Does everybody want to be a NP?

allnurses Guide · Nov 1, 2015

You can't really compare the 3 USMLE or COMLEX steps to the NP exams. Steps 1 is basic biochem, micro, physio and hard sciences that really isn't touched anywhere in the nursing realm. Step 2 CK/CS (with oral boards and practical testing) is more clinically based but still with a foot in the hard/basic science. Step 3 (where I think you got your high 90s%) which has the highest pass rate is just a capstone which most physicians don't even study for. There was a trial some years ago when NPs trialed an "amended" step 3 and about half failed. I have not taken the NP license exam but from practice books and official practice questions, the content really isn't impressive compared to Step 1/2 practice tests I have tried. These step exam scores (rather than just pass/fail) are also vital for med students and residency matching. NPs just need to pass.
Step 1-8 hours
Step 2-9 hours plus 12 live patients H/P scenarios
Step 3- 16 hours over 2 days
If the nursing regulation bodies are going to do nothing to stop the flood of NP students and programs, a more difficult licensure exam will be needed to filter those who are truly ready to practice. I would even welcome multiple exams.

I was not comparing the exams, just the pass rates.

All you have to do is browse the student NP forums to see that lots of graduate NPs fail the board exams, as "easy" as they are. They may be a bit more difficult when you are sitting in front of the screen taking them though too.

Making a more difficult NP credentialing exam could help stop the non-quality programs but at a significant cot to the system. Stopping the accreditation of the programs is much easier and more financially responsible.

Ruby Vee, BSN · Nov 1, 2015

I don't even think we should compare NP with floor nurse, because a typical floor nurse will not have an advanced degree. Am I wrong?

Bedside nurse here. I have an advanced degree. Went and got an MBA, then decided that I really didn't want to leave the bedside.

Editorial Team / Admin · Nov 2, 2015

I don't even think we should compare NP with floor nurse, because a typical floor nurse will not have an advanced degree. Am I wrong?

Bedside nurse here. I have an advanced degree. Went and got an MBA, then decided that I really didn't want to leave the bedside.

Cola, I think you'd be surprised by the number of bedside nurses who do have advanced degrees. Like Ruby, I have an advanced degree with no plans of leaving bedside in the near future. I have an MSN in nursing education, and I am still at the bedside. Yes, I will likely leave the bedside when I no longer have the capability of keeping up with the physical demands of bedside nursing. No, my advanced degree isn't clinically based like an NP. But it is an advanced degree, and you will find nurses with masters or doctorates in all manner of nursing jobs.

dudette10, MSN, RN · Nov 2, 2015

I too have noticed that many, many nurses are working on their FNP. I have no desire to be an NP, so I am pursuing the nursing education track. I've also noticed that many FNPs go into teaching without ever working as an NP. I tend to question the quality of a program whose prelicensure faculty haven't worked bedside in decades and whose NP faculty have never worked as an NP. But that's where we are...

if I wanted to be a provider, I would have gone to med school. That's all I'm gonna say about that.

Jules A, MSN · Nov 2, 2015

I too have noticed that many, many nurses are working on their FNP. I have no desire to be an NP, so I am pursuing the nursing education track. I've also noticed that many FNPs go into teaching without ever working as an NP. I tend to question the quality of a program whose prelicensure faculty haven't worked bedside in decades and whose NP faculty have never worked as an NP. But that's where we are...
if I wanted to be a provider, I would have gone to med school. That's all I'm gonna say about that.

It is horrifying that what are supposed to be high quality universities have so many professors with zero nursing experience. In my PMHNP program only a few of the professors had ever practiced as a NP. It was frustrating when as a experienced psych RN I knew things the NP instructors didn't know.

Unfortunately I lacked the insight and maturity as a younger person or I would have gone to medical school. Hindsight is 20/20 I guess.

NOADLS · Nov 2, 2015

I had no idea that there was ever an issue with NP instructors never having (much, if any) experience as a NP. I have a few instructors on different ends. At the end of the day, I think it comes down to the learner to develop into a good NP.

I vow to become a well respected NP by having beaten more candycrush levels as a NP than any other NP!

la_chica_suerte85, BSN, RN · Nov 2, 2015

That is a new concept for me. I hear a lot of people talking about it because so many times I hear, "No more than 5 years bedside or you'll wreck your body." So, a lot of people think that's just the progression. But, I've never heard people being disparaging about being an RN as compared to being an NP. That's a completely different kind of situation. Also, since the BSN preparation is basically the mainstay, it seems like, just with any other Bachelor's, you're expected to continue going forward. Difference here, though, is that with a BSN-RN, you can pretty much be a badass without really having to continue your education (unless you want to teach or research or whatever academic route one would desire).

So, no, I don't think a lot of nurses are NP-bound. I want to go because I'm a big nerd and I want to teach and research and I'm old and don't expect to do bedside for 30 years (because I really will wreck my body).

Elvish, BSN, DNP, RN, NP · Nov 2, 2015

This has not been my experience, either personally or among my coworkers (NP and otherwise).

Our NPs and nurses get along pretty well. Each of us values the work the other does.

I'm going back to NP school for a very specific set of reasons that have nothing to do with it being a 'real' job.

LPNtoRNin2016OH, LPN · Nov 2, 2015

So funny, seems like everyone is having this conservation lately, we were just talking about this at work! With all the aspiring NPs out there, there won't be any floor nurses out there lol. I have zero zip desire to go beyond BSN. And only doing BSN because I have too, otherwise I wouldn't bother. I am in my bridge program and am savoring the day I no longer have to go to school and have a life again. And everything I hope to do in my career can be pursued with a BSN. I do not want more student loan debt and quite simply I do not want the responsibility of a NP role.

WKShadowNP, DNP, APRN · Nov 2, 2015

Dang, my body is a wreck but I'll blame the truck that t-boned me, not the 14 years of nursing and 6 years of prenursing.

aaiandrea · Nov 2, 2015

Good day my dear friends and fellow nurses. It saddens me to hear the impression some of you are getting from our NP peers. I am one of the first NPs , meaning , I'm old ,rolling off the assembly line , sort of speak. Now I am fortunate enough to be a preceptor for our students, and hope never to hear any of these words from them.We are ALL nurses and have one goal ,like dear Florence educated and instilled in all of us. It starts " in front of God and this assembly" Aid the suffering, assist the Physician etc..... and most of all " do no harm."

We are not any better, just different. Ever now and then I have to perform a pre-employment physical for one of our ICU peers, boy do I shiver with respect. Surely I tell them so, how scary all these tubes are to me, and he or she manages them with a blink of her eye.

have we thought about Neonatal ICU??? my oh my, not for me or hospice care??My hat is off to all of you out there and please stay in touch and let me know how you feel about us , I will help if I can. It is true, we NP's get under heavy attack from Physicians, Peers and patients, so we have to continue educate ourselves not to get caught under the wheels. The medical Board would like to eliminate most of our duties and the state legislator's are not much help. However who works in inner cities and rural townships , areas of Physician shortage , mostly NP's. remember the time when male Nurses had such hard time getting accepted?? well you probably are too young to remember.

So my dear Nightingales, we are all in this together. Write me back and let me know what you think, my respect and caring is with you and in God we trust. Andrea. Andrea Anderson FNP, PhD CEO AAI Health Service Inc. 1001 Shoreline Ste 105 Alameda, Ca 94501

In 1989 I had the nerve to start my own practice as a " standing alone NP,"i do not have to tell you how this came across to the medical board. Well, one day I shall write all about it, but now all the best to you

Dogen · Nov 2, 2015

The national pass rate for the board exams is in the mid-80s depending on the exam, slightly less but similar to the NCLEX. Compared to the USMLE steps in the mid-upper 90s.
Sure the exam could be harder but that's not fixing the real problem, IMHO.

In another post you propose halting the accreditation of low-quality NP programs. This is definitely not my area of expertise. In what way is inhibiting the accreditation of low quality programs easier and more cost effective than making credentialing exams harder? Both the CCNE and ANCC seem like pretty cumbersome agencies, both fairly dependent on the schools pumping out graduates to fund them.

Here's my back of the envelope thinking: If the ANCC's FNP exam has roughly the same pass rate as the USMLE and the NCLEX, but low quality NP programs exist (and exist in great enough numbers to be a problem), there are a limited number of explanations. Graduates of those programs must still be passing their exams, which suggests the exam doesn't adequately distinguish those who are entry-level prepared from those who aren't.

Anecdotally, my school boasts a 100% pass rate for the last several years (I don't have actual data, it was said to me by the director of my program). It's possible for that to happen with a test at any difficulty level, but the more rigorous the test is the less likely this becomes... and so inversely the continued trend suggests (but obviously can't prove) that the test may not be sufficiently difficult. If making the test harder temporarily decreases the number of graduates who become credentialed are they not then, also, limiting the number of poorly prepared NPs who get to start practicing on real people?