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Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,466 (60% Liked) Likes: 10,519

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  • 2:58 pm

    Quote from Dodongo
    NP educational programs hurt the profession. There's a reason so many people, working NPs included, feel this way. And, as a student experiencing the educational process for NPs at this very moment, I think I am more than qualified to comment on it.
    What exactly about your experience, haven't not yet even begun clinical training yet alone had any actual clinical practice experience, makes you "more than qualified" to determine competent clinical practice?

    One thing you need to keep in mind as your do your training is that the most dangerous providers are the ones that practice beyond their experience, knowledge, and training.


    Quote from Dodongo
    As I stated above, I felt strongly enough about it that I sought out additional educational opportunities.
    Congratulations, graduate school (in every discipline) is about the self-directed work that you do.

    Quote from Dodongo
    You are free to use biased, systematic reviews performed almost exclusively by nurses to prove your points, but any one who is experienced in evaluating research knows these studies are low quality. We all know that until a head to head, randomized controlled trial is performed, there's really no way to know if NPs provide EQUAL care to that of physicians. This study, of course, will never be performed as it is impossible in health care and probably unethical.
    What studies are you talking about? Please, cite them here. Now that you mention that they "will never be performed", example of landmark RCTs published in major peer-reviewed medical journals:

    Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.

    Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

    Quote from Dodongo
    the educational process is hurting the profession as a whole. Imagine. If we were to include graduate level anatomy, physiology and increase our clinical hours (something that many NPs and NP students are opining for) what would PAs and MDs have to say against us? Nothing.
    Why not make NP school longer than medical school with a 15 year residency program at the end? You wouldn't mind spending another few hundred thousand and working for basically free for 15 years would you? Especially when there is no evidence that outcomes would be any better. What would you use as your rationale to justify that additional cost and time?

    NP education has it problems and we (practicing NPs and educators) need to tackle them, in my opinion, but there truly isn't any evidence right now to support it.

  • 8:51 am

    Quote from Dodongo
    I commented that I was more than qualified to comment on the educational process of NPs. As I am, right this very moment, experiencing it.
    You are beginning to experience it but you haven't had any clinical experience so you don't have any experience in the application of that knowledge.

    FWIW I haven't commented at all on physician education or PA education, only the outcomes of that education on clinical practice, and even that is to cite the data not give an editorial.


    Quote from Dodongo
    ...treatment is absurdly standardized. In other words, with a study heavily biased towards the null. Even a registered nurse could follow the recommended AAP flow sheet for diagnosis and treatment of asthma, or the JNC for HTN or the ADA for diabetes. 9/10 times if you throw Advair, ACE or Metformin at these people you’ll be practicing within the standard of care.
    This comment right here highlights your lack of education and experience. If you practice with this kind of approach you are going to kill people. Real-life practice is far more complicated than you assume it is. Please, before you step foot in clinical practice, consider some humility, you may find things are not as black and white as your textbook or flowchart.


    Quote from Dodongo
    None of this is surprising, however, coming from studies with Mundinger as the lead author, as she is HEAVILY biased toward NPs given her background, much in the same way that studies published by drug companies are.
    This is the same conspiracy rubbish that anti-vaxxers use. This study was authored by a mix of nursing and medical researched and published in one of the most prestigious medical journals in the world. The results have been demonstrated over and over again. Please, cite a refuting study.

    Quote from Dodongo
    So you admit there are problems that need to be addressed, but don't think there is evidence that you and your colleagues should attempt to address them? Ok...?
    Yes, personally I do feel there are problems with NP education as it stands right now, and many of my colleagues (including me) have been very proactive in attempting to correct them. I would prefer not to wait for the data to begin to swing.

    Quote from Dodongo
    You have made it clear that you think only practicing NPs have any ability to comment on this at all so I will bow out.
    Please, comment if you wish, I'd be curious how you feel after some clinical experience.

  • Dec 4

    Quote from Dodongo
    I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements.
    Prepared for what, entry to practice as a novice provider?

    What is your statement based on? Published data? Professional experience as a provider? Professional experience as an educator? Opinions are fine but statements like this hurt the profession. Once you have finished your program and have been in practice, if you still feel this way, great, but until then you have to think about if you have the experience/expertise to be making this kind of statement.

  • Dec 4

    Quote from Dodongo
    I commented that I was more than qualified to comment on the educational process of NPs. As I am, right this very moment, experiencing it.
    You are beginning to experience it but you haven't had any clinical experience so you don't have any experience in the application of that knowledge.

    FWIW I haven't commented at all on physician education or PA education, only the outcomes of that education on clinical practice, and even that is to cite the data not give an editorial.


    Quote from Dodongo
    ...treatment is absurdly standardized. In other words, with a study heavily biased towards the null. Even a registered nurse could follow the recommended AAP flow sheet for diagnosis and treatment of asthma, or the JNC for HTN or the ADA for diabetes. 9/10 times if you throw Advair, ACE or Metformin at these people you’ll be practicing within the standard of care.
    This comment right here highlights your lack of education and experience. If you practice with this kind of approach you are going to kill people. Real-life practice is far more complicated than you assume it is. Please, before you step foot in clinical practice, consider some humility, you may find things are not as black and white as your textbook or flowchart.


    Quote from Dodongo
    None of this is surprising, however, coming from studies with Mundinger as the lead author, as she is HEAVILY biased toward NPs given her background, much in the same way that studies published by drug companies are.
    This is the same conspiracy rubbish that anti-vaxxers use. This study was authored by a mix of nursing and medical researched and published in one of the most prestigious medical journals in the world. The results have been demonstrated over and over again. Please, cite a refuting study.

    Quote from Dodongo
    So you admit there are problems that need to be addressed, but don't think there is evidence that you and your colleagues should attempt to address them? Ok...?
    Yes, personally I do feel there are problems with NP education as it stands right now, and many of my colleagues (including me) have been very proactive in attempting to correct them. I would prefer not to wait for the data to begin to swing.

    Quote from Dodongo
    You have made it clear that you think only practicing NPs have any ability to comment on this at all so I will bow out.
    Please, comment if you wish, I'd be curious how you feel after some clinical experience.

  • Dec 4

    Quote from Dodongo
    I commented that I was more than qualified to comment on the educational process of NPs. As I am, right this very moment, experiencing it.
    You are beginning to experience it but you haven't had any clinical experience so you don't have any experience in the application of that knowledge.

    FWIW I haven't commented at all on physician education or PA education, only the outcomes of that education on clinical practice, and even that is to cite the data not give an editorial.


    Quote from Dodongo
    ...treatment is absurdly standardized. In other words, with a study heavily biased towards the null. Even a registered nurse could follow the recommended AAP flow sheet for diagnosis and treatment of asthma, or the JNC for HTN or the ADA for diabetes. 9/10 times if you throw Advair, ACE or Metformin at these people you’ll be practicing within the standard of care.
    This comment right here highlights your lack of education and experience. If you practice with this kind of approach you are going to kill people. Real-life practice is far more complicated than you assume it is. Please, before you step foot in clinical practice, consider some humility, you may find things are not as black and white as your textbook or flowchart.


    Quote from Dodongo
    None of this is surprising, however, coming from studies with Mundinger as the lead author, as she is HEAVILY biased toward NPs given her background, much in the same way that studies published by drug companies are.
    This is the same conspiracy rubbish that anti-vaxxers use. This study was authored by a mix of nursing and medical researched and published in one of the most prestigious medical journals in the world. The results have been demonstrated over and over again. Please, cite a refuting study.

    Quote from Dodongo
    So you admit there are problems that need to be addressed, but don't think there is evidence that you and your colleagues should attempt to address them? Ok...?
    Yes, personally I do feel there are problems with NP education as it stands right now, and many of my colleagues (including me) have been very proactive in attempting to correct them. I would prefer not to wait for the data to begin to swing.

    Quote from Dodongo
    You have made it clear that you think only practicing NPs have any ability to comment on this at all so I will bow out.
    Please, comment if you wish, I'd be curious how you feel after some clinical experience.

  • Dec 4

    Quote from Dodongo
    I commented that I was more than qualified to comment on the educational process of NPs. As I am, right this very moment, experiencing it.
    You are beginning to experience it but you haven't had any clinical experience so you don't have any experience in the application of that knowledge.

    FWIW I haven't commented at all on physician education or PA education, only the outcomes of that education on clinical practice, and even that is to cite the data not give an editorial.


    Quote from Dodongo
    ...treatment is absurdly standardized. In other words, with a study heavily biased towards the null. Even a registered nurse could follow the recommended AAP flow sheet for diagnosis and treatment of asthma, or the JNC for HTN or the ADA for diabetes. 9/10 times if you throw Advair, ACE or Metformin at these people you’ll be practicing within the standard of care.
    This comment right here highlights your lack of education and experience. If you practice with this kind of approach you are going to kill people. Real-life practice is far more complicated than you assume it is. Please, before you step foot in clinical practice, consider some humility, you may find things are not as black and white as your textbook or flowchart.


    Quote from Dodongo
    None of this is surprising, however, coming from studies with Mundinger as the lead author, as she is HEAVILY biased toward NPs given her background, much in the same way that studies published by drug companies are.
    This is the same conspiracy rubbish that anti-vaxxers use. This study was authored by a mix of nursing and medical researched and published in one of the most prestigious medical journals in the world. The results have been demonstrated over and over again. Please, cite a refuting study.

    Quote from Dodongo
    So you admit there are problems that need to be addressed, but don't think there is evidence that you and your colleagues should attempt to address them? Ok...?
    Yes, personally I do feel there are problems with NP education as it stands right now, and many of my colleagues (including me) have been very proactive in attempting to correct them. I would prefer not to wait for the data to begin to swing.

    Quote from Dodongo
    You have made it clear that you think only practicing NPs have any ability to comment on this at all so I will bow out.
    Please, comment if you wish, I'd be curious how you feel after some clinical experience.

  • Dec 4

    Welcome student NPs and prospective student NPs!

    Starting your journey towards advanced practice and the provider role is a stressful time (we all know, we have been there) but also is a time to really embrace your transition and have the freedom to be an active learner. This time will be the foundation your career and your practice is built on. Unfortunately, this is a stage that is often mired by anxiety related to clinical placements.

    I wanted to take some time and share my personal opinions on some frequently asked questions and frequently discussed topics. I would like to offer some guidance in a two-part post on this topic, this is part one of two.

    First off, a little about me. I am a board-certified Family Nurse Practitioner and I work in a mixture of both inpatient and clinic settings with a small independent adult internal medicine practice. I live in a state that requires a collaboration agreement but I practice almost fully independently (as fully as I am comfortable with, see below). I have been on the clinical and didactic faculty at a local NP program as well as a lecturer and clinical preceptor for a local medical school. I have been an active preceptor for most of my NP career. I am active in the local and national NP association. I am not, however, the be-all-end-all of NP advice, so take everything as the opinion of one person with some experience.

    Now on to the 10 questions I most frequently hear from students, both in school/practice and here at AN:

    1. How do I find a clinical placement?
    2. How much RN experience do I need before I start clinicals?
    3. How do I prepare for my first clinical?
    4. What is expected of me at my first clinical?
    5. Do students really fail clinical?
    6. What is the most important goal for my first clinical rotation?
    7. What do I do if I am not sure about something?
    8. How do I handle a disagreement with a preceptor?
    9. What if I make a mistake?
    10. What if my preceptor does something different from what I have learned in school?

    And here are my thoughts on each, perhaps other experienced members will add theirs as well. In part one I will take the first 5 questions as I see them. I will add a second installment with the later five out of ten.

    How do I find a clinical placement?


    Hopefully you are going to a program that helps you secure quality preceptor spots, this is my personal/professional bias, but your clinical experience is critical to your success as an NP and programs that leave that up to a student are not doing their students any favors. That being said I realize it is a trend for programs to not secure clinical sites and that there are good programs that no longer offer this. Remember there are a surplus of NP students and a relative lack of preceptors, and preceptors are (most often) not paid and often take on extra work and/or lost productivity earnings to take a student while many more are prohibited from taking students by their employer.

    Just like finding the right job, finding the right clinical site depends on using your existing network contacts, your school’s network contacts, and making a personal effort. Talk to your family, your friends, your coworkers, your classmates, your alumni/ae, and your personal providers to see if anyone can help you get a “foot in the door” with anyone. Getting that initial contact is important. Join both the AANP and your local state NP association; they often have resources to help students find preceptors, it helps you network, and the dues are often very cheap/free for students. Make a professional and succinct resume and cover letter and hand deliver it to local practice managers; focus on small practices where you can get a face to face with the manager but also understand that many offices are very busy and won’t have time to sit down with you. Cast a wide net.

    Don't expect to have much luch posting on message boards for preceptors.

    Lastly, try and avoid any paid services. They are often not helpful and offer limited guarantees and return on your investment.

    How much RN experience do I need before I start clinicals?

    This is a hotly debated topic and you can do a search on this website for a myriad of opinions. Most importantly is you need to have your RN before you can start APN clinicals.

    From my experience, there is no universal answer to this question. There are students with no experience that perform very well and there are nurses with ages of experience that struggle. They are, for the most part, the outliers. It is true that the RN role and the NP role are very different, but there are also important aspects they both share. I normally answer this question with a question: how much experience do you think you need? Self-reflection is very important at the provider level. The first step is to evaluate yourself and understand what you need; shadows some NPs and see if you are totally lost or ready to jump in. The second step is to figure out what your school requires. The third step is to discuss with prospective preceptors what they feel is appropriate.

    While RN experience may not be required of everyone there is very little argument that some RN experience won’t benefit just about everyone. I don’t love that some student NPs are also trying to work their first RN job, learn that role, go to school, and also do NP clinicals. There is, for me, too much confusion there.

    How do I prepare for my first clinical?

    This is one of the most stressful things for students along with the “what is expected of me” question below, and they are intimately related.
    The first step is to do some research on the type of practice you will be joining for your semester. You can search the internet to find the most common reasons for visits to that speciality and the most common diagnoses. You can find through your school resources the guidelines for treating common diseases in that setting.

    The second step is to reach out to your preceptor ahead of time and convey that you have done step 1 and ask if there is anything specific that you could do to prepare.

    The third step is to assemble an acceptable wardrobe to wear for your clinical rotation: it’s ok to find something professional but inexpensive and wear the same thing each day (often once a week) if you don’t have the money to buy a whole new wardrobe. Don’t show up looking unprofessional.

    The fourth step is make sure you can get there on time!

    What is expected of me at my first clinical?

    As state above, this is intimately related to how you prepare. You will be expected to show up on-time and as scheduled, in appropriate attire, with a basic understanding of the type of patient you are expected to see and some general idea of the type of practice. This is pretty universal.

    I expect my first semester students to #1 be safe and #2 to be open to learn and active in the process. I also expect them to communicate with me openly, as I consider that part of #1 (safety). I also expect my first-time students to be able to have a general idea of how to obtain a basic comprehensive history and do a basic comprehensive physical exam. That’s all I ask at the start of the first semester.

    On the first day I expect students to just get acclimated to the environment; meet the staff, navigate the EMR, shadow me through the day on acute and chronic visits or rounds. I welcome students to be involved with me in discussion between patients and get involved in physical findings I will identify; as above be honest if they can’t see/hear/feel them.

    From that point on my expectations are dictated by the student: I first challenged to identify normal from abnormal as this is required for safe practice. Next I have students begin to focus their history and exam and to begin to formulate crude differentials with a focus on ruling out the most dangerous possibilities. Next I have students start thinking about potential treatment plans followed by what their actions would be on the next visit if unsuccessful. That is as far as most students will get in their first rotation. It may be basic for some, a challenge for others, but if a student can focus on those things they have a good foundation to build on.

    Do students really fail clinical?

    Yes. Students fail clinical; when it happens it is (almost) always the fault of the student for breaking very clear and simple rules. For me there are only three ways you can fail your first clinical semester.

    The first is that you don’t show up or you show up late. There are always situations that can be excused but if you are either chronically late or unreliable you have failed yourself and thus your clinical rotation. This is the worst type of failure because t shows you are not invested in your career.

    The second (and most important) is that you are clinically unsafe; this changes every semester with your expectations. For a first semester student being clinically unsafe (to me) is giving medical advice your are not qualified to give, not being able to identify normal from abnormal by the end of the semester, or being unable to consider crude differentials and/or doing what I call “pigeonholing” repeatedly. This is the best type of failure because it protects your career from a lawsuit. Repeat your semester and improve.

    The third is not being honest with me. Your job is to be a student and it is ok to make mistakes and it is your time to see and hear and feel and learn. If I ask you to look in an ear and tell me what you think and you say “I don’t know what I am looking at” or “I can see” that’s fine because it’s honest. If you look in the ear and say “the membrane is pearly gray and the landmarks are visible” when there is a full cerumen impaction then you are both unsafe (see the second reason) and dishonest; if you can’t see and don’t tell me than I don’t know you can’t see and you will never learn normal and abnormal (see the second reason).

    It’s rare I fail a student but it is always in that student’s control and that student’s best interest. I have also had a student I failed come back and be one of the best NP’s I know. It’s not the end of your career it’s the start of it.

  • Dec 4

    Quote from Fnpatlast
    I want to thank you all for your responses to my post. I want to provide a brief update. I'm 3 months into the difficult job. I have wanted to work so close to home for over 10 years! This is my first NP job and it is the hardest job anyone can have in primary care. I'm expected to see 20-30 patients a day. I'm currently seeing about 20. What gets me is the way I get yelled at when I make mistakes. My superiors are very disrectful. They say things like-you can be sued for that or that is malpractice. I feel so awful for not knowing as much as they do. It is a physician run practice and there's a lot of animosity towards NPs. I'm currently interviewing at other places. I will travel if I have to. I can even go back to work as an RN. Please keep me in your prayers. I can't wait to submit my resignation letter.
    Best of luck.

    There should be no disrespect or unprofessional behavior in a professional environment.

    Three months into your new role if you are seeing 20 patients a day, depending on acuity, you are bound to make mistakes or miss things, which isn't good for you, the patients, or the practice. If those mistakes are truly "malpractice" mistakes (meaning they have damages directly resulting from substandard care) than you should resign immediately as you are putting your license and future in continued jeopardy.

    Hope it all works out.

  • Dec 4

    Quote from Dodongo
    NP educational programs hurt the profession. There's a reason so many people, working NPs included, feel this way. And, as a student experiencing the educational process for NPs at this very moment, I think I am more than qualified to comment on it.
    What exactly about your experience, haven't not yet even begun clinical training yet alone had any actual clinical practice experience, makes you "more than qualified" to determine competent clinical practice?

    One thing you need to keep in mind as your do your training is that the most dangerous providers are the ones that practice beyond their experience, knowledge, and training.


    Quote from Dodongo
    As I stated above, I felt strongly enough about it that I sought out additional educational opportunities.
    Congratulations, graduate school (in every discipline) is about the self-directed work that you do.

    Quote from Dodongo
    You are free to use biased, systematic reviews performed almost exclusively by nurses to prove your points, but any one who is experienced in evaluating research knows these studies are low quality. We all know that until a head to head, randomized controlled trial is performed, there's really no way to know if NPs provide EQUAL care to that of physicians. This study, of course, will never be performed as it is impossible in health care and probably unethical.
    What studies are you talking about? Please, cite them here. Now that you mention that they "will never be performed", example of landmark RCTs published in major peer-reviewed medical journals:

    Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.

    Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

    Quote from Dodongo
    the educational process is hurting the profession as a whole. Imagine. If we were to include graduate level anatomy, physiology and increase our clinical hours (something that many NPs and NP students are opining for) what would PAs and MDs have to say against us? Nothing.
    Why not make NP school longer than medical school with a 15 year residency program at the end? You wouldn't mind spending another few hundred thousand and working for basically free for 15 years would you? Especially when there is no evidence that outcomes would be any better. What would you use as your rationale to justify that additional cost and time?

    NP education has it problems and we (practicing NPs and educators) need to tackle them, in my opinion, but there truly isn't any evidence right now to support it.

  • Dec 3

    Quote from Dodongo
    I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements.
    Prepared for what, entry to practice as a novice provider?

    What is your statement based on? Published data? Professional experience as a provider? Professional experience as an educator? Opinions are fine but statements like this hurt the profession. Once you have finished your program and have been in practice, if you still feel this way, great, but until then you have to think about if you have the experience/expertise to be making this kind of statement.

  • Dec 3

    Quote from Dodongo
    NP educational programs hurt the profession. There's a reason so many people, working NPs included, feel this way. And, as a student experiencing the educational process for NPs at this very moment, I think I am more than qualified to comment on it.
    What exactly about your experience, haven't not yet even begun clinical training yet alone had any actual clinical practice experience, makes you "more than qualified" to determine competent clinical practice?

    One thing you need to keep in mind as your do your training is that the most dangerous providers are the ones that practice beyond their experience, knowledge, and training.


    Quote from Dodongo
    As I stated above, I felt strongly enough about it that I sought out additional educational opportunities.
    Congratulations, graduate school (in every discipline) is about the self-directed work that you do.

    Quote from Dodongo
    You are free to use biased, systematic reviews performed almost exclusively by nurses to prove your points, but any one who is experienced in evaluating research knows these studies are low quality. We all know that until a head to head, randomized controlled trial is performed, there's really no way to know if NPs provide EQUAL care to that of physicians. This study, of course, will never be performed as it is impossible in health care and probably unethical.
    What studies are you talking about? Please, cite them here. Now that you mention that they "will never be performed", example of landmark RCTs published in major peer-reviewed medical journals:

    Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.

    Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

    Quote from Dodongo
    the educational process is hurting the profession as a whole. Imagine. If we were to include graduate level anatomy, physiology and increase our clinical hours (something that many NPs and NP students are opining for) what would PAs and MDs have to say against us? Nothing.
    Why not make NP school longer than medical school with a 15 year residency program at the end? You wouldn't mind spending another few hundred thousand and working for basically free for 15 years would you? Especially when there is no evidence that outcomes would be any better. What would you use as your rationale to justify that additional cost and time?

    NP education has it problems and we (practicing NPs and educators) need to tackle them, in my opinion, but there truly isn't any evidence right now to support it.

  • Dec 3

    Quote from Dodongo
    NP educational programs hurt the profession. There's a reason so many people, working NPs included, feel this way. And, as a student experiencing the educational process for NPs at this very moment, I think I am more than qualified to comment on it.
    What exactly about your experience, haven't not yet even begun clinical training yet alone had any actual clinical practice experience, makes you "more than qualified" to determine competent clinical practice?

    One thing you need to keep in mind as your do your training is that the most dangerous providers are the ones that practice beyond their experience, knowledge, and training.


    Quote from Dodongo
    As I stated above, I felt strongly enough about it that I sought out additional educational opportunities.
    Congratulations, graduate school (in every discipline) is about the self-directed work that you do.

    Quote from Dodongo
    You are free to use biased, systematic reviews performed almost exclusively by nurses to prove your points, but any one who is experienced in evaluating research knows these studies are low quality. We all know that until a head to head, randomized controlled trial is performed, there's really no way to know if NPs provide EQUAL care to that of physicians. This study, of course, will never be performed as it is impossible in health care and probably unethical.
    What studies are you talking about? Please, cite them here. Now that you mention that they "will never be performed", example of landmark RCTs published in major peer-reviewed medical journals:

    Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.

    Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

    Quote from Dodongo
    the educational process is hurting the profession as a whole. Imagine. If we were to include graduate level anatomy, physiology and increase our clinical hours (something that many NPs and NP students are opining for) what would PAs and MDs have to say against us? Nothing.
    Why not make NP school longer than medical school with a 15 year residency program at the end? You wouldn't mind spending another few hundred thousand and working for basically free for 15 years would you? Especially when there is no evidence that outcomes would be any better. What would you use as your rationale to justify that additional cost and time?

    NP education has it problems and we (practicing NPs and educators) need to tackle them, in my opinion, but there truly isn't any evidence right now to support it.

  • Dec 3

    Quote from Jules A
    That means NPs are reimbursed from insurance at the same rate for doing the same job which I support and which in theory should increase our value and compensation however no worries because I'm sure the number of co-dependent NPs with zero business savvy will continue to accept horrible paying jobs. All while feeling self righteous because if they didn't personally do the prior authorizations, answer the phones or scrub the office floor it wouldn't get done and all their beloved patients would surely perish. Written only partially tongue in cheek.
    I am really on the fence about the "equal pay" issue, I can see a valid argument on both sides.

  • Dec 3

    Quote from Dodongo
    I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements.
    Prepared for what, entry to practice as a novice provider?

    What is your statement based on? Published data? Professional experience as a provider? Professional experience as an educator? Opinions are fine but statements like this hurt the profession. Once you have finished your program and have been in practice, if you still feel this way, great, but until then you have to think about if you have the experience/expertise to be making this kind of statement.

  • Dec 3

    Quote from Dodongo
    I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements.
    Prepared for what, entry to practice as a novice provider?

    What is your statement based on? Published data? Professional experience as a provider? Professional experience as an educator? Opinions are fine but statements like this hurt the profession. Once you have finished your program and have been in practice, if you still feel this way, great, but until then you have to think about if you have the experience/expertise to be making this kind of statement.


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