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 am an NP student currently in my clinical rotations. The school I am getting my MSN at required 1year of experience before you could even start with a basic grad level stats course. This semester has been my first one doing hands on patient care and I now have 3 years of experience behind me, by the time I graduate I will have 5 years of experience. So I can agree with this post and it being scary not to have the experience especially someplace like in the ICU where you are playing guess that symptom. It means nothing to have all those credentials if you can't apply it to realistic situations. I will never be that FNP who looks down on my nursing staff....I work at clinic with a Nurse who has her Diploma and she is a wealth of information and gives great advice!!! There just seems to be an overall lack of disrespect in the profession and that really bothers me.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
one more thing... do you have thoughts on how a person might become more competent?
the best nurses, physicians, pas and nps i've ever met are the ones who do not believe they know everything. they're willing to listen and to learn from anyone who might be able to teach them something. rather than insist that she needed a 12 lead to diagnose a paced rhythm, that np might have asked me to show her why i thought it was paced, and then listened with an open mind. rather than insist on doing it her own way, she might have solicited other opinions, especially from her colleagues (and i count myself among them) who might have seen it before.
understand that you're just beginning to learn, admit that you know very little of what you need to know, and listen to those who might be able to teach you. arrogance is scarey. arrogance in someone who knows very little is very scarey. arrogance in someone who doesn't know what she doesn't know is downright terrifying!
While I am sympathetic to market forces that encourage people into grad school without a bit of experience, I have always felt that the NP curriculum RELIES on the nurse having bedside experience and I had always hoped to avoid becoming an NP without experience.
The good news is that I found a new grad spot in an ER with a great residency and have been nursing about 18 months now. The longer I stay, the more I realize what I don't know and I remain eager to learn.
I have worked the past few night shifts and run into a girl I went to nursing school with who went straight to an E-NP program after nursing school. Almost two years since we graduated and she sounds like an enthusiastic new grad who has NO CLUE what she is saying. In conversing with her, she would just stare at me blankly when I responded to her questions re my patients. She has no clue! lol
Its my tendency to also agree with the sentiment that the quality of NPs has been going down. I was delivered by one 11 years ago. She was amazing. Now, I am shocked by their poor assessment skills and have decided to pursue my MD if I ever pursue another degree in my life.
Specializes in Med-Surg/Peds/O.R./Legal/cardiology.
KaKa, like Ruby Vee, I was not making a blanket statement to include ALL nurses, NPs, PAs, etc., nor does EVERYONE choose to become a bedside nurse. I am simply referring to the fact that the FOCUS seems to have moved away from the patient..who has gotten lost in the shuffle somewhere.
Specializes in Med-Surg/Peds/O.R./Legal/cardiology.
Ayorenee, your statement says a lot. "I will never be that FNP who looks down on my nursing staff".... A). They are not YOUR staff B). Do you realize the underlying implication of that statement?
Ayorenee, your statement says a lot. "I will never be that FNP who looks down on my nursing staff".... A). They are not YOUR staff B). Do you realize the underlying implication of that statement?
It is funny how you took a positive post and turned it so negative...so let me correct myself...so you can sleep better tonight "I WILL NEVER BE THE FNP WHO LOOKS DOWN ON MY COLLEAGES, COWORKERS OR OTHER STAFF MEMBERS!!!!" I wont look down on someone who does not have as high a degree as me.
ebear try not to read into things so defensively my original comment was positive and although "YOU" read into it negatively it was by no means to put myself on a pedal stool indicating that oh now that I am an NP, these are no longer colleges but my personal staff and assistant...not at all. For future reference ask for clarification of my statement before you wave an accusing finger implying my post had an underlying tone to it.
Jenny maybe it's petal stool( I am so sleepy) but it's an expression of putting yourself or someone putting you or regarding to you on a higher level than others and those were not my intentions although they were highlighted as such.
Specializes in Med-Surg/Peds/O.R./Legal/cardiology.
I can assure you that your statement, explanations, etc. will not affect my sleep. Perhaps you need to examine your own defensiveness, Ayorenee. Good night.
ayorenee
21 Posts
I am an NP student currently in my clinical rotations. The school I am getting my MSN at required 1year of experience before you could even start with a basic grad level stats course. This semester has been my first one doing hands on patient care and I now have 3 years of experience behind me, by the time I graduate I will have 5 years of experience. So I can agree with this post and it being scary not to have the experience especially someplace like in the ICU where you are playing guess that symptom. It means nothing to have all those credentials if you can't apply it to realistic situations. I will never be that FNP who looks down on my nursing staff....I work at clinic with a Nurse who has her Diploma and she is a wealth of information and gives great advice!!! There just seems to be an overall lack of disrespect in the profession and that really bothers me.