NP education - a rant

Specialties NP

Published

I came to the site today and saw lot's of posts of wonderfully excited people interested in becoming NP's. The vast majority of the tones of education were: "I have the opportunity to become and NP through an advanced MSN program" or "I'm sales person at Target with a Bachelors in sociology, and with just one year of school I can become an RN then get my NP degree!!!"

Sorry about this but....Being a nurse practitioner is more than just getting the degree. The job requires experience. Not a year of med surg, not a two year Master's, but some real NURSING experience. We are NURSE PRACTITIONERS, that's nurses with additional skill to allow the diagnosis and treatment of patient problems. It requires the inate skill that makes a nurse magnified to the 'nth degree. What makes good providers as NP's is the same characteristic that made them good nurses. It's experience.

I'm not on a high horse, just an NP that has seen too many "rammed through the system, get their money" NP's. This job is serious. It's serious on several levels. First and formost, you are being entrusted with the care of people that put their complete fath in you to make good decisions and provide quality care.

This IS different that being a nurse. How many times have you sat back as a nurse and berrated a provider about their choice of treatment plan or pushed for the provider to make a decision and get on with it. That all changes when you're the one with the RESPONSIBILITY for the decision. Yeah, it's an ear infection, yeah amox should do the job. Are you ready to commit fully to giving someones most honored item, their child, a drug that could kill them??? It's not cook book. It requires a base of knowledge, experience, reponsibility, and a committment to furthering your skills. It's a lifestyle!

The second group you matter to is the professional community. As NP's, we let the schools go freaking haywire in putting out as much crud as they wanted. They saw dollar signs and began pumping out graduates without regard to job markets or the economy of NP's. Boom, a flood of NP's. Fully half of them are transfer's in from "associated science's". Read sociology, psychology, earth sciences...all able to take their bachelors in science, convert to an RN in one year, and complete their master's in two more. These people may ultimately make good NP's, but not in three years!!!! What makes anyone think that this is the way to put NP's on the map??? What kind of fodder is given to the medical community, especially, to denounce the practice of NP's as being amateurish, poorly skilled, etc. It really opens us up to all kinds of flaming by other medical groups.

If you're an RN, thinking about becoming an NP, don't do it for the salary, chances are you're going to make more as an RN in the right setting. If NP is for you, go out and work, get a job, get several and work in areas like the ER(still, in my opinion, the best experience), community health care, critical care, etc. Then after a couple of years, think about going the MSN/NP route. You will be a better provider, it gives more credence to the profession, and ultimately the little kid with the OM will thank you for your skills.

I know a rant, but it makes me nuts to think that being an NP is anything less than the greatest honor innursing you can become.

Specializes in Postpartum.
Unfortunately for DE students, all the nurses at those clinical sites are very well aware that the vast majority of Vandy students never practiced as nurses. One of the students I knew hated going to clinicals every day because a LVN would constantly tell her that she had no business becoming a NP without any nursing experience. I can tell you this, going through clinicals and having to be "on top of the game" is tough enough without having to deal with those attitudes day in and day out. And if you think that's bad, then try doing clinicals with a NP who went the traditional route!

See, this is the attitude that just baffles me. Why not reserve judgement and give students what they are in clinicals for- a learning experience, not a whole lot of attitude on top of that. The bottom line is that graduates of DE programs will be "new nurses" just like new BSNs & ADNs. Everyone has a learning curve and isn't going to be running the show from day one. New DE MSNs will have managers supervising them just like other new grads, who will evaluate the competence and safety of their practice. And if the evidence shows that their patient outcomes are good- then really, what is all the fuss about? My word- we should want more nurses, not fewer!

When I was applying to programs, I asked if there was any way I could join an in progress undergrad BSN cohort- and there was no such option at any of the schools near me. The only option that would get me into school without having to re-take a lot of useless (non-nursing, non-science) classes was the DE programs. The ADN programs had very long waiting lists and were a joke in terms of pre-reqs (college writing...um, I was an English major, but I guess that doesn't count. college math...does statistics or either of the two math classes I took in undergrad count, no? ok.) I'm far from apologizing for the speed of my program or clinical hours or my lack of nursing knowledge, at the end of my program I'll be a new nurse- just like every other new nurse.

Just wondering, what do nurses who are anti-DE programs think of PA programs- same length of program (or shorter), usually more clinicals, same scope of practice once they graduate? Do new PAs need to be put in their place as well?

-Jess

Cyndee, you should consider re-reading your last paragraph and thinking how it would sound to a new nurse - ANY new nurse. You're basically saying that sight unseen, you and your colleagues are ready to go out of your way to berate my choices and sabotage my learning? If you care about helping patients, isn't this counterproductive? On the other hand, if you're honestly concerned about my non-existent level of expertise, why don't you try harder to train people like me, rather than wasting time making my life miserable? I don't understand.

By the way, med students begin clinicals in their second year of medical school. The large majority never practiced nursing or medicine prior to this exposure. But don't we all have to start somewhere?

Specializes in NICU/Neonatal transport.

Wow, you seem to encourage the staff to harrass people in their clinicals. I would hate going to clinicals too if I was berated and mocked every time I showed up. The fact that the student kept showing up speaks a lot for her and very little for the rest of you.

And you misspeak. You do not have to have 2 years experience before applying to an NNP program, you have to have 2 years experience before beginning any clinical component.

Like Jess, I felt it was asinine for me to repeat a bunch of humanities courses to become a nurse when I already had a Bachelor of Arts and Humanities. And going the ADN route involved years of waiting lists - years I didn't have to wait.

Again, these programs have been around for decades, producing good, capable and qualified nurse practitioners.

btw, even those who are not going through a track that requires a period of practice are still nurses. Just because you don't approve and have an illogical hatred of them, does not mean they aren't nurses. They pass the NCLEX, same as you.

Specializes in Postpartum.
Every single "DE" student I knew had a tough time during clinicals, specifically because they were lacking nursing experience.

Did they have a hard time just because they lacked nursing exp or was it because those helpful, experienced nurses were giving them a hard time as well?

Just because MDs can be miserable to each other during their training doesn't mean we should emulate that behavior!

-Jessica

See, this is the attitude that just baffles me. Why not reserve judgement and give students what they are in clinicals for- a learning experience, not a whole lot of attitude on top of that. The bottom line is that graduates of DE programs will be "new nurses" just like new BSNs & ADNs. Everyone has a learning curve and isn't going to be running the show from day one. New DE MSNs will have managers supervising them just like other new grads, who will evaluate the competence and safety of their practice. And if the evidence shows that their patient outcomes are good- then really, what is all the fuss about? My word- we should want more nurses, not fewer!

When I was applying to programs, I asked if there was any way I could join an in progress undergrad BSN cohort- and there was no such option at any of the schools near me. The only option that would get me into school without having to re-take a lot of useless (non-nursing, non-science) classes was the DE programs. The ADN programs had very long waiting lists and were a joke in terms of pre-reqs (college writing...um, I was an English major, but I guess that doesn't count. college math...does statistics or either of the two math classes I took in undergrad count, no? ok.) I'm far from apologizing for the speed of my program or clinical hours or my lack of nursing knowledge, at the end of my program I'll be a new nurse- just like every other new nurse.

Just wondering, what do nurses who are anti-DE programs think of PA programs- same length of program (or shorter), usually more clinicals, same scope of practice once they graduate? Do new PAs need to be put in their place as well?

-Jess

I guess I'm a little confused...there's a big difference between being in a "DE" RN program and a "DE" NP program. Being a new NP and a new nurse at the same time is absolutely ridiculous! Something else, NP's do NOT practice under a nurse manager, we work independently or collaborate with a physician...NOT A NURSE!

As far as what "we" think of the PA programs? Well, let me see...in my state one only has to graduate from a certified program and pass a national exam before they can practice as a PA. I know of 3 programs in this state (TX) which only require a Bachelors degree (start to finish) for a person to become a PA. Medical experience isn't necessary to apply, just the pre-reqs. Also, there are still "certificate" programs out there for PA's...equivalent to an Associates degree. Gee...I spent 6 years in college and had 10 years of experience as a BSN before going to graduate school...what do I think? I think it's a good thing that PA's are supervised by physicians, that's what I think!!

Wow, you seem to encourage the staff to harrass people in their clinicals. I would hate going to clinicals too if I was berated and mocked every time I showed up. The fact that the student kept showing up speaks a lot for her and very little for the rest of you.

And you misspeak. You do not have to have 2 years experience before applying to an NNP program, you have to have 2 years experience before beginning any clinical component.

Like Jess, I felt it was asinine for me to repeat a bunch of humanities courses to become a nurse when I already had a Bachelor of Arts and Humanities. And going the ADN route involved years of waiting lists - years I didn't have to wait.

Again, these programs have been around for decades, producing good, capable and qualified nurse practitioners.

btw, even those who are not going through a track that requires a period of practice are still nurses. Just because you don't approve and have an illogical hatred of them, does not mean they aren't nurses. They pass the NCLEX, same as you.

Tell me of ONE, just ONE NP program that has been around for decades that did not require a person to practice as a RN before applying. The direct entry NP programs began in the 90's, not decades ago.

Did they have a hard time just because they lacked nursing exp or was it because those helpful, experienced nurses were giving them a hard time as well?

Just because MDs can be miserable to each other during their training doesn't mean we should emulate that behavior!

-Jessica

They had a hard time specifically because they lacked nursing experience.

Cyndee, you should consider re-reading your last paragraph and thinking how it would sound to a new nurse - ANY new nurse. You're basically saying that sight unseen, you and your colleagues are ready to go out of your way to berate my choices and sabotage my learning? If you care about helping patients, isn't this counterproductive? On the other hand, if you're honestly concerned about my non-existent level of expertise, why don't you try harder to train people like me, rather than wasting time making my life miserable? I don't understand.

I'm confused...there's a big difference in training a new nurse and a new NP. I'm not in the position to train a new nurse, because I'm a nurse practitioner and our roles are different. And I can't just magically transfer the knowledge that I've gained through years of experience. No matter what you say/think, experience is the best teacher.

I went back to my "official" graduation in May and several of the "DE" NP's were working as RN's. Since we had actually graduated in Aug '05, we had already been out in the work force for 8 months. The majority of them said that they felt they needed to gain nursing experience before they worked as a NP. So, maybe experience DOES make a difference when the rubber hits the road. What do you think about that?

Something else, I have never been rude to "DE" NP's and I'm not trying to make your life miserable! I'm just voicing my opinion and trust me, my opinion is very popular among the nursing profession.

Specializes in NICU/Neonatal transport.

1974 at Yale, was the first Direct Entry nursing program. Since then, many programs have grown and there may be people you practice with who were, once upon a time, a direct entry student. They may not share that tidbit with you because of your excessively negative attitude.

"Employers rated Vanderbilt's MSN graduates who did not have a nursing background equally high in terms of level of preparation for APN positions as those who entered with a BSN degree."

"We know that employers love hiring accelerated graduates because they are bright, have a track record of success, and possess an understanding of the work world not always found in younger students,"

http://www.aacn.nche.edu/Publications/issues/Aug02.htm

No one in my nursing class has ever taken a "mental health day" as I've heard undergrads do. We all take our studies exceptionally seriously. We have higher pass rates for the NCLEX and our diverse backgrounds mean that we bring more to the table than your average 21 year old graduate.

My degree is in spanish and international studies, so I can work as a bilingual nurse, in additional, I have a much deeper understanding of cultural issues that come into play with health care. I am also a NICU parent, which gives me a deeper insight to the struggles that families are going through when their child is ill. I don't talk about the difficult parents, because I know that when your child is sick, we all become difficult and they are scared out of their minds that their baby could die. Too many nurses roll their eyes or get annoyed.

In my class, we have: a forensic criminology graduate, two speech therapists, 2 respiratory therapists, 3 social workers (with masters of social work), a physical therapists, 2 people who were accepted into Med school but decided they preferred the nursing framework, 3 language majors, one opthamologist, several chemistry type people, accountants and a few other things I can't remember.

Apart from degrees, our class speaks 12 languages between us, many have children, three gay students, men, immigrants, people with english as their second language, military families, grandparents, people from rural and urban areas, you name it, we've got it, it seems.

We are highly intelligent and highly motivated. We work our butts off in not only the book learning, but the clinical components. We have received nothing but compliments and rave reviews from not only the staff that works with us in clinicals, but from patients themselves. We are critical thinkers from other fields that are learning to apply those to the nursing process.

People will fail if you want them to fail. You say you don't treat them poorly, but I cannot imagine how you could have such a negative and vitriolic attitude towards DE students that you would actually treat them as you would your precious traditional masters.

This has ruffled my feathers a bit, I'll admit. These are exceptionally challenging programs and you act as though it is like a drive-thru masters. Many days I'm in classes from 7am until 9pm. That is not easy. It's not particularly fun either. But I am willing to do it in order to achieve my goal.

Specializes in NICU/Neonatal transport.

I'm also going to say that as you mentioned, the roles of the RN and APN are different. And I think there is an advantage to our schooling because from day one, we are taught how to deal with the nursing issues, but also prepared for the day when we will be the NPs. We are taught that we will not have the luxury of always relying on someone else to make the hard decisions and write the orders. That soon enough, we will be the ones directing the nurses and so we can't be too settled into the position of just waiting for orders from the NP or Dr.

Specializes in Education, FP, LNC, Forensics, ED, OB.

o.k., i'm going to step in here and ask that everyone please stop the one-on-one personal discussions/attacks/put-downs. it serves no purpose, really.

we are all professionals and are striving for the same exact thing. to be the best that we can be in our respective careers and serve the public with the utmost in professionalism and dedication while offering the best in care.

we come from diverse backgrounds, as evidenced here; we come to the same end - advanced practice nursing......nurse practitioners/clinical nurse specialists.

please, let's not make this a "he said, she said".

would hate to close this thread.

thanks!

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