This is a story about how I got accepted to a big name online for-profit:
A phone number kept calling me incessantly for weeks... I finally answered, prepared for my usual, "I'm on the no-call list so please remove me from your call list." It was a rep from some school I hadn't heard of, but apparently I'd filled out some webform.
Had I? OK... "are you good to go in my state? Well, I'm not interested but... OK I'll look at your application." I'd filled out the whole application in about 10 minutes while on the phone with the rep with 6 questions:
"Where do I submit my references information?"
"Where do I submit my CV?"
"Transcripts?"
"What are the application essay guidelines?"
"What is the interview like?"
"Is there an application fee?"
The answers were: "we don't need references, no CV, only transcripts for your BSN (not the other 5 schools), no essay, no interview, no fees."
I almost asked if they were a real school or if this was some kind of joke, but I played along because I was thoroughly amused. I sent one transcript, worth $5 for my amusement. Then I hit the internet to learn about this school.
I learned the school is a for-profit. Oh..... now it makes sense! I learned Walden doesn't have a physical campus, only office buildings that house the servers, executives, and recruiters (aka admissions advisors). Perusing threads on this forum only darkened the reputation. Yet, they are accredited by HLC and CCNE.
36 hours later I received my acceptance email. I declined. The admissions advisor started leaving me voicemails implying I must have clicked on the wrong button... I could still change my mind. I wrote him an email politely informing him I'd declined. He left me another voicemail that was distinctly aggravated.
I'm not opposed to the idea of online programs, but there have to be standards because a profession is perceived and regulated by its lowest common denominator. This selection process for lowest common denominator in NP education is a joke. No entry standards lets in good students too, but don't filter the subpar. It implies the standards once in the program won't be high either. The bar for admission should be higher than a RN license, a pulse, and the ability to sign off on student loans.
One way to address this issue would be to create additional, optional “board like” certification exams that were more difficult but would convey useful information to the public. Keep in mind that some NP practitioners are grandfathered into practice who don’t even have a masters in nursing. Standards can (and perhaps should) continue to evolve but if we raise the proverbial bar to the level of physicians then much of the benefit of increased access and lowered costs may be compromised. Also, most studies to date indicate that NP’s provide equal or better outcomes compared to physicians. Also, anecdotally in my casual observation of board certified psychiatrists (at least at my clinical practice) prescribe exponentially more benzodiazepine medications on a long term basis than NP’s even those who went to distance education schools. While, this is only one metric it seems to form a paradigm that is emblematic of a more cautious less “med centric” approach.
Working in a teaching hospital - drs. are both over and under educated. They are overeducated in the shotgun approach to every specialty. Undereducated that they spend a lot of time learning things that are not going to significantly assist them as clinicians. And I think a large part of it is that hospitals rely on them for low cost workers. You think NPs are paid poorly? Ask a resident or fellow.
In my ideal world, the health care providers would be one discipline and the different levels are basically what level of degree you have. First everyone would start as a PCA/Tech, then more education you are the bedside provider, more education, you are the person that rounds on the patients/does basic primary care, more education, you are the specialist/supervising provider, more education, you are doing more research, but also practicing clinically as a supervisor, and should be helping with translation of research, more education or perhaps better, different education? you are the person doing the research, but no clinical experience necessarily/wanted.
All these roles are vital to have experienced, IMO, and depending on goals and aspirations, they can go into it with the plan and keeping in mind how their role will change in the future. It would cut down on the education for people who are planning on going into primary care and focus it into what they will need to know, and they don't have to struggle through trying to caring for micropreemies, because they "need the experience" - They don't, and if they decide to switch specialties, back to school to add a certification.
Much of medical school testing requires memorization which is increasingly outdated in today's digital world. Knowledge is good, knowing how to find resources is good, rote memorization that you forget later is worthless busywork.
Working in a teaching hospital - drs. are both over and under educated. They are overeducated in the shotgun approach to every specialty. Undereducated that they spend a lot of time learning things that are not going to significantly assist them as clinicians. And I think a large part of it is that hospitals rely on them for low cost workers. You think NPs are paid poorly? Ask a resident or fellow.
In my ideal world, the health care providers would be one discipline and the different levels are basically what level of degree you have. First everyone would start as a PCA/Tech, then more education you are the bedside provider, more education, you are the person that rounds on the patients/does basic primary care, more education, you are the specialist/supervising provider, more education, you are doing more research, but also practicing clinically as a supervisor, and should be helping with translation of research, more education or perhaps better, different education? you are the person doing the research, but no clinical experience necessarily/wanted.
All these roles are vital to have experienced, IMO, and depending on goals and aspirations, they can go into it with the plan and keeping in mind how their role will change in the future. It would cut down on the education for people who are planning on going into primary care and focus it into what they will need to know, and they don't have to struggle through trying to caring for micropreemies, because they "need the experience" - They don't, and if they decide to switch specialties, back to school to add a certification.
Much of medical school testing requires memorization which is increasingly outdated in today's digital world. Knowledge is good, knowing how to find resources is good, rote memorization that you forget later is worthless busywork.
We need to change the way we are doing things.
I believe that your post may be at the heart of why NP’s are able to demonstrate such good outcomes in primary care despite relatively less education. There is both a law of diminishing returns with regard to education and outcomes as well as a potential negative selection bias between those able to successfully complete medical school and the traits most integral to positive primary care health outcomes. When you can combine this with a more holistic approach and the ability to spend more time with patients due to lower cost NP’s have some significant intrinsic advantages to offset some of our disadvantages.
I’m not sure what drives question difficulty. I think the pass rate for PMHNP was around 92% in 2018 slightly higher than FNP rates. I’m not sure that making the test harder would make for better providers. I passed the NCLEX with minimum questions, had SAT’s in high 1400’s, essentially a 4.0 student, but am a very weak ICU nurse because I am a mechanical skills moron. Conversely I’ve known ICU nurses who failed the NCLEX at least once who are amazing nurses. Also, my preceptor failed the psychiatric boards three times and is a fantastic clinician adored by his patients. I’m not sure these tests are predictive of clinical competency.
ANCC - an arm of ANA with their other profit making scheme (Magnet Certification for hospitals)
I am so glad to see that someone else sees how ANA has turned into "a profit making scheme" with their ANCC certifications and Magnet application, visits and recognition.
The role of the NP is losing its status because these schools are accepting everyone and not looking at their background, no entrance exam or anything. Just because you were a good bedside nurse will not make a good NP, you have to be knowledgeable not only about treatments but diagnosing, differentials, and management etc.
myoglobin, ASN, BSN, MSN
1,453 Posts
One way to address this issue would be to create additional, optional “board like” certification exams that were more difficult but would convey useful information to the public. Keep in mind that some NP practitioners are grandfathered into practice who don’t even have a masters in nursing. Standards can (and perhaps should) continue to evolve but if we raise the proverbial bar to the level of physicians then much of the benefit of increased access and lowered costs may be compromised. Also, most studies to date indicate that NP’s provide equal or better outcomes compared to physicians. Also, anecdotally in my casual observation of board certified psychiatrists (at least at my clinical practice) prescribe exponentially more benzodiazepine medications on a long term basis than NP’s even those who went to distance education schools. While, this is only one metric it seems to form a paradigm that is emblematic of a more cautious less “med centric” approach.