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

[OCDEMS]

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:

I was recently reading a rather controversial blog post over at www.kevinmd.com, which many of you may recognize as one of the leading physician blogs on the Internet. The article was basically about how nurse practitioners consider the term “mid-level” provider insulting. I digress, because that is not the point of this thread nor do I want to devote time to hashing out the viewpoints already expressed in that blog’s comments section. While reading, I was perplexed by the number of NPs who kept saying, almost verbatim, “I don’t practice medicine, I practice advanced nursing.” I was reading this and was like, “What does that even mean?” “What is this advanced nursing you’re speaking of?”

To clarify, I’m very familiar with the role of nurse practitioners. I understand the politics of the profession and also know that the NP vs. MD/DO debate has been played out on this forum ad nauseam. I would ask anyone who replies to avoid getting stuck in such a debate, again. I have several friends who are nurses, some of them BSN prepared, and every one that I’ve ever asked to describe “nursing theory” to me has said it’s basically BS. When I’ve asked them to give me the official party line, they basically recite that it’s a “holistic” approach to patient centered care involving “nursing care plans” and “nursing diagnosis.” Basically, from my conversations with them, these things seem to be entirely engineered theories meant to distinguish nursing from the larger house of medicine that few of them believe in or take seriously. 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.

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[Nymphicus]

One important technicality is that the practice of nursing is regulated and overseen by the board of nursing while the practice of medicine is overseen by the board of medicine. The board of medicine can't regulate the scope of nursing practice.

 

[AnnoyedByFreud]

I am of the belief that advanced practice nursing (to clarify, I am referring to the role of the NP, CNM, CRNA, not so much the CNS) is not different from practicing medicine. If TPTB in medicine hadn't allowed for such a huge physician shortage, then the creation of alternate roles to fill in the gap (PAs, NPs, etc.) would never have flown. The reason it is referred to as a form of nursing is so that it can be regulated by the BON.

 

[pamac]

^i pretty much agree with that. When you get down to basics, what NPs are ultimately talking about is that they are overseen be the board of nursing. Many NPs may not even have come to that conclusion, but when they find it impossible to delineate the difference, then all we can do is run with our own ideas. Id go further and say that it's advanced nursing because a nurse with additional training is practicing it, and is overseen by the BON. More holistic than medicine?.... my tail feathers.

 

[Promethean]

One important technicality is that the practice of nursing is regulated and overseen by the board of nursing while the practice of medicine is overseen by the board of medicine. The board of medicine can't regulate the scope of nursing practice.

This is not accurate at all. In my state, the nursing board is explicitly subordinate to the medical board. The docs have absolute authority over the nurses scope here.

And that is the entire problem with the nursing profession. Nurses are limited in how they talk about what they do because they are explicitly forbidden to do anything that might cross the line into practicing medicine. So, in order to care for patients in a practical sense, they must go through convoluted dances to avoid stepping on medical toes.

We can't say, "The patient has diarrhea." Or rather, we aren't supposed to. That is technically a medical diagnosis, beyond our scope. What we are expected to say, what we are taught in nursing school to say, is "The patient is experiencing an alteration in elimination, related to bowel continence, as evidenced by loose stools, fecal urgency, etc." Of course, practically, we stop saying that as soon as we are not in school or under the scrutiny of a regulator, because no one else in medicine has time to listen to us reel all that out. It isn't that we are too dense to call it diarrhea, or that we enjoy having to the facts out with a lot of fluff and theory... it is that we are pushed into that position.

To answer the original question, the difference between nursing and medicine is that nursing is about the practicalities of direct patient care, whereas medicine is more to do with the theory. Docs know they want the patient to receive a certain amount of a drug, nurses know how to administer it safely. Physicians know that the patient is at risk for skin breakdown, nurses know what interventions to employ to prevent it.

I can't speak too much about advanced practice nursing. I've personally decided that if I want an expanded role, the best way to go about it is to study medicine, not nursing. Less verbal yoga, more hard science.

 

[pamac]

This is not accurate at all. In my state, the nursing board is explicitly subordinate to the medical board. The docs have absolute authority over the nurses scope here.

And that is the entire problem with the nursing profession. Nurses are limited in how they talk about what they do because they are explicitly forbidden to do anything that might cross the line into practicing medicine. So, in order to care for patients in a practical sense, they must go through convoluted dances to avoid stepping on medical toes.

We can't say, "The patient has diarrhea." Or rather, we aren't supposed to. That is technically a medical diagnosis, beyond our scope. What we are expected to say, what we are taught in nursing school to say, is "The patient is experiencing an alteration in elimination, related to bowel continence, as evidenced by loose stools, fecal urgency, etc." Of course, practically, we stop saying that as soon as we are not in school or under the scrutiny of a regulator, because no one else in medicine has time to listen to us reel all that out. It isn't that we are too dense to call it diarrhea, or that we enjoy having to the facts out with a lot of fluff and theory... it is that we are pushed into that position.

To answer the original question, the difference between nursing and medicine is that nursing is about the practicalities of direct patient care, whereas medicine is more to do with the theory. Docs know they want the patient to receive a certain amount of a drug, nurses know how to administer it safely. Physicians know that the patient is at risk for skin breakdown, nurses know what interventions to employ to prevent it.

I can't speak too much about advanced practice nursing. I've personally decided that if I want an expanded role, the best way to go about it is to study medicine, not nursing. Less verbal yoga, more hard science.

That may not be accurate at all in your state, but in mine and many (most?) others, the BON isn't subordinate to the BOM. However, the case you are making is eloquent and might have some truth to it, especially the part where you talk about nurses dealing with the practicality vs theory, as well as us being expected to describe a condition rather than refer to the diagnosis. That's why everyone gets frustrated when they buy a nursing diagnosis book to use for school, and can't make heads or tails if what they are reading. We go on to never use that book again because we just refer to what the doctor diagnoses, and run with it. But even your description doesn't account for hands on medicine and procedures, nor the role of the NP, which is decidedly less aligned with the nursing methods and more in line with medicine.

 

[Promethean]

That may not be accurate at all in your state, but in mine and many (most?) others, the BON isn't subordinate to the BOM. However, the case you are making is eloquent and might have some truth to it, especially the part where you talk about nurses dealing with the practicality vs theory, as well as us being expected to describe a condition rather than refer to the diagnosis. That's why everyone gets frustrated when they buy a nursing diagnosis book to use for school, and can't make heads or tails if what they are reading. We go on to never use that book again because we just refer to what the doctor diagnoses, and run with it. But even your description doesn't account for hands on medicine and procedures, nor the role of the NP, which is decidedly less aligned with the nursing methods and more in line with medicine.

Which is why I, and many others, don't really understand the NP role. It blurs the line between nursing and medicine, claiming all the while to be entirely the former and not at all the latter.

I see them go out of their way to pay homage to their nursing background, to such an extent that they deny that they are treading into medical territory. That is, in large part, where a lot of the discomfort comes in for people outside the nursing profession. They see something quacking like a duck and swearing it is a swan. It looks disingenuous and possibly sinister, breeding an us vs. them paranoia among doctors. If the nursing profession were to honestly admit that its advanced practitioners are practicing nursing-flavored medicine, that they are essentially PAs with a broader clinical history, that would cut at the foundations of the BS mountain they make their novices climb. They would have to throw away all those nursing diagnosis manuals.

Don't get me started on those. One of the reasons I am turning my back on the profession is that it has allowed "Energy Field Disturbance, related to situational stressors, as evidenced by alterations in aura pattern and brightness" to be a legitimate nursing diagnosis for so long. I know that virtually no one in practice uses that voodoo, but the fact that it is sanctioned and taught makes me ill.

OMM may or may not be voodoo, but it does at least involve something as tangible as the musculoskeletal system.

 

[deleted480308]

Imagine if you will a board of archery and a board of firearms. both can accomplish simple things like shoot that deer at 20yrds. But, by the time you are shooting a rabbit at 100yrds, a board of firearms trained hunter is all but required. now imagine a few archers realized there wasn't always a board of firearms hunter around when they needed one, so they buy a few rifles and try to teach themselves how to use them. eventually they say they are just as good at shooting that rabbit at 100yrds and they want to do so, they call themselves advanced practice archers or archer practitioners. The board of firearms gets upset and says you don't have the approved training from the board of firearms. The archer practitioners (with gunpowder residue on their fingers) says they aren't under the board of firearms because they are archers. They just practice "advanced archery".

I don't care how advanced your archery is, if you are using a .30.06 rifle.....you are in board of firearms territory.

 

[el_duderino]

Imagine if you will a board of archery and a board of firearms. both can accomplish simple things like shoot that deer at 20yrds. But, by the time you are shooting a rabbit at 100yrds, a board of firearms trained hunter is all but required. now imagine a few archers realized there wasn't always a board of firearms hunter around when they needed one, so they buy a few rifles and try to teach themselves how to use them. eventually they say they are just as good at shooting that rabbit at 100yrds and they want to do so, they call themselves advanced practice archers or archer practitioners. The board of firearms gets upset and says you don't have the approved training from the board of firearms. The archer practitioners (with gunpowder residue on their fingers) says they aren't under the board of firearms because they are archers. They just practice "advanced archery".

I don't care how advanced your archery is, if you are using a .30.06 rifle.....you are in board of firearms territory.

This was.. interesting, lol.

 

[Promethean]

I don't care how advanced your archery is, if you are using a .30.06 rifle.....you are in board of firearms territory.

That is a complex, testosterone-laden analogy, but I think it captures at least one view of the issue. I will be interested to see if it recieves a counter argument/alternate imagery.

I don't disagree. As I said, I think that NPs are essentially PAs with a background in a practical clinical discipline. I am courting flames to say it, but I think that the intraprofessional turf wars could be mitigated if it were admitted that they are practicing medicine in much the same way as PAs, and so they should be administered by the Board of Medicine.

 

[el_duderino]

I don't disagree. As I said, I think that NPs are essentially PAs with a background in a practical clinical discipline. I am courting flames to say it, but I think that the intraprofessional turf wars could be mitigated if it were admitted that they are practicing medicine in much the same way as PAs, and so they should be administered by the Board of Medicine.

This might be dropping a bomb in the thread, but saying the above is akin to saying "the abortion debate could be mitigated it it were admitted that abortions end human lives, and the debate should be over which circumstances in which this is permissible."

 

[deleted480308]

This might be dropping a bomb in the thread, but saying the above is akin to saying "the abortion debate could be mitigated it it were admitted that abortions end human lives, and the debate should be over which circumstances in which this is permissible."

<----best bomb emoticon I could find

 

[Promethean]

This might be dropping a bomb in the thread, but saying the above is akin to saying "the abortion debate could be mitigated it it were admitted that abortions end human lives, and the debate should be over which circumstances in which this is permissible."

And yet, that is my position on that matter as well. At parties, I stick to talk about the weather and local sports teams.

EDIT: I actually think that is an astute comparison. In both cases, discomfort with the demonstrable fact of the matter leads to semantic obfuscation which only empowers the extreme ends of the debate, at the expense of the rational and the moderate.

EDITED once more for subject verb agreement. My superego is a verbose grammarian.

 

[OCDEMS]

Which is why I, and many others, don't really understand the NP role. It blurs the line between nursing and medicine, claiming all the while to be entirely the former and not at all the latter.

I see them go out of their way to pay homage to their nursing background, to such an extent that they deny that they are treading into medical territory. That is, in large part, where a lot of the discomfort comes in for people outside the nursing profession. They see something quacking like a duck and swearing it is a swan. It looks disingenuous and possibly sinister, breeding an us vs. them paranoia among doctors. If the nursing profession were to honestly admit that its advanced practitioners are practicing nursing-flavored medicine, that they are essentially PAs with a broader clinical history, that would cut at the foundations of the BS mountain they make their novices climb. They would have to throw away all those nursing diagnosis manuals.

Don't get me started on those. One of the reasons I am turning my back on the profession is that it has allowed "Energy Field Disturbance, related to situational stressors, as evidenced by alterations in aura pattern and brightness" to be a legitimate nursing diagnosis for so long. I know that virtually no one in practice uses that voodoo, but the fact that it is sanctioned and taught makes me ill.

OMM may or may not be voodoo, but it does at least involve something as tangible as the musculoskeletal system.

Ok, I’m glad most people have a similar opinions to what I’ve already heard: that it is an essentially made up fairy tale meant to justify independence from the medical board and create “distinctiveness” among two profession that are, over time, completing the same mission.

Let me make a suggestion: Why don’t we, as the medical profession, step up and say, “Ok, if you want to be physicians, then start your own medical schools just like DOs did over a 100 years ago. Make sure you model the education on the way we do things, complete with a 3-step licensing exam that contains similar material and we’ll create a third pathway to becoming a physician. Allopathic physicians, osteopathic physicians, and nurse physicians.”

I just think this is the safest way to address what everyone knows is coming: nurse practitioners slowly entering into more and more fields of medicine. Now, when I’ve made this suggestion before, I get the same argument: “We’re practicing nursing, not medicine.” Since everyone here has established that particular argument is BS, can we move on to how we bring nursing into the fold?

 

[deleted480308]

Ok, I’m glad most people have a similar opinions to what I’ve already heard: that it is an essentially made up fairy tale meant to justify independence from the medical board and create “distinctiveness” among two profession that are, over time, completing the same mission.

Let me make a suggestion: Why don’t we, as the medical profession, step up and say, “Ok, if you want to be physicians, then start your own medical schools just like DOs did over a 100 years ago. Make sure you model the education on the way we do things, complete with a 3-step licensing exam that contains similar material and we’ll create a third pathway to becoming a physician. Allopathic physicians, osteopathic physicians, and nurse physicians.”

I just think this is the safest way to address what everyone knows is coming: nurse practitioners slowly entering into more and more fields of medicine. Now, when I’ve made this suggestion before, I get the same argument: “We’re practicing nursing, not medicine.” Since everyone here has established that particular argument is BS, can we move on to how we bring nursing into the fold?

why would they? they are winning the legislative battle to do it their way

 

[AnnoyedByFreud]

Ok, I’m glad most people have a similar opinions to what I’ve already heard: that it is an essentially made up fairy tale meant to justify independence from the medical board and create “distinctiveness” among two profession that are, over time, completing the same mission.

Let me make a suggestion: Why don’t we, as the medical profession, step up and say, “Ok, if you want to be physicians, then start your own medical schools just like DOs did over a 100 years ago. Make sure you model the education on the way we do things, complete with a 3-step licensing exam that contains similar material and we’ll create a third pathway to becoming a physician. Allopathic physicians, osteopathic physicians, and nurse physicians.”

I just think this is the safest way to address what everyone knows is coming: nurse practitioners slowly entering into more and more fields of medicine. Now, when I’ve made this suggestion before, I get the same argument: “We’re practicing nursing, not medicine.” Since everyone here has established that particular argument is BS, can we move on to how we bring nursing into the fold?

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.

 

[Promethean]

Ok, I’m glad most people have a similar opinions to what I’ve already heard: that it is an essentially made up fairy tale meant to justify independence from the medical board and create “distinctiveness” among two profession that are, over time, completing the same mission.

Don't mistake me. Nursing is not medicine. They are different, complimentary disciplines. Nursing is nursing, and it really is a thing unto itself. Nurses are not undertrained doctors, and I have met very few physicians who would not be lost at sea if required to do nursing care.

The issue is when nurses want to stop being nurses via a short cut. Practicing medicine while calling it nursing is a problem. If nursing were respected for what it is, which is direct patient care and personal service, then it would not strive to be something it is not.

 

[AnnoyedByFreud]

This is not accurate at all. In my state, the nursing board is explicitly subordinate to the medical board. The docs have absolute authority over the nurses scope here.

This is definitely more the exception, not the norm. Are you in the South?

 

[OrthoGoddess]

Being a nurse myself I can tell you that nursing is more continuation of care, while medicine is more decision making, diagnosing, and treating. For example, if the physician performed a cleft lip repair on a young child, the nurses responsibility is to monitor the lip and make sure there are no complications (continuation of care). Nurses, as a result, are usually the ones who spend the most time with the patient...giving them their medications, helping them with their basic hygiene needs (i.e., toileting, bathing, feeding, etc.) answering all of their questions, and notifying the doctor if anything goes wrong. Both professions work side by side and can not thrive without the other.

 

[Zenman1]

Which is why I, and many others, don't really understand the NP role. It blurs the line between nursing and medicine, claiming all the while to be entirely the former and not at all the latter.

I see them go out of their way to pay homage to their nursing background, to such an extent that they deny that they are treading into medical territory. That is, in large part, where a lot of the discomfort comes in for people outside the nursing profession. They see something quacking like a duck and swearing it is a swan. It looks disingenuous and possibly sinister, breeding an us vs. them paranoia among doctors. If the nursing profession were to honestly admit that its advanced practitioners are practicing nursing-flavored medicine, that they are essentially PAs with a broader clinical history, that would cut at the foundations of the BS mountain they make their novices climb. They would have to throw away all those nursing diagnosis manuals.

Don't get me started on those. One of the reasons I am turning my back on the profession is that it has allowed "Energy Field Disturbance, related to situational stressors, as evidenced by alterations in aura pattern and brightness" to be a legitimate nursing diagnosis for so long. I know that virtually no one in practice uses that voodoo, but the fact that it is sanctioned and taught makes me ill.

OMM may or may not be voodoo, but it does at least involve something as tangible as the musculoskeletal system.

I’ll give you my perspective but it’s colored by my other training. I’m a Psych NP and I sit in my office treating Soldiers just like the psychiatrists around me. I do initial evals and make diagnoses, order meds, therapy, do follow-ups with med management and therapy, and order necessary labs, a rare CT or MRI, sleep studies, and occasional other consults to primary care, urology, neuro, etc.. What is different is that I can use any one of a number of theories to view a patient. These are the theories that many nursing students call “fluff courses” and want to spend as little time as possible on them. This may be because their teachers don’t explain the purpose of a theory, how to use them, or that all professions are theory-driven, otherwise you’re known as a trade school graduate. I think in nursing school you learn concepts while in medical school you memorize a wad of material and try to fit a patient into a diagnostic category. Physicians, for the most part I think, stick hard and fast to the science bible, in spite of the fact that most peer-reviewed studies are hardly worth the paper they are written on. There are plenty of comments on this even from journal editors themselves. I didn’t become a fanatic of the science-based approach and actually trained in other approaches just so I would have the experience rather than a belief for or against them. I studied Chinese medicine philosophy, Tai chi (which has quite a few studies behind it) for healing plus it’s fun to beat people up with it also, the Korean martial art of HapKiDo, Reiki, Japanese Zen shiatsu, Chinese medical and martial qigong, studied with Q’ero Indians in Peru and Shipibo medicine people in the Amazon. I think that’s everything.

So, I have a big toolbox to choose from. The other day I saw a young lady who had miscarried and was having dreams of the baby progressing from an infant to 5 years of age and asking for a name. So how would you treat this young lady?

While I don’t see auras I understand it’s easy to learn how to do so. If you don’t believe in energy fields you might want to wake up Einstein and have a chat with him. Everything is energy so what you’re basically saying is that you have a lack of knowledge on the subject. I teach medical qigong (basically energy medicine) to Soldiers in a functional restoration program (I’m credentialed by the hospital) to help them deal with chronic pain, which has not been successfully “fixed” by Western medicine. I won’t go into what all I teach them but I’m sure some will be glad to take your money if you ever want to place a bet with them that it doesn’t help them.

 

[Promethean]

I’ll give you my perspective but it’s colored by my other training. I’m a Psych NP and I sit in my office treating Soldiers just like the psychiatrists around me. I do initial evals and make diagnoses, order meds, therapy, do follow-ups with med management and therapy, and order necessary labs, a rare CT or MRI, sleep studies, and occasional other consults to primary care, urology, neuro, etc.. What is different is that I can use any one of a number of theories to view a patient. These are the theories that many nursing students call “fluff courses” and want to spend as little time as possible on them. This may be because their teachers don’t explain the purpose of a theory, how to use them, or that all professions are theory-driven, otherwise you’re known as a trade school graduate. I think in nursing school you learn concepts while in medical school you memorize a wad of material and try to fit a patient into a diagnostic category. Physicians, for the most part I think, stick hard and fast to the science bible, in spite of the fact that most peer-reviewed studies are hardly worth the paper they are written on. There are plenty of comments on this even from journal editors themselves. I didn’t become a fanatic of the science-based approach and actually trained in other approaches just so I would have the experience rather than a belief for or against them. I studied Chinese medicine philosophy, Tai chi (which has quite a few studies behind it) for healing plus it’s fun to beat people up with it also, the Korean martial art of HapKiDo, Reiki, Japanese Zen shiatsu, Chinese medical and martial qigong, studied with Q’ero Indians in Peru and Shipibo medicine people in the Amazon. I think that’s everything.

So, I have a big toolbox to choose from. The other day I saw a young lady who had miscarried and was having dreams of the baby progressing from an infant to 5 years of age and asking for a name. So how would you treat this young lady?

While I don’t see auras I understand it’s easy to learn how to do so. If you don’t believe in energy fields you might want to wake up Einstein and have a chat with him. Everything is energy so what you’re basically saying is that you have a lack of knowledge on the subject. I teach medical qigong (basically energy medicine) to Soldiers in a functional restoration program (I’m credentialed by the hospital) to help them deal with chronic pain, which has not been successfully “fixed” by Western medicine. I won’t go into what all I teach them but I’m sure some will be glad to take your money if you ever want to place a bet with them that it doesn’t help them.

Voodoo helps, sure. I'm not being facetious. I think there is a role for shamans, witchdoctors, hedge magicians, and priests. They can absolutely help people feel better.

But that help does not belong in medicine or nursing, which are scientifically based disciplines. The problem I have with practicing magic and calling it medicine is that you are trading on people's expectation that your treatments have a scientific basis. That is fraud. If you brought them the same treatments with no pretense of it being "alternative medicine" they might recognize it for what it is and choose a more traditional treatment.

Given that you have expressed disdain for science, I do not believe that we will have any intellectual common ground upon which to further this discussion. Therefore, I will only be grateful to you that you have provided an exquisite example of what is wrong with the nursing profession, that I am so pleased to walk away from it.

 

[Boatswain2PA]

... I think that NPs are essentially PAs with a background in a practical clinical discipline....

Except for the growing number of direct entry NP programs....and the (still) many PAs who have years of experience as nurses and medics. Oh, and the VASTLY different educational process between the two.

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....

Dr. Eugene Stead came up with the idea of the PA profession not because there was a lack of physicians (primary care or otherwise), but rather because he wanted the community physician to have someone to help him practice medicine so that he could do a better job of keeping current. He got the idea from seeing the dichotomy of practice between the community physicians and those who were in the academic centers. At the time, those in the academic centers were practicing "cutting edge" medicine, while those in the rural community were far behind because the academics had residents do most of the patient care as they continued research, while the community docs could never "get away from the office" to keep updated. Then he visited a physician friend in western North Carolina who was able to keep up on all of the new literature, and go to the conferences, because he had taught his office worker (I think his name was Amos) to do many of the day-to-day procedures. (http://pahx.org/stead-jr-eugene)

Being a nurse myself I can tell you that nursing is more continuation of care, while medicine is more decision making, diagnosing, and treating. For example, if the physician performed a cleft lip repair on a young child, the nurses responsibility is to monitor the lip and make sure there are no complications (continuation of care). Nurses, as a result, are usually the ones who spend the most time with the patient...giving them their medications, helping them with their basic hygiene needs (i.e., toileting, bathing, feeding, etc.) answering all of their questions, and notifying the doctor if anything goes wrong. Both professions work side by side and can not thrive without the other.

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.

..... What is different is that I can use any one of a number of theories to view a patient...So, I have a big toolbox to choose from.... I teach medical qigong (basically energy medicine) to Soldiers in a functional restoration program (I’m credentialed by the hospital) to help them deal with chronic pain, which has not been successfully “fixed” by Western medicine. I won’t go into what all I teach them but I’m sure some will be glad to take your money if you ever want to place a bet with them that it doesn’t help them.

Translation: "I know more than you do, and I'm in a senior vice-president level position with the Veterans Affairs."

 

[Zenman1]

Translation: "I know more than you do, and I'm in a senior vice-president level position with the Veterans Affairs."

I do know more than you. Always have and always will as I don't have a personality disorder that gets in the way. And I continue to precept PA students. I don't work for the VA but for the Army treating active duty Soldiers and a few dependents. Our new hospital commander is a FNP by the way.

 

[Promethean]

I do know more than you. Always have and always will as I don't have a personality disorder that gets in the way. And I continue to precept PA students. I don't work for the VA but for the Army treating active duty Soldiers and a few dependents. Our new hospital commander is a FNP by the way.

This is how I feel about you playing witchdoctor to American soldiers who deserve real treatment when they present for healthcare.

 

[LiamNeesons]

With that said, I have a question I’d like to have answered by my nursing colleagues:

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

 

[Boatswain2PA]

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

They are in love with him over there. There is simply no humor amongst the militants....

 

[LiamNeesons]

I’ll give you my perspective but it’s colored by my other training. I’m a Psych NP and I sit in my office treating Soldiers just like the psychiatrists around me. I do initial evals and make diagnoses, order meds, therapy, do follow-ups with med management and therapy, and order necessary labs, a rare CT or MRI, sleep studies, and occasional other consults to primary care, urology, neuro, etc.. What is different is that I can use any one of a number of theories to view a patient. These are the theories that many nursing students call “fluff courses” and want to spend as little time as possible on them. This may be because their teachers don’t explain the purpose of a theory, how to use them, or that all professions are theory-driven, otherwise you’re known as a trade school graduate. I think in nursing school you learn concepts while in medical school you memorize a wad of material and try to fit a patient into a diagnostic category. Physicians, for the most part I think, stick hard and fast to the science bible, in spite of the fact that most peer-reviewed studies are hardly worth the paper they are written on. There are plenty of comments on this even from journal editors themselves. I didn’t become a fanatic of the science-based approach and actually trained in other approaches just so I would have the experience rather than a belief for or against them. I studied Chinese medicine philosophy, Tai chi (which has quite a few studies behind it) for healing plus it’s fun to beat people up with it also, the Korean martial art of HapKiDo, Reiki, Japanese Zen shiatsu, Chinese medical and martial qigong, studied with Q’ero Indians in Peru and Shipibo medicine people in the Amazon. I think that’s everything.

So, I have a big toolbox to choose from. The other day I saw a young lady who had miscarried and was having dreams of the baby progressing from an infant to 5 years of age and asking for a name. So how would you treat this young lady?

While I don’t see auras I understand it’s easy to learn how to do so. If you don’t believe in energy fields you might want to wake up Einstein and have a chat with him. Everything is energy so what you’re basically saying is that you have a lack of knowledge on the subject. I teach medical qigong (basically energy medicine) to Soldiers in a functional restoration program (I’m credentialed by the hospital) to help them deal with chronic pain, which has not been successfully “fixed” by Western medicine. I won’t go into what all I teach them but I’m sure some will be glad to take your money if you ever want to place .... doesn’t help them.

Are you high?

 

[Boatswain2PA]

Are you high?

It's not that he's "high". However he has far surpassed anyone who has allowed themselves to be constricted by the false restraints of science. Instead he has freed his mind from these bonds, and therefore has achieved a level of "Zen" that allows him to be the great holistic healer of all things mind, body, soul and karma.

Either that or he is a nut-job in a nice, cushy, over-paid government job that doesn't require actual results from which he will NEVER be fired.

 

[LiamNeesons]

OP, please continue to share your views with as many people as possible, preferably politicians.

 

[Zenman1]

This is how I feel about you playing witchdoctor to American soldiers who deserve real treatment when they present for healthcare.

Well since you're ill informed let me remind you that the Soldiers are there because they have not been helped by what you think is the ultimate in treatment. The program, set up here by a full bird Colonel, is their last chance to learn to deal with their chronic pain before being medically discharged from the Army. The "S" in Soldiers is capitalized by the way.

 

[Zenman1]

Are you high?

No, don't drink or smoke.

 

[Zenman1]

It's not that he's "high". However he has far surpassed anyone who has allowed themselves to be constricted by the false restraints of science. Instead he has freed his mind from these bonds, and therefore has achieved a level of "Zen" that allows him to be the great holistic healer of all things mind, body, soul and karma.

Either that or he is a nut-job in a nice, cushy, over-paid government job that doesn't require actual results from which he will NEVER be fired.

Oh, I could be fired at a moment's notice. However, the chief of psychiatry seems to want to keep me around, as does my immediate boss…sorry. "Constricted by the false restraints of science."

"The models we learn in today's healthcare training put constraints on where we search for healing for ourselves and for others." Cecile Carson, M.D.

 

[LiamNeesons]

"The models we learn in today's healthcare training put constraints on where we search for healing for ourselves and for others." Cecile Carson, M.D.

Interpretation #1: Thank God for that. Without constraints more people would practice gypsy trickery.

Interpretation #2: Mmm, yes. Healing is all about positive energy which transcends all limits.

See what I did there? I can interpret fluffy nothingness however I want. That's why the rational among us agree to keep things scientific.

 

[LiamNeesons]

No, don't drink or smoke.

Alright, alright...







You sure?

 

[Zenman1]

Interpretation #1: Thank God for that. Without constraints more people would practice gypsy trickery.

"The models we learn in today's healthcare training put constraints on where we search for healing for ourselves and for others." Cecile Carson, M.D.

Uh, let me re-write this for you. "What I learned in medical school put constraints on where we search for healing…. " That's why he's a member of the Society for Shamanic Practitioners just like me. You keep going downhill while I'm going uphill.

 

[LiamNeesons]

"The models we learn in today's healthcare training put constraints on where we search for healing for ourselves and for others." Cecile Carson, M.D.

Uh, let me re-write this for you. "What I learned in medical school put constraints on where we search for healing…. " That's why he's a member of the Society for Shamanic Practitioners just like me. You keep going downhill while I'm going uphill.

Ohhhh, you were serious. You're a shaman. I get it now. Wait, why are we in jeeps?

 

[Zenman1]

Ohhhh, you were serious. You're a shaman. I get it now. Wait, why are we in jeeps?

I'm not a shaman as I don't practice in that role full-time. I'm a shamanic practitioner when it's appropriate. I'm in a Jeep because they are more fun than riding a Jackass.

 

[LiamNeesons]

I'm not a shaman as I don't practice in that role full-time. I'm a shamanic practitioner when it's appropriate.

"You could be a parrrrrrrt, time, shaman!!!"

 

[Makati2008]

Let's stay on topic everyone.

 

[oldiebutgoodie]

I am a CNS (like an NP in my state), and found it quite interesting that once I started grad school (at the same university as I got my BSN) the "nursing diagnoses" were never discussed again, including that stupid one about "energy fields". (I would love to meet whoever decided THAT was a standard nursing diagnosis). Most of my training was medical, my rotations were medical, and now I practice with a collaborative physician (a concept I support, BTW), making medical decisions.

So, the whole concept that NPs are doing something magic and different than PAs or physicians is nonsense, in my opinion. However, nursing has a stronger organizational voice than PAs. I also think the NP concept was fueled by old time nurses pissed after years of being abused by physicians. Just a theory.

So why didn't I become a PA?
1. Time
2. Expense
3. No part time options
4. I'm old, don't think I could have done the full time PA training, which I have great respect for.

Oldiebutgoodie

PS--I have no problem with being called a "midlevel".

 

[Zenman1]

Do you have a problem with "energy fields" or that it's a nursing diagnosis? Every culture on earth recognizes the concept and anyone in the healing profession should be aware of it.

 

[el_duderino]

Do you have a problem with "energy fields" or that it's a nursing diagnosis? Every culture on earth recognizes the concept and anyone in the healing profession should be aware of it.

....

 

[Promethean]

"Energy field disturbance" is ridiculous and offensive as a nursing diagnosis.

I don't have a problem with its use by someone who isn't pretending to be practicing a science based discipline. If you are a shaman, or a priest, etc, then you deal in matters of faith in that which cannot be seen/tested/proven. Some people take comfort in that sort of thing, and are entitled to seek it out.

Patients who present for medical or nursing care are entitled to evidence-based care. It is fraudulent to abuse the trust they place in you as a nurse by trying to pass your faith off as science based care.

You are either a fraud, or a fool, or possibly both.

 

[Zenman1]

"Energy field disturbance" is ridiculous and offensive as a nursing diagnosis.

I don't have a problem with its use by someone who isn't pretending to be practicing a science based discipline. If you are a shaman, or a priest, etc, then you deal in matters of faith in that which cannot be seen/tested/proven. Some people take comfort in that sort of thing, and are entitled to seek it out.

Patients who present for medical or nursing care are entitled to evidence-based care. It is fraudulent to abuse the trust they place in you as a nurse by trying to pass your faith off as science based care.

You are either a fraud, or a fool, or possibly both.

Faith is important in medicine is it not? The path I have taken is exploring beyond the blind faith of believing in one modality, but in experiencing others. Remember I said experiencing, not believing. You'll believe it when you experience it and that what I tell people, for example, in the 1st hour of my qi gong class. I ask them to do their best not to believe what is happening but just to experience. I tell them they can think it's the craziest damn stuff ever, just go for the experience. If their chronic pain is helped then they can believe it.

You want to focus on EBM but which research is correct? You have read about all the journal retractions, and even journal editors bemoaning the poor quality of research they are publishing. Believing everything published in a medical journal is pretty foolish I'd say. Heck, most the physicians, including the chief of psychiatry, that I work with certainly don't have the blind faith you have.

Now try to explain a lot of science without using the word "energy." I got the MRI results back on a patient today. Explain how an MRI works.

Anytime you want to think I'm a fool, I'll bet $1,000 if you want to meet in person (unless it's against TOS of this site) and we'll play a little.

 

[el_duderino]

Faith is important in medicine is it not? The path I have taken is exploring beyond the blind faith of believing in one modality, but in experiencing others. Remember I said experiencing, not believing. You'll believe it when you experience it and that what I tell people, for example, in the 1st hour of my qi gong class. I ask them to do their best not to believe what is happening but just to experience. I tell them they can think it's the craziest damn stuff ever, just go for the experience. If their chronic pain is helped then they can believe it.

You want to focus on EBM but which research is correct? You have read about all the journal retractions, and even journal editors bemoaning the poor quality of research they are publishing. Believing everything published in a medical journal is pretty foolish I'd say. Heck, most the physicians, including the chief of psychiatry, that I work with certainly don't have the blind faith you have.

Now try to explain a lot of science without using the word "energy." I got the MRI results back on a patient today. Explain how an MRI works.

Anytime you want to think I'm a fool, I'll bet $1,000 if you want to meet in person (unless it's against TOS of this site) and we'll play a little.

You're trying to imply that "energy fields" as a "nursing diagnosis" is somehow real on the basis of "energy" being an actual thing.

Your posts terrify me. It seems that you're not a physician, and I'm having trouble figuring out exactly what you are. But the combination of the things you say and the fact that you practice *something* is awful.

 

[Zenman1]

You're trying to imply that "energy fields" as a "nursing diagnosis" is somehow real on the basis of "energy" being an actual thing.

Your posts terrify me. It seems that you're not a physician, and I'm having trouble figuring out exactly what you are. But the combination of the things you say and the fact that you practice *something* is awful.

I think you don't like nursing diagnosis…neither do I..and maybe that dislike makes it hard for you to realize that everything is energy. If that is so, then have I not ruffled your feathers and caused a disturbance of energy? Don't be terrified. I work in a large 50-60 person department. If I was nuts I'd have been kicked out long ago vs having a full case load of patients and even billing for that crazy qi gong stuff I do. I don't run around smoking the place up or wearing feathers. Remember the lady I mentioned earlier who had miscarried and was having dreams of the baby progressing from an infant to 5 years of age and asking for a name? I just asked her if she could entertain the idea that it was the spirit of her baby, go alone or with a friend to our hillside outdoor chapel, have a little ceremony, name the baby and tell him it's time to move on. Ceremonies are powerful. And since she had vegetative symptoms of depression I prescribed Celexa. I'll let you know what happened when she returns.

 

[Promethean]

Now try to explain a lot of science without using the word "energy." I got the MRI results back on a patient today. Explain how an MRI works.

Anytime you want to think I'm a fool, I'll bet $1,000 if you want to meet in person (unless it's against TOS of this site) and we'll play a little.

Just because it is the same word, does not mean that it is used the same way in all applications. Energy, the demonstrable phenomenon which can be measured, is not the same thing as the mystical version of energy, which denotes fuzzy, incoherent notions that cannot be reproduced in a laboratory setting. If you broaden the meaning of the word until it becomes meaningless, so do your assertions. I can explain how an MRI works, but you cannot explain how your so-called "healing energies" work. I can design an experiment to demonstrate the concepts of electricity, magnetism, and atomic behavior but you cannot show me how your faith impacts the cellular mechanisms that underpin life.

You are also conflating the temporary uncertainty around the validity of scientific/experimental results with the permanent uncertainty surrounding your voodoo. Yes, sometimes, fraud happens in the sciences, and sometimes experiments aren't reproduceable. However, over the medium and long term, fraud is rooted out and a better understanding can develop from new experiments. With your mystical practices, there is never any clear evidence, never any peer review. If you can proof that your hocus pocus does anything whatsoever beyond placebo, James Randi has a $1,000,000 prize for you.

You can never do that, though, because your means of protecting and maintaining your ignorance is to dispute the very method by which testable, reproduceable, measurable knowledge is gained. Once I realized that, I ought to have kept to my first instinct and refused to engage with you at all. Debating you is like Bill Nye debating the creationists... it gives the impression that your crackpot drivel is worthy of notice, let alone debate.

As for your offer to meet to "play a little," I have a pretty firm rule against meeting with guanopsychotics from the internet. Thanks all the same.

 

[Zenman1]

Just because it is the same word, does not mean that it is used the same way in all applications. Energy, the demonstrable phenomenon which can be measured, is not the same thing as the mystical version of energy, which denotes fuzzy, incoherent notions that cannot be reproduced in a laboratory setting. If you broaden the meaning of the word until it becomes meaningless, so do your assertions. I can explain how an MRI works, but you cannot explain how your so-called "healing energies" work. I can design an experiment to demonstrate the concepts of electricity, magnetism, and atomic behavior but you cannot show me how your faith impacts the cellular mechanisms that underpin life.

Yes, I can explain what I do and last did so Tuesday afternoon. Haven't there already been enough studies showing thoughts can influence cellular mechanisms to you to realize that?

You are also conflating the temporary uncertainty around the validity of scientific/experimental results with the permanent uncertainty surrounding your voodoo. Yes, sometimes, fraud happens in the sciences, and sometimes experiments aren't reproduceable. However, over the medium and long term, fraud is rooted out and a better understanding can develop from new experiments. With your mystical practices, there is never any clear evidence, never any peer review. If you can proof that your hocus pocus does anything whatsoever beyond placebo, James Randi has a $1,000,000 prize for you.

I contacted Randi 15-20 years ago and he refused because I was actually going to be touching someone. At least he realizes the value of touch. You can not believe how invested he is in that money never going anywhere. Peer review might be all your neighboors and friends talking about how they actually got better after doing such and such, or thousands of years of field research, versus what I see in most of my medical books, "Despite this lack of evidence for efficacy from controlled studies...." Clinical experience probably guides most of us vs these studies.

You can never do that, though, because your means of protecting and maintaining your ignorance is to dispute the very method by which testable, reproduceable, measurable knowledge is gained. Once I realized that, I ought to have kept to my first instinct and refused to engage with you at all. Debating you is like Bill Nye debating the creationists... it gives the impression that your crackpot drivel is worthy of notice, let alone debate.

As for your offer to meet to "play a little," I have a pretty firm rule against meeting with guanopsychotics from the internet. Thanks all the same.

I think it is you who are protecting and maintaining your ignorance. Myself and others (call some of the physicians I listed earlier and have a chat with one of your peers) have dared to learn another language and have a broader view, as well as many more tools in our tool box. You are correct in that we can't have a conversation because you don't know the language. You'd be appearing the same if you were trying to have a conversation with an astrophysicist...totally lost. Offering to bet you should strike fear in you as I'm one of those "put up or shut up guys." Anyway, have a good one.

One other thing. Many of the physicians I have met while training in shamanism, for example, have done so because they realized that their medical training distanced them from their own inate healing abilities. I'm a Psych NP running a walk-in clinic every morning. As such, I see everyone's patients and hear their complaints about their physician provider and I know exactly why the physicians do as they do...their training. So, when you finish your training keep that in mind.

 

[el_duderino]

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

 

[Promethean]

I think it is you who are protecting and maintaining your ignorance. Myself and others (call some of the physicians I listed earlier and have a chat with one of your peers) have dared to learn another language and have a broader view, as well as many more tools in our tool box. You are correct in that we can't have a conversation because you don't know the language. You'd be appearing the same if you were trying to have a conversation with an astrophysicist...totally lost.

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.