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.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
you will have to forgive me for the spelling, grammar mistakes....i wrote this quickly and hit post!
thanks again!
wow -- three posts and you've posted them all in my thread!
i've been working with nps and pas for at least 27 years. in the past, rns had to have five or more years of clinical experience to go on to advanced practice. the nps i knew in those days were great . . . the np education model was designed with the idea that the nurse practitioner already had some bedside experience. now those requirements have become a lot more flexible, and we seem to have a rash of nps entering the workforce with little to no bedside experience before going on to their np programs. it shows.
i work with some terrific nps (strangely, those are the nps who have more than five years of bedside experience as nurses before going on to school) and some out and out scary nps. (and those are the ones who went straight from bsn to msn with little or no pause in between). i work with one np of the latter education model who might actually turn out to be terrific -- the big difference between her and the nps who are scary is that she actually pays attention -- to the patient, to the nurse, to the resident -- to anyone who might teach her something. many of the others are so impressed with the letters after their names they don't listen.
the education model for pas is different . . . they get a lot of clinical in school and most of the ones i work with aren't as impressed with themselves and the letters after their names. they also pay attention and learn. i enjoy working with them.
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.
i'm not sure what that meant . . . "np training is completely than rn training." spelling and grammar may have made that phrase more comprehensible.
yes, i'm still working at the bedside. my masters is not in nursing. and if you'll re-read my original post, you'll see that some of my more educated colleagues have advanced degrees in studies other than nursing. russian literature, for example. while i admit that experience plus an advanced degree in russian literature would make a better np than some of the nurse practitioners i work with, that's not the current educational standard.
i'm happy for you that you were able to get the degree of your dreams and hope that you've landed the job of your dreams. i hope that you listen well to the experienced bedside nurses in your specialty and don't disregard what they say and what they try to teach you because you're so impressed with all of the initials after your name.
You know if you all just read what Ruby says for what it is... the truth.
I know no NPs with under 10 years experience as RNs, and most of them have specialized for at least half of those years.
You just don't know what an NP is supposed to be if you haven't been around one of these. The knowing just flows from them no matter the situation. They don't need to hesitate in their actions, they command. Docs defer to them.
One of my classmates sister graduated from a BSN program last year and has had difficulty finding a job...guess what she's doing now...yep you guessed it...she is in a NP program:eek:
It doesn't matter how motivated, intelligent, or book smart a person is. You cannot be experienced as a practitioner of any kind without bedside knowledge. Experience develops over time, through trial and error, and learning through various sources. Without having at least three years before becoming a practitioner, well....that's less than ideal. And just because some programs accept brand new grads, it doesn't mean they should.
It doesn't matter how motivated, intelligent, or book smart a person is. You cannot be experienced as a practitioner of any kind without bedside knowledge. Experience develops over time, through trial and error, and learning through various sources. Without having at least three years before becoming a practitioner, well....that's less than ideal. And just because some programs accept brand new grads, it doesn't mean they should.
The bolding is mine. Joanna73's point cannot be stressed enough.
Medicine gets this. How many patient presentations does a resident physician see in 80+ hour work weeks over 3-6 years? Thousands. Then, and only then, does the physician practice independently. And s/he will still struggle with the stigma of lack of experience for another several years.
I've asked this question on this board before: do you really not think that a clinician's judgement at 5 years will be superior to the clinical judgement s/he possesses with only 1-2 years experience?
If I had to spend 10 years as a bedside RN then to go to NP school, I would not have done it. It would have made more sense to spend those 10 years pursuing a medical degree in order to work using my medical knowledge (which is the point of NP program). Heck, I would have gone to PA schools. However, what makes sense to me is getting an NP degree, followed by residency, followed by fellowship to gain "experience."
The NP's that I know, take care of routine problems using evidenced based guidelines. However, complicated cases or unexpected results are discussed with the Attending. Are you bedsides nurses assuming that NPs are making all the decisions? Are you aware of what goes on in the backgound between the MD and the NPs at your local hospital? Before becoming involved in the NP role, I used to think NPs were practiting independently. I am just curious if you are going based on assumption or is it based on a little digging around to see who is truly calling the shot in the backgound.
I remember someone said to me, " the NP on my floor is lazy, all she does is sit at her computer." I laughed, because it was pure ignorance and an assumption. The NP hospitalist that she spoke off was busy analyzing data, communicating with patient's family, following up with consultation from the different teams, keeping the Attending updated on the patients' condition, writting orders per attending request, writting discharged notes, progress notes.... Following up with the pharmacists, religious ministry, social worker etc....
Ignorance is bliss. After that same person spent a day as a student NP in the shoe of that hospitalist... She said "I dont like the work of a hospitalist, it is too much work"
Like someone I know put it, being an NP is like being a permanent upper resident or fellow MD. Unless you are in one of those few states where NPs practice independently of an MD.
I guess I am one of those person that will never be pursuaded that being a bedside RN is key to being a successful NP. I would much rather see NP's rotate in the different branches of medicine just like the MDs. Learning as much as possible and seeing as many patients as possible just like the MD. I would rather see NPs do what has been shown to work for years in order to take care of patients safely and independently, which is what the MDs and the DOs have beig doing for years. As some of you stated, there are RNs who have spent 20 years at the bedside and are terrible NPs.
Why is that? Could it be because as an NP we have to learn how to make Medical differential diagnoses. We have to learn about Medical diagnoses and not nursing diagnoses or nursing interventions. As NP, yes nursing interventions are also employed but we go beyond that. We have to learn about treatment, diagnotics tools etc.... We have to learn how to make certain medical decision and how to use evidence based practice. That is the whole of point of residency and fellowship programs.
As a resident and as a fellow, NP will work directly with an attending and or an experience NP that will help guide them in those areas. Come on give me a break. No one can tell me that being a bedside RN will do those tricks. Really?? If so, you are lying to yourself.
Working with someone who call the shot and learning and practicing to be that person who make the tough decision, is not the samething. I think it is better to learn to be excellent at what you do directly, rather than work at similar but different job in order to be great at your goal job or role.
a little sacatics. Here it is.--->So to my CNA friends go head spend 5 to 10 years as a CNA in order to have bedside experience so you can become an RN. As a matter of fact spend 5 to 10 years volunteering at the bedside in order to become a CNA.
It take a special person to be a CNA, a RN, an MD, an NP etc..... I know many NPs, who said they cannot do the job of an RN. Not because they think they are better than an RN but because it has its unique challenges just like every other field. I applaude individuals who knows their limit. I also know many RNs who dont want to do the job of a CNA for the same reason.
So why spend years learning the skills for a job that you know is not for you, when you can use that time to learn the skills necessary for what you truly want to become.
So go ahead. Shredd me into pieces. I dont care. Make fun of my grammar. Make fun of my ideas. That is why this is America. A country where an artist, a lawyer, a pharmacist, a comedian, a reseach scientist etc... can wake up one day and decide I want to pursue nursing as a degree because I can. No one is born with a sign on their forhead that states you are destined to be this or that.
So to my new grads, dont get discourage. Keep doing your thing. Learn to be the best at what you do. Set goals for yourself. There is so much that you can do with nursing. Learn what you need to do in order to get there. Stay positive. It is a tough market but remember everyone had to start somewhere.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
the np's that i know, take care of routine problems using evidenced based guidelines. however, complicated cases or unexpected results are discussed with the attending. are you bedsides nurses assuming that nps are making all the decisions? are you aware of what goes on in the backgound between the md and the nps at your local hospital? before becoming involved in the np role, i used to think nps were practiting independently. i am just curious if you are going based on assumption or is it based on a little digging around to see who is truly calling the shot in the backgound.
i remember someone said to me, " the np on my floor is lazy, all she does is sit at her computer." i laughed, because it was pure ignorance and an assumption. the np hospitalist that she spoke off was busy analyzing data, communicating with patient's family, following up with consultation from the different teams, keeping the attending updated on the patients' condition, writting orders per attending request, writting discharged notes, progress notes.... following up with the pharmacists, religious ministry, social worker etc....
believe me, i am aware of who calls which shots. in the background and the foreground.
and i am aware of what the nps are doing on their computers all day. can you day "sporcle?"
Ok then. Since you are aware of the collaborative/supervisory relationship between NP/PA and the attending, with the exception of the few states that allow NP to work independently of an MD. Now you can see why like another post stated that the BON, MB and the states clearly disagrees with you.
Hopefully, fundings will go into supporting nursing education so we can have more preceptorship opportunities via residency/fellowship in order to gain more training at every level of nursing (CNA, LPN, RN, NP, DNP etc...).
Ruby Vee, BSN
17 Articles; 14,051 Posts
wow -- three posts and you've posted them all in my thread!
i've been working with nps and pas for at least 27 years. in the past, rns had to have five or more years of clinical experience to go on to advanced practice. the nps i knew in those days were great . . . the np education model was designed with the idea that the nurse practitioner already had some bedside experience. now those requirements have become a lot more flexible, and we seem to have a rash of nps entering the workforce with little to no bedside experience before going on to their np programs. it shows.
i work with some terrific nps (strangely, those are the nps who have more than five years of bedside experience as nurses before going on to school) and some out and out scary nps. (and those are the ones who went straight from bsn to msn with little or no pause in between). i work with one np of the latter education model who might actually turn out to be terrific -- the big difference between her and the nps who are scary is that she actually pays attention -- to the patient, to the nurse, to the resident -- to anyone who might teach her something. many of the others are so impressed with the letters after their names they don't listen.
the education model for pas is different . . . they get a lot of clinical in school and most of the ones i work with aren't as impressed with themselves and the letters after their names. they also pay attention and learn. i enjoy working with them.
i'm not sure what that meant . . . "np training is completely than rn training." spelling and grammar may have made that phrase more comprehensible.
yes, i'm still working at the bedside. my masters is not in nursing. and if you'll re-read my original post, you'll see that some of my more educated colleagues have advanced degrees in studies other than nursing. russian literature, for example. while i admit that experience plus an advanced degree in russian literature would make a better np than some of the nurse practitioners i work with, that's not the current educational standard.
i'm happy for you that you were able to get the degree of your dreams and hope that you've landed the job of your dreams. i hope that you listen well to the experienced bedside nurses in your specialty and don't disregard what they say and what they try to teach you because you're so impressed with all of the initials after your name.