Before starting my NP program I was so proud and enthusiastic about becoming an NP. But as time goes by, I am growing more and more frustrated with my curriculum. Completed my first year and do not see the end of theories, roles, paradigms and politics etc. "Paradigm" has become one of those words that raise my blood pressure.... Diagnosis, treatment, patho and pharm. are completely de-emphasized "we are nurses, not doctors". So, how in the world do you apply the "paradigm" when you do not even know some of the essential stuff? Do we completely rely on our previous nursing experience and pay price of obtaing "NP" title by enduring hours and hours of endless and useless "fluff"??? I got much more out of my associate RN program in terms of ability to perform basic patient care than out of "advanced" nursing curriculum. I expected that we'd study similar to undergrad. issues but on a deeper level, but so far, there is no end of "fluff". I have checked out other universities programs' descriptions and they are very similar to mine....Except, for some progressive schools that, I believe, would have 2 pathos and 2 pharm. courses. Where this education will take me? What is the school thinking? Are the professors' hands tied? I do not blame some physicians who are against removing collaborative agreement.
Has anyone gone through this frustration while enrolled in an NP program? I have seriously thought about defecting to med. or PA school as a result of being so extremely disappointed. Any thoughts?
I recall being incredibly frustrated the first semester of my NP program as we had not yet started clinicals. Our instructors were PhD's who had not seen patients in years, or who volunteered at free clinics without diagnostic capacity to keep up licensure. Very different from private practice or any other practice. Lots of speeding through power points that did not make a whole lot of sense or encourage dialogue.
I was thankful for my RN experience because I could see the BS... my patho instructor reported "how to diagnose ARDS" from articles, I was working in ICU at the time and knew that anyone trying that in the clinical environment would look like a nutcase. Oftentimes we were presented with the gold standard instead of how things are diagnosed practically. I naively thought at this level there would not be hoop-jumping but there definitely was.
Clinicals were the saving grace, I had some amazing preceptors and studied on my own to learn and then apply the guidelines. That is where the real learning occurred, in my opinion.
My cohort wanted more time spent on entrepreneurship, billing and coding, the role of the nurse practitioner (what is it that we do, or bring, that is NOT being a mere physician extender? what makes us different? how is that seen or proven practically?), and contract negotiation.
I think we were left with a lot of role confusion and inability to see how our practice is different from the medical model. Of course there is the whole holistic nursing model PHILOSOPHY, but many of us were not seeing that in our clinical settings (patients q15 minutes, etc.)... and how to make an argument that this holistic thing was something we had that other providers did not have. If anything our knowledge of health promotion was not that extensive or special. Sort've like how the ideal of being a holistic healing nurse practitioner meets actual job responsibilities.
I can really identify with the frustration, especially during the early part of a program. I look at it this way. I'm about to graduate this December with my FNP. I'm in my last rotation prior to a "transitions" semester (think final practice and/or work for no money!) On thinking back to my first year, it seems to me that the annoying fluff does serve an obtuse purpose...it makes you stop thinking like a RN and forces you to reorient your noodle to accomodate a broader point of view. Kinda like its there to break you down before you are built back up. As you get past the endless parade of fluff-n-stuff, you start to piece together the patho, assessment and disease processes as a unit as opposed to the sequential order of learning. If you're in an NP program, your goal is to learn how to identify, assess and treat without assistance...quite an assimilation from where we all started. I found that once my clinical courses started, my learning has grown exponentially and the pieces are coming together better than I ever thought they could. And, whatever you do, thank your preceptors! So, what I guess I'm saying is, think of the fluff as a necessary evil. It distracts you from recognizing how much you are learning. That being said, I would love to see our programs increase their emphasis on patho, pharmacology and assessment. We will ultimately live or die by the nuts and bolts. Just remember, school is a begining and you won't know it all. After graduation the real learning begins.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
Just remember, school is a begining and you won't know it all. After graduation the real learning begins.
Totally agree with this. No matter what type of HCP one becomes, be it NP, PA or physician, no one hits the ground running right after they graduate. Some may think they do, but they most definitely don't.
I wholeheartedly agree. Our program did eventually get past the fluff, but PA programs I think have more hard science. So far I'm not impressed with DNP curriculums at all either.
A rather disheartening thread but not a complete suprise. I have just begun my NP education and have already begun to see that I am going to need to supplement with other resources. Patho has been interesting but not satisfying my "why and how" nature. ( Side Note- I understand that it was written by nurses but I have not been impressed with Huether & McCance.)
We used that for my BS program, but I confess I quite liked it. What specifically haven't you been impressed with? Is there another text you like better?
I just really, really hope that I find a great preceptor - yes, 'I find' her/him - but the school can give me a list of people who've done it in the past. Still - where do I go to find out who was a great preceptor? That's what I need to work on over the next year.
I share in the frustration. My first semester included a fantastic patho class, and one Nursing and Health Organizations something or other class. I could not TELL you what this class was about. It COULD have been about the healthcare system -- but I'm not sure.
They had us do a business plan and carry it out in a group project. Now, if it had been taught correctly, it would have been useful, but it ended up being a lot of people who know NOTHING about business and marketing doing endless power point projects w/ an instructor who knew even less about business and marketing. As a past busines/marketing professional, my head just about exploded in this class.
Totally agree with this. No matter what type of HCP one becomes, be it NP, PA or physician, no one hits the ground running right after they graduate. Some may think they do, but they most definitely don't.
I think the problem is that physicians and PA's hit the ground running faster than NP's due to education and clinical experence differences. I originally entered nursing to become a NP. However, due to weak didactic and clinical time I find myself gravitating towards the PA or DO option. There are certainly exceptions, some schools have great programs. Unfortunately these seem to be drown out by many more with the aforementioned "fluff". Nursing could rationalize that students gain the theory and 'fluff' in their BSN education. This would allow APN/NP didactic to be focused on pathophys and practice. Clinical time should also be expanded to at least meet PA clinical time.
I think the problem is that physicians and PA's hit the ground running faster than NP's due to education and clinical experence differences. I originally entered nursing to become a NP. However, due to weak didactic and clinical time I find myself gravitating towards the PA or DO option. There are certainly exceptions, some schools have great programs. Unfortunately these seem to be drown out by many more with the aforementioned "fluff". Nursing could rationalize that students gain the theory and 'fluff' in their BSN education. This would allow APN/NP didactic to be focused on pathophys and practice. Clinical time should also be expanded to at least meet PA clinical time.
(bolding mine)
Most of the "fluff" (which I don't necessarily consider "fluff," although my grad program had a bare minimum of that sort of thing and was predominantly solid clinical education/experience) in the MSN programs is content related to the difference between a staff nurse role and mid-provider role and making that transition -- so material covered in a BSN program would not supply that. Also, the theory content in my program was directly, concretely related to the clinical practice for which we were being prepared and was definitely necessary and useful. I can't speak to the curricula in other programs; however, I was v. happy with the education I got in my graduate program and how well I was prepared for clinical practice in my field. Maybe people need to "shop" more carefully for graduate programs before they sign up -- I notice an awful lot of people on this board (and people I've known in "real life") seem to take for granted that they're going to attend whatever school is located closest to them, or whichever program is cheapest, or whichever program is quickest or easiest, without considering that there really are significant meaningful differences among schools/programs.
Let's not forget ... More and more medical schools are adding humanities courses to their curriculums (e.g. music, art, literature, etc.). Medicine has recognized the benefits of such "fluff" in helping its practitioners become more aware of the human condition and their role in people's lives. They have found that such courses "improve the thinking" of med students -- who need more than just the hard sciences to be good physicians.
While I would never be one to support poor preparation in the hard sciences ... nursing would be foolish to follow the "old" path of medicine and eliminate all else. We should work to improve the quality of the "fluff" so that its usefulness becomes more evident to the students taking those courses.
And I heartily agree with Elkpark. If you don't like the curriculum of a particular school ... or its teachers are of poor quality ... you should choose a different school.
VivaRN
520 Posts
I recall being incredibly frustrated the first semester of my NP program as we had not yet started clinicals. Our instructors were PhD's who had not seen patients in years, or who volunteered at free clinics without diagnostic capacity to keep up licensure. Very different from private practice or any other practice. Lots of speeding through power points that did not make a whole lot of sense or encourage dialogue.
I was thankful for my RN experience because I could see the BS... my patho instructor reported "how to diagnose ARDS" from articles, I was working in ICU at the time and knew that anyone trying that in the clinical environment would look like a nutcase. Oftentimes we were presented with the gold standard instead of how things are diagnosed practically. I naively thought at this level there would not be hoop-jumping but there definitely was.
Clinicals were the saving grace, I had some amazing preceptors and studied on my own to learn and then apply the guidelines. That is where the real learning occurred, in my opinion.
My cohort wanted more time spent on entrepreneurship, billing and coding, the role of the nurse practitioner (what is it that we do, or bring, that is NOT being a mere physician extender? what makes us different? how is that seen or proven practically?), and contract negotiation.
I think we were left with a lot of role confusion and inability to see how our practice is different from the medical model. Of course there is the whole holistic nursing model PHILOSOPHY, but many of us were not seeing that in our clinical settings (patients q15 minutes, etc.)... and how to make an argument that this holistic thing was something we had that other providers did not have. If anything our knowledge of health promotion was not that extensive or special. Sort've like how the ideal of being a holistic healing nurse practitioner meets actual job responsibilities.