ACNP without research, theory, etc

ROLO · Aug 9, 2012

OH, and I needed to add, I used/use research and theory every day. I am sort of scared of those who do not (or think they do not). Evidence based practice, best practice guidelines, new treatment modalities, patients perceptions of their caregivers, spirituality in breast cancer, the theory of caring...as an advanced practice nurse, SERIOUSLY, how can you not use research or theory to some degree?! The parts of research and theory (mostly research) that I do not care for are the parts that I did not truly master. One of these days I will re-visit those areas that I did not entirely grasp, and I am thinking I will find them interesting and even helpful.

8mpg · Aug 9, 2012

OH, and I needed to add, I used/use research and theory every day. I am sort of scared of those who do not (or think they do not). Evidence based practice, best practice guidelines, new treatment modalities, patients perceptions of their caregivers, spirituality in breast cancer, the theory of caring...as an advanced practice nurse, SERIOUSLY, how can you not use research or theory to some degree?! The parts of research and theory (mostly research) that I do not care for are the parts that I did not truly master. One of these days I will re-visit those areas that I did not entirely grasp, and I am thinking I will find them interesting and even helpful.

ROLO... I understand how important research is and the idea of evidence based practice. I just know that I do not need to know how to conduct the research but simply understand the use. I used evidence based practice everyday from reading the research, not from conducting it myself. I do not need a masters level course (I had a bachelors level course) on how to read research.

SHGR, MSN, RN, CNS · Aug 9, 2012

One more 'high horse' comment......
You must learn that research proves nothing. It only demonstrates a relationship, the lack of a relationship...The following example is a real headline but I will use bogus numbers to make my point...
Recently headline read something like, "Spanking leads to mental illness in children."
"Study of 20 mentally ill teens shows that they were all spanked as children."
....
The correct title should be "Mentally ill teens more likely to have been spanked as children."
The devil is in the details.

Ha, that study sounds like the researchers learned study design from Andrew Wakefield.

bsnanat2 · Aug 9, 2012

Unfortunately no one really knows how many 'Wakefields' are out there, unexposed. This is even more reason to be able to critically examine research, to be able to raise the proper questions before accepting and acting on research. Part of this is knowing to some degree how research should be conducted. I used to feel that my undergrad research was enough, that is, until grad research proved otherwise.

We cannot and should not get away from research courses, but perhaps the manner in which they are taught should be improved.

Advanced Practice Columnist / Guide · Aug 10, 2012

OP, a good ACNP program incorporates research evidence in the entire program especially in terms of the sequential ACNP didactics and not just from a single graduate level "nursing research" course. It is important that a review of evidence from the literature is what's driving lectures on how to treat ARDS for example, how levels of evidence are used in the current management of ACS, and how PPI's are not superior to H2 blockers in stress ulcer prophylaxis.

A hallmark of a good research finding is if the results are replicated in other similar studies, hence, the overwhelming support of evidence. Evidence-based medical practice is never typically taught in a graduate "nursing research" class but should be part of the ACNP didactics. It is important in ACNP practice more than anything else. Hopefully, you'll find a school that makes this a priority.

I think it is ridiculous to say that NP students could not critically examine research without going through a nursing research class. The Wakefield example was fueled by sensationalism and was not widely supported by the medical community. It did not result in a practice change as far as recommendation for vaccination in kids from both CDC and the Academy of Pediatrics, all it did was scare parents on both sides of the pond.

SFDRN · Oct 11, 2012

Juan and NPreform, I could not agree with you more. We need comprehensive ACNP education reform that actually reflects what ACNP's do on a day-to-day basis. I have suffered through one year of ACNP education so far, have just started my second year. Today, in my ACNP III class, I sat through 3 hours of basic oncology lectures that were aimed at prelicensure students. The speakers didn't even know who they were presenting to--they asked us midway through if we were FNP students. Not even a mention of how to manage an inpatient oncology patient, oncologic emergencies, or anything relevant for the ACNP. Then, in the afternoon, I sat through my "clinical conference" class where the instructor basically walked us through the syllabus AGAIN (she did this last week at the first class, too) and the five different writing projects we're doing for a CLINICAL CLASS this quarter. Every quarter is the same--write at least 3-5 "scholarly papers" aimed at prepping you to write a comprehensive exam which is basically just another paper. Don't get me wrong, I am a huge fan of research and evidence-based practice and am a major believer in using practice guidelines to deliver the best care. But since when does "writing scholarly papers" prepare RNs to become NP's? I can see a few papers here or there. But 5-6 a quarter?

Meanwhile, we got exactly 1 quarter of patho, 1 quarter of pharm, 1 class each on CV, respiratory, endocrine, GI, and neuro. But 3-4 classes each on standardized procedures, issues facing NP's, ethical dilemmas, use of theory in practice, etc. etc. Not to mention an entire REQUIRED class on how to build powerpoint presentations and make sure that any health education materials you produce meet the American public's 5th-8th grade reading level (easily done by using the Word Count feature in MS Word).

It is time to absolutely DEMAND that future NPs (too late for us, alas) receive the education that will actually prepare them to be functioning NPs when they graduate. And yes, I think residencies are absolutely necessary. But this may just encourage schools of nursing to slack off more on clinical hours (which they already do at the prelicensure level--reassuring students that "the hospital will teach you everything you need to know").

NP's are great and we definitely bring a fresh perspective to patient care. But let's not pretend that for the most part, NPs practice medicine. We need to be trained as such. NPs and PAs should join forces and create a combined midlevel curriculum. Just look at the CRNA curricula--it is so much more focused on the biomedical model of caring for patients--because that's what they need to do!

CCRNDiva, BSN, RN · Oct 11, 2012

SFDRN, I have to agree with you. After a year of full time course work, I'm finally into my specialty courses, (ACNP w/ critical care focus). I thought I would finally get into the meat and potatoes of my major. Surprise, I have 3 presentations and a paper that will account for half of my grade for a diagnostics course. Like you, these papers/presentations are meant to prepare for my comprehensive exam, which is, aha, just another paper!! I am lucky to get a full lecture (3 hours) devoted to each body system, while some are lumped together in one lecture but I've had entire lectures dedicated to quantitative research or how to develop a PICO question and an entire course dedicated to various nursing theories. Something is wrong here!!! I understand that this is how it has been done, but it is time for a change.

We were told during orientation that they want us to publish. I understand that improves the reputation of their program but I want to take care of patients, critically ill patients, for that matter. I feel like I need another pharmacology course (and my course was taught by an awesome instructor who is both a PharmD and an ACNP) and I could use courses dedicated to the pulmonary and neuro systems. I had to take a cardiovascular course as an elective to expand my knowledge of the cardiovascular system. You would think the DNP would address these deficiencies, but sadly, it does not. I doubt my future patients are going to care that I had to master writing papers to complete my program or that I've been published in a peer-reviewed journal. I think they would like to know that I have a firm understanding of their disease process.

I don't know how a direct entry student could master the clinical content in my program. We are frequently told "I'm not going to elaborate on this, you guys should understand this from you current practice." Which is probably why my program insists upon practice as an RN prior to clinicals. We have several students, however, who have less than 3 yrs of practice and they struggle at times. I stalk Medscape daily to try to supplement my learning. I ask the docs to explain what I don't understand when I'm at work. I'm also looking into supplementing my clinical time next year and applying to a fellowship after graduation. I'm not trying to bash my program, (its a top 50 program), I just feel that the format for NP education needs revamping and tacking on additional research, transitional research, EBP, policy, and finance courses and calling it a practice doctorate is not going to cut.

CRF250Xpert · Oct 11, 2012

I pretty much spend my whole day thinking, "I wonder what Orem would do?" Then I wake up, realize I have a ton of pt's to see, Dx,Rx plan, etc - such much work - so little time for theory reflections and comparrison. Probably why I spend my day in an exam room and not a classroom.

Advanced Practice Columnist / Guide · Oct 12, 2012

Today, in my ACNP III class, I sat through 3 hours of basic oncology lectures that were aimed at prelicensure students. The speakers didn't even know who they were presenting to--they asked us midway through if we were FNP students. Not even a mention of how to manage an inpatient oncology patient, oncologic emergencies, or anything relevant for the ACNP. Then, in the afternoon, I sat through my "clinical conference" class where the instructor basically walked us through the syllabus AGAIN (she did this last week at the first class, too) and the five different writing projects we're doing for a CLINICAL CLASS this quarter. Every quarter is the same--write at least 3-5 "scholarly papers" aimed at prepping you to write a comprehensive exam which is basically just another paper. Don't get me wrong, I am a huge fan of research and evidence-based practice and am a major believer in using practice guidelines to deliver the best care. But since when does "writing scholarly papers" prepare RNs to become NP's? I can see a few papers here or there. But 5-6 a quarter?
Meanwhile, we got exactly 1 quarter of patho, 1 quarter of pharm, 1 class each on CV, respiratory, endocrine, GI, and neuro. But 3-4 classes each on standardized procedures, issues facing NP's, ethical dilemmas, use of theory in practice, etc. etc. Not to mention an entire REQUIRED class on how to build powerpoint presentations and make sure that any health education materials you produce meet the American public's 5th-8th grade reading level (easily done by using the Word Count feature in MS Word).
It is time to absolutely DEMAND that future NPs (too late for us, alas) receive the education that will actually prepare them to be functioning NPs when they graduate. And yes, I think residencies are absolutely necessary. But this may just encourage schools of nursing to slack off more on clinical hours (which they already do at the prelicensure level--reassuring students that "the hospital will teach you everything you need to know").

After a year of full time course work, I'm finally into my specialty courses, (ACNP w/ critical care focus). I thought I would finally get into the meat and potatoes of my major. Surprise, I have 3 presentations and a paper that will account for half of my grade for a diagnostics course. Like you, these papers/presentations are meant to prepare for my comprehensive exam, which is, aha, just another paper!! I am lucky to get a full lecture (3 hours) devoted to each body system, while some are lumped together in one lecture but I've had entire lectures dedicated to quantitative research or how to develop a PICO question and an entire course dedicated to various nursing theories. Something is wrong here!!! I understand that this is how it has been done, but it is time for a change.

Unfortunately, these are recurring themes in many programs across the US. Almost 10 years ago when I was an ACNP student, we were singing the same tune: why are we wasting precious ACNP didactic time on guest lecturers who have no idea what ACNP's do? That Oncology lecture example that SFDRN gave is the exact same scenario I experienced as a student. It is a pity, I had very little Oncology experience as a bedside RN to begin with and here comes this guest lecturer who is an NP in a cancer institute (well-qualified in my opinion) who made a Powerpoint presentation that covered the basics of hematologic malignancies and delved very little on how the various conditions applied to a patient presenting in acute illness.

At the end of the presentation, she asked if the content was helpful and upon realizing that we were ACNP students, she remarked "Oh, I could have touched more on Oncologic Emergencies then". I blame the program director at the time for not giving this poor woman a heads up on what the ACNP course syllabus covered. I now work in a high acuity ICU that admits very sick newly diagnosed Hema-Onc patients presenting in blast crisis, needs plasmapheresis, needs to initiate chemotherapy combos, who quickly go into febrile neutropenia, pulmonary edema, cardiovascular compromise, and sepsis, needs to be watched for tumor lysis syndrome, patient who are s/p Stem Cell Transplants with pancytopenia, GVHD etc - I can't say I'm thankful for my ACNP program for the preparation. What have made a big difference is keeping communication open between the ICU team and Hema-Onc team.

I still believe that the biggest culprit is the lack of detailed regulations on minimum clinical competencies for ACNP's. NP leaders write documents after documents of competencies (see NONPF website) that are heavy with general nursing language and are devoid of "real world" clinical skills and knowledge required in such a challenging patient population. Apparently, AACN (Critical Care Nursing Association) is coming out with updated competencies that will truly address the complexity of adult in-patient clinical management.

I also think that it is about time we do away with just thinking about making sure the student meets 500 or so hours of clinical rotations. It doesn't even matter how many hours we do because the more important issue is that competencies are being met in the clinical setting by making sure that students are being exposed to clinical scenarios that hone clinical decision-making skills based on all organ systems covered in the ACNP curriculum. Another bone of contention for me is the ANCC certification exam which I found to be predictable, heavy on non-clinical questions, and does not truly assess clinical competence. We need to make things tougher even to the point of requiring oral boards.

CCRNDiva, BSN, RN · Oct 19, 2012

It is a very frustrating situation and I don't understand why the PTB and program directors are not listening. For you and your fellow students to have complained about the same deficiencies we, as current students, are complaining about is insane. I have entire courses individually dedicated to health care ethics, role socialization, health care finance, health care policy, research, theory, epidemiology yet the body systems are covered in one class each.

Advanced Practice Columnist / Guide · Oct 20, 2012

It is a very frustrating situation and I don't understand why the PTB and program directors are not listening. For you and your fellow students to have complained about the same deficiencies we, as current students, are complaining about is insane. I have entire courses individually dedicated to health care ethics, role socialization, health care finance, health care policy, research, theory, epidemiology yet the body systems are covered in one class each.

Hopefully your clinical rotations will make up for those deficiencies. Pick a setting that has a teaching service (i.e., an academic medical center for your rotations). I know you go to school in an institution with a medical center and medical school. Our ACNP students in the ICU attend residency morning conferences and there are a lot of good lecture topics every morning for the whole month they're with us covering every aspect of ICU care from hemodynamic monitoring, ARDS, ventilatory modes, infection control and antibiotic choices, case presentations, M&M's, etc. Take advantage of those.