Advocating for the Integrity of the ARNP

[JackStrawRN]

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.

[CuriousConundrum]

Require a graduate admission's exam and GPA minimum > 3.0.  State boards disapprove and customers avoid online schools that don't have a university building kids can walk into and take classes in.  Removing "nursing theory" and "community health" classes and flushing those down the toilet.   Become less focused on paper writing like some Master of Arts program and more focused on clinical training.   Mirror PA school to the degree that ALL APRNs should have basic medical training (prosected cadavers, physio, pathophys, biochem, immunology, micro) beyond the light weight rubbish we had in undergrad and complete training in int med, peds, neuro, waveforms/labs/images. Follow that basic medical education with focused training for a year in family, psych, acute, gyneo or whatever else NPs are doing now.  

[subee, MSN, CRNA]

Tegridy said:

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

No, the 2nd half was describing one of my early nights of having to work alone less than a month out of school.  In olden times we were prepared to work alone from the git go.  

[subee, MSN, CRNA]

subee said:

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.

The hospitals want to shape their nurses to conform to that hospital's philosophy and procedures.  Call it a prolonged orientation or call it a residency but most institutions have become complicated .  I don't think that graduates who didn't have the opportunities that the diploma grads had should be thrown out on their own.  Do most residencies require the student to pay the hospital back if they leave early?   Having said that, does anyone monitor the quality of residencies.  New grads who are permitted to skip med surg and go directly into something like NICU really need this intensive orientation to a specialty they didn't see much in school.  

[subee, MSN, CRNA]

CuriousConundrum said:

Require a graduate admission's exam and GPA minimum > 3.0.  State boards disapprove and customers avoid online schools that don't have a university building kids can walk into and take classes in.  Removing "nursing theory" and "community health" classes and flushing those down the toilet.   Become less focused on paper writing like some Master of Arts program and more focused on clinical training.   Mirror PA school to the degree that ALL APRNs should have basic medical training (prosected cadavers, physio, pathophys, biochem, immunology, micro) beyond the light weight rubbish we had in undergrad and complete training in int med, peds, neuro, waveforms/labs/images. Follow that basic medical education with focused training for a year in family, psych, acute, gyneo or whatever else NPs are doing now.  

Agreed.  The problem is that we could never.get enough people graduated and working because not enough people could afford it.  We need private university and hospital partnerships so that students could work off some of their school expenses, like a diploma program.

 

 

 

[FullGlass, BSN, MSN, NP]

Late to this thread.  Don't all states require NP licenses to be renewed every few years?  In CA it is every 4 years.

I would love for all new NP grads to have 1 year residency, but that can't be mandated unless there is money to pay for it and that hasn't happened yet.  It would be nice if the NP groups would politically advocate for Social Security to pay for this, or some states that really need providers might do this for their own state, like CA.

I am totally opposed to mandating RN experience for primary care or other non-hospital specializations.  The evidence indicates it does not produce better outcomes.  For hospital-based specialties, yes, RN experience makes sense, but the decent schools already require this.

I just think we need to more strictly regulate the schools.  There are too many crappy NP schools that will accept anyone with a pulse, and the for-profit schools also saddle their grads with ridiculous amounts of debt.  Medicine does not allow this and they are right.  It should be reasonably hard to get into NP school, because then we will have smarter NPs to begin with.  I think there could be a place for for-profit schools, but they have to have similar admissions and academic standards to reputable schools.

I also think the current DNP is silly.  We need a clinical DNP that improves clinical expertise, not management skills.

[Corey Narry, MSN, RN, NP]

Guest1144461 said:

I have to throw in my anecdote of precepting. ACNP programs generally ALL require experience (1-2 years). I found my 2nd profession students with the bare minimum nursing experience were by FAR my best students.

The nurses with 8-10 years+ experience generally performed the least well.

This is off topic but I relate to this a lot. I am in In-Patient Cardiology and have been precepting AGACNP students from various "well known" programs. It doesn't even matter the school, some students who have been nurses for a while ceratinly are slower to understand concepts, have a hard time organizing their thoughts in order to present their patients, and could not write a decent note.  I actually find the younger students more smart and able to analyze and problem solve. 

Perhaps it is a problem within bedside nursing as it is practiced currently. When I was an ICU NP, the bedside nurses were amazing and were independent thinkers. Now that I work in various hospital floors, I find floor nurses' roles too limiting...they can't do much and can't make decisions so that everything has to be run with a provider for risk of "getting in trouble". I get pages of pt VS before giving a med even when the VS are normal. I think our profession has taken the critical thinking out of bedside nursing,

[londonflo]

juan de la cruz said:

I get pages of pt VS before giving a med even when the VS are normal.

Is this related to computer formatting? Years ago when "notes by exception" started we had students write on separate paper what was important to this patient, before any writing went into the record. It stopped the VS stable, AO x3 etc. Now it has become "if it isn't charted, it wasn't assessed".

[FullGlass, BSN, MSN, NP]

subee said:

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.

I don't understand your thinking with this statement.  MDs are required to complete internship and residency after 4 years of FT medical education.  Are you saying that MDs receive inadequate schooling?

[CuriousConundrum]

FullGlass said:

I don't understand your thinking with this statement.  MDs are required to complete internship and residency after 4 years of FT medical education.  Are you saying that MDs receive inadequate schooling?

If NP programs are needing their graduates to be residents it sort of defeats the role of the NP. If you want to electively engage in a residency, DNP or anything else that blows your skirt up then have at it. PAs have elective residencies. Even the pharmacists do, but neither profession requires it. 

The hospital systems have political reach in maintaining physician residencies for cheap labor. Also, given the generic nature of medical school the grads need a residency to specialize and even still they, like us, find much lacking in their educational pathways - NPs obviously lacking more. As an outlier, I've had psychiatrists tell me they thought their residencies were excessive. 

[FullGlass, BSN, MSN, NP]

CuriousConundrum said:

If NP programs are needing their graduates to be residents it sort of defeats the role of the NP. If you want to electively engage in a residency, DNP or anything else that blows your skirt up then have at it. PAs have elective residencies. Even the pharmacists do, but neither profession requires it. 

The hospital systems have political reach in maintaining physician residencies for cheap labor. Also, given the generic nature of medical school the grads need a residency to specialize and even still they, like us, find much lacking in their educational pathways - NPs obviously lacking more. As an outlier, I've had psychiatrists tell me they thought their residencies were excessive. 

NP schooling is far less rigorous than medical school or PA school.  Medical school is 4 years FT, PA school is 2 years FT.   In contrast, NP school is 18 months - 2 years part-time (for an MSN).   It's really PT even for "full time" NP programs because a lot of NPs work as RNs while attending school.

There either needs to be a lot more clinical rigor in NP programs or there needs to be 1 year NP residencies.  I'm not advocating for the same length of residencies as MDs.  A psychiatrist typically has around 4 years of combined internship/residency, and many also do a fellowship for a year or 2.  I seriously doubt any reputable MD would say there should be NO internship/residency.

 

[CuriousConundrum]

FullGlass said:

NP schooling is far less rigorous than medical school or PA school.  Medical school is 4 years FT, PA school is 2 years FT.   In contrast, NP school is 18 months - 2 years part-time (for an MSN).   It's really PT even for "full time" NP programs because a lot of NPs work as RNs while attending school.

There either needs to be a lot more clinical rigor in NP programs or there needs to be 1 year NP residencies.  I'm not advocating for the same length of residencies as MDs.  A psychiatrist typically has around 4 years of combined internship/residency, and many also do a fellowship for a year or 2.  I seriously doubt any reputable MD would say there should be NO internship/residency.

 

I'm definitely aware of the difference and have long castigated the vapid and shallow nature of both RN and NP training. I don't think a residency is a solution. As we see, nurses don't generally do a good job of designing clinical education. I don't think anything I mentioned suggested physicians have said to me there should be no residency. We'll never see improved NP education on the university side, and with the obscene rise in online schools it's all only going to get worse. 

[FullGlass, BSN, MSN, NP]

CuriousConundrum said:

I'm definitely aware of the difference and have long castigated the vapid and shallow nature of both RN and NP training. I don't think a residency is a solution. As we see, nurses don't generally do a good job of designing clinical education. I don't think anything I mentioned suggested physicians have said to me there should be no residency. We'll never see improved NP education on the university side, and with the obscene rise in online schools it's all only going to get worse. 

You appear to be contradicting yourself.  Since you don't have confidence that NPs can improve the quality of NP education through school, then that is exactly why residencies are needed.  Residencies are not run by NP schools, just as medical residencies are not run by medical schools.  Residencies provide a combination of additional clinical experience plus some didactic content.  Every NP I know that has been fortunate enough to be in an NP residency has been very happy they were able to complete the residency.  

The biggest weakness of NP education is lack of clinical hours.  Residencies address this.

Here is an example of an NP residency program for primary care:

https://www.VA.gov/san-francisco-health-care/work-with-us/internships-and-fellowships/nurse-practitioner-residency-program/

 

Another example for psychiatry:

https://www.VA.gov/northern-california-health-care/work-with-us/internships-and-fellowships/psychiatricmental-health-nurse-practitioner-residency-program/

I wish I had been able to go through an NP residency