NP education - a rant

Gennaver, MSN · Feb 10, 2005

I think the concern for me is the lack of required work experience. Being in the NICU I can't imagine anyone becoming a really competent NP without a few years working as a nurse. I don't have a magic number, but the NPs I have really admired for their abilities were all nurses for more than 5 years before becoming NPs so they had a lot to draw on. Many hospitals won't train nurses for the really intensive babies until they have at least a year of working under their belt. Plus they need to be trained for deliveries, for surgical procedures and recovery, etc. There is just such a wide range of things to learn. I suppose there are some people who could work for a year or two and be great, but I don't think that's the norm. I respect the students who say "I'll work for as long as I feel it's necessary", but I am concerned with the people who are just willing to put in the minimum time so that they can be NPs as quickly as possible. I don't think they understand what they are getting into.

I agree with you.

So does the school where I hope to pursue my NP at too, they will not allow direct entry anything other than the core NP courses right away and for the more intense specialties, (pediatrics, midwives, etc) you have to have more than just the year before you can start those.

So, if you do the math by the time anyone in any direct entry program graduates as an NP, (even like me as an ANP) they will have a minimum of three years working full-time as a Registered Nurse while attending classes part time.

As you state, most hospitals will not train nurses to work with intensive babies with under a year experience...our program requires all together more than that.

Also, for anyone calculating to 'just do the minimum time working so they can be an NP...? That is what the OP promoted to justify this whole thread. Do you mean to suggest that there are not "non-graduate entry program" Nurses who also want to become an NP? Really, then who all the online BSN/MSN programs for then? They aren't for us because our programs are different.

If I encounter any people who have that 'purchaser' attitude, I am certain that they will cause me to feel the same way as you mention your concern.

Gennaver

DidiRN · Feb 10, 2005

Even if the NP is not accelerated, I still stand that it is simply not enough time to make anyone with no nursing experience a chance at being a competent practitioner. You are assuming your education will completely, totally prepare you for the outside world, and you are absolutely completely wrong on this. This is what I and many others are talking about. You are arguing over the level of education and seems to me, not even considering experience as anything that important. As an NP, you will be doing things and responsible for things that medical students/residents must practice for several years before they are independent, and you will be doing this in a much shorter period of time. Two years is just not enough time with no experience at all, or even part time experience, or IMHO full time experience has much of a chance at being a safe NP.

So it really doesn't matter how much education you receive, if you do not have enough adequate RN experience, most of us feel you cannot be a safe competent nurse practitioner. Even the NP's on here (and the original OP is an NP!!) have stated so. Why is this so hard to understand? Does not logic dictate that one with direct exposure to the field would have a better understanding than someone with very little?

I am not talking about schooling at all...I am talking about the level of experience in the real world. There is a HUGE difference that you don't understand.

I know of four NP's personally who worked in the ICU before becoming an NP. All of them had well over 10 plus years RN experience before pursuing this. One of them told me that she was expected to learn how to insert a central line after being shown ONE TIME by a resident. She was actually laughing about how silly that was. Mind you, this was someone with many years ICU experience, has assisted in countless CVC insertions, but that does not mean by far that you could actually do one yourself by being shown one time, or even observing so many. And she is actually one of the best RN's I've had the pleasure with in working in my career. Very smart, very competent ICU nurse. But even she recognized that she was not adequately prepared in dealing with CVC insertions (she did not go through an acute care NP program, which probably would have trained her to do this). And if you are wondering why, then you have little understanding of being an RN. Only an arrogant fool that is too concerned about not being wrong or looking bad infront of others would even attempt such a thing and very much endanger the patient's life. I've seen people do these kinds of things without adequate preparation (not in this kind of scenario) and they are the most dangerous nurses/physicians I have ever seen. That also would be like me saying I could perform surgery after being trained as a scrub nurse.

I really don't know how else to put it to help you understand my point of view. I told my sister this one time, a non-medical person, who does not understand the level of responsibility that a RN has (and I'm talking a basic RN here, not an NP) . I said, do you realize, that if I receive an order from a physician, with all those years of experience, that if I do not catch his mistake, that I am held legally responsible for his mistake as well and can be sued and also lose my license? I have a two year associate degree. Two years and I can be held accountable for his/her mistakes, one who has been studying and practicing medicine for many, many years. Two years of education isn't by far going to prepare you COMPLETELY to question the order of a physician, only intense experience from working on the floor/unit.

Okay, now there is something to discuss, good.
Firstly, the NP is not accelerated, only some BSN for non-nursing BA/BS degree holders. Many of these accelerated BSN programs do then allow direct entry to the NP program. Although, direct entry is somewhat of a misnomer because work experience as an RN is required prior to any specialty courses.
In an accelerated BSN the only portion that is accelerated is that the accelerated students skip their summer vacation breaks.
Yup, they take the exact same nursing portion classes. Theory, pharmeceuticals, physiology and everything else. Not accelerated on the nursing content. That is a misconception.
For the graduate entry programs there are some that have the above mentioned accelerated BSN, (merely the same as the final two years of the traditional BSN programs, minus that luxurious summer vacation) and there are the graduate RN certificates, (which is what my program will have).
The graduate certificate is like the final two years of a BSN program, (again, minus any summer breaks) four semesters straight through but, these are all 400 level classes, (not 500 like I wrongly posted before).
So, Like I asked earlier, (know that you know the difference), why does my four semesesters of 12 intense 400 level classes versus the mere six classes at the community college worry you so?
Oh, after those four semesters towards the RN certificate, then we are supposed to work for a minimum of a year before we can begin the Nursing Practitioner portion. NO, those are not accelerated, they are real, and in person, not online, classes with RNs from various backgrounds who earned their degree either from an ADN, Diploma, BSN or grad certificate. Wow, huh?
Do you understand your misperception now?
Also, once you have a BA/BS completed or an AS, (I know this) you are no longer elidgible for any financial aid or loans to take out to pay for a second one. Hence this is a very nice thing about the graduate RN certificate over the accelerated BSN. It is still the same content as a BSN versus the ADN yet, it is given in a graduate courseload and students are indeed able to finance their education through appropriate loans and financial assistance.
Gennaver
p.s. sheesh, the nursing stuff is not rushed, only the time frame excluding those wonderful summer vacations

fergus51 · Feb 10, 2005

Gennaver, I do feel the same about anyone who is just thinking of the fastest way to get to be an NP without having even started working (the prenursing student who says "Well, I can get my ADN, work for the minimum amount of time then enroll in an RN-MSN program..."). They worry me because I really don't know how realistic that is and I feel like a lot of them are just being set up to fail.

It isn't the general ed classes or the liberal arts classes that I care about, it's the actual hands on time working with babies and their families that matters more in my opinion. There will surely be some people out there who can become proficient at NICU nursing very quickly as Smile123 pointed out. I just think they are extremely rare. I've yet to meet one who felt really confident at being a staff nurse working with intensive babies in less than 3 years, and obviously being an NP carries much more responsibility. Honestly, if someone told me that they felt ready to be an NP after one year of working as a staff nurse in the NICU, I would think they were crazy. I don't know what the magic number should be; I'm not the one to make that decision. Obviously I am not the master of the universe and I don't get to decide who should be an NP and who shouldn't. I'm just saying I don't think it is the wisest decision for someone to ONLY think about how quickly they can get through to their ultimate goal. Like I pointed out, I respect the people who realize that they may need a year or two in their specialty or they may need more. I also think it would be better if all nursing education was more standardized in terms of clinical time rather than allowing so much variation between schools (and I mean ADN, BSN and MSN when I say that).

Unfortunately the law of supply and demand doesn't guarantee that we will only have good providers. Some hospitals are short staffed enough that they'll hire anyone with a pulse. What's scary to me is when new, relatively inexperienced NPs get hired on in those hospitals which are already short on experienced staff. They won't get the support they need to flourish as practitionners. Couple an inexperienced NP with inexperienced RNs and inexperienced docs and you have a recipe for disaster. I really feel like a lot of our practitionners (NPs and residents in particular) aren't getting the support that they should get because of short staffing. I have this maternal feeling towards the new workers and I really try to help them anyway I can, but if even I as a fairly new staff nurse myself, can see some very serious deficits then I think that's a bad sign.

Again, this is just my opinion limited to one specialty area and we all know that old saying about opinions:) I actually do not think midwifery should require as much work experience as NICU-NP, so go figure:)

Jess RN · Feb 10, 2005

I think it would be better if all nursing education was more standardized in terms of clinical time (and I mean ADN, BSN and MSN when I say that).

I'm totally with you there fergus. I think it would be a better service to nurses to grandfather everyone currently licenced and working now and come up with a national standard for what an RN and an NP means in terms of education and clinical training.

I'm chatting offine with a 1st year direct entry student and she is taking at least a year or two between the RN and NP portion of her program to really feel confident in her skills.She mentioned that she didn't feel that there were enough clinical hours in the RN portion of her program but also noted that there were just as many hours as she would have had in some ADN programs she looked at. So I think what is key is to work enough hands on so you really feel confident in the RN role before attempting to work *clinically* in the NP role. I don't however see the problem in taking the master's level NP theory courses while working as an RN.

At an infosession I went to this week they mentioned that 1/2 of the class slows it down after the RN portion and works as an RN for a while and just takes the theory courses of the NP component. I coult totally see myself doing that and at both the schools I've applied to they allow you to take as much as 5 years to finish the NP portion.

Ideally I think I'll want to plow through the RN part get licensed and then work more or less full or 3/4 time as an RN taking like one thoery course a semester for 3 or 4 years. The I'll slow down to part time and take the NP clinical courses and finish up within the 5 year time limit. For me - I think that will be enough to feel confident in the role. I wouldn't even apply much less consider attending a school that forces you through the curriculum and clinical practica in 2 or 3 years because I want more flexibility than that would offer.

Thanks for all the food for thought- I know this thread has gotten heated at times- and I think that is because it seems from some comments that we direct entry students are being discounted out of the box. I really appreciate the more nuanced and thoughtful responses.

-Jess

DidiRN · Feb 11, 2005

I personally would like to see basic nursing education overhauled a bit, no matter if you already have a Bachelors degree or Associate Degree in something unrelated or fresh out of high school. I would like to see alot more clinical time spent for students, something like an internship or whatever. The old diploma nursing programs seemed to give alot more quality clinical experience than what I am seeing today. Not only will it give you a great foundation to practice as a bedside RN, but also help you in your advance degree.

The students in my neck of the woods (and I can't speak for anywhere else of course) towards the end of their program, are not taking a full load. In other words, they still are not functioning fully as an RN would when they take a job. They should at least get a taste of it. I'll give you an example. When I was in my last quarter of school, my college started to do something new, they told us we were going to function fully as an RN. We took a full patient load like a regular RN would. We did an entire 8 hr shift doing assessments, meds, treatments and gave report to the next shift. I learned more in that quarter than I did in any other. It really was a great help in transitioning me from the student role to a working RN role. I still needed orientation of course, but not as extensive as what I see now. Even that, nursing is much more complicated now, patients are much more sicker, we are dealing with alot more technology and we have alot more responsibility than when I had when I graduated (20 years ago). Before my final quarter, I was only taking less than half of what a working RN was taking. That is not giving you a realistic idea, and that's why I talk about the "real world" of nursing.

So if I could change anything, I would change the basic program to include much more clinical experience. What I see around here is a couple of days a week for six hours. Perhaps in other areas of the country it's not that way, I don't know. I do personally know of a few students who did internships on my unit for a month. One took a job there after graduation, but resigned shortly after. Even spending a month on the same floor she took a job at, still did not give her enough preparation for what she experienced as a working RN. It's really a shame. It was not her fault at all. You would think that would give you enough time to get a feel for the place, but it actually didn't.

As for the NP, I personally think you should be an RN for 3 to 5 years in the appropriate area (I actually was just going to say five years minimum). For example, if you want to be a Women's Health NP, you can't work as an RN in ICU for 3 to 5 years, that won't give you any perspective into it. Heck, even though I've been an RN for 20 years, I wouldn't feel I would qualify the way things are now in NP school to be a Neonatal NP or a Women's Health NP, I don't even know what a normal cervix looks like, LOL!! :) If you want to be an Acute Care NP, then perhaps you should have some unit experience.

But a current NP would be a better one to ask this than me. They are actually functioning in this role, and I am not :) But I do feel that I have enough experience to have a valid opinion on this, as well as other bedside RN's.

Sherri-
What course of academic and clinical preparation would you suggest for someone with a bachelors in an unrelated field? Just curious- because I wonder if it is not all that far off from how some Direct Entry programs can be structured. Be specific if you would- how many years in school to be an RN- how many years practicing as an RN- how long should a masters program be and how many clinical hours should it contain to produce safe competant NPs?
-Jess

Gennaver, MSN · Feb 11, 2005

Even if the NP is not accelerated, I still stand that it is simply not enough time to make anyone with no nursing experience a chance at being a competent practitioner. You are assuming your education will completely, totally prepare you for the outside world,
.

Your assumption about what I assume is wrong, I am however under the assumption that my total time devoted, (in class, in clinical and while working,) will indeed have an impact, how is that wrong?

and you are absolutely completely wrong on this. This is what I and many others are talking about. You are arguing over the level of education and seems to me, not even considering experience as anything that important.

If this is how you see it then you have not been reading the posts that I have written....the total years working and gaining experience plus those with the education...

As an NP, you will be doing things and responsible for things that medical students/residents must practice for several years before they are independent, and you will be doing this in a much shorter period of time.

Hmmm. well lets see, the two years to become a graduate certificate RN, (this is not an MSN nor an NP but a gradute certificate RN), plus the year experience before starting nursing practitioner and then another three to four years while doing that and that would have the absolute basic minimum for my adult nurse practioner work to be completed in lets see, about seven years. Yeah, gosh, that is too soon....

Two years is just not enough time with no experience at all, or even part time experience, or IMHO full time experience has much of a chance at being a safe NP.

No kidding, of course it is not. Why haven't you stopped repeating that false bit of information? Nobody does DO it that way.

So it really doesn't matter how much education you receive, if you do not have enough adequate RN experience, most of us feel you cannot be a safe competent nurse practitioner. Even the NP's on here (and the original OP is an NP!!) have stated so. Why is this so hard to understand?

Yes, yes, why is this so hard for you to realize that you are repeating a lie, it doesn't happen that way. That whole two year bunk is not real, its a myth...

I know of four NP's personally who worked in the ICU before becoming an NP. All of them had well over 10 plus years RN experience before pursuing this. One of them told me that she was expected to learn how to insert a central line after being shown ONE TIME by a resident. She was actually laughing about how silly that was.

Obviously she was not comfortable nor felt prepared. Perhaps another NP would have felt differently, discretion is a good thing, maybe she wasn't eager to learn this or had not communicted with the resident her level or lack of training.

Mind you, this was someone with many years ICU experience, has assisted in countless CVC insertions, but that does not mean by far that you could actually do one yourself by being shown one time, or even observing so many. And she is actually one of the best RN's I've had the pleasure with in working in my career. Very smart, very competent ICU nurse.

Yes, how good for you and her...although we are all different...after only being a nurses assistant for about 8 years a doctor asked me to assist with a patient and an emergency happened, I didn't flinch when the doc asked me to hold her organs out of the way so he could reach somehting impromput because the situation dictated this out of necessity, we are all different..

But even she recognized that she was not adequately prepared in dealing with CVC insertions (she did not go through an acute care NP program, which probably would have trained her to do this).

You are assuming...they may, they may not...probably is not certain

And if you are wondering why, then you have little understanding of being an RN. Only an arrogant fool that is too concerned about not being wrong or looking bad infront of others would even attempt such a thing and very much endanger the patient's life.

Whewie, I'd say you are truly projecting here...you are far from knowing the 'me' that I am or how I treat patients, my work ethic, my moral and personality make up. Phew, issues?

I've seen people do these kinds of things without adequate preparation (not in this kind of scenario) and they are the most dangerous nurses/physicians I have ever seen.

I can read, you have been gravely affected, egads, I hope you at least had the gumption to tell them to stop whatever it was that they were doing and that you would report them and that you did report them, or did you prefer to just gossip?

That also would be like me saying I could perform surgery after being trained as a scrub nurse.
[/quote}
Um, are you trying to say that when my Graduate nurse RN certificate is complete, and I then work and continue my education and finally become an Adult Nurse practitioner that it would be akin to you performing surgery cold?
I really don't know how else to put it to help you understand my point of view. I told my sister this one time, a non-medical person, who does not understand the level of responsibility that a RN has (and I'm talking a basic RN here, not an NP) . I said, do you realize, that if I receive an order from a physician, with all those years of experience, that if I do not catch his mistake, that I am held legally responsible for his mistake as well and can be sued and also lose my license?
Yes, I am aware of this, I have been around health care and hospitals since 1989, yeah, my hands on too, in the ER assisting and learnign since then.
I have a two year associate degree. Two years and I can be held accountable for his/her mistakes, one who has been studying and practicing medicine for many, many years. Two years of education isn't by far going to prepare you COMPLETELY to question the order of a physician, only intense experience from working on the floor/unit.
Oh, I have indeed already questioned orders of physicians and I am not even complete with my non-nursing BA degree....Its more than education sherrimrn...or haven't you been listening to your own self?
Gennaver

DidiRN · Feb 11, 2005

:banghead:

I give up. Even my 13 year old could understand what I am getting at when I explained this to him.

Just your response to me in regards to the CVC insertion story just completely proved my point...you believe my friend could have attempted a CVC insertion after being shown one time.....you have no idea about the scope of an RN practice, therefore, it's senseless to argue with someone with no understanding when they don't understand the basics of the profession. Do you even know what happens if you were to attempt a CVC insertion without knowing what you are doing? If you did, you would not even have questioned me or my friend's responses on it. You just invalidated yourself.

Here's another analogy, then I am done. Let's suppose I walked into my son's classroom tomorrow and tried to argue with his teacher about proper teacher methods and debating about the proper education level of teachers. I have only sat in the classroom and watched a few teaching sessions, and been a student myself. I would have ZERO understanding of the skills involved in the ENTIRE process of being a good teacher. There is more to it than meets the eye. I would have no credibility to debate these kind of things with her, for what I have observed or done does not mean I truly understand the WHOLE scope of what she does.

Almost every RN has agreed with the OP. Only students with no nursing background have argued against it. You don't have to be in the nursing profession at all, or even a high school diploma, to come to the conclusion that an RN, in the field, would have a more insight into it than a prospective student.

I just don't know how more basic I can get with this.

Ted · Feb 11, 2005

please. . .

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thank you for your consideration.

the allnurses.com staff

fotografe · Feb 11, 2005

Here's another analogy, then I am done. Let's suppose I walked into my son's classroom tomorrow and tried to argue with his teacher about proper teacher methods and debating about the proper education level of teachers. I have only sat in the classroom and watched a few teaching sessions, and been a student myself. I would have ZERO understanding of the skills involved in the ENTIRE process of being a good teacher. There is more to it than meets the eye. I would have no credibility to debate these kind of things with her, for what I have observed or done does not mean I truly understand the WHOLE scope of what she does.

But, if you did the teacher education program at a college, and did your student teaching, then wouldn't you feel like you had some basis to discuss this with a seasoned teacher? I don't think anyone fresh out of school thinks they know it all -- not teachers, not doctors, not engineers -- but to say that going through an accredited program and passing the licensing exams, then studying at a higher level while working makes you incompetent, I think you are just really stretching. Yeah, some people will be completely incompetent, some people will be green for a long time, and some people will be able to function quite competently right out of the gate. I think you generalize way too much, and it is clear you oppose the Direct Entry Master's programs. I agree with you that the programs need more clinical time. Comparing them to the PA programs, the clinical time is just a fraction. I think your energy would best be spent lobbying the accrediting organizations to increase the clinical time for nursing student at all levels. The suggestion for full-time nursing internships is a good one. Northeastern University already has that built into their curriculum. www.neu.edu

Gennaver, MSN · Feb 11, 2005

I give up. Even my 13 year old could understand what I am getting at when I explained this to him.

Okay.

Just your response to me in regards to the CVC insertion story just completely proved my point...you believe my friend could have attempted a CVC insertion after being shown one time......

Um, No I do not, matter of factly I commended her on using her discretion. I suppose your vested ego based interest really IS preventing you from seeing what I am writing.

Gen

DidiRN · Feb 11, 2005

Yes, but I am not talking about that. If you look back, I am talking about folks who aren't even in the program yet. That's where I'm coming from. I've never done any kind of teaching on a grade school level, I've never taken any classes. I'm sure there's some kind of learning theories or reasons why a teachers operates the way she does based on education that I as a layperson would not have any clue about. That's what I mean.

Bottom line, I am only questioning the amount of floor experience that you will receive while training. Everyone is looking at the numbers here, the quantity and not QUALITY. If you think I am stretching here, well, you have a right to your opinion of course, but all I can say is that you will eventually find this out on your own. It's nothing personal, I'm not questioning you as a person and telling you that you WILL fail; it's not based on how smart you are, how determined you are to make it. Nobody is going to be successful at anything if they don't have the proper training or background.That's all I am saying. I have found that recent grads are not prepared enough on a basic level nowadays, never mind an advanced practitioner. I have seen this with my own eyes, and that is why I am concerned.

But, if you did the teacher education program at a college, and did your student teaching, then wouldn't you feel like you had some basis to discuss this with a seasoned teacher? I don't think anyone fresh out of school thinks they know it all -- not teachers, not doctors, not engineers -- but to say that going through an accredited program and passing the licensing exams, then studying at a higher level while working makes you incompetent, I think you are just really stretching. Yeah, some people will be completely incompetent, some people will be green for a long time, and some people will be able to function quite competently right out of the gate. I think you generalize way too much, and it is clear you oppose the Direct Entry Master's programs. I agree with you that the programs need more clinical time. Comparing them to the PA programs, the clinical time is just a fraction. I think your energy would best be spent lobbying the accrediting organizations to increase the clinical time for nursing student at all levels. The suggestion for full-time nursing internships is a good one. Northeastern University already has that built into their curriculum. www.neu.edu

jeepgirl, LPN, NP · Feb 11, 2005

I have found that recent grads are not prepared enough on a basic level nowadays, never mind an advanced practitioner. I have seen this with my own eyes, and that is why I am concerned.

Well, I'm just not quite sure what to say. You are lumping all recent grads together and saying that they are not prepared enough to practice on a basic level? You've seen it with your own eyes? You've never laid eyes on me. How can you say that? You can't just lump everyone together and make a generalization like that. You seem to be doing that quite a bit in this thread.