Ellen NP

I’ve never been harmed or seriously threatened by a psychiatric patient. I’ve been threatened by antisocial people in the ED....”if you don’t give me xyz drug (opioid, benzodiazepine) I’ll tear tbisplace apart.” I assure them that we will not allow it, promise that they’ll be medicated if they try but that it won’t be the drug of their choice OR that I’ll call police, will press charges and will show up in court. That’s usually sufficient. The ED is far more dangerous than a psych unit. Patients with dementia and/or delirium are more dangerous than psychiatric patients.

All new nurses have clinical experiences during school. They do not count for ‘experience.’ If the hospitals are truly looking for experience, you do not qualify.

Nevertheless, what we really need as NP's is more clinical training. If you want to teach, write, develop policies or do research, a DNP may well advance your career. If you want to have a 100% clinical practice, you need more clinical training hours. The 'old' MSN programs had real research and leadership coursework. We translated research into practice through rigorous 12-18 month projects. We had more clinical training hours. WE had performance exams with mock patients before we could advance to the next course. Those programs have been replaced by others with fewer clinical hours and less rigorous prerequisites for entry into the programs. The DNP programs are bringing back that work that we had in the early MSN programs into their curricula. When the DNP was first planned, the idea was to add a few additional courses to our already rigorous curricula to meet a doctoral standard. Today, a post MSN DNP can easily take several more years of study.

This would make it a clinically valuable degree. Of course, as it exists now, the DNP is open to non-clinicians.

This was my experience 20 years ago but this has changed. Medical education is more holistic and NP education has become less rigorous and less standardized in terms of clinical training. Too bad that clinical nursing background is no longer required for NP education.

My internist does all of these things and has superior medical training as have my past internists. Current medical training is much more holistic than in the past. Physicians are receiving more holistic training and NPs are having even less standardized clinical training. This is not a winning strategy for our profession.

I did take all those hard sciences as well as 2 full years of Calculus (Calc 4). I can actually understand statistics, pharmacokinetics, read and interpret research. I use those sciences (that too many nursing leaders dismiss) every single day. I am distressed when I see nursing programs that have 'Chemistry for nursing students," and other science lite courses. no wonder we can't have more advanced sciences in graduate school. We do not have adequate basic science education. I'm skipping the DNP. If I want more management, leadership, etc., I'll either finish the MBA that I've half completed or get an MPH/DPH.

I work in a state with FPA after 2 years of full time practice with supervision from either and experienced NP or physician in the same specialty. We have a good number of psychiatrists so FPA is not a barrier to finding psychiatrists as someone suggested. Very few NP's have gone back for their DNP in this area. There is no monetary incentive to do so in my organization, a large academic medical center. The local university attempted to transition to a DNP entry for NP training. Applications fell considerably and they reinstated the MSN track. Most DNP programs do not add clinical training beyond that in the MSN program. Capstone hours are usually focused on a project and do not involve actual clinical training. It's unfortunate that the DNP is leadership and policy focused in most programs rather than adding more advanced clinical training. That said, if you plan to teach at the graduate level or yearn for a position in nursing leadership, the DNP makes sense. I'm happily teaching undergraduates in the clinical setting and my MSN is fine. It's unfortunate that nursing educators chose not to develop a clinical doctoral degree. Many of us would have jumped at that opportunity.

I love my position as an NP on our Psychiatry Consultation Liaison service. I work in an academic medical center which has an inpatient med-gero-psych unit, and Acute psychiatric Unit (ED) and an active CL service. I work midnight to 0800, Sun-Wed, no weekends, holiday or call. I see whomever is most emergent and that may be on the inpatient unit, in the ED, or on the consult service.

many physicians have no understanding of NP education. We cannot just jump from specialty without training. An NP with 20 years experience may have no neuro expertise. Physicians often believe that we are trained like PAs as generalists. It's unfortunate that the physician and NP in this case did not discuss her actual experience and training needs prior to hiring.

Just an FYI, in an independent state, were are NOT supervised by physicians. In fact, in my state, new grads can have their two year supervisory requirement met with an NP or physician. I happen to love both PAs and NPs. Neither is 'better' than the other.

Family PMHNP is now the only option. The adult only track is no longer offered just as the adult np (ANP) track has been discontinued. They are trying to prepare all specialties across the lifespan. I did my training at Drexel. It was a great program.

They won't be identical questions, just similar. Every test is a bit different.

I actually passed the first time but know others who passed on the 2nd.

My understanding is that it will be essentially the same. They always vary from test to test.

I specifically tailored my clinical training to include neuropsychobiology, neuropsychopharm, etc. since I work with individuals with complex comorbid medical and psychiatric illnesses. My MSN program was quite good with actual medical didactics but I definitely took it a step further by concentrating my training to prepare me for the role I wanted. One of the great weaknesses of NP education is lack of standard curricula. Every program is different. Not so withmedical school PA programs, pharmacy, etc.

It's the PRACTICE doctorate, not clinical and is described as such.

Many independent practice states do require a period of supervision. Maine requires the equivalent of two years full time practice supervised by either a physician or experienced NP priorto granting independence.

The DNP was in no way meant to prepare NP's to compete with physicians. Too many people actually believe this and it certainly adds to animosity between prifessions. More clinical training is not even necessarily included. Practice hours spent in development if a process improvement project cannot be compared to clinical training in assessment, diagnosis and treatment of patients.

The DNP is not similar to the MD. You can get a DNP with a leadership or education focus and no advanced clinical training. NP's with DNP's do not have more clinical training than do MSN prepared NP's. Their additional hours are practice hours, not clinical. We all need to be very clear that DNP training is not at all comparable to medical training. Physicians spend thousand's of hours in clinical training and then graduate to another 3-5 years of focused clinical training. NP's are advanced practice nurses who provide skilled care. We need to accept that we are not the same as MD/DO's. Read the work around the development of the DNP. Nowhere does it compare our education to that of physicians.

NPs in Maine don't even need an on call physician although I think it's wise to have collaborative relationships with multiple providers.

I don't believe that malpractice insurers will cover this kind of situation. Termination is not the same as being sued for malpractice. If the patient had sued then malpractice coverage would help.

Are you close to a law school? Some schools take on work pro bono to get experience for students who are supervised by faculty?

Wow, a contract to repay training? You are lucky to be out of this place. I wonder if the contract is legally valid.

I can't believe that you were warned for a parking infraction. We can potentially be ticketed but it goes through the parking dept and doesn't involve HR or nursing dept.