The future of NP education

  1. Good afternoon,

    There seems to be so many "types" of NP schools and certifications. I don't necessarily think that does a service to NPs. Im disappointed that my program did not have the opportunity or requirement for ortho or surgical rotations. By splitting up the NP programs into specialities - we are self limiting ourselves by requiring more education and board certifications if we ever desire to do other specialties. There probably does need SOME speciality education but not like we have now.

    WHNP, psych/mental health NPs and CRNAs are probably good as is.

    FNPs, Adult gero primary care NPs, pediatric primary care NP -> why not just primary care NP instead? I understand people not wanting to work with peds or whatever but still

    Adult gero acute care Np, pediatric acute care NP, emergency NP --> straight up Acute care NP works fine

    All DOs or MDs go to "medical school", not "acute care med school" or "primary care med school". Same with PAs!

    Then there all the different certifying bodies, ANCC, AANP, plus lots more I don't feel like looking up.

    I can understand where those are coming from who like the individual programs but I don't think that is the best for the future.

    This isn't meant to ruffle feathers, just to generate conversation. Im interested in hearing personal views.
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  2. 12 Comments

  3. by   Dodongo
    I actually like the "specialty" tracks. I just think they are implemented poorly. IMO there should be the following tracks:

    Anesthesia
    Psych/Mental Health
    Acute Care
    Primary Care
    OB/GYN
    Neonatal

    They should all train NPs to care for all age groups, within that specific medical specialty. More importantly, state boards of nursing should limit NPs to practicing within their scope. I've said it before but it makes all NPs look bad when you have someone trained in primary care trying to function in the hospital or in psych, etc.

    I think the theory is that you have the broad RN training where we are exposed to peds, OB, psych, etc, so we have an idea of what we want to "specialize" in. The tracks actually align us to some degree with physician training. They choose a specialty and stick with it (granted they do it in residency, not medical school). Our "specialties" are still broad enough to give us some laterality.

    Further, all programs should require 1500-2000 clinical hours, graduate level gross anatomy, OR/first assist training for acute care tracks, in person lab/skills training - essentially, there's a lot I would change.
  4. by   ACNP2017
    Quote from Dodongo
    They should all train NPs to care for all age groups, within that specific medical specialty. More importantly, state boards of nursing should limit NPs to practicing within their scope. I've said it before but it makes all NPs look bad when you have someone trained in primary care trying to function in the hospital or in psych, etc.
    This is a little pet peeve of mine. Having FNPs evaluating ESI 2s and 3s in the ER (not fast track/thru care/urgent care) is not ideal. Im getting my post-masters FNP so my marketability is larger for ERs.

    I can't speak to all programs but mine had an in-person skills labs.
  5. by   Dodongo
    Quote from ACNP2017
    This is a little pet peeve of mine. Having FNPs evaluating ESI 2s and 3s in the ER (not fast track/thru care/urgent care) is not ideal. Im getting my post-masters FNP so my marketability is larger for ERs.

    I can't speak to all programs but mine had an in-person skills labs.
    Absolutely agree. I know a FNP hired into an ICU and it took a long time to get them up to speed. No training with vents, pressors, or other common critical care modalities. It wasn't good. Unfortunately, the intensivist group hired a PA the next time around.
  6. by   FullGlass
    Quote from ACNP2017
    This is a little pet peeve of mine. Having FNPs evaluating ESI 2s and 3s in the ER (not fast track/thru care/urgent care) is not ideal. Im getting my post-masters FNP so my marketability is larger for ERs.

    I can't speak to all programs but mine had an in-person skills labs.
    The fault is with the ERs that hire FNPs to work outside their scope of practice.
  7. by   ACNP2017
    Quote from FullGlass
    The fault is with the ERs that hire FNPs to work outside their scope of practice.
    The problem is that fact that there is no standard acute care NP program and certifying body that encompasses the entire lifespan. lol I wish there was. Yes it would make the program longer but it would be worth it.

    FNPs are meant to be outpatient.
  8. by   ICUman
    Quote from FullGlass
    The fault is with the ERs that hire FNPs to work outside their scope of practice.
    Oh, not the provider's fault? Maybe FNP's should actually be competent in the area they are applying for. As is expected by the employer.
  9. by   Dodongo
    Quote from ICUman
    Oh, not the provider's fault? Maybe FNP's should actually be competent in the area they are applying for. As is expected by the employer.
    Right? The only ones who really understand the complicated nature of NP educational paradigms is NPs. Hospital HR departments and physician groups hiring NPs probably don't understand that FNPs are not trained to do inpatient work. They know that 1) the person has an NP credential and 2) the person is applying for this position, ergo, they should be qualified. Obviously not the case.

    In my example posted above, that FNP made all NPs look bad because he wasn't trained to work in the ICU. The intensivist group doesn't know the difference between ACNPs and FNPs, and so they thought NPs were poorly trained in general. I, not being one to suffer such nonsense, had an impromptu meeting with the CCM chief to explain the difference in training/education, and to encourage the hiring of ACNPs in the future (because I do think ACNPs are better trained for ICU work than PAs).
  10. by   SpankedInPittsburgh
    I'm a DNP student going into my last semester after working in a busy ER for a long time. I think specialization is a great idea. These programs try to cover "everything" and as a result you get a narrow knowledge of a ton of information. The future of NP seems to be a DNP. Instead of spending almost a year working on this glorified term paper designed to give us some of the credibility of a PhD how about have us concentrate on what most of us will be doing which is not statistical analysis and data collection. I've read many, many of these CAPSTONES and most lend little to the profession. I don't know the answer to this absolutely but my significant other for several years was an MD. She stated that the docs were to busy trying to learn how to cure sick folks to engage in this exercise and wasn't part of medical school or their residency. I don't know if its part of current medical school curriculum presently but it seems like a tremendous amount of educational time and resources spent on little practical return to me. Anyway that's my two cents. Happy New Year's!!!
  11. by   Riburn3
    In general I agree with the OP. We fragment ourselves too much, and the reality is there is a lot of overlap in the various NP degrees and specialties.


    I got my FNP first, and am glad I did because it was very broad and I got a great taste of everything. A couple of years after, I got my AGACNP and it felt much more like I was getting a specialty, building on my FNP.


    I personally think it would be cool if NP programs focused for 2 years in general family practice, and if you really wanted to, you could stick around and focus in a specialty area like peds, women's health, acute care, etc for an extra year.
  12. by   renzlao
    Quote from SpankedInPittsburgh
    I'm a DNP student going into my last semester after working in a busy ER for a long time. I think specialization is a great idea. These programs try to cover "everything" and as a result you get a narrow knowledge of a ton of information. The future of NP seems to be a DNP. Instead of spending almost a year working on this glorified term paper designed to give us some of the credibility of a PhD how about have us concentrate on what most of us will be doing which is not statistical analysis and data collection. I've read many, many of these CAPSTONES and most lend little to the profession. I don't know the answer to this absolutely but my significant other for several years was an MD. She stated that the docs were to busy trying to learn how to cure sick folks to engage in this exercise and wasn't part of medical school or their residency. I don't know if its part of current medical school curriculum presently but it seems like a tremendous amount of educational time and resources spent on little practical return to me. Anyway that's my two cents. Happy New Year's!!!
    I agree. Instead of doing tons of research / term paper, I would prefer a DNP with a year of fellowship or residency to an area of specialty. This will add thousand of clinical hours to our training. I am only on my 2nd semester though, what do I know lol
  13. by   db2xs
    Quote from Dodongo
    IFurther, all programs should require 1500-2000 clinical hours, graduate level gross anatomy, OR/first assist training for acute care tracks, in person lab/skills training - essentially, there's a lot I would change.
    I too believe that the NP curriculum needs to be solidified and bolstered. Definitely more clinical hours! Why don't we have more required clinical hours? I would imagine the schools would tell you that Yes, they're providing "graduate-level gross anatomy," but I can tell you that they are not doing that, and "advanced" patho and "advanced" pharm are ... not advanced. At least from my experiene.

    It makes more sense to me to have an intensive general NP program, and then afterward one can choose to branch off, the way MDs do it. As an adult-gero primary care NP student who is not interested in taking care of children, I would be willing to learn pediatric medicine if it were required of me in a more intensive program.
    Last edit by db2xs on Jan 8 : Reason: typo
  14. by   Wuzzie
    I'm going to have to respectfully disagree on one aspect of what the OP wrote. Pediatrics should not ever be lumped in with adult care education. Children are not small adults. The margin for error in assessment and treatment is way too small and the consequences of making what might look like a minor error can be disastrous. I've seen it happen over and over.

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