Latest Comments by BostonFNP

BostonFNP Guide 39,253 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,471 (60% Liked) Likes: 10,554

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  • 4

    Quote from morelostthanfound
    Does anyone really believe that a busy nurse with a team of sick patients has time to do a deep dive into a literature review or EBP recommendations?
    If your BSN program changed your mind on this one statement, that would likely be enough to improve clinical outcomes significantly.

  • 13
    Hospicegal90, thfc, Rose_Queen, and 10 others like this.

    I find it very interesting that at the same time the PA is being chastised for belittling nurses, nurses are belittling his credentials.

    Obviously the PA was out of line, and I feel he should be directly confronted with it (in a professional manner): pull him aside, say "I heard what you aid in there about nurses being stupid and I feel like we should have a discussion about that". I am willing to be he would get really apologetic and probably feel pretty regretful in retrospect, and maybe, he would think twice before doing that again.

    Posting here undermining his education/role is doing exactly what he did and it does nothing but show a vengeful attitude towards a teammate.

  • 2

    Quote from Horseshoe
    Nursing would probably be more supportive of education changes if experienced, practicing RNs could be grandfathered in a similar manner to PTs.
    (To the best of my knowledge)

    PTs decided to make the change prior to there being evidence that a higher degree improved outcomes, and more specifically, increasing the education level of those already in practice improving outcomes. They were proactive. They were also gunning for independent practice and increasing the degree helps that.

    Nursing couldn't do it back in 1965 and now we are being reactive.

  • 4
    chare, AliNajaCat, psu_213, and 1 other like this.

    Quote from ModernRN
    So why all the critical thinking skills that are required all of a sudden?
    1. Because research has shown better outcomes are associated with BSN+ degree RNs.

    2. Because of the nursing surpless, employers are afforded the ability to be picky about who they hire and have started to prefer it.

    3. Because of Magnet status. See 1 and 2.

    Why do you all of a sudden bring it up?

  • 2
    SmilingBluEyes and KatieMI like this.

    I know I will not be popular but I do feel compelled to speak from the prescriber side of the table.

    We deal with scenarios similar to this every day in primary care, often multiple times per day. Overtreatment of uncomplicated ARS/ABRS is responsible for a considerable portion of the antibiotic resistance we are currently faced with in this country. There is a huge body of research on the topic. Naturally "younger" providers will practice in a more black and white, by the EBP guidelines fashion; I am not sure this is a bad thing. There is still an art to medicine as well as a practice of medicine and over time as you get to know patients you have a better understanding of how to best manage them. While I agree with previous posters that it is important to engage your patients in their own care and take that into consideration when developing their plan of care, but at the end of the day it is my job to do what I think is best for the patient, and sometimes being the best provider means that I say no to a script. A good provider isn't your buddy, a good provider does what they think is best.

    FWIW, I lost a family member to complications from ABRS. I understand the human side and I do my best to balance that with EBP but I am very conservative with antibiotics (and opioids for that matter) and I stick as closely to guidelines as possible. It doesn't mean I don't listen, I do, but I don't always agree.

    Also, Z-pak for ABRS is even worse, at least use a reasonable abx.

    Ok, grab your pitchforks and give me a head start.

  • 6
    BCgradnurse, WKShadowRN, verene, and 3 others like this.

    Quote from ICUman
    Can you share with us what you and your colleagues have said or done to help correct this issue?
    In short, we have worked with and continue to work with the following issues, including running some pilot studies which should shed some light on things within the next year:

    1. Improving the pre-clinical and clinical experience. NP programs depend heavily on clinical experiences and there is a lack of standardization both within and across NP programs when it comes to the type and quality of these experiences. The pre-clinical experience has been suggested as an important factor in transitioning the RN into the provider role; we are looking at data from standardized patient experiences as pre-clincial preparation. Clinical experience, as mentioned, is variable and we are looking at ways to standardize this process. One of the most important factors is quality preceptors, and unfortunately, many programs are placing less preference on the quality of preceptor and instead allowing/forcing students to secure their own placements, at times with untrained preceptors and in less-than-ideal settings. We are working on pilot trials to identify and qualify these experience in hopes that we can ultimately change accreditation requirements if deemed necessary.

    2. Standardizing the NP didactic curriculum. There are a number of topics being looked at and addressed/adjusted here. Again this ultimately falls to accreditation but there needs to be a effective model in place and that times a good deal of time. One of my personal pet peeves here is the fragmentation of the core clinical classes with the core pharmacology classes.

    3. Preceptor training. We have looked at preceptor training as there is ample evidence from other disciplines that outcome quality is dependent on the effectiveness of the preceptor in their role; sadly many preceptors have never done any formal (or informal) training.

    So, just a little of what I have been working on

  • 1
    WKShadowRN likes this.

    I don't want to derail the thread so I will try and keep this short.

    Quote from Dodongo
    I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements.

    I don't know why I can't help myself here. Looking back through this thread, you've actually agreed with many of my points, but now it seems you're trying to be contrary for the sake of argument.

    I disagree with your sweeping statement you made, and I don't think you have the experience and/or data to support your generalization. I am not being contrary but I do feel like posts like that should be challenged so other readers don't just take them as fact.

    Quote from Dodongo
    So how can you say that I can't comment on an educational process I am experiencing, but you can comment on other professions because med students rotate with you? Doesn't make sense.

    Do you feel you have a good idea how the educational process you are experiencing is going to impact your clinical practice? Do you feel you can extrapolate that to all NP programs?

    Quote from Dodongo
    Note how I said we could take REGISTERED NURSES and, using the current evidence based protocols that most clinicians use, achieve appropriate outcomes in patients with simple, straight forward asthma, HTN and diabetes (which, whether you like to admit it or not, are very standardized treatment algorithms).

    Again, get some clinical experience under your belt and see if you still feel that "standardized treatment algorithms" are easy to apply to clinical practice and don't require advanced practice to implement.

    Quote from Dodongo
    I'll continue to argue these points even if you disregard them because I'm still in school.

    FWIW I think you will probably be a good NP if you approach it with the same kind of academic and intellectual vigor as this thread. I know it is unsolicited advice, but enjoy your time as a student and learn as much as you can, the NP ed battle can be fought in a few years, it will probably still be there. Again, take it or leave it, but it is very important in clinical practice to consider your education and experience and remaining inside of it. Best of luck in school.

  • 5
    BCgradnurse, SummitRN, MurseJJ, and 2 others like this.

    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.

  • 6

    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.

  • 1
    msn10 likes this.

    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.

  • 4
    BCgradnurse, SummitRN, msn10, and 1 other like this.

    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.

  • 4
    Soliloquy, elkpark, WKShadowRN, and 1 other like this.

    Quote from Dodongo
    My program has 7 clinical semesters and I plan on working every shift my preceptor does during that time frame. The 800 clinical hour requirement is appalling.
    How many hours have you done so far?

    Quote from Dodongo
    But to try and say that the average NP is better equipped than the average physician to practice medicine is insane.
    I don't think anyone (perhaps save for the trollish folks) are trying to argue that NPs are "better equipped to practice medicine". There is a substantial amount of data on physician vs NP outcomes on a myraid of core measures that demonstrates comparable outcomes for both groups. Are there parts of medicine that aren't covered by those types of studies, absolutely, and these data can not be extrapolated to all of medicine, however, it certainly suggests that NPs are competent in their roles as providers.

  • 0

    Quote from bruins79
    Hello all!

    I am currently looking into NP programs and was wondering if anyone has any advice, has attended any of the Boston FNP programs, any pros or cons...any input would be useful! I have been looking into UMB, Simmons, Rivier (Nashua).. thanks in advance
    I'd look into Simmons, MGHIHP, BC, UMB, UMW.

  • 0

    Quote from Dovedane
    Does the make a nurse guilty of crime, I don't think so.
    If any of those meds were controlled substances it does make it a crime...

  • 0

    Quote from elkpark
    Actually, I doubt that the schools would care about that ...
    But over a few years they would lose accreditation and be gone. It's something we can all do rather than sitting around!