Op-ED: Practicing Medicine vs Practicing Advanced Nursing

Rnis, BSN, DNP, APRN, NP · Dec 16, 2020

20 hours ago, TheMoonisMyLantern said:

I appreciate your experience and am actually glad to hear it. I would love to be wrong about these programs, all I can go by is what I hear from my colleagues and what I read online, thus my original reply where I asked if recent studies had been done on NP efficacy from these programs.

I do want to note however that you mentioned you chose preceptees who had strong clinical backgrounds. I think that fact may explain why you had such a positive experience. I wonder if you were to precept a student without that strong clinical background if you would have to seem experience. Perhaps but I can't help but doubt it.

As I stated, most students who ask me to precept have a strong background. Almost all students I turn down is because I have already committed to other students. I can think of only 1 or 2 students that I passed on because I didn't like their resume. Honestly ....they probably would have been fine.

I do work as an adjunct in a graduate program and I can tell you there is pretty strict guidance in place for what these programs should look like and they adjust the program to meet those recommendations regularly as do online programs. While students at the school I work at do participate in a hybrid model......I think a lot of their coursework could be effectively done online. The bulk of training happens in the clinical setting with hands on experience. I do think it would be reasonable to require a 1 year internship for full licensure for new grads but I continue to feel confident in the NP role /training.

myoglobin, ASN, BSN, MSN · Dec 16, 2020

7 hours ago, FullGlass said:

Frontier is a very reputable school with an excellent reputation. It has been around for a long time.

I believe that it was the first NP school to educate nurse midwives in the United States. Also unlike my school (The University of Southern Indiana which I really liked) they required three trips to campus for hands on clinical/evaluations. They also required a higher level statistics class, It is my opinion that they are an excellent school based upon the information that I have.

Rnis, BSN, DNP, APRN, NP · Dec 16, 2020

45 minutes ago, myoglobin said:

I believe that it was the first NP school to educate nurse midwives in the United States. Also unlike my school (The University of Southern Indiana which I really liked) they required three trips to campus for hands on clinical/evaluations. They also required a higher level statistics class, It is my opinion that they are an excellent school based upon the information that I have.

Their instructor flew out to see my student and also had a case study class/ get together for all area students that they invited me to (I didn't go). I was very impressed. I don't know about the reputations of any online schools, as I did not consider any of them.

TheMoonisMyLantern, ADN, LPN, RN · Dec 16, 2020

2 hours ago, Rnis said:

As I stated, most students who ask me to precept have a strong background. Almost all students I turn down is because I have already committed to other students. I can think of only 1 or 2 students that I passed on because I didn't like their resume. Honestly ....they probably would have been fine.

I do work as an adjunct in a graduate program and I can tell you there is pretty strict guidance in place for what these programs should look like and they adjust the program to meet those recommendations regularly as do online programs. While students at the school I work at do participate in a hybrid model......I think a lot of their coursework could be effectively done online. The bulk of training happens in the clinical setting with hands on experience. I do think it would be reasonable to require a 1 year internship for full licensure for new grads but I continue to feel confident in the NP role /training.

Thank you for your insights. I'm glad that the experiences I've read about and been told about from my colleagues is not universal and that people have had positive experiences and that the programs are more engaging than self study.

I am still trying to figure out what direction I want to go with my career and education. I don't really have an interest in management or administration. Education interests me but I have some serious conflicts in philosophy as far as what undergraduate nursing education should entail, I.e. preparing students for NCLEX versus real world nursing. I have considered advanced practice, but it just seems like everyone wants to be an NP and I don't know if I want to contribute to the saturation that is occurring in many areas. I do get tired of not having the autonomy to make clinical decisions which makes becoming a provider appealing. I also don't want to go into a large amount of debt because as of now I have no student loans. I enjoy bedside nursing for the most part, but I feel like I'm little more than a drone in a hive and I know that one day that won't be enough. I do know that no matter what I choose I want to be challenged, and I want to be engaged in my learning and not just told to read a textbook and write a paper each week.

At any rate my point is that I'm glad to hear that people have had different experiences than what I've researched and heard about, thanks again.

myoglobin, ASN, BSN, MSN · Dec 16, 2020

Why do you have to go into large amounts of debt? I spent about 7k per year at the University of Southern Indiana and since I was to busy to go on vacation in the Summer we probably saved more than that. My income went from about 60k as a bedside RN to about 300k. Whether you become an NP or not it will still become oversaturated (or it won’t). I am still an RN, but now also a licensed NP in four states so how is my situation any worse?

TheMoonisMyLantern, ADN, LPN, RN · Dec 16, 2020

6 minutes ago, myoglobin said:

Why do you have to go into large amounts of debt? I spent about 7k per year at the University of Southern Indiana and since I was to busy to go on vacation in the Summer we probably saved more than that. My income went from about 60k as a bedside RN to about 300k. Whether you become an NP or not it will still become oversaturated (or it won’t). I am still an RN, but now also a licensed NP in four states so how is my situation any worse?

Didn't you say in another thread that you and your wife had like 170k in student loans?

myoglobin, ASN, BSN, MSN · Feb 8, 2021

On 12/16/2020 at 9:01 AM, TheMoonisMyLantern said:

Didn't you say in another thread that you and your wife had like 170k in student loans?

Yes, but most of my debt was accrued getting my ASN, BSN and other college credits (over 150 in related Sciences). I accrued essentially no additional debt for my PMHNP (but neither have I paid down the debt that I've held for the last 15 years). Now that I'm earning around 28K (and my SO is on the path to doing the same) plus per month I will hopefully progress in that direction. Essentially, I used student loans to subsidize our income when I was in my undergrad program so that I wouldn't have to work full time (indeed even then I had an academic scholarship that paid most of my tuition).

nomadcrna, DNP, CRNA, NP · Feb 21, 2021

On 12/12/2020 at 7:46 PM, TheMoonisMyLantern said:

Hiring companies are starting to be the ones deciding that some online schools are not providing an adequate education needed for nurses to become providers. People have posted on this forum for a couple years now how graduates from schools like Walden are starting to be passed over for graduates from brick and mortar schools because they've had negative experiences with graduates from online for profit schools. I'm not saying that ALL graduates from those types of schools are unprepared because obviously you get what you put into your education. What I'm saying is that we should not be paying a college to teach ourselves how to become an NP. I believe online education has its place but NOT in its current iteration. If you believe that a Walden education is on par in regards to rigor and scope with your lowest ranked PA program, you're delusional (that's a generalized "you" not you specifically, Myoglobin). If nurse practitioners want to be able to continue to independently practice and gain IP status nationally, then their standards for education for entry into practice must reflect that desire. What these for profit online schools are doing is CRIMINAL. They're charging students an inflated tuition price for a medium that is essentially self study. If all you have to do is read a textbook and write a few papers to become an NP why not get rid of the middleman (the school) and let the BON hand out NP licenses if you pay the right price and read the right textbook. C'mon we both know there's a lot more to being a provider than what a textbook teaches. Most nurses know that, they know that much of what you learn requires hands on experience, oh wait, that's right NP schools don't require nursing experience prior to admission anymore so not all of those nurses have ANY real world experience and don't know what they don't know. Yes, I realize there's a big difference between being a staff nurse and a provider however bedside nursing experience is invaluable in many ways.

I sound like I don't like NP's. But the exact opposite is true. I am a HUGE supporter of NP's and PA's but especially NP's. I have two NP's that I see regularly for my own care. But I think NP education has gone down the wrong path in many ways. Lack of rigor, lack of admission reqs, lack of required nursing experience, lack of clinical placements, all being significant problems. We can hide behind studies that are quickly becoming dated, or we can acknowledge that NP education needs to be enhanced, because if that doesn't happen and NP's begin to harm patients and become a liability to their employers then you can say goodbye to IP and big salaries and hello to being a laughing stock in the medical community so much so some NP's may have to go back to being staff nurses, or in some case be a staff nurse for the first time.

Yet you have no clue about the education. ALL NP programs have clinical requirements. There are NO all online schools.
In the real world, initials mean nothing. FP physicians, NPs and PAs. All interchangeable. Good and bad in all of them.

TheMoonisMyLantern, ADN, LPN, RN · Feb 22, 2021

7 hours ago, nomadcrna said:

Yet you have no clue about the education. ALL NP programs have clinical requirements. There are NO all online schools.
In the real world, initials mean nothing. FP physicians, NPs and PAs. All interchangeable. Good and bad in all of them.

Thank you for stating the obvious. I don't believe anyone has said that there are any ALL online schools that require no clinical component, although give it another 10 years in the direction it's going and the whopping 500-600 clinical hours required by most for profit online schools for NP programs will probably be whittled away even more. Further more, these schools don't exactly keep their delivery method and content of curriculum a closely guarded secret so through talking with current/previous students, contacting the school, and online research it is perfectly reasonable to "have a clue" about the education.

I agree that there's good and bad practitioners regardless of licensure, and I don't get too caught up in the alphabet soup behind names, however, there are differences in education and quality and scope of education are important in order to keep integrity of the profession.

Online education has its place in NP education and some schools do a really good job but there are others that are getting a negative reputation.