One NP with online education

Published

Specializes in Retired.

https://www.medpagetoday.com/nursing/nursing/82253

"Family physician Amy Townsend, MD, first learned of Optimum Family Wellness in January of 2017 when a friend of hers, a physically fit man in his 40s, told her that he was going to be visiting the clinic.

Although the Nederland, Texas clinic was run by nurse practitioners, Townsend was initially unconcerned because her friend had no serious health problems and was simply seeking a refill for his routine thyroid medication.

But Townsend quickly grew skeptical when her friend showed her the slew of lab tests ordered by nurse practitioner Kevin G. Morgan even before an initial office visit -- a panel of nonspecific hormone tests including a C-peptide, growth hormone, prolactin, and a random cortisol level, which added up to a whopping $6,500.

But more worrisome to Townsend were prescriptions that nurse practitioner Morgan had prescribed for her friend: testosterone injections and a higher dose of thyroid medication, despite the fact that the patient's initial labs were completely normal, including a healthy testosterone level of 696.

Worried about the risk of excessive testosterone, which is associated with an increase in heart attacks in men, Townsend called Morgan personally to discuss the treatment plan. "He was contrary and condescending to me, offering to 'send me literature' on testosterone therapy," Townsend recalled.

A family nurse practitioner, Morgan received his master's degree in nursing in 2013 from McNeese State University, a 100% online program. Morgan had neither the training nor experience to treat endocrine problems like thyroid disease or low testosterone. And to Townsend, he seemed unconcerned about the potential side effects of these medications.

Instead of continuing the conversation, Townsend asked for Morgan's supervising physician.

Texas law requires that nurse practitioners be supervised by a physician. Morgan's supervising doctor at the time was Marian Querry, DO. Querry, a general surgeon, did not have the same medical background as the nurse practitioner she supervised, nor was she a specialist in endocrine problems. She practiced at a location 150 miles away from Optimum Wellness."

I don't understand why the nursing guru's don't have any interest in improving the standards of our educational system. Are they all doing side gigs as on line instructors? Just anecdotal but a girlfriend's mother was recently admitted to hospital because of low Na and the patient had warned the NP that her Na tended to drift low but the NP insisted that patient take the Lasix, which resulted in the admission for saline drip. My own NP was only too happy to prescribe huge amounts of narcotics which resulted in her and her MD losing narcotic scrip writing privileges. Not sure a better education can stop this kind of stupidity but it can't hurt! The line that "well, they pass the exams at the same rates" doesn't fly because it just means that the board exams are too easy. If they have no nursing experience how are they supposed to filter out the critically ill from the run of the mill? They'd be the first to miss the healthy young person with a serious post-op complication because they've never actually seen anyone go south. I don't know if the above story will ever circulate among the public but it's just embarrassing that we ask so little of our own. I'd rather be taking advice from an experienced med-surg floor nurse any day.

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Specializes in Med-Surg, NICU.

What is the point of this thread other than to bash NPs and the nursing profession as a whole?

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Specializes in Retired.

Geez. I just accused someone else of nurse bashing on another thread:) The point of the thread is: why are we asking so much more of nurses and cheating them of the education they are paying for? Why does nursing do such a poor job of policing it's own education? If CRNA's accepted this model of advance practice education, I would fear for the lives of the patients on the tables. Nurses are paying lots of money for these graduate classes and yet have to go out and find their own preceptors and we accept this pathetic occurrence as normal education? The schools don't slash their fees when they don't provide the basic service of instruction...students are still paying for "instructors" who have no relationship with the college. Students have the right to know that their instructors have been indoctrinated into the school that is receiving the money...that the instructor has any value as an instructor. I've noticed that the student CRNA's want to work in the rooms with the people closest to their age...the youngest and most inexperienced, and the ivy league university to whom they are paying a fortune thinks that is acceptable. There is not even an instructor from the university in the next two counties. If we want practitioners who are CONSISTENTLY prepared to go into the world and work autonomously, we have got to do better than this.

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Specializes in mental health / psychiatic nursing.

I see 3 separate issues here:

1) Competency and standards to evaluate competency for entering practice - are the boards enough, should the be modified? Should there be additional benchmarks? Re-certification criteria during practice?

2) Education - How much (length of time) and in what format (hybrid, in-person, online, partime vs fulltime) and what are the standards for education? Should formalized residency and/or internship requirements be put into place?

3) Experience - how much and what kind of experience is needed? Is this the same for all NP specialties? Is there ever a time that non-nursing experience is applicable? How does one evaluate non-clinical nursing experience etc?

Unfortunately there has been relatively little research looking at educational and experience pathways to NP practice and practice outcomes. I would really like to see some in depth research done on NP practice and what makes a good NP vs an unsafe one. Is it the person, the education, their previous professional experience, the particular clinical rotations and/or residency training?

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Specializes in Retired.

All wonderful questions that will require years of research for answers. But meanwhile when MD's find out that one can become an NP on line, it just gives them ammunition. And I'm someone who used a NP to to my thyroid bx. because I knew she was an experienced intensivist who worked for an ace ENT surgeon. Had a totally different experience with one in my PCP's office. Straight from IT to NP. Fortunately I was able to fend for myself with her. NP's have used the argument that they are better prepared for advanced practice than PA's who have no previous medical experience. Well, as it turns out, neither to some of the NP's so they shouldn't use that logic since anyone can see the ads for ridiculous programs on the AN website. We can only survive as well as the politicians allow us and we have to be better than our competition.

Also is the educational justice angle for the students who aren't getting the instruction they signed up for. This is just what happens when we are willing to crank'em out like hotdogs. The purpose of our nursing programs has become graduating...not educating.

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Specializes in NICU/Mother-Baby/Peds/Mgmt.
3 hours ago, verene said:

I see 3 separate issues here:

1) Competency and standards to evaluate competency for entering practice - are the boards enough, should the be modified? Should there be additional benchmarks? Re-certification criteria during practice?

2) Education - How much (length of time) and in what format (hybrid, in-person, online, partime vs fulltime) and what are the standards for education? Should formalized residency and/or internship requirements be put into place?

3) Experience - how much and what kind of experience is needed? Is this the same for all NP specialties? Is there ever a time that non-nursing experience is applicable? How does one evaluate non-clinical nursing experience etc?

Unfortunately there has been relatively little research looking at educational and experience pathways to NP practice and practice outcomes. I would really like to see some in depth research done on NP practice and what makes a good NP vs an unsafe one. Is it the person, the education, their previous professional experience, the particular clinical rotations and/or residency training?

I agree with all this but especially experience. I knew of a nurse who was in a midwifery program. She had NO previous OB experience, and they're teaching her to be a midwife?!? Ridiculous. I think two years is the minimum someone should be in the field, two years full-time.

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Specializes in Med-Surg, NICU.
6 hours ago, Undercat said:

Geez. I just accused someone else of nurse bashing on another thread:) The point of the thread is: why are we asking so much more of nurses and cheating them of the education they are paying for? Why does nursing do such a poor job of policing it's own education? If CRNA's accepted this model of advance practice education, I would fear for the lives of the patients on the tables. Nurses are paying lots of money for these graduate classes and yet have to go out and find their own preceptors and we accept this pathetic occurrence as normal education? The schools don't slash their fees when they don't provide the basic service of instruction...students are still paying for "instructors" who have no relationship with the college. Students have the right to know that their instructors have been indoctrinated into the school that is receiving the money...that the instructor has any value as an instructor. I've noticed that the student CRNA's want to work in the rooms with the people closest to their age...the youngest and most inexperienced, and the ivy league university to whom they are paying a fortune thinks that is acceptable. There is not even an instructor from the university in the next two counties. If we want practitioners who are CONSISTENTLY prepared to go into the world and work autonomously, we have got to do better than this.

You speak in absolutes.

I am attending an online FNP program (highly rated). EVERYONE in my class has acute care experience. My program arranges my clinical sites for me.

While I do know that there are some sub-par programs, there are plenty of great ones out there. It is up to the student to do his or her research prior to investing thousands of dollars into a program.

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Specializes in Med-Surg, NICU.
57 minutes ago, Undercat said:

All wonderful questions that will require years of research for answers. But meanwhile when MD's find out that one can become an NP on line, it just gives them ammunition. And I'm someone who used a NP to to my thyroid bx. because I knew she was an experienced intensivist who worked for an ace ENT surgeon. Had a totally different experience with one in my PCP's office. Straight from IT to NP. Fortunately I was able to fend for myself with her. NP's have used the argument that they are better prepared for advanced practice than PA's who have no previous medical experience. Well, as it turns out, neither to some of the NP's so they shouldn't use that logic since anyone can see the ads for ridiculous programs on the AN website. We can only survive as well as the politicians allow us and we have to be better than our competition.

Also is the educational justice angle for the students who aren't getting the instruction they signed up for. This is just what happens when we are willing to crank'em out like hotdogs. The purpose of our nursing programs has become graduating...not educating.

I'm not sure what your deal is with online programs, but there are many reputable brick and mortar schools that offer their programs online or in a hybrid form because some people don't have the luxury of not working while going to school. My school is a state university that EVERYONE knows about. It offers the program in-class AND online and has extreme proctor programs during exams (so students can't cheat).

Yes, I do know that there are some terrible programs. I know some students going to some horrible schools that don't even provide lectures (students are expected to read their textbooks and then take tests) or labs and the students are forced to vie for clinical spots. But if students would stop trying to take the easy route by applying for these scam programs and demanding better, these schools wouldn't exist.

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Specializes in mental health / psychiatic nursing.
53 minutes ago, Elaine M said:

I agree with all this but especially experience. I knew of a nurse who was in a midwifery program. She had NO previous OB experience, and they're teaching her to be a midwife?!? Ridiculous. I think two years is the minimum someone should be in the field, two years full-time.

In the field as an RN or in the specific specialty they plan to practice in? This is one of the many things we need to consider. Is a clinical social worker career changing into PMHNP role after several years of experience in social work more or less qualified for PMHNP role than an RN with the same number of years of experience whose career has been in ambulatory surgery?

Likewise would you rather an experienced doula or an experienced orthopedic nurse becoming a midwife? Does outside relevant experience have any play at all or do we want nursing experience and if so - what kind? Does working as an L&D RN increase capacity to work as an midwife or is there the potential for role blur and not having clear lines between the role one used to have the role one now occupies?

Is there ever a point of having too much RN experience where role transition becomes more difficult? Is it the number of years of nursing practice or the quality of that nursing practice which predicts success?

We don't actually have research to support answers to these questions. I'm not arguing with you at all - I think RN experience is valuable - we just don't have clarity on what kind of experience essential, which is valuable, and which may not be relevant at all. Nor is there any way to systematically evaluate potentially relevant non-nursing experience which may or may not be valuable to NP role.

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12 hours ago, Elaine M said:

I agree with all this but especially experience. I knew of a nurse who was in a midwifery program. She had NO previous OB experience, and they're teaching her to be a midwife?!? Ridiculous. I think two years is the minimum someone should be in the field, two years full-time.

Many reputable midwifery programs do not require OB experience. In fact, sometimes the students that don't have OB experience do better on testing because the entire model of midwifery is very different from the medical model.

I only had GYN experience prior to my CNM program.

Example: On one project for a case study, one my classmates, who is an experienced L&D nurse and an RNC, insisted that you CANNOT have a patient push until she was full dilated at 10 cm....even with a strong urge. If the patient is at 10 cm without an urge, everybody is rounded into the room and mom starts pushing.

You'll rarely see a well-trained midwife manage a labor like that. Hospital RNs are taught high-intervention is best...and that is exactly what is killing mothers in this country and taking their babies down with it. She learned under the medical model and she didn't know any different because she had never been taught any different and because she had been in the field for 10 years, she wasn't exactly open to other ways of doing things. There is nothing magical about 10 cm and zero evidence to support stopping a mother from pushing.

My patients push with a strong urge. I don't care if I checked them five minutes ago and they were at 7 cm. If they want to push, they push. I don't count, I don't direct them until the very end, their body knows what to do. If they are at 10 cm and mom and baby are OK? No urge to push? Mom labors down. When baby is ready, baby will let mom know.

Same with continuous fetal monitoring they slap on everybody in the hospital when they walk in the door?....in a low risk mother (keyword: Low risk) there is zero evidence they improve outcomes. None. Intermittent monitoring is equal. The only thing continuous monitoring increases is c-sections and operative delivery because everybody freaks if baby has one decel.

I just wanted to offer a different perspective. But yes, entering CNM programs without OB experience is perfectly fine and very OK.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

As a practicing ACNP, I have to agree that the relative ease in getting admitted to a nurse practitioner program sets our profession up for individuals like Mr. Morgan who are able to gain licensure and legally practice quackery and harm others. In theory, it would be harder for physicians to accomplish such a criminal feat if they have to go through the lengths of medical school and residency and even fellowship to practice.

However, there have also been anecdotes of physicians who have done similar types of voodoo medicine as Mr. Morgan...that is, practicing using modalities that are outside the norm of evidence based medicine. Clearly, all provider groups could be infiltrated by bad apples and such bad apples shouldn't be viewed as a representation of the specific profession we fall under. The fact is, many NP's practice safely and within established guidelines.

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I couldn't even finish reading the link, it was making me sick. And yes, there are unscrupulous MD's out there as well.

With regards to the NP in the article, I don't think he has a knowledge deficit, to use nursing terminology. I think he has a character deficit.

That isn't taught online or in a classroom.

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