Are online ANP degrees destroying our credibility?

SHGR, MSN, RN, CNS · Feb 25, 2012

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!

I know I'm not really supposed to be in this discussion but Jill, I think you are missing Zenman's point completely, which was part of his point. Learning is learning. A person is a learner, or is not. All of your experience as a nurse, a healthcare worker, or as a person is a big part of that- not just the in-class time. Not just the clinical time. It starts long before "school" and continues long after "school."

jilljw · Feb 25, 2012

I know I'm not really supposed to be in this discussion but Jill, I think you are missing Zenman's point completely, which was part of his point. Learning is learning. A person is a learner, or is not. All of your experience as a nurse, a healthcare worker, or as a person is a big part of that- not just the in-class time. Not just the clinical time. It starts long before "school" and continues long after "school."

Learning is not just learning. Otherwise, why would we not put a time threshold on having enough hce and let someone sit for a national exam. Then let them Dx, Tx, Rx, etc. It is not to the same level. Dx the easy stuff, yes, not a problem with enough exposure. My mom can probably Dx some of the easy stuff. The issue comes into play with the "zebra conditions". Understanding how to Dx these uncommon conditions is what differentiates providers. It takes repetitive experience in a provider setting. You also have to be able to understand the "science" pathophysiology, so you can provide the optimal Tx for the different types of diseases. These things are not taught in nursing school. I have been working in a hospital for 12 years and have never seen a doctor/pa/np explain this stuff to a nurse w/o dumbing it down to a pt. level.

I do understand what he is saying. Just totally disagree. Being a nurse is so far away from being a midlevel and I won't even put a MD/DO in this category, because their experience and education so much more advanced. It is like saying that since I took several high school calculus classes it would qualify me to teach it. I have been exposed to teachers and saw how they explained things. Why go to college and get a teaching credential with a math degree? Would you entrust your child's education to a school full of non-post high school educated teachers? Maybe they had to retake a few grades and had more observational exposure to teaching. In fact maybe they were a teacher's aide. I feel that OJT in non-provider positions such as a medic, RN or anything else is not the same as being an actual provider. These are two very different things.

nomadcrna, DNP, CRNA, NP · Feb 25, 2012

Please stop using the term midlevel. We are not midlevels. Every NP organization has come out against that term. We provide the same level care as our physician counterparts. We are judged (peer review) in both court and medical community alongside our physician counterparts.

BTW, I applaud him. He is talking about building on his experiences. Much different than starting out with little to no medical knowledge.

I agree with him, btw.

studentdrtobe · Feb 25, 2012

Please stop using the term midlevel. We are not midlevels. Every NP organization has come out against that term. We provide the same level care as our physician counterparts. We are judged (peer review) in both court and medical community alongside our physician counterparts.
BTW, I applaud him. He is talking about building on his experiences. Much different than starting out with little to no medical knowledge.
I agree with him, btw.

I see nothing wrong with using the term mid-level provider. It doesn't say anything about the quality of care you provide, but it does give an idea of the level of training you have received. It's certainly not the highest level of training (MD/DO), so it's completely appropriate to use the term mid-level provider. It's common terminology in the clinic and I've never come across anyone in the real-world opposed to the term or offended by it.

Patti_RN · Feb 25, 2012

Good point, nomadcrna! I'm guilty of using that term, myself! Sheesh! As long as we lump ourselves BELOW physicians, we'll be thought of as having less expertise and lower competency.

I've heard some arguments in favor of changing the names of CRNAs and NPs taking the word 'nurse' out of the titles. I'm not sure how I feel about that as it seems to be a desire to discredit the roots of our education; but I see the point that as long as the word 'nurse' is part of a title, it possibly gives patients an erroneous impression of what NPs and CRNAs actually do.

zenman · Feb 25, 2012

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.

I'm not sure why you don't get this. You can dx all you want informally even while a nurses' aide, just not formally. I've been doing it all my life as I described. If you say "I think this patient has CHF and you think of the reasons why you came up with that you are diagnosing. Now, walk up to a physician and ask him, "Hey, is this CHF?"

zenman · Feb 25, 2012

Additionally, Psych is completely different than the other parts of medicine. Completely different!

Every patient you see is a "psych" patient, btw.

Aymese · Feb 25, 2012

In defense of my online MSN education!!:

I don't know about other online MSN programs, but in my ACNP program at the University of Alabama at Birmingham, we are required to come to campus for our midterms and finals in all 3 of the acute care theory courses. The exams are closed book/notes and proctored by a professor and camera monitored. 80% or greater is required to pass the courses. Students performed 5 OSCEs (on-site clinical evaluations in which we are video-taped in the med school mock clinic and assess, diagnose, and treat a patient with a specific cc) throughout the final 4 semesters of school. We also receive clinical site visits from faculty once/semester.

Like a previous poster mentioned, the reputation of the school I chose was extremely important in my decision to pursue my degree online. I would not have even looked at Walden, Phoenix, Kaplan, etc. Many physicians throughout my clinical rotations have regarded UAB to be a prestigious establishment for medical education. The School of Nursing takes pride in its reputation and holds its online students to high standards. Most of our video-taped lectures were from the MDs and ACNPs that work at UAB Hospital. Adv pharmacy was taught by Samford University school of pharmacy professors. Online live classroom sessions were taught by our professors and had supporting powerpoint and attendance is taken.

Finally, having standards for waiving the GRE if you achieve a certain GPA in undergrad should not devalue a degree achieved online.

You have to evaluate all aspects of the school you are choosing and be ready to back up the quality of your education for skeptics (understandably so).

I am glad you are taking advantage of the opportunities presented to you. I just think it would be interesting for a group of online students to be compared to resident students and look at their national certifying exam scores.
She does prove my point. If you told an MD/DO this story about looking up answers or even a PA they would laugh you out the room. It is much more difficult to not have a resource except for your brain to pass a test. It is not about teaching yourself (online) being harder, but what provides the best training and puts out the best product. If I couldn't remember something on a test I only had my best guess or got it wrong.
VICEDRN is right. My thoughts don't matter. Thankfully we have a powerful political lobby that affords us our rights regardless if there is a decline in standards!

prairienp · Feb 25, 2012

I see nothing wrong with using the term mid-level provider. It doesn't say anything about the quality of care you provide, but it does give an idea of the level of training you have received. It's certainly not the highest level of training (MD/DO), so it's completely appropriate to use the term mid-level provider. It's common terminology in the clinic and I've never come across anyone in the real-world opposed to the term or offended by it.

Do you call the optometrist a midlevel? a podiatrist? I am in the real world, consider me opposed and offended.

nomadcrna, DNP, CRNA, NP · Feb 25, 2012

Here ya go.So you see, it is insulting.

http://www.aanp.org/NR/rdonlyres/5AC2D9E3-74FA-4BF2-BF2F-1E424A62E516/0/AANPMLP.pdf

In October 2004, the American Association of Colleges of Nursing (AACN) published aThe American Academy of Nurse Practitioners (AANP) opposes use of terms such asposition paper focusing on the issue of converting the terminal degree for advanced practice“mid-level provider” and “physician extender” in reference to nurse practitioners (NPs) individuallynursing from the Master's to the Doctor of Nursing Practice (DNP) by the year 2015.or to an aggregate inclusive of NPs. NPs are licensed independent practitioners. AANPAACN convened two task forces consisting of AACN members to identify the "Essentials forencourages employers, policy-makers, healthcare professionals, and other parties to refer to NPsthe DNP", similar to the "Essentials" currently in use for nurse practitioner (NP) master'sby their title. When referring to groups that include NPs, examples of appropriate terms include:programs, and the "DNP Road Map" to propose a process for smoothly accomplishing thisindependently licensed providers, primary care providers, healthcare professionals, and clinicians.goal by 2015. The concept of a practice or clinical doctorate has been under discussion within the NP community since 2001 when the National Organization of NP FacultiesTerms such as “midlevel provider” and “physician extender” are inappropriate references(NONPF) established a task force to examine the issues from the NP educationalto NPs. These terms originated in bureaucracies and/or medical organizations; they areperspective. The American Academy of Nurse Practitioners (AANP) and the Americannot interchangeable with use of the NP title. They call into question the legitimacy of NPsAcademy of Nurse Practitioners Certification Program participated in these activities asto function as independently licensed practitioners, according to their established scopesthey have unfolded. In 2008, AANP facilitated the NP Roundtable, a coalition of NPof practice. These terms further confuse the healthcare consumers and the general public,organizations, to consider the current issues surrounding the DNP movement. The coalitionas they are vague and are inaccurately used to refer to a wide range of professions.published "Nurse Practitioner DNP Education: Certification and Titling: A Unified Statement" in June 2008.The term “midlevel provider” (mid-level provider, mid level provider, MLP) implies that the care rendered by NPs is “less than” some other (unstated) higher standard. In fact, the standard ofThe rationale for the shift in the academic preparation of nurses in advanced practicecare for patients treated by an NP is the same as that provided by a physician or other healthcarefocuses on several issues, including the observation that advanced practice nursing isprovider, in the same type of setting. NPs are independently licensed practitioners who providecurrently one of only a few health care disciplines that prepare their practitioners at thehigh quality and cost-effective care equivalent to that of physicians.1,2 The role was notmaster's rather than the doctoral level. Most licensed independent practitioners (LIPs) suchdeveloped and has not been demonstrated to provide only “mid-level” care.as podiatrists, psychologists, optometrists, pharmacists, osteopaths, medical doctors, and dentists are prepared at the clinical doctoral level. Moreover, it is clear that the course workThe term “physician extender” (physician-extender) originated in medicine and implies that the NPcurrently required in NP master's programs is equivalent to that of other clinical doctoralrole evolved to serve an extension of physicians’ care. Instead, the NP role evolved in the mid-programs. It is important, however, that the transition to clinical doctoral preparation for NPs1960’s in response to the recognition that nurses with advanced education and training were fullybe conducted so that master's prepared NPs will not be disenfranchised or denigrated incapable of providing primary care and significantly enhancing access to high quality and cost-any way.effective health care. While primary care remains the main focus of NP practice, the role has evolved over almost 45 years to include specialty and acute-care NP functions. NPs areThe following issues, therefore, will need to be addressed in order for the preparation ofindependently licensed and their scope of practice is not designed to be dependent on or anNPs at the clinical doctoral level to be developed in a logical and equitable fashion.extension of care rendered by a physician.1. The quality of the preparation of current master's and post-master's NP programs mustIn addition to the terms cited above, other terms that should be avoided in reference to NPsnot be compromised. NPs have demonstrated their skills in providing high quality careinclude "limited license providers", "non-physician providers", and "allied health providers". Theseto their patients regardless of gender, age or socioeconomic status. The conversion ofterms are all vague and are not descriptive of NPs. The term "limited license provider" lacksNP programs to offer a doctorate in nursing practice does not change that fact. NPsmeaning, in that all independently licensed providers practice within the scope of practice definedprovide safe, high quality care in all specialties and practice sites in which they areby their regulatory bodies. "Non physician provider" is a term that lacks any specificity byinvolved.aggregately including all healthcare providers who are not licensed as an MD or DO; this term could refer to nursing assistants, physical therapy aides, and any member of the healthcare team2. The transition to the new title must be handled smoothly and seamlessly, so that there isother than a physician. The term "allied health provider" refers to a category that excludes bothno negative impact on NP practice and sound patient care, and to maintain parity.medicine and nursing and, therefore, is not relevant to the NP role.

I see nothing wrong with using the term mid-level provider. It doesn't say anything about the quality of care you provide, but it does give an idea of the level of training you have received. It's certainly not the highest level of training (MD/DO), so it's completely appropriate to use the term mid-level provider. It's common terminology in the clinic and I've never come across anyone in the real-world opposed to the term or offended by it.

jilljw · Feb 26, 2012

Here ya go.So you see, it is insulting.
http://www.aanp.org/NR/rdonlyres/5AC2D9E3-74FA-4BF2-BF2F-1E424A62E516/0/AANPMLP.pdf
In October 2004, the American Association of Colleges of Nursing (AACN) published aThe American Academy of Nurse Practitioners (AANP) opposes use of terms such asposition paper focusing on the issue of converting the terminal degree for advanced practice“mid-level provider” and “physician extender” in reference to nurse practitioners (NPs) individuallynursing from the Master's to the Doctor of Nursing Practice (DNP) by the year 2015.or to an aggregate inclusive of NPs. NPs are licensed independent practitioners. AANPAACN convened two task forces consisting of AACN members to identify the "Essentials forencourages employers, policy-makers, healthcare professionals, and other parties to refer to NPsthe DNP", similar to the "Essentials" currently in use for nurse practitioner (NP) master'sby their title. When referring to groups that include NPs, examples of appropriate terms include:programs, and the "DNP Road Map" to propose a process for smoothly accomplishing thisindependently licensed providers, primary care providers, healthcare professionals, and clinicians.goal by 2015. The concept of a practice or clinical doctorate has been under discussion within the NP community since 2001 when the National Organization of NP FacultiesTerms such as “midlevel provider” and “physician extender” are inappropriate references(NONPF) established a task force to examine the issues from the NP educationalto NPs. These terms originated in bureaucracies and/or medical organizations; they areperspective. The American Academy of Nurse Practitioners (AANP) and the Americannot interchangeable with use of the NP title. They call into question the legitimacy of NPsAcademy of Nurse Practitioners Certification Program participated in these activities asto function as independently licensed practitioners, according to their established scopesthey have unfolded. In 2008, AANP facilitated the NP Roundtable, a coalition of NPof practice. These terms further confuse the healthcare consumers and the general public,organizations, to consider the current issues surrounding the DNP movement. The coalitionas they are vague and are inaccurately used to refer to a wide range of professions.published "Nurse Practitioner DNP Education: Certification and Titling: A Unified Statement" in June 2008.The term “midlevel provider” (mid-level provider, mid level provider, MLP) implies that the care rendered by NPs is “less than” some other (unstated) higher standard. In fact, the standard ofThe rationale for the shift in the academic preparation of nurses in advanced practicecare for patients treated by an NP is the same as that provided by a physician or other healthcarefocuses on several issues, including the observation that advanced practice nursing isprovider, in the same type of setting. NPs are independently licensed practitioners who providecurrently one of only a few health care disciplines that prepare their practitioners at thehigh quality and cost-effective care equivalent to that of physicians.1,2 The role was notmaster's rather than the doctoral level. Most licensed independent practitioners (LIPs) suchdeveloped and has not been demonstrated to provide only “mid-level” care.as podiatrists, psychologists, optometrists, pharmacists, osteopaths, medical doctors, and dentists are prepared at the clinical doctoral level. Moreover, it is clear that the course workThe term “physician extender” (physician-extender) originated in medicine and implies that the NPcurrently required in NP master's programs is equivalent to that of other clinical doctoralrole evolved to serve an extension of physicians’ care. Instead, the NP role evolved in the mid-programs. It is important, however, that the transition to clinical doctoral preparation for NPs1960’s in response to the recognition that nurses with advanced education and training were fullybe conducted so that master's prepared NPs will not be disenfranchised or denigrated incapable of providing primary care and significantly enhancing access to high quality and cost-any way.effective health care. While primary care remains the main focus of NP practice, the role has evolved over almost 45 years to include specialty and acute-care NP functions. NPs areThe following issues, therefore, will need to be addressed in order for the preparation ofindependently licensed and their scope of practice is not designed to be dependent on or anNPs at the clinical doctoral level to be developed in a logical and equitable fashion.extension of care rendered by a physician.1. The quality of the preparation of current master's and post-master's NP programs mustIn addition to the terms cited above, other terms that should be avoided in reference to NPsnot be compromised. NPs have demonstrated their skills in providing high quality careinclude "limited license providers", "non-physician providers", and "allied health providers". Theseto their patients regardless of gender, age or socioeconomic status. The conversion ofterms are all vague and are not descriptive of NPs. The term "limited license provider" lacksNP programs to offer a doctorate in nursing practice does not change that fact. NPsmeaning, in that all independently licensed providers practice within the scope of practice definedprovide safe, high quality care in all specialties and practice sites in which they areby their regulatory bodies. "Non physician provider" is a term that lacks any specificity byinvolved.aggregately including all healthcare providers who are not licensed as an MD or DO; this term could refer to nursing assistants, physical therapy aides, and any member of the healthcare team2. The transition to the new title must be handled smoothly and seamlessly, so that there isother than a physician. The term "allied health provider" refers to a category that excludes bothno negative impact on NP practice and sound patient care, and to maintain parity.medicine and nursing and, therefore, is not relevant to the NP role.

Then take the USMLE I & II. Pass the medical boards. Then you will prove that your education is substantial enough not to be labeled a mid-level provider. You are a health care provider. A medical practitioner. We are not MD/DO, to raise yourself to this level is a hoax. Don't confuse reality with political antics. Our profession has a very strong union lobby that affords us many very cushy rights. It sounds like buyers remorse. I like being a mid-level and understand our importance in the healthcare profession. In addition, I understand our limitations. Medical school is still available to anyone who qualifies and is willing to commit to the social and financial sacrifices.

jilljw · Feb 26, 2012

I'm not sure why you don't get this. You can dx all you want informally even while a nurses' aide, just not formally. I've been doing it all my life as I described. If you say "I think this patient has CHF and you think of the reasons why you came up with that you are diagnosing. Now, walk up to a physician and ask him, "Hey, is this CHF?"

You can also Monday morning quarterback NFL games all day long. It still does not properly prepare you to get on the field and play the actual role.