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.
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.
It's a little bit hard to get "impressed" with your "high" degrees. I find it beyond embarassing that you think pedestal is petal stool or whatever. I would never mention it if not for the fact that you seem to feel pretty important with your advanced education. Just as important is the ability to communicate effectively, which includes possessing insight into how your words and messaging would be received by others. Use of "my nurses" is a total deal breaker for most but you aren't able to understand the message it conveys.
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.
That's usually the way it works up here. If you want to specialize in Adult Health or Primary Care, they would want experience in Emerg and or Medsurg/ Acute Care. If the focus is geriatrics, then experience with seniors, and Psych would require at least a year or more in psych nursing within that 2 to 3 year stint.
We have a select number of NP programs in Canada and many qualified applicants. The schools can afford to be choosy, and so they should be. online programs don't exist. I am also considering this route, but after a year of nursing, I wouldn't even dream of it. After another 3 to 4 years of working, I'll consider applying. Like many said...you don't know what you don't know. Work experience matters.
Okay...I gotta add my 2 cents worth to this fight. I am an new grad NP with 10 years RN experience! I will say that my RN experience has definitely made me have a better bedside manner and honed my "listening" skills. When it comes to critical care, I am way over my head which is why I chose family practice where I hope I can prevent some of that critical care need--such as MIs, DM comas, etc.
However, I do wish to agree with another post...NPs approach care much differently than RNs. We need to realize that an inexperienced NP is no different than a new grad MD. There is a lot to learn. What we need to realize is that we are all in this providing health care boat together and must work as a team. I know that NPs/MDs are human and make mistakes that experienced RNs know better. How politely was the error explained (as in the original post)? Attitude is everything. And, of course, if the NP/MD is adament about you following their orders to the letter, you do have the right to refuse their order--just document your behind off when you do.
I guess I am the weirdo of the NP world. I came up the ranks starting as an aide. I have never forgotten what was like to be the peon; I treat everyone with the utmost respect and dignity and always thank my supporting staff whole heartedly.
@Kyprn...wish to defer for a minute....A New MD is certainly different from a New NP...Those rotations in med school are thousands of hours for clinicals....in residency you eat, live, shower, play in the hospital. Definitely the NP approach is different from the floor nurse but to get to that point you need continuous bedside clinical experience and not some 600 hours in the program clinicals. NP schools should enforce a 3 year minimum bedside experience before consideration.
Back to the OP....thanks for hammering the point...its ridiculous that a BSN can graduated in January and then by August they have enrolled in an NP program. I would rather treat myself than see one of this for my care...and trust me they are out there flooding the healthcare system. I have experienced excellent NP's out there who are competent and know what they are doing but when you talk and listen to them, you realize that they honed their skills before becoming advanced practitioners. Ruby is expressing a genuine concern that needs to be looked into. Nurses follow provider orders but at the same time a clever nurse has to determine the rationale of those orders or question when in doubt. Otherwise it will end up being a lawsuit and the loss of that license you worked hard for.
@Kyprn...wish to defer for a minute....A New MD is certainly different from a New NP...Those rotations in med school are thousands of hours for clinicals....in residency you eat, live, shower, play in the hospital. Definitely the NP approach is different from the floor nurse but to get to that point you need continuous bedside clinical experience and not some 600 hours in the program clinicals. NP schools should enforce a 3 year minimum bedside experience before consideration.
Back to the OP....thanks for hammering the point...its ridiculous that a BSN can graduated in January and then by August they have enrolled in an NP program. I would rather treat myself than see one of this for my care...and trust me they are out there flooding the healthcare system. I have experienced excellent NP's out there who are competent and know what they are doing but when you talk and listen to them, you realize that they honed their skills before becoming advanced practitioners. Ruby is expressing a genuine concern that needs to be looked into. Nurses follow provider orders but at the same time a clever nurse has to determine the rationale of those orders or question when in doubt. Otherwise it will end up being a lawsuit and the loss of that license you worked hard for.
My apologizes for not articulating exactly what I was trying to say. Sometimes what is in the mind doesn't always come out clearly when you write it down. What I meant when referring to new NPs and new MDs is that they are both NEW progessionals. All thru school you've been the student, even internship and residency, an MD is still the student. Once you are out on your own, you don't have the mentor or instructor to fall back on. Some new professionals cannot handle the boss role well. Some let it go to their heads, are "bossy" know it alls, while others are so insecure they are wishy-washy. And some others need to prove that they are boss. That because their underlings do not have the same training therefore cannot possibly contribute to the current case. Does this make sense in this light?
I think the situation described in the initial post was a case of somebody (the NP) not knowing what they should have known and too proud to admit it. As another said in a post..."we are all nurses" and the goal is to provide quality patient care AS A TEAM. (Not all people are good team players and that goes on both ends of the spectrum.)
Yes I concur that going straight thru all the way to the top at NP without the nursing experience may not be the best thing, given the short amount of training that we have. When the NP program started it was for experienced nurses who had learned what most MDs do in med school by their yrs of bedside experience. However, you still have to prove yourself in NP courses. Anything less than an 85% is failing...not so with med school. Also there are some NP programs that have a full yr of 5 days a week full time clinical rotations. I myself have over 1,000 hrs clinical rotation time in. Plus I have 10 yrs RN experience; if you add in my yrs as an aide, that would be 18 total.
And here's food for thought that will most likely get me hung...none of us will argue that nurses are the front line forces in health care. They are with the pts daily and most often the ones providing life saving treatments, yet they only have to have 2 yrs of educational training; LPNs even less or so I've been told. It is what we learn after we graduate that makes us great nurses.
Specializes in Oncology; medical specialty website.
Okay...I gotta add my 2 cents worth to this fight. I am an new grad NP with 10 years RN experience! I will say that my RN experience has definitely made me have a better bedside manner and honed my "listening" skills. When it comes to critical care, I am way over my head which is why I chose family practice where I hope I can prevent some of that critical care need--such as MIs, DM comas, etc.
However, I do wish to agree with another post...NPs approach care much differently than RNs. We need to realize that an inexperienced NP is no different than a new grad MD. There is a lot to learn. What we need to realize is that we are all in this providing health care boat together and must work as a team. I know that NPs/MDs are human and make mistakes that experienced RNs know better. How politely was the error explained (as in the original post)? Attitude is everything. And, of course, if the NP/MD is adament about you following their orders to the letter, you do have the right to refuse their order--just document your behind off when you do.
I guess I am the weirdo of the NP world. I came up the ranks starting as an aide. I have never forgotten what was like to be the peon; I treat everyone with the utmost respect and dignity and always thank my supporting staff whole heartedly.
See, here's the thing..."my staff." You don't own anybody. Staff may work with you, but they don't belong to you.
I came up the ranks starting as an aide. I have never forgotten what was like to be the peon; I treat everyone with the utmost respect and dignity and always thank my supporting staff whole heartedly.
Some new professionals cannot handle the boss role well. Some let it go to their heads, are "bossy" know it alls, while others are so insecure they are wishy-washy. And some others need to prove that they are boss. That because their underlings do not have the same training therefore cannot possibly contribute to the current case.
I find it interesting that your wording indicates that there are indeed peons and underlings.
Also, in an acute care setting, I don't believe a NP is considered boss of the staff any more than a physician is the boss of nurses in that same setting.
Specializes in Oncology; medical specialty website.
Some new professionals cannot handle the boss role well. Some let it go to their heads, are "bossy" know it alls, while others are so insecure they are wishy-washy. And some others need to prove that they are boss. That because their underlings do not have the same training therefore cannot possibly contribute to the current case.
I find it interesting that your wording indicates that there are indeed peons and underlings.
Also, in an acute care setting, I don't believe a NP is considered boss of the staff any more than a physician is the boss of nurses in that same setting.
I noticed that as well. "Underlings that cannot possibly contribute to the case."
Some new professionals cannot handle the boss role well. Some let it go to their heads, are "bossy" know it alls, while others are so insecure they are wishy-washy. And some others need to prove that they are boss. That because their underlings do not have the same training therefore cannot possibly contribute to the current case.
I find it interesting that your wording indicates that there are indeed peons and underlings.
Also, in an acute care setting, I don't believe a NP is considered boss of the staff any more than a physician is the boss of nurses in that same setting.
I might irritate some people here but I don't actually believe an experienced, educated, intelligent bedside RN is necessarily a 'lower rung' or 'underling' of a NP.
Just because the NP writes orders for RN doesn't mean one is the 'underling' of the other.
Example - We 'write orders' (requests which are not necessarily standing orders) for lab and radiology then the lab scientist and radiologist may review the results (work) - does that mean they are the 'underlings' of the bedside RN's ??
Try working in a small (23 beds only) rural hospital where doctors are considered nearly divine by the administration and you will discover that there is a true hierarchy. And I have heard more than once from a doctor: What medical school did you graduate from to tell me this or that? And I have been told when I was an aide: "You're just an aide, what do you know?" I just added the wording because of the way I have been treated in the past by both doctors and nurses. I am not saying that all doctors feel nurses are inferior or nurses look down on aides the same way. However, there are those out there who do. One bad apple spoils the bunch. We all have a job to do and each contributes the best of their training and expertise.
Specializes in Oncology; medical specialty website.
Try working in a small (23 beds only) rural hospital where doctors are considered nearly divine by the administration and you will discover that there is a true hierarchy. And I have heard more than once from a doctor: What medical school did you graduate from to tell me this or that? And I have been told when I was an aide: "You're just an aide, what do you know?" I just added the wording because of the way I have been treated in the past by both doctors and nurses. I am not saying that all doctors feel nurses are inferior or nurses look down on aides the same way. However, there are those out there who do. One bad apple spoils the bunch. We all have a job to do and each contributes the best of their training and expertise.
Just because you may have been treated badly in the past does not give you license to do the same to others. That was your wording on two separate posts. It makes me wonder if you don't share those same sentiments.
nursing1980
3 Posts
It's a little bit hard to get "impressed" with your "high" degrees. I find it beyond embarassing that you think pedestal is petal stool or whatever. I would never mention it if not for the fact that you seem to feel pretty important with your advanced education. Just as important is the ability to communicate effectively, which includes possessing insight into how your words and messaging would be received by others. Use of "my nurses" is a total deal breaker for most but you aren't able to understand the message it conveys.