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.
Specializes in Former NP now Internal medicine PGY-3.
Does having RN experience even matter for CRNA? I know it's a requirement but in general what does the ICU have to do with the OR besides titrating drips LOL to some preset number. Not a rhetorical question.
The ICU teaches us respiratory physiology, cardiac physiology, interpreting 12 lead EKG's, responding to an emergency, having a bit more leeway in decision making regarding where all those drips should be set, how the drips work and which put a bigger load on the heart and which don't...you know, pretty much the nuts and bolts of the body. They don't want to have to re-teach everything from the bottom. We used Guyton for our courses in respiratory, cardiac and endocrine courses (all separate 3 credit courses) and all taught my MD's. We also had a month ICU rotation for which is was very useful to have the previous experience. We learned more fine tuning of vents, intubation skills outside of the OR etc. My last day of school was a 24 hour call shift with a presenting case of malignant hyperthermia arount 5:30 am after an all nighter. It was the attending's first night of call and he had never seen a case either. Do you think it was useful to have two people in the room who had been prepared for that emergency after working 22 h ours straight? Two days after that I started my first job and two weeks after that I had to take call alone which included doing spinals and inserting a central line (alone) in a shocky elderly patient. The case had to start immediately before the attending could arrive. CRNA's can work under the surgeon - we do not need an anesthesiologist in the room. Are you starting to get the picture? It was the most stressful time of my life but all ended well, including the shocky 80 something year old female who was discharged to home. AND, we have to be the calm person in the room. Do you not think some years of ICU under one's belt doesn't make a difference?
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
I have to say that my 10+ years of ER experience as a RN are what prepared me best to become an NP. As a triage RN, many times you are the one trying to figure out what could possibly be wrong with the patient so you can make the right decision as to having the person safely wait or bringing them in for immediate treatment. Your assessment, judgement, and ability to think critically better be spot on.
Rarely does anything textbook present to the ER. You have to know the subtle signs and symptoms of many different life-threatening cases (MI immediately comes to mind) in order to know which rabbit hole to jump down. Many times you are examining and getting things started on the patient before the doc (or NP, PA) sees them. Also, with how the healthcare system is so challenged, you will see cases present to the ER that could be handled at an outpatient facility.
My nursing experience taught me to know what I don't know. It also taught me how to prioritize, how to think on my feet, and how to handle things when shi* hit the fan. I will never, ever discredit my nursing experience. It was crucial in helping me become the NP I am today.
The NP profession was initially supposed to be for the "expert" nurses (think Benner's "Beginner to Expert”) who were excellent clinicians with years of experience under their belts. The original programs were not developed with new grad RN's in mind.
My best recommendation is this - if you want to become an NP (outpatient family, adult, ped), then get experience in the ER. You will be amazed at how much crosses over to the outpatient side of things.
Specializes in Former NP now Internal medicine PGY-3.
Spacklehead said:
I have to say that my 10+ years of ER experience as a RN are what prepared me best to become an NP. As a triage RN, many times you are the one trying to figure out what could possibly be wrong with the patient so you can make the right decision as to having the person safely wait or bringing them in for immediate treatment. Your assessment, judgement, and ability to think critically better be spot on.
Rarely does anything textbook present to the ER. You have to know the subtle signs and symptoms of many different life-threatening cases (MI immediately comes to mind) in order to know which rabbit hole to jump down. Many times you are examining and getting things started on the patient before the doc (or NP, PA) sees them. Also, with how the healthcare system is so challenged, you will see cases present to the ER that could be handled at an outpatient facility.
My nursing experience taught me to know what I don't know. It also taught me how to prioritize, how to think on my feet, and how to handle things when shi* hit the fan. I will never, ever discredit my nursing experience. It was crucial in helping me become the NP I am today.
The NP profession was initially supposed to be for the "expert" nurses (think Benner's "Beginner to Expert”) who were excellent clinicians with years of experience under their belts. The original programs were not developed with new grad RN's in mind.
My best recommendation is this - if you want to become an NP (outpatient family, adult, ped), then get experience in the ER. You will be amazed at how much crosses over to the outpatient side of things.
You bring a good point to certain nursing specialties having useful knowledge transfer to the provider role
Specializes in Former NP now Internal medicine PGY-3.
subee said:
The ICU teaches us respiratory physiology, cardiac physiology, interpreting 12 lead EKG's, responding to an emergency, having a bit more leeway in decision making regarding where all those drips should be set, how the drips work and which put a bigger load on the heart and which don't...you know, pretty much the nuts and bolts of the body. They don't want to have to re-teach everything from the bottom. We used Guyton for our courses in respiratory, cardiac and endocrine courses (all separate 3 credit courses) and all taught my MD's. We also had a month ICU rotation for which is was very useful to have the previous experience. We learned more fine tuning of vents, intubation skills outside of the OR etc. My last day of school was a 24 hour call shift with a presenting case of malignant hyperthermia arount 5:30 am after an all nighter. It was the attending's first night of call and he had never seen a case either. Do you think it was useful to have two people in the room who had been prepared for that emergency after working 22 h ours straight? Two days after that I started my first job and two weeks after that I had to take call alone which included doing spinals and inserting a central line (alone) in a shocky elderly patient. The case had to start immediately before the attending could arrive. CRNA's can work under the surgeon - we do not need an anesthesiologist in the room. Are you starting to get the picture? It was the most stressful time of my life but all ended well, including the shocky 80 something year old female who was discharged to home. AND, we have to be the calm person in the room. Do you not think some years of ICU under one's belt doesn't make a difference?
Okay the first part of this post has great merit. The second part sounds like it was describing CRNA school not nursing experience. I see how ICU experience can help for those not just coasting through
I suggest scrapping the master's and make a DNP (4 yrs in length) the only option. Revamp the curriculum: drop the majority of research classes and include gross anatomy&physiology, etc. for years 1/2. Years 3/4 will be a mandatory residency in your field. That'll surely weed out those who were hoping for an easy ride.
I suggest scrapping the master's and make a DNP (4 yrs in length) the only option. Revamp the curriculum: drop the majority of research classes and include gross anatomy&physiology, etc. for years 1/2. Years 3/4 will be a mandatory residency in your field. That'll surely weed out those who were hoping for an easy ride.
Is this 4 years full time? That's very unrealistic IMHO. 4 years part time..that's better than what we have now and a welcome change. Should the stude ts have the opportunity to concentrate on a functional specialty such as education or research? If students attended classes year around, they would have enough credits for the DNP. I never even knew NP students weren't required advanced A and P classes. Yikes!
Specializes in Former NP now Internal medicine PGY-3.
subee said:
Is this 4 years full time? That's very unrealistic IMHO. 4 years part time..that's better than what we have now and a welcome change. Should the stude ts have the opportunity to concentrate on a functional specialty such as education or research? If students attended classes year around, they would have enough credits for the DNP. I never even knew NP students weren't required advanced A and P classes. Yikes!
I thought they had to take advanced classes too. Those were probably the only somewhat helpful classes back in my program.
Is this 4 years full time? That's very unrealistic IMHO. 4 years part time..that's better than what we have now and a welcome change. Should the stude ts have the opportunity to concentrate on a functional specialty such as education or research? If students attended classes year around, they would have enough credits for the DNP. I never even knew NP students weren't required advanced A and P classes. Yikes!
Offer full and part-time of the curriculum. It's better than the mess we have now. Have the core classes and then the students will begin their concentrations followed by residency.
We were required to take advanced A&P. However, I would've loved to have some type of pared down gross A&P. I am a hands-on visual person, so it would've been nice to have as part of the curriculum. Not sure how to make that happen though.
I'd def pay a residency or fellowship trained app more if I was hiring. Probably substantially.
Good! I just accepted a 10-month fellowship program. ? I am over the moon about it. There are TWO fellows: me and one other. Which is an enormous problem, of course, that lots of people think residencies/fellowships are needed, and there are so few available.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
I wish there were more residency programs! I would have loved such an opportunity.
As far as getting paid more, though, be aware that if you're in a union job you don't get credit for things like that. The pay is the pay and that's all you can get. But still, the experience would be well worth it even if it doesn't translate into a higher initial salary.
I wish there were more residency programs! I would have loved such an opportunity.
As far as getting paid more, though, be aware that if you're in a union job you don't get credit for things like that. The pay is the pay and that's all you can get. But still, the experience would be well worth it even if it doesn't translate into a higher initial salary.
If the students were getting a proper education ,they wouldn't NEED a residency program. Why should we dump on the employer what should he the educational system's responsibility? The students are paying for subpar diploma factories.
Tegridy
583 Posts
Does having RN experience even matter for CRNA? I know it's a requirement but in general what does the ICU have to do with the OR besides titrating drips LOL to some preset number. Not a rhetorical question.