Standardization of NP Education

Specialties NP

Published

  1. What immediate requirement will improve NP education

    • 37
      More clinical experience
    • 21
      2 years minimum admission requirement
    • 41
      Science and medicine based curriculum
    • 13
      Upgrade the DNP curriculum
    • 3
      Other

57 members have participated

Hello All,

I'm probably going to get alot of backlash from this but what can I say. I live life on the edge. These are my thoughts on the subject.

Firstly, as I browse on Allnurses occasionally, I see alot of hate towards NPs with no bedside experience. Despite being a nurse and a NP as completely different roles, several reviewers see this experience as mandatory. I can see how one can say that nursing experience can help you anticipate what to order and certain conditions but it's not an all-in-all experience to fall back on. Furthermore PAs, MDs, DO, hell even other allied health jobs don't absolutely require bedside care in order to be accepted into these programs so why be in a tizzy about NP school. I feel like is a personal matter. This notion also confirms that nurses dont even agree with the preparation that current NP schools provided.

With that being said, this requirement is at the discretion at the school but I wish there was just a straight-black-and-white standard of admission requirements so this argument can dissolve.

Secondly, even some brick-and-mortar NP schools have students find their own preceptor which is ludicrous and insulting. I'm paying money for experience that I have to seek out myself ... does not make sense. I can't name any other healthcare profession that does this. I'm sure someone will rebutle this but that's a 1%. NP schools should supply their own preceptors despite being online or on campus.

Thirdly, raising the minimum clinical hours from a mere 500 to 1000+ will add more respect to clinical aspect of NP schooling and also give the student adequate time of exposure to practice in their the new role.

NP/DNP curriculum needs dramatic reforming. The 3 P's are great. But what else can we add gross anatomy? Cadavers? I want to know what you guys think on this subject matter.

I have also seen hundreds of posts on how the DNP has no clinical significance to the profession. Disclaimer *I do not have my DNP* but I will say is after looking at numerous MSN-DNP programs all the classes are just repeat masters graduate classes with varying names per campuses. I understand the doctorate is a scholarly degree but even the clinical doctorate has a bunch of "fluff". I really appreciate the new PA doctorate curriculum as it is definitely focused on scholarly aspects of improving speciality. So my question to DNP students and graduates, what would you change about the DNP program?

What will become of NP education and what are nurse educators and NPs going to do to advocate for these changes? I'd love to hear reccomendations.

I find it humorous how everyone gets on these threads and says, "Oh, well, my school was great. It was so good. I got a great education. It was so hard and the standards were so high. I don't know where these other people are going."

I mean, come on, school matriculation requirements and curriculum are objective measurements. There are far far far more schools that have little to no barriers to entry or graduation than those that do. So, I really don't care what school you personally went to. That's not the point of these threads. We need standardization. I also went to what I would consider a good school - I purposefully chose that. HOWEVER, more NPs choose sh*tty schools on purpose to avoid any semblance of hard work, than those that purposefully choose schools that will challenge them.

The problem is that option exists. There shouldn't be any bad schools to choose from, because we should have an accrediting body that holds each and every school to an acceptable minimum standard. Things like, minimum of 2 years "relevant" RN experience (can be determined by the program, so psych experience for PMHNP, ICU for ACNP, etc), minimum GRE scores, minimum gpa, in-person interview, gross anatomy at the graduate level, program arranged preceptorships and clinical experiences, etc.

I went to a private college, well regarded, before online even existed. No GRE, no specific experience required, and I am pretty sure they admitted most of the applicants. The quality of the program was mediocre at best. I am almost entirely self taught.

To be fair, I am not sure if any program can teach you to be a good Psych NP. Too much of the soul of a practitioner is involved.

A real fire in the belly is needed, otherwise you'll be just like those crappy psychiatrists that see their patients for 5 minutes and write refills.

I can't speak to NP practice, as I'm in a CRNA program now, but I'd like to weigh in on the side of gross anatomy. I have learned leaps and bounds more in this gross anatomy class with a cadaver lab than I ever did as an undergrad, and it is astounding to me now how much this "base" knowledge would have helped me simply as an RN, let alone as an advanced practitioner. I wish I had known to take it years ago for my own knowledge. I definitely think it should be part of a base curriculum for any APRN. So many (not all) RNs are tactile or hands on learners, and this helps that.

I also think it's a little nuts that you have to find your own preceptors. My friend struggled with this, and for as much as most usually pay for their education, I don't think it's too much to ask to have preceptors in place.

I find it humorous how everyone gets on these threads and says, "Oh, well, my school was great. It was so good. I got a great education. It was so hard and the standards were so high. I don't know where these other people are going."

I mean, come on, school matriculation requirements and curriculum are objective measurements. There are far far far more schools that have little to no barriers to entry or graduation than those that do. So, I really don't care what school you personally went to. That's not the point of these threads. We need standardization. I also went to what I would consider a good school - I purposefully chose that. HOWEVER, more NPs choose sh*tty schools on purpose to avoid any semblance of hard work, than those that purposefully choose schools that will challenge them.

The problem is that option exists. There shouldn't be any bad schools to choose from, because we should have an accrediting body that holds each and every school to an acceptable minimum standard. Things like, minimum of 2 years "relevant" RN experience (can be determined by the program, so psych experience for PMHNP, ICU for ACNP, etc), minimum GRE scores, minimum gpa, in-person interview, gross anatomy at the graduate level, program arranged preceptorships and clinical experiences, etc.

Well, as one of those annoying people who occasionally posts that I went into a good school, I do so because I get annoyed when people post (as they often do on this site) that it doesn't make any difference what school you go to because they're all bad, none of them have any standards, they all require you to find your own preceptors, nursing is all about OTJ learning because no school really prepares you for practice, etc. That simply isn't true, and I feel a need to point that out when those statements get made. It also bugs me that so many people complain that their program wasn't any good, and then it turns out that they did less research to choose a graduate program than they would to buy a new refrigerator, and just went to the closest or most convenient or cheapest school without asking any questions or considering any other options. How many of the people who post here about how bad their program is are the same people who post here asking about which programs are the quickest and easiest (as people often come here to ask)?

I agree with you completely that the problem is that bad, weak programs exist, and they largely do so because so many people want to be able to be advanced practice nurses without having to put forth any significant effort to become one. So many nurses want to be taken seriously as professionals, but don't want to do the academic "heavy lifting" that other professions take for granted. Well, we can't have it both ways.

Specializes in Family Nurse Practitioner.
Well, as one of those annoying people who occasionally posts that I went into a good school, I do so because I get annoyed when people post (as they often do on this site) that it doesn't make any difference what school you go to because they're all bad, none of them have any standards, they all require you to find your own preceptors, nursing is all about OTJ learning because no school really prepares you for practice, etc. That simply isn't true, and I feel a need to point that out when those statements get made. It also bugs me that so many people complain that their program wasn't any good, and then it turns out that they did less research to choose a graduate program than they would to buy a new refrigerator, and just went to the closest or most convenient or cheapest school without asking any questions or considering any other options. How many of the people who post here about how bad their program is are the same people who post here asking about which programs are the quickest and easiest (as people often come here to ask)?

I agree with you completely that the problem is that bad, weak programs exist, and they largely do so because so many people want to be able to be advanced practice nurses without having to put forth any significant effort to become one. So many nurses want to be taken seriously as professionals, but don't want to do the academic "heavy lifting" that other professions take for granted. Well, we can't have it both ways.

As one of the annoying people who despite doing my research, being willing to meet stringent admission standards and going to a well respected, BM school that did provide preceptors albeit most their own recent grads my opinion on the lack of quality is as much due to the excessive nursing fluff that dominates all of our curriculum. I don't believe any program is immune to that condition. The nursing focused courses are in my opinion are a waste of precious time that could be better used training NPs to be clinicians.

That said from what I've anecdotally seen recently my education was of significantly higher quality than the many schools now accepting anyone who can pay tuition. I agree we need to do the heavy lifting but also think that needs to be across the board as again even the highly esteemed programs continue to be dominated by nursing fluff.

Specializes in Psychiatric and Mental Health NP (PMHNP).

Overall, I was happy with my education at a top 5 B&M nursing school. The "fluff" courses had been minimized to the bare minimum required for accreditation. Of course, I wish we had more clinical hours, but I believe the best way to address that is through NP residencies.

I do not understand the calls for gross anatomy. Anatomy was a prereq for my school and my UCLA anatomy class used human cadavers and fulfilled the prereq requirement for UCLA med school. I do think a clinical anatomy class would be a useful addition.

Personally, I wish my school had provided more instruction on musculoskeletal and orthopedics, derm, and procedures. One poster's school had minimum numbers for pelvic exams, etc, and that seems like a good approach.

One of the great things about a nursing career is that there is so much flexibility. RNs have many different career paths available. It is also wonderful that a person can start as an MA or CNA and gradually work their way up to an APRN role while continuing to work. That demonstrates a high level of motivation and dedication and we need those folks, as they bring a wealth of experience to bear.

I am opposed to adding a bunch of classes and clinical hours to NP education because that is going to increase costs. Education costs are already ridiculous and the last thing we need is to add more expense and additional student debt. NP residencies provide additional didactic instruction and clinical hours and also provide a stipend to the NP resident. We need to find a way to pay for that and given the shortage of primary care providers, Medicare and other government resources should fund this.

I don't care about PA education and it is comparing apples to oranges. PA school covers everything - primary care, acute care, etc. We'd have to compare their clinical hours and education in specialties comparable to the NP training, so I'm not sure they get that much more when we compare apples to apples. PAs are going into psych and there is no way they have comparable training to PMHNPs. I would also argue that PA education can't compare to WHNP, Peds, CRNA, Nurse Widwife training, etc. At any rate, people who want the PA education are free to apply to PA school and become PAs. I haven't seen any actual evidence that PAs provide a higher quality of care. If anyone has such evidence, please share.

I agree admissions standards for NP school should be increased and am against the schools that admit anyone with a pulse. We need more high quality NP schools that can accomodate students that have to work their way through school.

It also bugs me that so many people complain that their program wasn't any good, and then it turns out that they did less research to choose a graduate program than they would to buy a new refrigerator, and just went to the closest or most convenient or cheapest school without asking any questions or considering any other options. How many of the people who post here about how bad their program is are the same people who post here asking about which programs are the quickest and easiest (as people often come here to ask)?

I mean, isn't that crazy though? That choice shouldn't even have to be made. Physicians and PAs don't have to research schools to differentiate between those that will prepare them to practice medicine, and those that won't. All of those programs provide appropriate training as their accrediting bodies have *actual* standards. Those students research schools and rank them based on location, tuition, and other "soft" criteria (how about, the real possibility they won't be accepted because admission standards are so high?? Something unheard of in the NP world) because no matter which program they choose, they will be trained in medicine! The same cannot be said for NP programs. It's an awful situation we've found ourselves in. I have literally been on rounds with RNs who are in NP school who readily admit - to all present: physicians, pharmacists, nutrition, etc - that they are learning nothing in their NP programs. They think it's no big deal - that it's maybe even something to joke and laugh about! How the hell does that make NPs look? Terrible. And I shut those RNs down saying they should withdraw from that program for the sake of their patients, themselves and their coworkers.

These schools should not be allowed to operate.

Although this topic has been debated and argued from all points, how will the education actually be improved? Many NP's and students on this board agree that there is room for improvement. But, I don't see academic NP's wanting to change the current course, from my point of view they don't seem interested in adding more science-based classes. I am not sure if they are having a hard time recruiting and retaining qualified instructors. I must say that although the NP and PA program differs vastly, as a student I can see the difference. In both my rotations I have worked alongside PA students and I have had to bring my A game. The preceptors I have usually have PA students and are very willing to teach/guide students but their expectations are higher and I quickly found that out in the first few days. Unless we as students demand higher standards nothing will change. I have heard other NP students say they chose so and so program because it was easy and they don't get tested or exams etc. For this student, in particular, her poor investment showed in the clinical setting and the doc was disappointed in her skills considering she will be graduating soon. Sadly, it is human nature if there is a 'shortcut' so to speak people will take it and think later about the consequences. Students continue to seek out these easier programs and think little about how it impacts their career in the long run.

Just my 2 cents

Specializes in Adult Internal Medicine.

Over the years I'm not sure how many times a core group of posters has debated this, but I do think/hope its been done enough times that we respect each other's opinions and while we may not see eye-to-eye, we can see the other point of view. In lieu of rehashing old debates, here is my fresh take on these issues:

(I am sure I will take flak for this, it's ok, hit me with it)

This post is an example of the flawed approach that nursing has used for decades. Get general consensus there is some type of problem, invite everyone to give their opinion on the topic (regardless of their relevant experience, expertise, knowledge, etc), roll some opinions down the hill until the snowball reaches sensationalist size, then make some sweeping yet poorly-thought-out changes which are subsequently poorly executed. Wait 50-60 years to see if they come to fruition without putting any substantial pressure on them.

How about this? We get some data. Quality quantitative and qualitative data in sufficient amounts to have statistical power to investigate if this is an issue or not and the factors that influence it. Once the data is analyzed develop detailed strategies to correct factors which are impacting the profession negatively balanced with the impact of those corrections. Then repeat the whole process constantly so the profession is being directed and streamlined by a growing body of data.

Practicing APNs that consider this an issue should be getting involved with the AANP and the ANCC (or other certifying body), get on panels, and help drive this change. Schools won't change without pressure. Prospective students will still consider the quick/fast/easy/cheapest path. If decent students stop considering poor programs than those programs will accept even worse students. If quality preceptors start refusing to precept than poor programs will either place that burden on the students or start paying poor quality preceptors which will increase cost even further.

Specializes in Adult Internal Medicine.
Something unheard of in the NP world) because no matter which program they choose, they will be trained in medicine!

Medicine has had these problems with foreign medical graduates and, specifically, Caribbean medical schools. They had similar problems with osteopathic schools a few decades ago. They are able to control it much better due to the residency requirement. Perhaps a path forward, and one I had never really thought of, is to regulate precepting experiences more tightly via a national selection and a structured program that is required to be board-eligible. It would likely add time and cost to NP preparation.

Specializes in Family Nurse Practitioner.
How about this? We get some data. Quality quantitative and qualitative data in sufficient amounts to have statistical power to investigate if this is an issue or not and the factors that influence it. Once the data is analyzed develop detailed strategies to correct factors which are impacting the profession negatively balanced with the impact of those corrections. Then repeat the whole process constantly so the profession is being directed and streamlined by a growing body of data.

Or how about this? While we are waiting for said data why don't we attempt to prevent our profession from decompensating? We could use our good old fashioned critical thinking skills and consider that having little to no admissions criteria added to little to no experience requirements for instructors and no standards for preceptors is unlikely to result in skilled providers. I'm weary of nursing's grandiose love of "data" for things that shouldn't require the fanfare of a full-on capstone project to predict the outcome.

Specializes in Family Nurse Practitioner.
The "fluff" courses had been minimized to the bare minimum required for accreditation. Of course, I wish we had more clinical hours, but I believe the best way to address that is through NP residencies.

How many credits would you estimate between your BSN, and MSN on the "bare minimum required" nursing fluff? I bet there at least 12 that could have been better spent on valuable topics such as ortho, derm, musculoskeletal etc. As someone who did BSN, master's, post master's and doctorate the time and money spent on these tired regurgitated nursing focused courses makes me more than a little bitter.

I totally agree about NP residences.

Specializes in Adult Internal Medicine.
Or how about this? While we are waiting for said data why don't we attempt to prevent our profession from decompensating? We could use our good old fashioned critical thinking skills and consider that having little to no admissions criteria added to little to no experience requirements for instructors and no standards for preceptors is unlikely to result in skilled providers. I'm weary of nursing's grandiose love of "data" for things that shouldn't require the fanfare of a full-on capstone project to predict the outcome.

Lol nursing loves subjective data that's about it.

How do you propose that "we" require schools to have stricter admission criteria?

What are the faculty and staff criterion for ACEN accreditation and how would you change them?

How do we change the current preceptor environment? Or should we? I've seen it argued here that "find your own preceptor" is a great thing.

+ Add a Comment