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.
One more thing... Do you have thoughts on how a person might become more competent?
That seems to be a catch in nursing? Since nursing is slim on the residency/internship thing, how does one gain skills? Get a job doing the very thing you want to become competent in! If you and your patients are more or less intact after your first 3-6 months, then you are well on your way to being a competent nurse.
Nursing seems to involve a lot of "sink or swim". I say "sink or swim" and not OTJ training, because to me, the term on-the-job-training implies structured supervision, not the "here-ya-go-call-me-if-you-really-get-stuck-but-you-shouldn't-have-to-because-this-is-the-job-you-were-hired-to-do-and-I-dont'-have-time-to-do-my-own-job-much-less-yours" pattern that seems to occur in certain areas of nursing.
I imagine that in the past, nursing students were thrown into more "sink or swim" situations, especially where students essentially functioned as part of the nursing staff. Anyone who graduated, then, had already been through this trial-by-fire. With today's liability concerns, though, students may not be given the opportunity to "sink or swim" (aren't allowed to do much of anything clinically) and so the "sink or swim" part of clinical nurse "training" occurs after one has earned their license and has landed a job with full legal responsibility for the nursing care.
Similarly, NP education was built upon the assumption of solid real-world clinical experience. Those in NP programs had already been through the "sink or swim" aspect of nurse learning, either as students or as new grad staff nurses. Direct entry programs, then, delay the "sink or swim" aspect of clinical nurse "training" until after the inexperienced student has their RN and NP licenses in their pocket.
I don't believe in NP, I only am treated by a Doctor when I am ill. No amount of arm twisting can change my mind. And after reading some of these posts, I'm doubly sure I will stick with MD's.
there are good doctors and bad ones, and they all had the same education and post-school training. there are good nurses and bad ones, at bedside, in white coats, or behind desks. generalizations are odious. i, for one, and my husband for another, have been fortunate to get our care from truly excellent nps. one caught my sudden vision loss at 2pm on the friday of a 3-day holiday weekend for the serious thing it was, and had me in a retinal ophthalmology specialist's office in an hour getting my torn retina fixed, thus saving me from continued traction on my fovea and certain blindness if it had been left until tuesday.
i have also had my husband seen by a dermatologist who didn't know how to assess a wound after he whacked off a precancerous lesion, and let it fester for two weeks with the sutures still in place. i finally said, screw this, and snipped them out myself and took over the job.
see, anecdote is not the singular of data. remember this when somebody says, "all .....s are bad and i'll never work with one/treat with one again, and you shouldn't either."
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.
Gotta agree Joanna. Our PN education up here is 2+ years, while many US posters have said 9 MONTHS.
The best NP I've ever worked with worked up north in settlement postings before she returned south to become one of the first NPs in our area. Even the younger ones, have had at least five years work experience, again often northern or isolated areas, where they had to be proficient.
I'm thinking American nursing education may be the issue. We've had issues with the accelerated BScNs not knowing what they don't know. I shudder to think of an NP with no prior nursing background (like the CPA turned NP that someone posted about).
Oh come on. What is this not believing stuff. Sheesh. Lets not go all crazy now.
If I have unexplained abdominal pain, I'm probably not going to the Take Care Clinic or the Minute Clinic. Heck we are nurses, we've already r/o the minor stuff, haven't we? I mean we can assess ourselves (at least I hope you all can). I'm past the nursing assessment and I choose my doctor, whether GP or specialist.
I go to the minute clinic to get abx for a sinus infection, etc. I already know I've got it... don't need a doc. If the NP sees something different, then I sure will listen and as with all practitioners advice, I'll decide what's going to be done, as will all of you, right?
I have no problem with NPs whatsoever. If I am in a hospital and my surgeon sends a PA or NP to do s/p assessment, cool. I know my docs, and I know they will carefully pick who they want to represent them.
BTW it is easy to look these folks up, and see what's what.
The only time I have worked with NP's is when I get floated to the ER, along with PA's, and that is back in the fast track. Overall I have had good experiences.
When I was in college, there were several NP's who worked at the student health clinic. My PCM is an NP. My experience with NP's have been very positive. I feel like they take the time to listen to me and my concerns. But then again, I have never had a bad experience with MD's and PA's (unless I am calling them at 0300 to get orders for something....)
Maybe it is because there are RN's who decide they want to go to NP school fresh out of RN school. But I've noticed that there are programs that are now requiring at least 1-2 years of experience of bedside nursing, depending on the field, so I guess it just depends.
Gotta agree Joanna. Our PN education up here is 2+ years, while many US posters have said 9 MONTHS.
The best NP I've ever worked with worked up north in settlement postings before she returned south to become one of the first NPs in our area. Even the younger ones, have had at least five years work experience, again often northern or isolated areas, where they had to be proficient.
I'm thinking American nursing education may be the issue. We've had issues with the accelerated BScNs not knowing what they don't know. I shudder to think of an NP with no prior nursing background (like the CPA turned NP that someone posted about).
i totally agree with you
i wanna say we had this discussion about this, how there are 15 different ways to become a nurse. lvn, diploma, asn, bsn, absn, el-msn, doctorate, PhD etc.....
i mean everyone has to start somewhere but the bottom line is people who major in different subjects apply and become Rns then get their NP, well now they got this fancy MSN and NP and their RN but no experience...how these people get hired as NP's is beyond me.
my friend was telling me a situation where her guy friend was in a el-msn program and after he got his RN he took a break to gain experience. well he still didnt have his masters, and of course his undergrad was not a BSN or anything. so no one would hire him because he didnt have a degree.
so i dont know if that is how that particular school worked it out but it seems to me the only way NP's can practice is like how CRNA's become licensed and that is with 2-3 years of bedside nursing, the more specialized the better. now i dont know how the NP schools work but thats my idea to fix the issue.
Specializes in Med-Surg/Peds/O.R./Legal/cardiology.
This entire thread leaves me empty. The basic question for me is: "IS ANYONE INTERESTED IN THE BRASS TACKS OF TAKING CARE OF PATIENTS ANYMORE?" Seems to be a contest of "my degree is higher/better than YOUR degree" and a never ending push to pile degrees higher and higher. Just sayin'.....
Eweee! Taking care of patients? That would be so hard!!!!! I just want to dispense meds and not have to get my hands dirty. And a white lab coat would be just super. Now, I do believe about half of the NP's are experienced and know their stuff....but that's not good enough when more and more patient care is being delegated. Do we hear doctors complain about that useless internship and residency? Or the request that they show up in person for classes instead of logging in? Somehow it's OK for nurses to be let loose with second-rate educations because we're "just" nurses?
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
This entire thread leaves me empty. The basic question for me is: "IS ANYONE INTERESTED IN THE BRASS TACKS OF TAKING CARE OF PATIENTS ANYMORE?" Seems to be a contest of "my degree is higher/better than YOUR degree" and a never ending push to pile degrees higher and higher. Just sayin'.....
Yes. However, some of us, like me, must take a different track to take care of patients due to a body that can no longer handle the day to day tasks of bedside nursing. I can, though, take care of patients as a NP. Sure, it's not as a bedside nurse, but at least I am still involved in patient care, just a different level. Maybe other NP's/NP students do have the desire to play the "my degree is higher/better than YOUR degree" game, but not all of us are that way. It's sad though, that it seems to be a common, and maybe deserved, view of others who choose to not go that route....
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
I'm not sure I understand the hoopla over online classes? These, at least mine, aren't easy. It is nice, of course, to be able to learn online, especially when one lives in an area that it's not easy/convenient or feasible to be in a live classroom. Clinicals are stringent, hands on, not online (and surely, no one thinks they are?). Why not attend classes via the internet? The materials are identical to a live classroom, courses are specific to the requirements for licensure, so really, they aren't any easier.....
Ruby, you write beautifully. This thread initiated a much needed dialogue. I noticed that a lot of later posts are wandering far from the OP topic and have become more about personalizing the concerns raised by a long time bedside nurse. I'd be so happy to have Ruby to learn from. New nurse or new NP.
I think it's wonderful people are becomming nurse practitioners. There was a time in the 70's NP's had to put up with a lot of ridicule and resistance from the Medical Community. Perhaps that's why they were good listeners and very careful. I agree with another poster who says bedside nursing isn't something one wants to stay in for long. No wonder it's seen as a stepping stone.
All said and done. I hope all nurses use this thread to look at their own practice and make the effort to go the extra mile to listen to the concerns of family and all involved. I've noticed lab, respiratory therapy, PT, OT,CNA's, and where I work housekeeping and dietary know the patients in a different way, and it can add up to big clues. (I remember the one who had natural substances brought by her family and it turned out they were causing the excessive bleeding and platelet problems. The dietary aide saw them given. Asked the family, and told the Nurses who looked it up, talked to pharmacy, who looked it up and told the MD's.)
)
jjjoy, LPN
2,801 Posts
That seems to be a catch in nursing? Since nursing is slim on the residency/internship thing, how does one gain skills? Get a job doing the very thing you want to become competent in! If you and your patients are more or less intact after your first 3-6 months, then you are well on your way to being a competent nurse.
Nursing seems to involve a lot of "sink or swim". I say "sink or swim" and not OTJ training, because to me, the term on-the-job-training implies structured supervision, not the "here-ya-go-call-me-if-you-really-get-stuck-but-you-shouldn't-have-to-because-this-is-the-job-you-were-hired-to-do-and-I-dont'-have-time-to-do-my-own-job-much-less-yours" pattern that seems to occur in certain areas of nursing.
I imagine that in the past, nursing students were thrown into more "sink or swim" situations, especially where students essentially functioned as part of the nursing staff. Anyone who graduated, then, had already been through this trial-by-fire. With today's liability concerns, though, students may not be given the opportunity to "sink or swim" (aren't allowed to do much of anything clinically) and so the "sink or swim" part of clinical nurse "training" occurs after one has earned their license and has landed a job with full legal responsibility for the nursing care.
Similarly, NP education was built upon the assumption of solid real-world clinical experience. Those in NP programs had already been through the "sink or swim" aspect of nurse learning, either as students or as new grad staff nurses. Direct entry programs, then, delay the "sink or swim" aspect of clinical nurse "training" until after the inexperienced student has their RN and NP licenses in their pocket.