How much did NP school prepare you?

Specialties NP

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I have heard that Nurse Practitioner school is not as rigorous as other grad schools (such as CRNA school). I would like to become either a ACNP or a CRNA in the future. I am very interested in science-based learning, and am wondering which option would be best for me. I have such a strong passion for cardiac disorders, and could really see myself becoming a Surgical Cardiac ACNP. However, CRNA interests me for the hard-core science that is taught. CRNA students get such in-depth pharmocology and pathophysiology classes.

For any ACNPs out there, did you feel confident in your pathophysiology and pharmocology knowledge after graduation? Or did you attend a fellowship after?

...I've been working (although it seems like thats probably frowned upon by you).

To answer your questions, i'm saying that even if I didn't work, it would've been really really difficult to to obtain the kind of hours that you are suggesting. Because its so difficult to find good preceptors and there are plenty of students, theres always another student in line to begin a rotation once I have finished "x" number of hours for that term. And I can say I am an exceptional student - I come prepared and I'm a quick learner. But my preceptors have students booked for a year and a half out and quite frankly, almost nobody wants a student all the time. Who would? Theres no compensation and for me to really see patients and write notes and develop plans, its kind of a headache for them logistically for us to see patients around each other and it slows them down.

Another point that I would like to make is - of course PA's and residents dont work in their programs. Whatever work they do WOULD NOT BE MEANINGFUL in their career because they only have a degree to fall back on, not anything they can actually do anything clinically with. My work in the PICU along with school is ABSOLUTELY helpful in my future career. I learn things every day that will ultimately help me in my future practice, but where would a PA work with their science degree that provides them with patient interaction?

While I understand your point (work less and do more clinical hours), I still feel like you are dismissing that barriers that would allow a person to reasonably do so. Of course I could quit my job and try to do more clinical hours, but what happens when I can't get them and I just sit at home instead? At least what I'm doing for money is expanding my brain and contributing to my knowledge.

I am by no means minimizing PA programs or anything of the sort. I do think they come out (generally) better prepared on the textbook side of things. But, regardless of what that reason is, I don't think its because people don't work during those programs. Maybe it is because of admissions standards or because they find good clinical placement or for whatever the reason. But for Dodongo to essentially say its because people are lazy because they dont devote their whole life a "go above and beyond!" is a little unrealistic given the current restrictions of NP programs. That was my only arguement.

So - you *chose* to go to NP school. Knowing full well you would be responsible for arranging your own clinical rotations. AGAIN - do I think that NP programs should find their students preceptors. Yes. I also think they should require >2000 hours in the clinical year, a gross anatomy class, surgical training, etc. But they do not. So what options does one have?

1. Go to whatever NP school you want. Reputation and rigor be d*mned. Go with whatever preceptors you can find. Complete ~800 hours while working full-time.

2. Go to an NP school with some standards. Read on your own AND find appropriate preceptors and complete an appropriate/extra amount of clinical time at the provider level.

3. Go to PA school.

4. Or, if you don't want to do the APP thing, go to medical school.

There are sacrifices to be made with any of the above options. Time, money, knowing what you're doing when you graduate... I know which sacrifice I would prefer to make. You can take the smartest person out there but if you only train them to a certain (low) level, they're only going to be able to practice at that (low) level.

Finally, RN work experience does not substitute for training at the provider level. I would hope that an NP student would realize this, but here we are, having this argument. It's super that you learn at work. I would hope so. But you aren't being tested constantly by a preceptor. You aren't doing H&Ps. You aren't writing progress notes. You aren't ordering diagnostic testing and working on differentials. You aren't diagnosing and you certainly are not coming up with treatment plans.

I know that feelings get hurt when someone disagrees with the path you've chosen, but luckily, I'm just some random, anonymous internet troll. However, my opinions, while only my opinions, still have merit. And I think more than you're willing to admit.

It will give you the license you need to practice. How good you will be is up to you and the effort you continue to put in.

1 Votes
Specializes in Family Medicine, Medical Intensive Care.

CRNA school was alluring to me too because of the hard-science focus, but I honestly can't see myself in the OR. Yes, NP school is lacking in the hard-science department, but no one is stopping you from reading medical school textbooks to supplement what you learn in school. It's what I did during my FNP program, and it helped put me above the rest as well as being over prepared for boards. Overall, NP school is what you make of it.

Specializes in CRNA, Finally retired.

Rather than NP shool being what you make of it, NP school should be what it makes of you. That is what the student us PAYING for. If CRNA students must be provided instructors, ALL grad students should have the same advantage. So many of our NP programs are a disgrace.

Specializes in Anesthesia, ICU, OR, Med-Surg.

There isn't a direct correlation regarding the GRE exam and a person successfully completing an advanced practice nursing program. I completed CRNA school without the GRE exam and did very well.

1 Votes
Rather than NP shool being what you make of it, NP school should be what it makes of you. That is what the student us PAYING for. If CRNA students must be provided instructors, ALL grad students should have the same advantage. So many of our NP programs are a disgrace.

I think whatever effort you put into school is really what you make out of it. Whatever effort you make in life is what you make out of your life. Same concept in once you graduate and get a job. Physicians/NPs/PA don't become successful without actually putting work into it. Perhaps NP schools are not based on a "medical model" as what most people say but I also know that not all med schools are perfect either. Medical students worked really hard to get their MD because they sat and read for hours trying to understand the materials and reading above and beyond what they are expected to read for class. Lots of residents I know have told me that they never learned about IV fluids in school, they were never prepared for it while in school, they learned that on the job and they read about it. I know this because I went to an online NP school but I studied everyday at a medical library in San Antonio and did my work there. I sat with MD students and MDs and watched how they studied and how focused most of them were and used what I saw as motivation for me to read more and learn more.

I think people are well aware before they go into NP school whether they have to set up their own clinical practicum. Most prospective students are also well aware that we are not based on a medical model. Many complain about how they are unprepared they are after graduating from NP schools. There are a few things that I noticed that NP students should be doing differently to get the best experience they can get out of school.

1.NP students usually work as RNs at the same time that they are going to school. Some work full time/part time. The more you work, the less time you have time to read the material that you are assigned. Some just barely survive and do the bare minimum of reading just to pass the test and do the pump and dump” information in their brain rather than really understanding the material and using critical thinking on interventions to stimulate why we would use one intervention rather than the other. Perhaps if one cuts back on work they would have more time to understand the material

2.NP students don't realize that the role of a RN and a NP is totally different. When we were students we thought we knew but we really didn't know once we had our first job. We are so focused on trying to balance between our RN job and NP school that we keep doing our jobs as RNs to make money – which is what we have been doing most of our work lives, this is what we are used to, we are experts as RNs – which in ways does help us sharpen our clinical skills. However, what are we actually doing to prepare ourselves for the role of being a NP other than going to clinicals and using the pump and dump” learning method? We could be going to NP conferences to network with other experienced NPs or going to NP course reviews way before we graduate but most students don't even take the time to do that. Then once we graduate we complain about how unprepared we were because NP school taught us nothing”, yet we blame all of it to the NP school program and we absolutely know that we are not the one to blame because we act like NP school is responsible for all that we know and don't know.

3.Most NP students want to stay in town for their clinical practicum so that they save money and they can keep doing their RN job. I get it! Who wants to travel outside of town and spend more money? Saving money is ideal, everyone's situation is different. I had to set up my own clinical practicums. A physician I worked with said it is important to pick a site that will give me good variety of experience even if I had to go out of town or state so a solid foundation could be made. I took that advice. My school did not allow me to work out of state. I did go out of town and spent my own money for accommodations for different clinical sites. I made sure that my preceptors have interviewed me in person and I have interviewed them as well to see if we are a great fit months before my clinical practicum with them started. If they said that it was not necessary to meet in person, I would request that we do so that I can … 1. See the clinical site, 2. Browse the bookshelf of their office to see what books they have (and perhaps read this on my own, for my own learning) and ask them any tips or how they want me to prepare prior to clinical that would make patient care go smoothly. 3. So that I can also ask them in person what they expect of me as their student. MD/PA students go out town and out of state to vary their clinical experience. NP students just sometimes settle with clinicals like retail clinics to stay in town which sometimes isn't the best due to their protocols of steering away from higher acuity patients which limits handling more complicated health conditions which won't really make good variety of experiences.

I am not against people who work in school nor I am judging but it is a hard balance to make. If you put more time towards one or the other the other aspect is going to suffer. I guess the question is what is your priority? No one can answer that for you but you only.

NP school is definitely NOT what it makes of me. NP school is what I make of it.

Life is definitely NOT what it makes of me. Life is what I make of it

I am the captain of my ship and I will steer the ship however and whichever I want to and I will do it successfully” --- this is my motto when I faced challenges in work and life balance while in NP school and it continues to be my motto today.

Extremely discouraging... It will come down to employers only hiring from certain programs. Supply and demand is the last barrier. Once the supply of NPs reaches a critical max employers will become more particular in their hiring. For profit/online NP grads will return to the bedside. Hopefully that will back up to the subpar programs at some point as well. Time will tell.

In the mean time NP students need to STOP working full time, complete clinical hours full-time and read more.

You keep referrig to NP work schedules. I know a med student ( a former nurse) who, despite it being against the rules, worked on the weekends as a nurse due to financial needs. As an adult, who has worked continually since being a teenager, to support myself, I don't want anyone telling me to stop working for school. There are no absolutes when it comes to education. There are standards and ways to achieve those standards, none of which involves taking yourself or your family to the poor house while being uninsured.

Dudongo, your predictions appear to be the same as a dooms day preacher. For profit and on-line NPs will return to bedside? First of all, most programs are going on-line, even from the very top schools. Who is going to be asking if your program is on-line if you graduated from a well-known B&M school? What's a for-profit school? How do you know what is school is categorized as a for-profit school according to the U.S. tax codes? Someone mentioned the difficulty in securing preceptors, which is a barrier to doing more clinical hours. Do you know that NPs are not the only ones having this problem? Do you know that NPs and PAs, as well as residents, may do clinicals side-by-side? The quality of the rotation may be good or bad for all of them, depending on the preceptor. The advantage that a med student or resident has is the vast amount of hours they are spending in different rotations. If an NP wants to be the same as an MD, why not go to med school?

Right now, NONE of the programs out there are taking NP education as seriously as warranted. By looking down on students who have to work, or whose programs require less clinicals than others, we do not help the profession. In a previous post you stated what type of student you would be willing to precept. That comment was disappointing to hear, as there is such a shortage of preceptors. Many NPs cannot precept unless their larger organization allows it, and some don't want to because they want to be as productive as possible and a student will slow them down. While as a student, you may see things one way, the reality is that there are many factors influencing NP education, and we may not be aware of a fraction of the information out there. Don't pass on the chance to precept an "on-line, for-profit or someone who worked full-time, as that individual may actually be a trained MD from another country who is not willing to go through the entire residency program again, but wants patient care. I know many like that, and they are much more humble than many of the NP posters on AN.

Many students feel very confident in their abilities on day one (some while they are still students) and I have always worried about them. Physicians worry too, because "they dont't know what they don't know." While some schools provide excellent education, no one is ready to work independently on day one.

Just some thoughts of concern from anelderly NP.

1 Votes
You keep referrig to NP work schedules. I know a med student ( a former nurse) who, despite it being against the rules, worked on the weekends as a nurse due to financial needs. As an adult, who has worked continually since being a teenager, to support myself, I don't want anyone telling me to stop working for school. There are no absolutes when it comes to education. There are standards and ways to achieve those standards, none of which involves taking yourself or your family to the poor house while being uninsured.

Dudongo, your predictions appear to be the same as a dooms day preacher. For profit and on-line NPs will return to bedside? First of all, most programs are going on-line, even from the very top schools. Who is going to be asking if your program is on-line if you graduated from a well-known B&M school? What's a for-profit school? How do you know what is school is categorized as a for-profit school according to the U.S. tax codes? Someone mentioned the difficulty in securing preceptors, which is a barrier to doing more clinical hours. Do you know that NPs are not the only ones having this problem? Do you know that NPs and PAs, as well as residents, may do clinicals side-by-side? The quality of the rotation may be good or bad for all of them, depending on the preceptor. The advantage that a med student or resident has is the vast amount of hours they are spending in different rotations. If an NP wants to be the same as an MD, why not go to med school?

Right now, NONE of the programs out there are taking NP education as seriously as warranted. By looking down on students who have to work, or whose programs require less clinicals than others, we do not help the profession. In a previous post you stated what type of student you would be willing to precept. That comment was disappointing to hear, as there is such a shortage of preceptors. Many NPs cannot precept unless their larger organization allows it, and some don't want to because they want to be as productive as possible and a student will slow them down. While as a student, you may see things one way, the reality is that there are many factors influencing NP education, and we may not be aware of a fraction of the information out there. Don't pass on the chance to precept an "on-line, for-profit or someone who worked full-time, as that individual may actually be a trained MD from another country who is not willing to go through the entire residency program again, but wants patient care. I know many like that, and they are much more humble than many of the NP posters on AN.

Many students feel very confident in their abilities on day one (some while they are still students) and I have always worried about them. Physicians worry too, because "they dont't know what they don't know." While some schools provide excellent education, no one is ready to work independently on day one.

Just some thoughts of concern from anelderly NP.

I feel like a broken record here, but the vast majority of MD and PA students do not work. So you know 1 med student who worked part-time during school? That, compared to thousands and thousands of others who did not work, means very little (probably nothing to be honest). The vast majority of these students find it more important to take out loans and do school/study full-time. Medicine is an enormous body of knowledge. 1 year (or less at many NP schools) of part-time didactic study with 1 year (or less again) does not even begin to scratch the surface. The other provider level professions seem to agree on this while nursing, for some reason, thinks being debt free is more important than learning.

I am absolutely a doom-sayer about this but I will tell you it's already becoming a reality in many areas. The part of the country in which I currently live is becoming quite saturated with NPs and PAs. The salaries are pitiful at the larger institutions - some of the lowest in the country. Employers are asking where students graduated. It's happening. And it's as easy and looking online to see if a program is 100% online versus hybrid/B&M. We all know which schools have poor reputations.

And by giving sub-par nursing education a pass we do not help the profession. And come on. How many FMG MDs do you know that are NPs now from online schools? You know many like that? You are a very well connected person then. 99% of the people graduating from online NP programs are nurses looking for the easiest, quickest, cheapest route to practice not FMG MDs. That was a fairly silly argument.

I agree. No one is ready to work independently on day one. But some are more ready than others.

I am of the opinion that NPs need to try and salvage this situation. We should be strengthening our applicant pool, not diluting it further or letting it stagnate. Sacrifices need to be made when it comes to education. Work/money, time, learning. Something's gotta give. NPs have chosen learning. MD and PA have chosen money and time.

While MDs and PAs may appear to be confident, I know new grad MDs and PAs and inside, they are terrified! There are an increasing number of NP residency programs becoming available, so new NP grads should apply to these. As NPs, we can advocate for more NP residency programs. MD residencies are funded by Social Security. We should be working with our state and national legislators to develop more NP residencies. These are typically 6 to 12 months long and combine clinical hours with academic study.

While MDs and PAs may appear to be confident, I know new grad MDs and PAs and inside, they are terrified! There are an increasing number of NP residency programs becoming available, so new NP grads should apply to these. As NPs, we can advocate for more NP residency programs. MD residencies are funded by Social Security. We should be working with our state and national legislators to develop more NP residencies. These are typically 6 to 12 months long and combine clinical hours with academic study.

I would absolutely be on board to have NP residencies funded in the same manner as physician residencies. This would require more specialization on the part of the NP - something I personally support, however, I don't know if many others would support this. We already have a large enough problem with FNPs working inpatient and acute care NPs working outpatient, etc.

Specializes in Neurology, Psychology, Family medicine.

There are still very few NP residencies. While more may be opening they tend to focus in specific states. Or they tend to focus in a specific region. Primary care residency are far and few between. So while this is going in the right direction it's far from the solution due to its very slow state of maturity.

Read/study these texts and you will be golden:

Netter's Atlas of Human Anatomy

Guyton and Hall Textbook of Medical Physiology

Robbin and Cotran Pathologic Basis of Disease

Andreoli and Carpenter's Cecil Essentials of Medicine

And the pharmacology text of your choosing. I read Lippincott's Pharmacology. I guarantee if you read these you will be light years ahead of any NP or PA student and more on track with a medical student. Were these assigned to me during NP school? Nope. Did I read them anyways? Every word - well, half way through Cecils.

ALSO, the "Made Ridiculously Simple" series. So far I've read the Clinical Anatomy, Clinical Physiology, Clinical Pathophysiology, Clinical Pharmacology and Clinical Radiology books in the series. There are many others and I hope to read more. They are written by physicians for boards preparation, but I've met some APPs that have loved them as well. Excellent books for learning the quick and dirty in each area of medicine. Great mnemonics, pictures, etc. 5 stars.

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