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've got an awesome NP. And I'm an annoyingly non-compliant patient. She talks me into what she thinks is really important. Let's me be stubborn when it can pass for now. LOVE her.
And an amazing ED NP did some sutures on my little sis's face. You have to know where to look to see the scar. And discovered a fracture that nobody expected was there. (Huge pain tolerance and decreased sensation made for hidden broken bone.)
There's room for everyone. And anyone new to their position should look to the people that have been there a while for guidance, even if their "rank" is "lower."
Give me someone competent. I don't care what the letters after their name happen to be. If you can get me better, that's what I care most about.
I'm lucky to work with some really great mid-levels. PA and NP. They make my job easier. Love them!!
Well said!I can't believe so many program out there for an NP are popping up. It's getting ridiculous. A lot of students that can't get into BSN programs, get a degree in sociology or psych or something then go straight to their little MSN-NP programs. 2 years they are a RN, no experience as an RN but they got their coveted NP. It's just scary! Do these schools not have experience required like the CRNA programs?It really worries me that we will (if not already) have too many NPs and not enough RNs (working as RNs since I know an NP is an RN). What will happen to the nursing profession? If you talk to any pre nursing or nursing students, most want to be an NP. No interest in bedside at all! It's just sad because thats what nursing was built on. Now an RN is just a means to end, that end being their precious NP
***before someone jumps on the "you hate/are jealous of ambitious students or NPs" I am warning you that I am not jealous, or hate NPs/NP students, just saying my opinion like you do yours.
Specializes in Oncology; medical specialty website.
I've got an awesome NP. And I'm an annoyingly non-compliant patient. She talks me into what she thinks is really important. Let's me be stubborn when it can pass for now. LOVE her.
And an amazing ED NP did some sutures on my little sis's face. You have to know where to look to see the scar. And discovered a fracture that nobody expected was there. (Huge pain tolerance and decreased sensation made for hidden broken bone.)
There's room for everyone. And anyone new to their position should look to the people that have been there a while for guidance, even if their "rank" is "lower."
Give me someone competent. I don't care what the letters after their name happen to be. If you can get me better, that's what I care most about.
I'm lucky to work with some really great mid-levels. PA and NP. They make my job easier. Love them!!
Once again, someone who is not even an RN yet much less a NP talking about "how scary" the NPs will be. Are you for real?
You need to really take a chill pill...
I am entitled to my opinion regardless what you think I know and not know. You do not know me, you do not know what I know. So as I said, you need to calm down.
Now, I love how people take things WAY out of context. They take a few words and twist them so nicely because they know their argument is shot to crap. Now I said that the fresh NPs, who didn't have to get any RN experience, come out with their proud initials, and start dictating everything. That is who I was talking about. YOU on the other hand put a few words of mine and twisted them to make everyone, and sadly yourself, think I mean every NP. Um, no, sorry to bust your bubble there. There are a lot of good ones, that know what they are doing and have lots of experience. I dont know if they choose that route or that was the way it was but they are really good NPs. You must be of the "I dont care if my NP has the zero experience" variety to take care of you. Well, that is fine, but dont come crying to us when they screw you up!
So the REAL question is, and most of us can agree here, is
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.
I don't think you need to be an NP to evaluate the issue. In fact, I think its helpful not to be an NP for two reasons: the first is that you can evaluate all of the different types of providers without prejudice and the second is that you can evaluate which one would suit you.
Since I love the ER and would never give it up, the limited scope of practice in the ER (yup, the ER I admit it) is not for me.
HOWEVER, my friend, in my state: an NP can not so much as prescribe a PO narcotic without getting a second signature from an MD. (State law NOT ER policy) Their prescribing rights are exceptionally limited. Their skills are also limited. I would never attend 2 years of grad school so I could go groveling for a signature on a vicodin script that the docs hand out like candy and even a second year resident can sign on his or her own.
An NP in women's health told me she can't perform colposcopies and neither can any of the NPs in her group and none in the state she came from that she knew of had that skill either. (She came from Oregon). Frankly, this made her sound like the only thing she can do is write scripts for birth control pills and do pelvics n paps and I told her so and she readily admitted that the scope was limited. She pointed out there was plenty of work to do on that basic level that no one needed to train her to do one.
Acute care NPs are similarly limited to skills that are essential basics of care. The ones I have spoken to are not permitted to perform initial assessments on admitted patients and can only round and modify orders per protocol (still needing a signature for most Iv meds and all narcotics)
These ARE the facts my friend, not my personal truth. I formed an opinion off of an assessment I made with as much objectivity as any of us can have and its just as valid as yours.
Specializes in Anesthesia, Pain, Emergency Medicine.
NPs are independent in OR and yes NPs do colposcopies in OR. They also have full prescriptive authority. No limitations on scope of practice. Don't you hate it when FACTS are actually supported instead of the "someone told me this so it is a FACT:
Sooo, where does that leave your Oregon FACTS? Many here will read what your wrote and believe it.
So your facts are still not correct.
Lets see, I do central lines, chest tubes, intubate, ventilator management, ER, primary care, chronic pain, admit and care for inpatients and even pre-natal care and basic womens health like IUDs and paps.
Ask some of the ACNP here if they are limited. Ask the FNPs doing solo ER coverage in many rural towns if they are limited.
Those are the facts and until you are a NP and understand practice and credentialing, it is only your OPINION.
Is seems to be common to mistakenly project the practice limitations at your facility to all NPs everywhere.
Looking at viced's location, I will give him this. NPs are incredibly limited in Georgia. If I was going to be an NP, I'd get out of Georgia to do it.
That being said, judging NP scope of practice using the data set of Georgia isn't a fair way to assess it. For the reason that it is incredibly limited compared to pretty much every other state.
Lets see, I do central lines, chest tubes, intubate, ventilator management, ER, primary care, chronic pain, admit and care for inpatients and even pre-natal care and basic womens health like IUDs and paps.
I am a proponent of the role of the nurse practitioner and the unique value they can bring to healthcare.
I get the point you are trying to make by listing all your skills.
I'm not suggesting that this is true in your case, but, it's easy to end up as a jack-of-all, master of none, if you're not careful.
Outcomes are tied to volumes. That's what I look for. Regardless of whether my primary care provider is a NP, MD, or DO, as a rule, there are probably others more qualified to manage my ventilator settings.
That paced rhythm situation was downright scary. Any ICU nurse should know that is a paced rhythm, experienced or inexperienced, and an NP needs to know that for obvious reasons, as well.
I agree that bedside experience is necessary to become a proficient and knowledgeable NP. However, the amount of bedside experience is dependent on the individual. 2 years of experience may be enough for some people, and 2 years of experience may not be for another. Some people are just more capable than others, so what takes one nurse 5 years to get may take another just 1 year.
I am an ICU nurse, as well, and I plan on going back for my NP in the future. If I am competent and ready to go back after 2 years of experience, I will attend. If I am not ready yet, then I will wait. It really is a personal choice that requires reflection on one's abilities/nursing experience. I will most likely wait anyway since I enjoy working the floor, and want to get my CCRN, start a family, all of that jazz.
There are great NP's out there just as there are great MD's and great nurses. There are also not so great NP's out there just as there are not so great nurses and not so great doctors.
wooh, BSN, RN
1 Article; 4,383 Posts
I've got an awesome NP. And I'm an annoyingly non-compliant patient. She talks me into what she thinks is really important. Let's me be stubborn when it can pass for now. LOVE her.
And an amazing ED NP did some sutures on my little sis's face. You have to know where to look to see the scar. And discovered a fracture that nobody expected was there. (Huge pain tolerance and decreased sensation made for hidden broken bone.)
There's room for everyone. And anyone new to their position should look to the people that have been there a while for guidance, even if their "rank" is "lower."
Give me someone competent. I don't care what the letters after their name happen to be. If you can get me better, that's what I care most about.
I'm lucky to work with some really great mid-levels. PA and NP. They make my job easier. Love them!!