Applied
Nursing Research
Vol. 13, No. 3 August 2000
EDITORIAL
The Attending Model in Nursing
A
s a discipline, we struggle with creative ways
to keep experts at the bedside and infuse
current research into practice. Professional medi-
cine has had an attending model for many years. In
that model, a senior experienced physician rounds
with junior staff, residents, and interns in order to
impart knowledge and experience, as well as
supervisory guidance. This model holds promise as
a mechanism for achieving our goals. For those of
us who are academic nurses without joint appoint-
ments or private practices, the attending model can
provide a way for us to engage in practice, bring
expert knowledge to the bedside, and infuse re-
search into practice.
In academic nursing, it has not been common for
tenured professors to have a regular clinical prac-
tice, although this is changing. There are several
current models including the joint appointment
model, the faculty practice model, the moonlight-
ing model, the episodic clinical consultant model,
and the nursing center model. Let me briefly review
each.
● A joint appointment occurs when a faculty
person has both an academic and a clinical role,
and is paid by each entity. In that model, for
example, the academic program might reim-
burse half the salary, while the hospital or other
clinical system would reimburse the other half,
and there would be responsibilities and roles in
each setting.
● In the faculty practice model, the hospital would
buy out a portion of the faculty member’s effort
in order to retain the faculty at one setting in a
specific advanced role.
● The moonlighting model is one where the faculty
member works evening, weekend, or other ‘‘off’’
hours in the clinical setting, not only to maintain
clinical experience, but also to supplement a
salary.
● The episodic clinical consultant model (e.g.,
clinical nurse specialist model) occurs when a
faculty member responds episodically, when
requested, around certain clinical problems.
● The nursing center model is a clinic practice,
where clients can come, on a fee-for-service
model (some have Health Care Financing Admin-
istration reimbursement structures) for health
promotion, screening, and intervention.
The nurse-attending model is different from
those described above. A monthly rotation schedule
is developed, encompassing a variety of faculty and
areas of expertise for a schedule, which can be laid
out for the year. Senior nursing faculty would
develop the schedule for a clinical unit and lead
expert nursing rounds as well as be available for
consultation for the month by telephone or in
person, depending on the situation.
The nurse-attending model has meaning only if
one can discern a measurable change in nursing
practice. During the month of July 1999, I had the
opportunity to pilot the nurse-attending model at
Mount Sinai Hospital in New York City. I rounded
with the staff daily, monitoring progress in the
patients and engaging in a dialogue with the staff
around management and treatment strategies, in
this case, for common geriatric problems. We were
able to initiate the following:
1. The systematic use of assessment cards by the
Applied Nursing Research,
Vol. 13, No. 3 (August), 2000: pp 113-114 113