NP education - a rant

medsurgnurse, RN · Feb 2, 2005

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.

Do NP schools really accept students who are not already an RN. My school required, RN, BSN and one year experience. Most of us are older experienced folks.

fergus51 · Feb 2, 2005

700 hours? That's less than 18 weeks of full time work. They think they can train someone without healthcare experience to be an NP in that time? That is scary.

Jess RN · Feb 2, 2005

I am also deeply disturbed by the numbers of first semester nursing students who state that they will be a CRNA in 5 years. They say 'I graduate, get my one year of experience and start CRNA school." It absolutely scares me.

Again, do anesthesiology residents scare you? They have about as much schooling and clinical practice in med school that a Bachelors prepared nurse with a year of RN expereince plus a CRNA master's program would have, no?

I don't want to get all gender bias here- but why is it so scary to some nurses that a bright, focused nurse can achieve her (presumably, her) goals without spending years and years in an RN role which in this case particularly does little to prepare her for the job she ultimately wants to be doing, as a nurse anesthetist? But it somehow is less scary that docs can do it in slightly longer timeframes and with a larger scope of practice. Is it because med students are mostly men?

Sorry to be so provocative here.

Jess

Jess RN · Feb 2, 2005

700 hours? That's less than 18 weeks of full time work. They think they can train someone without healthcare experience to be an NP in that time? That is scary.

I should have been more specific- the 700 hours are only for the advanced practice componant. There are also clinicals above this that are part of your RN training. Still, I don't think it's enough.

-Jess

Gennaver, MSN · Feb 2, 2005

Just a general disclaimer at first to say that I for one do not think the previous posters "have no idea what they are talking about". They are voicing their informed opinions, based on thier experience. I think it is possible for Gennaver to also have an informed opinion that differs from the majority of the posters on this thread, based on her research and experience. I don't know what Gennaver thinks specifically in response to your questions above, but I'll have a go at this:
1. Direct Entry NP programs aren't being offered at a few fly by night schools. They've been around for a while and are at established, excellent schools like Yale and Columbia. I just kind of assume that they know what they are doing and know how to train competant, safe NPs.
...
-Jess

Hi Jess,

You were right on target with some of the things I was trying to clarify. It did seem like the original ranter thought that all we needed to do to become a graduate entry np was to hang up our McDonalds or Targe aprons and go to school for a year.

Although, since reading through more comments on this thread I do realize that some posters here not only think that NPs who become one without years of exclusive bedside RN work are incapable I also see how some of the posters in this thread also think that all new RN grads are poorly equiped and incapable too! Surprising, really, all new RNs? Could they merely have meant green,just like they were too one day?

That pretty much clarifies this thread as not having any validity.

It was indeed started as a rant and it continues to be one. In other words, it seems very dubious as to any validity. I am very grateful to the countless nurses and doctors that I have worked with over the years who did let me hands on work with them, (knowing that it was their malpractice insurance and that they must have really known me and my ability well, although, like I said, even if I was a Target employee with a Sociology degree....so?)

Gennaver

DidiRN · Feb 2, 2005

You really seem to be taking this as a personal attack on your ability to do this. If you really read carefully, you will find that most feel the education you would receive would be inadequate, not you or future nurse jess as students or nurses in the future. They are not insinuating that you or anyone else can never do this. Only the way your education would be given to you in the form of a rapid entry MSN-NP. I admire anyone with high ambitions, but please do not ignore folks who have been in this business for a long time who question this way of training. That is a very unwise thing to do. The OP may have come rather caustic to you and insulted you, but others completely agree with the bottom line message of it. That to me gives it tremendous validity.

If you read more of the BB, you will find multiple examples of RN's/LPN's who used to be NA's who tell time and time again how they really never knew what being a nurse was like until they were graduated, received their license and actually practiced on their own. I guess I don't understand people who do not listen to others who have much more experience in the field.

I'd like to know what kind of hands on work you did with the doctors and nurses that had something to do with their malpractice insurance. Can you explain exactly what you were doing? I'm curious.

Still waiting on the explanation of "integration" in your previous post.

Hi Jess,
You were right on target with some of the things I was trying to clarify. It did seem like the original ranter thought that all we needed to do to become a graduate entry np was to hang up our McDonalds or Targe aprons and go to school for a year.
Although, since reading through more comments on this thread I do realize that some posters here not only think that NPs who become one without years of exclusive bedside RN work are incapable I also see how some of the posters in this thread also think that all new RN grads are poorly equiped and incapable too! Surprising, really, all new RNs? Could they merely have meant green,just like they were too one day?
That pretty much clarifies this thread as not having any validity.
It was indeed started as a rant and it continues to be one. In other words, it seems very dubious as to any validity. I am very grateful to the countless nurses and doctors that I have worked with over the years who did let me hands on work with them, (knowing that it was their malpractice insurance and that they must have really known me and my ability well, although, like I said, even if I was a Target employee with a Sociology degree....so?)
Gennaver

DidiRN · Feb 2, 2005

Physicians have a tremendous amount of hands on training as well as classroom training that take many years that is much more intensive than for an RN. Four year of undergrad, four years of med school, and then the years in their chosen field (ie anesthesia).RN and NP training and education doesn't come even close to that. Don't look at just the number of years but on what exactly they are doing in those years. Compare hours spent in the hospital training to classroom work.

I think gender has zero to do with this. Look at the huge amount of female pre-med, interns and residents, as well as physicians. It doesn't scare us in that we think we are "threatened", we are scared for the patients who unknowingly would be taken care of by someone without enough education and experience and would be harmed. That is what is scary.

Again, do anesthesiology residents scare you? They have about as much schooling and clinical practice in med school that a Bachelors prepared nurse with a year of RN expereince plus a CRNA master's program would have, no?
I don't want to get all gender bias here- but why is it so scary to some nurses that a bright, focused nurse can achieve her (presumably, her) goals without spending years and years in an RN role which in this case particularly does little to prepare her for the job she ultimately wants to be doing, as a nurse anesthetist? But it somehow is less scary that docs can do it in slightly longer timeframes and with a larger scope of practice. Is it because med students are mostly men?
Sorry to be so provocative here.
Jess

BeenThereDoneThat74, MSN, RN · Feb 2, 2005

do np schools really accept students who are not already an rn. my school required, rn, bsn and one year experience. most of us are older experienced folks.

sadly they do. it's about the $$$ i suppose.

you know, i think another thing that offends some nurses here, is that some students have no intention of becoming a nurse, and are just going through the motions just to become an np. as a future educator, i think that would bother me, if i was teaching a student who didn't feel she (or he) needed to learn x,y,z because nps don't do that.

and it also seems that these same people don't believe what the seasoned nurses (or nps) have to say. no one is taling anyone out of becoming an np. it's just advice. granted, no one asked for advice in this thread (it started as a rant). but there are other ones where advice is asked for, yet people challenge it. that's the thing about advice, you do what you want with it.

we've all had different personal experiences, some of which we feel are worth sharing (as a learning exerience). you guys don't have to listen. i look at everything i read here (or hear from other nurses) as food for thought. :)

fergus51 · Feb 2, 2005

I should have been more specific- the 700 hours are only for the advanced practice componant. There are also clinicals above this that are part of your RN training. Still, I don't think it's enough.
-Jess

Ok, makes a little more sense, but I agree it stll wouldn't be enough for me. I'm glad you are obviously willing to put in more time so that you'll be confident enough to practice.

fergus51 · Feb 2, 2005

Again, do anesthesiology residents scare you? They have about as much schooling and clinical practice in med school that a Bachelors prepared nurse with a year of RN expereince plus a CRNA master's program would have, no?

I know this wasn't directed at me, but yes, residents scare me. Not anesthesia in particular, but I have worked with too many residents to not be scared of their ability to practice without close supervision. Have you worked with many? I prefer working in teaching hospitals and I love most of our residents, but I know they need a whole lotta support and supervision. It isn't because they aren't intelligent, it's just that experience does matter and by definition they don't have enough to practice independently yet. Every practitionner was at that stage at one point.

jeepgirl, LPN, NP · Feb 2, 2005

I can see what some nurses are saying... that they want NP's to have years of experience as RN's before they start their NP. And that's fine.

I think that there are some people who basically want to go straight through because they have other reasons. For me, for instance, I have a three year old. I want to have more babies, and honestly, I want to be done with school before my kids are out of school!

So here was my plan. I got my ADN. Now, I am working full time while I get my BSN. When thats done, I haven't decided if I will go straight into MSN or if I will wait a year, take a break, and then go in. Either way, it makes little difference. Either way, when I graduate I will only have 3-4 years of nursing experience. I plan on going part time to school while working FT. I say that that is an acceptable amount of experience in most instances.

I do wonder, however, how a PA can go in and not have previous experience and be a mid-level also without question. And NP... we just have a fit if someone has little experience beforehand. Not all PA programs offer more clinical hours than NP.

I can see why some people want to do direct entry or progress through the programs fairly quickly. Because they want finish that chapter of their lives and get one with more important things. I can't blame them for that. I would just try to encourage them. Like I said, I can see all sides of the issue. But I don't think that these people need to be discouraged, you know? Those that progress right through are usually very smart, enthusiastic, and motivated people.

Someone mentioned something that made me think of something. I worked as an NA while I worked while going to school. I graduated when I was 20 years old. I'm sorry, but doing NA work was completely and totally different than being the RN. And you know, it makes me furious when I get an NA (not going to school, either) that says "Oh, I've been doing this for 5 years, so I am basically an RN." I've put more than one of THOSE in their place for saying that crap. I usually bring up the fact that I was a teen volunteer for three years (I did NA work on the floor, not candy striping!) then I worked for 2 years as an paid NA and now I'm a nurse.

And you know what... I didn't know squat. And even if you know some of the interventions... what is more important is knowing the rational behind those interventions and pulling it all in together to manage the care and specialize it for that specific patient. Any NA that thinks she is basically a nurse is dangerous.

Now, the previous poster did NOT say that at all (so I'm not bashing you!), but it just made me think of it.

And, when I go for that NP, I'm not going to tell myself that I've had all that experience as an NA so I will be ok. I expect that I will probably be the youngest and least experienced nurse in the pack. So, that means I'm going to have give a 110% to everything I do. I just hope that those I am with in school and while training encourage me rather than shoot me down!

fergus51 · Feb 2, 2005

I've never worked with PAs, but I was under the impression that they were supervised by a doc (as opposed to NPs). Aren't they?