How much did NP school prepare you? - page 3

I have heard that Nurse Practitioner school is not as rigorous as other grad schools (such as CRNA school). I would like to become either a ACNP or a CRNA in the future. I am very interested in... Read More

  1. by   staphylococci
    CRNA school was alluring to me too because of the hard-science focus, but I honestly can't see myself in the OR. Yes, NP school is lacking in the hard-science department, but no one is stopping you from reading medical school textbooks to supplement what you learn in school. It's what I did during my FNP program, and it helped put me above the rest as well as being over prepared for boards. Overall, NP school is what you make of it.
  2. by   subee
    Rather than NP shool being what you make of it, NP school should be what it makes of you. That is what the student us PAYING for. If CRNA students must be provided instructors, ALL grad students should have the same advantage. So many of our NP programs are a disgrace.
  3. by   SRNA4U
    There isn't a direct correlation regarding the GRE exam and a person successfully completing an advanced practice nursing program. I completed CRNA school without the GRE exam and did very well.
  4. by   aprnKate
    Quote from subee
    Rather than NP shool being what you make of it, NP school should be what it makes of you. That is what the student us PAYING for. If CRNA students must be provided instructors, ALL grad students should have the same advantage. So many of our NP programs are a disgrace.
    I think whatever effort you put into school is really what you make out of it. Whatever effort you make in life is what you make out of your life. Same concept in once you graduate and get a job. Physicians/NPs/PA don't become successful without actually putting work into it. Perhaps NP schools are not based on a "medical model" as what most people say but I also know that not all med schools are perfect either. Medical students worked really hard to get their MD because they sat and read for hours trying to understand the materials and reading above and beyond what they are expected to read for class. Lots of residents I know have told me that they never learned about IV fluids in school, they were never prepared for it while in school, they learned that on the job and they read about it. I know this because I went to an online NP school but I studied everyday at a medical library in San Antonio and did my work there. I sat with MD students and MDs and watched how they studied and how focused most of them were and used what I saw as motivation for me to read more and learn more.

    I think people are well aware before they go into NP school whether they have to set up their own clinical practicum. Most prospective students are also well aware that we are not based on a medical model. Many complain about how they are unprepared they are after graduating from NP schools. There are a few things that I noticed that NP students should be doing differently to get the best experience they can get out of school.
    1. NP students usually work as RNs at the same time that they are going to school. Some work full time/part time. The more you work, the less time you have time to read the material that you are assigned. Some just barely survive and do the bare minimum of reading just to pass the test and do the “pump and dump” information in their brain rather than really understanding the material and using critical thinking on interventions to stimulate why we would use one intervention rather than the other. Perhaps if one cuts back on work they would have more time to understand the material

    2. NP students don’t realize that the role of a RN and a NP is totally different. When we were students we thought we knew but we really didn’t know once we had our first job. We are so focused on trying to balance between our RN job and NP school that we keep doing our jobs as RNs to make money – which is what we have been doing most of our work lives, this is what we are used to, we are experts as RNs – which in ways does help us sharpen our clinical skills. However, what are we actually doing to prepare ourselves for the role of being a NP other than going to clinicals and using the “pump and dump” learning method? We could be going to NP conferences to network with other experienced NPs or going to NP course reviews way before we graduate but most students don’t even take the time to do that. Then once we graduate we complain about how unprepared we were because NP school taught us “nothing”, yet we blame all of it to the NP school program and we absolutely know that we are not the one to blame because we act like NP school is responsible for all that we know and don’t know.

    3. Most NP students want to stay in town for their clinical practicum so that they save money and they can keep doing their RN job. I get it! Who wants to travel outside of town and spend more money? Saving money is ideal, everyone’s situation is different. I had to set up my own clinical practicums. A physician I worked with said it is important to pick a site that will give me good variety of experience even if I had to go out of town or state so a solid foundation could be made. I took that advice. My school did not allow me to work out of state. I did go out of town and spent my own money for accommodations for different clinical sites. I made sure that my preceptors have interviewed me in person and I have interviewed them as well to see if we are a great fit months before my clinical practicum with them started. If they said that it was not necessary to meet in person, I would request that we do so that I can … 1. See the clinical site, 2. Browse the bookshelf of their office to see what books they have (and perhaps read this on my own, for my own learning) and ask them any tips or how they want me to prepare prior to clinical that would make patient care go smoothly. 3. So that I can also ask them in person what they expect of me as their student. MD/PA students go out town and out of state to vary their clinical experience. NP students just sometimes settle with clinicals like retail clinics to stay in town which sometimes isn’t the best due to their protocols of steering away from higher acuity patients which limits handling more complicated health conditions which won’t really make good variety of experiences.

    I am not against people who work in school nor I am judging but it is a hard balance to make. If you put more time towards one or the other the other aspect is going to suffer. I guess the question is what is your priority? No one can answer that for you but you only.

    NP school is definitely NOT what it makes of me. NP school is what I make of it.
    Life is definitely NOT what it makes of me. Life is what I make of it


    “ I am the captain of my ship and I will steer the ship however and whichever I want to and I will do it successfully” --- this is my motto when I faced challenges in work and life balance while in NP school and it continues to be my motto today.
  5. by   Stepney
    Quote from Dodongo
    Extremely discouraging... It will come down to employers only hiring from certain programs. Supply and demand is the last barrier. Once the supply of NPs reaches a critical max employers will become more particular in their hiring. For profit/online NP grads will return to the bedside. Hopefully that will back up to the subpar programs at some point as well. Time will tell.

    In the mean time NP students need to STOP working full time, complete clinical hours full-time and read more.
    You keep referrig to NP work schedules. I know a med student ( a former nurse) who, despite it being against the rules, worked on the weekends as a nurse due to financial needs. As an adult, who has worked continually since being a teenager, to support myself, I don't want anyone telling me to stop working for school. There are no absolutes when it comes to education. There are standards and ways to achieve those standards, none of which involves taking yourself or your family to the poor house while being uninsured.

    Dudongo, your predictions appear to be the same as a dooms day preacher. For profit and on-line NPs will return to bedside? First of all, most programs are going on-line, even from the very top schools. Who is going to be asking if your program is on-line if you graduated from a well-known B&M school? What's a for-profit school? How do you know what is school is categorized as a for-profit school according to the U.S. tax codes? Someone mentioned the difficulty in securing preceptors, which is a barrier to doing more clinical hours. Do you know that NPs are not the only ones having this problem? Do you know that NPs and PAs, as well as residents, may do clinicals side-by-side? The quality of the rotation may be good or bad for all of them, depending on the preceptor. The advantage that a med student or resident has is the vast amount of hours they are spending in different rotations. If an NP wants to be the same as an MD, why not go to med school?

    Right now, NONE of the programs out there are taking NP education as seriously as warranted. By looking down on students who have to work, or whose programs require less clinicals than others, we do not help the profession. In a previous post you stated what type of student you would be willing to precept. That comment was disappointing to hear, as there is such a shortage of preceptors. Many NPs cannot precept unless their larger organization allows it, and some don't want to because they want to be as productive as possible and a student will slow them down. While as a student, you may see things one way, the reality is that there are many factors influencing NP education, and we may not be aware of a fraction of the information out there. Don't pass on the chance to precept an "on-line, for-profit or someone who worked full-time, as that individual may actually be a trained MD from another country who is not willing to go through the entire residency program again, but wants patient care. I know many like that, and they are much more humble than many of the NP posters on AN.

    Many students feel very confident in their abilities on day one (some while they are still students) and I have always worried about them. Physicians worry too, because "they dont't know what they don't know." While some schools provide excellent education, no one is ready to work independently on day one.

    Just some thoughts of concern from anelderly NP.
  6. by   Dodongo
    Quote from Stepney
    You keep referrig to NP work schedules. I know a med student ( a former nurse) who, despite it being against the rules, worked on the weekends as a nurse due to financial needs. As an adult, who has worked continually since being a teenager, to support myself, I don't want anyone telling me to stop working for school. There are no absolutes when it comes to education. There are standards and ways to achieve those standards, none of which involves taking yourself or your family to the poor house while being uninsured.

    Dudongo, your predictions appear to be the same as a dooms day preacher. For profit and on-line NPs will return to bedside? First of all, most programs are going on-line, even from the very top schools. Who is going to be asking if your program is on-line if you graduated from a well-known B&M school? What's a for-profit school? How do you know what is school is categorized as a for-profit school according to the U.S. tax codes? Someone mentioned the difficulty in securing preceptors, which is a barrier to doing more clinical hours. Do you know that NPs are not the only ones having this problem? Do you know that NPs and PAs, as well as residents, may do clinicals side-by-side? The quality of the rotation may be good or bad for all of them, depending on the preceptor. The advantage that a med student or resident has is the vast amount of hours they are spending in different rotations. If an NP wants to be the same as an MD, why not go to med school?

    Right now, NONE of the programs out there are taking NP education as seriously as warranted. By looking down on students who have to work, or whose programs require less clinicals than others, we do not help the profession. In a previous post you stated what type of student you would be willing to precept. That comment was disappointing to hear, as there is such a shortage of preceptors. Many NPs cannot precept unless their larger organization allows it, and some don't want to because they want to be as productive as possible and a student will slow them down. While as a student, you may see things one way, the reality is that there are many factors influencing NP education, and we may not be aware of a fraction of the information out there. Don't pass on the chance to precept an "on-line, for-profit or someone who worked full-time, as that individual may actually be a trained MD from another country who is not willing to go through the entire residency program again, but wants patient care. I know many like that, and they are much more humble than many of the NP posters on AN.

    Many students feel very confident in their abilities on day one (some while they are still students) and I have always worried about them. Physicians worry too, because "they dont't know what they don't know." While some schools provide excellent education, no one is ready to work independently on day one.

    Just some thoughts of concern from anelderly NP.
    I feel like a broken record here, but the vast majority of MD and PA students do not work. So you know 1 med student who worked part-time during school? That, compared to thousands and thousands of others who did not work, means very little (probably nothing to be honest). The vast majority of these students find it more important to take out loans and do school/study full-time. Medicine is an enormous body of knowledge. 1 year (or less at many NP schools) of part-time didactic study with 1 year (or less again) does not even begin to scratch the surface. The other provider level professions seem to agree on this while nursing, for some reason, thinks being debt free is more important than learning.

    I am absolutely a doom-sayer about this but I will tell you it's already becoming a reality in many areas. The part of the country in which I currently live is becoming quite saturated with NPs and PAs. The salaries are pitiful at the larger institutions - some of the lowest in the country. Employers are asking where students graduated. It's happening. And it's as easy and looking online to see if a program is 100% online versus hybrid/B&M. We all know which schools have poor reputations.

    And by giving sub-par nursing education a pass we do not help the profession. And come on. How many FMG MDs do you know that are NPs now from online schools? You know many like that? You are a very well connected person then. 99% of the people graduating from online NP programs are nurses looking for the easiest, quickest, cheapest route to practice not FMG MDs. That was a fairly silly argument.

    I agree. No one is ready to work independently on day one. But some are more ready than others.

    I am of the opinion that NPs need to try and salvage this situation. We should be strengthening our applicant pool, not diluting it further or letting it stagnate. Sacrifices need to be made when it comes to education. Work/money, time, learning. Something's gotta give. NPs have chosen learning. MD and PA have chosen money and time.
  7. by   shibaowner
    While MDs and PAs may appear to be confident, I know new grad MDs and PAs and inside, they are terrified! There are an increasing number of NP residency programs becoming available, so new NP grads should apply to these. As NPs, we can advocate for more NP residency programs. MD residencies are funded by Social Security. We should be working with our state and national legislators to develop more NP residencies. These are typically 6 to 12 months long and combine clinical hours with academic study.
  8. by   Dodongo
    Quote from shibaowner
    While MDs and PAs may appear to be confident, I know new grad MDs and PAs and inside, they are terrified! There are an increasing number of NP residency programs becoming available, so new NP grads should apply to these. As NPs, we can advocate for more NP residency programs. MD residencies are funded by Social Security. We should be working with our state and national legislators to develop more NP residencies. These are typically 6 to 12 months long and combine clinical hours with academic study.
    I would absolutely be on board to have NP residencies funded in the same manner as physician residencies. This would require more specialization on the part of the NP - something I personally support, however, I don't know if many others would support this. We already have a large enough problem with FNPs working inpatient and acute care NPs working outpatient, etc.
  9. by   lwsoccjs
    There are still very few NP residencies. While more may be opening they tend to focus in specific states. Or they tend to focus in a specific region. Primary care residency are far and few between. So while this is going in the right direction it's far from the solution due to its very slow state of maturity.
  10. by   Dodongo
    Quote from Dodongo
    Read/study these texts and you will be golden:

    Netter's Atlas of Human Anatomy
    Guyton and Hall Textbook of Medical Physiology
    Robbin and Cotran Pathologic Basis of Disease
    Andreoli and Carpenter's Cecil Essentials of Medicine

    And the pharmacology text of your choosing. I read Lippincott's Pharmacology. I guarantee if you read these you will be light years ahead of any NP or PA student and more on track with a medical student. Were these assigned to me during NP school? Nope. Did I read them anyways? Every word - well, half way through Cecils.
    ALSO, the "Made Ridiculously Simple" series. So far I've read the Clinical Anatomy, Clinical Physiology, Clinical Pathophysiology, Clinical Pharmacology and Clinical Radiology books in the series. There are many others and I hope to read more. They are written by physicians for boards preparation, but I've met some APPs that have loved them as well. Excellent books for learning the quick and dirty in each area of medicine. Great mnemonics, pictures, etc. 5 stars.
  11. by   Stepney
    Quote from aprnKate
    I think whatever effort you put into school is really what you make out of it. Whatever effort you make in life is what you make out of your life. Same concept in once you graduate and get a job. Physicians/NPs/PA don't become successful without actually putting work into it. Perhaps NP schools are not based on a "medical model" as what most people say but I also know that not all med schools are perfect either. Medical students worked really hard to get their MD because they sat and read for hours trying to understand the materials and reading above and beyond what they are expected to read for class. Lots of residents I know have told me that they never learned about IV fluids in school, they were never prepared for it while in school, they learned that on the job and they read about it. I know this because I went to an online NP school but I studied everyday at a medical library in San Antonio and did my work there. I sat with MD students and MDs and watched how they studied and how focused most of them were and used what I saw as motivation for me to read more and learn more.

    I think people are well aware before they go into NP school whether they have to set up their own clinical practicum. Most prospective students are also well aware that we are not based on a medical model. Many complain about how they are unprepared they are after graduating from NP schools. There are a few things that I noticed that NP students should be doing differently to get the best experience they can get out of school.
    1. NP students usually work as RNs at the same time that they are going to school. Some work full time/part time. The more you work, the less time you have time to read the material that you are assigned. Some just barely survive and do the bare minimum of reading just to pass the test and do the “pump and dump” information in their brain rather than really understanding the material and using critical thinking on interventions to stimulate why we would use one intervention rather than the other. Perhaps if one cuts back on work they would have more time to understand the material

    2. NP students don’t realize that the role of a RN and a NP is totally different. When we were students we thought we knew but we really didn’t know once we had our first job. We are so focused on trying to balance between our RN job and NP school that we keep doing our jobs as RNs to make money – which is what we have been doing most of our work lives, this is what we are used to, we are experts as RNs – which in ways does help us sharpen our clinical skills. However, what are we actually doing to prepare ourselves for the role of being a NP other than going to clinicals and using the “pump and dump” learning method? We could be going to NP conferences to network with other experienced NPs or going to NP course reviews way before we graduate but most students don’t even take the time to do that. Then once we graduate we complain about how unprepared we were because NP school taught us “nothing”, yet we blame all of it to the NP school program and we absolutely know that we are not the one to blame because we act like NP school is responsible for all that we know and don’t know.

    3. Most NP students want to stay in town for their clinical practicum so that they save money and they can keep doing their RN job. I get it! Who wants to travel outside of town and spend more money? Saving money is ideal, everyone’s situation is different. I had to set up my own clinical practicums. A physician I worked with said it is important to pick a site that will give me good variety of experience even if I had to go out of town or state so a solid foundation could be made. I took that advice. My school did not allow me to work out of state. I did go out of town and spent my own money for accommodations for different clinical sites. I made sure that my preceptors have interviewed me in person and I have interviewed them as well to see if we are a great fit months before my clinical practicum with them started. If they said that it was not necessary to meet in person, I would request that we do so that I can … 1. See the clinical site, 2. Browse the bookshelf of their office to see what books they have (and perhaps read this on my own, for my own learning) and ask them any tips or how they want me to prepare prior to clinical that would make patient care go smoothly. 3. So that I can also ask them in person what they expect of me as their student. MD/PA students go out town and out of state to vary their clinical experience. NP students just sometimes settle with clinicals like retail clinics to stay in town which sometimes isn’t the best due to their protocols of steering away from higher acuity patients which limits handling more complicated health conditions which won’t really make good variety of experiences.

    I am not against people who work in school nor I am judging but it is a hard balance to make. If you put more time towards one or the other the other aspect is going to suffer. I guess the question is what is your priority? No one can answer that for you but you only.

    NP school is definitely NOT what it makes of me. NP school is what I make of it.
    Life is definitely NOT what it makes of me. Life is what I make of it


    “ I am the captain of my ship and I will steer the ship however and whichever I want to and I will do it successfully” --- this is my motto when I faced challenges in work and life balance while in NP school and it continues to be my motto today.
    This is beautifully said and I thank you. Many comments clearly do not address the complexity of going to NP school. Everyone who attends graduate school realizes that much of the learning is up to you. That is why you study for hours before even attending lecture. The NP conferences and the pre-conference experiences are excellent. There are other types of workshops that can benefit the student. I agree that travelling to the best clinical sites is worth it. I did it and while it was expensive, it was the best learning experience. The student should also be willing to admit to deficits in knowledge and seek out opportunities to gain experience in those areas.

    There is not just one way to learn and decsions should be left up to the student. I still think clinical experiences should be set up by the schools. This eliminates needless time in searching for sites and ensures that preceptors are meeting standards for preparing students.
  12. by   shibaowner
    Quote from Stepney
    This is beautifully said and I thank you. Many comments clearly do not address the complexity of going to NP school. Everyone who attends graduate school realizes that much of the learning is up to you. That is why you study for hours before even attending lecture. The NP conferences and the pre-conference experiences are excellent. There are other types of workshops that can benefit the student. I agree that travelling to the best clinical sites is worth it. I did it and while it was expensive, it was the best learning experience. The student should also be willing to admit to deficits in knowledge and seek out opportunities to gain experience in those areas.

    There is not just one way to learn and decsions should be left up to the student. I still think clinical experiences should be set up by the schools. This eliminates needless time in searching for sites and ensures that preceptors are meeting standards for preparing students.
    Totally agree with you. During my NP program for Adult and Geriatric Primary Care, we did have some choices for clinicals. I did 2 rotations in SNFs combined with active retiree healthcare, 1 rotation in an Urgent Care, and 1 rotation in an outpatient orthopedic/sports medicine/pain mgt clinic. All were fantastic! My preceptors did give me the chance to learn procedures. In addition, I took advantage of supplementary clinical opportunities, such as working in a diabetes specialty clinic (option in addition to required hours) and in an occupational healthcare clinic (onsite in a large workplace). These were all excellent prep for general primary care. The school also provided additional optional seminars on suturing, EKG interpretation, reiki, LGBTQ and transgender health. There was also an optional track (included in tuition) for HIV management with associated clinical hours. It really is up to the student to take advantage of both academic and clinical opportunities. Med students eat, breathe, drink medicine before and during med school - very self-motivated, independent learners. The best NP students are the same.

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