Are online ANP degrees destroying our credibility?

Cessna172 · Feb 23, 2012

This thread is actually funny in a weird way. You have hard core proponents of "brick and mortar" schools and those who are using online education to achieve the goal also. My school is an actual university, a block away from my house, where I received my BSN, but their NP programs are mostly online now. I see my dean whenever I want to, and she is very helpful, but most communication is through email. What I am beginning to see, since I never researched other schools, is there are varying levels of standards, rigor, and overall end product (the graduate) among different schools. At least, that's what I am perceiving by all the people who have responded to this thread.

I actually cringed at the thought of having to do an online NP program, as I really wanted the traditional classroom environment, however, that was not offered in my area. I have learned that unless the student really dedicates themselves to the learning, then it will all be a waste when time to actually practice. I can understand the bias many have toward online learning, and I had the same bias before beginning this. The reality in my area, (laugh and make rude comments if you must, I live in south Louisiana), is that the MD's are generally welcoming and are willing to employ NPs. I still have a year left, but I have received 3 offers of employment within the last month by two MD's and one was by the wife of another MD. Jobs aren't pouring out of the woodwork, but these people knew how I practiced as an ICU nurse, and I assume they think I will apply myself just as well as an NP one day. They all know that the course is online, and it must not really matter all that much to them. One of the MDs, a cardiologist, has several NPs from my school working with his group. I imagine if they had a choice between NPs who attended a traditional classroom, vs. an online school, that might make a difference, but my school previously did have only classroom teaching until a few years ago for NPs. Maybe the schools reputation is good enough that it still influences the perception that quality NPs are being taught there.

I'm not trying to debate anyone on this, I respect your differing opionions.

mrmedical, ASN, BSN · Feb 24, 2012

In my opinion, and this is going to offend more than a few people, but our perceptions and views of advanced nursing education and it's value in a field such where the main objective is managing patients care, the priority and the questions we need to ask ourselves is are these programs putting out educated and competent practitioners.

The point I am trying to articulate is that online classes, while they may be accessible, convenient, and cost effective for many people; is irrelevant and I feel that many of these diploma mills are pushing out providers that should not even be practicing in the first place yet have managed to matriculate because they have thrown enough dollars at the education.

Very much akin to what is happening on the RN level, you see a large influx of students paying good money to graduate as an RN from diploma mills yet objectively are clinically incompetent and are a danger with patients. How do I know? I have coworkers that are the epitome of this. Sure they passed the NCLEX or whatever their licensing board is (but lets be honest, the NCLEX contrary to popular belief, is not that difficult) and as a result you have sub-par practicioners entering the field who should not have been accepted at all, yet due to the ease of accessibility by online schooling get to fulfill their fantasy of being an nurse. And while that's romantic is the sense that they get to fulfill their dreams, the frank and mean truth is that, there are many who for the sake of patient vitality should not be.

Perhaps people need to really reevaluate if they should be going to nursing, let alone NP school if they have a mortgage, and three kids, and work part time - understand while those things are important to you being the student, even more so is the quality of education derived because that directly affects patient outcomes. That is, I feel (here comes the offensive part) if you're not willing to put in 100% and give the sacrifice but want to take the "easy way" (relatively speaking) may be being a primary provider isn't for you.

Now, it would be naive to say that some don't matriculate through traditional programs, but the rate I estimate is much less due to the understanding that those who attend in class education are more willing to sacrifice more family time, money, and a good portion of their personal life solely based off the fact they made the sacrifice to do so in the first place and have to meet the demand of attendance.

Now, in class education doesn't get of scot-free either. As many of you will agree, current NP education needs a serious overhaul, and NOT what the ANA is proposing with the idiotic "DNP". While their are many good NP schools who focus on clinically relevant courses like physical exam, patho, microbiology (graduate level), histology, and pharmacology there are equally as many who scape by with the minimum and top off graduation with more "Therapeutic Communication" classes.

This is why many MDs prefer PA's, because their education is much more comprehensive and consistent across the board that your average NP schools. Having your patients like you and connecting with them because you mastered therapeutic communication is great, but at the end of the day the clinician who is able to recognize NOT ONLY the presentation of disease and the differential but the underlying pathogenesis and its associated secondaries is what is going to save the patient. Not to say that you should be a cold person, but understanding illness and the why and how is to be stressed upon.

On an anecdotal note, I've worked with some NPs who have been in the game for a long time before they got their degree from a GOOD school and they made the sacrifices of family, time, and friends to be the best practitioner they can for their patients. And now, after all the schooling, their family is still there for them. On the other hand, while moonlighting at a free clinic with several current NP graduates from one of these diploma mills doing H&Ps and physicals with residents and PAs was one of the most embarrassing moments for me in my nursing career as they (the NP new grads) could not identify BASIC anatomy or associate bacteria and their sensitivities to brand antibiotics (as it was not taught to them). Needless to say, the attending physician was enraged that these new grads could not palpate and identify the epicondyl or recommend Amoxicillin for a basic sinus: they were simply incompetent, and furthermore were down right dangerous to the patient - and they passed their boards.

The moral of the story is 1) NP education needs to step up it's quality and consistency to be respected 2) needs to filter out the riff-raff, not everyone and their mom can or should be an APRN, and 3) Online programs need to be assessed for their efficacy and quality of instruction. 4) Not all online schools are poor, but many are popping up due to demand and oversaturate the market with many half-baked practitioners.

Thanks for reading. Like it? Tell me what you think. Don't like it? Feel free to make a counter point.

nomadcrna, DNP, CRNA, NP · Feb 24, 2012

you would have more credibility if you were a np. discussing np programs and what they need to do when you are not an np damages your argument.

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educationrn-asn

nursing specialtiesemergency, telemetry

as does recommending amoxicillin for a basic sinus? i assume you mean basic sinusitis? no antibiotic would be better.

the attending was "enraged"? really?

sorry, your story just does not add up.

mrmedical, ASN, BSN · Feb 24, 2012

you would have more credibility if you were a np. discussing np programs and what they need to do when you are not an np damages your argument.
[h=2]registered user[/h]
educationrn-asn
nursing specialtiesemergency, telemetry
as does recommending amoxicillin for a basic sinus? i assume you mean basic sinusitis? no antibiotic would be better.
the attending was "enraged"? really?
sorry, your story just does not add up.

with all due respect, my listed credentials on this website do not simply invalidate my point. an appeal to accomplishment is a basic logical fallacy.

for all you know i may or may not have advanced degrees in other academic areas (which are irrelevant to the discussion), and the lack being and np does not mean that i cannot critique and that my arguments lack substance. truly, if that were the case, and only members of a certain professional group could weigh in on topics concerning the said profession, it would be just a circle jerk of patting each other on the back.

in fact, i would go farther as to say my views are more objective in being a 3rd party and not muddled by emotional ties to my profession. and speaking without condescension, if i changed my allnurses about me to "mrmedical np-c, msn, b.sc., as, acls, pals, bls... ad infinium" maybe i would be taken more seriously?

to provide clarity to my story - as i mentioned was anecdotal - however did leave a sour taste in my mouth concerning np programs that spit out students like there is no tomorrow. furthermore, is it so far-fetched that a clinic in the inner city that sees hundreds maybe even thousands of uninsured patients 24/7 that an attending would get upset over overly lengthy exam times, nonindicated abx, or lack of basic clinical skills. they would just as readily rip apart interns and pa students for not knowing their stuff.

next time, address my argument and not my person. we are adults here capable of a rational discourse and if you present something that i did not consider or a different point of view, i have the humility to accept that my opinion may be wrong and needs to be reassessed: and i will admit to it. i hope that you have the audacity to act the same, and if not, please: save both of us from wasting time.

nomadcrna, DNP, CRNA, NP · Feb 24, 2012

If you were an NP, you would understand what may have been happening. So yes, you would be much more credible. AS it is now, you are an outsider looking on and making judgements that may or may not be true. No fault of your own, you just don't have the knowledge base. So your opinion may be objective but it is still not based on facts and knowledge.

"Objective issues are issues where the reality is whatever it is, regardless of whether we know about it, or whether we think about it. For example, I may think that no train is coming, so I walk across the railroad tracks, but then a train runs me over -- that means it was the objective truth that the train was coming, despite my incorrect belief to the contrary. "

If you want to argue FACTS, not an opinion not based on facts, find someone else. As it stands now, that facts are on my side.

1. "I feel that many of these diploma mills are pushing out providers that should not even be practicing in the first place yet have managed to matriculate because they have thrown enough dollars at the education.

Your personal opinion based wholly in your head. Not based on facts or evidence.

Do you have any evidence to support your premise?

Very much akin to what is happening on the RN level, you see a large influx of students paying good money to graduate as an RN from diploma mills yet objectively are clinically incompetent and are a danger with patients.

RN diploma mills? Clinically incompetent and are a danger to patients. Really?

yet due to the ease of accessibility by online schooling get to fulfill their fantasy of being an nurse. And while that's romantic is the sense that they get to fulfill their dreams, the frank and mean truth is that, there are many who for the sake of patient vitality should not be.

Online clinicals? This I would like to see. Once again, no facts at all. Just meaningless words.

This is why many MDs prefer PA's, because their education is much more comprehensive and consistent across the board that your average NP schools.

Once again, you have absolutely no knowledge of education and practice of PAs or NPs. Coming from someone who has done this for over 20 years, PAs and Nps are interchangeable. There are good and bad in both camps.

BTW, in primary care, physician, NP and PA are also interchangeable. Once again, ive seen good and bad in all three types of practitioners.

Having an associates degree and being an RN does not make you an expert on the knowledge base and practices of PAs and NPs.

Needless to say, the attending physician was enraged that these new grads could not palpate and identify the epicondyl or recommend Amoxicillin for a basic sinus: they were simply incompetent, and furthermore were down right dangerous to the patient - and they passed their boards.

Sounds like either the attending was incompetent for recommending amoxicillin for for "basic sinus" or it is what you think is appropriate, when it is actually not.

A new grad NP is just like a new grad RN. They need mentoring and have a huge amount of learning left to do. The same with PAs.

The moral of the story is 1) NP education needs to step up it's quality and consistency to be respected 2) needs to filter out the riff-raff, not everyone and their mom can or should be an APRN, and 3) Online programs need to be assessed for their efficacy and quality of instruction. 4) Not all online schools are poor, but many are popping up due to demand and oversaturate the market with many half-baked practitioners.

I just have to shake my head at the lack of critical thinking above.

1. Why do you think NP education needs to step up its quality? I actually agree on this point but for a different reason I'm sure.

2. Riff-raff? LOL

3. Every program, including distance education programs are assessed and accedidated before the students are allowed to sit for boards and get a state license. Seems you are unaware of this.

4. Programs don't just "pop up". See #3. You have a huge process that must be done to became a NP program.

It is hard to look in from the outside and not fully understand the issues. I understand this. I'd recommend going on beyond your basic education, get an advanced degree as a NP and you might look at things differently.

Running down others does not necessarily make yourself look better.

Cwiema · Feb 25, 2012

What about the fact that to complete an online DNP, one has to have 1000 hours of hands-on clinical experience with an MD or NP? I start my DNP program at Loyola, New Orleans this summer, so I'm harldly an expert, however I think clinicals is where I'll learn how to be an APN prior to actually becoming licensed and practicing.

jilljw · Feb 25, 2012

What about the fact that to complete an online DNP, one has to have 1000 hours of hands-on clinical experience with an MD or NP? I start my DNP program at Loyola, New Orleans this summer, so I'm harldly an expert, however I think clinicals is where I'll learn how to be an APN prior to actually becoming licensed and practicing.

My husband went through the military's PA school (IPAP). He previously had a BSN before getting his MPAS. He had over 2000+ hours of patient contact from the program. There was little his BSN did and 4 years of nursing in the ICU to prepare him for the military's PA school. Academically it was much more difficult, as he studied twice as much as I did for my ANP. I did brick and mortar. We went to undergraduate together and his grades were a lot higher than mine, so I know that it is not due to my superior intelligence. I also have to agree with my husband that my prior nursing experience did not provide any advantage to actually Dx and Tx pts. Should NP programs not demand more clinical hours? DNP programs with only 1000 hours. That is less than half of what my husband did for a masters program. I wish my program had more hours. I felt ill prepared in comparison to my husband after we finish our respective programs. I graduated my NP program with about 600 hours. That is is it. Maybe the military's PA program has higher standards than most. Irregardless I still feel that doctors learn during residency and midlevel practitioners learn during clinical rotations. Why not require a higher standard?

jilljw · Feb 25, 2012

My husband went through the military's PA school (IPAP). He previously had a BSN before getting his MPAS. He had over 2000+ hours of patient contact from the program. There was little his BSN did and 4 years of nursing in the ICU to prepare him for the military's PA school. Academically it was much more difficult, as he studied twice as much as I did for my ANP. I did brick and mortar. We went to undergraduate together and his grades were a lot higher than mine, so I know that it is not due to my superior intelligence. I also have to agree with my husband that my prior nursing experience did not provide any advantage to actually Dx and Tx pts. Should NP programs not demand more clinical hours? DNP programs with only 1000 hours. That is less than half of what my husband did for a masters program. I wish my program had more hours. I felt ill prepared in comparison to my husband after we finish our respective programs. I graduated my NP program with about 600 hours. That is is it. Maybe the military's PA program has higher standards than most. Irregardless I still feel that doctors learn during residency and midlevel practitioners learn during clinical rotations. Why not require a higher standard?

He did 2920 hours to be specific.

zoidberg, BSN, RN · Feb 25, 2012

agree fully with the last two. clinical hours need to be increased. and just to point out another issue in the angry person who was saying give everyone with a sinus infection amoxicillin... new research is finding there is no need to use antibiotics for that. and btw there is not just one epycondyl, there are multiple. you have more than one limb. i hope, if not i apologize in advance for being insensitive, though i doubt that is the case.

zenman · Feb 25, 2012

my husband went through the military's pa school (ipap). he previously had a bsn before getting his mpas. he had over 2000+ hours of patient contact from the program. there was little his bsn did and 4 years of nursing in the icu to prepare him for the military's pa school. academically it was much more difficult, as he studied twice as much as i did for my anp. i did brick and mortar. we went to undergraduate together and his grades were a lot higher than mine, so i know that it is not due to my superior intelligence. i also have to agree with my husband that my prior nursing experience did not provide any advantage to actually dx and tx pts. should np programs not demand more clinical hours? dnp programs with only 1000 hours. that is less than half of what my husband did for a masters program. i wish my program had more hours. i felt ill prepared in comparison to my husband after we finish our respective programs. i graduated my np program with about 600 hours. that is is it. maybe the military's pa program has higher standards than most. irregardless i still feel that doctors learn during residency and midlevel practitioners learn during clinical rotations. why not require a higher standard?

i'm calling really serious learning issues on this one. my teacher wife teaches a course on how to learn and she says she can teach a class on how to learn in geography class but finds that students can't transfer that knowledge over into learning english, for example. looks like she is correct.

as a nurses’ aid i learned about the hospital environment and everyone’s role in healthcare. i learned how to position patients and when i should move them. i learned more about medical “lingo” and the interactions among all the hospital personnel. i learned about how to give enemas and other procedures. i even took an ekg course and learned to read the new monitors we had installed in our little hospital. i learned all kinds of “stuff” from the respiratory and physical therapists. i always asked questions and kept my eyes opened. our general surgeon even let me into the or and had me assist him with procedures in the emergency room. there was much as a nurses’ aid that was of benefit in np school.

then i went back into the army as a medic. (do i really have to go into detail here as i’m sure you’re starting to get the picture.) i finished this year of training, got my lpn license, and challenged the california state board of nursing and passed. i then went to work in a level 3 er. again, i was exposed to many medical and traumatic emergencies and the meds and other treatments for them.

all through my long career i learned things that helped me in np school. a few examples are that i would notice what meds were given for certain conditions. i would try to second guess the physicians by diagnosing the patients and deciding what meds i would give them. then, i’d see what the physician did. i would listen to heart sounds or bowel sounds, for example, then notice what the physician found and how he documented it. i would ask the physicians why they did certain things. this is just a small sample but do you understand now that almost everything you learned prior to np school will help you in np school and after?

so, before i entered np school i had around 70,000 hours of experience. my np program was 700 plus hours. all my experience which also includes icu, med-surg, home health, psych, rehab, etc. prepared me for np school and to dx and tx patients.

i have no problem with the pa program as we would probably benefit from more clinical hours in np school, especially for those with little clinical experience. i even considered going the pa route once. however, and especially since i'm a psych np i wanted to specialize in one area and already had medical experience out the wazoo. i have worked with several paa and have had to teach them about psych, and that you do not automatically write orders to transfer a medical patient to psych just because they have been in a psych unit before. the patient is fine thank you and you can send them home when you're done with them.

even when i graduated from np school i considered each job as an extension of my clinicals. i tailored each job so i would get the experience i wanted. i now do inpatient psych, outpatient psych, and floor consults for hospitalists, intensivists, and ed physicians, all in the same hospital. so, i really think there's a problem if one thinks their prior experience didn't help in pa or np school.

zenman · Feb 25, 2012

duplicate post.

jilljw · Feb 25, 2012

duplicate post.

zenman, i am not implying the pa profession is better than ours. in fact, we really function the same. i am just advocating for more clinical hours. it better prepares practitioners for their first 1-3 years of experience. over time i think it all evens out and depends on the individual and their willingness to continue and expand their education base.

not sure how your observations from as a nurse helped you prepare for dx and tx. you observe things as a nurse, but as a practitioner you dx. these are two different perspectives. if you however were in the military you know that certain professions like an 18d or idc might gain applicable knowledge from past experience and education. these are two professions that are not available to civilians, so it is not applicable to the entire student population. additionally, psych is completely different than the other parts of medicine. completely different!