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]

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.

Post-hospitalization for a medical problem, yes - we would do the follow-up. Post-surgical - they would see the surgeon for follow-up. The only thing r/t surgery that we did in FP/IM was pre-surgical clearances. I see that now since I work in PAT for an anesthesia group. The patients already have their f/u appointments scheduled with their surgeons when they get to me a week or two prior to their procedure. Even if it was an emergency surgical procedure - their initial f/u is with the surgeon. Most surgeons I know don't want the FP doc handling anything r/t the surgery they performed - and if they do, they at least want a telephone consult.

[zenman]

My FP personal physicians don't even set foot in the hospital anymore. You're turned over to the hospitalist.

[BCgradnurse, MSN, RN, NP]

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.

While patient reviews may show how "likeable" a provider is, they also demonstrate that they're satisfied with the level of care they receive, i.e. they feel they were listened to, they feel their health improved, they feel they were treated appropriately. Patients often do know when they are getting substandard care-I think it's very patronizing to say they don't.

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.

I have to disagree here. Just because you're not an expert doesn't mean you aren't doing a good job. I never meant to imply that I'm an expert. I'm certainly a novice, but I still do a very good job. Part of doing a good job as a novice involves knowing your limits and knowing when to ask for help, and then learning from the experience. I think that applies across the board to any profession.

Quite frankly, I don't understand the constant bashing and one upmanship that goes on within the nursing profession and across the lines to other providers. I don't think it serves to make us better providers, if anything, it "cheapens" us. Yes, I think the NP role would be better served by having a more rigorous, standardized curriculum. But we don't have to compete with PAs, MDs, DOs, etc. as to who's better. We're all different and all have something to offer to health care and to our patients. Can't we leave it at that?

[dgenthusiast]

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.

While patient reviews may show how "likeable" a provider is, they also demonstrate that they're satisfied with the level of care they receive, i.e. they feel they were listened to, they feel their health improved, they feel they were treated appropriately. Patients often do know when they are getting substandard care-I think it's very patronizing to say they don't.

I have to disagree there. Patients are absolutely stupid when it comes to understanding medical care. I don't care it's politically incorrect to say that. The average person has no understanding of physio/path/pathophys/pharm/etc to understand whether he/she is receiving quality medical care. Just looking up something on WebMD doesn't make the average Joe knowledgeable enough to make judgements on quality of clinical care. It's not patronizing to say patients don't know when they're getting substandard care. It's the truth. To think otherwise, in my opinion, is far worse. Patient surveys basically show that the patient likes you because maybe you spent more time with him/her or maybe you truly "listened" to them, etc. Patients don't have the medical knowledge base, not even the fundamentals, to judge the quality of care you provided.

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.

I have to disagree here. Just because you're not an expert doesn't mean you aren't doing a good job. I never meant to imply that I'm an expert. I'm certainly a novice, but I still do a very good job. Part of doing a good job as a novice involves knowing your limits and knowing when to ask for help, and then learning from the experience. I think that applies across the board to any profession.

Quite frankly, I don't understand the constant bashing and one upmanship that goes on within the nursing profession and across the lines to other providers. I don't think it serves to make us better providers, if anything, it "cheapens" us. Yes, I think the NP role would be better served by having a more rigorous, standardized curriculum. But we don't have to compete with PAs, MDs, DOs, etc. as to who's better. We're all different and all have something to offer to health care and to our patients. Can't we leave it at that?

Sorry, but in the medical world, there's no such thing as "equal but different." There is a hierarchy and it exists for a reason. The attending is at the top of totem pole. His/her only equals are other attendings. Nurses, NPs, PAs, residents, med students, etc are all part of the team, yes. But, please, don't think that they're all equal. Now, before you get angry, I'm not saying they're not equal as people or anything like that. I'm saying, in terms of medical knowledge, providing quality clinical care, etc, they are not equal. You would be equal to an attending if you went to med school, residency, and became board certified in the same specialty as the attending. If not, you are below the attending on the totem pole. He/she has the ultimate say on patient care.

[BCgradnurse, MSN, RN, NP]

You're entitled to your opinion but I think you're wrong. Patients are not experts, but they are not at the complete other end of the spectrum either. Patients are not stupid and to say they are further enables the whole old school "I am the all knowing provider, you must do as I say" mentality. There's no place for that in this day and age. Frankly, I would not want to see a provider who has that kind of attitude towards patients, no matter how much of an expert he or she may be.

Second, you misunderstood what I said about different levels of probiders. I didn't say anything about separate but equal. I said we all had something to offer. I don't consider myself the educational or skill level equivalent of an MD. Bit, I have a role to play in health care that is just as valuable as an MD, as do PAs and any other health care professional.

[PICUPNP]

I guess all of your patients are in the medical field? If not, they have ZERO idea about standard or substandard care. These are concepts we learn in our training and apply daily to patient care. The average Joe Schmo relies on their providers to treat them appropriately. How would an average person know if they were prescribed the right therapy or not? They rely on their doctor, pa, or np to tell them. I definitely don't want the most likeable provider for my wife and kids...I want the one who knows what they're doing in treating patients!

[BCgradnurse, MSN, RN, NP]

Wow, why all the hostility?? Patients aren't experts, but they don't know "zero". If you treat them as such, then in my opinion, you're a lousy provider. Of course the patients rely on us to treat them appropriately. But they also know if they're getting better or not. Treating them like they're ignorant is just plain wrong. I really hope your paternalistic attitude does not come through to your patients, the way it's coming through in this forum.

[PICUPNP]

Wow, why all the hostility?? Patients aren't experts, but they don't know "zero". If you treat them as such, then in my opinion, you're a lousy provider. Of course the patients rely on us to treat them appropriately. But they also know if they're getting better or not. Treating them like they're ignorant is just plain wrong. I really hope your paternalistic attitude does not come through to your patients, the way it's coming through in this forum.

No hostility here..just experience talking. When you've been in your profession more than a year, you will understand. I don't treat patients like they're ignorant. I didn't say that.. What I did say was that patients don't have the same knowledge that we have and couldn't know if they were being treated approriately. This can be seen every day across the states and elsewhere in pediatrics. How many times does it take to get across the fact that viruses don't need abx? If a parent has no idea about treating something as simple as a cold, how can you expect them to know if they received the appropriate treatment for something more complex like a pneumonia or etc? Also, your comments about my attitude are unfounded. Sounds like more backlash from being a man in a female dominated profession.

[BCgradnurse, MSN, RN, NP]

I've been in healthcare for more than 25 years, so I think I do understand. You did directly say patients know zero, which I find to be untrue and narrow minded. Patients may not always know if they're not getting the right treatment, but they will know if it's not working. My comments about your attitude are based on what you posted....not unfounded at all. Again, I hope that doesn't come across in your care.

[BCgradnurse, MSN, RN, NP]

PICU,

I apologize if I've offended you. That was not my intent. I'll leave it at that.

[dgenthusiast]

You're entitled to your opinion but I think you're wrong. Patients are not experts, but they are not at the complete other end of the spectrum either. Patients are not stupid and to say they are further enables the whole old school "I am the all knowing provider, you must do as I say" mentality. There's no place for that in this day and age. Frankly, I would not want to see a provider who has that kind of attitude towards patients, no matter how much of an expert he or she may be.

Thanks for the reply. You're right that some patients may know more than zero. That still doesn't make them competent judges of the quality of medical care they receive. That's the reason they're coming to you, the provider. If they correctly knew what diagnosis/treatment they should be receiving, MDs/DOs/NPs/PAs/etc are obsolete. Patients, on average (there will be exceptions of course), do not have much medical knowledge beyond some HS/college bio course they took. The extent of their knowledge maybe goes to reading up something on WebMD. But WebMD is not a comprehensive source for learning physio/path/pathophys/pharm/etc. Patients go to the provider precisely because the provider has the medical knowledge to treat them and, hopefully, provide competent care.

Saying patients are stupid doesn't mean I am further promoting the old paternalistic view of medicine. I don't know how you put those two together but that is definitely not what I said. Medical providers are there to inform and, more importantly, advise the patient. The patient doesn't have to listen to the provider; they're not forced down one treatment path either. Options are laid in front of them and based on the advisement of the provider, patients choose a treatment option (which generally tends to be what the provider suggests since the provider has far, far greater knowledge and experience in the area). Hope this clears up what I was saying.

[dgenthusiast]

i have been a fnp for more than 23 years and a provider for 29, i agree with bc grad we need to treat patients as knowing more than zero. i guess it is one of those "nursing" fluff courses that suggests treating patients with dignity. thus, i am suggesting that the "fluff" in np programs should be in other provider curriculums instead of only the "hard" sciences.

i disagree that "fluff" is needed in md/do programs, for example. i don't know how you personally define fluff, but when i'm using the term, i'm talking about the business management, nursing activism/theory, etc, type of courses that don't help at all in taking care of patients. there's no place for those, imo, in a medical curriculum and they definitely should not be constituting up to half the credits in the np/dnp curricula either. i don't see how taking a few courses on business management/nursing activism helps me treat a patient with dignity. that's something most people learn far before ever entering medical training.

forgive me if i'm misreading your last sentence or two of your post and don't take offense to this, but nurses are not the jedi masters of holistic care. medical schools (both allopathic and osteopathic) have been teaching this "holistic" approach for decades now. the "holistic" approach pretty much comes down to the preference of the individual provider and how he/she treats patients, not what training background they have. so, please, don't continue to think that only nurses can provide holistic care while mds only treat the disease. it's absolutely not true (it might've been back in the 70s, but it's definitely not true today).