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I am not sure on what side of the fence I stand on as of yet. I am having difficulty squaring the different level of standards for an APN to practice medicine vs a physician. Can somebody explain this to me?

Specializes in New Critical care NP, Critical care, Med-surg, LTC.
6 hours ago, Oldmahubbard said:

At the same time the quality of NP education is declining, which I think is indisputable, FPA is increasing. I fear a perfect storm, but I hope to be at least semi-retired by then.

Yes. When I was applying to schools I did what I thought was decent research, found a school well rated according to some websites I thought were reputable. I've been disappointed since enrolling. With extra work on my part and lucking out with fantastic preceptors I hope to be prepared. I would have preferred a school I felt was actually preparing me, because paying to do it myself, and be frustrated with group projects, has not been ideal.

That being said, I'm now completing clinical rotations where I see some questionable judgment decisions from NPs, PAs and MDs alike. Sometimes bright people make mistakes, and sometimes not very bright people can make it through board certifications.

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The group projects were asinine. Do MD students do any moronic group projects?

Embarrassing. For shame.

I am just fervently praying the whole debacle doesn't hit the front page of the NY Times in the next 5 years.

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7 hours ago, Oldmahubbard said:

The group projects were asinine. Do MD students do any moronic group projects?

Embarrassing. For shame.

I can't agree with you both more! I think we are currently in a race to the bottom of NP outcomes. You can't browse the internet without an endless onslaught of, "It's-so-easy you can be an NP without ever changing out of your PJs," type ads for NP schools. How is it possible that an ever increasing amount of increasingly poorly trained NPs is a sustainable model? How are the quality NPs who practiced at the bedside, attended a rigorous school, and maintained on-going education going to keep their credibility in this sea of lunacy?

Do MD students do moronic group projects? Maybe one or two...but it certainly isn't combined with reflective journaling as the basis of their education. They are also in school for four years before starting residency. Then they spend 3+ years decidedly not doing group projects, rather they have years of supervised practice in their own specialty, plus rotations in other, relevant medical disciplines. Oh, plus mandatory weekly specialty-specific educational lectures, morbidity and mortality conferences, case reviews, and on-going board preparation quizzes. You cannot possibly convince me that the "bedside nursing experience" an RN brings to NP school somehow makes up for all that.

Source-married to an MD, been together through his medical school/residency and my nursing school.

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Specializes in CCRN BSN Student FNP.

I am in my last semester in an FNP program after 15 years in a mixed Trauma 2 ICU. I think I am very cautious about FPA. I am reminded by the limitations of my education every day as I discuss my patients with the physicians.

What used to be an inexpensive, quick but high effort degree for decent pay has now become a 4 year slog full of fluff costing 40,000k. This drive for the DNP is frustrating. What is the basis of this? Was there any evidence of need for a DNP? Is the traditional MSN model not enough? Or is it more of the same where academia feels the need to increase the educational requirements to justify the income level as has been done throughout the last 60 years of nursing.

One big benefit of NP to the healthcare system are lower reimbursement rates.....increased education requirements = more educational costs, time, effort, group projects= same income. What sense is that? Oh thats right NPs are equal to physicians and should be reimbursed as such. Again no savings....

At my university it is possible to go from BSN to DNP with one year of bedside experience. Clinical experience only 1200 hours total and that doesn't even equal the PA's program requirement of 1500 hours

IF DNP "must" be "a thing" then at least make it more clinically oriented... all these filler classes about leadership, healthsystems, informatics and health policy leadership is a bunch of bunk. Its like the nursing academia are trying to turn NPs into the koolaid man crashing through the door yelling "I am a case-manager! A policy leader! I am a practitioner! I am EVERYTHING TO EVERYONE! and you.......you are a puny physician!" Sometimes I wan't to say just pick a lane, be great in your clearly defined role, and help the system out.

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Specializes in CCRN BSN Student FNP.
On 9/14/2019 at 8:16 PM, Penguins10 said:

Current supervision requirements are almost always a facade and essentially about asserting physician control as a professional guild.

I am happy to critique NP education, but I don’t think requiring nominal physician supervision helps patients, nurses, or physicians.



Should there not be physician control? After all they invented the practice of medicine. They are responsible for setting standards of practice. Why are there 2 different levels of requirements for practicing medicine? MD, DO and DC all have to take state medical boards. Why not NPs?

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
22 hours ago, Oldmahubbard said:

The group projects were asinine. Do MD students do any moronic group projects?

Embarrassing. For shame.

I am just fervently praying the whole debacle doesn't hit the front page of the NY Times in the next 5 years.

Agreed. I'm hoping that by the time there is mass questioning of the academic standards I will have proven myself a competent colleague to my future coworkers. I can't imagine that things will be able to go on as they are for too long without sweeping changes coming down. However, people keep touting peer-reviewed research papers that show decent outcomes for NPs, so maybe we are being overly critical because we have seen what is going on. Perhaps everyone that is graduating also feels the need to augment their learning and we are a prepared work force.

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Frankly speaking I would not want some NPs to have FPA. The California diploma mill is churning them out faster than we change clothes. Yes I am an NP and yes I went to school in California and let me tell you I'm still i'm still wondering how some people I graduated with have the license to practice. Just calling it how it is.

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Specializes in Nephrology, Cardiology, ER, ICU.

Okay guys FPA doesn't mean a free for all with APRNs randomly caring for pts w/o oversight or physicians to discuss cases with.

I'm in IL, the home of the AMA and we recently passed the FPA law and it was effective July 1st. I'm the proud holder of a FPA APRN license. This isn't going to change my practice one little bit: if I have a question/concern, you'd better believe I'll be talking to one of the nephrologists I work with. After 13 years whether I have FPA or not, I have seen some things and can easily care for the issues I've encountered w/o MD conference. Its there though if I need it.

However, what I do plan on doing:

1. Medical missions

2. Volunteer more as an APRN in areas where there is a need

3. Embark (perhaps) on setting up my own practice

I plan to do these things though with the caveat that just because I'm a FPA APRN, that doesn't mean I know things I don't - I won't get in over my head. As with MDs and other colleagues, we owe it to our patients to be the best, most prudent, knowledgeable and compassionate provider we can be.

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Specializes in CCRN BSN Student FNP.
46 minutes ago, traumaRUs said:

Okay guys FPA doesn't mean a free for all with APRNs randomly caring for pts w/o oversight or physicians to discuss cases with.

It doesn't?

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It is up to the APRN to know when they should refer. But it is true in a FPA state, there is no physician oversight.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I think everywhere in the world, no matter the profession, the people that scare us are those that can't or won't admit what it is that they don't know. Sometimes this issue comes up in relation to APRNs and people seem to think they've got the market cornered on people with substandard educations and a lack of skills/ability to do a job that they somehow got. Working as a floor nurse I have colleagues that scare me a bit. And in some ways I think they are more dangerous to a patient because they could make an immediate mistake with dire consequences. Of course APRNs could do the same, but so could my mechanic or electrician.

I know my contributions to this thread got slightly off topic related to education (or lack thereof), but I'm glad to read traumaRUs' post about some of the benefits to FPA and how it will impact some APRNs practice. I have a lot to make myself educated about when I get through my education and I'm glad to have resources like this site to help.

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Specializes in Nephrology, Cardiology, ER, ICU.

I should clarify my comment about MD oversight. I meant that we (APRNs) still can’t just take off and do everything an MD can do. I’m in nephrology and have a FPA license. However I don’t plan to go transplant a kidney tomorrow or place a fistula. These are not my skill sets. However for me I’m already pretty autonomous. And at least in IL I must still have a supervising MD for accessing the monitoring site

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