Latest Comments by BostonFNP

BostonFNP Guide 43,661 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care NP. Posts: 4,744 (61% Liked) Likes: 11,518

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  • 1
    Dodongo likes this.

    Quote from Stepney
    First, I really did mean overrated, as in too much emphasis. Reason is this: a person who comes into a program with great undergrad or high school grades may not be as knowledgeable as they thought they were. A Youtube video of 2 brothers discussing college entrance, tells freshmen students not to talk about their 4.0.
    Is the source you are citing really a "youtube video of 2 brothers"?

    So lets get this straight. I will take 1000 students with a 4.0 GPA and teach them to be an NP. You take 1000 students with a 2.0 GPA and you teach them to be NPs. You think we will have the same outcomes with quality? With board pass rates?

    Quote from Stepney
    There are many variables involved in pass rates for the boards, including how many people are taking boards in each specialty from each school. If only 3 people took boards in 1 year and 1 failed, you'll have a dismal pass rate. Are NPs practicing successfully without taking the boards? Not all states require you to be board certified prior to practicing. I'm not sure how you obtained the statistics for pass rates for each school. NP certification is not like the NCLEX. Please post your sources. My curiosity is peaked. The new NPs that I spoke to from on-line or for-profit schools have passed their boards on the first try and I saw the proof. They're happily practicing in their first jobs.
    There are very few practicing NPs that have not successfully passed a national board exam. There are 3 states which do not require national certification to practice as an APN, however, there are very few employers, very limited 3rd party payers, and no malpractice insurance carries which support this practice. The number of NPs in this category is non-significant.

    I have access to my state's pass rates due to the work that I do. There is also a recent online site that sampled 200+ NP programs for their pass rates. For the purpose of your argument we can very easily use NCLEX pass rates to show that some programs are consistently better than others on average. You want me to cite you numbers on that?

    Quote from Stepney
    I will never say that I have not made an error. In fact, I assume that I make more errors than I am aware of. That's why I feel it's so important to be humble. I am not a novice in practice, so I definitely know that there's a lot to learn beyond school.
    How long exactly have you been in NP practice? And how many student have your precepted in APN from various programs?

    Quote from Stepney
    Maybe I'm protesting too much in order to save my own job!
    Did you graduate from an on-line program or B&M? A for-profit or non?

    Quote from Stepney
    All of us are familiar with the term evidence-based. Our opinion or our experience is of no consequence. Post the research. Post the numbers. It's easier to understand and accept. (I tried to get those numbers. So far the boards don't seem to have them readily available, but it will still be a little suspect, since not everyone takes the board).
    So you say to post data with a pretext that you probably won't believe it based on a small number of outliers? That sounds suspicious for bias...

  • 0

    Quote from Stepney
    OK, GPAs are overrated.
    They are inflated not overrated.


    Quote from Stepney
    Passing or failing boards has nothing to do with the type of school you attended.
    To be totally honest, this is just an asinine argument to try and make. Quality programs have consistently higher pass rates than sub-quality programs and relatively stable across graduating classes. This may be due to the quality of the program or the quality of the applicants or both, but there is no arguing that pass rates between programs are significantly different.


    Quote from Stepney
    100% of the MDs I've seen giving incorrect diagnosis or treatment came from B&M schools. How's that for statistics? No one is perfect. We are all fallible.
    I am not sure what you point is here, everyone makes incorrect diagnoses. There is a major logistical fallacy here if you are suggesting that because everyone makes errors then everyone is the same. Out of curiosity, how long have you been practicing and diagnosing? Do you think you have never made an error? Do you think that your error rate as a novice is the same as everyone else's?

    Quote from Stepney
    Let's build each other up. And precept.
    This doesn't have anything to do with "building each other up" we are not talking about individuals. I will always help individuals to the best of my ability but that doesn't erase my concerns, and the concerns of many practicing NPs, re: the exponential increase of poor quality programs and the downstream effects of this, be it B&M or online.

    How long have you been precepting?

  • 0

    Quote from Owlgal
    I even asked about anecdotal stories of unqualified NPs that seem to all come from the same "terrible" schools. If we don't have data that clearly points out that these terrible online (for profit) NP programs are truly turning out poor performing NPs, then it just sounds like a bunch of complaining because "those NPs are stealing our jobs" or some-such.
    I have seen first hand what lower entrance standards and poorer quality programs produce, it's why my practice and several other practices locally only take students from two local programs (or nurses that we know personally/professionally). In those cases the students were so poorly prepared that too much of a burden fell on the preceptor to teach these students from the ground up, which to be frank, most practicing NPs don't have time to do in clinic. Personally my last attempt at a student from an online program (which, sadly in retrospect, I took because they offered to pay $2500/semester) didn't last the first day as the student arrived having never taken an advanced practice physical assessment course nor any knowledge how to conduct an H&P.

    You don't have to take my anecdotes, do your own research. There are plenty of posts here about failing the national board exams multiple times (which I suspect we would all agree is a bare minimum to practice safety), reach out to those posters and see what their incoming gpa and experience was and what program they went to.

  • 2
    BCgradnurse and shibaowner like this.

    Quote from juan de la cruz
    I'd have to agree with this. I've worked with various NP's of mixed stats in terms of RN experience, school attended, direct entry, etc. In the end, I feel that certain individuals have the knack, talent, intelligence, or whatever to succeed as NP's.
    Absolutely, the variability between individuals is much greater than that between programs and experience has been my experience.

  • 2
    shibaowner and BCgradnurse like this.

    Quote from Owlgal
    And then I think, "Holy crap, this person is, what, 25 years old with zero healthcare experience prior to NP school!" -- no wonder physicians are all up in arms about NPs.
    Because this time of the year interns definitely know exactly what to do right!

  • 7
    elkpark, LibraSunCNM, shibaowner, and 4 others like this.

    Quote from Owlgal
    I see a whole lot of hate for the online Nurse Practitioner programs. I'm wondering if anyone has any statistics regarding poor performance based on whether a NP went the traditional route versus online?

    Or are we assuming that they are lesser simply because they "must be" inferior?

    Personally, I don't think that anyone should be going through an NP program without at least 3-4 years of solid nursing experience. I'm far more concerned about a young NP straight out of school who has no real-world healthcare experience than I am about an experienced RN going the online route for their NP.

    Thoughts?

    And to disclose, I am one of those online, for-profit school NP students that seem to draw all the negative attention. Of course, I've also been a nurse for about 14 years and have been in hospital administration for the last several years.
    I am more concerned about an experienced RN going through a crappy NP program than I am about a direct entry NP going through a quality NP program.

    The real point here is that online vs B&M is the wrong question, it is quality vs non-quality. There are some fantastic quality online and hybrid programs and there are some crappy ones. The same is true for B&M.

  • 1
    Dodongo likes this.

    Just continuing the dialogue here not trying to pin you personally to anything.

    Quote from elkpark
    I agree with you about your second point, but, to me, meh. The ones who didn't want to be identified said that it was because they were afraid of getting in trouble with their employers. I can see that as a concern.
    Honestly, I sincerely doubt any physician is going to get fired over voicing their opinion, it suspect this has much more to do with the fact most down want their colleagues to judge them for their opinion, especially given that many physicians rely pretty heavily on NP/PA as a revenue stream.

    Quote from elkpark
    "a highly qualified nurse who is trained to treat certain medical conditions ..." The author does refer to NPs as "highly qualified," and, yes, says that the NPs referred to studies that have shown similar outcomes -- but the author doesn't dispute the NP's statement about that, or, in my reading, suggest that there is a problem with the studies.
    This is the qualifier that I have a problem with. What "certain medical conditions" are NPs trained to treat? In comparison, are physicians then trained to treat all medical conditions? Just like physicians, NPs treat all medical conditions that lie within their scope and training.

    Quote from elkpark
    But, to each her or his own. I have no dog in this fight (perhaps that's why I don't find the article as slanted as some others do).
    We all have our bias for sure. It's interesting for me, as both male and a nurse, because I read in this article implicit bias in word choice from the author that reminds me of implicit bias in gender. Makes me consider my own word choice.

  • 2
    ICUman and elkpark like this.

    Just continuing the dialogue here not trying to pin you personally to anything.

    Quote from elkpark
    I agree with you about your second point, but, to me, meh. The ones who didn't want to be identified said that it was because they were afraid of getting in trouble with their employers. I can see that as a concern.
    Honestly, I sincerely doubt any physician is going to get fired over voicing their opinion, it suspect this has much more to do with the fact most down want their colleagues to judge them for their opinion, especially given that many physicians rely pretty heavily on NP/PA as a revenue stream.

    Quote from elkpark
    "a highly qualified nurse who is trained to treat certain medical conditions ..." The author does refer to NPs as "highly qualified," and, yes, says that the NPs referred to studies that have shown similar outcomes -- but the author doesn't dispute the NP's statement about that, or, in my reading, suggest that there is a problem with the studies.
    This is the qualifier that I have a problem with. What "certain medical conditions" are NPs trained to treat? In comparison, are physicians then trained to treat all medical conditions? Just like physicians, NPs treat all medical conditions that lie within their scope and training.

    [/QUOTE]But, to each her or his own. I have no dog in this fight (perhaps that's why I don't find the article as slanted as some others do).[/QUOTE]

    We all have our bias for sure. It's interesting for me, as both male and a nurse, because I read in this article implicit bias in word choice from the author that reminds me of implicit bias in gender. Makes me consider my own word choice.

  • 1
    NurseSpeedy likes this.

    Strep throat can be added to the list.

  • 5
    MelEpiRN, ICUman, MurseJJ, and 2 others like this.

    Quote from elkpark
    The author refers to NPs as "highly qualified" and mentions that "that studies have shown there is no significant difference in outcomes between patients who are seen by nurse practitioners and those who are seen by medical doctors."
    The author actually doesn't state that directly in either case. "Highly trained to treat certain medical conditions" and "nurse practitioners counter that studies have shown..". Semantics, but perhaps important semantics. Throughout the article there are some interesting word choices and I think that's what makes me feel while reading that the article has a serious slant.

    I do think it is interesting that the physicians they spoke with weren't willing to put their names on their comments, all the NPs seemed to be happy to do that.

  • 3
    WKShadowRN, JustMe54, and TriciaJ like this.

    To be completely honest, the little anecdote sounded entirely fictitious like those made-up patients that drug reps use to try and sell you their drug.

    I love the comments from "doctors" that wouldn't even use their real names. It's just poor journalism.

  • 3
    shibaowner, BCgradnurse, and Jules A like this.

    Quote from Jules A
    Please cite your source that those with actual nursing experience had worse clinical skills.
    I suspect they are referencing this:

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

    For those without access, the relevant discussion:

    "An unexpected finding was that there was a significant negativecorrelation between years of experience as a RN and NPclinical practice skills as assessed by the NPs’ collaboratingphysicians. Longer experience as a RN was associated withlower rankings of NP skills competency by the physicians."

  • 0

    I wonder if she had gone to nursing school?

  • 6
    Serhilda, VivaLasViejas, cleback, and 3 others like this.

    It has been interesting to read the feedback, especially from those with their own history on mental illness. It has made me consider my own thoughts on the matter.

    I keep going back to the example the OP provided of a patient visiting the ED for a fracture. An admission for a decompensated psychiatric event is wholly different in my opinion, by the sheer nature of requiring inpatient level of care, so I started comparing a mental health admission to a CHF admission.

    Does the nature of it being a psychiatric admission change the ethical consideration in this case? While I would argue that in either case there are ethical concerns, do the both sit at the same place in the spectrum?

    I do feel that if we take the generic definition of decompendated metal illness that we all learned in school (a disturbance in thought, mood, or behavior) and we combine that with the fact a patient made their first connection with someone providing their care at that time, does that place the patient at higher risk than if a patient with decompensated heart failure does the same?

  • 19
    Orca, BCgradnurse, Tomascz, and 16 others like this.

    Quote from sarahg88
    It upsets me that there is a blanket policy on all of this.

    No authority can dictate my life.

    As for my professionalism, I am a highly respected nurse in my field and work with great compassion and competency.

    The fact that all of you are so disgusted makes me question your stigma. Right now, I'm saddened to think I work with people such as all of you.
    My two cents.

    First, I disagree that in any way it is "right" for your coworkers to judge or gossip about you. That is just not professional. They may question your professionalism and you may lose some professional respect, but hat is not a blanket excuse for co-workers to gossip. That's just trash.

    Second, I can only assume you came here to get the opinions of other nurses not personally connected to your situation. As most have suggested, when you take the personal component out of this and look at just the facts, there are some ethical concerns. There is a blanket policy not because of stigma but because of the importance of protecting both the nurse and the patient. You mention that you are highly respected and, honestly, that professionalism will be questioned. You have had a glimpse of what how your nursing colleagues feel about it. There is no legal issue here (at least by US standards) but there is an ethical one, and you need to decide if you can personally and professionally accept that or not.


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