"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.
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.
Students shouldn't have to shop to avoid a sub-par school. It's up to nursings' accreditation procedures to make sure that students don't get fleeced. Everybody thinks their own school has a good reputation (well, almost everybody). It's nice that your school arranges your clinicals, but who are your instructors on site? Are they being paid by your program to instruct you or are they just doing it as a way for their group to harvest new employees?
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.
The student CRNAs want to work in the rooms with younger CRNAs because they are easier to get along with. Many of the "seasoned" CRNAs haven't read an anesthesia article or book in years and are set in their ways. The younger, hungrier ones are up to date with current practice and can use an ultrasound.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
I did a lot of research before finding my NP program. Yes, it's on-line, because I still have to work. Some people don't find that an acceptable reason, but it's what I had to do. The program had good reviews from sites like US News and World Report, and has a brick and mortar program as well. I do not think I'm getting an education worth what I'm paying. However, I am well aware of the responsibilities I will be taking on in an acute care role. I have some fantastic preceptors, and my clinical experiences so far have exceeded my expectations because my preceptors have been willing to teach. And I've always found that hands on learning was where things really stuck for me, not the book learning from a classroom. I will do what I have to in order to make myself successful at passing the boards and being a competent provider.
Am I fooling myself if I think I can overcome what I think is a subpar program? Maybe. But I've had good feedback from the preceptors I've worked with that they think I can be successful in the role, and they're not the blowing smoke kind of people. I guess my point is that I think many people have the best of intentions of being competent providers, but they may be stuck with not the best education. I didn't have the option to start over again, thousands of dollars already paid, so I'm making the best of it.
There are brilliant people from lesser regarded educational institutions and there are ding dongs from ivy league schools. I don't think it's possible to paint any profession with a broad brush related to competence.
What is the point of this thread other than to bash NPs and the nursing profession as a whole?
But is she wrong?
I refuse to precept student from any for-profit college or university. I used to take them all but not anymore. There was a distinct difference in students from for-profit schools versus not-for-profit. There are three in particular that need to be shut down, but I'll be kind and not mention those programs.
The last student I took from a for-profit school got into a debate with me because she was permitted to "count" observation only visits for her NP program. Even if we discussed the patient and she never put her hands on them..she said it counted. I had her modify her weekly report (it was her first week with me) and the school called me about it because there were several patient visits she would lost. I said, "Clinical is for hands on...and exam isn't an exam unless you lay your hands on the patient or actively engage in questions to figure out what to do next." I refused to sign off on any patient where she was not participating in care.
CCNE accreditation is a complete joke if that is the "standard" for accreditation. The standards are so low at some of their schools I'm shocked the BON even recognizes the degree.
What is the point of this thread other than to bash NPs and the nursing profession as a whole?
She's not bashing the nursing profession or NP's.
She is correctly saying that NP's should have actual experience as nurses before going on to advanced practice - at least a couple of years.
She is, also correctly, saying that schools should require said experience before accepting students as NP's.
I hope that she is contacting legislators to get appropriate legislation passed because it seems our profession is not regulating itself in this regard.
I do wonder about PA's as well. What kind and extent of exposure do they have prior to being unleashed on the public?
CRNA's have to have, I believe, some ICU or ER experience before CRNA school. At least, it used to be required. I guess it still is. And it is right that it be that way.
W ay back in the '70's, nurses could go to Anesthesia school without any ICU experience. But everything is so incredibly more complex today. I think the requirement of ICU before Anesthesia school is warranted. I wonder what CRNA's think? Does their ICU experience help them in A school?
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?
The student CRNAs want to work in the rooms with younger CRNAs because they are easier to get along with. Many of the "seasoned" CRNAs haven't read an anesthesia article or book in years and are set in their ways. The younger, hungrier ones are up to date with current practice and can use an ultrasound.
Students shouldn't have to shop to avoid a sub-par school. It's up to nursings' accreditation procedures to make sure that students don't get fleeced. Everybody thinks their own school has a good reputation (well, almost everybody). It's nice that your school arranges your clinicals, but who are your instructors on site? Are they being paid by your program to instruct you or are they just doing it as a way for their group to harvest new employees?
Contracts. That is why my school has a very low acceptance rate. It is tightly regulated. The school is one of the top programs in the country.
She is correctly saying that NP's should have actual experience as nurses before going on to advanced practice - at least a couple of years.
She is, also correctly, saying that schools should require said experience before accepting students as NP's.
I hope that she is contacting legislators to get appropriate legislation passed because it seems our profession is not regulating itself in this regard.
I do wonder about PA's as well. What kind and extent of exposure do they have prior to being unleashed on the public?
CRNA's have to have, I believe, some ICU or ER experience before CRNA school. At least, it used to be required. I guess it still is. And it is right that it be that way.
W ay back in the '70's, nurses could go to Anesthesia school without any ICU experience. But everything is so incredibly more complex today. I think the requirement of ICU before Anesthesia school is warranted. I wonder what CRNA's think? Does their ICU experience help them in A school?
Most NPs have nursing experience. I had four years before starting and many others had more than a decade. Sure there a few classmates with only one or two years but none of us are newly minted RNs without any real world experience.
And tbh, I find that although my experience helps me, I often find myself getting caught up in the tasks and checking the boxes and patient satisfaction scores than providing actual nursing care or pathophysiology of my patients' disease.
This is all amusing, as we've had this discussion at work more than once. Some anecdotal food for thought: I worked with (and got stuck with as a patient) a few brick and mortar NPs who had NO acute care experience prior to being licensed as NPs. It seems like some of the traditional schools are going the way of online schools, because I've met a couple NPs that I wouldn't let treat my worst enemy.
Edit: the only experience they had was clinicals in their BSN program. They liked to tell peeps they didn't have to work the floor.
I actually don't see a problem with online education. The requirements for admission is another issue. It's commonly agreed on that even md/do students hunger for online didactics because it's just way more efficient and everyone at this point is an adult learner.
Once admitted, the problem lies in quality of rotation sites, preceptors, and how stringent the standardize tests are. Even md/do schools have trouble with sub-par rotation sites, especially for certain rotations where being a part of a big teaching service and seeing as many unique pathology as you can is important - surgery or IM for example.
Subee2, BSN, MSN, CRNA
308 Posts
Students shouldn't have to shop to avoid a sub-par school. It's up to nursings' accreditation procedures to make sure that students don't get fleeced. Everybody thinks their own school has a good reputation (well, almost everybody). It's nice that your school arranges your clinicals, but who are your instructors on site? Are they being paid by your program to instruct you or are they just doing it as a way for their group to harvest new employees?