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.
Frankly, if anyone/anything is to blame for the influx of NPs with no nursing experience, it is the powers that be that are SHUTTING NEW GRADS out of the profession. I graduated 18 months ago. GPA top of the class, straight As, volunteer experience etc. No job after 6 months of looking. At that point what were my options? Stay home and cry? That was when I decided to apply to grad school, and fortunately I was able to get in to a PNP program that would take me without experience. I would have been HAPPY to work as a bedside nurse, and I will still be happy to work bedside if I can't find a job as an NP after graduation. Hey, maybe with a master's I'll at least be considered for those jobs that are refusing to look at me now.
i'm not angry at nurses who choose to leave the bedside -- i just think that with the education model we have for nurse practitioners, they need to actually be at the bedside for awhile before going through an np program. you cannot leave where you haven't been.
excellent point, what i have seen is cookbook care from some of the new nps.
the race to prescribe because i can. reality is that you need to listen to your patient,
evaluate all of the symptoms and then suggest the best treatment etc.
you learn evaluation and listening skills at the bedside and it is a disservice
not to require a few years of nursing experience before being allowed to continue to np.
I used to think NP's should have more experience on the floor, but most are working full-time and going to school part-time and are still getting experience over the years of their NP program. Now I encourage new RN's to consider NP as bedside nursing is a dangerous trap for many!
I'm not saying clinic work as an NP will be great as that has been reduced to assembly line conditions as well where Dr's and NP's are alloted 7-10 minutes per patient, and you wonder why you feel rushed at the doctors office! Where will it end? I don't know, but at least they won't have to worry about getting injured and ended up in chronic pain or disabled and I've seen too much of that over the years!
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,
A
pharmacies etc.
libbyliberal: NP program is only 30 credits? As a CRNA, I'm disappointed that an "advanced practice" degree is only 30 credits when NP's are increasingly going to be stepping up the plate to do primary care, a specialty that requires a huge body of knowledge. I'd also like to reply to previous poster who was defending on-line courses;
it's just not the same when you don't have an instructor at your side to help you apply what your covering in classroom to current clinical presentation.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
the np students that i work with work night shift so they can get their schoolwork done while they're on the job. the majority of them aren't getting any more experience than they can help . . . spend most of their at-work time avoiding work so they can study or complain about their professors. there are exceptions, of course -- about 40% of them are exceptions. but most of them care neither about their patients or their jobs.
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 practioner 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 amiodorone 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 amiodorone." 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 amiodorone -- 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.
hello ruby,
are you a bedside rn? just curious, it does not make a difference in my reply. i don't think it's the amount of time the np practiced prior to becoming and np, but it sounds like there is a personality issue with some of the nps.
for instance you mentioned the online shopping etc. of course i don't work with you, but work time is for work. we are only human so there will be occasional personal calls or last minute ticket reservations online, but these should be kept to a minimum. it sounds like there is a problem with the work ethic of some of the nps.
i must point out that np training is completely than rn training. for example, rns are not trained in medical assessment, management, diagnosis, treatment and management. nps are. yes, as rns, we should (and i stress should) have excellent assessment skills at baseline, however, going through differential diagnosis, the workup, test interpretation is an extension of the rn practice.
i am a new np who trained in acute care and work in the inpatient setting. i was an rn 1.5 years before i went back to school and only had 4 years of rn experience when i started my first job. i think the difference with me is that i worked at a top 10 hospital were a lot was expected of the rns. we did physical assessments, interpreted labs, participated in rounds, reviewed medications daily in conjunction with lab interpretation, trended results etc. so, the only thing we did not do was the differentials. i believe the nps level of training is the foundation for success - not the amount of time he/she was an rn. its quality, not quantity that is important.
that being said, have you worked with pas? what is your opinion of them as they have no (usually) nursing experience. also, why are you still working as a bedside rn if you have your masters, as well as the nurses you mentioned that have their phd? unless you have a masters as an np (or any of your colleagues), you don't have the training to run through at least 4 top differentials based on history, physical exam, symptoms and presenting complaints. if you do have that training, why are you wasting your time? i'm not saying this to be rude in anyway, but if you have the degree and brains, then why not apply them. a phd has nothing to do with clinical practice. it is a research focused degree on a particular topic that does not prepare you for clinical practice.
Also, I forgot to mention, it is important for the RN who works in the acute care setting as an NP to actually have a degree as an Acute Care NP - NOT FAMILY OR ADULT. I feel very strongly about this. For instance, the NPs I work with (in the inpatient setting) have FNP and Adult NP and I think (and the attending MDs also think) they are terrible. One even worked in the ICU prior to this job. I feel that is because the FNP and Adult NP does not prepare the NP for acute episodic illnesses and critical care (assessment, differentials, diagnosis, treatment and management). Just working in an ICU as an RN is not enough. FNP and Adult train in PRIMARY CARE, which is completely different. There are fewer acute care programs, but it irritates me that a lot of RNs will get a FNP or ANP at a cheaper college because they don't want to pay for the acute care degree at a more expensive school, but then want to slide into an acute care position. So I'm wondering how many of the NPs you work with actually have an acute care degree?
egotism is "characterized by an [color=#0645ad]exaggerated estimate of one's intellect, ability, importance, appearance, wit, or other valued personal characteristics"[color=#0645ad][1] - the drive to maintain and enhance favorable views of oneself.
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 practioner 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 amiodorone 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 amiodorone." 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 amiodorone -- 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.
the nln and the top nursing academics in the us disagree with you ruby. if you have a beef take it up with them.
I agree there should be some bedside experience gained before going to an NP program. (or any advancement, for that matter) How much should be necessary is hard to say. Some nurses and mid-levels who have many years under their belts can be pretty scary, as well as some new nurses and mid-levels can really have it together. I guess a lot of it comes down to what they say about "you get out of your education what you put into it."
In response to WHOO's comment:
"As said above, someone's got to graduate at the bottom of the class, no matter what job they have."
You've heard this joke, I'm sure: Q- What do you call the med student who graduates last in the class?
JeanettePNP, MSN, RN, NP
1 Article; 1,863 Posts
Frankly, if anyone/anything is to blame for the influx of NPs with no nursing experience, it is the powers that be that are SHUTTING NEW GRADS out of the profession. I graduated 18 months ago. GPA top of the class, straight As, volunteer experience etc. No job after 6 months of looking. At that point what were my options? Stay home and cry? That was when I decided to apply to grad school, and fortunately I was able to get in to a PNP program that would take me without experience. I would have been HAPPY to work as a bedside nurse, and I will still be happy to work bedside if I can't find a job as an NP after graduation. Hey, maybe with a master's I'll at least be considered for those jobs that are refusing to look at me now.