I can tell you for one, it isn't easy to take care of patient full of tubes in "virtual suspended animation".

I can't speak for all nurses, but I certainly don't feel that we are the only ones saving their lives, but I do feel we have a big part of it. We run codes with or without a physician at bedside.

I've experienced numerous times practitioners looking for suggestions from us on certain treatments or orders. It's a team effort. I very much disagree that nurses only deal with fixing the patient at the time of what's going on. We have to deal with all the other disciplines to make sure the patient gets what they need after they're discharged.

I'm kind of all over the place here, but am just tired of nurses being knocked. We don't think we're smarter than the doctor, I didn't go to med school, but we do know more than just "holistic" treatment. I know where I work, my physicians trust my clinical judgement. No one in healthcare could do their job without the other disciplines efforts and skill.

[LESH]

No one in healthcare could do their job without the other disciplines efforts and skill.

Amen and great post mrssmith1017.

LesH

[Sirpaul1990]

Hello,

 

I am a UT Southwestern PA student and I have a blog with recent topics comparing a PA to Nurse Practitioners and Physicians (allopathic and osteopathic). I also have articles about the medical versus the nursing model you might find helpful. Take a look and subscribe.

 

DoseOfPA.blogspot.com

 

Thanks,

Paul

[LT_Oneal_PAC]

Hello,

 

I am a UT Southwestern PA student and I have a blog with recent topics comparing a PA to Nurse Practitioners and Physicians (allopathic and osteopathic). I also have articles about the medical versus the nursing model you might find helpful. Take a look and subscribe.

 

DoseOfPA.blogspot.com

 

Thanks,

Paul

^ below average comparison and contrast. Assumptions stated as facts with no evidence, heavy on physician glorification, watered down on the PA side, and too harsh on NP.

[wannabePA-S]

^ below average comparison and contrast. Assumptions stated as facts with no evidence, heavy on physician glorification, watered down on the PA side, and too harsh on NP.

 

Agreed with @Oneal. The entire article seems watered down.

 

"They also might give a lecture on hand washing and possibly try to make arrangements for you to miss work or school, if necessary."

 

The first part sounds like what every provider would tell a patient AKA infection control. And the second part sounds like a work note.

[coloradopa]

^ below average comparison and contrast. Assumptions stated as facts with no evidence, heavy on physician glorification, watered down on the PA side, and too harsh on NP.

Actually it overestimates the NP training. High on the clinical hours (500-750) required. Also overstates amount of experience nurses have prior to NP and its application. 

[LT_Oneal_PAC]

Actually it overestimates the NP training. High on the clinical hours (500-750) required. Also overstates amount of experience nurses have prior to NP and its application.

Proclamation without evidence. While I know the hours required for licensure is 500 for a masters, it is 1000 for a DNP. Most schools require over the 500. Even my the shotty NP school I attended required 750. If you have evidence to the contrary, please show it. I know I can find multiple schools requiring over 500. Of course they are all a far cry from PA requirements.

 

Secondly it says most have the minimum, 0-2000 hours, before application. Tell me how saying most have less than a year of experience is overestimating? You think they have negative years of experience? I bet I can go find stats showing the average being >1 year, can you find one that says less?

 

The test of my comments stand that it was weak on PAs and places physicians on a pedestal. How is 150weeks in 4 years 2-3 times education that PAs get? Math doesn't make sense. There are other parts as well, but that isn't the subject of your comment.

 

Lastly, why are you always harping on me when I'm only trying to be even handed, Dave? I'll always agree PA education is better. I remember reading you're unbiased nature on SDN, all nurses, and here when I was just starting and deciding what I want to be. It really shaped me. Now it seems the only time you chime in is if someone has said anything remotely positive about NPs

[LT_Oneal_PAC]

Also the only reason I commented on the blog is because I'm tired of seeing ads for student blogs on how to get into PA school, PA vs NP, blah blah, hoping to one day get money from a website or book deal. Students aren't experts in any of these subjects.

[coloradopa]

Proclamation without evidence. While I know the hours required for licensure is 500 for a masters, it is 1000 for a DNP. Most schools require over the 500. Even my the shotty NP school I attended required 750. If you have evidence to the contrary, please show it. I know I can find multiple schools requiring over 500. Of course they are all a far cry from PA requirements. Secondly it says most have the minimum, 0-2000 hours, before application. Tell me how saying most have less than a year of experience is overestimating? You think they have negative years of experience? I bet I can go find stats showing the average being >1 year, can you find one that says less? The test of my comments stand that it was weak on PAs and places physicians on a pedestal. How is 150weeks in 4 years 2-3 times education that PAs get? Math doesn't make sense. There are other parts as well, but that isn't the subject of your comment. Lastly, why are you always harping on me when I'm only trying to be even handed, Dave? I'll always agree PA education is better. I remember reading you're unbiased nature on SDN, all nurses, and here when I was just starting and deciding what I want to be. It really shaped me. Now it seems the only time you chime in is if someone has said anything remotely positive about NPs

I reply because I'm sick of people putting up NP Koolaid as fact. I called you out on the your comment that there were many studies that showed NP equivalence to physicians. I'll call you out here. Show me one single requirement that a DNP has to have 1000 hours. There isn't one because there are no standards for DNP. There is a recommendation from AACN but its widely ignored. You can get a DNP and not be an NP. We have CNL doing it here. So it doesn't mean that they have more hours. In addition because you say so is exactly what you complain about. There are two studies that I am aware about which look at NP hours. One is from 1994 and showed ANP hours at 597 hours on average. Range 180 to 1600 (although 1600 represented the Davis and Stanford dual programs). The other study that I am aware of was by the State of California and looked at Typhon data from state NP and PA programs. From what I remember NP between 550 and 800. Davis in the middle at around 1800 and Riverside with something like 2400. If you have other studies that show actual NP hours as opposed to anecdote please show them. 

 

From an experience standpoint there are two issues. One the unknown number of direct entry NPs and RNs that have gone directly to NP because they have been unable to find RN jobs. There is no data at all on what the average NP has in terms of experience. The other is how the nursing experience (if it exists) is directly relevant to NP practice. 

 

If you want to say proclamation without evidence then show some evidence. Not Koolaid. 

 

That being said the PA part is wrong in a number of areas. If you count vacations etc for PA programs its unlikely that you can come up with 100 weeks. It probably averages more like 95 over all the programs (remembering there are a few 18 month programs and one 36 month program). I would also think that the statement that PAs graduate with 2000 clinical hours is suspect. The average is probably around there but like everything its a range. Also the description of ARC-PA is hard to understand. 

 

From the NP standpoint he has a number of things wrong. AACN is American Association of Collages of Nursing. There is no requirement for 700-1400 hours in a specialty for certification. 

[LT_Oneal_PAC]

I reply because I'm sick of people putting up NP Koolaid as fact. I called you out on the your comment that there were many studies that showed NP equivalence to physicians. I'll call you out here. Show me one single requirement that a DNP has to have 1000 hours. There isn't one because there are no standards for DNP. There is a recommendation from AACN but its widely ignored. You can get a DNP and not be an NP. We have CNL doing it here. So it doesn't mean that they have more hours. In addition because you say so is exactly what you complain about. There are two studies that I am aware about which look at NP hours. One is from 1994 and showed ANP hours at 597 hours on average. Range 180 to 1600 (although 1600 represented the Davis and Stanford dual programs). The other study that I am aware of was by the State of California and looked at Typhon data from state NP and PA programs. From what I remember NP between 550 and 800. Davis in the middle at around 1800 and Riverside with something like 2400. If you have other studies that show actual NP hours as opposed to anecdote please show them.

 

From an experience standpoint there are tow issues. One the unknown number of direct entry NPs and RNs that have gone directly to NP because they have been unable to find RN jobs. There is no data at all on what the average NP has in terms of experience.

 

If you want to say proclamation without evidence then show some evidence. Not Koolaid.

Safety of the NP. Not all are RCT, but many are.

 

http://m.rheumatology.oxfordjournals.org/content/33/3/283.short

 

http://m.thorax.bmj.com/content/57/8/661.short

 

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2648.1999.01071.x/abstract;jsessionid=7965FE4236700F9794E2420A284D8435.f02t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false

 

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2648.2002.02431.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

 

http://jama.jamanetwork.com/Mobile/article.aspx?articleid=192259

 

 

Here is one program that requires 1000 hours, like you asked. If you google DNP 1000 hours you'll find plenty:

http://nursing.missouri.edu/academics/dnp/pdfs/d5-documentation-of-1000-hours.pdf

 

Here is a link that shows CCNE accreditation of a DNP program requires 1000 hours. Look under question 6. I tried to copy the quote directly but the phone is not cooperating:

 

http://www.aacn.nche.edu/ccne-accreditation/DNP-FAQs.pdf

 

I could not find any facts about average years of experience. Not that I find it important since they still can enter with zero experience. I only contest that the average was less than a year. Since no one can say, then perhaps we shouldn't be speculating either way.

[Joelseff]

Also the only reason I commented on the blog is because I'm tired of seeing ads for student blogs on how to get into PA school, PA vs NP, blah blah, hoping to one day get money from a website or book deal. Students aren't experts in any of these subjects.

They spam this place with these "advice blogs" which I think are more self pats on the back for them. And when do you have time to blog if you are a PA-S anyway?

 

 

 

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[coloradopa]

Safety of the NP. Not all are RCT, but many are.

 

http://m.rheumatology.oxfordjournals.org/content/33/3/283.short

 

http://m.thorax.bmj.com/content/57/8/661.short

 

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2648.1999.01071.x/abstract;jsessionid=7965FE4236700F9794E2420A284D8435.f02t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false

 

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2648.2002.02431.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

 

http://jama.jamanetwork.com/Mobile/article.aspx?articleid=192259

 

 

Here is one program that requires 1000 hours, like you asked. If you google DNP 1000 hours you'll find plenty:

http://nursing.missouri.edu/academics/dnp/pdfs/d5-documentation-of-1000-hours.pdf

 

Here is a link that shows CCNE accreditation of a DNP program requires 1000 hours. Look under question 6. I tried to copy the quote directly but the phone is not cooperating:

 

http://www.aacn.nche.edu/ccne-accreditation/DNP-FAQs.pdf

 

I could not find any facts about average years of experience. Not that I find it important since they still can enter with zero experience. I only contest that the average was less than a year. Since no one can say, then perhaps we shouldn't be speculating either way.

The question was about studies showing NP clinical hours. No real reply there. I assume that you agree that there are no studies or reports out there. As for the rest you chose to compare NP practice to physician practice in an attempt to show the hours don't matter?

 

You posted four British studies and the one US study. Are you aware of the training differences, educational differences and practice differences between the UK and the US? Given the different practice environment its pretty much impossible to compare NP practice in the UK with that of the US. You did correctly identify the one NP vs physician RCT. You quoted the six month interim analysis that was published in JAMA? Why did you not quote the end of the 2 year study? For extra credit look at the number of patients lost to follow up. 

As for you other posts, did you bother to read them? The Missouri sheet you show clearly shows that the program counts MSN hours as part of the DNP. So yes the DNP should have a total of 1000 hours between NP and DNP but thats a far cry from your statement "While I know the hours required for licensure is 500 for a masters, it is 1000 for a DNP. " If you meant that the total hours required for a DNP are 1000 then I misunderstood you. The AACN paper also differentiates between <2009 programs and >2010 programs which have very different program requirements. Going forward there are two different standards in play (one which requires 1000 hours and one that doesn't. There is also at least one other accreditation organization that I am aware of (although there has been some consolidation in nursing accreditation programs). 

 

The AACN is an attempt to expand the hours required (which was the finding of the Canadian College of Nursing's study of Canadian NP programs) in order to better prepare NPs for practice. 

 

I'll stand by my statement. There is exactly one RCT which shows compares NPs to physicians over a six month period. There are any number of studies that compare NP (or PA) care of patients to residents when both are under the supervision of physicians. There are also any number of studies that compare NP (and PA) care of patients in collaboration with physicians. I'll agree that there are no studies that show NP hours are insufficient for supervised practice. However, there is a strong self selection bias for NPs that choose to work as NPs. In addition nursing organizations are increasingly placing limitations on the breadth of NP practice. 

[LT_Oneal_PAC]

The question was about studies showing NP clinical hours. No real reply there. I assume that you agree that there are no studies or reports out there. As for the rest you chose to compare NP practice to physician practice in an attempt to show the hours don't matter?

 

You posted four British studies and the one US study. Are you aware of the training differences, educational differences and practice differences between the UK and the US? Given the different practice environment its pretty much impossible to compare NP practice in the UK with that of the US. You did correctly identify the one NP vs physician RCT. You quoted the six month interim analysis that was published in JAMA? Why did you not quote the end of the 2 year study? For extra credit look at the number of patients lost to follow up.

As for you other posts, did you bother to read them? The Missouri sheet you show clearly shows that the program counts MSN hours as part of the DNP. So yes the DNP should have a total of 1000 hours between NP and DNP but thats a far cry from your statement "While I know the hours required for licensure is 500 for a masters, it is 1000 for a DNP. " If you meant that the total hours required for a DNP are 1000 then I misunderstood you. The AACN paper also differentiates between <2009 programs and >2010 programs which have very different program requirements. Going forward there are two different standards in play (one which requires 1000 hours and one that doesn't. There is also at least one other accreditation organization that I am aware of (although there has been some consolidation in nursing accreditation programs).

 

The AACN is an attempt to expand the hours required (which was the finding of the Canadian College of Nursing's study of Canadian NP programs) in order to better prepare NPs for practice.

 

I'll stand by my statement. There is exactly one RCT which shows compares NPs to physicians over a six month period. There are any number of studies that compare NP (or PA) care of patients to residents when both are under the supervision of physicians. There are also any number of studies that compare NP (and PA) care of patients in collaboration with physicians. I'll agree that there are no studies that show NP hours are insufficient for supervised practice. However, there is a strong self selection bias for NPs that choose to work as NPs. In addition nursing organizations are increasingly placing limitations on the breadth of NP practice.

Ok. Cool.

[JohnnyM2]

They spam this place with these "advice blogs" which I think are more self pats on the back for them. And when do you have time to blog if you are a PA-S anyway?

 

Ok, well, most of the advice on this forum needs to be taken in the context of the person giving it. If you read enough posts, you can begin to understand who knows something and who is just full of b.s.

Why in particular, would you object to a PA-S giving advice about PA school or how to get in? In all likelihood, no one is completely qualified to give this advice since the schools are all different to some degree and the admission requirements are constantly changing. That having been said, students who have applied more than once and/or to multiple schools, and been accepted, probably have as good an idea as anyone how to get accepted. If they want to promote their advice blogs, that's ok. No one has to read them or watch their videos but some are pretty good. Isn't it, after all, the purpose of this forum to share advice, knowledge and experiences with others? Despite its imperfections, I find the forum to be very useful and have found some great information, though I recognize much of the advice needs to be taken with a grain of salt or verified through other sources. I guess I am just a big believer in freedom of expression, a belief apparently not shared by some freaky moderator who thought himself/herself the guardian of pc and deleted my witiest piece of advice. Oh well.

 

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[JohnnyM2]

 

Oops! The first paragraph, above, was by Joelseff. The second was a reply by Johnny M2. Sorry, Joelseff. I didn't mean to make it look like you wrote my paragraph.

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[Joelseff]

It's one thing to offer your advice but another to post it in every pre pa category hoping to get hits, that's called spam...whatever...

 

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[JohnnyM2]

Ok. I get that it really bugs you so I won't press the point.

 

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[Lymphonucleosis]

The nursing "model" is one that focuses on the patient as a whole and looks to prevent rather then treat. When I was learning the model it felt very unscientific and more of memorization then understanding and logical reasoning.

 

For example a medical diagnosis would be, "hypertension"

 

A nursing diagnosis would be "high blood pressure related to eating poorly and low exercise as evidenced by the patient stating it"

 

The nursing model seeks to eliminate all medical terminology and ideology from its diagnoses and theories. This is inherently flawed however since nursing operates WITHIN the medical and scientific field. They would always tell us that we can't diagnose but we can NURSING diagnosis, o good!