NP Education and Practice

Trauma Columnist · Sep 12, 2008

I think many of us felt inadequate in school. When I took my current job in nephrology, I knew nothing. It was scary. However, I knew my learning curve was steep and I asked for and got 4 months orientation. Even now, 2 years into it, I still ask questions and make an effort to study.

What area are you looking at going into? Maybe you could do some clinical time in that area to help you be more comfortable.

As to your experience, I do think L&D is a specialty area and you might not have the exposure to med-surg and primary care that some of your fellow students have. However, I still think you can be successful though it may involve some additional study outside the classroom. If you are still working, have you considered transferring to a more general floor? That might give you a little more solid med-surg and generalist point of view.

Good luck - some angst is normal...

oldiebutgoodie, RN · Sep 12, 2008

I have been taking core FNP classes for the past year. I have now started clinical rotations. I am in Adult rotation. I am in an internal medicine practice. I feel there is so much to learn and know. I feel inadequate. I know I am still a student and have 4 clinical rotations to go through. But I am wondering if others feel like this. Is this how it is? Or should I know more than what I do? Or will I learn enough to be a FNP by the time I graduate and pass boards? I almost feel like the education for the FNP is not enough to actually be doing what they are doing. I guess I doubt I will be ready to function at such an advanced role in 1 year from now. Maybe I am just doubting myself. Maybe the education is adequate to function at the FNP stage by the time you graduate. There seems so much to learn in primary care, complex, and it carries so much responsibility. I almost wonder if going for an MD is what I personally need to feel ready to do this sort of practice. Are there residency programs out of FNP school which will help better prepare me after graduation?So what are your personal experiences in school and out and where did you learn the most???? I guess I should throw in my background. RN for 3 years in L and D. Maybe I have been limited by only L and D experience. The responsibility and level of knowledge to be an FNP scares me. One professor told me that once you are an FNP and enter the clinical setting you are just as much respobsible as an MD. That is a lot of weight for only 2 years of FNP school versus an MD and 4 years of med school and 3 or 4 years residency. Are there others out there like me? The thing I do like to think about is how many poor people I can help when I get out of school.

Hi, Dancie,

I am in an NP program, and am over 1/2 done now, and so far, I don't feel any of my classes have been/will be helpful in practice. I think these NP programs waste too much time on epidemiology, research, theory, blah blah blah. I just hope the rest of my program steps it up a little bit so I may feel a tad more competent.

Oldiebutgoodie

ANPFNPGNP · Sep 12, 2008

I have been taking core FNP classes for the past year. I have now started clinical rotations. I am in Adult rotation. I am in an internal medicine practice. I feel there is so much to learn and know. I feel inadequate. I know I am still a student and have 4 clinical rotations to go through. But I am wondering if others feel like this. Is this how it is? Or should I know more than what I do? Or will I learn enough to be a FNP by the time I graduate and pass boards? I almost feel like the education for the FNP is not enough to actually be doing what they are doing. I guess I doubt I will be ready to function at such an advanced role in 1 year from now. Maybe I am just doubting myself. Maybe the education is adequate to function at the FNP stage by the time you graduate. There seems so much to learn in primary care, complex, and it carries so much responsibility. I almost wonder if going for an MD is what I personally need to feel ready to do this sort of practice. Are there residency programs out of FNP school which will help better prepare me after graduation?So what are your personal experiences in school and out and where did you learn the most???? I guess I should throw in my background. RN for 3 years in L and D. Maybe I have been limited by only L and D experience. The responsibility and level of knowledge to be an FNP scares me. One professor told me that once you are an FNP and enter the clinical setting you are just as much respobsible as an MD. That is a lot of weight for only 2 years of FNP school versus an MD and 4 years of med school and 3 or 4 years residency. Are there others out there like me? The thing I do like to think about is how many poor people I can help when I get out of school.

I want you to know that I absolutely agree with you on this. I went through a dual ANP/GNP program and spent 800 clinical hours training with internists. After that training, I felt that I could have functioned in a minor emergency setting, which I did, but certainly not in internal medicine. I also filled in occasionally for a family practice doc (she saw 15 yrs and up) and it was NOTHING like internal medicine. I had no problem filling in for her at all and she said I did a great job.

After a couple of years, I went back to school to become a FNP (I needed to be able to see kids for urgent care) and I spent another 500 clinical hours in training. I had to do a certain number of hours in pedes, OB and I even had to redo hours in adult/gero. Of all the specialties, I still felt like I needed the most training in internal medicine. I've completed FAR more clinical hours than any FNP I know and there is NO WAY I would want to practice alone in an internal medicine setting. I work with 2 family practice docs, but our patients are more like IM patients (elderly) and I am SO thankful I have the docs around. I've learned so much and I'm still learning something new every day.

Frankly, I think FNP's should spend a minimum of 2,000 hours in training b/c they cover EVERYTHING! I think it's a crime that the certifying bodies only require 500 clinical hours for each specialty. Furthermore, I think the certification exams don't even begin to cover enough information. I've taken exams in 3 specialties through both the AANP and ANCC and I'm here to say that they are NOT adequate in ascertaining whether a person can safely function as a NP.

Something else, it's important to remember that we function much more like doctors and NOT nurses - it sometimes amazes me that I'm allowed to do this job at all. Your professor is 100% right!

Dont' worry about your nursing background, b/c I've seen ICU nurses with 20+ years of experience fall on their face when they were doing their clinicals in primary care. I suppose they could have done better in an Acute Care program.

jer_sd · Sep 14, 2008

Just like nursing school NP education gives you a foundation to build your skills. We all hated non clinical courses, but classes like research or epidemiology will become more use full as your skill level progesses and you add to your abilities.

Both of the full time NP positions I have had were in the same area i practiced in as a RN. I was ready for the routine care on graduation. I was able to recognize the abormals and ask for help from my co-workers. I am in a specilty area so I enounter a more narrow scope of issues usually. But I have had patients where my general training was extremly important.

Having said that My first NP program was exceptonal. I am amazed on what i was able to learn and the instructors were great. I can imagine that some programs are average and some sub par.

Despite the program the effort you put into it will be the greatest asset. Don't just refill BP medications look at what medications the patient is on, comorbid conditions and try to put together the big picture on the patient. Rather than just sa BP is controlled on current treatment and refill. If you can attend clinicals full time you will see much more than just 10-20 hours a week. Try to see patients in follow up if possible. During clincals I studied more than when I was in didactic lectures.

Put extra effort into your education it will pay off in the long run. You will not be perfect when you graduate but you will have a solid foundation to build your skills.

Jeremy

zenman · Sep 14, 2008

Just like nursing school NP education gives you a foundation to build your skills. We all hated non clinical courses, but classes like research or epidemiology will become more use full as your skill level progesses and you add to your abilities.
Jeremy

:up: Those epidemiology classes can come in handy. I have a physician friend who is an epidemiologist and have had fun talks with him. FYI -the world is very concerned about the large number of chickens in Bangladesh. We recently had a 15 month old kid here who was part of an influenza study. Turns out that the kid had Avian flu and survived. He was diagnosed via his lab work at the CDC after the fact. Investigators went back and found out that the parents had bought a chicken and it ran around the house for a few hours before the mother and a neighbor slaughtered the chicken. Investigators also found out from the chicken market that the seller had a few chickens die that day.

Many people keep chickens in their house. Why? To prevent them from being stolen. Chicken farming is a great micro-loan opportunity for poor people around here. Most of the time when a chicken farmer has a bunch of chickens dying, he will slaughter all his chickens and rush them to market at a cheap price. This might be the only opportunity for poor people to get some protein.

I asked about decreasing the number of chickens and switching to another source of meat, such as rabbits. A vet said that they have tried that with fish farming and goats but that the population is not very educated and training is a big issue. It also seems that vets rather than physicians, are the key to saving the world from Avian flu.

Remember that Avian flu is mostly a problem with chickens, but not ducks...ducks love the stuff! Lesson over; now wasn't that fun?

squinky12 · Sep 14, 2008

In my opinion, nurse practitioner education gives you a foundation that prepares you to learn to practice as a nurse practitioner. I was lucky during school since I already had 8 years of pediatric nurse experience and only had to learn about kids in NP school. However, I did have to learn circumcisions, suturing, pelvic exams, male prostate exams, ADHD evaluations, developmental testing, and many other things I was unfamiliar with.

I think having good preceptors is crucial and taking the time to focus on learning and understanding a given situation rather than pressure to "see" a certain number of patients is helpful. Having worked in a "teaching" hospital with med students, interns and residents I can honestly say that most of them have very little idea what to do with an actual patient at first and learn by doing.

Just be gentle with yourself and don't think you are going to graduate and begin practice "knowing it all". I still learn new things all the time (medicine constantly evolves--we all learn as we go) and see conditions/problems that I have never seen before after 18 years as a nurse practitioner. This is what makes my job fun and challenging. Plus, the ability to use words like "boogers" and "poop" on a daily basis.

ANPFNPGNP · Sep 14, 2008

In my opinion, nurse practitioner education gives you a foundation that prepares you to learn to practice as a nurse practitioner. I was lucky during school since I already had 8 years of pediatric nurse experience and only had to learn about kids in NP school. However, I did have to learn circumcisions, suturing, pelvic exams, male prostate exams, ADHD evaluations, developmental testing, and many other things I was unfamiliar with.

I would like to know what you think about FNP programs only requiring 500 clinical hours...some require more, but I have yet to see one that requires more than 800. Do you feel that is adequate training for a NP who is licensed to see all ages and OB?