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 CCU, SICU, CVSICU, Precepting & Teaching.
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.
please quote the post you're referencing.
i have had lots of experience with good nps -- and bad ones. unfortunately, these days the latter outnumber the former.
My school requires one to two years of bedside experience in your desired field. Bedside experience is priceless and I think it is crazy for someone to go on without it. Besides how are they going to know for sure that they want to be an NP and what to specialize in without any experience as an RN?
I don't think one can be a competent NP without at least a couple of years of bedside nurse, maybe even more.
Specializes in Long term care, Rehab/Addiction/Recovery.
As stated by many others, I too have always had positive interactions with Pa's as both a Pt and professionally. I wonder why that is? Is it possible that as Pa's we see them as a different "food group"?? I am reading the responses to Ruby's post (observation). Most of the NP students were not defensive and agreed that no RN or anyone should zip thru an NP program. But they do. I think its in the water in Nsg schools these days. I overheard a gaggle of Nsg students recently,"When are you starting your NP program?" Response," "Oh right away". BTW, they were speaking to a RN with 6 months experience. She seemed almost embarrassed that she hadn't started "her" program yet. I have worked with some good NP's, and some I wouldn't let take care of my cats. I try to judge them each on there own merits.
If you're talking about me in particular, I have administered pretty much all of the major psychiatric medications many times.
Lol, nope I'm not talking about you personally since I don't know you unless you were that chick beside me in class who thought quoting textbooks was a sufficient trade-off for actually having met a psychotic patient.
To clarify: just because someone has 25 years of experience it does not mean she is an excellent nurse. No way, she might know 1 million tricks from experience but that doesn't mean much. I work with so many nurses who have more than 12 years of experience,yes they are sweet and kind but they are not very smart. Some of them do whatever the docs tell them without knowing the rational. They don't even bother to learn.Just because someone dedicated 13 years of life to nursing school and has so much more knowledge than others this alone does not make you a good nurse. Communication skills and nursing knowledge combined makes a good nurse. Experience alone does not get you very far.
rnsrgr8t made an interesting point a page back. Schools in my area are pumping out NPs as fast as they can. In my 25 years since I graduated with my BSN, I've gotten thousands of come-ons from schools (my own included) about "finishing up", i.e. getting that MSN/NP.
My region is super-saturated and most of my MSN/NP friends end up working part time for less money than they ever made in their lives or going back to hospital care as RNs. I think the profession is being oversold and maybe that's why so many are in the market with zero experience.
Don't you also think that lots of these direct entry people really believe, like any normal person would, that, they will be taught everything they need to know? I mean, enough to function on the floor without putting anybody in danger at the very least. They all fully realize that it takes years to gain foothold, but seriously, you do go to college in nursing TOTALLY believing that you will be comfortable for the most part as you start out your first job. It does seem ridiculously absurd that you would leave school without at least that.
Heck, I think we all went to college believing that "they" (whomever "they" are - some regulating body) would not allow inadequate training. After all, lives are at stake. I remember fellow students trying to calm one another by saying, "They wouldn't let us all out there as nurses if they weren't going to be sure we could function well :rolleyes:" Then we'd try to laugh it off as if our worries were totally unfounded.
Just think of all these people going direct. Wow, I just wonder, after all that big money, how many now are going to totally bail. I mean, really? there isn't even a decent support system for entry level basic RNs in most places.
I don't want to sound ignorant but I think its the schools. Can't get into an masters program with a bachelors in another field and get you RN MSN and NP certification without having an ounce of experience? Maybe that's why its like this? Just a guess, I maybe wrong
I have to admit, I was feeling apprehensive when I began reading your post. I am a "new NP" with just under a year of RN experience - and SO very insecure about it. I am insecure because I fear becoming, or looking like, the picture that you have just painted. I worry that I will not have the answers, that I need to go back for more experience, or perhaps that I don't belong. Worst of all is that I want to know, and do well, and I want to listen.
I actually think you make good points. Arrogance is very dangerous. I didn't feel like you were, in the end, generalizing everyone - but the person you described clearly had an issue.
I think new NP's do have to be careful. No matter how much you "know" in your head, you are being asked to apply and consider many many complex dynamics and variables. There must always be a give and take, and balance.
Unfortunately, as I said, I has less than one year of experience - never once did I even touch on feeling confident in what I was doing. However, I was offered a fellowship which paid for my master's and DNP coursework, but I had to go full-time and they literally requested that I not work. I saved over 100K in loans by taking it. I can't say for sure whether or not it was the best choice, but it's the one I made.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
One more thing... Do you have thoughts on how a person might become more competent?
Bedside experience and practice, practice, practice. Bedside experience that cannot possibly be obtained on line. Humility, so you know how to ask why and for help. Respect for those who may not have more degrees than you but may have more experience and knowledge on some things....and listening skills....listen to those around you as you may hear something you need to learn.
When all this NP started it was as the BSN level (back in the early 80's) and then there was the push for more and more education and more and more "freedom to practice" by APNs and I feared then it would cause the degradation of the nursing profession. I have been asked on more that one occasion about going back to school because I'm so "smart" or if I had any"ambition" to return to school to "further" myself. When I answered that I was happy being a bedside nurse or middle management/supervision, that I was happy right where I was being the best of who I am.....I have on more than one occasion been told in response "You have no desire to better yourself?" or "You have no ambition to better yourself?"
Why can't I be admired and respected for being the best bedside nurse I can be....and be respected because I am an expert at what I do? and being the best bedside nurse I can be is somehow a lack of ambition. Now all I hear about is "how fast can I get away from the bedside to make the good money" and not the best that I can be.......I hear you Ruby...and feel your pain .
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
One more thing... Do you have thoughts on how a person might become more competent?
If you are lucky enough to work with patient and understanding doctors, other NP's, or PA's - always ask them for another opinion if you have any questions about a patient, treatment, diagnosis, etc. Discuss with them difficult cases you have; ask them to bring you in their room if they have an interesting/difficult case. When you go home at night, research any conditions you saw that day that weren't straight-forward or you were unsure of. Learn about them, their differentials, treatment options, etc. Being an NP is being dedicated to continuing the learning process. It is the only way you can be the best NP you absolutely can be. Being an NP is not a "job" you can just leave at the end of the day.
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Ruby Vee, BSN
17 Articles; 14,051 Posts
please quote the post you're referencing.
i have had lots of experience with good nps -- and bad ones. unfortunately, these days the latter outnumber the former.