Difficulty of NP education

Jules A, MSN · Nov 5, 2015

Other than advanced patho which I found challenging likely because it had been decades since I had taken A&P my opinion is that NP school was ridiculously easy and I went to decent brick and mortar schools. Once I got past my ADN the rest of my nursing education was fairly lack luster.

I think there should be a minimum of 2 years of RN experience, additional pharmacology and a reduction of the multitude of nursing fluff courses. The number of schools offering NP now combined with the minimal nursing experience new grads seem to have is going to likely either require fellowships or our outcomes will suffer, imo.

studentFNP16 · Nov 5, 2015

Thank you for your reply. I completely agree with you that for new graduates whom have had only a few years of RN experience should undergo a fellowship/residency of some sort. We have a duty to our patients and at the end of the day we are responsible. Mandating a minimum requirement of two years should definitely be implemented. I personally don't know anyone who hasnt been a nurse for two years in my program.

Furthermore, I agree that any master's level education should be rigorous. Mine has personally has. I find myself studying 10 hrs per day on top of trying to manage 20+ week clinicals. Nurse Practitioner education should be more difficult (of course in a different way) than you previous degree in my opinion. Would it be fair to assume that PA education and MD education is more rigorous than nursing school, we should expect the same. Thanks for the reply Jules!

sauce · Nov 5, 2015

At least the initial post says for only people who have graduated to respond, so the seemingly large crowd of all knowing np hopefully shouldn't chime in on this topic and say that nurse practitioner school is equal to med school and all of this other ridiculous stuff they like to say.

But no basically its not adequate, not hard, doesn't completely prepare us clinically, and our board exam is a lol.

How can one be prepared to deal with such a variety of diseases in a 2 to 3 year program with like 500-600 clinical hours?

That's right you can't.

allnurses Guide · Nov 5, 2015

studentFNP16 said:
This is a topic for those whom have already graduated Nurse Practitioner school; what was your experience? Did you find NP school to be more difficult, as difficulty, or less difficult than nursing school?
-Do you think we are doing enough to prepare future NP to practice safely
-What are your recommendations for the standards we should be held accountable to

Curious, is this for a school assignment of for personal knowledge?

I am not sure whom you refer to with the "we". My personal opinion is that some programs have produced quality NPs for decades and they continue to do so. Unfortunately there are programs now that I have concerns about, though I have limited interaction with those programs and haven't seen any data on it. II also have concerns about the trend towards not securing preceptors. There are concerns about the current system from my perspective. I also know there are good quality programs out there.

I think we need more research honestly. Find out which programs and which individuals are successful and why then make sure accreditation requires these features. I also think there needs to be more research about the role of RN experience because the extant data is limited and in fact favors less rather than more.

PG2018 · Nov 5, 2015

Nothing about either undergraduate or graduate (NP) nursing was difficult. However, the amount of paper writing and research involves makes it more akin to majoring in history or English. Particularly, the assigned paper topics are laughable, i.e. assess a community (why), compare and contrast nursing theories (who cares), promote a goal of Healthy People 2020 (clinicians don't read this), research a topic of interest and approach an entity about a policy related to that topic and draft a change to that policy and try to motivate them to adopt your policy (not happening), etc.

Are we being prepared sufficiently? Nope or at least not institutionally. Compared to physician residency training, which includes a lot of assigned reading and conferences, NP training is deficient in both content and required hours work. The scientific training of most nurses is nil.

Jules A, MSN · Nov 5, 2015

PsychGuy said:
research a topic of interest and approach an entity about a policy related to that topic and draft a change to that policy and try to motivate them to adopt your policy (not happening), etc.

Dude if you did this I think you completed your DNP capstone project, especially if it was on something as complex as handwashing, LOL. Going forward we will need to start calling you Dr. PsycyGuy.

sauce · Nov 5, 2015

Ill be content if they add in a pure biochemistry class, physiology (not this pathophysiology mixed stuff, i mean you need to learn how stuff is SUPPOSED to work before you learn about the problems associated with the body..... and undergrad A and P was laughable also) and add more clinical hours. In pharm they teach you what such and such medicine works on such and such receptor, but unfortunately before pharmacology you never heard of that receptor, so its useless information unless you take the time look it up yourself. Plus if you don't understand the different types of receptors and how medicines interact with them (one week of pharmacodynamics and kinetics don't cut it) your basically throwing medicine at people that you assume just floats into the cells and fixes stuff.

And people try to argue that writing papers is better learning than tests. FALSE. And do not try to use blooms taxonomy to try to refute this. Writing papers only helps if you are interested in writing papers, then you learn, but like Psychdude said, we are providers not english teachers with a minor in nursatology. Test, test test test test, multiple choice tests out the rear, then they can elaborate to preceptors in clinical to verify their understanding. You can word questions to test understanding of concepts, not just rote memorization also, unfortunately most nursing professors don't know this. We should at least have been provided 5000 multiple choice questions prior to graduation. Pound that information vigorously into our brains, so even those not interested in learning are forced to. That will weed out the weak and make the lazy still have to kick butt to pass. Make it hurt, make it burn, make it painful so only those who really want to do the job can make it through. If we are gonna make 6 figures, then we should get vicariously mentally demolished by the amount of information provided. NO PAIN NO GAIN.

Add in biochemistry, physiology, 1000 clinical hours, two step board exam (one basic science based, one clinically based) and we will have competent providers.

Regarding nursing experience. One year, thats it, the transition between RN to APRN is so great too much rn experience can hurt some people, but you need at least a year to make sure you can at least function as a human in public.

allnurses Guide · Nov 5, 2015

sauce said:
Ill be content if they add in a pure biochemistry class, physiology (not this pathophysiology mixed stuff, I mean you need to learn how stuff is SUPPOSED to work before you learn about the problems associated with the body..... and undergrad A and P was laughable also) and add more clinical hours.
Add in biochemistry, physiology, 1000 clinical hours, two step board exam (one basic science based, one clinically based) and we will have competent providers.
Regarding nursing experience. One year, thats it, the transition between RN to APRN is so great too much RN experience can hurt some people, but you need at least a year to make sure you can at least function as a human in public.

The program I went to and work with required organic Chemistry, biostats, and physiology as well as the traditional prereqs, so often I forget bother programs don't. If nothing else it would be a rate limiting step for programs.

I also think that preceptors need to be more criticaland at least fail out those that can't function as humans.

I honestly hate the "year experience" when they are doing that year while taking graduate courses/clinics. I feel it makes them a crappy novice RN and a crappy student NP. If programs require 1+ years before graduating asan NP, make the students take a break from school.

Jules A, MSN · Nov 5, 2015

BostonFNP said:
I also think that preceptors need to be more criticaland at least fail out those that can't function as humans.

This recently happened at a local program and trust me someone has to be extremely incompetent for a preceptor to even want to go through the hassle of failing them and this student just restarted with another preceptor the next semester.

allnurses Guide · Nov 5, 2015

Jules A said:
This recently happened at a local program and trust me someone has to be extremely incompetent for a preceptor to even want to go through the hassle of failing them and this student just restarted with another preceptor the next semester.

I put my students through their paces. I have only failed a few but I am honest with them and don't hesitate to get their program faculty involved. I am supportive of students but I also challenge them no matter how good they are.

PG2018 · Nov 5, 2015

sauce said:
Ill be content if they add in a pure biochemistry class, physiology (not this pathophysiology mixed stuff, I mean you need to learn how stuff is SUPPOSED to work before you learn about the problems associated with the body..... and undergrad A and P was laughable also) and add more clinical hours. In pharm they teach you what such and such medicine works on such and such receptor, but unfortunately before pharmacology you never heard of that receptor, so its useless information unless you take the time look it up yourself. Plus if you don't understand the different types of receptors and how medicines interact with them (one week of pharmacodynamics and kinetics don't cut it) your basically throwing medicine at people that you assume just floats into the cells and fixes stuff.
And people try to argue that writing papers is better learning than tests. FALSE. And do not try to use blooms taxonomy to try to refute this. Writing papers only helps if you are interested in writing papers, then you learn, but like Psychdude said, we are providers not english teachers with a minor in nursatology. Test, test test test test, multiple choice tests out the rear, then they can elaborate to preceptors in clinical to verify their understanding. You can word questions to test understanding of concepts, not just rote memorization also, unfortunately most nursing professors don't know this. We should at least have been provided 5000 multiple choice questions prior to graduation. Pound that information vigorously into our brains, so even those not interested in learning are forced to. That will weed out the weak and make the lazy still have to kick butt to pass. Make it hurt, make it burn, make it painful so only those who really want to do the job can make it through. If we are gonna make 6 figures, then we should get vicariously mentally demolished by the amount of information provided. NO PAIN NO GAIN.
Add in biochemistry, physiology, 1000 clinical hours, two step board exam (one basic science based, one clinically based) and we will have competent providers.
Regarding nursing experience. One year, thats it, the transition between RN to APRN is so great too much RN experience can hurt some people, but you need at least a year to make sure you can at least function as a human in public.

I agree with most of what you've said. I think biochem is a seriously lacking element of NP education. After I finished my master's I read a biochem text and had a lot of ah ha moments. Obviously, that type of stuff isn't something you remember long-term if you don't work with it on a daily basis, but it provided some clarity. I too believe biochem, perhaps horizontally aligned with physiology as prereqs to pharmacology and pathology would be great.

I think more experience in the clinical setting will foretell the ability to relate to people. I'm completely against requiring RNing oneself before becoming a NP. I couldn't care less about being a RN myself and didn't find it particularly helpful for my present niche.