NP Worries

LadyT618, MSN, APRN, NP · Oct 11, 2019

My advice to you is if you are concerned about "misdiagnosis or litigation issues" which may arise from being ill-prepared as a new NP, get a few more years of experience under your belt prior to pursuing an NP program. Not to say that fear will go away, but with a little bit more experience, you may feel a tad bit more comfortable once you're completed your NP program.

Every NP program is different and every student will get something different from within a given program. There are so many programs out there and you have to take students' views with a grain of salt because their experience may not be yours. For me, my experience in my Post Master's NP program has been great. In my opinion, I feel I have been adequately prepared. I will be completing my program in December. My program does not prepare you for the boards specifically, like in nursing schools preparing students to take the NCLEX. Instead, they've given me the tools to adequately diagnose, treat and manage patients in primary care, at least as a starting point. I found my Master's in Nursing Education program taught more theory, but that was the nature of that program. I don't find a lot of theory in my NP program, but there will be a fair share of paper writing no matter what NP program you choose. As for my program, the papers are actually relevant to what we are learning in order to become providers.

I hope this helps in some way. I'm originally from Brooklyn and got my ADN from the now-closed LICHSON but didn't decide to pursue advanced degrees until moving out of NY so I can't help you with regard to choosing a good school. But I've ALWAYS heard good things about Downstate, so I don't think you can go wrong with going there.

Wish you luck!

ADNRN2016 · Oct 16, 2019

@LadyT618, thank you so much for your reply! I really appreciate it. I suppose getting more RN experience does make sense before becoming an NP. I have heard somewhere that NP's are faced with more litigation issues than MD/DO's due to misdiagnosis, but it is reassuring to hear that there are some great NP programs out there that adequately prepares their providers. Thanks!

peaceluvandnursing · Oct 17, 2019

That is NOT true! If you look on the ANCC website and AANP and other places, the litigation rate for NP's has NOT increased and stays around 2%.

I did read, even though veryow incidence, that most litigations are about "failure to refer when needed".

SopranoKris, MSN, RN, NP · Oct 17, 2019

I'm an NP student. I'm currently in my didactics and clincals for Family Med, Peds & OB/Gyn. I'm a critical care RN and I was nervous at the thought of having to treat Peds & OB/Gyn patients because it's so far removed from my wheelhouse of skills/knowledge. However, you have to remember: a) you're going to learn advanced assessment skills in Peds & OB/Gyn in your Assessment course, which is usually taken before you start didactics. Then once you start didactics, you're going to learn how to diagnose, prescribe, make a treatment plan, etc.

I was so nervous with my first Peds patient. Now I don't mind it at all. And I've done so many PAPs/pelvics that I've lost count. I'll be doing the OB portion of OB/Gyn in a few weeks. I feel so much better about it now that Peds & Gyn isn't so "scary". I have fantastic preceptors and I have learned so much in clinicals. That's where it all really clicks.

I would suggest that you get a bit more experience as an RN before you jump into NP. One year isn't very much time and you really need to be confident in your nursing assessment skills before embarking on this type of program. You'll get used to what a COPD, DM, or CHF patient looks like when they're having exacerbations, what meds they take, what their lab values looks like, etc., when you have bedside experience. It's definitely important.

bryanleo9 · Oct 19, 2019

Schools don't teach you how to diagnose. You have to put in hours a day self studying as well as having great preceptors. I don't recommend NP programs if you can't sacrifice hours a day to study. Your future patients deserve that and many doctors do not support np as a legit career. We have to shine.

umbdude, MSN, APRN · Oct 19, 2019

56 minutes ago, bryanleo9 said:
Schools don't teach you how to diagnose. You have to put in hours a day self studying as well as having great preceptors. I don't recommend NP programs if you can't sacrifice hours a day to study. Your future patients deserve that and many doctors do not support np as a legit career. We have to shine.

That has not my experience. My school is in fact the only place that teaches me how to diagnose methodically. In my clinical preceptorship setting there's usually not enough time to make an accurate diagnosis since the goal is to stabilize and discharge. Often there are provisional diagnoses but the focus is on stabilizing severe symptoms with meds.

I appreciate that my NP program provides me with a framework on diagnosis and treatment, while my clinical preceptorship shows me how things are done in real life. They go hand-in-hand.

FullGlass, BSN, MSN, NP · Oct 21, 2019

If you want to be an acute care NP and work in a hospital, then you need at least one year of RN experience to get into a reputable acute care NP program. Hospitals are moving away from FNPs, as hospitals separate out peds and adult patients. FNP is a primary care role.

You do not need RN experience to become an FNP because the actual EVIDENCE indicates FNPs with RN experience do not perform any better. However, if working as an RN for awhile makes you feel more secure, by all means do so.

NP students must specialize and FNP is only one track of many. If you don't want to deal with peds, then you don't have to. Pick the APRN track that is the best fit with your aptitudes and interests.

Anyone who completes a good NP program will have more than adequate preparation in "practical knowledge in diagnoses, medications, and general disease management. " That is the whole point of NP school. If you only want an easy NP program that will accept any student with a pulse, you probably won't get a very good education. It is up to you to do the research and apply to good NP schools.

Any provider runs the risk of malpractice litigation. That's why we have insurance. NPs are not any more likely to have legal issues than MDs.

Honestly, you come across as very timid and fearful and I'm not sure you are cut out to be a provider. Being a provider is a huge responsibility. I suggest you think long and hard about why you want to be an NP and don't do it just because you think it is some kind of promotion, because it is not.

ThePrincessBride, MSN, RN, NP · Oct 22, 2019

18 hours ago, FullGlass said:
If you want to be an acute care NP and work in a hospital, then you need at least one year of RN experience to get into a reputable acute care NP program. Hospitals are moving away from FNPs, as hospitals separate out peds and adult patients. FNP is a primary care role.
You do not need RN experience to become an FNP because the actual EVIDENCE indicates FNPs with RN experience do not perform any better. However, if working as an RN for awhile makes you feel more secure, by all means do so.
NP students must specialize and FNP is only one track of many. If you don't want to deal with peds, then you don't have to. Pick the APRN track that is the best fit with your aptitudes and interests.
Anyone who completes a good NP program will have more than adequate preparation in "practical knowledge in diagnoses, medications, and general disease management. " That is the whole point of NP school. If you only want an easy NP program that will accept any student with a pulse, you probably won't get a very good education. It is up to you to do the research and apply to good NP schools.
Any provider runs the risk of malpractice litigation. That's why we have insurance. NPs are not any more likely to have legal issues than MDs.
Honestly, you come across as very timid and fearful and I'm not sure you are cut out to be a provider. Being a provider is a huge responsibility. I suggest you think long and hard about why you want to be an NP and don't do it just because you think it is some kind of promotion, because it is not.

I disagree. I am in the FNP track right now and I think having acute care experience helps tremendously as I have so many past cases to connect and reinforce what I am learning. It also helps that I literally have experience across the lifespan, from brand new preemies to elderly patients in hospice.

I would be a distinct disadvantage without those years at the bedside.

FullGlass, BSN, MSN, NP · Oct 22, 2019

11 minutes ago, ThePrincessBride said:
I disagree. I am in the FNP track right now and I think having acute care experience helps tremendously as I have so many past cases to connect and reinforce what I am learning. It also helps that I literally have experience across the lifespan, from brand new preemies to elderly patients in hospice.
I would be a distinct disadvantage without those years at the bedside.

Good for you. As I said, if someone feels they need that RN experience, then they are free to work as an RN before becoming a primary care NP.

My point is the evidence indicates that RN experience is not necessary for primary care NPs. As a grad student, you should know by now that we make these decisions based on evidence, not anecdotes or opinions.

I went straight through from an ABSN to NP, had no trouble getting a job, and my performance has always been rated very high. Since you didn't do that, you have no way of knowing if you would have been okay with that path.

Your path worked for you. Great. That doesn't mean everyone else has to follow the same path, especially when it is not necessary.

ThePrincessBride, MSN, RN, NP · Oct 22, 2019

4 minutes ago, FullGlass said:
Good for you. As I said, if someone feels they need that RN experience, then they are free to work as an RN before becoming a primary care NP.
My point is the evidence indicates that RN experience is not necessary for primary care NPs. As a grad student, you should know by now that we make these decisions based on evidence, not anecdotes or opinions.
I went straight through from an ABSN to NP, had no trouble getting a job, and my performance has always been rated very high. Since you didn't do that, you have no way of knowing if you would have been okay with that path.
Your path worked for you. Great. That doesn't mean everyone else has to follow the same path, especially when it is not necessary.

Someone sure is snippy and quite rude.

As someone without RN experience, you cannot possibly know how invaluable the experience is. I also don't particularly care that you didn't have a hard time finding a job...there are places that will hire anyone with a pulse.

And if you did go to grad school, you would also know that studies and results can be twisted and manipulated in any such way.

FullGlass, BSN, MSN, NP · Oct 22, 2019

27 minutes ago, ThePrincessBride said:
Someone sure is snippy and quite rude.
As someone without RN experience, you cannot possibly know how invaluable the experience is. I also don't particularly care that you didn't have a hard time finding a job...there are places that will hire anyone with a pulse.
And if you did go to grad school, you would also know that studies and results can be twisted and manipulated in any such way.

What is your problem? You found a path that worked for you. Great. Do you have an issue with me acknowledging that?

Fact: the top NP schools do not require RN experience for primary care NPs. That is a fact. Why do you think that is the case? The people at those schools that make those policy decisions are know a lot more than you do.

There are people who know from the get-go that they want to be a primary care provider. I want to make sure they understand the FACTS, and not get scared off from their chosen path by anecdotes and opinions.

The topic of whether or not RN experience should be required for primary care NPs has been beaten to death here. The reason even the top NP schools do not require RN experience for primary care NPs is that the evidence indicates it does not produce higher quality outcomes. In fact, in one (blinded) study, NPs without RN experience were rated higher by MDs on PE skills. Perhaps there should be more studies, fine. But given that you obviously haven't familiarized yourself with any of these studies, you are not in a position to claim that they are flawed. It is intellectually lazy to dismiss studies just because they don't support your opinion.

Please feel free to contact the Deans of Hopkins, Yale, U Penn, UCLA, UCSF, and so on to complain that they should change their admissions policies because you think you needed RN experience before becoming an FNP, then get back to us with their responses.