Nursing students who want to be NP's

Nurses General Nursing

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Anyone else notice that many of their nursing students are becoming nurses as a stepping stone to being a nurse practitioner but have little interest in being a floor nurse? I'm worried we won't have bedside nurses before long.

Specializes in Med-Surg/ ER/ homecare.

Sorry about the above, looks like I accidentally embedded my reply in yous:)

My comment was tongue in cheek but you can feel free to disagree.

I am sure you knew some NP students you were confident would go on to be just wonderful providers. Some questions about that: What about these students made you so sure they would be amazing? Was it just because they had nursing experience? Did they go on to be great providers? How do you know? On what metric are you evaluating their clinical performance in that role?

I am a little confused as to what exactly you feel the "shortcut" is? Not requiring nursing experience? What does the extant literature suggest re: prior nursing experience on NP clinical outcome?

It's a little sad one of the biggest challenges novice NPs face as they enter practice is other nurses who have strong opinions on the issue but little-to-no experience in NP education or NP practice.

I am currently seeing 3 NPs in 3 separate specialties (I have issues....LOL). It never occurred to me to investigate their backgrounds until last week, when I had an issue with one of them making some questionable judgment calls with regards to my treatment. It was then and only then that I investigated her background.

I always, always, ALWAYS investigate my MDs prior to seeing them, however. All of the NPs I am seeing are the care extenders of carefully selected MDs. I went ahead and looked up the backgrounds of the other two NPs I see. The one I have an issue with went straight from undergrad to graduate school. I have no idea if that affected her lack of proper clinical judgment and not being up to date on the latest evidenced based practice. Of the three NPs I see, she is the "greenest." One NP I see was a physician in another country. The other, who is actually my primary care provider, had 24 years' nursing experience prior to obtaining her APRN. I have never had an issue with the other two providers.

Anecdotal evidence, yes, however, there it is.

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
My comment was tongue in cheek but you can feel free to disagree.

I am sure you knew some NP students you were confident would go on to be just wonderful providers. Some questions about that: What about these students made you so sure they would be amazing? Was it just because they had nursing experience? Did they go on to be great providers? How do you know? On what metric are you evaluating their clinical performance in that role?

I am a little confused as to what exactly you feel the "shortcut" is? Not requiring nursing experience? What does the extant literature suggest re: prior nursing experience on NP clinical outcome?

It's a little sad one of the biggest challenges novice NPs face as they enter practice is other nurses who have strong opinions on the issue but little-to-no experience in NP education or NP practice.

I am not an MD but can have an opinion about what I witness an MD performing what I consider inadvisable or even dangerous. My opinions are based on my experience as a nurse. Nurses can have opinions without being in an NP or MD role.

Some graduate programs are better than others, and many are trying to improve the experience. At the end of my program, all of us, both NP and CNS students, were asked what ideas and recommendations we had. That was 1999, a while ago. I admit I do not read the research literature anymore so cannot comment about how much RN experience before becoming an NP correlates with any outcome. I would speculate graduate programs could answer that. Perhaps viable research for a PhD candidate? I stand by my statement that any RN needs experience before being accepted into an NP program, or any graduate program for that matter. Exactly how much I cannot say. It's alarming to me that today nursing students are not being prepared for a traditional RN role, and hospitals are picking up the slack. Some of us here are concerned.

Specializes in Adult Internal Medicine.
The one I have an issue with went straight from undergrad to graduate school. I have no idea if that affected her lack of proper clinical judgment and not being up to date on the latest evidenced based practice. Of the three NPs I see, she is the "greenest."

Anecdotal evidence, yes, however, there it is.

I can certainly understand your point here and I do think there are some legitimate concerns regarding novice NPs practicing in the specialty setting as there is often a dearth of both education and training. That being said, it is also a sample size of 3, so its hard to make any generalization about that across all of NP education and practice. Also, I would add, just because someone has ages of experience doesn't mean they don't make clinical judgement errors and in some cases may make it less likely they employ EBP.

In the end, personally you need to have faith in your providers (and their staff) and it sounds like you don't in at least one of those scenarios.

Specializes in ICU, LTACH, Internal Medicine.
I am currently seeing 3 NPs in 3 separate specialties (I have issues....LOL). It never occurred to me to investigate their backgrounds until last week, when I had an issue with one of them making some questionable judgment calls with regards to my treatment. It was then and only then that I investigated her background.

I always, always, ALWAYS investigate my MDs prior to seeing them, however. All of the NPs I am seeing are the care extenders of carefully selected MDs. I went ahead and looked up the backgrounds of the other two NPs I see. The one I have an issue with went straight from undergrad to graduate school. I have no idea if that affected her lack of proper clinical judgment and not being up to date on the latest evidenced based practice. Of the three NPs I see, she is the "greenest." One NP I see was a physician in another country. The other, who is actually my primary care provider, had 24 years' nursing experience prior to obtaining her APRN. I have never had an issue with the other two providers.

Anecdotal evidence, yes, however, there it is.

If not a secret, how exactly you "investigate" your providers, especially if you have no idea whatsoever what did they actually do during their training and no means to check it?

(contrary to public knowledge, not all medical residencies, as well as not all NP programs are created equal, and the big names may or may not play any role in the process. And if one of my patients suddenly starts to ask questions "to investigate" my past, I'll be happy to refer him to Boards website to see that my clean license, and ask a person running the desk to send the letter informing him that he has 30 days to request his full medical record to present to another provider of his choice).

Specializes in Adult Internal Medicine.
I am not an MD but can have an opinion about what I witness an MD performing what I consider inadvisable or even dangerous. My opinions are based on my experience as a nurse. Nurses can have opinions without being in an NP or MD role.

That's why we have the internet so we can all have opinions! Opinions are fine but I do think people should always consider whether they have the knowledge/perspective/expertise to share their opinion, especially if it is presented as fact, as part of their professionalism. There are some opinions here that seem to blend into defamation at times. That damages the whole profession.

Some graduate programs are better than others, and many are trying to improve the experience.

Absolutely. There has been an exponential increase in poor NP programs that needs to be addressed.

I stand by my statement that any RN needs experience before being accepted into an NP program, or any graduate program for that matter.

But what is that statement based on if not the extant data/literature? Professional experience? Personal preference?

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
That's why we have the internet so we can all have opinions! Opinions are fine but I do think people should always consider whether they have the knowledge/perspective/expertise to share their opinion, especially if it is presented as fact, as part of their professionalism. There are some opinions here that seem to blend into defamation at times. That damages the whole profession.

Absolutely. There has been an exponential increase in poor NP programs that needs to be addressed.

But what is that statement based on if not the extant data/literature? Professional experience? Personal preference?

My statement is based on my professional experience, entirely anecdotal, albeit enough to carry some weight. As I said, I have not read any current literature on how much RN experience is necessary or recommended for acceptance into any nursing graduate program. I have no doubt my alma mater would be able to provide that data. But I'm not interested in pursuing the information. My interests lie elsewhere....So my disclaimer is that it is only my opinion.

It is sad that sometimes others' opinions here are attacked via disparaging responses. And I agree it damages the profession.

Specializes in ICU, LTACH, Internal Medicine.

I admit I do not read the research literature anymore so cannot comment about how much RN experience before becoming an NP correlates with any outcome. I would speculate graduate programs could answer that. Perhaps viable research for a PhD candidate? I stand by my statement that any RN needs experience before being accepted into an NP program, or any graduate program for that matter. Exactly how much I cannot say. It's alarming to me that today nursing students are not being prepared for a traditional RN role, and hospitals are picking up the slack. Some of us here are concerned.

The fact is, there is NO RESEARCH WHICH SAYS SO.

Yes, you read it right. Nothing says that any "previous experience", nursing or non-nursing, significantly influences NP's outcomes, in any way. Just like there is NO RESEARCH saying with any degree of definitivity that some kinds of providers are really better or worse.

Moreover, there is a ton and more of quality and performance research done about NPs. Practically all these studies are composite - meaning, they do not differentiate between NPs who spent zero, 1-3, 5 - 10 or 25+ years at bedside before going into NP school. Due to the recent (last 10 to 15 years) mushrooming of NP schools and de-facto absense of common curriculum (yes, all NPs have to study advanced patho and such, but some of them do 80% of clinical disciplines for 18 months in accelerated MSN and some do 80% of policy/shmolicy fluff and research for 4 years in full time DNP, so the relative volume of clinical studies varies enormously from one program to another), there is ongoing constant influx of new NP grads who, that is to say, diluting the common research pool. Now, if, as some assume here, level of readiness for practice of these grads would be changing negatively over these 10 to 15 years, - if they were really that bad, making mistakes all the time, overprescribing, overordering studies, etc. - then all performance/quality statistics would be skewed, and the skewing would increase with every data/year.

There is NO EVIDENCE of such skewing in composite studies, done either by Goverment or private insurance companies. Year by year, NPs demonstrate overall performance compatible by quality outcomes in the roles they can be compared with MDs or PAs. Which means, that the new NPs either are more or less ready for practice as they walk out of school, and/or taught quickly and effectively while beginning their practice, gain necessary knowledge speedily enough and controlled well enough. Who and how does it, we do not know from these studies but there is no other statistical explanation of the data we have on hands so far. You can deceive yourself or others, but you cannot deceive numbers.

Specializes in Adult Internal Medicine.
My statement is based on my professional experience, entirely anecdotal, albeit enough to carry some weight. As I said, I have not read any current literature on how much RN experience is necessary or recommended for acceptance into any nursing graduate program. I have no doubt my alma mater would be able to provide that data. But I'm not interested in pursuing the information. My interests lie elsewhere....So my disclaimer is that it is only my opinion.

It is sad that sometimes others' opinions here are attacked via disparaging responses. And I agree it damages the profession.

You feel attacked because others have challenged your opinion which you state you have no interest in and have not done any research on?

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.

Specializes in ICU, LTACH, Internal Medicine.
You feel attacked because others have challenged your opinion which you state you have no interest in and have not done any research on?

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.

Because the first article doesn't seem to be available for free, I am putting here one "unexpected" finding from it:

-

There was a significant negative correlation between years of experience as an
RN
and NP skills according to collaborating physicians.

Which means, basically, the more time one spent mastering and perfecting that bedside care, the WORSE he or she was doing as an NP
according to collaborating physicians
(i.e. the very people who can be held as a "gold standard" of MEDICAL education).

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
You feel attacked because others have challenged your opinion which you state you have no interest in and have not done any research on?

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.

Huh??? I never said I felt nor have I ever felt attacked here. I said some others' opinions here appear to me to be attacked. Please reread my post.

I'm out of this. This is not a hill I want to die on. Best wishes.

Specializes in Adult Internal Medicine.
Huh??? I never said I felt nor have I ever felt attacked here. I said some others' opinions here appear to me to be attacked. Please reread my post.

I'm out of this. This is not a hill I want to die on. Best wishes.

Sorry, if I misinterpreted I apologize. I enjoy debating topics and I do my very best not to make anything individual or personal.

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