Should NP training be standardized?

  1. I have a colleague who has 3-5 years NP experience in internal medicine then she switched over to a specialty clinic (I think neurology) where she worked for 7 years. She was then hired in a neurology clinic here in our state. She was fired in 3 months later because the neurologist was upset that given her extensive experience, from what I heard anyway "she doesn't know much."

    IME, NPs are trained by their supervising physicians especially when it comes to specialties. As corny as it sounds, I feel like her firing was grossly unfair. Maybe in the 7 years that she worked in that out of state clinic, most of her patients were follow-ups where the treatment plan has been outlined and/or she was only given simple cases like headache etc.

    Her situation makes me wonder should NP training be standardized especially with specialties? I would appreciate your thoughts on this.
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  2. 16 Comments

  3. by   babyNP.
    As far as I can recall, the only "standard" things about NP programs is that they must have the 3 Ps (patho, physical assessment, and pharm) and at least 500 clinical hours.

    In the neo world virtually all schools require 2 years of NICU experience, although it's not required to take boards these days. I think the experience is necessary since neonates are such a different type of patient than what one learns about in nursing schools.
  4. by   TicTok411
    I would think it difficult to jump from specialty to specialty. I got out of school and went straight into a specialty and lord help me if I ever find myself in family practice down the road. Certain skills and knowledge seem to fade if you are not using it on a semi regular basis. I do think a NP/PA can transition from family/Urgent care. ED to a specialty but to go from one to the other and then jump again - I would not recommend it. It takes a longer time to be or develop into a competent provider in a specialty practice and it requires more effort on the individual.

    You need way more than 3 months to even begin to feel comfortable in neuro or really any specialty for that matter. I have been told (and I kinda believe it) an NP/PA needs a full year to develop the experience and skills to begin to practice with adequate competence in a specialty.
  5. by   WKShadowRN
    I think yes. And this is my topic for my DNP project. The Barnes article often referenced in these forums doesn't fully address It, in my humble opinion. I want to build from her findings and discover more specifically the difference in outcomes with and without a fellowship.

    Plus I want to develop or make recommendations for a standard onboarding . That might be more ambitious for the proposed project but it's still something bearing scrutiny.
  6. by   juan de la cruz
    Specific to the situation described by the OP, I wouldn't attribute the NP's inability to satisfy the expectation of the medical staff in terms of competence in Neurology on her NP education. She's been in practice for at least 10 years and whatever her knowledge base is now comes from her years of practice and much less so from her NP education.

    I do agree that NP training should be more standardized. There are multiple entry points to the role now and even those with years of bedside RN experience have variable knowledge base in terms of medical management. I think all NP training should have a general adult and pediatric medicine base on the first year of training and that specialization (Acute Care, Family Practice, Psych, etc) should start on the second year. Of course that would require more clinical training and more didactic content addressing medical management. Still, that does not solve the issue of specialization in Neurology and the other Medicine and Surgical sub-specialties but I think that's where fellowships can address gaps.
  7. by   Riburn3
    I agree with Juan. It would be nice if we all got some broad adult/gero/peds advanced practice education, and then specialized a bit more later on. Or train everyone right off the bat as FNP's, and then offer specialty post graduate programs that only add an extra year on to the education. This is essentially what's done in medicine, and we would still be hitting the market faster. Of course nurses have to make everything more difficult, where we even have multiple certifying boards.

    More specifically, I think in this case it was likely a situation where the hiring physician expected more out of someone that has 7 years of neurology NP experience. Whether that's fair or not, I can't say, but for the most part, any specialty physician I've ever had proposition me for a job always talks about how they will "train" me.

    In my last position, I worked with an NP that had 10 years experience when I was just a new grad. Although she definitely had more knowledge, she was much, much slower than me in terms of volume seen, and the patients really disliked her. Our boss eventually let her go because he was expecting more from someone with so much experience. Even with a standardized education, you can't fix some people.
  8. by   KindaBack
    In my view, if NPs want to be respected as equivalent to physicians, they should demand that their training be standardized as it is with physicians.

    I've encountered some terrific NPs but an NP license is not nearly the guarantor of the training quality of the practitioner as it is with a physician.
  9. by   Worddeuce
    Yes. When you walk into see an MD you know the level of training they have been through to get where they are. When your treated by an NP only he/she knows their skill level.
    Last edit by Worddeuce on May 18 : Reason: Add on
  10. by   goatmomma
    I think the training should be standardized. But - nurses are not the equivalent of physicians - that is not the goal. If you want to be the equivalent - you need to go to medical school and do a residency. Nurses bring a different set of skills to the table.
  11. by   ElvishDNP
    Quote from KindaBack
    In my view, if NPs want to be respected as equivalent to physicians, they should demand that their training be standardized as it is with physicians.

    I've encountered some terrific NPs but an NP license is not nearly the guarantor of the training quality of the practitioner as it is with a physician.
    I don't know, I've seen some pretty awful physicians out there too, terrible clinicians and terrible people. It would be nice if (as MDs can) NPs could hold a board-certification in their subspecialty as well as the NP cert. More hoops to jump through, certainly, but I think people would do it for the prestige. I would love to see more standardized education in this country anyway, from kindergarten up to and including postgrad degrees.
  12. by   goatmomma
    I don't think it helps the cause when we bring up the fact that we know some physicians that are "terrible people." The truth is the bar is much higher for entry to medical school, the training much more rigorous. Yes, we all know a few bad ones but if they passed the boards they have a good knowledge base in their specialty. NPs would do well to have the same.
  13. by   BCgradnurse
    I would like to see more standardized education that focused more on actual practice skills than some of the softer stuff. I also wish that residencies (paid) were more available and eventually, mandatory.
  14. by   DTWriter
    Before standardization, it would be nice if NP schools were required to provide preceptors for their students.

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