Does everybody want to be a NP?

[Cola89]

Or... should I say does every NP think all nurses want to be NPs?! In my experience, that's how they act. Even when I'm being seen as a patient, the NP is hurried, and seriously has an air like "yeah, bet you wish you were an NP". Even the nurses who are just in NP SCHOOL say things like 'yeah, I'm going to get my REAL education so that I can be a REAL professional/get a REAL job.' So rude!

Is being an NP really that much better than say having an MBA? Or being a PT? Or a registered dietician? 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?

[Ruby Vee, BSN]

I do wonder whether the NP job bubble is going to burst? I have absolutely no hard numbers but it does seem like "everyone" is either in NP school or planning on it. In my last unit, 1/2 of the nurses were in school part-time to become NPs. I would get floated to higher acuity ICUs and the numbers would be worse when you threw in the folks leaving to start CRNA school.

At some point there ia going to be a glut of NPs, right?

In some areas, there's already a glut of NPs. I've worked with two who weren't able to find NP jobs within our hospital system. So they put in two years as staff nurses in order to pay back the tuition money to the hospital system.

[Ruby Vee, BSN]

I am about to graduate with my BSN. There are a lot of nursing students in my semester who feel pressured to go on with their education and do Grad School. And it's not only them, it's me too. Especially as female nurses, there is a rush to get higher education done now, before family and kids come and we don't have time to focus on education like this again until we are 40. There are so many NP and DNP programs available to RNs; you can specialize in anything and then go back and get certification in something totally different. That's the beauty of nursing.

The down side of nursing is that "nurses eat their young" (which we will save for a whole other discussion). Another downside of nursing is the "totem-pole" mentality, which you all have been discussing, and to which I will now add my two cents: While I was attending CNA classes, my instructors told us that we might see some of that hierarchy in our clinicals. The doctor trumps the nurse, the nurse trumps the CNA, the CNA trumps the housekeeper. I don't think it has to be that way.

I say that each of us can help to break that hierarchical mentality in constructive ways (rather than destructive ways). One way to break that mentality is to break the glass ceiling of higher education. My friend did just that, going from housekeeper, to CNA, and now she is a nurse in the same hospital she was a housekeeper. When we do break that glass ceiling, we still need to remember where we came from and the amazing people we left behind. When a CNA becomes an RN, that RN knows full well how hard the job of a CNA is and is willing to lend a hand with call lights and ADLs. Thank you to all you nurses who do that. We love you for it. For all you nurses who have never been a CNA, and who may notice that your NPs are putting on airs, I ask you this question: How do you treat your CNAs? How do you treat your housekeepers? etc. Where are your airs?

Now we get to the meat of the matter. And that is PRIDE. What is different about those NPs who are approachable down to earth and friendly? I think they have less pride; they want everyone to grow but realize that their path might not be the path for everyone. Pride is a two way street; it can happen top down and bottom up. YIKES. So how do we avoid pride as nurses? Is there a class system between us and our patients? Do we seem rushed sometimes?

We all defy the totem-pole mentality in our own way. Please share yours. I like to be that CNA who says hi to the doctors and tries to learn from them, and I like to be that nursing student who always says hi to the housekeepers.

I haven't noticed a totem-pole mentality in nursing -- every place I've worked, the health care team works as a TEAM. Everyone -- from medical director of the department to the CNAs works together within their job description to ensure that the care plan is appropriate for that particular patient, and then that it is followed. I've seen an attending physician assisting a CNA in getting a patient out of bed and I've seen NPs helping the RN clean up poop. It doesn't happen often because each has their own work to do, but I've never had the impression that anyone thinks they're "above" certain tasks or certain health care team members.

And as far as "nurses eating their young", that's just plain wrong. And insulting.

[Ruby Vee, BSN]

Please, do tell how you transitioned from RN to HIM... (!)

What's a HIM?

[Farawyn]

What's a HIM?

Homosapien with a member.

[Ruby Vee, BSN]

Can't say I have had the best experience with NP's. My wife chose to see the NP at my doctor's medical practice and was very disappointed that the NP seemed disorganized and flighty. Didn't do a very thorough history to get at the problem. Rushed to prescribe pain medication rather than try other modalities.

My interaction with a Neuro NP at work made me question her intelligence as she consistently tried to provide detailed incentive spirometer instructions to nearly unconscious patients. And tried to tell me, the PACU nurse, how to administer anti-emetics. I suppose she knew her Neuro stuff but lacked common sense.

We also had an NP student who used (a lot of) company time and bedside computer to do her school work. She had a fit and stopped talking to the charge nurse who turned off the computer at the end of the work day and apparently lost some unsaved school project. She graduated this summer, passed her boards then left. Two weeks of open shifts remain without coverage. Bridges burnt and smoldering. Tacky, selfish and unprofessional. Yeah, all of those.

Certainly this forum has a lot of talk about going on to become an NP. Like anyone who doesn't is a stooge. I really think it's mostly talk to feed an insecure ego.

I'm not sure where the advanced practice aspect works with the direct entry model. "Advanced" implies you have the basics down pretty well and obtaining a "Master's" degree leads one to believe you have mastered something.

I'm sure there are advanced practice nurses more than worthy of the name but as a group and especially the new ones I vote NO CONFIDENCE.

Years ago, entry to an NP program required five years of experience at the bedside. The NPs that graduated from those programs were for the most part, wonderful to work with. I say that as a patient and as a colleague.

These days, people go directly from BSN to MSN and become NPs without ever having worked at the bedside. Too many of those nurses have no common sense or critical thinking ability. Worse, too many of them seem to think they're "better than" the bedside nurse. They're condescending and will not accept suggestions. That's sad. When the 20 year bedside nurse tells the brand new NP that "he just went into atrial fib and the NP requires a 12 lead to "prove it" (and then cannot read the 12 lead and has to ask the attending), treatment is delayed and things get missed. Too many brand new NPs without bedside experience don't trust the bedside nurse to assess and report changes in patient condition. Again, treatment is delayed, things get missed and it tends to annoy the bedside nurse.

I also have an issue with working night shift next to all the NP students. They spend the shift doing their homework and *I* spend the shift answering their lights, responding to IV pumps beeping and, in one case trouble shooting a balloon pump that stopped. That tends to annoy me as well.

[Ruby Vee, BSN]

There are a number of reasons, including:

1. Not continuing to support the physician agenda.

2. Not continuing to degrade nursing.

3. Not sounding uninformed.

Degrading nursing? I don't think so. I see far more "midlevels" degrading bedside nursing.

[Ruby Vee, BSN]

The NPs I have met care very little about nurses. They appear to care about as much if not less than physicians. Going off the understanding that all (most?) NPs were once bedside care nurses, they do very little to advance nursing as a whole. Basically, they will, can, and do differentiate from and step on us "low-level" nurses just to advance themselves. Very selfish and uninterested in helping "our" cause as nurses as a whole.

This!

But the idea that most NPs were once bedside nurses is becoming less and less true.

[Ruby Vee, BSN]

I find it mystifying that this thread is trying so hard to discredit NPs. Is it jealousy? .

I find it mystifying that people actually believe this malarky that anyone who disagrees with or doesn't like them is just jealous.

[Farawyn]

Years ago, entry to an NP program required five years of experience at the bedside. The NPs that graduated from those programs were for the most part, wonderful to work with. I say that as a patient and as a colleague.

These days, people go directly from BSN to MSN and become NPs without ever having worked at the bedside. Too many of those nurses have no common sense or critical thinking ability. Worse, too many of them seem to think they're "better than" the bedside nurse. They're condescending and will not accept suggestions. That's sad. When the 20 year bedside nurse tells the brand new NP that "he just went into atrial fib and the NP requires a 12 lead to "prove it" (and then cannot read the 12 lead and has to ask the attending), treatment is delayed and things get missed. Too many brand new NPs without bedside experience don't trust the bedside nurse to assess and report changes in patient condition. Again, treatment is delayed, things get missed and it tends to annoy the bedside nurse.

I also have an issue with working night shift next to all the NP students. They spend the shift doing their homework and *I* spend the shift answering their lights, responding to IV pumps beeping and, in one case trouble shooting a balloon pump that stopped. That tends to annoy me as well.

I agree there should be RN experience before becoming an NP. If that is not the case anymore, I agree with making NP programs more selective and the exams more difficult.

[Ruby Vee, BSN]

Homosapien with a member.

Cute.

[chevygirl1987]

What's a HIM?

Health information management.

[BostonFNP, APRN]

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?

Many quality programs have pass rates of 100% for the past decade.

My argument would be that while increasing the board difficulty will limit the number of poorly trained NPs entering practice it does so after they have incurred the cost of their education, then they go into a holding pattern and keep trying to pass by brute force attempt after attempt. I'm just not sure that's an effective or cost-effective way of accomplishing the goal.

Degrading nursing? I don't think so. I see far more "midlevels" degrading bedside nursing.

Don't let them. No individual, regardless of their role or degree, should be allowed to act in a degrading manner. Bedside nurses are the most important member of the healthcare team while a patient is hospitalized and should be treated as such.

This!

But the idea that most NPs were once bedside nurses is becoming less and less true.

The trend is down, yes, but the average new-grad NP still has 9 years of RN experience.