Advocating for the Integrity of the ARNP

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Specializes in Family Practice.

Anybody know of any groups working to advocate for stricter education and licensing requirements?

Some elements that might be advocated for would include:

- Increased federal dollars to fund residencies or other incentives for hospitals/clinics to develop such programs.

- 5 years of full time RN work experience in a hospital related to the tract one is pursuing and/or standardized testing to measure baseline competency.

- Mandatory 1 year residency or at least mandatory MD supervision before independent practice is considered w/ a certification required once independent practice is requested. 

- Renewal of licenses every 4 years.

I would like to here opinions about items mentioned above, but more importantly, I would like to know of groups that are doing serious work to advocate for these changes.

And no, I'm not an AMA 'plant'. I'm an FNP dedicated to solidifying our place in the medical field.

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Specializes in Former NP now Internal medicine PGY-3.

IDK but something like making all the NP degrees 1.5 full time years plus one year residency would be nice. And remove some of the redundant certs and just have:

ped outpatient

adult outpatient

inpatient medicine

ICU med

er

psych

women's health

maybe a few specialty tracks?

 

and get rid of FNP it's too broad. Family medicine is even too broad. 
Specialties should be as narrow as they can be. Even inpatient and outpatient general med are like completely different. 
 

Im not sure prior experience helps much. 

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Specializes in Anesthesiology, General Practice.

Thanks OP. I agree there is a quality control issue among NP programs in the country. This is now beginning to be reflected in data slowly (and quite sadly). I was also critical of my FNP program as I advanced through it. 

I am not aware of any organizations advocating for change - but would gladly sign up. in MA, NPs can practice independently after two years of supervised practice in their field, which may be a compelling model for other states moving towards independent NP practice.

The easiest way to make NP preparation stronger across the board would be to make certification (exam, etc) more rigorous. Programs have to report their pass rate and I think students would not enroll in a university with a 50% pass rate. However, with more than one certifying body this is difficult.

Tegridy - I agree and disagree with you somewhat. We should simplify NP specialties and help them mirror medical pathways. I would argue for the following NP specialties:

Adult NP (acute and primary care competencies)

Pediatric NP (acute and primary care competencies)

Family NP (primary care across the lifespan)

Emergency NP (Emergency care across the lifespan)

PMHNP (Psychiatric care across the lifespan)

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Specializes in oncology.
KetafolDNP said:

Programs have to report their pass rate and I think students would not enroll in a university with a 50% pass rate.

 The For-Profit story: The Florida LPN to RN programs without accreditation do not post these statistics but still get so many enrollees who say " I am motivated and can teach myself".

 

 For LPN to RN:

  1.  specific faculty requirements for minimal education for preparation and minimal education/experience for opening your own school. 
  2.  Owners showing funding that continues to support all students from admission to graduation with out closure.
  3. Tight requirements for NCLEX passing rates.  (Florida I am looking at you for these)  NO 10% below national passing rate for 3 years before probation or 5 years from establishment of the first class to graduation for accreditation and then limping along until you are closed, discredited by states like NY and WA with students left with a $15,000 to $20,000 tuition paid and no ability to take NCLEX in discerning states. 
  4. There are No admission criteria, dubious exit exams and high tuition all taking advantage of someone's dreams. 

 

Question: As it currently stands: Are NP programs  now required to disclose their pass rates on their websites and have enrolling students sign off as acknowledging them?

We also need admission requirements that consider prior educational achievements and current educational ability. Full time employment should be the exception ...." not I work full time, have 25 children and need a quick and fast program. because I deserve it" . No more entitlement programs just because you are an RN you can be an NP. Students entering an RN program should see their educational goal as being an RN, not "I'm here to be an NP".

whether for profit or not for profit we need pass-through standards on courses (not tests being a minimum of a grade and papers a majority), and specific accreditation standard not a blanket CCNE., 

 

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Specializes in Family Practice.

I agree with separating adult and pediatric outpatient. Not so sure about Women's Health...if I have a patient that comes in with pelvic pain does that make it Women's Health? Can I perform a pap for a female patient I see for other primary care concerns?

I think all programs are 1.5 years at least, right? But yes, completely agree on the residency. It seems FQHCs are leading this in outpatient settings through federal grants. Not sure how inpatient programs are funded.

I disagree with prior experience quite a bit. Of course it matters how those 'years of experience' are spent -- not sure how to measure that though. 

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Specializes in Former NP now Internal medicine PGY-3.
KetafolDNP said:

Thanks OP. I agree there is a quality control issue among NP programs in the country. This is now beginning to be reflected in data slowly (and quite sadly). I was also critical of my FNP program as I advanced through it. 

I am not aware of any organizations advocating for change - but would gladly sign up. in MA, NPs can practice independently after two years of supervised practice in their field, which may be a compelling model for other states moving towards independent NP practice.

The easiest way to make NP preparation stronger across the board would be to make certification (exam, etc) more rigorous. Programs have to report their pass rate and I think students would not enroll in a university with a 50% pass rate. However, with more than one certifying body this is difficult.

Tegridy - I agree and disagree with you somewhat. We should simplify NP specialties and help them mirror medical pathways. I would argue for the following NP specialties:

Adult NP (acute and primary care competencies)

Pediatric NP (acute and primary care competencies)

Family NP (primary care across the lifespan)

Emergency NP (Emergency care across the lifespan)

PMHNP (Psychiatric care across the lifespan)

I'm just not a fan of combined adult and ped medicine. Two completely different specialties. Just an opinion though

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Specializes in Former NP now Internal medicine PGY-3.
JackStrawRN said:

I agree with separating adult and pediatric outpatient. Not so sure about Women's Health...if I have a patient that comes in with pelvic pain does that make it Women's Health? Can I perform a pap for a female patient I see for other primary care concerns?

I think all programs are 1.5 years at least, right? But yes, completely agree on the residency. It seems FQHCs are leading this in outpatient settings through federal grants. Not sure how inpatient programs are funded.

I disagree with prior experience quite a bit. Of course it matters how those 'years of experience' are spent -- not sure how to measure that though. 

Pap could be included in the adult med part. I should have specified which specific tasks. 
 

I think they are all 1.5 at least, but it's probably reasonable to dispose of the part time options. 
 

im not sure if experience helps though still or if it should be a req. more of a question than a statement from my end. 
 

I would say hospitals could fund residencies with a contract to work there afterward for a few years. Or the govt but I'm not sure how NP residencies are funded. 

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Specializes in Community health.
JackStrawRN said:

- 5 years of full time RN work experience in a hospital related to the tract one is pursuing and/or standardized testing to measure baseline competency

 

I am definitely in favor of more stringent requirements.  I have an acquaintance who recently graduated from some online MSN program, and is practicing as a psychiatric NP now, and I have been horrified to  observe how lacking her program was.

I am only going to nit-pick a tiny part.  It's the "in a hospital" part.  All of my nursing experience is outpatient; I am now enrolled in a PMHNP program, and I plan to work outpatient after I graduate, because I have a great deal more experience there.  I 100% agree that you should have to be an experienced nurse before you enter an APRN program, but there are many different types of nursing, and working in a hospital prepares you to work in a hospital, it doesn't prepare you for all the other environments.

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Specializes in CRNA, Finally retired.
CommunityRNBSN said:

I am definitely in favor of more stringent requirements.  I have an acquaintance who recently graduated from some online MSN program, and is practicing as a psychiatric NP now, and I have been horrified to  observe how lacking her program was.

I am only going to nit-pick a tiny part.  It's the "in a hospital" part.  All of my nursing experience is outpatient; I am now enrolled in a PMHNP program, and I plan to work outpatient after I graduate, because I have a great deal more experience there.  I 100% agree that you should have to be an experienced nurse before you enter an APRN program, but there are many different types of nursing, and working in a hospital prepares you to work in a hospital, it doesn't prepare you for all the other environments.

I disagree.  Nurses need to be exposed what the body looks like when it's not working so when we are in real life, we can identify when people are in danger.  But besides seeing what diseases can do to the patient, there's  a whole bunch of other skills we learn when working with people who aren't at their best.  Intuition, time management, being able  to respond to that emergency that happens only once ever year, etc.  People who enter APRN programs should also have experience in the specialty that they have chosen to specialize in.  It's a real waste of time to teach elementary nursing skills at the graduate level.

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Specializes in Former NP now Internal medicine PGY-3.

Residency or fellowship requirement or nothing TBH. I've Too many headaches from APP er providers and/or hospital groups with mostly APPs that I can count. 
 

and please separate out inpatient from outpatient med from everything. 

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As long as the programs are majority online with 0 admission standards and no preceptor oversight, the programs are going to be substandard. I am actually a fan of online learning but the NP model/construct is horrible.

I think there was a govt funded "NP residency" program a year or so ago similar to GME funding. Not sure where that went.

RN experience IMO doesn't matter, life experience and general intelligence/critical thinking do.

The specialties are w/e, who can be a specialist with 500 hours?

The only way to fix this is to tighten admission standards so schools can't admit everyone and expect the student to facilitate their own education. Also we NEED more residencies/fellowship and incentives for hospitals and clinics to form them.

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Specializes in CRNA, Finally retired.
Numenor said:

As long as the programs are majority online with 0 admission standards and no preceptor oversight, the programs are going to be substandard. I am actually a fan of online learning but the NP model/construct is horrible.

I think there was a govt funded "NP residency" program a year or so ago similar to GME funding. Not sure where that went.

RN experience IMO doesn't matter, life experience and general intelligence/critical thinking do.

The specialties are w/e, who can be a specialist with 500 hours?

The only way to fix this is to tighten admission standards so schools can't admit everyone and expect the student to facilitate their own education. Also we NEED more residencies/fellowship and incentives for hospitals and clinics to form them.

I agree with much of your post with the exception of dismissing RN experience.  If the nursing component is so irrelevant,  let's not call it advanced practice nursing since the fledgling NP's have never been nurses.  Since so many of the NP programs are so academically challenged, maybe we should just get rid of them and let everyone just apply for a PA program since it's irrelevant to be a nurse.  You can never know what you don't know without experience.    

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