Experienced NPs

Jules A, MSN · Nov 25, 2016

I meant to include the opinions of experienced RNs also as the eyes and ears on floor RNs are second to none. :)

PG2018 · Nov 25, 2016

While I haven't notched five years of experience on my prescription writing pen, I have five with nursedom combined.

So my qualms are with the schools primarily. If they taught adequately, experience, competence, and "independence" would quickly become moot issues.

Second, my eye rolls largely happen with nurses wanting to become FNPs because of perception that it's somehow preparation to do everything.

For what FNPs get, I honestly think ALL NPs should get PLUs specialty training in their chose field whether it be more family , medicine (adult), peds, psych, gyn, or heck even derm, allergy, neuro, EM, etc.

PAs and physicians, regardless of specialty, are trained as generalists. Their license is generic. Residency is what yields their specialty and fellowship for a subspecialty.

Third, with all of nursing, the complete lack of consensus on how all nurses will be licensed and utilized drives me absolute nuts.

Now, finally, at the moment at least I'm doing exactly what I had in mind when I envisioned my NP career. Surprisingly, I started in that capacity and am so limited in that the only place I have to go is down, lol.

Jules A, MSN · Nov 25, 2016

Now, finally, at the moment at least I'm doing exactly what I had in mind when I envisioned my NP career. Surprisingly, I started in that capacity and am so limited in that the only place I have to go is down, lol.

Thanks! And yeah right there with ya. Its unlikely my income will remain sustainable with all the equivalent of Walmarts and BJs popping up across the street. To remain solvent I'm probably going to have to venture solely into addictions and pain management which is largely attempting to undo the horrific prescribing of others. I'm thankful I'm heading into the last decade of my career as opposed to the first.

Trauma Columnist · Nov 25, 2016

Jules - I've been an APRN for over 10 1/2 years. I had 14 years total nursing experience before that; 12 as an RN and 2 as an LPN. (Nursing is a second career, military was the first and not in nursing)

Our practice does have 8 APRNs now where we had 4 when I got hired. Our APRNs (who I have a hand in employing) are first rate. We range in age from 26 to 62, get along very well, work as a team and generally get the job done very well. We are valued in our practice and frequently thanked. (I got two Thanksgiving texts from the two docs I work with most often thanking me for all I do to care for our patients and for working so hard).

Our younger APRNs do have other goals: starting a family, several have kids at home, two are childless, two of us have adult kids. Yet, we all get along well.

All of us have similar work ethics and as we all work independently of each other, we are only in contact via phone/text.

Maybe its the environment you are working in?

Advanced Practice Columnist / Guide · Nov 25, 2016

Jules, you're in for a long gripe session, lol.

Here's my take. It's probably a generational thing but I'm noticing a lot of the new grads (who are typically millenials) do tend to require more hand-holding and coddling (experienced as RN or not).

There is that air of entitlement of "I deserve this job", "I don't need to work that hard", "I can't handle night shift", etc. I also notice a big deficiency in the ability to critically think (i.e., slow thought processing in putting together a coherent, organized, and elegant presentation of patients on rounds, difficulty piecing together the summary of the patient's clinical picture).

On top of that, it takes them hours to finish a freaking H&P which leaves them unable to do any other work. And you know what, I've observed that it doesn't matter whether they graduated from Ivy League or Podunk State U. We've let go of a few new hires actually for under-performance.

So that's it and that's not really a long gripe but I'm sure I'm going to ruffle some feathers. If it's any consolation, I don't know what my seniors were saying about me when I was new myself.

Aromatic · Nov 25, 2016

Havent been posting cuz its finals week but damn it jules stuck a hook in my mouth and unfortunately pissing off scrubs is the only pair of clippers i got.

1. Jules and Psychguy are pretty much always right on this forum. So listen to them if you dont want to suck.

2. I can compare med school to NP school so unless you have experienced both then listen.

3. Gross anatomy sucks

But anyway....

I found NP school to be way too easy. The required work to get by (at a well respected BM school) was completely subpar for what we do in the real world. Reading about a diagnosis once is not enough to handle many of them so even if you read a whole text on primary care front to back you still dont know it all.

700 clinical hours is laughable. And I cant stand the nurse practitioners that come out thinking they know it all. I had one of the ER docs I work with, first words he said to me, "I cant stand all these nurse practitioners that come in here thinking they know everything after 2 years of school compared to my 4 years of med school, 4 years of residency, and what not." You know what I told him. I told him his damn straight right. Because he is. And hes getting more right as the days go on.

So if you are one of these new grad NPs, or an NP in school, or one of the DNP degree huggers, listen up, you wont be fully prepared for practice when you graduate and do not think you know it all. Your education, no matter how much time you put in, or how difficult you find it, is not enough. Some people find basic algebra to be hard, doesnt mean it is.

What you can do to prevent this is go to at least a decent school, learn outside the classroom, and learn on the job. its that simple. Pick up medical texts and read your ass off your first year or two, then you might be competent.

If you want to suck go to some for profit online garbage school and do the minimal work required so you can either, 1. not get hired, or 2. get laughed at on your first job.

While there are great NP providers out there, they are the ones who do the work required of the JOB not the fluffy schooling they receive. Med school may be overkill by a bit, but when somebody's life is in your hands who would you rather have calling the shots for you and your family. yes, there are crappy docs out there too purely in it for the money, but at least med school is a finer filter in regards to getting the scrubs out that should be wiping butt instead of practicing medicine. (FMGs not so much unfortunately, I have seen tons of awful FMGs)

So if you want to be a good NP understand what it takes, if not, then just do the minimal work required for whatever you are doing.

And dont get me started on the DNP, which does not help the problem, its pretty much worthless for clinical practice.

Everybody wants to do what a doctor does but nobody wants to go to med school....

to all those experienced NPs out there that do a great job though. your top of the line since you took the time to learn what you needed without forced motivation via "school"

Jules A, MSN · Nov 25, 2016

Maybe its the environment you are working in?

Good point and I would also guess your specialty is somewhat insulated as well as attracting those with a serious desire to work in a complicated, real medicine, specialty. Hmmm so maybe you are hoarding the cream of the crop? lol. As an attending on an inpatient psych unit I am privy to the medication regimens both psych and somatic of other providers in a dual metro area with a large number of universities as well as the plethora of online stuff available now. For full disclosure however one of my favorite new grad NPs is 30yo with 4 years solid RN experience so not exactly an old timer. At my different jobs I work with approximately 10 psych NPs and although like at your place we all get along and are respectful the variation of abilities is glaring.

random_nurse12 · Nov 25, 2016

I have been a nurse for 16 years. I have an MSN, I am not an NP, and I teach FT. I still work in acute care.

I would not say it in a group of nurse friends, but I am extremely cautious with seeing an NP. I know far too many that were barely competent as nurses and I don't trust them. I have some friend NPs I would trust because I know their background as nurses. At a Minute Clinic or the like, really there is no choice, but let's be honest a lot of experienced nurses could do that job without a graduate education.

I think salaries will decrease over time because there are just too many schools pumping out NPs. I have former students that are in NP programs now and it is frightening. They were poor students, mediocre nurses, and the idea they would be prescribing in three years scares me to death.

I have often tossed around the idea of going back for a post-master's certificate. For now, I am not doing it. I am not convinced I would be happier as an NP. While my NP friends make more money than me (but not by a lot) they also work twice the hours.

It is a shame what we have done to graduate education in nursing. I feel like, for the most part, undergraduate education is good. Or at least in my experience it is. I am not saying it is perfect, but I feel like for the most part we produce safe graduates that are ready for entry level practice. Why do we lose that at the graduate level? Open book tests? Finding your own clinical? Would medicine ever do that to itself? No, absolutely not. Graduate nursing programs are raking in the money for universities because they are costing very little to run. Everything is online with professors taking huge numbers of students, no cost for clinical sites or clinical instruction....

So much focus on theory and research and so little on patho, pharm, and actual disease process. At least at one time it required nursing experience, but now that is gone too. How you can be an advanced practice nurse if you didn't have any practice to ADVANCE?

Nurses are exhausted from the bedside and the treatment of nurses. They want a way out. And the majority of nurses are not on a forum such as this and have no idea that the education is sub-par or are in denial of it.

I have a high schooler that is interested in NP and I am trying to push him towards PA.

PG2018 · Nov 25, 2016

It's interesting when I see academics wanting to enter advanced practice. I'm in advanced practice and would love to get in bed, if you will, with academia. I'd make 45% of what I make now, judging by the state salary schedule as an assistant professor, but I want to lecture in my free time and have a next generation career. I don't want to do RN clinical groups. That's for the birds.

Aromatic · Nov 25, 2016

yeah academia isnt big bucks at most places. i got offered a 65k a year cush job at my old school for an np lab coordinator thing. the docs make about 150k at their cush job teaching stuff. usually the ones that work either already made their fortune and just want to relax and pass on the knowledge (like psychguy said)

Neither is awful for a 35 hour workweek and zero stress though really

random_nurse12 · Nov 26, 2016

Academia has its own stress, it's different stress, but really there are no stress free jobs. It's about what you are willing to deal with it and what fits your personality. Some people go into teaching thinking it will be one thing and it is quite another, I think that may be one reason you see people wanting to make the switch. It was never for them. And the other is money. Even those that love it, can not always make it work financially.

In my perfect fantasy world, ever nurse would get the opportunity to spend a year as FT faculty. Seeing it from the other side is eye-opening.