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 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.
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 .
kind of like claiming to be a pediatrician with nothing but an md, and 3 kids. (no residency in pediatrics). "book learning" is all well and good- but if someone can't apply it on a real person, it's useless, imho. i haven't had a np for a while, and back then, the online programs weren't an option. but, if i get an np now (which is fine- i have had very good nps as a personal healthcare contact; i have a cousin who is an np- and went to in-person classes), i'll ask how much bedside experience they have. i've found most nps (from a while back- maybe still the same?) are more likely to listen, and also consider that i've got some awareness of what's going on. but i don't want a "drive-by education" in someone who is dealing with my health. jmo. :)
I'm in a weird position of being the only RN in my circle of middle aged friends. Now that all of their kids are looking for a gold clad profession here is what I hear about 6-7 times a year:
"my kid needs a career that will be solid. They don't have what it takes to do all that disgusting stuff (bedside care) but they say they'd like seeing patients in an office and prescribing medications. Do you think NP is for them?".
My point: I see people interested in a respectable career in health care but wanting to skip bedside nursing. I personally and professionally do not think you should be able to have the title APNP without at least 2 years of RN experience in direct care. NPs are still nurses and should have skills at the fundamentals. I see many who do not.
I have an NP that's awesome. Love her. Think it's funny when I call to make an appointment and they say, "I can't get you in to see the doctor until next week, do you mind seeing the nurse practitioner?" Because I haven't EVER seen that MD. I'd not like it if I had to see the MD.
Work with some really great PAs and NPs. They're so great at running interference for us. :)
Have also met some mid-levels that were dumb as a box of rocks. (My fave being the PA that thought that a teenager's blood alcohol level was ok because it was "low.") As said above, someone's got to graduate at the bottom of the class, no matter what job they have.
Shame on us for lowering standards. Average CRNA has 8 years edperience before school. Thats a standsrf worth emulating. Get rid of online programs. We need more credibility and less people with mediocre skills.
Specializes in Critical Care; Cardiac; Professional Development.
I am an older student about to graduate in December with every intention of going on to APN. I guess I just don't hear Ruby Vee as being derisive. Is she blunt? Yep. But I appreciate that. She makes good points. I am no spring chicken, so on one hand I feel a clock-ticking desperation to get my education out of the way and get to my goals as soon as possible. On the other hand, I am now in transition from student to actual nursing practice and filled with the terror I had only read about until now. My desire to be a GOOD practitioner, whatever my credentials, is strong. I hope that never dies. And to date, I am breathlessly appreciative of experienced nurses who are willing to guide me.
I agree that discounting what an experienced floor nurse has to say and what she knows is just silly and dangerous for a new NP, frankly no matter how many years she has of experience. The truth is, the more expertise that goes into caring for a patient, the better the outcome most of the time. That's one of the many benefits of team care. It doesn't matter if the level of practice is different if one is not seeing the basic level accurately and thoroughly.
I don't have a lot of time left in my life to practice nursing. 20 years if I am lucky enough to stay physically fit and mentally healthy. Bluntness is going to serve me much better than politically correct coddling. The NP role is different, yes. But it is supposed to incorporate the baseline level of nursing assessment. It is not different to the level of no longer being nursing. Therefore to say that the level of practice an NP puts into place is so far beyond or different from the floor nurse (and therefore the floor nurse must not have anything valuable to contribute) is frighteningly incorrect. If the baseline isn't there, the "advanced practice" is going to be swiss cheese - full of holes. You can't see what you don't even know to look for.
Specializes in Oncology; medical specialty website.
I understand your frustration Ruby and as always you have put it eloquently.
However...
there is a reason NP's do not have much bedside experience anymore and it is because we are burning them straight out of nursing. Increased patient loads, dramatically skyrocketing acuities, steadily decreasing resources, complete lack of mental health benefits, increased legality, and lateral violence are chasing new nurses out as fast as they can fill out the application to go back to school.
There are many facets behind the green NP other than just their lack of experience. Go back a few decades and nursing was a solid profession that you got into and stuck with (tell me you don't feel that vibe from nurses who have been in the profession for longer than say fifteen years). Today, to be honest, if you spend too much time at the bedside you risk depression, OCD, anxiety disorders, and all the health complications that come with it.
Now, of course, there are soon to be NP's like my good friend who simply are using nursing as a stepping stone to get where they want to be. That is a goal, and sometimes the quickest route isn't the best, but it gets you there. Hopefully there will be a strong nurse who will gently grab these new NP's by the chin and help guide them along their path. Because you can't change the trajectory, only try to help them navigate the obstacles.
You know, it really shouldn't be our job to educate these inexperienced NPs. They should already have "the right stuff" to be an NP. Good grief, we're responsible for educating new nursing grads, keeping our eye on the new interns/residents, nurses who have transferred into the dept. who don't have experience with that particular specialty...when do you have time to actually do patient care?
If a nurse wants an advanced practice role, she/he should already have the foundation to practice at a higher level. These nurses shouldn't need to be led by the hand by staff.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
I have participated in this topic numerous times over on the NP side of this site and have seen the argument from both sides, so I will just post what my experience has been. I have been an RN for 14 years and have been an NP for 2 of those years. For those NP students or those brand new NP's who claim that you don't need any bedside RN experience to be successful as an NP - I wholeheartedly disagree with you. NP programs were initially developed to build off of the "nursing" foundation that you are "supposed" to have prior to entering the program. In the not too distant past, NP programs would not accept new RN's with less than 1-2 years' nursing experience; hence the term "Advanced Practice Nurse." There have been numerous times where my years of nursing experience have helped me to not miss critical diagnoses that could have been easily missed. Yes, NP school will teach you the "common" and "typical" signs/symptoms/presentations of various different conditions, but what it won't teach you are those atypical, subtle presentations that only someone who has seen them before will likely pick up. Textbooks are great, but they can't teach you everything. This is where bedside nursing experience comes in to play; also being humble enough to admit when you don't know something, but being knowledgeable enough to refer to the appropriate specialist.
Yes, being an NP is entirely different than being an RN - but (contrary to what some will lead you to believe) having bedside RN experience will only HELP you to be a much better provider, especially in the very beginning of your NP career. It truly is about being able to know what you don't know - and not trying to pretend like you do know it all. Everyday at work I am extremely thankful to have been an ER nurse for several years, especially since I work alone. You will not typically get several weeks' orientation with another provider as an NP. You will be expected to perform competently on your own from the very beginning. No hand-holding happens at this level. For those who say RN experience won't help you to be a good NP, then I am afraid you are one of those who does not know what you don't know.
One problem I see these days is that one can go to school to to be a family nurse practitioner and then be hired to work the night shift as a mid level provider in a critical care unit. Being a crititical care practitioner is an art and there is no substitute for experience. MD's get years of bedside "clinicals" during residency where they live in the ICU before ever being turned loose on their own. Why is there not an NP "residency" for areas that require a lot of intense additional skill? I don't know about you but IMHO spending a few weeks rotating through the various specialties during clinical in your NP program does not an expert make.
Just like MD's who speicalize in a specific area have to take addtional training post mecical school, I think that NP's should also have additional "residency" after NP school.
Why do I say this? Because a scenario like this often happens these days. The new grad ICU nurse with 6 months of experience encounters a challenging situation and the NP who is working the night shift has also just graduated NP school and has little more ICU experience than the bedside nurse she is going to give orders to. In it's most simple terms we have a very frightening situation here called the blind leading the blind.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
just curious...what do you think about pa?....no bedside experience..yet function similarly to np.
np education assumes that the potential np has had some experience -- and some expertise at the bedside. pa school does not. they emphasize clinical experience more. the pas i work with are, uniformly, great. they respect the nursing staff a whole lot more than the nps do as well.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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?
nurses used to have to have at least five years of experience before they could even apply to np programs. that's how the np programs were planned. things may have changed, but a nurse who goes directly into the np program after finishing her bsn has no real experience even if she does work at the bedside while she's still in school. (from what i've seen, most of them slapdash through their assignment so they can sit down and study for their next test.) that said, if every new practitioner realized how little they know, that would go a long way toward mitigating the damage they can do. a modicum of respect for the smart, savvy and hardworking rns who chose not to be nps would be a good thing as well.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
One problem I see these days is that one can go to school to to be a family nurse practitioner and then be hired to work the night shift as a mid level provider in a critical care unit.
Luckily, many states are starting to regulate this so that NP's are restricted to only practice in the area in which they are educated and certified for. As an FNP, I wouldn't even dream of stepping foot into the units and writing orders. NO way, NO how! Only ACNP's should be on the units!
xtxrn, ASN, RN
4,267 Posts
absolutely agree.
kind of like claiming to be a pediatrician with nothing but an md, and 3 kids. (no residency in pediatrics). "book learning" is all well and good- but if someone can't apply it on a real person, it's useless, imho. i haven't had a np for a while, and back then, the online programs weren't an option. but, if i get an np now (which is fine- i have had very good nps as a personal healthcare contact; i have a cousin who is an np- and went to in-person classes), i'll ask how much bedside experience they have. i've found most nps (from a while back- maybe still the same?) are more likely to listen, and also consider that i've got some awareness of what's going on. but i don't want a "drive-by education" in someone who is dealing with my health. jmo. :)