the patient and the profession (McKenna, 1994)". Essentially, the nursing model
accounts for the whole patient, not just the disease or condition requiring
treatment. It allows nurses to deliver care to patients using a systematic
approach of assessing, planning, implementing and evaluating patient care - this
is a cyclic nursing process with detailed guidance for each step of care.
Nurses believed that the medical model was not a focus of their discipline, but
with the advent of university educated nurses and the quest for professional
recognition, the nursing model evolved. Nursing is sometimes called "holistic
practice" or "integrative medicine" and this could be because NPs often take
courses in therapeutic communication.This type of medicine focuses on health
and wellness of the overall patient rather than treating the disease itself and
focusing on the patient-physician relationship. NP programs are grounded in the
nursing model and help students master competencies required for the care of
multiple populations (adults, children, and families).
Nurses (RNs) come from a background of care plans where they associate
nursing assessments for their patients, but not medical diagnoses. Detailed
assessments are necessary to establish the individuality of the patient. Planning
is done to prevent recurrence of treated problems. Goals are set so that
evaluation can be measured or tested. Plans are made for intervention to
achieve goals. Evaluation is done to analyze whether improvement was made.
Once complete, effective care is believed to be given. However, this is a nursing
process, incomplete without a scientific foundation or a systematic construction.
The nursing model itself has a different structure. Roper, Logan, and Tierney
(2000) describe the five parts of the nursing model as:
Activities of Living (communication, breathing, eating & drinking, elimination, etc.)
The Patients Life Span
Dependence-Independence Continuum (parts of life when pt. cannot perform
activities of living independently)
Factors Influencing the Activities of Living (Biological, Psychological,
Sociocultural, Environmental, Politico-economic)
Ex. NP must be aware of psychological stressors on Activities of Living and
impacts on patient. Patient suffering from anxiety may withdraw from
communication, refuse to eat and drink and be unable to sleep.
Individuality in Living (Each patient may do them differently, expressing
themselves as an individual)
A PA, physician, and NP work side by side and do the same things in the same
ways. Most can perform line removals, manage medications, perform H&Ps, etc.
Although there are differences, there is also lots of crossover in both models. It is
crucial that you realize there are good and bad physicians, PAs and NPs all
around and it is important to recognize that we cannot pinpoint one poor
practitioners mistakes on an entire group of providers. Even though we may be
trained in different models, come from various backgrounds, have unequal
amounts of experience, etc. we are all responsible for the same patients and the
same goals. We work as a team to ensure patient safety and life longevity.
Doctors tend to work longer hours and take more night and weekend call, but
nurses are starting to take call also.
The thing about nursing is that nurses have a great deal of responsibility and not
a whole lot of power. A nurses job is not just to take orders but someone does
have to do that and nurses do carry out the orders of doctors, and nurses work
can require a fair amount of physical labor. But as the person who sees the
patient the most, nurses also observe and report problems or complications that
arise, and are usually the first to notice when something is not right. The nurse
might have to seek and order for the thing she knows the patient needs, but
she/he is the patients first line of defense. This advocacy is, in my opinion, the
most important thing a nurse does. A good nurse sees what her patient needs
and makes sure it happens. Again the lines are blurring, as more nurses have
prescriptive authority and do more of the diagnosis.
3. Logistical. Heres the kicker. The barrier to entry in medicine is extremely
high. There are so many hoops to jump through, so many meaningless math
classes to ace, so many standardized tests, that some people who would make
great doctors get weeded out. It will take you 8 to 12 years to become a practicing
physician. The money, time, and hoop-jumping might not be worth it. You dont
need to be exceptionally smart, you just have to be very persistent. Nursing is an
easier way to go educationally, but your knowledge base of medicine will be more
limited, and you will be working under more supervision. A nurse can go on to
get graduate degrees that allow a greater scope of practice, but the educational
process is not as complete or as uniform.
Either way you choose, be very sure it is what you really want to do. Both fields
are demanding and rewarding and take a great deal of commitment.
Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine
for real.