Clarification on NP Curriculum?

db2xs · Feb 8, 2018

NP education needs a large upgrade. There are a couple of nonsense courses that should be entirely eliminated.

omg, you can say that again. How about Nursing Leadership? Concepts in Population Health?

FullGlass, BSN, MSN, NP · Feb 8, 2018

First, I am going to summarize what I would say to someone who asked me about the NP vs PA curriculum, given that their goal is to work in an ED and care for all ages.

A. The FNP is a primary care role. If you enroll in an FNP program, you will NOT receive any acute care education or have any acute care clinical rotations. The school websites are very clear on this.

B. Currently, NP acute care curriculums require specialization in either Adult/Geri Acute Care or in Peds Acute Care. Enroll in one of these programs and you will receive acute care didactic content and you will have acute care clinical rotations.

C. Earning an FNP will take about 18 to 24 months. If you then wish to earn certification as an ED NP, then that requires a certain number of clinical hours and some additional education, plus taking an exam. So that is some additional time and $ (although your employer may pay for part or all of it).

D. PA school generally takes about 24 months. It is a more generalist education that will include acute care content and rotations.

E. Would you be comfortable working in an ED as a new grad FNP when you did not have any acute care education or clinical rotations?

F. The reality of job search for a new grad NP is that it is competitive, unless you want to work in a remote area or in an area with a shortage of NPs. These are generally considered less desirable areas to live in. So, you have to consider where you want to live and work. If you want to live and work in a big city and work in a large hospital ED, there will likely be other candidates for ED NP openings. Which new grad NP do you think will have the edge in competing for ED jobs? An FNP or an acute care NP or PA?

G. Whenever a professional of any sort is practicing outside the scope of their experience and training, there is increased risk. Period. Let's take a hypothetical example: a new grad FNP is working in the ED and makes a mistake and the patient suffers serious harm. There is a malpractice lawsuit. The plaintiff's attorney is going to jump all over the fact that the new grad FNP had no acute care education or clinical rotations, I guarantee it. So the point is not whether at a macro level ED FNPs have worse quality of care, etc. The point is that at the individual FNP level, if that person is sued, not having had the acute education and training will place them at a higher risk for a buttload of legal and possibly, financial, hurt.

H. At least at my school, the primary care NPs were very sternly warned not to take an acute care job, because their education and training had not prepared them for this type of work. Now, let's think about this. A new grad NP is going to need recommendations and references. Those are likely going to come from professors and preceptors. Will all of them be comfortable doing this for job in which they know their former student had no education or training?

I. Since I am a new grad NP and just went through the job search process, my interviews focused on my clinical rotations. My prospective employers wanted to know how my education and rotations had prepared me to work in their setting. They did ask me about the types of patients, cases, and procedures I was familiar with. I am an AGPC NP. So what on earth would I say if I went to an acute care interview, especially if it was an ED interview? (Let's say this is a large hospital that has a separate Children's Hospital and ER). "Uh, no I didn't have a single rotation in a hospital or ED." Personally, I would be terrified to take on such a job.

J. I accidentally submitted an application to a well-regarded hospital for an acute care role and they turned me down, responding that I was not an acute care NP! (The posted job description was not clear - I thought it was in an outpatient clinic).

K. What about getting accepted into a good NP program? That is a competitive process and requires interviews and/or essays, including one's career goal. So, if a school explicitly states that their FNP program prepares one for primary care and an applicant states they want to work in an ED, how would the school view such an application?

L. In summary, I would advise a prospective NP student to choose a program that will best prepare them for their intended role. Someone who wants to be an ED NP should choose AGACNP or PedsACNP. Another option to consider is PA. While many FNPs are working in EDs, one should consider how comfortable they would be doing so, given that it may make it harder to find a job and that there would be potential legal risks. In addition, should they choose to go for their FNP and then work in an ED, they are going to have a very steep learning curve.

When advising prospective students, they should be guided along the optimum path to maximize their career success.

What is the mantra of NP full practice authority? As the 2011 IOM report states, "advanced practice registered nurses (APRNs) should be able to practice to the fullest extent of their education and training." (Emphasis added). FNPs are not educated or trained in acute care.

Here are some constant threads on this forum:

NP curriculums should be more rigorous and NP schools should be more selective to improve the quality of new grad NPs
NP programs are inferior to PA programs because PA programs are more rigorous and offer broader education and training
NP programs should have more clinical hours and we need more NP residencies

Given the above constant complaints, it is truly amazing to me that some individuals, especially those who have made the above criticisms of NP education and training, would turn around and advise a prospective NP student to knowingly choose an NP program that will not give them any education or training for the job they want to perform!

Note: the original question was about NP curriculums. The best way to get this information is from the various school websites.

I'm done. This topic has been beaten to death.

DO_question · Feb 8, 2018

I haven't abandoned the post. I am learning a ton! I appreciate all the input guys, it really gives me more understanding and more importantly more things to research. Shared the post with the GF, so if she's got some questions I bet she will chime in at some point.

Thank you all again!

Jules A, MSN · Feb 9, 2018

Whenever a professional of any sort is practicing outside the scope of their experience and training, there is increased risk. Period. Let's take a hypothetical example: a new grad FNP is working in the ED and makes a mistake and the patient suffers serious harm. There is a malpractice lawsuit. The plaintiff's attorney is going to jump all over the fact that the new grad FNP had no acute care education or clinical rotations, I guarantee it. So the point is not whether at a macro level ED FNPs have worse quality of care, etc. The point is that at the individual FNP level, if that person is sued, not having had the acute education and training will place them at a higher risk for a buttload of legal and possibly, financial, hurt.

I happen to agree and the attitudes of some new grads that as long as a facility hires them that means they are capable of doing the job is frightening to me.

H. At least at my school, the primary care NPs were very sternly warned not to take an acute care job, because their education and training had not prepared them for this type of work.

At my FNP program we got the same thing which I respected. What I find very curious is one of your peers, I suspect same graduating class, was on here recently regaling us with tales reminiscent of that special grandiose flavor of JH KoolAid insisting she was told by their faculty that she was qualified to specialize in psychiatry with only the AGNP if she got an orientation. Regardless of my opinion on the quality of non psych NPs practicing in psych I think this, as above, is a significant liability. Its all fun and games until someone loses an eye.

wondern, ASN · Feb 9, 2018

We do diagnose on a lot of cases. We are part of a larger Adult Critical Care Medicine service and rotate on all the adult ICU's - Med/Surg, Cardiac, and Neuro. In some cases, diagnosis is already established, like in the case of a patient coming from the OR ...
The more challenging case for me are when I'm dealing with medical ICU patients coming in with a puzzling constellation of symptoms...we don't always need an attending to start the diagnostic process. Because hospitals are mandated to have a physician in charge of each patient, we call or inform the attending of what we're doing and what the diagnosis we made on a patient.
As an academic medical center, we are the last destination for patients that most other hospitals can't handle. Diagnoses such as hemophagocytic lymphohistiocytosis, posterior reversible encephalopathy syndrome, botulism, creutzfeldt jakob disease are examples ofcases I've seen but required a collective effort from an entire ICU provider team + consults to confirm.

Very interesting. Thanks for the explanation.

Interestingly, that avatar is an Instagram picture I took in Scottsdale, AZ while attending a conference. It reminded me more of Miami Vice a show in the 80's which is certainly dating me. Yes, I'm in California but in the colder north. Yes, there are beaches but they have freezing waters so the surfers are covered neck to ankle with wet suits unlike SoCal where they probably just wear board shorts. It' a cool area here nevertheless with a heyday notable for the "summer of love" but now overcome by techies and the likes of Zuckerbergs and whoever runs twitter or whatever new app kids are into these days. That last part makes the area a bit annoying for old guys like me.

Wow you took that shot?! It is so surreal looking. Very nice. It'd make a great postcard or t-shirt even. :cool:

I do remember Miami Vice and that handsome Don Johnson. His daughter Dakota, now in the movies, looks so much like him.

Oldmahubbard · Feb 9, 2018

I happen to agree and the attitudes of some new grads that as long as a facility hires them that means they are capable of doing the job is frightening to me.
At my FNP program we got the same thing which I respected. What I find very curious is one of your peers, I suspect same graduating class, was on here recently regaling us with tales reminiscent of that special grandiose flavor of JH KoolAid insisting she was told by their faculty that she was qualified to specialize in psychiatry with only the AGNP if she got an orientation. Regardless of my opinion on the quality of non psych NPs practicing in psych I think this, as above, is a significant liability. Its all fun and games until someone loses an eye.

A patient died in my first year of practice as a Psych NP after I prescribed a well known antipsychotic, which he truly needed, for a month.

His triglycerides went from 150 to 1200 in that time frame. He developed necrotizing pancreatitis, then diabetes, with renal and ultimately respiratory failure.

People who feel they can dabble in this field terrify me.

Depending on where you work, half the people who tell you they are "hearing voices" are probably lying.

CJforme01 · Mar 20, 2018

Yes, This!!