Nursing students who want to be NP's

quazar · Apr 21, 2017

I can certainly understand your point here and I do think there are some legitimate concerns regarding novice NPs practicing in the specialty setting as there is often a dearth of both education and training. That being said, it is also a sample size of 3, so its hard to make any generalization about that across all of NP education and practice. Also, I would add, just because someone has ages of experience doesn't mean they don't make clinical judgement errors and in some cases may make it less likely they employ EBP.
In the end, personally you need to have faith in your providers (and their staff) and it sounds like you don't in at least one of those scenarios.

I did have faith in her, until she jumped from zero to "we need to put you on a super high risk medication for a super low risk condition" without even properly reviewing all the data. Her recommendations go directly AGAINST the current (2016) recommendations for this particular condition. So yeah, it had zero to do with whether or not I "had faith" in her and everything to do with her competence, or lack thereof. What she was suggesting was not only overly aggressive and inappropriate, but could have had very serious adverse side effects for me that would have caused a domino effect with other systems in my body and possibly landed me on OTHER medications. Telling me I need to "have faith in my providers" sounds very paternalistic, raises my hackles, and smacks of the old "doctor knows best" mentality. I categorically refuse to blindly trust my providers and never question them.

quazar · Apr 21, 2017

If not a secret, how exactly you "investigate" your providers, especially if you have no idea whatsoever what did they actually do during their training and no means to check it?
(contrary to public knowledge, not all medical residencies, as well as not all NP programs are created equal, and the big names may or may not play any role in the process. And if one of my patients suddenly starts to ask questions "to investigate" my past, I'll be happy to refer him to Boards website to see that my clean license, and ask a person running the desk to send the letter informing him that he has 30 days to request his full medical record to present to another provider of his choice).

The healthcare system where I receive my care lists alllllllll of their healthcare providers' bios on their website, complete with schooling, location, and years attended at said schooling, in addition to blurbs about what they did during their training, what their interests are, links to pub med articles they've authored, etc.. It's pretty freaking easy to research providers. Contrary to your belief, nothing nefarious happened.

Bottom line for me here, people: I think NPs need bedside nursing experience. Some of you here take offense to that....okee doke. I'm not going to change my mind, and I refuse to apologize for having an opinion that bothers some posters here. This thread is beginning to exhaust me and feel like a torturous merry go round. Two clear signals for me that it's time for me to be done.

caliotter3 · Apr 21, 2017

One of my peers, while in nursing school, stated she had plans to become a physician. She even had the institution picked out. Just out of curiosity, (about 40 years later), I looked her up on the internet. I found a lot of public information because apparently she never changed her surname due to marriage. She had a mundane career as a nurse, eventually going into teaching. I also know what I said about a year earlier than that. Ha, ha, ha! The plans of mice and men and nursey babies!

allnurses Guide · Apr 21, 2017

I did have faith in her, until she jumped from zero to "we need to put you on a super high risk medication for a super low risk condition" without even properly reviewing all the data. Her recommendations go directly AGAINST the current (2016) recommendations for this particular condition. So yeah, it had zero to do with whether or not I "had faith" in her and everything to do with her competence, or lack thereof. What she was suggesting was not only overly aggressive and inappropriate, but could have had very serious adverse side effects for me that would have caused a domino effect with other systems in my body and possibly landed me on OTHER medications. Telling me I need to "have faith in my providers" sounds very paternalistic, raises my hackles, and smacks of the old "doctor knows best" mentality. I categorically refuse to blindly trust my providers and never question them.

I'm not sure you understood my point because it sure sounds like after she tried to put you on a super high risk medication you lost faith/trust in her as a provider. Is that not true?

I'm not sure where blind trust and never question came from, but, if you have lost faith or have no trust in a provider then it's in everyone best interest not to see that provider again.

In one way or another, this story demonstrates the danger of not knowing what you don't know. Every provider needs to be consciously aware of that.

Wuzzie · Apr 21, 2017

Boston, I'm purely curious but the thought occurred to me. Is a CRNA considered more advanced as a practioner than a CNP? The reason I ask is that CRNA programs require significant experience to be considered for admission while many NP schools do not. I've always looked at the two as being on the same level so the disparity in admission requirements is a bit confusing. Do you think a new grad with no bedside experience should be able to go straight into a CRNA program and if so why do you think the current requirements are so stringent?

quazar · Apr 21, 2017

I'm not sure you understood my point because it sure sounds like after she tried to put you on a super high risk medication you lost faith/trust in her as a provider. Is that not true?
I'm not sure where blind trust and never question came from, but, if you have lost faith or have no trust in a provider then it's in everyone best interest not to see that provider again.
In one way or another, this story demonstrates the danger of not knowing what you don't know. Every provider needs to be consciously aware of that.

>

Yes, you are correct, having faith in one's provider is essential, and I will not be seeing that particular NP again.

Since I responded totally inappropriately to you with that last post, I stand by my conviction that I NEED TO GET OUT OF THIS THREAD. I need a time-out. Hah.

I wholeheartedly apologize for taking your head off.

allnurses Guide · Apr 21, 2017

Boston, I'm purely curious but the thought occurred to me. Is a CRNA considered more advanced as a practioner than a CNP? The reason I ask is that CRNA programs require significant experience to be considered for admission while many NP schools do not. I've always looked at the two as being on the same level so the disparity in admission requirements is a bit confusing. Do you think a new grad with no bedside experience should be able to go straight into a CRNA program and if so why do you think the current requirements are so stringent?

I don't think one is more advanced than the other (CNMW, CNP, CRNA, CNS) but the roles are very different. I am not qualified to speak towards CRNA because frankly I know very little about the role and what it takes in education and experience to competently perform it. From a basic perspective I would say that CNRA is a very focused role and requires focused experience prior to school. When it comes to CNPs it's hard to decipher exactly what if any nursing experience is as beneficial to the preparation of novice NPs.

There is also a supply & demand side to this equation as well and CRNAs reap the benefit of that, whether that is a factor, I'm not sure. Perhaps a CRNA can give their two cents as I really don't have the expertise to do anything but speculate on that.

allnurses Guide · Apr 21, 2017

I wholeheartedly apologize for taking your head off.

It's ok, we all have misfires, context is often difficult on the internet.

I do agree with you on the issue of novice NPs working in specialty roles, I posted previously on an experience of referring one of my primary care patients to a specialist because I felt I lacked the experience to treat the patient and the patient saw the specialist's brand new NP right out of school. After talking to the NP on the phone it was clear that I knew far more than she did about the diagnosis; it highlights the importance of having fellowship trained and/or experienced specialists available to see referrals.

SmilingBluEyes · Apr 21, 2017

I think one thing we call agree on. We all want what is best for our patient. And we all want stringent standards to advanced practice.

Where it goes off the rails is what each of us thinks those standards should actually be.

And whether or not actual nursing experience (and I keep saying, not necessarily bedside but actual head to toe assessment experience) is necessary for admission to, and practice in, the advanced role.

I don't see us agreeing on this matter any time too soon. But I see good points on all sides.

allnurses Guide · Apr 21, 2017

I think one thing we call agree on. We all want what is best for our patient. And we all want stringent standards to advanced practice.
Where it goes off the rails is what each of us thinks those standards should actually be.
And whether or not actual nursing experience (and I keep saying, not necessarily bedside but actual head to toe assessment experience) is necessary for admission to, and practice in, the advanced role.
I don't see us agreeing on this matter any time too soon. But I see good points on all sides.

I do agree there should remain stringent standards for advanced practice. I think most of us also probably agree that there should be some more stringent accreditation of NP programs.

I also feel we need to be very careful that any change made are done so based on evidence that they improve quality of care; I haven't seen enough evidence that RN experience correlates with quality care, either in the literature or in practice. That doesn't mean it doesn't exist, it just means I haven't seen it sufficiently demonstrated in large samples.

Physical assessment is a vital part of the provider role (and sadly an art that is being lost even in medical training). There is evidence that structured health assessment courses with standardized patient experiences benefit novice providers and this perhaps is a better avenue for that experience than at the nursing level. Some nurses do a great physical exam and are competent in differentiating normal from abnormal, however, the vast majority of even experienced bedside nurses have a great deal to learn in taking a developed history and conducting a quality provider exam, and honestly this should be expected. Again, there is also not a guarantee that a nurse with extensive RN experience has had any assessment experience in a long time.

2mint · Apr 22, 2017

Here's one from a non-ACNP:

"Mar 10, '16 by emsguy, BSN, EMT-I

I am an RN with a BSN currently in my second semester as an FNP student.

As a Family Nurse Practitioner we are trained as primary care providers and sometimes generalist. So our education is geared towards managing this population in the outpatient setting, treating chronic conditions and referring or consulting with another provider....

....

The point is an FNP curriculum is designed to create an outpatient novice primary care provider, not an intensivist, hospitalist, or emergency department provider."

Jules A, MSN · Apr 22, 2017

Academic institutions, however, have not asked my opinion about any of this!

No but the CCNE has. Deadline May 5th.

Thanks to stickit34 for posting this in the specialty section!

American Association of Colleges of Nursing | CCNE Accreditation