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 hope that this "marginal psych nurse" is good at diagnosis and aware of drug interactions, which, to be frank, are not taught to RNs. Hope they check to see you don't have any liver, kidney, cardiac issues or seizure history and are aware of medical differentials that you could have that can masquerade as psychiatric conditions. Because that is a subject that is comprehensively taught in RN school. Right?
.
I think the point is not what you learned in nursing school - nurses learn more OTJ than they could even have conceived of in school. Your posts are coming across as very disdainful of nurses in general - not just this one, but earlier you made several references to how you "saved" many patients from "experienced" nurses. Saying things like this just makes the OP's point.
I think the point is not what you learned in nursing school - nurses learn more OTJ than they could even have conceived of in school. Your posts are coming across as very disdainful of nurses in general - not just this one, but earlier you made several references to how you "saved" many patients from "experienced" nurses. Saying things like this just makes the OP's point.
I am responding to the negative attitude I perceived in the original post, which I find pretty disrespectful in its own right.
My attitude certainly does not prove the OP's point. The OP's point was that newer nurses are inappropriate candidates as NPs. This is simply not true and should be determined on a case-by-case basis. Nurses are most dangerous at two years? Ludicrous, where's the evidence for that.
Not only are there newer nurses who have succeeded as NPs, but there are a host of "experienced" RNs who would utterly fail as NPs as they can't even perform the duties of an RN correctly. You want to point the finger at nurses with two years of experience? Go ahead-- that finger can be pointed right back.
You are NOT taught enough on the job as an RN to perform as an NP. Particularly not in my specialty.
Regardless of the level of qualification, there are the good, the bad, and the plain ugly! This problem will escalate as I now meet new nursing grads who would rather work as a tech in the ER, than an RN in a skilled nursing facility. All have plans to go on to be nurse practitioners, nurse anesthetists and so forth. I wonder if some of the blame for this sense of entitlement could be placed with the faculty and tutors in the nursing programs? Many of those who graduate with a BSN cannot even do the simplest of procedures such as IV's and catheter placement without obvious displays of anxiety. Like it or not, dexterity and observational skills are what makes a good nurse, be it an advanced practitioner or otherwise.
It would be nice if the nurse practitioners responding here were a little more polite and respectful whatever their opinions of 'nurses'. Ask any doctor, it doesn't pay to **** off the nurses, especially when you are covering the night shift!
Also, the sword cuts both ways. There are a couple of "experienced" nurses (decades of direct patient experience) and they are on the whole TERRIBLE at learning to be providers and not bedside nurses.
RN experience is nice, but working as an NP is a very different role and involves a very different skill set and approach to the patient. I'd be damned if I let these nurses manage someone close to me's medications compared to the psych NP students who get it, even though some of them have even less experience than I do.
I'm just a student, but I find this highly arrogant, rude and a little scary. I think it proves the OP's point.
I don't think anyone is denying that there are good and bad nurses, but not recognizing that a new NP, (whether he/she has tons of floor experience or not) doesn't know much is dangerous.
I am responding to the negative attitude I perceived in the original post, which I find pretty disrespectful in its own right.
My attitude certainly does not prove the OP's point. The OP's point was that newer nurses are inappropriate candidates as NPs. This is simply not true and should be determined on a case-by-case basis. Nurses are most dangerous at two years? Ludicrous, where's the evidence for that.
Not only are there newer nurses who have succeeded as NPs, but there are a host of "experienced" RNs who would utterly fail as NPs as they can't even perform the duties of an RN correctly. You want to point the finger at nurses with two years of experience? Go ahead-- that finger can be pointed right back.
You are NOT taught enough on the job as an RN to perform as an NP. Particularly not in my specialty.
The OP didn't say "all". She clearly stated "some".
I get it. I mean really, if you think about it, MD's have to do their share of bedside procedures and assessments before they're let loose.
Why shouldn't NP's?
It's frightening, to me, that people can come from nowhere with a degree in anthropology, or, oh, I don't know, say The Art of Rhetoric, and suddenly show up in my clinic to treat me, or my hospital to make decisions about the treatment for patients I am responsible for, and be so utterly disdainful of the experience and expertise surrounding them.
Not saying that's you, because I don't know you. But, the OP here clearly qualified her comments, yet you still took umbrage to them.
Why? Do you feel all of your NP peers are on the same level as you see yourself? I certainly don't think all of my "RN" peers are at my skill level.
There are a lot of nurses (and others) who are morons with alphabets after their names because they were morons when they went to school....now they're just expensive morons.
I've seen LVNs who are miles above some of the BSNs/MSNs, and RNs (of all sorts) that bite rocks BAD. The only PhD level nurses I've seen have elevated themselves so far above the real world that I don't count them in the mix- it wasn't some overwhelming respect of others that kept them "lofty". Some were great instructors, but weren't approachable (therefore not much use to work with). Yeah, there are good ones- but those went through working as nurses in the real world before perching themselves too far above the rest of us to even be noticed.
But that goes for any job, any profession. Some are just better than others, and someone has to graduate bottom of the class in all levels of all job categories. :) JMO
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?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i think experience should be a requirement to enter a np program just as it is a requirment icu nursing to be accepted to crna. which is usually at the very least one year critical care experience before you are considered for a admittance......and they are not on line.
there are over 100 accredited crna programs in the us, have not yet found one that is fully online. by comparison, there are over 850 accredited nurse practitioner programs, and over 60 of them are offered online.
for clarity: many of the crna programs do offer certain courses online. you will not necessarily be required to go to the campus (or the clinical sites) every day. there may be permitted clinical sites several hours away from the campus, which makes the program more accessible to people who don’t live next door to the school, but the crna specialty just does not seem to easily lend itself to the full distance learning model. imho neither should nursing or nurse practioner be pffered on line.
how does one learn how to be a nurse or advanced practice nurse, take care of patients and know what to do....when you spent your time on the computer instead of the bedside.....just saying .
.
Sanuk
191 Posts
I think the point is not what you learned in nursing school - nurses learn more OTJ than they could even have conceived of in school. Your posts are coming across as very disdainful of nurses in general - not just this one, but earlier you made several references to how you "saved" many patients from "experienced" nurses. Saying things like this just makes the OP's point.