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 Long term care, Rehab/Addiction/Recovery.
:confused: OK totally off topic, but when did Rn's and future Rn's begin to simply view graduation and a RN license to practice a "mere stepping stone" to get as far away from basic care as possible? To the top Baby here I come!! This seems to be the mantra. Look it, I have nothing against going back to school. Total respect for anyone holding down a job and wanting to better themselves. What I see now is if you don't, whats wrong with You?? If we all became NP's who is gonna have that A-Line insertion ready for you? Who is gonna hold your hand when you catheterize that preemie and talk you thru it ? I could go on ad nausea..I wont.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.
I agree that there is an overall lack if respect in the profession There are on line schools that have an all online cirriculum and I just don't understand how you can learn to be a nurse of anykind at home in your pj's. I agree that there is a "my degree is better than your degree" going on.....and although you say you will never look down at nursing satff and you respect the diploma nurse....when did the nursing staff become "yours"? Saying "my nursing staff" indicates ownership. As longer and I have been a manager and wore many hats I have always refered to the nurses as The Staff and the nurses who work on my floor/unit. So, no matter how innocent and well intended, it begins with claiming ownership by proclaming the staff as 'mine". It's just food for thought..:redpinkhe
More about this later, if i have time. My facility does not really use NPs. they do use PAs. I trust 99% of the residents 99.5% of the time more than any NP or PA. The PAs in the sub-surgical specilities seem to be really knowledgeable, however.
I agree 100%. In fact, I hate the possessive use in this way so much that if someone says this in a job interview with me, they are no longer a contender.
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.
This is a strange comment. Where I work our advanced practice nurses often have LESS education than the staff nurses.
Many of our staff nurses have degrees in other fields as well as their nursing bachelors and post-graduate nursing study.
Plus also there are not enough jobs for all the nursing masters prepared nurses - so they are working as staff nurses as well.
I work with staff nurses with law, engineering, IT, business, language degrees.
Many of them are educated to masters level elsewhere. So with their nursing bachelor degree plus post-graduate nursing - they outweigh our nurse practitioners in the education stakes.
I agree 100%. In fact, I hate the possessive use in this way so much that if someone says this in a job interview with me, they are no longer a contender.
Agree.
I don't want to 'work for' (LOL) somebody who has 'her nurses'
Specializes in Med-Surg/Peds/O.R./Legal/cardiology.
Agree.
I don't want to 'work for' (LOL) somebody who has 'her nurses'
Nor do I like it when an MD tells a patient "I'll have MY nurse do"...... The majority of MDs who make these comments are older and once had their own practice to hire/fire staff however they saw fit. Now that "MEGA" hospital systems employ physicians, this possessive phrase will more than likely die out. The only person who can refer to nurses as "my nurse" is the patient.
I was looking at the NP program requirements for a few schools in my area today, which are:
Previous BSN and 2 to 3 years minimum RN work experience
GPA of 3.0 or higher
Academic and 2 professional references
Letter of intent: Why do you want to be an NP? What nursing experiences can you bring to the program? What area are you interested in pursuing?
A disclaimer clearly states that if any of those components are lacking, or if your letter of intent is ambiguous, you will not be considered.
That's the way it should be, because it is advanced practice.
If that 2-3 years RN experience included some time in the speciality they are applying for I would be thrilled to see schools adopt this criteria. Mine which is a very well respected university took anyone in the psych np program with no regard for actual psychiatric experience and in one case a new grad with no nursing experience at all.
:confused:
ebear, BSN, RN
934 Posts
...oh. I'm going to sleep after I get off my pedal stool. Just kidding, Ayorenee. I feel a flame about to be thrown in my direction. :)