How do you feel? - page 2

Dear Fellow Healthcare Professionals, It brings me great joy to finally be pursuing an educational path and career as an Advanced Practice Provider. I have my Baccalaureate of Science in Nursing,... Read More

  1. by   mrcleanscrubs
    Hi umbdude, BSN, RN Pro ,
    I completely agree with you - I guess to some extent, no matter how prepared a healthcare provider may think they are, there is still a lot of uncertainty.
    I also think you hit the nail on the standards of our programs; what exactly is the standard? (rhetorical question) There really are no standards, according to my research. I have interviewed two NP programs so far, and BOTH have no proctored exams; I was completely shocked. I cannot understand how we are to evaluate who knows the material versus those who may not understand the material. I really wish there was a way Nursing programs in this nation would set a standard that is agreed upon. I am kind of sad because I want a rigorous program that tests me, and pushes me to my limits; I want to be a great Advanced Practice Provider. I really would love to stick with nursing, I am so proud of my career choice - and I think more people who are invested in nursing and healthcare and truly want to learn more about treating people, should become nurse practitioners and change the image portrayed to society. I had girls in my class who just wanted to be nurse practitioner because they said it was easy, and that "anybody could do it." This is what they disseminate throughout their friends and family members, that nursing is easy and anybody could do it.
    I loved this "At the end of the day, there are many outstanding NPs (just look at some on this forum). They all went through NP programs and learn on their own with help and experience. If they could do it, why can't you? Regardless, look for an NP program that provides preceptors. These programs generally ensure that the preceptors are actually doing their job of teaching the important materials."
    You are 100% right! You all inspire me. And you have a good point, I really want preceptors assigned through the program. Thank you for your in depth response!
  2. by   mrcleanscrubs
    Quote from Oldmahubbard
    Good luck finding a program that provides preceptors. My experience and from what I read.
    Yeah, that unfortunately is a sad truth many NP students face. I think it is ridiculous that we need to find preceptors on our own.
  3. by   mrcleanscrubs
    Hi TangoDeux ,

    Wow, awesome post; thank you for your extensive reply. I definitely will take your advice and make sure the programs I apply to have a preceptor agreement established for students. You are absolutely right, and being the hands on learner I am, I would hope that any clinical rotation I have is one that is staffed by professors/preceptors who are vetted properly; as you stated. Thank you!
  4. by   Oldmahubbard
    I did my NP program some 15 to 20 years ago at a well regarded campus school. We had some exams, which were definitely proctored, but many of the courses were graded by a paper, or a class presentation. I definitely remember exams in pharmacology and physiology, and maybe another course or two.

    There was a practicum exam in health assessment with a partner. It wasn't really that difficult, just a long routine to memorize.

    There were some local clinical placements, but since I lived 100 miles away (yes we used to drive 2 hours to attend classes), I had to find my own.

    I almost consider that part of my education, because as an NP, you have to have some balls, for lack of a better word. Asking strangers you don't know to precept you takes some balls!

    In working with a non-vetted preceptor who turned out to be crazy, if you will pardon the language, I lost an entire year. Yep, the nightmare you may have heard about.

    I consider that experience absolutely essential to my education.

    Just a few thoughts!
  5. by   Jules A
    Quote from Oldmahubbard
    Our main professor had no prescribing experience, if you can believe it.
    I can believe it and thought we must have gone to the same university but the dates don't line up! I was appalled to learn this and even more appalled when this person went on to get another position at an even more prestigious university as the department chair.

    I recommend investigating the experience of the faculty because many have minimal if any NP experience. It can be a plus to secure your own preceptors based on providers you know from your nursing experience to be competent. Your end product will mimic your mentors so pick carefully.
  6. by   Oldmahubbard
    This same professor asked me to give a talk to the undergraduate RN students on the last day of their Psych class. I came in and told of my experience working in forensics with very mentally ill men, and going to court as an expert witness for the state. In our state, a court order is required to treat mentally ill inmates over their objection. This was one of the best parts of the job, and I saw a number of dramatic recoveries.

    The professor and the students couldn't believe I was doing all this independently. Apparently there is a notion out there that Psych NPs only refill scripts for folks who have already been diagnosed by physicians.

    Not so.
  7. by   Dodongo
    Quote from mrcleanscrubs
    I have interviewed two NP programs so far, and BOTH have no proctored exams; I was completely shocked.
    Absolutely awful. Embarrassing.
  8. by   mrcleanscrubs
    @ Oldmahubbard
    Your scenario sounds like quite the roller coaster! Your dedication and perseverance brought you to where you are today; your experiences have made you wise and knowledgeable.
    Thank you for sharing!
  9. by   mrcleanscrubs
    @ Jules A ,
    Thank you for your response. I definitely agree with you - I will be looking investigating the experience of the faculty wherever I apply. I also agree with what you mentioned about picking mentors carefully, we absolutely mirror who guide us. Thank you!
  10. by   mrcleanscrubs
    @Dodongo ,
    Quite frankly, I do not even know how this is legal! lol. Very embarrassing; something must be done to change and standardize NP programs nationally.
  11. by   umbdude
    @ mrcleanscrubs:

    Recommend reaching out to the program directors for an informational interview, and ask them what they (and the specialty faculties) are working on and what experiences they have. I did that for all 3 programs I applied to and it made a significant difference when I had to choose which one to attend. I got a much better sense of quality of the program after doing that.
  12. by   mrcleanscrubs
    Quote from umbdude
    @ mrcleanscrubs:

    Recommend reaching out to the program directors for an informational interview, and ask them what they (and the specialty faculties) are working on and what experiences they have. I did that for all 3 programs I applied to and it made a significant difference when I had to choose which one to attend. I got a much better sense of quality of the program after doing that.
    That is a great idea, thank you for that awesome recommendation. I will definitely be reaching out to program directors and clinical faculty to assess the faculty individually as well as assess the quality of the education provided in the program. Thank you!
  13. by   FullGlass
    I'm surprised at the negativity regarding NP schools on this thread. It is up to applicants to research the school. You can look at rankings, but also talk to current students and to NPs that you know. There is a forum on allnurses for discussing specific schools.

    A key difference between NP school and PA school is that PAs study everything. NPs must select a specialty and only study that. PAs can't set up an independent practice, but in 23 states and in the VA, NPs have full practice authority.

    There are increasing numbers of NP residency programs, so that is an option. My classmates that applied to these got accepted and are happy.

    I don't know ANY new grad clinician that feels adequately prepared - be it an MD, NP, or PA. Pretty much everyone is nervous and anxious when first starting out.

    1. Do you feel as though your NP Program properly prepared you to safely and competently care for patients?

    Well, as much as could be expected. My rotations for Adult and Geri Primary Care NP:

    • Intro rotation in SNF - I'm not counting this as it was only like 32 hours
    • Humongous LTC facility (Geri) - awesome preceptor with 30 years NP experience, including international. Focus was on caring for elderly patients with chronic conditions, including Alzheimer's and polypharmacy (how to reduce # of drugs safely and gradually). Rotation also included new issues such as colds, flu, pneumonia, etc. Preceptor really knew her stuff and was excellent teacher. Also got to spend time at the Occupational Health Clinic at this facility was another NP and it was great to get exposure to this interesting field.
    • Inner city Urgent Care - awesome preceptor with 40 years NP experience, 30 in this clinic. Super busy urgent care with lots of variety and emergent patients. She is a great teacher and mentor. My favorite rotation. In addition, spent a few days of this rotation with an NP who is a nationally known diabetes educator at the hospital's outpatient diabetes center.
    • Pain mgt clinic - preceptor was DO with over 30 years experience who had also been a medical researcher. He was the considered the best pain mgt doc in the city; other pain doctors referred difficult cases to him. Excellent teacher. Also had a Sports Med MD in practice and he was a great teacher, too.

    In all my rotations, I was expected to ramp up to independently take Hx, do exam, develop different dx, defend my top dx, and recommend appropriate tests and prescriptions. Of course, all this was reviewed and corrected as necessary by preceptor. Also learned to chart as I went, for maximum efficiency.

    2. Do you feel that you truly have an in depth understanding of Anatomy & Physiology, Pathophysiology, and Pathology?
    Again, as much as can be expected. This is a life long learning process. My prereqs included anatomy and physiology. I had patho in the BSN program. Then I had Advanced Patho in the MSN program.

    The DO also precepted MD residents and I observed them, too. They weren't masters of anatomy by any means. The DO told me most med school grads don't have an in depth grasp of clinical anatomy and both additional study and experience relevant to the specialty are required.

    My pain mgt preceptor told me to always keep learning and make a habit of spending at least 30 minutes every day reading up on new treatments, etc., in medicine.

    3. Do you feel as if your medical questions in lecture were answered to an extent that clearly illustrated that your professors were truly knowledgeable in advanced practice/medicine?; In that, they actually answered your question and not just answering stating, "That is something you will learn, 'on the job.'"

    Yes, many of my faculty are nationally recognized subject matter experts. We also had many lectures from MDs from the adjoining medical school and hospital. Examples: radiologist gave lecture on medical imaging, cardiologist on EKG interpretation, psychiatrist on drug abuse, etc. Our pharmacology professor was the pharmacologist responsible for quality control at the adjoining hospital - he was just awesome.

    My faculty was comprised of lecturers, clinical instructors, preceptors, and a wonderful academic advisor. All the NP faculty both practiced and taught. All of them were excellent, IMHO.

    4. Do you feel that your thirst for medical knowledge was satisfied?
    This can never be satisfied, nor is it possible to learn everything in school. It is a lifelong process. My school did offer many incredible resources: multiple Grand Round lectures everyday, access to incredible nursing and medical research libraries, and many interesting electives and elective certificates that could be completed along with the regular MSN curriculum.

    I only had one "fluff" course in the MSN program - it was one class that combined Ethics and Nursing Theory. Ethics is important, and med students study this, too. Nursing Theory - bleah. With the exception of one statistics and one research class, every other class was clinically focused. And I think an NP must be able to evaluate research publications and be able to write an article suitable for submission to a peer-reviewed journal, which was the focus of our research class. The research class was also an opportunity to perform a "deep dive" on an area of personal interest.

    Again, in healthcare, learning is lifelong. That's also why we have CE requirements.

    5. Do you feel satisfied in your role as a Nurse Practitioner?
    I'm a new grad, so we'll see, but I am very excited to begin my new job, and of course, anxious to provide safe and effective patient care.