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.
As an NP student, I will have completed 1350 clinical hours, including BSN clinicals, by the time I graduate. Classmates who are in the three-year entry-to-practice program will have accumulated the same hours. Although they do not receive the BSN, they must complete the undergraduate program before moving on to the master's portion.
I have no interest in "playing minidoc." I'm a nurse. I'm working on an education that will support my limited scope of practice as an APRN.
As an RN with almost two years experience in the ER, is it okay if I admit that reading the posts from the APRN-C students with no bedside experience and the practicing NPs with no bedside experiences makes me laugh manaically?
Talk about not knowing what you don't know. Counting your student nursing clinicals as clinical experience towards an NP? Seriously? laugh out loud.
I have always planned on advancing my education but I had always hoped and have now had the beginning of an opportunity to learn skills at the bedside...and am grateful for it.
I presume you're referring to my post. As an RN entering my fourth year at the bedside -- including two in the ED -- yes, I do count my BSN education toward my clinical hours. The PA student has not accrued those hours prior to the start of his or her education and, like the non-nurse NP student, acquires them as part of the master's degree.
I don't take issue with differing opinions about what an appropriate education is for an NP; personally, I support the DNP requirement. But I find the resentment toward NPs by some posters -- not, notably, the OP -- to be curious. I wouldn't compare a PA to an MD. Why compare an NP to an RN? The jobs and the skill sets are distinctly different.
Specializes in Managed Care, Onc/Neph, Home Health.
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
@ Living4Peace, I asked that question in pure honesty. I didn't know I NP's that entered programs with no prior clincal got the type of clincal I was making reference to. So apparently not.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i presume you're referring to my post. as an rn entering my fourth year at the bedside -- including two in the ed -- yes, i do count my bsn education toward my clinical hours. the pa student has not accrued those hours prior to the start of his or her education and, like the non-nurse np student, acquires them as part of the master's degree.
i don't take issue with differing opinions about what an appropriate education is for an np; personally, i support the dnp requirement. but i find the resentment toward nps by some posters -- not, notably, the op -- to be curious. i wouldn't compare a pa to an md. why compare an np to an rn? the jobs and the skill sets are distinctly different.
isn't it interesting that so many who run out of arguments call up the same tired old "they're just jealous" chestnut. the op -- that would be me -- does not resent nps, and even enjoys working with many of them. the op does, however, have problems working with nps who had no bedside nursing experience before going on to advanced practice and doesn't know what she or he doesn't know and furthermore is so impressed with the initials after her own name that she or he won't listen to anyone with fewer or less impressive initials.
arrogant folks of any profession who don't know what they don't know and won't listen to someone who tries to help them out with that are an issue, to be sure. i was talking about the newly minted nps, however, who cannot differentiate a paced rhythm from v-tach and won't listen to the experienced icu nurse who is trying to help them with that. or who cannot recognize a fib from a rhythm strip and order a 12 lead which they then have to have interpreted for them by an md. who don't remember the difference between diamox and diuril and bristle when you call their attention to the error rather than say "thanks" and change it. i could go on and on.
those nps have the requisite msn and license to practice, but they lack experience to immediately recognize changes in patient condition the flexibility to change their plans as patient condition changes. bedside experience would help with that. bedside experience will hone those assessment skills beyond the 700 hours of clinical in the np program.
i've heard pas and the extra clinical time they get disparaged because "the np is going into a specialty and the pa gets a bit of everything." that doesn't wash. mds and pas do get a bit of everything, it's true. or did you think that cardiac surgery patients never have mental illness or renal failure? that a dermatology patient can't have an mi? that patients confine their issues to the one specialty they're being seen for today?
I presume you're referring to my post. As an RN entering my fourth year at the bedside -- including two in the ED -- yes, I do count my BSN education toward my clinical hours. The PA student has not accrued those hours prior to the start of his or her education and, like the non-nurse NP student, acquires them as part of the master's degree.
I don't take issue with differing opinions about what an appropriate education is for an NP; personally, I support the DNP requirement. But I find the resentment toward NPs by some posters -- not, notably, the OP -- to be curious. I wouldn't compare a PA to an MD. Why compare an NP to an RN? The jobs and the skill sets are distinctly different.
Do you not see how yours is a completely incongruous argument? First, its your clinical experiences as a student nurse add to your qualifications but then its "the role is completely different."
As for the roles, I disagree with you. The role of the NP is to expand on nursing's holistic approach to well-being and apply to the patients that they see. Part of the failing of NPs is that they are "mini-docs" as you say. They do not provide the patient holistic support and guidance that they need to improve their overall state of health but rather focus on pathophysiology.
As for your experiences in the ED, I am shocked that you think a doctorate is required to suture minor lacerations and I&D butt boils. Its kind of overshooting the mark don't you think? (The more complicated of both boils and lacerations requiring an MD in the emergency rooms I have been in.)
No, I don't see any incongruity. As I've indicated in my posts, I consider my BSN education valuable, but not all of it is relevant to the education I am now pursuing to become an NP. Much of it is; however, I don't believe that an NP needs bedside experience to manage hypertension and diabetes. Working as an NP beyond one's educational preparation is a completely different issue and, as indicated by LACE, won't be permitted for much longer.
I'm not sure on what you base your declaration of "the role of the NP." The NP and PA roles were developed in the 1960s in part to alleviate physician shortages and in part to create jobs for medics and nurses coming back from Vietnam. Yes, NPs and PAs focus on pathophysiology. I hope anyone who prescribes drugs does.
Your post then reduces the work of the ED NP to "sutur(ing) minor lacerations" and draining butt boils. That's a pretty broad brush.
Again, the OP did not take pot shots at NPs. She wrote that she was frustrated by the attitudes and behaviors of some while noting that others are excellent. The thread was then hijacked to NP bashing.
Jan 30 by Isitpossible A member since Feb '08 - from 'Philadelphia'. Posts: 346 Likes: 187
Awards:
RN FL,
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.
Isitpossible, this is not about not welcoming career changers into nursing. This very long and contentious thread is about the arrogance of people who have no foundation in patient care, and have no interest in obtaining one, and how they're being supported by the nursing establishment in becoming ARNP's as fast as those grades can be racked up, as if classroom learning, and even clinicals, were an adequate replacement for experience as a nurse. You are quite welcome into nursing and we are not resentful of your being a career-changer; I was one myself. I don't think anyone here is vilifying "newbies", and if that is how it felt to you, I hope you can allow us to apologize. I don't think that was anyone's intent.
I have had this dicussion many times over many years with many nurses at different educational levels and the general consensus is that it takes roughly 5 years to feel at least 90% clinically compentent with bedside skills ie: starting IV;s, breath sounds etc...It takes approx. 10 years to feel 90% competent with your knowledge base to where you really KNOW you are right and aren't afraid to put your behind on the line for it. And I say 90% because we never stop learning. That is my my problem with anyone making decisions for a critically ill patient with minimal experience.
No, I don't see any incongruity. As I've indicated in my posts, I consider my BSN education valuable, but not all of it is relevant to the education I am now pursuing to become an NP. Much of it is; however, I don't believe that an NP needs bedside experience to manage hypertension and diabetes. Working as an NP beyond one's educational preparation is a completely different issue and, as indicated by LACE, won't be permitted for much longer.
I'm not sure on what you base your declaration of "the role of the NP." The NP and PA roles were developed in the 1960s in part to alleviate physician shortages and in part to create jobs for medics and nurses coming back from Vietnam. Yes, NPs and PAs focus on pathophysiology. I hope anyone who prescribes drugs does.
Your post then reduces the work of the ED NP to "sutur(ing) minor lacerations" and draining butt boils. That's a pretty broad brush.
Again, the OP did not take pot shots at NPs. She wrote that she was frustrated by the attitudes and behaviors of some while noting that others are excellent. The thread was then hijacked to NP bashing.
No one is taking pot shots at NPs. We are discussing which providers we personally think are better prepared to take care of the patients. I am sorry if you think that anyone expressing an opinion that even remotely runs contrary to what you want to hear is "bashing." Its not. Its simply someone else's truth.
Speaking of the truth and since I work in an ER and its not my first ER, the truth is that the role of the NP in the ER is exceptionally limited and generally consists of 85% butt boils and suturing minor lacerations." When the scope of practice is more liberal like at my last job, they may also see funky lady partsl discharge patients and chronic low back and knee pain (but never new onset). From what I have seen discussed on here, this is a fairly sterotypic list for ER NPs.
As for NPs, we disagree. I do not consider the role to be pathophys oriented or about prescribing drugs, especially since in my state, you can even write for vicodin without an MD signing your script.
As for your statements, I have read through the posts here. Most of your posts are contradictory and in my opinion, do not consitute a well formed opinion about the actual practices of an NP but that's likely because you have spent more time in school evaluating the role as an academic and less time at the bedside acquiring skills and working with providers as your primary focus.
Specializes in Anesthesia, Pain, Emergency Medicine.
And yet you give your OPINIONS about NPs when you are not an NP? But since you work the ER, and that ER does not let NPs practice to their full extent. You assume that is the norm?
So it may be YOUR truth, but actually NOT the truth.
I would encourage people reading these posts to remember that all you read on the internet is not necessarily true. Take with a grain of salt what is said about NPs when that person is NOT an NP.
No one is taking pot shots at NPs. We are discussing which providers we personally think are better prepared to take care of the patients. I am sorry if you think that anyone expressing an opinion that even remotely runs contrary to what you want to hear is "bashing." Its not. Its simply someone else's truth.
Speaking of the truth and since I work in an ER and its not my first ER, the truth is that the role of the NP in the ER is exceptionally limited and generally consists of 85% butt boils and suturing minor lacerations." When the scope of practice is more liberal like at my last job, they may also see funky lady partsl discharge patients and chronic low back and knee pain (but never new onset). From what I have seen discussed on here, this is a fairly sterotypic list for ER NPs.
As for NPs, we disagree. I do not consider the role to be pathophys oriented or about prescribing drugs, especially since in my state, you can even write for vicodin without an MD signing your script.
As for your statements, I have read through the posts here. Most of your posts are contradictory and in my opinion, do not consitute a well formed opinion about the actual practices of an NP but that's likely because you have spent more time in school evaluating the role as an academic and less time at the bedside acquiring skills and working with providers as your primary focus.
Freedom42
914 Posts
As an NP student, I will have completed 1350 clinical hours, including BSN clinicals, by the time I graduate. Classmates who are in the three-year entry-to-practice program will have accumulated the same hours. Although they do not receive the BSN, they must complete the undergraduate program before moving on to the master's portion.
I have no interest in "playing minidoc." I'm a nurse. I'm working on an education that will support my limited scope of practice as an APRN.