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.
Regardless of the level of qualification, there are the good, the bad, and the plain ugly! This problem will escalate as I now meet new nursing grads who would rather work as a tech in the ER, than an RN in a skilled nursing facility. All have plans to go on to be nurse practitioners, nurse anesthetists and so forth. I wonder if some of the blame for this sense of entitlement could be placed with the faculty and tutors in the nursing programs?
This is incredibly true at least for the BSN program I graduated from. No one said they wanted to just be a nurse. Everyone had some further goal in grad school and I was even looked down upon for wanting to stay at the bedside for a while. I even had teachers insisting that we all need to go to grad school.
After the rough time I've had, I can see that maybe they had our best interests at heart when they tried to push us all into grad school right away so at least we wouldn't be at the bedside dealing with combative patients, lack of a lift team, and management not having your back.
But, I'm still here at the bedside because I love it regardless, and because I find it irresponsible (at least for me) to rush off to CRNA school or CNS school with all my theoretical knowledge without the skills and life experience to back it up. That's not everyone though.
I have been asked on more that one occasion about going back to school because I'm so "smart" or if I had any"ambition" to return to school to "further" myself. When I answered that I was happy being a bedside nurse or middle management/supervision, that I was happy right where I was being the best of who I am.....I have on more than one occasion been told in response "You have no desire to better yourself?" or "You have no ambition to better yourself?"
Why can't I be admired and respected for being the best bedside nurse I can be....and be respected because I am an expert at what I do? and being the best bedside nurse I can be is somehow a lack of ambition. Now all I hear about is "how fast can I get away from the bedside to make the good money" and not the best that I can be.......I hear you Ruby...and feel your pain .
Yeah. I hate when people say "Why don't you go back to school? You are so smart."
I always say "If all the smart nurses went to grad school, then there wouldn't be any smart nurses."
As you are only a nursing student wait until you have graduated, passed the boards and put in as much time on the floors/units as the nurses whom have posted, you might very well then reconsider your position. Until you've put in as many hours as they have in their shoes quite frankly you've no idea.
First and foremost the role of a professional nurse is that of patient advocate. Thus if another member of the healthcare team (MD, NA, NP, or whatever) does something or creates the potential for harm to the nurse's patient she or he is duty bound to "clean up the mess" as it were. Depending upon the situation at hand merely correcting an error (or preventing one) isn't the end of things. There can be consequences and repercussions that must be explained either via documentation and or other forms of communication. In short this can leave the nurse with not only failing to see the point of said healthcare worker but dreading his or her visit upon a patient.
For the record nursing is not now nor never has been some sort of bonded sisterhood where everyone got along by virture of belonging to the same profession.
As I've said before, once you graduate and start your nursing career you'll quickly realise it's wanting what is best for the patient that matters above all.
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.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i agree with ruby vee.
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.
even in the icu, i've worked with some great nps. the difference between the great nps and the scarey ones is the time they spent at the bedside as rns before going to graduate school. the more time at the bedside, the better the np. rather than banning nurse practitioners from the acute care setting, i think we should go back to requiring five years of bedside nursing experience (in the area of one's choice of specialty) as a pre-requisite to entering graduate school.
perhaps if one wants to be an np with no bedside experience, they should stay in outpatient settings. but the problem with that is there is so little back-up.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
medicine and nursing are two different disciplines.
i'm not sure where you've come up with the conclusion that "nurses are treated like crap and not respected," but it's not from your clinical experience since you admit that you're a student. in my experience, nurses are respected and are treated as the professional colleagues that we are by most. making an educated assessment about the deficiencies in experience/education of providers is not disrespecting our fellow nurses -- and even if it were, after thirty years at the bedside i have adequate basis with which to make that assessment.
before you make a statement such as "nurses turning their backs on other nurses and saying pa's are better, pitiful," please take the time to gain experience working with nurse practitioners who have had no experience as bedside nurses, nurse practitioners with substantial bedside experience and physician's assistants. after you have done so, you'll be in a position to make an assessment about the adequacy of education/experience for each group. making an educated assessment is neither disrespectful or pitiful. jumping to conclusions is.
i suspect that giving your supervisor a piece of your mind is, however, disrespectful -- especially if you didn't discuss her statement with her to find out exactly what she meant.
I am a newer nurse practitioner and was a RN for 5 years. I have to say that I am torn with some of the posts. I think you can find good and bad in any profession. There are RNs I've worked with that have been nurses for 20+ years and were awful, and many were great. I've met doctors that scare the crap out of me with unethical practices. I was skeptical with NPs with no RN experience and have met a good amount that went on to become wonderful NPs. The problem I think that is happening is that NPs are being pushed more and more to take on more, have a huge patient load, with little time to really look at things. I know that is a problem that I currently am experiencing. I'm double booked and overloaded and don't have the time to do a good job because the doctor I work for is money hungry and just wants to get in as many patients as possible.
That is really sad. I do see your point on the amiodarone. That is pretty bad. Everyone has limits and everyone needs to know what they are. If I don't know something, I sure will ask someone, even if it's a RN/LPN who is experienced.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Right now you can become a NP with a masters' degree. By 2015 (or 2014?) they want to make it mandatory to have a doctorate in order to become a NP. A lot of people are rushing to get it done now so they don't have to deal with the additional time and expense of pursuing a doctorate.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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 think your statement is completely and utterly the truth......!
Ok. I like being part of a solution. I think NP should be required to do residency and fellowships as part of the certification requirement. I think RN and NP roles are very different. However, medical Knowledge is medical knowledge. Medical knowledge can also be obtain through experience via residency and fellowship programs. Being a floor RN is not the only way to gain that knowledge and skillset. I love nursing. I want nursing to go far and to be at it fullest potential. I love the fact that as a nurse we can do so much. I refused to be part of any ideas that will keep us back. A little course on nursing history goes along way..... Learn about how PA field started. [Hint: it has its root in nursing] I also refused to endorse comments like I would go to an MD, PA and never see an APRN. Comments like that keep Nursing from reaching its fullest potential. At every levels, MD, PA, NP there are idiots. malpractice insurance exists for a reason.
Nurses lets not eat our young. Lets find a way to make the nursing field better from the CNA to the PhD level. Once upon a time you were a new grad and inexperience nurse. Remember that. Someone had to take you under his or her wing.
I say residency for every level of nursing. I think that is one way to gain experience and to become an expert at your level. I applaud residency program for new grad RNs. I am hoping this mentality will take place in the NP world as well. A few exist but not enough. That need to be the standard across the board. Heck even pharmacists have residency and fellolwship program. Why not NPs? I think that is what we need.
BTW, you can not become an NP without having x amount of clinical hours. And Nope those hours can not be gained via online courses. You need to physically see patient. Honestly, I dont see a problem with online courses. Taking non-clinical course online or in class, does not add or detract from your inexperience as a new grad. When an NP graduate, he or she will be a new grad and inexperience. Still, you have to pass your board, which is based on national standard. Lets identify the issues and stick to them. The issue is lack of experience. Lets not bring our profession down. Yes, some people with higher degree do think they are God. Isn't that true with every other profession? Not that I agree with that mentality. I think it is dangerous to assume that one knows it all whether it is a new grad or an experience nurse. Patient safety should be first. All that EGO, jealousy and everything else need to be place aside. It has no room in nursing.
A former classmate of mine from NP school just took a new job where she is expected to see 28-30 pts a day in family practice. No appointment, including physical with pap, post hospital discharge f/u or a newborn assessment is to go longer than 15 minutes. Please tell me how anyone, NP, PA or MD could provide comprehensive primary care that way and not miss something or make a mistake? The truth is, with reimbursements the way they are all of primary care is headed to 10-15 minute visits and we will all have to see 4-5 pts an hour just to keep the lights on. It is pretty scary and really is about doing more with less, and not about NP education and background in most instances.
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tokmom, BSN, RN
4,568 Posts
So true! Not everything you learn in nursing is learned from a book.