I'm sure I'm going to start a perfect storm of feces by saying this on allnurses, but here goes:
Nurse practitioners are getting dumber and dumber. There was a time when I would have used a nurse practitioner as my primary health provider without hesitation; when I would have even preferred an NP over an md. They were more careful, more thorough, and listened better. There was a time when I preferred dealing with nps over residents as providers in the ICU. They were more careful, more thorough and listened better. Those times are past.
I'm not saying I don't work with some good nurse practitioners. I work with twelve of them on a regular basis, and three of them are excellent, one has potential. The rest . . . Not so much.
It's not just that they're young and inexperienced. Youth is fleeting and inexperience can be cured. It's that they're not careful, not thorough and they don't seem to listen. Worse than that, at least six of the eight seem to believe that they're "Better than bedside nurses". Smarter, better educated, more aware of what's going on with the patient (from their vast experience and the copious time they spend with their patients in between shopping and doing crosswords on the internet) and better able to communicate with the attending physician than we are.
I don't deny that a nurse practitioner has a master's degree. But so do I, so does bethany, and so do some of my colleagues. One even has a phd. (OK, so it's in literature, but she has a phd.) yes, nps have more nursing education, but it seems that they have so little bedside experience they don't even know what they don't know.
The most dangerous nurse is one with about two years experience. They've got enough experience to be competent -- barely -- but not enough to know what they don't know, and too many of them think they know everything. Unfortunately, that's about the stage most of our nps were in when they graduated from their MSN programs and became nurse practitioners. So what we have in the ICU is eight nurse practitioners with two years or less of bedside experience, all of whom think they know everything they need to know about being a bedside nurse and most of whom think they know more than the experienced ICU nurse they're working with. But they don't.
Youth is fleeting and inexperience and ignorance are curable, but arrogance is dangerous. An NP who is so impressed with the initials after her name that she won't listen to the RN who has been at the bedside for ten years or more and who has been there, seen that is vastly more dangerous than a bedside RN with two years of experience. Even a two year nurse who is convinced she knows everything. Worse, the brand new nurses will listen to the NP with all of the initials after her name, whether or not she actually knows what's going on, before they'll listen to the experienced bedside nurse responsible for their orientation.
What brings on this rant, you ask? The NP who ordered amiodarone for the patient with the paced rhythm because she was so sure it was ventricular tachycardia. "We don't need to defibrillate him because he has a good blood pressure," she said self-importantly. "But let's load him with amiodarone." she wouldn't believe it was a paced rhythm when I showed her the rhythm strip with all those cute little pacer spikes. She wouldn't believe it was a paced rhythm when I showed her the 12 lead. Unfortunately, this is just one in a series of similar incidents.
About the amiodarone -- she did believe it was a paced rhythm when I showed her what happened when I turned off the pacer. (lots and lots of cute little pacer spikes and none of those wide qrs complexes she was so sure were v tach.)
They want to be nurse practitioners -- OK. That's great. But please listen to the experienced RN at the bedside. She just might teach you something.
Last thing I want to do is live a perpetual residency where I attend 3 years of grad school instead of 4 so I can end up deferring to someone half my age with a fraction of my patient care experience because I went to NP/PA school.
This is especially true in the ER. I love the ER. I never want to leave it and the scope of practice for an ER NP? It sucks and is super super limited. I don't want to suture lacerations or bust abscesses or perform what amounts to chart audits on trauma patients (adding whatever orders the docs forgot) as my main roles in the ER.
Sorry but that's not for me.
Being a PA sounds better than being an NP, at the ER I work at. Some of the doctors let the PAs put in chest tubes, intubate, perform lumbar punctures, and do other advanced skills only the territory of the doctor. I suppose with both the midlevel providers, it's really up to the doctors in the practice group. The other hospital system in my city employs both PAs and NPs, and there doesn't seem to be a difference in skills.
Still, why be controlled in your practice and just sacrifice blood, sweat and tears so that in the end, you are beholden to no one.
And remember, a lot of people decide to go to grad school and be NP's, because they can't seem to get any traction as a nurse ...nurses are far too busy undermining each other, writing each other up, and all that ridiculous CRAP. For me, I know it would take me YEARS to get ahead due to all of the politics, all of the favoritism ... and I don't have "years" as i am getting older. If anything, that is what I hope to get away from ...not necessarily patient care. Oh, and 12 hour shifts. . . maybe. Hopefully.
Agree. I'm not getting any younger either !
It will take me years to progress to management and it will be at the same rate as those grandfathered in with older nurse training here in Australia.
Retrospectively it has been a waste of time getting a bachelors and graduate degree when there are lots of competitors for management jobs who possess a hospital certificate, a piddly post-grad certificate and 10-20 years experience in the same speciality.
Going to NP after a couple of years experience makes more sense and I can understand why the newbies do it
Well, I have to say, whatever "isn't for you" in any sort of practice, then don't do it -- and also, DON'T KNOCK IT, because it might just be exactly what another person enjoys doing, or is seeking.
Just get so tired of nurses hacking, hacking on another.
Had a colleague tell me she wouldn't be an NP, "because she didn't want to be the 'patsy" for the doctor."
Well, some of us might be OK with that! Not that NP's are patsies for the doc, but many of us are ok in that secondary role, making less money, and having less responsibility as well. I'm ok with it ... so who cares?
Well, I have to say, whatever "isn't for you" in any sort of practice, then don't do it -- and also, DON'T KNOCK IT, because it might just be exactly what another person enjoys doing, or is seeking.
Just get so tired of nurses hacking, hacking on another.
Had a colleague tell me she wouldn't be an NP, "because she didn't want to be the 'patsy" for the doctor."
Well, some of us might be OK with that! Not that NP's are patsies for the doc, but many of us are ok in that secondary role, making less money, and having less responsibility as well. I'm ok with it ... so who cares?
I think maybe if the situation you described happened the way you described it, you might have been just a little sensitive. It sounds like she offered her opinion on the matter and you disagree. You certainly don't have to listen or even agree for that matter with her opinion.
Personally, I don't care what role you choose. I do hope you are happy in the role you pick because I personally don't enjoy watching people be unhappy. On the other hand, you probably should care less what others think of what you pick, too because its what makes you happy.
just sayin' :redbeathe
PS: Feel free to tell people that too! I would just say hey this is what I choose and I am happy when they start to talk negatively about it.
Being a PA sounds better than being an NP, at the ER I work at. Some of the doctors let the PAs put in chest tubes, intubate, perform lumbar punctures, and do other advanced skills only the territory of the doctor. I suppose with both the midlevel providers, it's really up to the doctors in the practice group. The other hospital system in my city employs both PAs and NPs, and there doesn't seem to be a difference in skills.
Still, why be controlled in your practice and just sacrifice blood, sweat and tears so that in the end, you are beholden to no one.
Agree with an earlier poster that PAs are generally better trained than NPs in this neck of the woods and in the ERs I have been in. My first job let PAs do a lot of skills until they started adding another provider to the schedule due to increased patient census and a desire to decrease wait times.
Of course, it was easiest to move the PA to Urgent Care and add an MD to the schedule which gave us two PAs in Urgent Care and two MDs in the ER. (The old schedule was one PA in Urgent Care, one PA floating between ER and Urgent Care and one MD.) Needless to say, the PAs who were used to working in the ER were not so happy that they were now in Urgent Care.
My thing is this: I am realistic and I see why adding an MD was the easiest thing to do. An MD is a more flexible role and can decompress Urgent Care and main ER. I can also see that if I were the PA, I would be upset but really can't complain because frankly? I knew that was part of the role! I just wouldn't want to wear those shoes after graduate school. I just wouldn't.
My original post was supposed to be positive but I see I am catching a lot of heat on here, so I do apologize for initiating "ownership" by stating I would not look down on "my nursing staff" due to having a higher degree. It was taken out of context. Had we been in a room/office setting having this discussion you would have seen my intentions were not to indicate ownership. So again for those of you who got upset, I do see your side of things and again no harm intended.
I have never worked with any good NPs in the hospital setting. I know that's harsh and I'm sure that they are out there, somewhere, I just haven't met any. It's not a good idea for them to learn on the job with no supervision.
I have had to take care of the quite a few catastrophes were missed by the NP. Maybe it's because I'm in ICU and that's all we get.
The idea of a newbie NP, with minimal experience in acute care, practicing in a hospital makes me uncomfortable. The ones that we have could not handle acute care and did the 30 NP credits to get away from hospital nursing. I guess the programs in my area aren't very good. And I agree that a doctorate should be required to call one's self an advanced practice nurse.
I think they should stay in the outpatient settings, wound care and doctors offices, pharmacies etc.
Eh, I don't think that APNs only belong in outpatient settings; the neonatal NPs I work with are excellent and they are a great resource for doctors to expand their reach. Then again, you are required to have two years of level 3 NICU RN experience to become board certified, so perhaps that has something to do with it...
To be honest, I find the nursing education in the US a little odd. There seems to be way too many schools, online programs, etc offered throughout the US, causing a HUGE saturation of nurses, and few jobs.
I'm a Canadian educated nurse, where the BSN is now mandatory. We only have a select number of schools to choose from which offer nursing, and there are no online BSN options. You go to class. If you want to be an NP, it is mandatory to work first.
Now, before I get flamed, I'm not saying the education is better per se. Just different. But....the nursing job shortage isn't nearly as bad, because there aren't as many avenues that people can choose to become a nurse, so that's a positive.
I am also Canadian born and educated, been in the US for 3 years working. I completely agree with your point on education. I think the nursing education is more standardized in Canada because there arent a million different pop up schools. I think thats a good thing.
Wow, I mean just WOW. I am a nursing student but when I read many of the posts on allnurses I am ashamed of the career I choose. I love medicine and have always held nursing in an esteem that I thought was well deserved until I actually had to be around nurses as a nursing student. Nurses are so absolutely desperate to be validated that they will do whatever they can to demean the nurse next to them in order to feel better about themselves. No wonder nurses are treated like crap and nurses are not respected, because you CANT RESPECT EACH OTHER. Nurses turning their backs on other nurses and saying PA's are better, pitiful. No wonder no one respects nurses, whether LPN, RN, BSN, NP whatever. Remember, everytime you undermine another nurse, you are undermining yourself. I remember once when I was practicing as a Vet Tech, our clinic received a flyer for a Vet Tech offering a continueing education course and my supervisor, who was also a Vet tech, said "why would I go to that, if I wanted to really learn something I would go to a class taught by a Vet". I was speechless and when I caught my breath I gave her a run down of exactly what I thought about her comment. Ridiculous people, really ridiculous.
whichone'spink, BSN, RN
1,473 Posts
Being a PA sounds better than being an NP, at the ER I work at. Some of the doctors let the PAs put in chest tubes, intubate, perform lumbar punctures, and do other advanced skills only the territory of the doctor. I suppose with both the midlevel providers, it's really up to the doctors in the practice group. The other hospital system in my city employs both PAs and NPs, and there doesn't seem to be a difference in skills.
Still, why be controlled in your practice and just sacrifice blood, sweat and tears so that in the end, you are beholden to no one.