Time to remove the "nurse" in APN?

  1. More and more, I am seeing posts from people who want to leap straight from taking the NCLEX into an advanced practice role. (Often you see plans of "pre-nursing" students already plotting their CRNA careers, but that's another story.)

    Also, an increasing number of schools are designing programs that greatly reduce or eliminate the need/chance for actual nursing experience before acceptance.

    It's almost as if the advanced practice role is becoming ever more distant from its origins, i.e. hands on nursing.

    On top of that, with questionable programs opening up (which often results in weak practitioners), is it possible that nursing as a whole gets a black eye by association?

    Bottom line: is it time for a divorce? Should advanced practice nurses be retitled and called something along the lines of physician's assistants?
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  2. 74 Comments

  3. by   ThePrincessBride
    No. It isn't.

    NPs were expected to have years and years of bedside experience prior to moving on to advance practice. RN knowledge AND experience are the foundations of NP practice. You cannot "divorce" NURSE practitioners/advanced practicing REGISTERED NURSES from the field of nursing. That is asinine.

    Lowering the standards just because it is trendy for pre-pre-nursing students to declare their goal of being NPs without ever setting foot on the floor as a nurse is just asking for trouble. LIVES are at stake. NPs are responsible for diagnosing, prescribing and formulating treatment plans. One small error can KILL someone.

    If anything, we need to demand more. We should expect advanced RNs to, you know, have the basics down before trying to become providers.

    But, in the end, it is all about the almighty dollar. Those schools don't give a crap about producing sharp, knowledgeable, safe and competent providers who can hold their own against the better prepared MDs and PAs. They care about getting money. The best way to do this is to lower the standards and let even the student with a 2.3, zero RN experience who flunk the NCLEX six times matriculate.
  4. by   Emergent
    How about if, instead of that, Advanced practice nurses be required to work as hospital nurses for a certain period of time? That's what I would propose.

    I know some will disagree with me, but I think nothing replaces actual experience at the bedside.

    Otherwise just eliminate the whole advanced practice nursing and have everyone become physicians assistants.
  5. by   sallyrnrrt
    My life was at stake by such APN, I had a closed chest injury where a crazed cow butt me in my chest, flipped me and walked on left elbow....compression fx t5...... 48 hr later increased increased pleuritic pain, I had to go back to ER as they forgot to give me tetanus.....I wanted a chestxray follow up.....as pleural effusion etc can devolve from such closed chest injury the brand new NP, never work as a nurse did not understand the pathophysiology I was concerned with, Plus she forgot to sign scrips she gave me......with my 45 years experience in critical care, cv surg, CCU and ER...... We had some "schooling"
  6. by   LovingLife123
    Quote from sallyrnrrt
    My life was at stake by such APN, I had a closed chest injury where a crazed cow butt me in my chest, flipped me and walked on left elbow....compression fx t5...... 48 hr later increased increased pleuritic pain, I had to go back to ER as they forgot to give me tetanus.....I wanted a chestxray follow up.....as pleural effusion etc can devolve from such closed chest injury the brand new NP, never work as a nurse did not understand the pathophysiology I was concerned with, Plus she forgot to sign scrips she gave me......with my 45 years experience in critical care, cv surg, CCU and ER...... We had some "schooling"
    That is crazy. No follow up CXR with a chest injury? Oh my.
  7. by   LovingLife123
    I see these direct entry programs as pretty much the sole reason that APRNs are not taken seriously in the field. It's why there is so much push back from the rest of the medical community and it's sad because there are plenty of great advanced practice nurses with tons of bedside experience.

    As long as schools continue with these programs and the myth that NP is the way to make the big bucks, it's not going to change and it's scary.
  8. by   sallyrnrrt
    Oh I ended up getting the follow up X-ray, I explained she did not know what she did not know......I also told her she was an imbarassement to APN programs.....but revenge was great when hospital. Administrator, called me after receiving my "press Gainey" survey...... A patient should not have to be more knowledgable than their provider......

    I am any thing but against APNs, my primary care has been mgt. by some seasoned nurses....that went on to APN , and I could not be more pleased......
  9. by   Here.I.Stand
    I'm sure there will be some indignation over this, and I admittedly have better things to do than read resesrch on the topic. (Professionally I only work with one APRN, who is extremely knowledgeable; personally, I vet individual NPs.)

    I have never gotten the idea of going from no practice to advanced practice, with no experience.

    I mean, we tell new grads all of the time that it takes a good year or two to become proficient. But if the newly licensed RN enters an NP program immediately, and doesn't work during the program "because the school doesn't recommend it?" That is A LOT of lost assessment practice, bedside manner practice, real-world exposure to different conditions and real-world pt response to treatments...

    And the proliferation of online programs... uff da. Do the preceptors that students choose get vetted by the school? Do all programs have proctored exams? Is the clinical component robust enough to produce a provider at the same level as a new MD or PA, despite the lack of nursing experience? (That last question is rhetorical!)

    Does anyone even think of attending med school or PA school, or even CRNA school online? Why is the model acceptable for a new grad RN-to-NP? I would love to see all APRN programs become comparable to CRNA programs: requiring experience, and being very selective about who is admitted.
  10. by   Jedrnurse
    Quote from LovingLife123
    I see these direct entry programs as pretty much the sole reason that APRNs are not taken seriously in the field. It's why there is so much push back from the rest of the medical community and it's sad because there are plenty of great advanced practice nurses with tons of bedside experience.

    As long as schools continue with these programs and the myth that NP is the way to make the big bucks, it's not going to change and it's scary.
    I'm curious; does anyone know how the ANA weighs in on no-experience direct entry programs?
  11. by   Here.I.Stand
    Quote from LovingLife123
    it's sad because there are plenty of great advanced practice nurses with tons of bedside experience.
    It really is. My mom has long held NPs in extremely high regard...at least since 1987. I had double pneumonia w/ atelectasis in my left lung, getting worse and not responding to the several oral antibiotics. She felt blown off by the MD that I'd seen (her exact words were "I asked if he thought it was pneumonia, and he just laughed."), but "Capt. M" really listened to the history my mom gave. I needed a 3-week hospitalization and IV antibiotics and Mucomyst nebs.

    When pregnant with my first child, I mentioned seeing the "midwife." She looked at me like I had two heads, and said "Midwife??" I explained what a CNM was, she looked visibly relieved and said, "oh, so like a nurse practitioner? That sounds great!"

    That's just one example from my personal life, but illustrates how the historically used model of expert nursing plus advanced education can instill a great deal of trust.
  12. by   elkpark
    I practiced as a psychiatric nurse for 10 years before I returned to school to become a child psychiatric CNS -- I'm not giving up the "nurse" in my title. I am, and will always be, a registered nurse, in addition to my other credentials. It's bad enough that the ANCC has "retired" the psych CNS role and credential -- y'all are going to miss us when we're all finally gone ...
  13. by   NightNerd
    Quote from elkpark
    I practiced as a psychiatric nurse for 10 years before I returned to school to become a child psychiatric CNS -- I'm not giving up the "nurse" in my title. I am, and will always be, a registered nurse, in addition to my other credentials. It's bad enough that the ANCC has "retired" the psych CNS role and credential -- y'all are going to miss us when we're all finally gone ...
    I miss it already! I would have loved to pursue this and (after obtaining sufficient bedside experience, of course!) think I probably would have been good at it.
  14. by   LovingLife123
    I have lots of girls on my unit going back to school for their masters and doctorates. Many of them having been nurses for years and I know they will be great APRNs. I'm excited for them to expand their knowledge and practice. I also work with some great NPs. The ones that are the best are the ones that have had years of experience on our unit and know our patients and have extensive knowledge about what brings our patients to our unit.

    My hospital has flat out stated they will not hire NPs with no experience. They said they are having a hard time finding qualified ones as these direct entry programs pop up.

    I feel like it devalues the degree and the experience that our great APRNs have. Advanced Practice is just that, practice. How many times a week do we field questions from people in here asking what is the quickest way to NP? And what we see in here in the tiniest drop in the bucket of people with this mentality.

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