NP education - a rant - page 5

I came to the site today and saw lot's of posts of wonderfully excited people interested in becoming NP's. The vast majority of the tones of education were: "I have the opportunity to become and NP... Read More

  1. by   DidiRN
    Let me ask you this, Gennaver. Why do you think experienced RN's who disagree with the direct MSN program, like you have read in the previous posts, have no idea what they are talking about? Why do you argue with their logic? What personally do you know that they don't?
    The consensus of this thread from multiple experienced RN's is that this is a poor idea. I tend to believe it, after reading so many negative posts on it.
    And what do you mean by "integration"??


    Quote from Gennaver
    Hi,
    I think you may not have read the part where I noted how it would be a year before we are allowed to start the NP portion. Hopefully in our 2 to 3 years after that point we can glean these precious critical thinking skills. If only to prevent the danger you foresee.

    Now, how about integrating? Or is this just doomsday bawling?

    Gennaver

    p.s. even if I hadn't had my previous hands on experience, (working with great mentors, nurses and doctors alike,) you seem so willing to discount the ability of graduate entry program NPs? Why? is there some specific case you know of?
  2. by   Jess RN
    Why do you think experienced RN's who disagree with the direct MSN program, like you have read in the previous posts, have no idea what they are talking about? Why do you argue with their logic? What personally do you know that they don't?
    Just a general disclaimer at first to say that I for one do not think the previous posters "have no idea what they are talking about". They are voicing their informed opinions, based on thier experience. I think it is possible for Gennaver to also have an informed opinion that differs from the majority of the posters on this thread, based on her research and experience. I don't know what Gennaver thinks specifically in response to your questions above, but I'll have a go at this:

    1. Direct Entry NP programs aren't being offered at a few fly by night schools. They've been around for a while and are at established, excellent schools like Yale and Columbia. I just kind of assume that they know what they are doing and know how to train competant, safe NPs.

    2. It's unclear to me how many of the pps are in fact NPs themselves. Since the scope of practice of an RN vs a NP is quite different, I wouldn't take what a long time RN says are essentials for NP as the absolute unchanging gospel truth.

    3. For the previous posters who are NPs and were RNs first, it strikes me as a kind of- "this is how I did it so this is the best way to do it" kind of argument. From all I'm aware, studies of NPs show that they give primary care with outcomes equal to or better than physicians. One would have to assume that some of those NPs were direct entry pathway NPs. Also, I haven't heard an outcry from BONs or professional organizations or the public for that matter about shoddy direct entry NPs out there making medical mistakes. Maybe this is a perception vs. reality thing, but I tend to doubt it.

    My kids are clamoring for dinner so I have to run- I could go on an on... IMHO more nurses at the primary care level are a good thing, not a bad thing. And as long as they are well trainied and competant to practice safely within their scope of practice- and I've seen no evidence to the contrary- especially in this thread- why the rant?

    Just my 2c- putting on my flame-retardant gear now....

    -Jess
  3. by   RN4NICU
    Quote from future nurse jess
    3. For the previous posters who are NPs and were RNs first, it strikes me as a kind of- "this is how I did it so this is the best way to do it" kind of argument. From all I'm aware, studies of NPs show that they give primary care with outcomes equal to or better than physicians. One would have to assume that some of those NPs were direct entry pathway NPs. Also, I haven't heard an outcry from BONs or professional organizations or the public for that matter about shoddy direct entry NPs out there making medical mistakes. Maybe this is a perception vs. reality thing, but I tend to doubt it.
    No flaming here, just an observation. Many MSN programs are beginning to require experience within the specialty area prior to allowing students to take their clinicals. For example, neonatal nurse practitioners (beginning this year, if I understand the new requirements correctly) must have 2 years of level III NICU experience before beginning their clinicals. From what I have observed in researching various programs, many NP specialties are starting to require RN experience. Just my opinion, but I believe that is why such roles are referred to as ADVANCED practice nursing.
  4. by   Jess RN
    Quote from RN4NICU
    No flaming here, just an observation. Many MSN programs are beginning to require experience within the specialty area prior to allowing students to take their clinicals. For example, neonatal nurse practitioners (beginning this year, if I understand the new requirements correctly) must have 2 years of level III NICU experience before beginning their clinicals. From what I have observed in researching various programs, many NP specialties are starting to require RN experience. Just my opinion, but I believe that is why such roles are referred to as ADVANCED practice nursing.
    Yeah, I'm totally with you here. I think acute care is a different ball of wax entirely. And from what I've seen in direct entry programs here in the Boston area, critical care pathways involve extra clinical time- to the tune of one or two extra years. I think that is totally appropriate. But primary care is just different- and I still think a post-MSN residency would be a great boon and make direct entry grads much more comfortable in their practice and more marketable too.

    -Jess
  5. by   DidiRN
    No flames here, Jess. Everyone has a right to an opinion But quoting from you, that you are "voicing their informed opinions based on their experience" is what concerns me. My understanding is that direct entry MSN-NP is fairly new. I have no problems at all with anyone who has no RN experience wanting to be an NP, but I'll tell you... when I see nursing schools churn out ill-prepared new grads year and year (and it's gotten so much worse) I really do not trust institutions that want to do something like this. Whether it be Yale or Columbia or whatever. They can't even properly prepare a new bedside RN, and that is why I personally am concerned about this new way of teaching NP's that you speak of. I am frustrated by these poor new grads who spend all this money for an education and come out into the real world completely ill prepared and totally stressed out and cry how they wish they wouldn't have gone into nursing. I see this more and more every year, and it saddens me. I feel really bad for them. I guess I would assume too that nursing school and NP school would prepare me too for whatever, but IMO I am not seeing them come out prepared at all on the basic level.
    Maybe I would change my mind of allowing the direct entry MSN-NP if you could have two years of clinical "residency" of some sort, along the lines of physicians. But I don't see that and don't hear of that happening anytime soon.

    Quote from future nurse jess
    Just a general disclaimer at first to say that I for one do not think the previous posters "have no idea what they are talking about". They are voicing their informed opinions, based on thier experience. I think it is possible for Gennaver to also have an informed opinion that differs from the majority of the posters on this thread, based on her research and experience. I don't know what Gennaver thinks specifically in response to your questions above, but I'll have a go at this:

    1. Direct Entry NP programs aren't being offered at a few fly by night schools. They've been around for a while and are at established, excellent schools like Yale and Columbia. I just kind of assume that they know what they are doing and know how to train competant, safe NPs.


    2. It's unclear to me how many of the pps are in fact NPs themselves. Since the scope of practice of an RN vs a NP is quite different, I wouldn't take what a long time RN says are essentials for NP as the absolute unchanging gospel truth.


    3. For the previous posters who are NPs and were RNs first, it strikes me as a kind of- "this is how I did it so this is the best way to do it" kind of argument. From all I'm aware, studies of NPs show that they give primary care with outcomes equal to or better than physicians. One would have to assume that some of those NPs were direct entry pathway NPs. Also, I haven't heard an outcry from BONs or professional organizations or the public for that matter about shoddy direct entry NPs out there making medical mistakes. Maybe this is a perception vs. reality thing, but I tend to doubt it.



    My kids are clamoring for dinner so I have to run- I could go on an on... IMHO more nurses at the primary care level are a good thing, not a bad thing. And as long as they are well trainied and competant to practice safely within their scope of practice- and I've seen no evidence to the contrary- especially in this thread- why the rant?

    Just my 2c- putting on my flame-retardant gear now....

    -Jess
  6. by   Gennaver
    Quote from sherrimrn
    Let me ask you this, Gennaver. Why do you think experienced RN's who disagree with the direct MSN program, like you have read in the previous posts, have no idea what they are talking about? Why do you argue with their logic? What personally do you know that they don't?
    The consensus of this thread from multiple experienced RN's is that this is a poor idea. I tend to believe it, after reading so many negative posts on it.
    And what do you mean by "integration"??
    Hi,
    Let me ask you this as well, did you read the intial poster who claimed that direct entry program participants were basically, "target salespeople" who want a quick and easy way to earn big money? All apologies to all target salespeople working with integrity and earnestness.

    Did the negativity of that rant escape you?

    So, if you find this to be a negative route I think it would not be my place in this forum to try to sway you. As for integration...various health care providers but.

    Exiting from this thread since the concensus here is indeed negative.

    Gennaver
  7. by   Jess RN
    I guess I would assume too that nursing school and NP school would prepare me too for whatever, but IMO I am not seeing them come out prepared at all on the basic level.
    sherrimrn, thanks for your response. Actually, the number of clinical hours in the two programs I've applied to worries me. To the point that I even looked at a PA program in my area simply because the clincial componant was double that of direct entry programs. We're talking 1600 vs 700 clincal hours prior to graduation. I ended up decising that I will treat my programs as two halves. I'll use it to get an RN in 18 mo- which I think no one would argue is totally do-able esp for a college grad who doesn't have to take the general non-nursing classes that would be involved in an ADN. Then I will work for a year or so as an RN before starting the advanced practice componant and continue to work part time as an RN while I take that second half nice and slow. In both of the programs I've applied to I can take upto 5 years to complete the advanced practice piece. That will give me the clinical experience that I personally think I would need and want- and also make me (hopefully) more marketable as an NP.

    The thing is for college grads- for some it doesn't make a lot of sense to spend more time to get an associate's degree then it would to get an RN as part of an advance practice pathway. Many would see an ADN as backtracking from an educational perspective- I'm not saying I do, but some would make that case. Anywho.. as long as you are well trained, confident in your abilities within your scope of practice and willing to be a lifelong learner, it's all good!

    -Jess
    Last edit by Jess RN on Feb 1, '05
  8. by   medsurgnurse
    Quote from CatskillNP
    I came to the site today and saw lot's of posts of wonderfully excited people interested in becoming NP's. The vast majority of the tones of education were: "I have the opportunity to become and NP through an advanced MSN program" or "I'm sales person at Target with a Bachelors in sociology, and with just one year of school I can become an RN then get my NP degree!!!"

    Sorry about this but....Being a nurse practitioner is more than just getting the degree. The job requires experience. Not a year of med surg, not a two year Master's, but some real NURSING experience. We are NURSE PRACTITIONERS, that's nurses with additional skill to allow the diagnosis and treatment of patient problems. It requires the inate skill that makes a nurse magnified to the 'nth degree. What makes good providers as NP's is the same characteristic that made them good nurses. It's experience.

    I'm not on a high horse, just an NP that has seen too many "rammed through the system, get their money" NP's. This job is serious. It's serious on several levels. First and formost, you are being entrusted with the care of people that put their complete fath in you to make good decisions and provide quality care.

    This IS different that being a nurse. How many times have you sat back as a nurse and berrated a provider about their choice of treatment plan or pushed for the provider to make a decision and get on with it. That all changes when you're the one with the RESPONSIBILITY for the decision. Yeah, it's an ear infection, yeah amox should do the job. Are you ready to commit fully to giving someones most honored item, their child, a drug that could kill them??? It's not cook book. It requires a base of knowledge, experience, reponsibility, and a committment to furthering your skills. It's a lifestyle!

    The second group you matter to is the professional community. As NP's, we let the schools go freaking haywire in putting out as much crud as they wanted. They saw dollar signs and began pumping out graduates without regard to job markets or the economy of NP's. Boom, a flood of NP's. Fully half of them are transfer's in from "associated science's". Read sociology, psychology, earth sciences...all able to take their bachelors in science, convert to an RN in one year, and complete their master's in two more. These people may ultimately make good NP's, but not in three years!!!! What makes anyone think that this is the way to put NP's on the map??? What kind of fodder is given to the medical community, especially, to denounce the practice of NP's as being amateurish, poorly skilled, etc. It really opens us up to all kinds of flaming by other medical groups.

    If you're an RN, thinking about becoming an NP, don't do it for the salary, chances are you're going to make more as an RN in the right setting. If NP is for you, go out and work, get a job, get several and work in areas like the ER(still, in my opinion, the best experience), community health care, critical care, etc. Then after a couple of years, think about going the MSN/NP route. You will be a better provider, it gives more credence to the profession, and ultimately the little kid with the OM will thank you for your skills.

    I know a rant, but it makes me nuts to think that being an NP is anything less than the greatest honor innursing you can become.
    Thank you, thank you.
    I agree with your post. I actually believe that Nursing schools should incraese the experience requirement for application to NP school. currently one year experience required. I am also deeply disturbed by the numbers of first semester nursing students who state that they will be a CRNA in 5 years. They say 'I graduate, get my one year of experience and start CRNA school." It absolutely scares me.
  9. by   medsurgnurse
    Quote from CatskillNP
    I came to the site today and saw lot's of posts of wonderfully excited people interested in becoming NP's. The vast majority of the tones of education were: "I have the opportunity to become and NP through an advanced MSN program" or "I'm sales person at Target with a Bachelors in sociology, and with just one year of school I can become an RN then get my NP degree!!!"

    Sorry about this but....Being a nurse practitioner is more than just getting the degree. The job requires experience. Not a year of med surg, not a two year Master's, but some real NURSING experience. We are NURSE PRACTITIONERS, that's nurses with additional skill to allow the diagnosis and treatment of patient problems. It requires the inate skill that makes a nurse magnified to the 'nth degree. What makes good providers as NP's is the same characteristic that made them good nurses. It's experience.

    I'm not on a high horse, just an NP that has seen too many "rammed through the system, get their money" NP's. This job is serious. It's serious on several levels. First and formost, you are being entrusted with the care of people that put their complete fath in you to make good decisions and provide quality care.

    This IS different that being a nurse. How many times have you sat back as a nurse and berrated a provider about their choice of treatment plan or pushed for the provider to make a decision and get on with it. That all changes when you're the one with the RESPONSIBILITY for the decision. Yeah, it's an ear infection, yeah amox should do the job. Are you ready to commit fully to giving someones most honored item, their child, a drug that could kill them??? It's not cook book. It requires a base of knowledge, experience, reponsibility, and a committment to furthering your skills. It's a lifestyle!

    The second group you matter to is the professional community. As NP's, we let the schools go freaking haywire in putting out as much crud as they wanted. They saw dollar signs and began pumping out graduates without regard to job markets or the economy of NP's. Boom, a flood of NP's. Fully half of them are transfer's in from "associated science's". Read sociology, psychology, earth sciences...all able to take their bachelors in science, convert to an RN in one year, and complete their master's in two more. These people may ultimately make good NP's, but not in three years!!!! What makes anyone think that this is the way to put NP's on the map??? What kind of fodder is given to the medical community, especially, to denounce the practice of NP's as being amateurish, poorly skilled, etc. It really opens us up to all kinds of flaming by other medical groups.

    If you're an RN, thinking about becoming an NP, don't do it for the salary, chances are you're going to make more as an RN in the right setting. If NP is for you, go out and work, get a job, get several and work in areas like the ER(still, in my opinion, the best experience), community health care, critical care, etc. Then after a couple of years, think about going the MSN/NP route. You will be a better provider, it gives more credence to the profession, and ultimately the little kid with the OM will thank you for your skills.

    I know a rant, but it makes me nuts to think that being an NP is anything less than the greatest honor innursing you can become.
    Do NP schools really accept students who are not already an RN. My school required, RN, BSN and one year experience. Most of us are older experienced folks.
  10. by   fergus51
    700 hours? That's less than 18 weeks of full time work. They think they can train someone without healthcare experience to be an NP in that time? That is scary.
  11. by   Jess RN
    I am also deeply disturbed by the numbers of first semester nursing students who state that they will be a CRNA in 5 years. They say 'I graduate, get my one year of experience and start CRNA school." It absolutely scares me.
    Again, do anesthesiology residents scare you? They have about as much schooling and clinical practice in med school that a Bachelors prepared nurse with a year of RN expereince plus a CRNA master's program would have, no?

    I don't want to get all gender bias here- but why is it so scary to some nurses that a bright, focused nurse can achieve her (presumably, her) goals without spending years and years in an RN role which in this case particularly does little to prepare her for the job she ultimately wants to be doing, as a nurse anesthetist? But it somehow is less scary that docs can do it in slightly longer timeframes and with a larger scope of practice. Is it because med students are mostly men?

    Sorry to be so provocative here.

    Jess
  12. by   Jess RN
    700 hours? That's less than 18 weeks of full time work. They think they can train someone without healthcare experience to be an NP in that time? That is scary.
    I should have been more specific- the 700 hours are only for the advanced practice componant. There are also clinicals above this that are part of your RN training. Still, I don't think it's enough.

    -Jess
  13. by   Gennaver
    Quote from future nurse jess
    Just a general disclaimer at first to say that I for one do not think the previous posters "have no idea what they are talking about". They are voicing their informed opinions, based on thier experience. I think it is possible for Gennaver to also have an informed opinion that differs from the majority of the posters on this thread, based on her research and experience. I don't know what Gennaver thinks specifically in response to your questions above, but I'll have a go at this:

    1. Direct Entry NP programs aren't being offered at a few fly by night schools. They've been around for a while and are at established, excellent schools like Yale and Columbia. I just kind of assume that they know what they are doing and know how to train competant, safe NPs.
    ...
    -Jess
    Hi Jess,
    You were right on target with some of the things I was trying to clarify. It did seem like the original ranter thought that all we needed to do to become a graduate entry np was to hang up our McDonalds or Targe aprons and go to school for a year.

    Although, since reading through more comments on this thread I do realize that some posters here not only think that NPs who become one without years of exclusive bedside RN work are incapable I also see how some of the posters in this thread also think that all new RN grads are poorly equiped and incapable too! Surprising, really, all new RNs? Could they merely have meant green,just like they were too one day?

    That pretty much clarifies this thread as not having any validity.

    It was indeed started as a rant and it continues to be one. In other words, it seems very dubious as to any validity. I am very grateful to the countless nurses and doctors that I have worked with over the years who did let me hands on work with them, (knowing that it was their malpractice insurance and that they must have really known me and my ability well, although, like I said, even if I was a Target employee with a Sociology degree....so?)

    Gennaver

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