Changed My Mind

[CraigB-RN]

Well since I can't decide what I want to be when I grow up, I've decided to drop the NP as of now. Going to finish a MSN, which I can get done in less than a year (education & Informatics). Now I know I'm taking a chance that a year from now I won't be able to find a post grad certificate program, but I'm keeping my fingers crossed.

I looked at scope of practice and how midlevels are looked at here in Atlanta, I looked at what i was learning as an FNP student ( I found out I don't care about pelvic floor dysfunction) and I'm not sure how the ACNP is going to be handled in ER's etc yet, so I figured why wast time and money.

Plus I was one of those people who took whatever short cut they could. I was having to spend to much time learning the chemistry, math etc and it was to hard to keep up and work full time.

[PMHNP10]

I have pondered this question of why I am dissatisfied for sometime and this is what I've come up with so far:

1. I miss the commaraderie of having other nurses with you on the floor with bedside nursing. Maybe I had a unique experience when I was a staff nurse, but I worked with a group of RNs that provided me with support and laughs. It wasn't always great - I definately had beef with some, but overall it was a great sense of working with a team. I don't get this with my present job.

ahhhhh...excellent, an issue I never considered; for the most part, I have enjoyed the nurses I've worked with too; so what you're saying is that you don't get together with your MD colleagues for a lunchtime round of 9 (is that the right terminology?)? :chuckle

2. High stress due to liability issues. I really don't think it's fair that I carry the same burden of liability as the MDs in my practice and yet get less compensation. I have no doubt that if something goes wrong with one of my patients I will be held accountable and not my medical director.

not sure where you live, but in TX, your scope is more or less determined by the MD you work with; for example, if he wants you to Rx, you can; if not, it's outside your scope; you can't Rx schedule 2's (although I think there is a procedure where you can gain this ability acording to the MHNP I work with--maybe it's setting specific; you can do H&ps, but can't Dx unless the doc allows you to, and the doc must sign off on a certain number of your charts each week; obviously if you want to Dx and Rx you work for a doc who's looking for a provider who's licensed to do so; hopefully much of this will change by the time I graduate, because I will most assuredly expect compensation for my valuable services

3. M-F, 8-5 is what some people are looking for, but I can't wait to go back to 12 hr shifts!

I couldn't agree more, but the job I'd most likely do actually has 12 hr shifts.

4. Ultimately more than any of this I am tired with some of the redundancy in primary care. It's a lot of the same. I know this is true in all specialties, but in primary care it's so much reassuring of well status to paranoid anxious patients and lecturing of healthy lifestyles to unhealthy patients with very few patients changing that sometimes I think I might go crazy!

That's one of the many things about psych I love, there is much variability. No 2 manics/psychotics/antisocials/etc. are alike. sure symptoms are similar, but behaviors (and stories) differ as do the treatments; first of all, most psychotropics work for about a third of a given population; and even when they do, often times they don't work forever, even if compliance is maintained

[zenman]

So re: the quote above, that is my concern as well. I think online NP programs are a scourge on specialized education. Although I do absolutely love online classes for lecture based classes--pharm, patho, stats, research, public health, dx testing, etc., I strongly believe online formats are toxic for portions of a program when great learning can occur when you are face-to-face with your colleagues and when you can share your experiences, thoughts and feelings with individauls who may have had similar experiences; it just isn't the same online

You sound confused. You love online for didactic courses but not for clinical courses. I've never heard anyone doing clinical other than face-to-face. I've had both brick and morter and online courses, both undergrad and grad and think having to sit in a classroom is one of the most inefficient methods of education and thankfully many educators think so also. I don't want to share my feelings, thoughts and experiences with fellow students. I want to do that with my preceptor who is hopefully ahead of me...not a peer.

[PMHNP10]

You sound confused. You love online for didactic courses but not for clinical courses. I've never heard anyone doing clinical other than face-to-face. I've had both brick and morter and online courses, both undergrad and grad and think having to sit in a classroom is one of the most inefficient methods of education and thankfully many educators think so also. I don't want to share my feelings, thoughts and experiences with fellow students. I want to do that with my preceptor who is hopefully ahead of me...not a peer.

I promise there is no confustion whatsoever on my part, so let me clarify so you can understand what I'm saying...

I'm not referring to clinical in any way. UT-H set up their programs to have core grad classes (e.g., theory, stats, research), core advanced practice classes (e.g. pharm, pathophys, legal and ethical, health promo, phys exam) and clinical focus classes which include an actual clinical portion but also has a class room portion--some refer to the classes of this part of the program as modules, in which there are 3, and each lasts 1 semester. For instance, in the psych program, one module will focus on individual therapy; one on group therapy; and one on family therapy. All the other masters programs have a similar setup of 3 modules (with corresponding clinical) with a different focus in each module.

It's these modules that I beleive should absolutely not be online; maybe web enhanced so you can view the lecture portion of the class, but IMHO as much of the class time should be spent with minimal lecture as possible. Again, IMHO, real learning occurs when you can have face-to-face discussion and sharing of ideas.

[PMHNP10]

I got cheated out of my 5 minute time limit to edit....

I wanted to add: I agree, sitting in a classroom for 1, 2, 3, 4 hrs while some instructor lectures at me is incredibly inefficient. Fortunately there are instructors out there who are able to enable a classroom environment conducive to learning without monotonously reading slides from a powerpoint.

[yellow finch, BSN, RN]

You sound confused. You love online for didactic courses but not for clinical courses. I've never heard anyone doing clinical other than face-to-face. I've had both brick and morter and online courses, both undergrad and grad and think having to sit in a classroom is one of the most inefficient methods of education and thankfully many educators think so also. I don't want to share my feelings, thoughts and experiences with fellow students. I want to do that with my preceptor who is hopefully ahead of me...not a peer.

In my undergrad program 90% of the lectures consisted of a powerpoint presentation with the instructor reading right off the screen. No details or depth beyond that. Questions were explained in short sentences and occasionally deviating from the subject. I can read a powerpoint and don't need someone to do it for me. Those courses were all self-study.

On the other hand, the online courses were more intense because we couldn't fudge our assignments and actually had to do research before posting. There were absolute deadlines that could not be avoided. This is partly why I chose an online FNP program. There were other reasons aside from this, but I find that my master's education has been extremely challenging and far more rewarding. Plus, I can't sit still for too long. I tend to drift and lose interest in what's going on in the classroom.

I agree with you in that my preceptors are the ones teaching me the practical knowledge I'll need once I'm working as an independent provider. I learn so much about the material we're learning in class during clinicals. As it happens, my school has greater than 95% passing rate on the NP boards. The online program must be working so far.