What kinds of patients do you see? - page 4

by Rizz

6,412 Views | 39 Comments

I'm finishing my BSN in 9 weeks, YES! My goal originally was to go straight into NP school initially but I've since been schooled that I should work for a while to gain nursing experience. One of my clinical instructors told me I... Read More


  1. 0
    Quote from zenman
    Yes, IMO it would be nice if you had 2,000 hours in your NP program and at least 2,000 more of real clinical hours plus clinically relevant courses in your DNP program.

    I believe that one is called "moving the goalposts." You held 2000 clinical hours as evidence of the superior standards of training for the PA, so lets just go ahead and leave it there. I mean sure, we could bid the hours up like some imaginary poker game, but that's just silly, so let's not.

    A PA student may have no healthcare background and have no healthcare related licensure whatsoever and is furthermore much less likely to work as a licensed healthcare professional while attending - therefore gaining exactly 0 of these "real" clinical hours before becoming a PA. Conversely, most NP students will work in jobs as Baccalaureate degreed, Registered Nurses, as their programs require both, attaining 1000's of those "real" clinical hours in the 2-5 years they spend attaining their NP.

    The argument for the requirement of time on the floor has already been deemed a failure, hence the forward movement of programs like those at Georgetown, Rush, George Washington, University of Pennsylvania, Johns Hopkins and so on and so on. Human beings are loathe to change and oftentimes human systems are only worse - but "we have always done it this way" is never an acceptable reason to maintain the status quo, and in the end that's really the only point left in this tired old subject because it stands independent of reason.
  2. 0
    Quote from Nurse Maru
    I believe that one is called "moving the goalposts." You held 2000 clinical hours as evidence of the superior standards of training for the PA, so lets just go ahead and leave it there. I mean sure, we could bid the hours up like some imaginary poker game, but that's just silly, so let's not.
    No, I said, "Uh, you do know PAs have 2,000 or so hours of clinical vs NPs 500 or so. So basically a PA with no experience and an NP with none...well, you see the difference." It's only a direct comparison. I said nothing about superior standards. I hope you now see your error in thinking.


    A PA student may have no healthcare background and have no healthcare related licensure whatsoever and is furthermore much less likely to work as a licensed healthcare professional while attending - therefore gaining exactly 0 of these "real" clinical hours before becoming a PA. Conversely, most NP students will work in jobs as Baccalaureate degreed, Registered Nurses, as their programs require both, attaining 1000's of those "real" clinical hours in the 2-5 years they spend attaining their NP.
    This is off the wall. Whether anyone works while going to school has no bearing on any thing. Just delete this entire paragraph as having no relevance to anything.


    The argument for the requirement of time on the floor has already been deemed a failure, hence the forward movement of programs like those at Georgetown, Rush, George Washington, University of Pennsylvania, Johns Hopkins and so on and so on. Human beings are loathe to change and oftentimes human systems are only worse - but "we have always done it this way" is never an acceptable reason to maintain the status quo, and in the end that's really the only point left in this tired old subject because it stands independent of reason.
    Deemed a failure? By who? Give me a source. I've been known to directly contact heads of university programs in the past to verify their comments, so keep that in mind. I went to Rush, btw andI'm continually going to school or learning something. Believe me I know about change and have no problem with it. The fact that I'm 61 yrs old and have 42 years of experience certainly doesn't mean I believe in, "we've always done it this way." Independent of reason? Go find a professor of logic and tell him your story. I'll be waiting.
  3. 2
    this is really good:
    [color=#0726a7]nursing experience: the credibility conundrum. | nursesforchange.org

    some comments from other forums:

    “i've met excellent nps, however they typically have years of clinical experience w/ all kinds of pts in various settings.”

    “hello as a soon to be graduate of np school i believe that my 10 years as a nurse has helped me be a better clinician.”

    “i am a fnp with 25 years of nursing combined with 11 years as an np. i would highly recommend if you go the np route, to work as an rn for at least a few years before becoming an np. you gain valuable patient skills doing this.”

    it’s not nursing but i asked my teacher wife, who is a whiz on neuroscience of learning, about whether teachers should get experience before going into a master programs: “yes. teach a while, then go for the masters. you have no clue what you are talking about until you have some experience first.”

    since people are asking for this i’ll just post it here:

    how to maximize your nursing experience for np school

    you will hear some people say that prior experience in nursing school is not relevant to np school. think for a minute how much bs that is and how illogical it is. i’ve had physicians tell me that working as a cna helped them as a physician. and yet nursing experience doesn’t help you as an np? something is really wrong with this picture. i challenge anyone who doesn’t believe what i say to find a professor who teaches logic and sit down with them for awhile.

    heck, what i learned kayaking in hawaii helped me in np school. i learned that you better be prepared; have all the needed equipment; have back-up systems; worry only about what was in your own kayak; know yourself and what you can handle; and sometimes all you can do is relax and go with it.

    here’s what you can do, and it’s what i did once i made a decision to go to np school. i already had 37 years of clinical nursing experience in a variety of settings, including teaching and in management prior to np school. so not only did i work alongside many nursing peers, i taught students, and i saw how nurses functioned from a management perspective.

    you will learn just by doing your job. with every very pair of lungs you listen to, or heart or bowel sounds you listen to, you are learning something. with every new med you hand out or every new disease you come across you are learning something. but instead of just doing your job maximize it by informing physicians you work with that you are going to np school and you would like their help.

    with every med you hand out take time to learn it from a provider’s viewpoint. why is the physician giving this med versus another? teach yourself, then ask the physician. here’s an example. i have a depressed patient. give them an antidepressant, right? well, are they also anxious? psychotic? sleeping too much? not sleeping at all? drug/etoh abuse? ptsd also? past history with any psych meds? family member with psych history? did a certain antidepressant help their best friend? is there a history of multiple suicide attempts? do they also have ocd symptoms? potential for side effects with this patient? do they have insurance coverage or do i need to prescribe the cheap stuff? will it be too sedating for them? will they gain weight? do i need to start with a lower dose than usual? do i need to combine different classes of antidepressants? do they even need meds? how will my meds interact with their other meds? will their age matter? will their race matter? do they also have chronic pain? what if they have chronic pain, depression, and anxiety? get it? start thinking like this while you’re working. most physicians will be glad to help you. do the same with every new condition, surgery, or disease you run across. follow the physician in the patient’s room and watch them do exams. listen to the patient’s lung sounds prior to the physician and then chat with them or read their progress notes to see if you come to the same conclusions.

    back to the depressed patient. they are depressed now but have they ever had a hypomanic episode? you could make them worse with an antidepressant. oh wait, i remember seeing some of these patients, even on our med floor, so i have an idea what to do! yea, that nursing experience helped!

    [color=#333233]think you’ll never treat a psych patient? think again. i consult on med floors every day, as well as icu, ccu, and ed. over the last few days i’ve seen a patient with a pruritic rash. all her meds had been stopped in order to try to determine which med might be the cause. unfortunately, she was also bipolar. she was being treated with prednisone. do you know the side effects of steroids? you better with this lady!
    [color=#333233]
    [color=#333233]it’s a lot of responsibility and you better have good sphincter control when you are the one making the decision.
    [color=#333233]
    [color=#333233]my thoughts that prior experience will benefit you before np school still stands. however, if the only option you have is to go straight through then do so.
    carachel2 and sirI like this.
  4. 0
    Excellent, zenman.
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    I don't think anyone is saying that RN experience is irrelevant. What they're saying is that there is more than one way to skin a cat. There's more than one way to develop a background that will set someone up for success as a NP.

    I, for example, will have little-to-no RN experience when I start my psych NP training. However, I have years of experience in differential diagnosis and assessment of psychiatric disorders under the guidance of clinical psychologists and graduate students. This was in a clinical research study where I trained for 8+ months in administering different assessments, including structured interviews, unstructured interviews, suicide risk, etc. I was in charge of making diagnostic decisions and if a case was complicated, we would discuss it as a team. All those hundreds of hours I spent won't count as "RN experience" or "healthcare experience" in the eyes of many people, but I see them as directly relevant to my future career. I would love to see someone tell me that this background won't help me as a clinician.

    I think I'll post this on that blog and see what the blogger thinks...
    Last edit by myelin on May 29, '12
  6. 0
    Quote from myelin
    I don't think anyone is saying that RN experience is irrelevant. What they're saying is that there is more than one way to skin a cat. There's more than one way to develop a background that will set someone up for success as a NP.
    Oh, they do. But you're bringing up a different angle, lol!

    I, for example, will have little-to-no RN experience when I start my psych NP training. However, I have years of experience in differential diagnosis and assessment of psychiatric disorders under the guidance of clinical psychologists and graduate students. This was in a clinical research study where I trained for 8+ months in administering different assessments, including structured interviews, unstructured interviews, suicide risk, etc. I was in charge of making diagnostic decisions and if a case was complicated, we would discuss it as a team. All those hundreds of hours I spent won't count as "RN experience" or "healthcare experience" in the eyes of many people, but I see them as directly relevant to my future career. I would love to see someone tell me that this background won't help me as a clinician.

    I think I'll post this on that blog and see what the blogger thinks...
    I think your experience is relevant. It's directly related to psych and will help you a lot. Those few psychologists who went and got their PMHNP probably found their experience very relevant also.
  7. 0
    Another thing I thought of was the experience requirement for my MBA program. Everyone had to be over 30 and have management experience. One 29 yr old got in because he owned his own company. Imagine all our "real-life experience classes" as well as having professors who actually worked, ie., HR professor was HR executive, Productions & Operations professor actually was Productions & Operations executive, etc.. Compare this with those MBA schools where you get an MBA with no experience and then go into companies and try to tell them what to do...laughable!
  8. 0
    Thank you! I guess I just get annoyed when people say "The only way to be a competent NP is to have worked some arbitrary number of years as an RN in some arbitrary setting.
  9. 0
    Quote from myelin
    Thank you! I guess I just get annoyed when people say "The only way to be a competent NP is to have worked some arbitrary number of years as an RN in some arbitrary setting.
    You're not alone.....it annoys me too!
  10. 0
    never mind
    Last edit by CCRNDiva on Jun 2, '12 : Reason: changed my mind


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