How much did NP school prepare you?

[Alexxoxox]

I have heard that Nurse Practitioner school is not as rigorous as other grad schools (such as CRNA school). I would like to become either a ACNP or a CRNA in the future. I am very interested in science-based learning, and am wondering which option would be best for me. I have such a strong passion for cardiac disorders, and could really see myself becoming a Surgical Cardiac ACNP. However, CRNA interests me for the hard-core science that is taught. CRNA students get such in-depth pharmocology and pathophysiology classes.

For any ACNPs out there, did you feel confident in your pathophysiology and pharmocology knowledge after graduation? Or did you attend a fellowship after?

[ArmaniX, MSN, APRN]

6 hours ago, fnpstudent123 said:

Definitely a stupid question but didn't want to bother emailing the head if I didn't need to.. I was looking to do extra clinical rotations on my off semesters (winter & summer) so that way I am getting extra experience. I already found a preceptor willing to take me over the summer. Normally, we need to find our own clinical placements, have the school approve the site, and the preceptors fill out forms evaluating our progress. Since this would be extra and not part of a required course would you even bother telling the school?

Also.. when I become an NP, should I list clinical sites & hours on my resume with my preceptors contact information or will this make it too lengthy?

I would definitely run this idea through your school and the head. You are in part representing the school and I’d wonder from terms of liability who would be at fault for an error. I think this is a bad idea, personally, and if you want to do extra clinical hours do it during your scheduled clinical rotation periods.

As far as resume... I can’t recall if I did place my rotation sites on my resume (I generally hate the idea) but if I did I simply listed the institution and department “Hospital by the Sea: Burn ICU”. Listing preceptor contact info is too much and can be someone you include as a reference (if/when requested) if the preceptor is okay with that.

[djmatte, ADN, MSN, RN, NP]

There is certainly a liability risk. Most schools won't allow you to work outside of their parameters because they don't just evaluate progress. They also check on safety of your practice which they can't efficiently monitor while on break.You might be able to get the preceptor to take you on as a shadow which isn't technically affiliating with any school. In this scenario the liability is on the company agreeing to the shadow. But you will be unable to do anything and there is limited ability to interact with patients.

If you're in NP school, I'm presuming you passed your RN boards. You may benefit from per diem work over the summer where you can practice your assessment skills in the clinical environment. Presuming you have the experience to get that kind of work. Outside that, my recommendation is to just focus on a rigorous study plan for down time.

[Oldmahubbard]

I agree, unfortunately, as good an idea as extra clinical hours seem to be, you simply can't do them on the side.

You might possibly be able to shadow someone, absolutely never touching a patient. Not even to take a blood pressure. Which wouldn't be clinical hours.

Yes I know most NP clinical hours are just shadowing. You would still need malpractice insurance, background check and proof of all your mantoux and vaccinations, etc, etc etc. This is not 1980.

It's just a bad idea.

I know it's crappy. Nobody cares one iota about poorly prepared NPs with minimal clinical hours entering the workforce, but then they are covered under a different insurance.

[Oldmahubbard]

Your best bet as a student NP is to work in the speciality as an RN, and go home every night to study intensely what you saw that day.

[Dodongo, APRN, NP]

12 hours ago, fnpstudent123 said:

Definitely a stupid question but didn't want to bother emailing the head if I didn't need to.. I was looking to do extra clinical rotations on my off semesters (winter & summer) so that way I am getting extra experience. I already found a preceptor willing to take me over the summer. Normally, we need to find our own clinical placements, have the school approve the site, and the preceptors fill out forms evaluating our progress. Since this would be extra and not part of a required course would you even bother telling the school?

Also.. when I become an NP, should I list clinical sites & hours on my resume with my preceptors contact information or will this make it too lengthy?

Sorry for the long post. Thanks everyone!

No, you can't do that. The school and the clinical site won't allow that. You are covered under the school's malpractice insurance as a student. If you go to the hospital outside of the clinical time frame, and say you are a NP student from so-and-so school, and something goes wrong, you will be up a creek. Just do extra during the semester.

I listed clinical site, specialty and time frames. Don't list clinical hours unless you do clinical full-time. Otherwise, listing 200-300 hours over an entire semester appears lackluster, especially compared to PAs (your direct competition for jobs) who have >2000 hours.

[DYS NP]

On the other hand, for most PA schools, clinical experience is recommended but not required for admission (this includes highly competitive PA programs like Yale, Cornell, BU). The undergraduate degree doesn't have to relate to health care.

The 2000-hour requirement in the PA program is divided into 4- or 8-week part-time rotations across 7 practice areas plus 1 elective (8 sites).

The NP requires a nursing degree (including clinicals) plus a year minimum of FT nursing experience (2000+ hours). In order to graduate, I will need 4000 RN hours in my specialty track in addition to the 500 minimum hours of NP preceptorship, half of which is with one preceptor in one clinical environment, similar to a residency.

Working as an RN is a different role, but it requires intensive education, clinical judgment, responsibility, and immersion in the environment we'll eventually practice in as NPs. Given that nurse training/experience is a program requirement, it's puzzling how infrequently it's included in the equation.

[Oldmahubbard]

Nursing experience in the speciality is not a requirement for many programs.

[PMHNP Man, MSN, APRN, NP]

I felt fine treating patients in an outpatient environment in which I did absolutely nothing but psych evals and med checks, 90792, 99213, 99214.

I didn't know anything about treating addiction or managing detoxification

I also didn't know how to work within an inpatient unit, e.g. interval histories, discharge summaries, and I'd never been indoctrinated into heavily sedating med regimens that inpatient units discharge their patients into outpatient with.

Finally, I had never even encountered conversion disorders in school, and because I trained with NPs who couldn't prescribe stimulants I knew nothing of ADHD, ASD, or paychostimulants. I also had no idea how to begin treatment and monitoring of neurocognitive disorders or even assess communication disorders.

Since then I've run inpatient, residential, detox, and ADHD clinics and do telemedicine geriatric psych units. This is over and above the standard, kooshy outpatient work I've done - the work I prefer and find most lucrative.

I think NP training should be longer and more robust. I'm also on NP /grad school faculty but in hindsight think I could've probably followed the same career progression with no actual training. It's all been so heavily self-taught. Granted, the learning curve would've been steeper!

[DYS NP]

24 minutes ago, Oldmahubbard said:

Nursing experience in the speciality is not a requirement for many programs.

That's true OMH. Honestly, it's a pro or a con, since you can end up siloed in one area of practice without learning skills in other areas.

[Oldmahubbard]

5 hours ago, PMHNP Man said:

I felt fine treating patients in an outpatient environment in which I did absolutely nothing but psych evals and med checks, 90792, 99213, 99214.

I didn't know anything about treating addiction or managing detoxification

I also didn't know how to work within an inpatient unit, e.g. interval histories, discharge summaries, and I'd never been indoctrinated into heavily sedating med regimens that inpatient units discharge their patients into outpatient with.

Finally, I had never even encountered conversion disorders in school, and because I trained with NPs who couldn't prescribe stimulants I knew nothing of ADHD, ASD, or paychostimulants. I also had no idea how to begin treatment and monitoring of neurocognitive disorders or even assess communication disorders.

Since then I've run inpatient, residential, detox, and ADHD clinics and do telemedicine geriatric psych units. This is over and above the standard, kooshy outpatient work I've done - the work I prefer and find most lucrative.

I think NP training should be longer and more robust. I'm also on NP /grad school faculty but in hindsight think I could've probably followed the same career progression with no actual training. It's all been so heavily self-taught. Granted, the learning curve would've been steeper!

Holy moly. No joke, I mean this

[umbdude, MSN, APRN]

5 hours ago, PMHNP Man said:

I didn't know anything about treating addiction or managing detoxification

I also didn't know how to work within an inpatient unit, e.g. interval histories, discharge summaries, and I'd never been indoctrinated into heavily sedating med regimens that inpatient units discharge their patients into outpatient with.

Finally, I had never even encountered conversion disorders in school, and because I trained with NPs who couldn't prescribe stimulants I knew nothing of ADHD, ASD, or paychostimulants. I also had no idea how to begin treatment and monitoring of neurocognitive disorders or even assess communication disorders.

Did you have a separate course in psychopharm while in grad school? We covered a lot of what you mentioned in our advanced psychopharm course.

I do think the NP clinical portion should be at minimum 1,000 hours (3+ semesters).

[PMHNP Man, MSN, APRN, NP]

9 minutes ago, umbdude said:

Did you have a separate course in psychopharm while in grad school? We covered a lot of what you mentioned in our advanced psychopharm course.

I do think the NP clinical portion should be at minimum 1,000 hours (3+ semesters).

We did have psychopharm in addition to the pharm all the other NPs take. We used Stahl's books. Nonetheless, course instruction seemed to center around outpatient meat and potatoes, i.e. mood disorders, anxiety disorders, psychotic disorders, and minimally personality disorders. It doesn't help that NP school don't have placements like med students and residents get and a student could do all 720 or so hours of training in one environment.