I'm deciding whether or not to go the PA or NP route. Yes, NP will have the doctorate level soon. So what. It really means little to me if NP programs are producing incompetent DNPs while PA programs produce competent PA-cs.
My wife is an NP. She had a crap education, crap clinicals, and really wasn't ready to practice once she graduated. This is a nationwide trend. A few months back, I heard top officials on NPR talking about this... they were aware programs nationally provide crap for competency and produce new grad NPs who are incompetent, but they're 'working on it'. This seems to be the case for my undergraduate nursing education, but that is another post alltogether.
So, my question is, is anyone aware of any COMPETENT NP programs in the West/Midwest (i.e. Colorado, Wyoming, Arizona, North and South Dakota, Montana, Oregon)?
This is why I'm considering PA school as well. I've heard TONS of NPs say their PA counterparts got much better training. I'd rather not deal with the incompetency, inadequacy and down right unsafe education I have received again.
Suggestions on competent programs that produce functional NPs?
I just want to make a point here without jumping into the fray: OP, perhaps you are offending without realizing it. You seem to be making a mistake that I made when I joined AN in that, you speak with authority but really are not in a position to. Having second hand experience in this through your wife and being a first year nursing student is hardly grounds on which to make a stand. Perhaps your wife's education was "crap", but the truth is education is what you make it. If she felt her school was not giving her what she needed she should have spoken up or supplemented her education herself. Harvard and Yale graduate idiots everyday. Education is what one makes of it. I don't know you or your NP wife, but I do know that your approach here is all wrong. A great NP or PA school is not going to make great NP's or PA's; they make themselves to a large degree. Your background and exposure to nursing at this point is a combination of the anecdotal and academic. The truth is "ain't nothing like the real thing baby!" Get some real nursing experience YOURSELF before you take such a strong stance on things. Again, not a shot at you or your wife, just the simple truth. My post here were hot and heavy for a while until I almost choked on humble pie at work. Now, I hope my posts will still have passion, just with a lot more common sense behind them. Bottom line? You really are in no position to make some of the statements you have made. Your words are indeed without a REAL knowledge base and do come off as dismissive of nursing, whether you intended that or not. Yes I know you are nursing STUDENT, and just because "my best friend is a....." (or wife) doesn't give you license to disrespect nursing as your tone suggests. Just a little advice. Nursing is not for everyone. Maybe your wife's institution did fail her. Either way, the two of you have some inward decisions to make. Know this: Good nurses take what they have been given and work wonders with it. They don't wait for someone to "give" it to them, whether that be in the form of education or not. Education, as is Nursing, as is life, is what YOU make of it.
As a new provider you face a depth of knowledge unlike ever experienced. The most important thing you should ask yourself is how your 1st job as a NP/PA will help develop you into a COMPETENT, EXPERIENCED provider.
Clinical inertia and clinical acumen are the ying and yang of medicine. You develop these two only through EXPERIENCE. Improving on those two concepts each and every time you treat a patient is what makes a provider competent. You can't be competent without experience. And you certainly can't get that experience in "school" or by arm chair quaterbacking.
My advice to you is go the PA route. So when you crash and burn your first time out as a provider you spare the nursing profession for your shortcomings. We all have them. We all crash and burn.
Some just do it more spectacularly than others.
TX RN, that is why I am in favor of residencies/fellowships for NPs, PAs too for that matter. PA and NP programs were originally intended to address the shortage of primary care providers. Now that NPs and PAs are specializing in practice in all things from CV surgery to oncology, additional training (in the form of clinical experience) may well be warranted. I've certainly noticed a prevalence of job postings for PAs in specialty areas that require experience or the completion of a residency.
Bsnanat 2, you've made some excellent points. I would also like to add that some people spend more time trying to decide which car to buy than what graduate program to attend. How many posts have we seen on this board asking for the cheapest NP program? I bet they far outnumber the posts looking for the best NP programs.
Many people told me "we all take the same certifying exams in the end" when I was looking for programs to apply to. A coworker who just finished his ACNP at one of the cheapest programs (a state school) told me that if he had it to do all over again, he would have relocated to attend a program that had a structured clinical placement program instead of an online program where he was required to piece together his clinicals. I didn't apply to that program. A couple of intensivists recommended that I attend a program affiliated with an academic medical center that routinely utilizes ACNPs to ensure that my clinical education and experiences would be robust. I took their advice to heart and applied to schools that fit the bill. I was open to relocating. My program isn't cheap, but they have an excellent reputation and 100% board pass rate. Their graduates are employed at some of the best hospitals in the country and they will assign my clinical placements. I travel 90 miles each way every Wed. for class and will have to travel for clinicals as well if I don't sell my house by then, but it is worth it to me.
Some people also want to complete a FNP program (to be more marketable) and expect to be able to specialize in anything with on the job training. These same people complain about their lack of training.
As evidence of what you're saying, I have noticed an influx of nursing students who have previous BS or Master's degrees in other subjects. Many admit to not having thought too much about their previous path and I often wonder how well-thought-out the nursing decision is too. We live in a world where everything is someone else's fault. Even when someone else doesn't do what they should, we have an individual obligation to make sure we do our part. There seems to be no argument that some NP programs are not up to par, but the question is, what do we do about it? Keep applying to these programs and keep coming out as incompetent grads? Or take the bull by the horns and supplement with questions and honest feedback to the program? When programs depend on you to come up with clinical assignments, don't wait until the last minute and go with whomever you can get. Instead, why not begin well in advance by giving serious thought to the quality providers where you live? How about a larger facility within a few hours drive? Many simply don't ask and want everything just done for them. I would say that, unless something changes, these are the same people who drop out of practice after a few years because they are not satisfied or things didn't turn out they way they thought. It amazes me sometimes that people who either are in advanced practice or pursuing it, post questions that can be answered with basic research. Yes, ask questions about perspective, experience or complex/obscure things, but not questions that can be answered by YOU reading YOUR state's practice act. We, as a profession, have to take the responsibility to be professional and accountable to ourselves and one another.
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
tx rn, that is why i am in favor of residencies/fellowships for nps, pas too for that matter. pa and np programs were originally intended to address the shortage of primary care providers. now that nps and pas are specializing in practice in all things from cv surgery to oncology, additional training (in the form of clinical experience) may well be warranted. i've certainly noticed a prevalence of job postings for pas in specialty areas that require experience or the completion of a residency.
i'm not sure which part of my post you reference to as validating your opinion.
in regards to your observation of specialty mid-level positions, pa's/np's should apply to positions which they feel qualified to fill. requiring residency training in np programs is not the answer. start off with a uniform and nationally recognized practice act discussion and you have my attention. the fragmentation of np practice regulations should be addressed first.
you seem to be analytical in your response and better suited to undertake a serious discussion in np training and practice. you're training to be one and will be there soon. the point being made to the op is better left to a quote i heard many years ago in my own search for "knowledge."
"the highest form of ignorance is when you reject something you don't know anything about."
TX RN, I was referring to your statement that experience makes a better provider and that we often don't get that experience in school. I apologize if I misunderstood the intent of your post.
Some have better clinical experiences than others. I'm not sure residencies should be mandatory but I support having them as an option to supplement the education I will receive in school.
I wonder if we will ever have a national practice act for NPs since each state is left to run their own medical and nursing boards.
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
CCRNDiva, no need to apologize. I know posting comments on internet boards leave subtleties and nuances from an otherwise friendly tone out and my reponses may seem abrasive. In an effort to keep responses concise I keep things short and to the point.
Not sure if you have heard of the concept of clinical inertia. Not sure if the OP has either. Many providers (NP, PA and MD's alike) struggle with clinical inertia in treating some very common conditions. Sometimes this leads to frustration or feelings of clinical inadequacy. It's not a concept that is "handled" and resolved with more training. Clinical inertia is part of the package of being a provider. You must recognize it, embrace it and only by experiencing it does one become better. Wash, rinse and repeat day in and day out.
The crux of the argument by the OP is hearsay and through what he "heard" on NPR. I would really like to see the transcript of the ANA shooting themselves in the foot by allegedly conceding ground on NP's receiving inadequate training.
BTW, NO, CNA experience doesn't count. Just thought I'd throw that out there.
It is NOT the ANA, but the IoM, College nursing leaders affiliated closely with the ANA.
2.) This is a NURSING forum... what did you expect, kudos for an inflammatory post?
3.) It doesn't matter if you have your doctorate in biophysics.... it's not nursing. But I can see how the previous post was knocking your ADN edu-ma-cation...
4.) CCRNDiva actually answered your question.... and it only took 5 pages. YAY!
5.) The idea that education is solely up to the student is a wheel barrel full of bull feces... it is a combination of a good teacher/institution and a hard-working student. To say it is solely the student's responsibility is bull pooey.
You could have worded it better... and people could have taken it better too. You did get your answer kind of though. There in the East (where I saw a previous post of you living), are many schools that fit the bill that CCRNDiva posted... though even a flowery, sugar-coated post would likely inflame someone. Such is life.
I give you props for thinking about your future education now. Why people gotta hate about you planning? I work at a hospital where the nurses get an attitude if you're an ADN going for your BSN, or your BSN going for your MSN or DoN... it's kinda like all those CRNA forum posts of ICU nurses hating 'cause another ICU-RN is going to CRNA school... education in any form is a path to enlightenment. It DOES matter who your teachers are, but also on the student.
Perhaps a better topic: What NP school did you go to, why?, what where the pro's/con's versus other forms of education (PA), what factors did you consider? what would you change, and what would you keep?
See? It allows actual NPs to be angry, or pleased and you get to find out about the actual subjects (schools) rather than this posts subjects (p is sed off nurses).!
bsnanat2
268 Posts
I just want to make a point here without jumping into the fray: OP, perhaps you are offending without realizing it. You seem to be making a mistake that I made when I joined AN in that, you speak with authority but really are not in a position to. Having second hand experience in this through your wife and being a first year nursing student is hardly grounds on which to make a stand. Perhaps your wife's education was "crap", but the truth is education is what you make it. If she felt her school was not giving her what she needed she should have spoken up or supplemented her education herself. Harvard and Yale graduate idiots everyday. Education is what one makes of it. I don't know you or your NP wife, but I do know that your approach here is all wrong. A great NP or PA school is not going to make great NP's or PA's; they make themselves to a large degree. Your background and exposure to nursing at this point is a combination of the anecdotal and academic. The truth is "ain't nothing like the real thing baby!" Get some real nursing experience YOURSELF before you take such a strong stance on things. Again, not a shot at you or your wife, just the simple truth. My post here were hot and heavy for a while until I almost choked on humble pie at work. Now, I hope my posts will still have passion, just with a lot more common sense behind them. Bottom line? You really are in no position to make some of the statements you have made. Your words are indeed without a REAL knowledge base and do come off as dismissive of nursing, whether you intended that or not. Yes I know you are nursing STUDENT, and just because "my best friend is a....." (or wife) doesn't give you license to disrespect nursing as your tone suggests. Just a little advice. Nursing is not for everyone. Maybe your wife's institution did fail her. Either way, the two of you have some inward decisions to make. Know this: Good nurses take what they have been given and work wonders with it. They don't wait for someone to "give" it to them, whether that be in the form of education or not. Education, as is Nursing, as is life, is what YOU make of it.