How do you feel?

Jules A, MSN · Jan 13, 2018

Great questions and you will find other threads on the pros and cons of being a NP and opinions on NP vs PA if you search here. If you aren't familiar with the usual suspects here let me be transparent, although I have enjoyed my nursing and NP years I tend to be cynical and protective of our profession. I believe we could lose much of the nursing theory fluff and improve by shifting our education toward the medical model. I believe we have done a great disservice to Nurse Practitioners by embracing a philosophy which values quantity over quality. The schools of course are in it to make money. They have come up with a brilliant plan to encourage undergraduates to remain there through graduate school. This results in excellent retention of those who wouldn't have returned to school as well as those who might have gone elsewhere if given the opportunity to gain actual nursing experience. We have great numbers now but will we continue to offer quality care as those numbers increase exponentially?

1. Do you feel as though your NP Program properly prepared you to safely and competently care for patients? No. If I had not had the years of RN experience I would not have felt competent after only 1 diagnosing and 2 pharmacology courses. Please note I went to a well known high ranking brick and mortar school. Unfortunately a majority of professors had minimal prescribing experience and for students who didn't have their own preceptors the majority of preceptors were recent graduates from the program. You will mirror those who trained you. My clinicals were done with MDs I had worked with and knew to be competent which helped immensely.

2. Do you feel that you truly have an in depth understanding of Anatomy & Physiology, Pathophysiology, and Pathology? No

3. Do you feel as if your medical questions in lecture were answered to an extent that clearly illustrated that your professors were truly knowledgeable in advanced practice/medicine? No

4. Do you feel that your thirst for medical knowledge was satisfied? No

5. Do you feel satisfied in your role as a Nurse Practitioner? Yes although in hindsight I wish I had gone to medical school

KatieMI, BSN, MSN, RN · Jan 13, 2018

1. Do you feel as though your NP Program properly prepared you to safely and competently care for patients?

Depends. Simple office one-time, one-size-fits-most problems (which are 85% of, say, urgent care in "uncomplicated" area - i. e. well served, no opioid epidemics, not poor, etc) - yes. The rest - not even near. That includes, for example, a classic SNF with 90-year old sweetes on average 21 meds/head (real one, the max was 40+)

2. Do you feel that you truly have an in depth understanding of Anatomy & Physiology, Pathophysiology, and Pathology?

I do because I have way more background than most people. At least, when I need to understand something more advanced it doesn't sounds like a rocket science for me. But I still read, read, read. Harrison and my set of med school books (in my program, most if not all students read them at least from time to time and professors turned heads other way if we cited them instead on "nursing" on clinical courses) and AAFP (I found a way to download their podcasts from hospital site for free :)

3. Do you feel as if your medical questions in lecture were answered to an extent that clearly illustrated that your professors were truly knowledgeable in advanced practice/medicine?; In that, they actually answered your question and not just answering stating, "That is something you will learn, 'on the job.'"

In my program "that's something you learn on job" was accepted only about local policies and rules. Not about science, pathology, etc.

BTW, in advanced practice nursing as well as in classic medicine many times it matters more not what you really know but how you show and present it. That is the kind of art you have to learn at work.

4. Do you feel that your thirst for medical knowledge was satisfied?

Nope, and it not gonna happen any time soon. I am going to live another 40 years or so.

5. Do you feel satisfied in your role as a Nurse Practitioner?

Yes, very much so. I like it WAY better than bedside.

Oldmahubbard · Jan 13, 2018

I will heartily agree with the other answers. No, my program did not begin to prepare me, even though it was a well known brick and mortar school. I absolutely prepared myself. Our main professor had no prescribing experience, if you can believe it.

Thankfully I prepared myself with good and bad role models. My first job was in a forensic setting, working with mentally ill inmates. It was inpatient, and I managed a caseload of about 20, but most were not acute. There was no pressure to "make numbers"and plenty of time to look things up. The pay was lousy, but what an education!

Since then, I have gone on to other jobs, and the pay is now excellent. Becoming an NP was the best thing I ever did in my life. The bedside was not at all for me, I was just constantly frustrated and bucking heads with people.

So, yes, being an NP has been very emotionally and financially satisfying for me.

That being said, I know people who have not made their NP career work for them, can't get out of debt, can't keep a job and make the productivity, etc.

I think both luck, and personal factors are probably involved.

mrcleanscrubs, BSN, RN · Jan 13, 2018

@Jules A ,

I could not agree with you more! I wish that NP programs were as standardized as PA programs, and more focused on the science aspect of care as opposed to the, psychosocial holistic political information we learn. That fluff really needs to be left in the past, and the model should be, as you stated, geared towards the medical model. Great Replies, thank you for your in depth responses!

mrcleanscrubs, BSN, RN · Jan 13, 2018

KatieMI, MSN, RN ,

Thank you for your reply! I cannot believe the clinical professors would turn their heads after students cited medical books; absolutely insane. I like how invested you seem to be in your studies - keep reading! I also like the answer you gave, for number four - that is the way to be, everyday is truly a learning experience.

Thank you so much!

mrcleanscrubs, BSN, RN · Jan 13, 2018

Oldmahubbard ,

Thank you for your reply! Wow, that is absolutely ridiculous - how could a professor teach without any prescribing experience; very unfortunate. I like how you took the time to separate your role models into good and bad ones, the bad ones showing you what not to do, and the good ones showing you what to do. Great reply, thank you!

Oldmahubbard · Jan 13, 2018

Haha, there were more bad role models than good!

KatieMI, BSN, MSN, RN · Jan 13, 2018

KatieMI, MSN, RN ,
Thank you for your reply! I cannot believe the clinical professors would turn their heads after students cited medical books; absolutely insane. I like how invested you seem to be in your studies - keep reading! I also like the answer you gave, for number four - that is the way to be, everyday is truly a learning experience.
Thank you so much!

I think you misunderstood. I meant that, although my school required us to use as primary sources books written for NPs and containing, on top of factual and necessary information, tons of useless junk about nursing process and philosophy's importance in treatment of staph throat, our professors (well, most of them) were quite satisfied if we worked through books used by medical school students instead. They even quietly recommended doing so but asked us not to advertise that to anyone :)

Thank God, we had only one cookie who was level 80 APA-nazi and insisted that writing a script for amoxicillin for the treatment of that staph throat was "nursing" action because we were "nurses, as opposed to doctors" - and that only one who was seriously despised by every student in class.

umbdude, MSN, APRN · Jan 13, 2018

OP -

I'm a psych NP student (finished 1 semester which included advanced patho). If you are considering either PA or NP, do read and ask questions on PA forums to get views from both sides. There's a lot of negative views on the nursing "fluff," and I agree to an extent, but these "fluff" courses are what define nursing from medicine. Ultimately, you have to decide whether you want to practicing nursing or medicine.

In terms of preparedness, nobody will or should feel prepared as a new grad. This isn't just for nursing. PA & MD new grads often feel like they don't know anything either, in the first year. I read a recent Medscape article about how experienced MDs feel that today's new MDs are ill prepared. Experienced RNs often feel the same about 1st-year medical residents. The reality is that the first 1-2 years post graduation will be tough, but most NPs will tell you that they catch up and feel much better. You're not going to learn everything in school. Most of the learning will come from your NP experience and learning you do on your own.

My concern with NP education (in general) isn't so much the curriculum, but the lack of academic standards. Some NP programs have rigorous intellectual requirements while some have close to none; and some for-profit programs do not even require proctored exams. Generally, a bright NP student is going to get a different amount materials than someone who has always just scrapping by courses with a weak foundation.

At the end of the day, there are many outstanding NPs (just look at some on this forum). They all went through NP programs and learn on their own with help and experience. If they could do it, why can't you? Regardless, look for an NP program that provides preceptors. These programs generally ensure that the preceptors are actually doing their job of teaching the important materials.

Good luck with your decisions.

Oldmahubbard · Jan 13, 2018

Good luck finding a program that provides preceptors. My experience and from what I read.

mrcleanscrubs, BSN, RN · Jan 13, 2018

KatieMI, MSN, RN ,

Oh I see, I definitely read that too fast. My mistake! lol. Your clinical professors knew what they were talking about when they recommended using those Medical books.

LOL!! Level 80 APA nazi, gosh; I think we have all had that ONE professor who just is, let's say, quite bizarre lol. Thank you!