I read a recent post regarding new graduates who cannot find work jumping on the NP bandwagon.
At work the other day, a new grad co-worker (less than 5 months experience) launched into a bitter tirade against a well known school for having the gall to expect her to have 2 years experience, have been involved in EBP, Committees and to have precepted before being allowed to even apply to join their ACNP program.....
Mind you, this nurse can barely handle her assignment... what makes her think that the NP is going to be an easy way out of floor nursing.... The courses take time and dedication and contrary to popular belief, graduation and subsequent employment are not a given..
I didn't read it but it's fairly old. Anything recent?
It is a landmark study. Maybe try reading it first....
Or perhaps:
Budzi, D., Lurie, S., Singh, K., & Hooker, R. (2010). Veterans' perceptions of care by nurse practitioners, physician assistants, and physicians: a comparison from satisfaction surveys. Journal of the American Academy of Nurse practitioners, 22(3), 170-176.
Everett, C., Thorpe, C., Palta, M., Carayon, P., Bartels, C., & Smith, M. A. (2013). Physician Assistants And Nurse Practitioners Perform Effective Roles On Teams Caring For Medicare Patients With Diabetes. Health Affairs, 32(11), 1942-1948.
Aigner, M. J., Drew, S., & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. Journal of the American Medical Directors Association, 5(1), 16-23.
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians. JAMA: the journal of the American Medical Association, 283(1), 59-68.
Ah I knew you were going to post this one, I have read it before.
Problems I have with it:
1. Mundinger, controversial former dean of Columbia's SON
2. Old (2000), prior to the advent of readily accessed internet where NP programs might have been more solid
3. The diseases highlighted aren't fascinating, hypertension, diabetes and asthma. Pretty run of the mill stuff
4. It's primary care, I have no problem with NPs treating chronic conditions in primary care. What I do find unreasonable is the specialization of NPs into areas like derm or cardiology with no formal residencies in place or NPs with full attending rights without physician oversight in a hospital. Or NPs saying they have the same knowledge base to work off of as a MD. Will we have NP surgeons next?
At one point a person just has to stop and say, why didn't you just go to med school?
Ah I knew you were going to post this one I have read it before. Problems I have with it: 1. Mundinger, controversial former dean of Columbia's SON 2. Old (2000), prior to the advent of readily accessed internet where NP programs might have been more solid 3. The comorbidities highlighted aren't fascinating, hypertension, diabetes and asthma. Pretty run of the mill stuff 4. It's primary care, I have no problem with NPs treating chronic conditions in primary care. What I do find unreasonable is the specialization of NPs into areas like derm or cardiology with no formal residencies in place or NPs with full attending rights without physician oversight in a hospital. Or NPs saying they have the same knowledge base to work off of as a MD. Will we have NP surgeons next?[/quote']
You have to admit those problems with the study are fairly minor; overall it was a well-powered, well-designed RCT.
Hypertension, diabetes, asthma, COPD all pretty standard run of the mill stuff. Also a handful of the most common and costly diseases in healthcare.
I will have to look back at acute care studies. From my professional experience, my re-admission rate is considerably lower than my collaborating doc; his duration of stay is slightly shorter than mine. We work as a collaborative team though so it doesn't mean much.
Mans there are plenty of NPs, myself included, that do surgical procedures, just not major surgery
You have to admit those problems with the study are fairly minor; overall it was a well-powered, well-designed RCT.
Hypertension, diabetes, asthma, COPD all pretty standard run of the mill stuff. Also a handful of the most common and costly diseases in healthcare.
I will have to look back at acute care studies. From my professional experience, my re-admission rate is considerably lower than my collaborating doc; his duration of stay is slightly shorter than mine. We work as a collaborative team though so it doesn't mean much.
Mans there are plenty of NPs, myself included, that do surgical procedures, just not major surgery
So do you think NPs would benefit from standardization across the board with school and curriculum? I know some that do x-ray interpretation but not suturing and vice versa. Do you not think a formal residency and a minimum RN experience before applying would benefit the profession?
I am not going to be super young when I finish my BSN (I will be 23, almost 24). And if I did go straight through, I will be 27ish with three to four years of fulltime nursing experience. A woman's fertility declines in her late twenties. If I were a man, I would have no problem waiting to have kids
Oh my, 23 or 24 is not super young?????? A healthy woman's fertility does not typically decline until 35.
So do you think NPs would benefit from standardization across the board with school and curriculum? I know some that do x-ray interpretation but not suturing and vice versa. Do you not think a formal residency and a minimum RN experience before applying would benefit the profession?
I absolutely think standardization would be a benefit; I wish the programs were nationally limited and fully standardized with two step exams plus board exams. All NPs should have experience with diagnostic interpretation; this is on our boards.
Basic surgical skills is also something I think should be in the NP curriculum, and it was in mine, but I do think technical skills are the easiest part of the job and really anyone can be taught to perform them.
Formal residency programs are wonderful, especially for speciality practices where they are most common now. I think they are of great benefit to practice but I don't think they are required for practice.
As far as RN experience I have both an objective and subjective response. Objectively, the evidence doesn't support that is of great value nor required for practice. Subjectively I think that my RN experience was important and my practice as an APN is better off for it, though in reflection I can honestly say that an additional year of NP experience would benefit me much more than a year of RN experience. Overall I think RN experience (in most cases) benefits practice though I have seen evidence to convince me it's required of practice.
As far as RN experience I have both an objective and subjective response. Objectively, the evidence doesn't support that is of great value nor required for practice. Subjectively I think that my RN experience was important and my practice as an APN is better off for it, though in reflection I can honestly say that an additional year of NP experience would benefit me much more than a year of RN experience. Overall I think RN experience (in most cases) benefits practice though I have seen evidence to convince me it's required of practice.
C'mon! There are certain things that are logically obvious that don't need a controlled study and peer review to know! One of them is that going from school to autonomous NP practice with only precepted clinicals as the extent of patient contact is a recipe for patient and NP disaster!
Would you want an MD who just graduated to be solely responsible for your care? Many of us have worked with interns, and I would be none too happy if any of them were making decisions about my care on their own.
I disagree with your perspective. Perhaps, for this nurse it is not time to be an NP, but that is not true of all new graduate nurses. The RN role and the NP role are COMPLETELY different. Being an RN on the floor for a few years is probably helpful but I don't think it makes one NP better than another... Yes some NPs don't feel prepared out of school, they can easily sign up for an internship and hang out with an MD or another NP before they begin to practice independently. Floor nursing isn't for some people.
Saying a GN shouldn't become an NP until they have x years of experience is like saying a CNA shouldn't be an RN until x years of experience... except this makes MORE sense because the CNA and RN have much more in common than the NP and the RN.
Sometimes I think that the nurses who discourage GN so much from being NPs are jealous because they are jealous that the twenty-something GN has the drive to become an NP, while the 45 year old nurse with 44 years of nursing experience (sarcasm) is still stuck at the bedside and can't imagine going back to school... Just an observation.... I'm jealous of my 22 year old friend who only has a few months until she's an FNP... It's okay to be jealous, but resist the totally natural urge to rain on their parade.
It is a landmark study. Maybe try reading it first....
Or perhaps:
Budzi, D., Lurie, S., Singh, K., & Hooker, R. (2010). Veterans' perceptions of care by nurse practitioners, physician assistants, and physicians: a comparison from satisfaction surveys. Journal of the American Academy of Nurse practitioners, 22(3), 170-176.
Everett, C., Thorpe, C., Palta, M., Carayon, P., Bartels, C., & Smith, M. A. (2013). Physician Assistants And Nurse Practitioners Perform Effective Roles On Teams Caring For Medicare Patients With Diabetes. Health Affairs, 32(11), 1942-1948.
Aigner, M. J., Drew, S., & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. Journal of the American Medical Directors Association, 5(1), 16-23.
Need more?
If you have more, yes, please list them.
As for the landmark study, I think it should be repeated. So much has changed in the last 14-15 years in terms of clinical guidelines, decision making tools, technology, currículum, etc.
It would be interesting to see if the results still hold up.
C'mon! There are certain things that are logically obvious that don't need a controlled study and peer review to know! One of them is that going from school to autonomous NP practice with only precepted clinicals as the extent of patient content is a recipe for patient and NP disaster! Would you want an MD who just graduated to be solely responsible for your care? Many of us have worked with interns and I would be none too happy if any of them were making decisions about my care on their own.[/quote']
I think everything should have a controlled peer reviewed study! Seriously, there are some things that are logically obvious that turn out to be incorrect, which is why I always try and base my decisions on studies, if they are available. From science training I tend to accept the null if there is no evidence. All rules have exceptions though.
In my opinion, NPs are educated to be collaborative providers, be that with MDs, DOs, or other experienced NPs. I would never recommend a novice NP move directly into autonomous practice. I have advocate many times on the importance of support network for novice NPs.
If you have more yes, please list them. As for the landmark study, I think it should be repeated. So much has changed in the last 14-15 years in terms of clinical guidelines, decision making tools, technology, currículum, etc. It would be interesting to see if the results still hold up.[/quote']
BostonFNP, APRN
2 Articles; 5,584 Posts
It is a landmark study. Maybe try reading it first....
Or perhaps:
Budzi, D., Lurie, S., Singh, K., & Hooker, R. (2010). Veterans' perceptions of care by nurse practitioners, physician assistants, and physicians: a comparison from satisfaction surveys. Journal of the American Academy of Nurse practitioners, 22(3), 170-176.
Everett, C., Thorpe, C., Palta, M., Carayon, P., Bartels, C., & Smith, M. A. (2013). Physician Assistants And Nurse Practitioners Perform Effective Roles On Teams Caring For Medicare Patients With Diabetes. Health Affairs, 32(11), 1942-1948.
Aigner, M. J., Drew, S., & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. Journal of the American Medical Directors Association, 5(1), 16-23.
Need more?