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.
I'm envious of the NPs who have time to "sporcle" (whatever that is) and shop on the internet at work, lol. I see patients back to back all day every day. Not to mention faxes, emails, phone calls, lab follow ups, and emergencies both major and minor. I am every bit as busy as I ever was in the units, I just get to sit down more often (at least for paps anyway)!
I love what I do. Though I have physician partners in the practice, I practice independently. It is what is expected of me from my state BON, my colleagues and my patients. It is very important to me that I don't let any of them down, so I take the responsibility seriously. Still, sporcling (?) sounds like fun...
To the OP: assuming a nurse is as good as one can expect as they get more years of experience and have the right mindset for being a NP, how many years of bedside nursing would you like them to have before becoming a NP?
I must have misunderstood Ruby Vee's post - because what I got out of it was not that a certain number of years makes an RN ready for NP school - but that when you're the NP with four years total nursing experience (including your education) standing next to someone who has been doing this for 20 years, and they are trying to explain something to you ... listen.
Ultimately, the NP still makes the call - but usually in a situation like that, the RN is trying to look out for their patient, and there is ALOT that can be picked up on the floor - be it psych (where you see how the drugs interact and a good physician will run you through side effects, toxicity symptoms and risks, and why they choose one med over another) or ICU (where you learn which rhythms usually get which meds first) or med/surg, or mother baby... MDs have residencies, PAs have roughly 10 times the clinical hours that an average NP requires - experience is experience, and experience + education (even when it comes from two different specialists) = gold
...., it begins with claiming ownership by proclaming the staff as 'mine". It's just food for thought..:redpinkhe
I guess I am the opposite - belonging to me I have always thought is a good thing. My staff, my doctor(s), my patient(s) ... I do everything in my power to take care of them, to learn from them, to protect them when appropriate... and I am THEIR nurse - hopefully one day to become their PMHNP.. but they will still be mine, and I theirs. :)
Just a fun story. I recertified my BLS this past Saturday. I am a nursing student. My partner was an ICU Nurse with 25 years of experience. This person did not know the ulnar artery, from the brachial artery. She certainly had NO idea how to do CPR. I could rattle off many more shocking shortcomings if I cared to take the time.....
Isolated case you might say.....well maybe.....but paintinf all the new NP's with the same broad brush is likewise unfair.
Years of experience does not always a good RN make.....
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i must have misunderstood ruby vee's post - because what i got out of it was not that a certain number of years makes an rn ready for np school - but that when you're the np with four years total nursing experience (including your education) standing next to someone who has been doing this for 20 years, and they are trying to explain something to you ... listen.
ultimately, the np still makes the call - but usually in a situation like that, the rn is trying to look out for their patient, and there is alot that can be picked up on the floor - be it psych (where you see how the drugs interact and a good physician will run you through side effects, toxicity symptoms and risks, and why they choose one med over another) or icu (where you learn which rhythms usually get which meds first) or med/surg, or mother baby... mds have residencies, pas have roughly 10 times the clinical hours that an average np requires - experience is experience, and experience + education (even when it comes from two different specialists) = gold
you got it. the rest is just debate. (although i still believe five years is a nice standard for admission into an np program.)
I think a year of med-surg hands-on early in a nursing career is a learning experience almost everyone can benefit from, and that sadly many people consider a "waste of time" as they race up the career ladder. Nothing like it for honing your instincts and humbling you all at once.
I fear the push by AANC for ever higher entry levels into nursing is going to set more new grads with various nursing degrees "loose on the streets", so to speak, with a lot of book learnin' and not enough experience with the actual living breathing messy and complicated humans that we call "patients". It's a short-sighted policy that is actually going to wind up diminishing the esteem our profession is held in.
If an ARNP can graduate being not really capable at the bedside, never having been there, and not as useful as a PA because the PA training is more like the medical model, I don't think that's resolved by upping the book learnin' to the Doctoral degree. It's just further down the same wrong road.
Specializes in Managed Care, Onc/Neph, Home Health.
I may get the "finger" after this comment. I throurly love my profession. It is very well respected. I have been at it for 28 years. I feel career change people are making a complete MOCKERY out of it. By not taking the field seriously. Not putting in the efforts of learning or WANTING to sincerly learn the craft/trade of the field. Not wanting to get with the "down and dirty" of the profession, as evidenced by having a degree in accounting or teaching or anthropology, and changing to nursing, then going straight to an NP program, with out any bedside nursing. (i only used those degrees as an example, please people) I feel you get my point. If my beloved profession is not in your heart....STAY FAR FAR AWAY.... I understand the stress, the long hours, and all that. But many of us love it. Many feel as i see so much on these thousands of blogs, the perfect gpa's and teas test is what makes a good nurse....getting into programs.
I am a career changer at 40, have a prior degree in sociology, and just completed a BSN program. My intent is to be a great competent nurse one day. I have no desire to make a mockery of the nursing profession. I am very interested in learning and growing from novice to competent nurse. Yes, I would like to earn a advance degree, but Im not in a rush to do so. I want the bedside hands-on patient experience. Maybe in a few years I will advance my education, but for now, I have sooo much to learn in simply becoming a competent nurse. Please welcome us newbies to the profession, we need your support and guidance.
I'm a second career nurse with (gasp) a prior degree in business. I have seen just as many nurses who got into the profession directly from high school "make a mockery of the profession" as I have seen career-changers. Just because our path to nursing was not straight and narrow does not make us any worse of a nurse. Your generalization of career-changers nurses is no different than the generalization of older nurses "eating their young"....both are judging an entire group because of the short comings of a few. Tread carefully when making sweeping generalizations.
I am a firm believer in a minimum RN practice hour requirement for entry in to NP education/licensure. I want it to be about 10 years practice, maybe 7.
Those in charge of the rule-making in our game of nursing practice have got to be some of the most spectacularly inept folks around.
This is why everything sucks for nursing in general.
After all, who would guess that such a thing would even be allowed if it were not a safe thing to do? You would believe that some nursing regulatory body would not allow it, that hospitals would not hire these NPs lacking nursing experience????
My point is that, it's not their fault that we have idiots at our helm.
What we have here is a conflict of the new state of nurses versus what nursing was in the past. I will admit, much of what many older nurses hold on to is antiquated. Nursing is moving in another direction and that is not a bad thing. I get that the NP role was designed for "seasoned" nurses to pursue higher education as mid-level providers, but things have changed. We now have new: technology, physiological information, and pharmacological information. Students are entering direct entry MSN programs with no bedside experience but with a solid clinical base to see and treat patients.
Much of the contention in this thread seems to revolve around inexperience and how that makes for an unprepared NP. Well, the role of the bedside nurse and the duty of the NP can't be paralled. Sure, seasoned bedside nurses have seen first-hand maladies and are familiar with how to care for them as a bedside nurse. NPs deal with the maladies and how to diagnose and treat them. Being that the job entails different approaches, I surmise that a nurse that hasn't had years of experience is very well capable of being a competent NP considering they took their education seriously during school and have the mental capacity to make the physiological connections.
BlueDevil,DNP, DNP, RN
1,158 Posts
I'm envious of the NPs who have time to "sporcle" (whatever that is) and shop on the internet at work, lol. I see patients back to back all day every day. Not to mention faxes, emails, phone calls, lab follow ups, and emergencies both major and minor. I am every bit as busy as I ever was in the units, I just get to sit down more often (at least for paps anyway)!
I love what I do. Though I have physician partners in the practice, I practice independently. It is what is expected of me from my state BON, my colleagues and my patients. It is very important to me that I don't let any of them down, so I take the responsibility seriously. Still, sporcling (?) sounds like fun...