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BostonFNP Guide 44,039 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care NP. Posts: 4,753 (61% Liked) Likes: 11,547

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  • Aug 15

    Quote from Nursey916
    I have a hard time understanding why people jump on other peoples post to say rude things. Like get a life. You don't know me or my background, so why dont you take your judgemental rhetoric elsewhere. (in response to Zyprexa)
    I don't understand why people post to a public forum if they're determined to take any response they don't like as "rude" and as justification for being nasty to the poster.

  • Aug 7

    Quote from Jules A
    As usual you make excellent points but I'm not sold that we should be concerned about any "unfair advantage". Don't these sound like traits that would be beneficial to a new grad NP especially in light of how brief and inconsistent the current state of NP education is at this time?

    The young BSNs would likely be well served by taking a few years to get to the point where they also have this advantage. I know for the schools it is about admitting the most students to make the most money however as with the ability to work and go to school, although sounds delightfully inclusive and politically correct, I don't think an acceptable reason to lower the bar and that is exactly what this is in my opinion.

    Working or not being able to work while in NP school might be an excellent topic for a new thread. 5 straight days of clinical would provide a more comprehensive education. As a business minded adult the thought of not being able to work would have forced me to think long and hard about starting NP school which might be a refreshing change as compared to today when anyone writing the check and filling out the application gets accepted. I continue to be alarmed by the number of people who are actually in a NP program and then post here indicating they are clueless as to what the program entails, don't know any NPs, aren't aware of the areas they will be certified to practice in and don't even know what salary they might be receiving. Ahhhh but make no mistake they are aware it is likely to be M-F, lol. Again raising the bar is not a bad thing in my opinion.
    We have to circle back to the question of what advanced practice nursing education really is. You an I came from the traditional model of experienced nurses in our respective fields of specialization who went on to pursue graduate education in the same specialty to become NP's. That seemed ideal and for some years was the defense NP's use to justify the inconsistencies in education and limited clinical hours. It made sense for us, we were just filling in holes in our knowledge in terms of how we would transition as providers in a milieu we were already familiar with.

    That's not the case with advanced practice education now. We have various routes and a diverse student body representing a spectrum of new inexperienced nurses and those who have been in practice so long that it's hard to undo what they already know (good or bad). However, the educational approaches has not kept up with this reality...didactics and clinical rotations are still being offered in a manner that seems to assume a pre-existing level of expertise that new nurses would never have. That's our problem with DE programs - we can't wrap our minds around being able to produce competent NP's without the pre-existing knowledge we brought to the program.

    That's why I'm proposing uniformity and no assumption whatsoever of any pre-existing knowledge prior to entering the NP program. And, yes, I was one of those students who took the NP route because of the ability to work at the same time while attending the program. Again, it was along the lines of me being experienced, knowing my way around Critical Care as a nurse, and being able to figure out what is useful in my education and what is pure fluff that I can easily ignore.

  • Aug 6

    Quote from BostonFNP
    That being said, you also have quite a ways to go and haven't really gotten into the major part of your advanced practice education, which in my opinion, begins with the start of clinical rotations and the associated didactics. It might get better for you shortly.
    I feel the same way in that clinical rotations is where the important learning happens.

    Having said that, the way NP clinical rotations are structured needs a lot of rethinking. One, I think we need to move away from the current "apprenticeship" model in clinical rotations where NP's pretty much mirror the role of their clinical preceptor and merely watch and learn how "they do things" without necessarily ensuring that the way things are done conforms to standards of practice based on the strength of evidence in research.

    Two, this model promotes the failed policy of finding your own preceptor some schools try to sell under the guise that graduate students should be mature learners who must already possess the skills to network, know their goals for NP education, and have a job lined up after they are done. This creates an unfair advantage to experienced nurses with pre-existing connections vs younger, fresh out of BSN students who could learn fast but are new to healthcare.

    Three, we don't learn by picking up two days of clinical rotations a week eventually collecting enough hours to meet the program mandated semester hours for the rotation. Consistency is sometimes the key, and at least in the acute care setting, we get better by being in the clinical setting longer and in closer succession. This may mean NP programs can no longer be "nice" and allow students to work their RN jobs while in school.

    The current approaches contribute to the inconsistencies in training and educational holes in the final product produced in the NP's who graduate in our programs. I propose standardizing clinical rotation only in settings that have had long tradition of teaching students and follow a structured exposure to clinical scenarios covering all the important points in the didactic curriculum with adherence to current standards of practice. Unfortunately, these types of practices are only likely to be found in settings that have affiliation with academic institutions.

  • Aug 3

    Quote from cjcsoon2bnp
    Do you feel that most NP programs are successfully producing graduates who are fully ready to assume the NP role in our current healthcare landscape? Or do you think that a majority of the issues are due to problems in education programs, healthcare institutions, and to a degree, the students themselves (e.g. professionalism, behavior, experience, expectations)?
    One of the biggest frustrations for me as a new grad PMHNP is that in my specialty we just aren't exposed enough to the medical realm and yet, so many of the patient's we work with have a ton of comorbid medical issues (many caused by the medications we prescribe). Without being duly certified in another specialty - FNP, AGPCNP, ACNP etc. - we can't really manage medical issues, and so many of our patients don't have access to primary care.

    One class of general pharmacology in combination with my psychopharmacology course and clinical rotations gives me knowledge about general pharmacological principles, mechanisms and interactions with the medications I prescribe but not enough were I would feel comfortable (or safe license/liability wise) where I would feel okay managing conditions like metabolic syndrome, diabetes, hypothyroidism etc.

    I chose the facility where I will be starting at based on the fact that I worked there as an RN and have a very clear understanding of the client population, what my caseload will look like, the fact that I have already built relationship with the MD's that work there and can go to them for help, and what supports I will have with medical management - however I know from recruitment stuff I've gotten not all facilities understand the limitations of the PMHNP position (and it seems some definitely try and push medical and psychiatric management on the practitioner).

    I've been an RN for a few years so I have no problem turning down places where I have a pretty good gut intuition would try and work me outside my scope (some facilities really don't care - you're just a way to make them revenue) or those that will low-ball me while having me work long hours on a salary (no thanks). However, one has to think - someone out there is taking these positions (seriously one of the county ED's was trying to hire a PMHNP on for $35/hr - and someone filled it).

    Like in a perfect world (on top of adding a lot more sciences to the NP degree and making admission standards more stringent) I really wish that they divided the specialties into two general tracks - Primary Care & Acute care - with every specialty starting with a year of doing general medical rotations (outpatient or inpatient depending on track) and then a second year of specialty rotations. Because honestly, I have absolutely no desire managing chronic medical conditions but I would like to have some proficiency in doing so (and not have it be a huge mess of liability) if I was in the position where it was necessary.

    I also really, really wish that other specialties got a lot more experience with psych - one thing that I found when I was doing ED consults was just how many primary care providers try to manage psychiatric issues and have no clue what they're doing. Like seriously - doing R/O Dementia on a 65 Y/O being managed on Xanax 1 mg PO TID for Anxiety, Percoset 10/325 PO Q6H BID PRN for Chronic pain, Ambien 20 mg PO QHS for Insomnia; sometimes with a stimulant thrown on top for chronic fatigue. Holy cow I'm half that person's age and spend my free time weight-lifting and I would be floored under the table and unable to remember anything with that regimen. No wonder they're having memory problems.

    These are just some of my thoughts on the whole thing.

  • Aug 3

    Quote from elkpark
    Perhaps because it's a serious illness that causes a lot of disability and death. Most all the nurses I know are "against the influenza." I, personally, am vehemently opposed to influenza -- which is why I, and most all the healthcare workers I know, get vaccinated against it each year.
    I too am very much against influenza which is why I voluntarily get a vaccination every year. As an interesting anecdote with regard to vaccinations - I (smart lady that I am) delayed getting my son the HPV due to some very "FAKE" news articles that I read on the web. I finally sat down with our son's pediatrician and discussed my concerns ( which every person with vaccine concerns should do) and decided that there simply was not enough evidence to justify my fears. The man cub has now had all his HPV vaccines and his manhood didn't fall off as the "doom sayers" predicted.


  • Aug 3

    Quote from shibaowner
    I truly do not understand why people are being coy about naming schools. Please just name the schools pertinent to an issue at hand.

    Juan, I don't know you. However, not attacking people personally has to go both ways. Again, I was attacked and I did not complain. You didn't jump to my defense, I noticed. Why is it adolescent to make a factual observation? I don't care if people attack me - I just want to have a useful debate. I will admit when I am wrong. In addition, this forum is not "owned" by posters that have been on here a long time. Just because someone has been active on this forum for a long time does not make their opinions more "valid." If you try to shut down people with differing opinions, this forum will cease to be useful.
    Saying "you had a chip on your shoulder" is uncalled for.

    However, not to defend elk again but I wish you would re-read what she wrote. That to me was a factual observation on her part and not an attack. You have, on multiple occasions defended that NP's in primary care do not need experience at the bedside as RN's illuminating it through published research (that are imperfect as many research are) and with your own personal experience going through BSN then straight to NP without ever working as an RN. That was clear enough and I respect that.

    Yet, on some of your posts in defending the NP role vs PA's, you made an argument that most NP's have bedside RN experience that seem to imply that it strengthens their credibility in having less total clinical hours in their training compared to PA's. That was the head scratcher she was alluding to because it seems like you contradicted yourself.

    You also mentioned in the very same post that one can not go to NP school without a BSN and you were proven wrong because there are NP's that never got a BSN because of the direct entry program route they took. I guess it does help that most of us have been posters here for a while because this is a fact that has been mentioned in these forums over and over again.

    I admire your passion but if I were a newbie (not on allnurses BTW but as an NP in general), I'd be careful what I post here without checking the facts because someone here more experienced will call you out on whatever inaccurate info you post.

  • Aug 2

    Quote from shibaowner
    The clinic I work for hires new grad NPs and PAs, provides extensive training, and also believes in precepting NP and PA students. We're going to hire at least 10 NPs and PAs in the next year. This group has a long history of hiring new grad NPs and PAs, and because of the excellent training, has never had a problem.
    That's great. I think that with your education at a reputable program and extensive on the job training, you will become an excellent clinician. I firmly believe in individual qualities and circumstances that affect the way each of us NP's turn out in the end. Sometimes, the stars align well that things work out in the best way. Think of someone who not only had no RN experience and went to a terrible school only to be fed to the wolves in a new NP job that has little support - that's a disaster and we don't need studies to prove that. I think we all agree that this happens and we all agree that we need to improve so that this risk is minimized.

  • Aug 1

    Here's my prescription:

    Keep all current Consensus Model based NP programs in the specialties they were intended to train NP's on.

    Form a new regulatory body tasked with only accrediting NP programs similar to COA for CRNA's and ACME for CNM's. Regulatory body to formulate new standards for NP education including but not limited to:

    - Ensuring that clinical preceptors are affiliated with the specific programs as faculty members. Students are not to find their own preceptors period.

    - Preceptors in each program, at a minimum, should be representative of the broad spectrum of specialties required in each of the Consensus Model-based NP track. FNP programs at a minimum, should have a faculty preceptor for Pediatrics, Women's Health, Family Practice, Primary Care Internal Medicine, and Fast Track/Urgent Care.

    Similarly, all AGACNP programs must have preceptors for Adult Emergency Medicine, Hospitalist Medicine, and Critical Care. Subspecialty preceptors are available as needed for elective clinical rotations that students pick based on their goals (i.e., Cardiology, Nephrology, etc).

    - Increase the clinical hour requirement to 1000 hours. Restructure clinical rotations in a manner that promotes consistency which may mean having the student be in the clinical setting 5 days a week for a month at a time.

    - All distance-accessible and on-campus programs must be compliant with the regulatory standards. In order to allow institutions some time to make arrangements to be compliant, a gradual phase in of the new standards must occur over a period of 5 years after which all institutions must meet the new standards to receive accreditation from the new governing body. Non-compliant institutions can not have their graduates sit for national certification.

    - All new NP programs being developed or in the planning stages of admitting students must comply with the newly established administrative and regulatory guidelines for accreditation.

    Roll back the recommendation to make DNP the entry to practice requirement. Make the DNP available as an option for NP's to advance into Leadership, Policy Making, Consulting, etc. roles.

  • Jul 31

    Quote from NurseYannie
    So many nurses are against the influenza I wonder why?
    Perhaps because it's a serious illness that causes a lot of disability and death. Most all the nurses I know are "against the influenza." I, personally, am vehemently opposed to influenza -- which is why I, and most all the healthcare workers I know, get vaccinated against it each year.

  • Jul 18

    Quote from Owlgal
    Can you (or anyone) point to data that suggests that candidates from online programs (that you, at least) deem inferior, are actually turning out incompetent or borderline competent NPs?
    You didn't understand my comment. In my opinion, whether or not a school is distance or on campus is of no consequence. The type of students admitted to either type of program is what matters. If an online program admits high caliber students, and the program is of a high quality, then that NP will probably be a good practitioner. Conversely, if an in person program has low/no admission standards and a poorly constructed curriculum, then the graduate NPs will probably be fairly awful.

    I am attending a hybrid program and am loving it. Some classes are recorded lectures and mostly reading, while others are live lectures. I have to go to campus for standardized patient scenarios, skills labs, etc. And all of my tests are proctored. Online programs can be done appropriately, however, there are many that are terrible and embarrassing and should be shut down.

  • Jul 11

    I don't think just because a program is on-line automatically makes it inferior. Many people learn well in that format. I prefer the B&M format cause that is the best way for me to learn. I also enjoy and benefit from the camaraderie of other students and the ability to work and study with others. I do have an issue with any program that does not have rigorous admission and performance standards and will admit any one who can pay.

    FWIW-I am one of those DE NP graduates that also seems to garner all the negative attention. My practice and my patients are doing just fine.

  • Jul 11

    - an NP "announces being a doctor"?
    - all NPs are doctorate prepared?
    - MRI found paraparesis being result a "side effect of medication"?? Gosh, I am burning of curiosity - what that might be? Easily reversible human model of MS? That's would be next Nobel prize in medicine, no doubts!
    - an NP saying that "there is no point of seeing a doctor"?
    - a person with M.D. goes for her gut feelings instead of dusting off her memory? Especially pathologist?? (these guys know patho better than most of other doctors, put together)

    Old USMLE/floor mnemonic: Old Parkins' got paresis >> first look for sumethin' else's!
    (new paresis in patient with Parkinson = stroke being #1 differential; and, yeah, patients with Parkinson are in the right age category for strokes of all kind, medulloblastomas, MS, DM complications, bleeds if they are anticoagulated, etc., etc.)

    As one of my former professor said, telling believable lies takes more knowledge than telling the truth. The whole thing is nothing else than a rudely made up compilation of mistakes and lies, written to scare off patients. That's why, I suspect, doctors in question were so unusually shy in revealing their names - for doctors with such names do not exist in the great state of Texas as well as anywhere else, and anyone with Internet access might find it out. Although, if every minute of good laugh adds five minutes to total life time, then thank you very much - I'm going to live half an hour longer

  • Jun 30

    Quote from BostonFNP
    Didn't we argue about this in the past?

    Glad to see you are moving on, the role will suit you.
    Haha we did, and I will admit that I was wrong.

    Thanks, applying for fellowship programs currently to reinforce my knowledge.

  • Jun 29

    What kind of NP do you want to be? In my acute program I heavily used my RN experience during internal med/hospitalist rotations. I imagine a smart student without RN experience (in another words, a qualified MD applicant) could do just as well as me. It's just going to be like drinking out of a firehouse for the first couple years. I was different as a RN, I always asked why and looked for the rationale behind MD decisions. Many RNs don't and thus their experience would be null and void.

    Summary: After going through a program I feel RN experience probably isn't necessary for the right student. (Even after being an a ACNP program that required 2 RN years in the ICU)

  • Jun 29

    Keep in mind that the RN (or physician) you take care of, may feel very vulnerable when a patient him/herself.

    I once awoke from what was supposed to be a day surgery, only to find myself admitted...on the floor that I actually worked on! Very vulnerable position and honestly, I was not well taken care of. I was appalled. I couldn't speak, and every time I'd ring the call light they'd ask "can I help you?" When I couldn't answer, they simply turned it off and didn't come in. It wasn't until I threw something out into the hallway that anyone paid attention to me. It really made me pay more attention to how I cared for my own patients.

    And remember, many times, it is assumed that because a patient is a nurse, they know everything you are talking about, when in fact the area of practice for that nurse may well be entirely different than whatever area she is currently a patient in so she may not be familiar with all of the jargon or procedures. (Trust me, I'd be in unfamiliar territory if I were a renal/CVS/ICU patient...those are not my thing).

    Just food for thought.