Enough With the "Nursing Model"

As I continue to monitor the movement toward advancing the NP profession, I can't help but think we are going about this the wrong way.  In the push to achieve higher levels of independence, nurse practitioner organizations are presenting NP's as equivalent to physicians, the difference between the two professions often stated as a "Nursing Model" rather than a "Medical Model" approach to patient care. 

In a recent CSPAN story, Susan Apold, board member of the American Association of Nurse Practitioners, was asked about the difference between nurse practitioners and physicians.  She stated that nurse practitioners can diagnose, treat and prescribe medications similarly to physicians however "we also bring a nursing model to the patient care situation...we are taught to take care of the whole patient".  Similarly, a KevinMD feature "What is so special about a nurse practitioner?" written by NP Kim Sakovich, noted that while physicians employ a disease-based approach to patient care, nurse practitioners do more.  She argues that not only do NP's diagnose and treat, they take a nursing-based approach focusing on the patient and their environment as a whole.

If nurse practitioners hope to establish greater respect and independence as medical professionals, our representatives must drop the "nursing model" as the benchmark for quality.  Do we not think physicians take into account "the patient as a whole"?  Of course they do.  I work in an emergency department treating a largely low income population.  If my physician co-workers did not prescribe generic medications to accommodate patient's financial constraints, the number of pharmacy callbacks would be insufferable.  Intuitively, they consider "the patient as a whole" in diagnosis and treatment.

Rather than arguing a "medical model" vs. "nursing model", nurse practitioners must differentiate themselves from physicians based on acuity.  An acuity-based distinction does not devalue from the NP role or diminish professional dignity.  Rather, it represents reality.  An argument that nurse practitioners are "lower than" or "unequal to" physicians is not meant as a personal attack but is reflective of an educational distinction.

As a nurse practitioner, I enjoy my place in the middle.  My role is different than that of a nurse while I am not qualified to treat the highest acuity patients or perform certain procedures.  This doesn't mean I don't work hard, my work ethic is solid.  This doesn't mean I'm not smart, I could have gone to medical school.  My "midlevel" status simply refers to the acuity of patients I treat.  I stick to diagnosing cases of abdominal pain but I don't perform the appendectomy.  My training prepared me to treat bronchitis, not do thoracotomy.

If nurse practitioners want respect from physician groups and greater independence in practice, reformulating our arguments is in order. 

Comments

I agree with what you are saying and really want to find a FNP school that leans more towards the medical model then the nursing model. Please does anyone have any suggestions for a school to look at? Please feel free to contact me direct at tao.fares at gmail

Robert

Very good points. By definitions of "medical vs. nursing models" NPs practice "medical model" every day as they diagnose and treat and MDs practice "nursing model" as they treat patient as a whole person by taking into the account socio- economics and interconnectedness of body and mind. The conceptual separation of advanced nursing practice and medical practice is rather useless and causes a lot of confusion as well as stirs up a lot of controversy.

Luba Lee

I couldn't agree more. I am currently in a Emergency NP program (Acute-care Adult-Ger/FNP) and one of my first classes spent most of the semester discussing the "nursing model" which was frustrating when attempting to differentiate it from the "medical model." Instead of trying to differentiate NPs from Drs, we should be examining and outlining our place in healthcare.

Ashlea Dollins

Well said. I get tired of hearing about the nursing model and how it differentiates NPs. There are plenty of MDs that treat the whole person, as you've suggested. You've hit this issue on the head.
- Jess, DNP Student - 3rd yr.

Jess Anderson

I agree with you. I think that the nursing line of argument is one of the reasons we have the conflicts we currently do with doctors. NPs have their place so do doctors and it will do us good to know our place and stick to it. I don't think PAs have these issues and some nurses choose to go that route rather than the NP route. Thanks for saying this.

Muna