frustrated with "fluff" in my NP program

[Grnrn]

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?

[Spacklehead, MSN, NP]

Wowza, with all due respect - I can honestly say that in all of my rotations the docs I was with did not take care of post-op problems, complications, etc. Anything r/t surgery was referred back the the surgeon. Same as in a hospital - inpatient surgical concerns get handled by the surgeons; general med. care is done by the hospitalist. They consult each other.

[t2krookie]

wowza, with all due respect - i can honestly say that in all of my rotations the docs i was with did not take care of post-op problems, complications, etc. anything r/t surgery was referred back the the surgeon. same as in a hospital - inpatient surgical concerns get handled by the surgeons; general med. care is done by the hospitalist. they consult each other.

ditto. they are referred to their treating surgeon. period. one would screen and treat/refer for the acute in a fp setting, but the physician who did the cutting will be the one to deal with the complications.

as to wowza's assertion concerning anxiety and depression having the potential to be complex, he is completely correct and completely avoiding the fact that any non-psych background pcp will not take responsibility for such a complex case. they are referred. you /treat/handle the exacerbation and make the appropriate referral. i can't count the times i had to point out the difference treatment regime between depression and bipolar depressed or bipolar manic v/s psychosis to our physicians and mid levels. i say again, the role is not super simple but neither is it rocket science. wowza and i have had several disagreements concerning appropriate roles for apns and it is "blindingly obvious" we will continue to disagree on a great many things.

[BCgradnurse, MSN, RN, NP]

Getting a little off track here, but as a Direct Entry grad I have to say that I am not "dangerous", "inappropriate", nor do I "cheapen" the profession. I may not have years of RN experience, but I have the skill set necessary to do my job well, as evidenced by my peer and superior reviews, and most importantly, by my patient reviews.

I worked my butt off and passed the same competencies and boards that any FNP has to pass, regardless of RN experience. So please don't dismiss these programs out of hand....let the individual's performance speak for itself. Now, back to to the fluff......

[DuluthMike]

I may not have years of RN experience, but I have the skill set necessary to do my job well, as evidenced by my peer and superior reviews, and most importantly, by my patient reviews.

I would have a very hard time believing that any practitioner, PA, NP, DO, MD, could do their job well in their first year with no experience beforehand. Perhaps that is my subjective view of what doing ones job well is, though. No one is saying that a direct entry NP (or PA for that matter) isn't going to be able to succeed. Rather, it is far more likely that you spend more time in the novice position before moving on to what I'd like to think of as doing ones job well.

The NP position was intended to take seasoned nurses and transform them into a practitioner. The PA role was created in a similar manner. It is not that you cannot succeed, but rather that it intuitively has to take longer to achieve competence.

However we are getting side tracked. I think some great points have been made about the lack of standardization for didactic and clinical experience. The market is saturated with programs that put forth the minimum. Again, these NP's could be great practitioners, they will just take a bit longer to season. In the mean time these programs have the potential to weaken the profession through public and peer perception and misconception.

[t2krookie]

getting a little off track here, but as a direct entry grad i have to say that i am not "dangerous", "inappropriate", nor do i "cheapen" the profession. i may not have years of rn experience, but i have the skill set necessary to do my job well, as evidenced by my peer and superior reviews, and most importantly, by my patient reviews.

i worked my butt off and passed the same competencies and boards that any fnp has to pass, regardless of rn experience. so please don't dismiss these programs out of hand....let the individual's performance speak for itself. now, back to to the fluff......

my apologies bc. i do not intend to attack your competence in particular rather than the process in which you came to be. just as an exceptional individual can come out of poor preparation and succeed, so can poor performers come through a similar program and become dangerous. as mentioned before, the concept of np came with the expectation of starting with an experienced nurse. the pathway has since twisted/morphed into a shortcut that has the "potential" for poor results.

[PICUPNP]

I would have a very hard time believing that any practitioner, PA, NP, DO, MD, could do their job well in their first year with no experience beforehand.

With regard to a DO or MD not being ready for practice right out of school, you're way off the mark. I have worked with many docs right out of school and they are FAR more prepared than any NP or PA is right out of their schooling. The reason for this is the extraordinary amount of clinical time they spend in training! NPs need more clinical time as well as a futherance of the hard sciences.

[Purple_Scrubs, BSN, RN]

So, what do you all recommend for a would-be FNP student in a local brick & mortar program. What could I do to "beef up" my educational experience.

I have already considered taking an extra semester of clinical courses beyond what is required. Are there any other classes I should consider? I have considered going straight for a DNP after the MSN just for the extra clinical and classroom experiences, but I hear that many of those programs are equally "fluffy", lol.

If I am going to do this, I want to be as prepared as possible coming out of school. Is it possible to get past the fluff and get a good solid education, or should I re-think my career options?

[PICUPNP]

Why not PA school? Better education, more clinical hours, and more patient interaction. Its a win-win situation.

[BCgradnurse, MSN, RN, NP]

I did more clinical hours than were required. My preceptors were great about letting me come in extra days and weekends. I would also recommend looking into an NP residency after graduation. There aren't many, but they are becoming more common. That will give you an extra year of supervised practice. Wish I could have done it.

[Purple_Scrubs, BSN, RN]

Why not PA school? Better education, more clinical hours, and more patient interaction. Its a win-win situation.

I did consider it, but I want to be a nurse educator someday, so it does not really fit with that plan. I also have to work right now, so it would be several years at the least before I could do it, if I was even able to swing it then. I like the nursing model and want to remain a nurse, I just wish the curriculum was more rigorous. I am not afraid of difficult, in-depth material especially if I am ultimately a better clinician for it.

[Purple_Scrubs, BSN, RN]

I did more clinical hours than were required. My preceptors were great about letting me come in extra days and weekends. I would also recommend looking into an NP residency after graduation. There aren't many, but they are becoming more common. That will give you an extra year of supervised practice. Wish I could have done it.

I wonder if facilities who do not have structured residency programs could be approached about offerring one on an individual basis. I would be willing to work for a reduced wage for a year if in turn I could have some mentoring, experience, and extra supervision while acclimating to the role.

[wowza]

Wowza, with all due respect - I can honestly say that in all of my rotations the docs I was with did not take care of post-op problems, complications, etc. Anything r/t surgery was referred back the the surgeon. Same as in a hospital - inpatient surgical concerns get handled by the surgeons; general med. care is done by the hospitalist. They consult each other.

Really? That surprises me. During my family med rotation I personally interviewed multiple patients who were coming the week after hospitalization for a check up. And my FM rotation was only for a month.

Getting a little off track here, but as a Direct Entry grad I have to say that I am not "dangerous", "inappropriate", nor do I "cheapen" the profession. I may not have years of RN experience, but I have the skill set necessary to do my job well, as evidenced by my peer and superior reviews, and most importantly, by my patient reviews.

I worked my butt off and passed the same competencies and boards that any FNP has to pass, regardless of RN experience. So please don't dismiss these programs out of hand....let the individual's performance speak for itself. Now, back to to the fluff......

I hate to nit-pick but I see this very often on this site and especially in some journal articles. Patient reviews tell you nothing about your competency as a provider. They just tell you that you are a likeable person- which while important is not as important as the actual skillset.

How are your patients going to know if they are getting substandard care? They won't. If you give a COPD patient with pneumonia azithromycin, they just come away with the fact that they got an antibiotic, not the fact that you gave them the wrong treatment.

I would have a very hard time believing that any practitioner, PA, NP, DO, MD, could do their job well in their first year with no experience beforehand.

With regard to a DO or MD not being ready for practice right out of school, you're way off the mark. I have worked with many docs right out of school and they are FAR more prepared than any NP or PA is right out of their schooling. The reason for this is the extraordinary amount of clinical time they spend in training! NPs need more clinical time as well as a futherance of the hard sciences.

While I agree, I think we can all agree that a new DO/MD still is a long way away from an attending physician.