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.
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
I can understand where the OP is coming from. However, not all NP's are incompetent and arrogant, just as not all RN's are competent. A wise NP will recognize that the bedside nurse is the one who she/he should trust to know the patient quite well because that bedside nurse is there ALL the time, not just during a hospital rounds experience. A wise NP will not tick off the bedside nurse. A wise NP will be thankful for the opportunity he/she once had to be at the bedside. etc., etc.... I will become a NP in 2012 (hopefully!), and believe me, I know I know nothing compared to many, a bit more than some, and never enough. As to the online vs "real live classroom"---my lectures are online and via internet classes in which we gather as a class via internet, hear each other & the professor. I have to be on my toes and very self motivated and organized, neither of which are my strong points. My clinicals are with physicians and NPs in various areas. I'm required to obtain a minimum of 600 hrs of hands on clinical as a student in my post-masters program, plus had to have 3 letters of reference, and a minimum of 2 years nursing experience (I have around 20). Does it mean I'm smarter than anyone else? Not at all. For me, and I have a feeling for others, it's an opportunity to continue at a different level in a profession I love. Please note I said "diffferent level" not "better level". I will say though, that the trend of people coming into this profession with non-nursing degrees bothers me to no end, and I find very scary....Okay, I'm done....
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
the blind leading the blind is exactly what i'm talking about.
but even more frightening is when one of the blind cannot be taught anything because she believes she already knows it all. and the other blind listens to her rather than to the sighted bedside nurse who might actually be able to teach her something.
I think Tait really has a great point. So does Ruby and all those who talk of the direct entry programs.
This is a very dangerous time.
If nursing was at all what it had been at least for a while - a profession that mentored/supported it's own - a lot of this desperation would not be happening for RNs. But since the big corporate take-overs began, lets say really in earnest about 12 years ago, things have permanently changed. Now it's all about how to find the cheapest labor. EVERYBODY is scared. Really, nursing is a very dangerous profession to be in now. Think of how little edu/support we have in acute care. Very little training now for new nurses on the whole (with some exceptions where there are good residencies) since late 2007. MDs are afraid too. I've been keeping up with that deal as well. Wow, they are even more like "babes in the woods", If they work for a big network, you'd be surprised! They are just like any corporate office worker, but more naive because after 12 years of edu, they are simply now adults with "no game" to keep hold of thier profession either, they are easy to bait and switch.
Then you have the quick money people riding the wave and the lie of the "nursing shortage". Then also, you have the corporate lobby trying to bring in foreign laborers to do a global change in workforce for nursing. It's on it's way folks, it really is.
This is a very scary time... I repeat, shaking my head. What to do, what to do....
This topic relates quite well to my feeling about 1 year Accelerated BSN programs as well - if I can't get an ART HISTORY degree in one year, should you be an RN within one? Totally nonsensical
1. Peer pressure. A trend that I've noticed (after graduating less than a year ago) is that my fellow floor nurses, family members, and friends have eagerly been asking me, "WHEN ARE YOU GOING BACK TO GRADUATE SCHOOL!?" and, "the longer you wait, the less you'll want to go back!"
2. I think that a lot of people don't want to feel pigeon-holed into doing a DNP in a few years. Perhaps there is a rush of less experienced people going back to get degrees now so that they don't have to do this? It sounds ridiculous, but I know several people from my graduating class are planning to go back to school sooner rather than later so that they can avoid being forced into getting a DNP.
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
Calabria--why would one be "forced into getting a DNP"? No one can force another to do so, unless the hospital is going that direction, then that's a conversation for another thread.
To be honest, I find the nursing education in the US a little odd. There seems to be way too many schools, online programs, etc offered throughout the US, causing a HUGE saturation of nurses, and few jobs.
I'm a Canadian educated nurse, where the BSN is now mandatory. We only have a select number of schools to choose from which offer nursing, and there are no online BSN options. You go to class. If you want to be an NP, it is mandatory to work first.
Now, before I get flamed, I'm not saying the education is better per se. Just different. But....the nursing job shortage isn't nearly as bad, because there aren't as many avenues that people can choose to become a nurse, so that's a positive.
Calabria--why would one be "forced into getting a DNP"? No one can force another to do so, unless the hospital is going that direction, then that's a conversation for another thread.
There's a lot of talk around where I live/work/went to school (Midatlantic/Northeastern U.S.) that hospitals will be going in that direction. I'm not sure if it's anxiety related to AACN recommendations or if it's truly valid.
There's a lot of talk around where I live/work/went to school (Midatlantic/Northeastern U.S.) that hospitals will be going in that direction. I'm not sure if it's anxiety related to AACN recommendations or if it's truly valid.
Exactly.
There is widespread belief that the AACN recommendations will be enacted and the DNP will become the entry-to-practice degree for NPs, but pre-existing NPs (with an MSN) will be grandfathered in.
Specializes in Peds Urology,primary care, hem/onc.
I have to agree with Ruby on this one. I have been a nurse fo 13 years and was an RN for 5 before I went back to school. I had a couple of classmates in school that were direct entry PNP students that had just graduated with their BSN. Now I am not making a sweeping statement saying they are now not good PNP's...but they had a LOT harder time through school than those of us who had experience. There are things that you learn at the bedside that simply cannot be taught in the classroom. I remember when I was a new grad nurse, I DID think I knew everything and frankly had to get knocked down off of my pedestle and learn the hard way that I DID not know everything. Some of my issues where just being young, naieve and not knowing how medicine and the politics work. I worked all through nursing school as a tech but the atmosphere and how you carry yourself is totally different as a nurse. I wonder if some of the younger NP students out there (and I am not judging EVERYONE on being young so DON'T flame me please) are just going through the normal growing pains that a lot of young people go through when they are first in a job field as an adult. However, they are doing it with a lot more potential for making a big boo-boo, especially if they have that arrogance that they have to learn to get rid of. A lot of times, that arrogance is covering up for fear and insecurity (that was what it was with me) around a lot of people who are experienced. Add the expectations of an advanced degree/role... imagine how inadequate they may feel! The other thought to consider is how easy would it be to get a job without any nursing experience? I know the job I am in now (the only one I have had as a PNP) required 5 years of peds nursing experience before they would even consider you. From the OP, it is obvious that not all places are requiring experience. I am truly sorry to some of the posters here that are offended by us really believing you need bedside experience to really be a competent APN.... it is a not a jab at YOUR education or abilities. It is just an honest statement that you would be EVEN BETTER if you had bedside experience. There are WAY too many programs out there and the market is getting saturated with new grad NP's (just like new grade RN's) that have been pushed quickly through an excellerated program and it is so hard for them after they graduated because they are not prepared. I believe we are doing them a disservice. I was only bedside on the floor for 18 months... but I tell you, there are things I learned and experiences I had that help me in my APN practice EVERYDAY. I know there are exceptions to every rule and there are NP's out there with bedside experience that are worse than the new grads without. I think what Ruby is saying is that there is a general trend that she has seen in her long years of RN experience and she is concerned about it. I am too.
Calabria--why would one be "forced into getting a DNP"? No one can force another to do so, unless the hospital is going that direction, then that's a conversation for another thread.
Right now you can become a NP with a masters' degree. By 2015 (or 2014?) they want to make it mandatory to have a doctorate in order to become a NP. A lot of people are rushing to get it done now so they don't have to deal with the additional time and expense of pursuing a doctorate.
I think you have not really experienced a good NP. I am not a NP but I resent this post.
Please don't stereo type your NPs over some lame experiences. They are like regular RN's. Some suck. some don't.
I originally had an issue with patients who looked at the NP like they were above me. But after a good look at me, and what they do, let them have the light, the responsibility..... the liability..... I don't care.
kakamegamama
1,030 Posts
I can understand where the OP is coming from. However, not all NP's are incompetent and arrogant, just as not all RN's are competent. A wise NP will recognize that the bedside nurse is the one who she/he should trust to know the patient quite well because that bedside nurse is there ALL the time, not just during a hospital rounds experience. A wise NP will not tick off the bedside nurse. A wise NP will be thankful for the opportunity he/she once had to be at the bedside. etc., etc.... I will become a NP in 2012 (hopefully!), and believe me, I know I know nothing compared to many, a bit more than some, and never enough. As to the online vs "real live classroom"---my lectures are online and via internet classes in which we gather as a class via internet, hear each other & the professor. I have to be on my toes and very self motivated and organized, neither of which are my strong points. My clinicals are with physicians and NPs in various areas. I'm required to obtain a minimum of 600 hrs of hands on clinical as a student in my post-masters program, plus had to have 3 letters of reference, and a minimum of 2 years nursing experience (I have around 20). Does it mean I'm smarter than anyone else? Not at all. For me, and I have a feeling for others, it's an opportunity to continue at a different level in a profession I love. Please note I said "diffferent level" not "better level". I will say though, that the trend of people coming into this profession with non-nursing degrees bothers me to no end, and I find very scary....Okay, I'm done....