CardiacRNLA

I know that this probably is not going to make sense to most people. But I have been and APRN for a little over 2 years. I have decided that the stress and responsibility is not worth it for me. And I would rather return to being either a procedural RN and/or a clinic RN. I do not see myself going back to the floor. I didn't leave my last APRN roll under the best circumstances through the complex with my supervising doctor, so I won't be able to get a reference there. I've been out of work since June, so I'm also concerned about that. Also, I have been away from the bedside for a little over seven years, but I was a stress lab nurse as recently as December 2021. Wondering what would be my likelihood to obtain an RN role? Any advice would be greatly appreciated.

Like your partner in crime, you seem to make so many assumptions about nursing. Again I'm glad you found a profession where your brilliance can shine. You are incorrect in that most physicians overestimate NPs abilities. They don't care. Because sadly for most NP roles, only patient volume and being delegated grunt work is what matters to physicians. I wish physicians did make positive assumptions about NPs. Anyway, I agree there are a lot of medical professionals who lack knowledge. But you seem to reflect this on nursing only. So when cardiologist (practicing for over 20 years) says to order a Lovenox bridge for a patient on a DOAC...am I the dumb one for knowing the guideline or is he?

There was some areas in which we had common ground. But now I realize you are not grounded in facts. And by the way, when I meant the rural role, I meant as primary care providers or even helping to smaller specialty practices in underserved areas. CRNAs by TRAINING cannot fill these roles either independently or collaboratively. You are providing conjecture about "nursing memes", "fluff" etc. I am glad that NPs suck. Maybe you were rejected from a CRNA program or upset you didn't go that route. Good luck and good day. I am sorry, we as a profession. don't meet your approval.

Role transition is not "fluff." It has also been studied with new grad RNs. The research goes back to the"good old days" before the advent of online learning. In addition, despite all you advocate you cannot change how an employer perceives the NP role or how to utilize an NP. Most employers don't give a rat's behind if you went to Yale, had 5 residencies and studied at the Sorbonne. They only care that are a less expensive way to create revenue. We are NOT physicians and we will NEVER be seen as colleagues due to the healthcare hierarchy. Which is okay, I am not an MD, I realize the limits of my training and I wanted to be a NURSE. While I agree that clinical standards should be beefed up and nursing "theory" classes should be reduced, I don't think the CRNA model is realistic. First, CRNAs don't do a residency, but they do have more clinical hours and have a more rigorous curriculum, no doubt. However, CRNAs while smart, valuable and much needed, they are not being called upon to meet access to care gaps in rural areas, underserved urban areas, etc. NPs are being tasked with doing this. This does not excuse diploma mills, direct-entry MSNs, etc. I think that there should be more clinical hours, less "theory classes," certain mandated residency or mentorship, and certain # of hours working under an MD before allowing independent practice. I am sorry you have come across all these terrible NPs. Not sure if it is due to your location, employer, etc? Maybe it's your perception of NPs? Most of the NPs I have come across are thoughtful, intelligent, and hardworking. There is certainly a way to advocate for improving NP studies without sounding like "I am too cool for school"

First off, I have no ire towards anyone. You commented on MY post. You and others are making broad based assumptions on ALL NPs because SOME, hell I'll even be generous and say a plurality, suck. You mentioned advocating for residencies. That is great. I feel like that residencies should be a mandatory part of NP training. And you are making my original point. Even if you went to Ivy League A+++++ DNP In-Person program, most are not 100% ready to be a provider IMMEDIATELY after school. (nor should you be in my opinion). It has been well researched that "role transition" is difficult for new NPs across the board. You mention the quality of NP programs/NP students, that is only ONE side of the equation. How about fixing the system that cuts all APPs short of mentoring or additional training, just so more patients can be seen (read: more billing)?

"NP turned MD/DO" means what exactly? I have met plenty of crappy MDs. The thing is though, that MDs close ranks and protect each other (even at times when they shouldn't). Juxtapose that with nursing, and suddenly everyone is an "expert" or thinks that him or her is better than their profession. Instead of crapping on your colleagues on an anonymous blog, why not actually do something to help the profession if you feel so strongly?

I always love this site because anonymous people with snarky attitudes love to apply their opinion broadly to every NP. So if I told you, I don't want independent practice at this point in my career, I actually WANT to learn and collaborate with my MD colleagues, would an appraisal of my situation any different?

That's great you realize it's a systemic problem. However your initial messages had a blaming tone of the NP: "20-somethings wanting to escape the bedside" "you're supposed to be autonomous.” Again you are conflating poor educational training with lack of mentorship and guidance. You don't think physicians get that? Physicians get a whole 4 year mentorship before acting independently. The NP educational programs have always have the same number of hours and credits. What has changed? The proliferation of diploma mills with low bar to entry. That can be changed. And in this we agree. However your responses made it seem as if an NP should get no mentorship, training and should be ready to make ANY decision immediately out of school. Perhaps I am misunderstanding? I don't think that is a realistic or safe expectation. Medical professionals of any discipline, there should always be room to ask for assistance. Even seasoned physicians will ask each other for guidance in difficult cases and refer if they aren't trained to treat the case. Why should NPs with less training be able to do this? Again, my post was my concern from lack of oversight, collaboration, and guidance. To think this shouldn't be provided AT ALL is as rather interesting perspective.

Well, let's just say this. I did make a comment on a public forum, correct. However, your initial response and subsequent responses made a lot of presuppositions. You say you are tired of precepting 20-somethings with meager experience wanting to leave the bedside. I totally understand that and this is valid. But I am NONE of those things. I am 40 and have 8 years nursing experience. Yes, part of my reasoning was that I was tired of the grueling work at bedside. However, another part was to learn and apply greater clinical reasoning. School starts the process (or at least it should) and then you hone it on the job. My employer does have an expectation, correct. Is it reasonable? In my opinion, no. Here are some examples: 1. I have always been in the inpatient setting, including NP clinicals. I am currently working the clinic (private) awaiting my hospital credentialing. My first day as soon as I walk in, my desk is topped with surgical clearances. As either a working RN or as an NP student, I have NEVER cleared patients for elective outpatient surgeries. So should school have prepared me for this? Do I make my own decision without asking anyone since I am supposed to be independent? 2. I am rounding at an LTACH (after less than 3 hours of shadowing). My supervising MD, who refuses to reach out to me or tells me he's busy writes ambiguous things in his notes. A patient is s/p ischemic CVA with no evidence of hemorrhagic conversion, has known Afib, no documented bleed elsewhere. He writes that during her STACH stay, the hospitalist stopped her AC saying she wasn't a good candidate, but it should be considered later. He goes to state that the pt has a CHA2DS2-VASc score of 7 and states "she is at high risk for stroke, and ideally she should be started on anticoagulation." He even says she should be started on warfarin and gives a goal INR. Does he start the AC? No he doesn't. Is there any reason why she shouldn't be on it? No, not that I see anywhere in the chart. So when I call and text him for clarification and he refuses to answer do I: a) start AC on my own unilaterally? b) just assume he doesn't want to restart it and hope the patient doesn't stroke out again? In the above scenario, if I just start the AC on my own and there was some reason that only the MD was privy to, and something happens to the patient, am I protected? I practiced autonomously, which in my state is ILLEGAL in the inpatient setting. What if the patient has another stroke or a PE or whatever? Does school prepare anyone for this? Even residents who are actual physicians would never make a decision and say "I need to discuss with my attending." So why as a mid-level would I not want clarification? Just so some doctor won't think I am dumb? Finally, I would love to have done a fellowship. I wanted to do a fellowship. It's not a matter of convenience for me. My husband put the kibosh on that both for financial and personal reasons. Otherwise, I would've felt more secure doing that. Again, I understand your frustration. I have seen and also heard of many NPs that make the profession look bad. I am not wanting to be coddled. I realize that this was going to be tough. But the lack of collaboration, guidance etc from my physician counterparts is not only frustrating, it is illegal. They sign off on my notes (which is usually days later and I know they aren't reading them) and I must have a collaborative agreement with them. I take my role super seriously. I want to deliver quality and competent care that they deserve. Not every new NP is solely looking to escape the bedside or motivated by money, etc. But thanks for the conversation. This again provides a reality check. Have a good one.

Oh, I get it now. Your get off my lawn” attitude doesn’t help anyone. First I’ll have you know that there are many nurses (including myself) who went to “in person” programs. How completely ridiculous that you would believe that asking for feedback/guidance somehow = lack of knowledge or skill? But I’m sure you were perfect IMMEDIATELY after graduation (in your own mind). If you think NPs are of low quality, then maybe it is YOU who had a low view of your profession. Using your logic, would you be okay with new grad RNs just being thrown into floor work with minimal guidance? After all, I went to RN school full time and 2 years of clinicals. Where I do agree is that the bar is set too low for entry to advance practice, heck, I’ll even say for nursing in general. But there’s a difference between lack of knowledge/ability and ensuring an adequate role transition. Does NP or CRNA school prepare you for every situation? Does schooling prepare you for the myriad of ways NPs are utilized? For every specialty? No, it doesn’t. For lack of sounding boastful, my concern is not a lack of ability. Quite the opposite. My employer (in my opinion) has too much confidence in me given my background and training. Maybe you were ready to jump in the deep end straight away. Good for you. Not everyone is like that. Role confusion is a well studied and long documented issue with advanced practice professsionals. Even BEFORE the proliferation of diploma mill NP schools. But to conflate this with “lack of standards” is patently absurd and rather insulting. But you do you and stay perfect! Hope you continue to enjoy the exodus of healthcare professionals!

If medical school alone made physicians ready to be providers, there would be no need for residencies. And being an RN does not count. While being an RN brings some clinical judgment and medical knowledge, the role does emphasize diagnosis or higher level of clinical judgment. There’s a definite learning curve. it’s not an issue of length of training. I received NO training. And furthermore, I’m being held responsible for things I never did before. That’s fine if I am given guidance and feedback. I’m not looking for a lengthy or indefinite training. Is it too much to be able to ask my supervising physician questions? Am I allowed to expect feedback on my performance? I would caution you to not think that professional organizations speak for all nurses or NPs. As a new NP, I welcome guidance and oversight from a physician. However once I gain experience, I would expect a level of autonomy. So I’m sure what has you pressed?

Well, I really wish I could find something else. But my market here is saturated it appears. And I've only been doing this for 6 weeks. At times, I really DO feel as if my license is being compromised. Prime example: this past Friday I went to the LTACH were we see patients. I tried to reach out to the "supervising physician" by phone and by text and he never answered back. Supervision of a new NP by phone, sigh. I'm balancing my comfortability, patient care ethics vs the reality of my finances. I'm not sure what to do. I'm going to speak the owner (the head MD) and see if anything changes.

If only, I wish I could do a fellowship. But there aren't really any here in Florida, oddly enough. And when I brought up an out-of-state fellowship to my husband right after I graduated, let's just say he wasn't on board LOL.

It’s kinda funny you say that about answering questions and triaging…because they have me doing that too LOL. Sigh ?

Thanks for your response! I could not agree more. Being an RN and an APRN is so different! During the interview process, I did relay those concerns. I was assured I wouldn’t be expected to be at the level of an seasoned NP. And because my credentialing would take a while that I would be brought along gradually. I’m not saying this was an intentional bait-and-switch. I believe the ideal situation and the reality of being short handed overshadowed everything. I really would like to make it work. But this is where I need to have a strong (and safe) foundation. I know I need to have this conversation. I need to write out what I’m going to say and have a plan to present.