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]

FullGlass said:

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

 

Please don't displace your unfulfilled desires to other nurses. Wouldn't you believe NPs would be consulted upon to design a residency? 

[FullGlass, BSN, MSN, NP]

CuriousConundrum said:

Please don't displace your unfulfilled desires to other nurses. Wouldn't you believe NPs would be consulted upon to design a residency? 

You are not making any sense.   You are also using "displace" incorrectly.

[HarleyvQuinn, MSN, RN, NP]

I disagree about getting rid of FNP - it's not too broad necessarily, it's how you use it. It works great with family medicine clinics in primary care where patients want to use one clinic for their whole family, but it requires the support of the physicians and PAs who also work in the clinic. I also think having specialists such as Pediatricians involved is key. Primary care used to be a very generalist role in and of itself - we've just hyper-specialized medical care over the years. 

 There are also other outpatient scenarios that aren't primary care where FNP works great - Urgent Care clinics. You need to be able to see all ages, it's not emergency care, but more a mesh of basic acute care visits you'd see in a primary care office and procedures that they used to do in primary care (suturing, I&D, basic fracture stabilization/care) but have gotten away from due to reimbursement issues. Occasionally get the ER patient who needs a quick call to EMS for transport because the community confuses urgent care and ER all the time. 

As for fixing the schooling? For one, while I don't mind online learning, there needs to be actual teaching done. I know no one wants to sit through lectures these days, but there should be an interaction between the students and professors regarding the material being taught and there is much to be gained in hearing the professor's own experiences in practice. There are also a multitude of skills that -need- to be learned before starting practice. This should involve direct interaction between the professors and the students - ensuring that the skills are being performed correctly, and on more than just one occasion throughout the program. Being able to perform procedures shouldn't be overlooked, either, as they're an expected part of advanced practice. We should stop sending NPs out into practice with "just pick it up at a conference" when it comes to suturing, I&Ds, splinting, casting, reading x-rays/ct/other imaging. Time spent with the professional models learning to perform the pelvic exam and testicular and digital rectal exam should be required, not a selling point, for a program. 

 Model the programs after our CRNA counterparts. Stop partnering our programs with the Nurse Administrator programs. They are not our peers. They are not providers. CRNAs and CNMs ARE. I had no problem with going to school year-round for approximately 2.5 years for my program, nor working hard in it. I was lucky to have skills evaluations, testing on model patients (real people, scripted situations, actual performing of HPI/exam/diagnosis), working with professional models, suture class, microscopy training, x-ray training, cadaver time, etc. The University that merged with the one I started at? They were looking at cutting some of these necessary components because of cost. All of my graduating cohort passed our boards on the first attempt. I would also keep in mind they only admitted small cohorts each year. 

[subee, MSN, CRNA]

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. 

A residency should be part of the college's program.  An orientation should be the hosital's responsibility.