I found this article last February. It saddens me that we nurses are still at the mercy of others trying to define and rename us. Nurses do have many roles and titles and I suppose the general public still gets a bit confused. (See Jane Van De Velde’s guest post last week)

My simplistic, but nonetheless challenging, solution is for nurses, whether we work in direct patient care, research, education, or Reiki, to write our own stories for the general public. If we don’t do it, others will do it for us.

Nurse Practitioners Are Not ‘Physician Extenders’

November 11, 2011

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“Physician extender.” It’s way past time to kill that term.

A study published in the October issue of Surgery found that adding an NP to the surgical team decreased the number of unnecessary ED visits by 50% and increased the use of visiting nurse, physical therapy, and occupational therapy services. A Medscape article (registration required) on the study explained the importance of the findings in this way: “According to the researchers, physician ‘extenders,’ such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week. . . .”

Sure enough, the stated purpose of the study was to determine if “integrating this physician extender into the surgery team” would improve outcomes and resource allocation. Ouch.

Experts in our own right. Nurse practitioners are not physician extenders. We are highly skilled and educated nurses who provide evidence-based care grounded in the nursing model. We are not “extensions” of anyone. We are colleagues and collaborators, independent clinicians and experts in our own right. Our purpose is to provide comprehensive care, promote health, educate, and advocate. It is not to relieve interns, supplement physician education, or be the low-cost alternative when physicians have to “do more with less,” as Medscape quoted one of the study authors. Yes, we should be integrated into health care teams, surgical and otherwise—because nurses provide a distinctive aspect of care that research has repeatedly shown to be essential to good patient outcomes.

The results of this study are certainly more good news about the effectiveness of NPs, though not surprising. As the authors noted, “Patients are no longer being discharged without support.” This is what nurses do and what distinguishes us from other health care providers: we look past curing the disease to see what optimal wellness means to each patient and do what needs to be done to help the patient get there. The positive results in this study didn’t come about because someone “extended” the physician’s role; it came about because a nurse was doing what a nurse does best.

nurse practitioner


My nursing career has taken me down many paths over the years. Presently, I am a Reiki Master Teacher as well as the founder of a nonprofit organization called The Reiki Share Project.

People often ask me what I “do.” And I usually begin by telling them that I am a registered nurse.

Their next question is…”Where do you work?”

This question always trips me up. People seem to think that if you aren’t employed as a nurse, then you stop being a nurse.

However, in my heart and my mind, I am always a nurse—no matter what. My nursing education and experience influences the way I view and interact with the world on a daily basis.

Thanks to all those client caseloads that I managed, the patient assessments I conducted and plans of care I wrote and implemented over the years; thanks to all those papers I wrote for graduate school—I am very systematic in my everyday approach to problem solving, organizing my life, and getting things done. My experience in dealing with patients also serves me well in my Reiki practice. And I have found joy and satisfaction in the process of writing articles, developing Reiki teaching curriculums and putting together newsletters for my nonprofit organization.

Thanks to that dying hospice patient who taught me that even though her life was nearly over, she could still experience healing on many levels—I bring that lesson forward to my Reiki practice knowing that even though curing many diseases may not be possible, there is always the potential for healing.

Thanks to all those hours of attending to patients and caregivers—I have honed my listening skills and have learned that sometimes that’s all that people want—just to be heard. So my husband, children, family, friends, and Reiki clients give me the opportunity to continue refining these skills.

Thanks to all those elderly homebound clients I visited who served me coffee and cookies, treated me like an honored guest, and sometimes begged me to stay just a little bit longer. I learned that simply being quietly present is a wonderful gift that we can give to others. Our “time” is a gift.

So, I continue to do my nursing work every day both personally and professionally in my Reiki practice. And I have developed a new response to the question: where do you work? I tell people that I am self-employed.

A Nurse By Any Other Name—

I read the New York Times article, A Small Picture Approach to Health Care last week with so what’s new thoughts hopping in my head. Sure, the economics of funding health care services continues to be a challenge but we nurses can see the real change agent of this model’s Advocate Health Care approach is the nurse as Care Manager. And what would the nurse be doing in order to ensure a positive outcome, such as reducing hospital readmissions, especially with geriatric patients as described in the article? Calling the patient on the phone, listening to what she says, educating her and making suggestions for change. Mrs. Cline, the patient described in this piece, has had marked improvement in her health, her “dizzy spells have subsided and she has not been hospitalized since May.”

The article further states, “The extra attention Mrs. Cline receives is the result of a radical departure from traditional fee-for-service medicine.” Well yes, I might concede that fee-for-service medicine has not utilized nurses effectively in the past. But a radical departure? Nurses have long been the patient advocates, case managers, health care coordinators and now care managers. The titles change but not nurses’ skills.

nurse with patient

The radical departure as far as I’m concerned is to recognize nurses cannot only make a difference improving patient outcomes but nurses’ interventions promote cost savings.

Read the article for yourself. Granted, restructuring of our ailing health care system ignites strong opinions. But I for one can see that the nurses role in this restructured delivery model improves the quality of life for all enrollees.

I am pleased to share this article from Reiki News Magazine ReikiInCancerCenter RNM 2 March 2012 written by Jane Van De Velde, DNP, R.N. Reiki is one example of the different skills nurses and nurse practitioners use in treating the whole patient: body, emotions, mind and spirit. Reiki is a complementary holistic healing practice, which creates many beneficial effects that include relaxation and feelings of peace, security and well-being.

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