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 think it's assessment skills that are the issue. The bedside nursing care and the diagnose/treat skills are different. But a few years of assessment skills are invaluable.
Specializes in Oncology; medical specialty website.
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.
Have you seen the thread where someone asks if there's a CRNA program that doesn't require experience?
I don't think you need to be "called" to be a nurse. I don't care if you're in nursing for the money, as long as you do right by your patients and co-workers. But I do care if you are too selfish to put in the experience that's needed in order to function in an advanced practice profession.
Specializes in Oncology; medical specialty website.
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.
The next time you need to fly somewhere, howsabout you get on a plane with a pilot who has no experience flying, but he just really, really wants to be a pilot and has a great GPA?
The next time you need to fly somewhere, howsabout you get on a plane with a pilot who has no experience flying, but he just really, really wants to be a pilot and has a great GPA?
Nice try, but you're not funny nor was your statement analogous. "Howsabout" you bring the condescension to a halt and then we can have an intelligent conversation, or at least to the extent that you can.
...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...
I understand where you are coming from and the point you present, but I think the biggest issue lies in that NP education, in comparison to other clinical masters level or doctorate level degrees (pharmacy, PT/OT, Speech Patho, PA, MD, ect...) is relatively poor and lacks a firm expected knowledge base. For example PA schools may differ in a couple classes, but the core curriculum is the same and it's focused on those things that make mid-level providers. Where as for NP schools (At least in my experience in the Southern US) can be all over the board in terms of course content. I've seen some very good post grad NPs, but I've heard and witnessed a lot of NP students that have vocalized how poor of instruction the received in their curriculum (many here on our own AllNurses forums). That leads me to believe that it is the curriculum that needs work; we don't need more 'therapeutic communication or the 'history of caring' at the NP level in my opinion. That's why I do think bedside care is important even if it means maturing those basic skills and assessments, because as it stands many of these "get your NP degree online" schools are a joke educationally and if anectodes are any indication, a good number of NP grads are not ready to manage patients for the sake of patient outcomes and saftey.
*EDIT: also, consider the mean number of clinical hours most NP students do is around 700hrs as opposed to other PCPs (PA's 1500+ and MD's 10,000+ hrs), in my opinion is a good argument for demanding more bedside experience before NP matriculation, because I doubt that they aren't gonna try and tack on more hrs to their curriculum.
Furthermore, I feel that the sentiment against students that just blow by the RN degree into NP programs are mainly because many feel they are using up valuable RN slots in lieu of taking the easy route and trying to get into NP school to fulfill their dream of playing "minidoc" or PCP, leaving many persons who want to actually be RN's in the dust or they feel insulted as a practicing RN that they are taking advantage of the system to get to the top of the ladder without going through the trials. I can certainly understand the malcontent whether or not it is justified is something else.
People who think they know everything -- or who are not secure enough to admit that they don't -- are a problem in any setting or profession, regardless of the initials they have after their name or how many years of experience they have under their belts. These characteristics are hardly limited to freshly minted NPs.
That said, an NP is not an NP is not an NP. Just like RNs, they have their specialties and education to support them. The problem is, we've got NPs practicing beyond their educational backgrounds. Should an FNP with no experience as a practitioner be able to go to work in an ICU? No. He or she has been educated for primary care, not acute care. Yet we see hospitals across the country putting NPs to work in settings for which they have not been educated.
Nowhere on this thread -- and forgive me if I missed it -- do I see reference to the APRN consensus model for self-regulation or the statement issued in 2010 by LACE. As I understand it, these statements are essentially closing the window on FNPs working in most acute care settings by 2015 unless grandfathered. That will be restricted to NPs specifically educated in acute care. FNPs will still be allowed to work in ED settings when under the direct supervision of an MD. At least, that's how it was explained to me by the head of the NP program in which I am enrolled. (Any clarification or correction is appreciated.) So, as I understand it, part of the problem identified by the OP -- the NP who has neither the education nor the experience to recognize a particular issue, apparently -- is going away.
The other major theme here is how much bedside experience an RN should have before starting the process of becoming an NP. I'm going to risk the same "perfect storm of feces" that Ruby Vee took in her original post and say: none.
I am in my third year as a hospital RN. I completed an Accelerated BSN for second-degree students because, though recruited for a three-year entry-to-practice NP program, I agreed with my adviser, who told me no hospital would hire me as an NP without hospital experience. With two years of hospital experience under my belt, I started going to school part-time for my master's degree. By the time I'm finished, I'll have five years of RN experience.
Will that bedside experience be valuable? Absolutely. Is it, however, essential? I don't think so. Without question, experience helps the practitioner to recognize the varying trajectories of illness. But as an NP student, I see that a significant portion of my BSN education, though valuable in itself, is not relevant to learning to diagnose, recognize differentials, and prescribe drugs (and I don't mean to reduce the role of NP solely to those tasks). The RN and the NP play very important roles. But those roles are very different, and they require very different skill sets, something I didn't fully appreciate until I was well into my NP program.
As for listening and learning from others, I'm all for it, no matter what your job or title.
I just have to say that I laugh every time a NP enters this thread and states that what really sets them apart and makes them unique is that they are able to make a "differential diagnosis". It's become a game now to see if it is mentioned.
Reminds me of a thread a couple weeks ago where the CNA was all puffed up. Instructor had told them that they were specially trained to do EKG's, in fact, the training was so specialized that the RN's were not even allowed to them.
Strong kool-aid being served up all around...........
Specializes in Oncology; medical specialty website.
Nice try, but you're not funny nor was your statement analogous. "Howsabout" you bring the condescension to a halt and then we can have an intelligent conversation, or at least to the extent that you can.
Speaking of condescension. No, I really have no desire to discuss this further with you.
Specializes in Managed Care, Onc/Neph, Home Health.
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.
Do they not do their rotations??? That in tandem with classroom information provides them with a bases to practice. I am tired of hearing how little clinical experience NPs have, especially in comparison to PAs. If one was to think critically they would realize that NPs have a specialty, PAs do not. With that being said NPs spend their clinical time within their chosen practice. PAs only have more contact hours because they see a bit of everything.
I don't know if you asked the question rhetorically or not, and I am not going to come to this thread to debate. I expressed my views, take them or leave them, just give me my due respect.....if not, I'm taking it
I understand where you are coming from and the point you present, but I think the biggest issue lies in that NP education, in comparison to other clinical masters level or doctorate level degrees (pharmacy, PT/OT, Speech Patho, PA, MD, ect...) is relatively poor and lacks a firm expected knowledge base. For example PA schools may differ in a couple classes, but the core curriculum is the same and it's focused on those things that make mid-level providers. Where as for NP schools (At least in my experience in the Southern US) can be all over the board in terms of course content. I've seen some very good post grad NPs, but I've heard and witnessed a lot of NP students that have vocalized how poor of instruction the received in their curriculum (many here on our own AllNurses forums). That leads me to believe that it is the curriculum that needs work; we don't need more 'therapeutic communication or the 'history of caring' at the NP level in my opinion. That's why I do think bedside care is important even if it means maturing those basic skills and assessments, because as it stands many of these "get your NP degree online" schools are a joke educationally and if anectodes are any indication, a good number of NP grads are not ready to manage patients for the sake of patient outcomes and saftey.
*EDIT: also, consider the mean number of clinical hours most NP students do is around 700hrs as opposed to other PCPs (PA's 1500+ and MD's 10,000+ hrs), in my opinion is a good argument for demanding more bedside experience before NP matriculation, because I doubt that they aren't gonna try and tack on more hrs to their curriculum.
Furthermore, I feel that the sentiment against students that just blow by the RN degree into NP programs are mainly because many feel they are using up valuable RN slots in lieu of taking the easy route and trying to get into NP school to fulfill their dream of playing "minidoc" or PCP, leaving many persons who want to actually be RN's in the dust or they feel insulted as a practicing RN that they are taking advantage of the system to get to the top of the ladder without going through the trials. I can certainly understand the malcontent whether or not it is justified is something else.
Just my 2c, lemme know what you think.
Well thought. I do agree with some of your points. I guess I have to agree to disagree with you on some of them but I see where you are coming from. And I even more appreciate it that you wrote to me without an air of condescension.
If you're having trouble with the "condescension" you're imagining in this thread, I foresee some real problems for you when you get out of school and meet the most condescending people in healthcare, the patients.
wooh, BSN, RN
1 Article; 4,383 Posts
I think it's assessment skills that are the issue. The bedside nursing care and the diagnose/treat skills are different. But a few years of assessment skills are invaluable.