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 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.
as others have already iterated, preparation is dependent upon the coursework of the program so lumping all into one description is just hyperbole. it is unfortunate that np education is so varied between programs but that is where we students need to exercise our due diligence. i agree with much of what you say. however, the statement that "clinical time should also be expanded to at least meet pa clinical time" is not a good idea nor is it needed. pa's are educated in the "generalist" way just as mds. education as "generalist" is a big part of the problem with md education for those who go on to specialize (80%+ of mds) and even worse for those who go further and sub-specialize. nps on the other hand are focused on a particular population. that is what we are designed to do. not to replace mds as generalist educated providers. np tracts do have more clinical hours in their "chosen" specialty and that is how it should be. some have more than others. my program for instance has 720 hours. that is more than the pa does on any particular rotation i believe. (corrections as for the fluff, i also lament it's purveyance in np curriculum.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
ITA with rookie. I have mentioned this in several other threads - NP education is more focused than PA education. PAs do surgical rotations, ED rotations, derm. rotations, etc., which are not needed by the NP specialties.
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.
That's not true. Med schools, in recent years, have put more emphasis on things like ethics, understanding the patient's financial situation, etc. But you will not see courses devoted to music, literature, art, etc, added to the curriculum. Why? It's simple. Those courses are useless for the practice of medicine.
Where med schools get diversity from is in the admissions process. That's where they look for people who think more than in a purely scientific manner. Being a musician, being a non-science major, etc, can be a huge boost in the med school application process if you can perform well academically (especially in prereqs and the MCAT). You're absolutely right that you need more than basic science knowledge to be a good physician. However, you don't need to waste time learning Shakespeare or Kantian philosophy (neither of which that vast majority of your patients will be familiar with) to be a good one.
That's not true. Med schools, in recent years, have put more emphasis on things like ethics, understanding the patient's financial situation, etc. But you will not see courses devoted to music, literature, art, etc, added to the curriculum. Why? It's simple. Those courses are useless for the practice of medicine.
Where med schools get diversity from is in the admissions process. That's where they look for people who think more than in a purely scientific manner. Being a musician, being a non-science major, etc, can be a huge boost in the med school application process if you can perform well academically (especially in prereqs and the MCAT). You're absolutely right that you need more than basic science knowledge to be a good physician. However, you don't need to waste time learning Shakespeare or Kantian philosophy (neither of which that vast majority of your patients will be familiar with) to be a good one.
Hmmmm.... I was just reading about the art class at Harvard Med School today in the current issue of The Chronical of Higher Education. It was reading that article today that prompted me to make my earlier post. Perhaps it is just an elective ... or a part of their education for advanced students or physicians post-licensure.
Reading these post brings a few things to my mind....I'm so concerned about people who are going into direct entry programs. Most of us are experienced nurses who can paddle our way through some of the classes that we might not find so useful. I have a master's degree in another health related area and found that many of my BSN classes were a repeat with a nursing fling to it! I sat through it because at the end of the day, I needed to get my paper. As I approach my MSN/FNP program, I'm sure there will be topics, classes, etc that seem to repeat or what I would consider less important because of my goal. I want to learn more clinical than non-clinical material. However, our MSN programs do not only prepare everyone to go into a clinical role. Therefore, they have a base in these programs that allow us to have similiar foundation core courses. As what was said earlier, focus on getting really good preceptors. I embrace learning and I think the fluff might be helpful for some. I think the "fluff" classes also show us how our profession leads us in many directions post graduation. I definitely think the programs could improve on what courses they offer. But it all depends on your work experiences, life experiences etc that will dictate what you may need as you progress through your profession.
ITA with rookie. I have mentioned this in several other threads - NP education is more focused than PA education. PAs do surgical rotations, ED rotations, derm. rotations, etc., which are not needed by the NP specialties.
Its a difference in emphasis. You might look at this as unnecessary, while I look at the various rotations as necessary components that make a competent FP provider.
PA education is set up to make a competent family practice PA. Basically its set up to produce a provider that can handle 85%+ (per the estimation of the original NAS study) of primary care encounters. The training follows the medical model. 75% of the time is spent studying the 10% of conditions that you will probably never see but have to recognize when you see them. The other 25% of the time is spent studying the 90% of conditions that you see every day.
The clinical rotations are set up in a similar manner. The required rotations are either intended to give a PA student intensive experience in an area of practice that may be hard to get or experience in rare conditions that you have to know how to handle. OB/GYN is an example of the first. Depending on the practice its difficult for students to get PAP/pelvic experience. A dedicated OB/GYN experience makes sure that PAs are competent in a fairly important FP skill set.
Psych and surgery are examples of the latter. For example it would be unusual for a FP practice to see an acute abdomen more than once a year. For someone that only does rotations in Family practice its unlikely that a student would see one. However, in a given surgery rotation it would be unusual if you did not see 4 or five per week. I actually learned more about depression treatment in my FP rotations. However, I learned what someone that was having a schizophrenic break looks like in my psych rotations. Its not something that you would be expected to treat in FP but its something that you have to recognize.
As far as hours, if you count all the primary care rotations (IM, Peds and FP x2) it would unusual to find a PA student that did not have 750 hours in FP (outside of the surgical PA programs). The sum total of the all the hours is meant to reinforce skills needed for FP.
PA education does produce a generalist, but its a generalist in the sense of the old school GPs. Trained generally in medicine to do primary care. The generalist education also lends itself to additional training necessary to do specialist medicine.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I find that all the frustration we have about all the "fluff" courses we have to take in our respective NP programs boils down to the fact that our Nurse Practitioner Educational Leaders continue to ignore the problem of lack of standardization in our curricula and not having a true system of accreditation for all NP programs. Instead, we got sidetracked with this DNP business that just added more confusion to the mix. I personally did not mind the "fluff" courses as they do give our training the unique nursing identity that is actually part of our title (that is, if anyone has forgotten that we are called Nurse Practitioners). However, I also believe that a more substantial clinical training that is consistent regardless of what particular institution students are attending is a must for our profession to continue to assert our credibility as providers.
If you look at specific NP programs across the US, you will find that some programs have more basic medical science content and more robust clinical courses than others though the programs all lead to the same NP track. Also notice that our regulatory boards continue to ask programs to come up with the bare minimum of clinical hours and didactic content and some programs do follow these bare minimums in their curricular content while other institutions who have more of a reputation to protect go over and beyond the basic requirements in the curriculum. We have made enough noise about the inadequacy of some NP programs that the AMA has cited this in their recent release about the need for continuation of close NP-physician supervision. It's time that NONPF and certification boards listen by being proactive and stop being defensive when our training is attacked by other professions.
its a difference in emphasis. you might look at this as unnecessary, while i look at the various rotations as necessary components that make a competent fp provider.
pa education is set up to make a competent family practice pa. basically its set up to produce a provider that can handle 85%+ (per the estimation of the original nas study) of primary care encounters. the training follows the medical model. 75% of the time is spent studying the 10% of conditions that you will probably never see but have to recognize when you see them. the other 25% of the time is spent studying the 90% of conditions that you see every day.
the clinical rotations are set up in a similar manner. the required rotations are either intended to give a pa student intensive experience in an area of practice that may be hard to get or experience in rare conditions that you have to know how to handle. ob/gyn is an example of the first. depending on the practice its difficult for students to get pap/pelvic experience. a dedicated ob/gyn experience makes sure that pas are competent in a fairly important fp skill set.
psych and surgery are examples of the latter. for example it would be unusual for a fp practice to see an acute abdomen more than once a year. for someone that only does rotations in family practice its unlikely that a student would see one. however, in a given surgery rotation it would be unusual if you did not see 4 or five per week. i actually learned more about depression treatment in my fp rotations. however, i learned what someone that was having a schizophrenic break looks like in my psych rotations. its not something that you would be expected to treat in fp but its something that you have to recognize.
as far as hours, if you count all the primary care rotations (im, peds and fp x2) it would unusual to find a pa student that did not have 750 hours in fp (outside of the surgical pa programs). the sum total of the all the hours is meant to reinforce skills needed for fp.
pa education does produce a generalist, but its a generalist in the sense of the old school gps. trained generally in medicine to do primary care. the generalist education also lends itself to additional training necessary to do specialist medicine.
david carpenter, pa-c
on the need for such a generalist education we must agree to disagree. i do not see that the "old school" model is needed in my interactions with gps and ed docs for many years. this discussion has come up repeatedly and the mds have universally indicated that they do not utilize more than a small percentage of what they learned and have mostly forgotten the rest. the old adage of "use it or lose it" is appropriate in this case. as for "acute abdomens", the normal range of screening i.e. lab work, films, symptomology, and physical exam; a competent rn can deduce and pass to an appropriate specialist/surgeon, let alone a np who has been trained further in detecting such. as for psych, a simple mini-mental competently done will give a general dx and depression anxiety symptomology is pitifully simple. this is not rocket science, and a rn with quality np training can assimilate and apply this knowledge quiet well. this does however get back to standards of np curriculum. most of us want more, but that may also simply be a reflection of our thirst for more knowledge and responsibility. i myself have a problem with the idea that a person with little to no nursing experience can bridge to rn and immediately enter a msn program of study. i think it is dangerous, inappropriate, and cheapens the whole concept of nurses assuming greater responsibility.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
David, my FNP program was set up in a similar fashion, and I agree that time spent in each FP "specialty component" should be required in order to produce a competent FNP. I did 2 rotations in FP settings, 2 rotations in IM, 2 rotations in peds, 1 rotation in OB/GYN, and 1 rotation in geriatrics at a nursing home. Psych issues were incorporated into each of those rotations, since those types of patients were seen at each setting. If it was too complicated, they were referred to a psychiatrist. Same went for derm - we did get it at each clinical site and had in-class education on it, but if it was beyond the obvious, it was referred out (just like the FP/peds physicians do all the time). I really don't believe as a FNP that a separate ED or surgical rotation is necessary. I honestly don't believe FNPs should be handling everything that comes through the ED doors (that's where the ACNP comes in to play) unless it is strictly fast-track (i.e. can be handled in a doctor's office). Also, FNPs just don't do surgery - so no need for that rotation. We did learn hands-on suturing, I&D and cryo.
I also am a huge believer in NP programs requiring intensive nursing experience before acceptance into a program, supporting the title of "advanced practice nurse." I also agree that a competent RN with a few years' experience could figure out if a patient had an acute abdomen; triage nurses do it all the time in the ED.
on the need for such a generalist education we must agree to disagree. i do not see that the "old school" model is needed in my interactions with gps and ed docs for many years. this discussion has come up repeatedly and the mds have universally indicated that they do not utilize more than a small percentage of what they learned and have mostly forgotten the rest. the old adage of "use it or lose it" is appropriate in this case. as for "acute abdomens", the normal range of screening i.e. lab work, films, symptomology, and physical exam; a competent rn can deduce and pass to an appropriate specialist/surgeon, let alone a np who has been trained further in detecting such. as for psych, a simple mini-mental competently done will give a general dx and depression anxiety symptomology is pitifully simple. this is not rocket science, and a rn with quality np training can assimilate and apply this knowledge quiet well. this does however get back to standards of np curriculum. most of us want more, but that may also simply be a reflection of our thirst for more knowledge and responsibility. i myself have a problem with the idea that a person with little to no nursing experience can bridge to rn and immediately enter a msn program of study. i think it is dangerous, inappropriate, and cheapens the whole concept of nurses assuming greater responsibility.
as an actual physician, i can tell you that you are wrong about the utility of a generalist education. it is completely vital, especially for someone in primary care who will be taking care of patients that come back from the hospital/surgery etc. without a basic knowledge of what goes on in those services, you cannot do your job as a pcp. how could you possibly take care of a post-op patient when you have never had a surgery rotation?
actually, depression and anxiety can be quite complex. an inpt psych rotation would have made that blindingly obvious.
t2krookie
82 Posts
as others have already iterated, preparation is dependent upon the coursework of the program so lumping all into one description is just hyperbole. it is unfortunate that np education is so varied between programs but that is where we students need to exercise our due diligence. i agree with much of what you say. however, the statement that "clinical time should also be expanded to at least meet pa clinical time" is not a good idea nor is it needed. pa's are educated in the "generalist" way just as mds. education as "generalist" is a big part of the problem with md education for those who go on to specialize (80%+ of mds) and even worse for those who go further and sub-specialize. nps on the other hand are focused on a particular population. that is what we are designed to do. not to replace mds as generalist educated providers. np tracts do have more clinical hours in their "chosen" specialty and that is how it should be. some have more than others. my program for instance has 720 hours. that is more than the pa does on any particular rotation i believe. (corrections as for the fluff, i also lament it's purveyance in np curriculum.