How not to suck! - page 3

I am an NP student who is doing fairly well in my program. I feel this program is challenging and is doing a sufficient job training me for a provider role. The only thing is I can't imagine being... Read More

  1. by   BCgradnurse
    I think it's a bit of an exaggeration and somewhat dramatic to say all NP programs suck. Many do, but some do have stringent admission criteria and give adequate preparation for a novice. I would like to see more science based education and less "fluff". I also think clinical hours should be increased and schools should have relationships with preceptors that have been vetted carefully. I was fortunate in that I had a few very reputable brick and mortar programs to choose from in my area. I researched them, visited the schools, and felt informed to make the best decision for me. The program I chose accepted less than 10% of applicants. I did not even consider applying to any for profit schools. I knew that a lot of my learning would be up to me, and would not take place in the classroom, and i was prepared to work hard so I wouldn't suck.

    It's also my opinion that many NP students (and probably many professionals in other fields) expect to graduate knowing more than they do. Maybe some of that is due to inadequate training, but much of it is due to the fact that we are all beginners or novices when we graduate, regardless of how smart we are or how much experience we've had in nursing or other fields. I'd love to see paid residencies for all NP graduates. It would be so beneficial to have a year with a mentor and would go a long way in increasing the competence and confidence of a new grad.

    So NPman, I'm glad you are asking how not to suck. It's encouraging that you have a realistic view of your training and that you know you still have a lot to learn once you graduate.
  2. by   Cococure
    Easy of course not I never said anything about being easy. Nursing is hard! I may only have 6 yrs of nursing experience but I am not the one to say it has been an easy road ...every time I get comfortable something new comes along or I see a patient or situation that I have never seen before. Life is not easy!!!
  3. by   BostonFNP
    Quote from NPman
    Thank you all for your comments. I am especially proud to have Jules comment. Let me clarify, I am in no way saying that I am capable or able to practice. I see so many threads of people saying how unprepared and incapable many NP's they come across are. My school is decent but I do find it lacking in the necessary skills needed. I am looking for good habits now so that someday I can be a better practitioner. I want to do primary care in the future. Please, nobody take this as prideful.....I am more concerned for my future patients.
    At the end of your program and following your board certification you should be prepared to competently and safely practice as a novice provider. It is vitally important that every provider understand their own limitations, can identify what is within them and what is not, and direct patients to an appropriate source of care should that be required. This is true of physicians, nurses, PAs, podiatrists, dentists, etc.

    I hope you have found a mentor or two; mentorship is underutilized in nursing and it can be the difference between your ultimate success or failure in the quality of your work or the quality of your life as a provider.

    Remember, skills can be taught to anyone at any time: it takes little medical knowedge to run an interrupted suture or perform an I&D, they are simply technical skills. It is the knowledge behind them that is important: what to suture and when to do it, what to open up in the clinic and what to refer, how to manage a complication, etc.
  4. by   Cococure
    Quote from Jules A
    If it makes you feel any better my program at a well known reputable state school sucked also but a majority of us had solid inpatient psych experience which in my opinion makes a difference and offsets our lack luster education. We had given the medications we would be prescribing thousands of times, knew the doses and preparation, saw the reactions both good and bad. If someone was having a dystonic reaction we could recognize it and address it quickly which is something in experienced NPs may never have seen especially because so many are precepted by NPs in an outpatient environment. I instinctively knew that if someone was describing elaborate hallucinations in an organized fashion there was likely something other than psychosis going on and that grandmom didn't suddenly become schizophrenic because she is seeing things, her benzo that she shouldn't even be on in the first place, is likely making her delirious. Hence the way I prepared to practice as a new NP started years earlier when I was a RN.

    I had professional contacts who I knew were competent and would precept me because you learn from your teachers and I have seen terrible prescribers teach their NP students exactly how to emulate them at terrible prescribing. My professional and personal circle was heavy with NPs and physicians who I learn from even at every happy hour we attend and who were available for a quick text if I had questions. That some are in NP programs, paying the expensive tuition and do not know anyone local in their upcoming specialty let alone how much money the NPs in their area are making to me is a clear indication that they did not do their homework and that in itself is enough to make me question their judgement.

    Saying it is up to the individual to choose a quality program doesn't do one thing to make the quality of new NPs improve because there will be many others who will disagree and go anywhere they can get in or those so out of touch with the actual profession that they don't realize their school has a terrible reputation.
    Jules, thank you for your insight. I am attending an in state school but I too find the education filled with "fluff" classes I am not happy with but it seems par for the course. I am not a fan of for profit schools by any means, they are not doing the profession any justice. I feel that this is a big step in my professional career and I have shadowed NP's and I do like the role. I was not about to invest money and time into something I will dislike later on. I am sure I will have good and bad days just like any other profession but my concerns are the same NPMann ...being a capable practitioner after graduating is very nerve wracking and down right scary. I too plan on doing more than the minimum practice hours to graduate. But, sadly there are not many options for NP fellowships or residences in my metro area they have 1 residency for ACNP's. My plan is to do my clinicals at locations where my interests lies.
  5. by   traumaRUs
    As a novice (in any field) it is acceptable and advisable to seek answers from those more experienced. I came into a specialty with which I had little experience as a novice APRN. I rec'd five full months of didactic plus clinical preceptorship = 800 hours. I was also expected to put in additional time studying which I did. At the end of the five months, I was seeing pts on my own but still had backup for issues with which I was unfamiliar.

    Even now, 10+ years later, the MD and I talk about issues occasionally though the occasions are now more a teaching point then me asking for advice regarding a certain pt/care situation. I am now the lead APN and the others come to me for advice. However, I still do not have all the answers. I still look things up.

    As nephrology moves into the primary care arena once again, I will look up more because for the past 10 years I have not taken care of all primary care issues where I will now.

    Providers that think they know it all, be they APRNs, PAs or physicians are the ones that we need to be afraid of...
  6. by   Angie O'Plasty
    Quote from traumaRUs
    As a novice (in any field) it is acceptable and advisable to seek answers from those more experienced. I came into a specialty with which I had little experience as a novice APRN. I rec'd five full months of didactic plus clinical preceptorship = 800 hours. I was also expected to put in additional time studying which I did. At the end of the five months, I was seeing pts on my own but still had backup for issues with which I was unfamiliar.

    Even now, 10+ years later, the MD and I talk about issues occasionally though the occasions are now more a teaching point then me asking for advice regarding a certain pt/care situation. I am now the lead APN and the others come to me for advice. However, I still do not have all the answers. I still look things up.

    As nephrology moves into the primary care arena once again, I will look up more because for the past 10 years I have not taken care of all primary care issues where I will now.

    Providers that think they know it all, be they APRNs, PAs or physicians are the ones that we need to be afraid of...
    Agreed 100%. We all need to keep learning continuously as clinicians, even once we are past the novice stage. This includes reading, continuing education activities, seeking mentorship, and learning from the days/situations when we "suck" or realize after the fact that there was something we could have done better. Certainly there is plenty of room for improvement in terms of clinical preparation/scientific content/fewer "fluff" classes in NP programs (and I don't mean by making the DNP a requirement, which I think is a terrible and counterproductive idea particularly given the current clinically irrelevant content of DNP programs...just making some changes to master's-level programs and getting rid of the degree-mill type programs), but ultimately it is your own responsibility to put in the effort to become the best clinician you can be. Your first few years in practice will shape your clinical performance more than your schooling, IMHO.
  7. by   Dodongo
    Quote from Aromatic
    Since your dedicated you will almost certainly do well once you graduate. Not sure which books they have you use in the ACNP program your in but when I was in the ICU I pulled much of my stuff from MGH critical care review. It was pretty helpful. Combine that with a physiology text such as Costanzo and youll be good as gold for ICU. Also found "the ventilator book" to be helpful and if you want an easy/quick pharm review sketchy medical videos are pretty good, but they arent super cheap but well worth it. currently using them for USMLE prep
    I'm currently reading through the Saladin physiology book as that is required for my physiology class (it's dense). I've heard the Costanzo text thrown out a few times here and there. I practically slept with my Netter atlas for anatomy. Haha. I'll have to look into the MGH critical care review. And in the summer I'll be reading Andreoli and Carpenter's Cecil Essentials of Medicine, which every physician I work with says is a must.
  8. by   aok7
    I am in my third semester of NP school. A big part of my plan includes staying positive. In addition to absorbing all I can in my courses, reading additional resources, appreciating mentors, and attempting to adjust my thinking in my hospital job toward that of a provider, I work on being strong so that I may continue to brush off the many naysayers out there. It helps to start with recognizing the psychology behind mean people! They're actually the ones who need recognized, so give them kudos and then keep up your own standards for learning all you can to be an effective NP.
  9. by   casias12
    Quote from JellyDonut
    I was an RN for over 20 years. I have earned the right to call it like i have seen it. For your info I am not insulting nursing - the autonomy of the nurse has dwindled to the point of making sure all the boxes have been checked by the end of your shift. It use to be common for the ICU nurse to VO any order that you needed and now you do not advance a diet without an actual order.

    I have walked several miles in those shoes!
    I feel the same way. I was a nurse for 15 years, and worked closely with physicians to gain trust and write "verbal" orders for things that made sense. As time went on, I think autonomy and involvement dwindled. Making the jump to nurse practitioner was, for me, a necessity.

    When I walk into hospitals today, never see the same nurse twice, and see them all sitting at the desk doodling on their i-things, I get a little annoyed. Ask a question of a nurse, the common answer is, "I don't know if he went to surgery yesterday, I've only had him for 4 hours".

    But any nurse who is planning to move up to NP should already be at a point in their career where they are thinking "I know what I would order/do for this patient. Man I wish I could just write the orders". That is someone who has enough experience to make the transition and be successful.
  10. by   OllieW
    Quote from casias12

    When I walk into hospitals today, never see the same nurse twice, and see them all sitting at the desk doodling on their i-things, I get a little annoyed. Ask a question of a nurse, the common answer is, "I don't know if he went to surgery yesterday, I've only had him for 4 hours".

    .
    When I walk in i am struck that more than half the staff are travelers or "just off orientation". Not saying they are bad at all, but something is happening in hospitals where they cannot hire or retain staff.
  11. by   addym
    Happy New Year! I hope someone can help me answer a few questions, especially those who are either an NP already or a student. As many of you are aware, AANP and ANCC has expired the Adult NP exam as of December 2016. Unfortunately I failed the AANP exam and of course I am devastated because I failed by a few points. What I am hearing is that those of us who graduated from the ADULT NP now has to obtain a post-certification in ADULT-GERO. I've been researching schools and the cost is unbelievable as well as the amount of time it will take to obtain the certification (18-24 months). Would anyone know of alternatives? I personally cannot afford another $20,000 or more to obtain this certification. I'm still paying on my bachelor and master student loans and financial aid is NOT available for a post-certification. Are there any other accreditations besides the AANP or ANCC that we can sit for the exam? I feel this is so unfair and feel we should be grandfathered in if we completed our degree/courses before December 2016. This decision to change was not made until well into my Adult program. Anyone who has insight on any of this please let me know. Thank you.
  12. by   Jules A
    Quote from casias12
    But any nurse who is planning to move up to NP should already be at a point in their career where they are thinking "I know what I would order/do for this patient. Man I wish I could just write the orders". That is someone who has enough experience to make the transition and be successful.
    Well said!
  13. by   BCgradnurse
    Quote from casias12
    I feel the same way. I was a nurse for 15 years, and worked closely with physicians to gain trust and write "verbal" orders for things that made sense. As time went on, I think autonomy and involvement dwindled. Making the jump to nurse practitioner was, for me, a necessity.

    When I walk into hospitals today, never see the same nurse twice, and see them all sitting at the desk doodling on their i-things, I get a little annoyed. Ask a question of a nurse, the common answer is, "I don't know if he went to surgery yesterday, I've only had him for 4 hours".

    But any nurse who is planning to move up to NP should already be at a point in their career where they are thinking "I know what I would order/do for this patient. Man I wish I could just write the orders". That is someone who has enough experience to make the transition and be successful.
    Then why go to NP school? Just sit for the exam and be done with it if you already know what to do? I'm being facetious of course, but that just seems a bit over the top. Anyone who thinks they already know what to do before going into a NP school is setting themselves up to be a dangerous provider.

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