CriticalACNP

For the love of Pete.... you're a freaking human being. We've all made mistakes and during my 18 years as a critical care NP, the mistakes you've listed, relatively speaking, wouldn't ever register on the Richter scale. The very idea of you being kicked out or suspended from what is typically an expensive education (and overwhelmingly time consuming) is beyond preposterous. Granted, I know you're in nursing school and you need have a clear understanding of the potential consequences of your mistakes...but seriously people, you've got to lighten up. She didn't force push Maalox in a triple lumen central line causing an iatrogenic pulmonary embolus and sudden death or forcefully wiggle an NGT into a endotracheal tube and initiate tube feeds - just two out of hundreds of costly mistakes at the hands of nursing students over the years (and yes, I realize they should have been monitored more closely and no, they weren't under my supervision. I've only precepted NP students). One thing is certain - nursing education hasn't changed and probably never will. Honestly, I've got a problem with the nurse that reported you and anyone feels the need to chastise my 'flippant disregard', please feel free. Nursing school unnecessarily creates over-the-top stress and for a nurse to report you to your instructor is far beyond petty. It's ridiculous and embarrassing. She should have pulled you aside and said "Hey, I know you didn't intend to leave this there and you've got a lot on your mind, but you can't leave crushed medicine in applesauce for two or three minutes while you seek guidance because some knucklehead might think it's crushed Ativan. I've been in critical care nursing more than 25 years (18 = NP) and I'm here to tell you that the nursing profession (and ESPECIALLY nursing education) is in serious need of an overhaul (i.e. attitude adjustment). I'm part of an intensivist team (consisting of critical care docs and seasoned NPs) and one of docs asked me recently, "Why is it you think that nurses always go after one another? What's the deal?" It's an often asked question and quite frankly, one I'd like not to be asked again. Thankfully my colleagues and I have always remained above the fray. I'm not suggesting mistakes should not be addressed. I'm suggesting that the threat of being expelled or suspended over a minor rookie mistake in which no one was placed in harm's way is beyond preposterous (and I'm stating this having seen mistakes you couldn't fathom as a student). Heck, medical students don't face such scrutiny or have to dodge the landmines nursing students do. Their stressors are altogether different. I've often thought about teaching nursing students both in the classroom and in the clinical field as to 1.) provide a stress free environment for the few I'd have (while keeping a close, watchful eye) and 2.) actually teach some incredibly useful things that you'll use/need DAILY as a nurse. Alas, I'm continually reminded that NANDA (nursing diagnoses) and care plans are still very much a part of the nursing curriculum (much to my chagrin) and for that reason, I refuse to partake. Anyway, best of luck with your endeavor.

I'll preface this post readily admitting that my opinion isn't going to go over well with many on this forum. Nevertheless, I feel compelled to address this issue. I've been working in critical care as an NP for 18 years with the past 10 being with an surgical intensivist team within a highly regarded hospital system in the Texas Medical Center. Numerous NP programs continually seek us to take their students. However, with the glutton of these ridiculous online programs and the gross lack of experience many (actually, most) of the nurses presenting to us, we are highly selective in who we choose after having "fired" a handful of said students. For the few here who have said these programs have very little to nonexistent standards in taking students, you are absolutely correct. So many people jump into nursing schools with the idea that they're going to immediately leap frog into an NP program. Moreover, there are (sadly) many programs who not only accommodate these students, but actually encourage it. At the end of the day, it's about the almighty dollar and it's absurd. Here's the bottom line - I couldn't care less how "experienced" or "confident "nurses" feel coming out of school (or even with a few years experience) because the fact of the matter is, it takes several YEARS of various experiences before you'll be prepared to enter into an NP program, much less practice at an advanced level - period. Is that to say you couldn't pass the class curriculum? Of course not... the curriculum in large part for most programs is an absolute joke (and particularly in comparison with PA programs). For example..Nursing theory? Seriously?? Sadly, I've seen some online programs advertise on Facebook that "NPs can practice in 20 states without the need of a collaborating physician". SMH... you have got to be kidding me. In addition to my primary employment, I moonlight at various hospitals and I'm often approached by newly minted nurses (and even nursing students) seeking advice on the NP profession and my response is always the same - "Don't even think about it. Learn to be a nurse first. Respectfully, you don't even know what you don't know. You must create a solid foundation of nursing experience from which to build from because quite frankly, an NP program isn't going to provide even a fraction of what you will need to practice autonomously as an NP." That's not an opinion - that's simply a fact. I strongly encourage nurses to have a solid eight years of nursing experience before pursuing a graduate degree because it takes that long to hone the necessary critical thinking skills, an asset woefully lacking in more than 90% of nurses today. Yes, I realize that's not a popular stance or what most of nurses want to hear. However, it's a statement based on years of hardcore experience in dealing with nurses and NP students. Also, a couple of pro tips - as preceptors, we are not there to educate/train you on the fundamentals of nursing. My team (as well as all good preceptors) FULLY expect you to come to the plate with a very strong knowledge base and solid experience from which we can help you to build upon. We're a busy team and haven't the time or the inclination to carry dead weight all day long. Secondly, if your nursing experience has always been in adult practice, please don't fool yourself into thinking that your semester in pediatrics and your ultra-light rotation in a pediatric clinical setting is going to prepare you to see children independently - it's more than ear infections and colds. I've digressed. Let's face it... there are plenty of professional organizations such as the American Medical Association (and numerous others) who have railed against the NP profession for many years and quite honestly, with the lack of standards in NP programs, it's hard to argue with them. Becoming an NP is more than achieving a glamours title. It's about practicing at an advanced level with the knowledge and skills obtained over many years and being accountable for YOUR actions and decision making. With that said, entering into a profession that you don't have the experience to support it does nothing to elevate your career but certainly does much to undermine the APN profession when costly mistakes are made (and yes, it happens regularly). Lastly, allow me to reiterate why I feel eight years of good experience is the benchmark for NP programs. Again, it comes from years of experience of working with NPs with various levels of experience. However, these highly profitable NP programs realize that motivated students are much more likely to continue their education immediately post baccalaureate versus gaining many years of experience, with life changes happening along the way. If you're not familiar with the book, "From Novice To Expert" by Patricia Benner, you'd do well to read it. As I said, nurses lacking in experience are also lacking in critical thinking, which only becomes honed with experience. Thus, to compensate for this lack of these skills and knowledge, NPs will, for example, order every test under the sun as if they're casting a wide net to see what they can drag up. It's incredibly costly and extremely wasteful and only serves to strengthen the argument of physicians opposed to APNs in practice. To be clear, this example only begins to scratch the surface. There are too many reasons to discuss at this point. Also, this post is not meant to be offensive to anyone. However, what little I've written is absolutely spot on and backed by the best NPs around. Thus, if it saves you any trouble, I'm not doing to debate the subject with anyone here as it would be an exercise in futility. Best of luck.