Clarification on NP Curriculum?

Oldmahubbard · Feb 4, 2018

I couldn't answer for everyone, but I am an MSN prepared NP. Anatomy and Physiology is taught at the basic RN level, then there is a second course of pathophys at the BSN level and then a third course at the MSN level which is very similar.

Microbiology and chemistry are only at the basic RN level. There is no specific biochem or immunology that I recall.

I know what you are thinking, and yes, NP education needs a large upgrade. There are a couple of nonsense courses that should be entirely eliminated.

Some of the more expensive schools arrange clinical sites. A large part of the time, the student will be on their own.

Based on my experience, she should not expect that school is going to prepare her for the role.

I went to a respected brisk and mortar program years ago, but I consider myself almost entirely self-prepared.

DO_question · Feb 4, 2018

Thank you Oldmanhubbard,

I see you generally understand my concerns!

Do you work in a primary care office? Or inpatient setting?

As far as education standards go, I know all diligent students in their disciples can see flaws, so I won't pick on NPs for that. I do however have a followup Q; How long did you work as a RN and to what extent do you feel that experience impacted your knowledge going into the program?

More specifically, how applicable did you feel RN experience was toward provider experience?

I know the original premise was to take seasoned nurses, but today and in this case it is frequently nurses with

Lastly, thank you so much for seeing this as just a guy trying to be helpful to his girlfriend. I've seen too many of these posts turn into some flame war on the interwebs.

Oldmahubbard · Feb 4, 2018

My specialty is Psych. I worked as an RN for about 7 years, becoming more and more interested in the PMHNP role, then I found work as an RN at an outpatient mental health clinic, which I did for 5 years while attending NP school. I also worked at an assisted living program where the majority of the residents were long term psych patients. My state has gotten out of that expensive business, for the most part, closing the beds. As a result, many people who would previously have been in psychiatric hospitals are now in long term care facilities.

The experience was indispensable. There is no way that a few hundred clinical hours could have prepared me. I prepared myself, by doing extensive independent study and research almost every night when I came home from work.

After graduation, I worked in an inpatient forensic setting for about 13 years. Yes, inmates, and most were either playing a game or very mentally ill. Lots of learning opportunities there, a great experience overall.

Now I am a consultant in the LTC setting. I go to 7 different nursing homes.

Regarding people who become NPs with little or no RN experience, I don't have very much of an opinion, because there are so many variables.

With the exception of Psych NP's, who definitely need relevant RN experience. In my opinion.

Advanced Practice Columnist / Guide · Feb 4, 2018

I also did a Master's degree but with an Adult Acute Care specialization, not FNP. I have years of experience as an RN at the bedside in tele, ICU, and ED prior to starting my program and I have been working as a Critical Care NP for 13 years.

NP programs regardless of specialty all require 3 P's (Pharmacology, Pathophysiology, and Physical Assessment) in the program which is typically completed in the first year prior to clinicals. Clinical rotations are specialty specific and come with a didactic component. We had a year of clinical rotations covering all body systems in the ACNP program. Our clinicals allowed flexibility in specialty placements but many ACNP programs require a semester of Hospital Medicine rotation. Critical Care, Cardiology, ED were popular rotations for many ACNP students.

My RN background helped in my program in that I am already familiar with the hsopital milieu and who's who and what the different health care roles and specialties are. I already knew a wide range of diagnostic tests and procedures having cared for patient who were having these tests and what the results mean in terms of what to expect the providers will order. I have also given enough medication including ICU drips to know what they are used for so that really made it easy to remember the basics of Pharmacology when I was learning the concepts again as a Master's student.

What my program helped me with is going a bit deeper on the evidence behind the use of medications and tests, what the guidelines tells us as providers, and how to use an organized thought process on weighing risks vs benefits that I never really had to worry about as much as a bedside nurse. Also, as a nurse, I have a good idea what physical examination findings would look like as nurses routinely assess patients, the NP program helped me focus in on tying together that patient presentation into a unifying syndrome that could lead to possible diagnosis which I also never practiced or paid much attention to as a bedside nurse.

A lot of the fine tuning in the role such as being more efficient, being more elegant in my choices of therapy and how to adjust doses accordingly, and procedures (central lines, arterial lines, sedation management, etc) were things that I was taught basics on as an NP student but got to practice more and develop as a skill in depth on the job.

DO_question · Feb 5, 2018

Juan,

Can you talk to me more about what procedures you do in the ICU? How is the team dynamic in that ICU? Are there residents? There's variety in how I've seen NP/PA used in the ICU so I would love to see how you guys do it.

Were you trained in these procedures during your training or only after?

Guys, great info. Thank you again.

babyNP., APRN · Feb 5, 2018

I would respectfully suggest that it might be more appropriate for your significant other to be doing this kind of research and asking her own questions...

The one thing I would caution her on is her motivations for doing FNP. It's a common trend for everyone to think that you can work anywhere if you're a FNP, but this is not the case and she will not be prepared well if she does this. It's like the saying, "jack of all trades, master at none." The Consensus Model also means that more and more states are following its rules, which will disallow FNPs from working in-patient and relegated to out-patient work.

Does she want to work with adults or kids? In patient or out patient? She should do some soul searching on this and will be a much better prepared NP if she is actually trained in the area in which she would like to work.

If you're curious, I work in a NICU exclusively. I had 6 years of RN experience at a Level IV NICU (for NICU, Level IV is the highest unlike Level I for trauma centers) and went to a brick and mortar school with an excellent reputation. The combination of high acuity experience and an excellent school that placed my clinical sites allowed me to bridge over to the provider role without much difficulty. I also had a 4 month new graduate orientation that is pretty standard in my field of work. In the NICU at our community Level II/III sites, I bill for my own admits, discharges, and procedures. I do pretty much any invasive procedure that a neo would do from intubation to chest tubes to central line placement, etc etc. The only thing I would probably not do would be a pericardiocentesis...that sounds scary as F although one of our neos rightfully pointed out, "well, babyNP, no one can really be credentialed on it, we may never do it on a live patient in our career!"

In a Level IV NICU (where I did work for a couple of years as a new NP), the role was similar but we did not bill because there was an in-house neo 24/7 and would get a higher reimbursement rate. We worked more in a role of a resident and rounded, wrote daily notes, troubleshooted problems throughout the day, although did not need as much oversight. In my community site, the neo bills for daily progress notes and any admits while here but then after she/he goes home, I do my own billing.

DO_question · Feb 5, 2018

Respectfully, I'm sure she will ask her own questions. This, as I stated, is to better educate me since she values my input (as I do her's).

She's setting up a variety of shadowing experiences before committing to anything. I'm sure what she learns shadowing will be the info she needs, this is just me wanting to reduce my ignorance.

SpankedInPittsburgh, DNP, RN · Feb 5, 2018

Yeah I'm getting ready to graduate from a respected bricks & mortar school with a DNP. I do believe that many of the courses that you describe you be taught again at a provider level of learning and that NP education needs a vast overhaul. However, that is not the reality of the situation and being an NP will require quite a bit of self-learning I believe. I'm an FNP student and in my hospital system it almost certainly means that I'll be working in the hospital. I don't know if that means I'll need additional credentialing or education at some point but almost all of our NPs are FNPs where I work. I also think more specialized training to fit whatever the role the NP will be filling is a great idea. I wish your significant other the best of luck

ACNP-Ray · Feb 5, 2018

I graduated from Texas Tech's Adult/Geri Acute Care NP program after having been an ICU/CCU/ER nurse for 10 1/2 yrs. I was trained in school to do central and art lines as well as lumbar punctures. Spent an entire day at my clinical site going from OR room to the next just doing intubations. On the job as far as getting privileges I had to be again precepted with another provider doing 15 intubations, 10 central lines, 15 art lines here in Dallas. The NP's usually run the night shift in the ICU but we can call a resident or our attending if we need to.

As to the type of NP she wants to be I can tell you it was difficult at first after graduation to get a hospitalist or ICU position due to not having the NP experience. So even though I'm acute care, I had to take some clinic/Internal Med jobs just to get a paycheck and get some experience behind me as an NP. FNP's on the other hand tend to have it a bit easier to find a job because a lot of docs don't mind training them right out of school in primary care. I have considered going back for my FNP to make myself more marketable and be dual certified. Also it depends on the kind of money she wants to make. I know I'm going to step on some toes here but at least here in TX I've seen FNP's being paid far less than what I make in the hospital. I made well over 160k last year working both as a hospitalist and part time as an intensivist whereas I don't know a lot of FNP's making over 115K This is also dependent on where in the country you two will end up being either for your residency or where you finally decide to live. Just my 2 cents, hope it helps.

DO_question · Feb 5, 2018

ACNP-guy,

That credentialing makes sense, same situation residents go through. So it's not a closed ICU? Hmmm I thought there would be a bigger market for acute care. Were your clinical rotations broken up between various ICUs or in a specific type (MICU, SICU, CVICU, etc)? How many hours did you do total?

SpankedInPittsburgh,

Thanks! She will do well in whatever she chooses. Good to hear a wide variety there.

Jules A, MSN · Feb 5, 2018

Respectfully, I'm sure she will ask her own questions. This, as I stated, is to better educate me since she values my input (as I do her's).

To be honest I thought the same thing as BabyNP and was hoping your girlfriend wouldn't think you are being intrusive.

The opinions I can offer are that for me personally my inpatient psychiatric RN experience was invaluable both due to the first hand experience I gained with medications and presentations as well as the professional contacts I made which had a significant impact on my opportunities and income.

Clinicals may or may not be set up for her, I'd suggest she vet and chose her own physician preceptors. You learn to practice based on your mentors and I have seen preceptors who are horrible train new NPs who's prescribing I can recognize by the meds they order. Perhaps you can assist her with contacts and also textbooks etc.