stickit34

Boards seek the absolute minimum for entry-level practice, which is a 65% or better on the exams. To me, 65% is failing, and not "weeding out" people who do not know what they're doing. What's more, the examinations themselves are a joke, having almost more theory than clinical questions on the exam. The question is how are we regulating the standards of nurse practitioner education and profession when we have schools with a 95% acceptance rate (Chamberlain University), who enroll thousands of students each semester, do not provide quality clinical sites while charging ridiculous tuition rates, and then slap a diploma in their hands and wait for the next round of tuition; I'm sorry, students. Sure, these sites are accredited, but have you ever actually examined the criteria for accreditation from AACN/CCNE? Its vague wording, along with no standards or minimums for entry, a pitiful minimum curriculum and clinical practice hours, is laughable and embarrassing. I suspect a reason why it's not changing is because one of the board members works for one of these online, find-your-own-site schools. However, it's developing a negative view of our profession, and is hurting our argument for independent practice. I'd be interested to see a study (or several, in fact) comparing the practice of students from these types of schools versus those who graduated from schools that provided them clinical experiences. And yes, people will get hired regardless of source of education. But word of mouth travels, and I have heard one too many times that parents will never send their kids to a NP who graduated from Chamberlain, or a colleague who questions how another Walden graduate NP even functions daily in her role.

Thank you everyone. Unfortunately I still with this practice, but I was able to convince them to credential me through CAQHC. However, there are also numerous other problems with overall practice. They don't provide cleansing towlettes for urine specimens, use alcohol soaked cotton balls inside of prep pads, and refuse to provide diapers for patients who forgot/didn't grab one on the way out. By they, I mean the practice manager, and she and I butt heads constantly. She refuses to provide me a computer (even though my contract says I get one), refuses to change any of the practices despite me asking her to do so and even offering to buy diapers out of pocket, and she even gives my patients her opinions on vaccines! I tried talking to my doctor about it and the practices, and he sort of shrugged his shoulder about it and nothing changed. I want to quit so badly but my husband doesn't want me to. I could have my full time RN position back in a heartbeat, and could work until another position came up. I have a 60 probationary period, so I can terminate without any consequence. What should I do?? I'm so overwhelmed and lost. My entire gut is screaming to run.

Hello everyone, So I accepted a job in a private pediatric office, and had my "orientation" yesterday. I put quotations marks in there because it wasn't an orientation at all. Instead, it was the office manager sitting around and gossiping while I was trying to pull information from her. When it came to billing, I asked her what information they would need for credentialing for insurance companies. She replied that I don't get credentialed, and that all the billing goes under the physician's name. When I said that doesn't sound correct, she stated that that's the way it's always been done. Apparently, I don't even get credentialed with Medicare and PA's Medicaid programs either, which I know for a fact that I need. I asked the billing coordinator if it's somehow under incident-to billing or how they bill the visits, and he had no idea what I was talking about. This practice also bills for 2 developmental tests at age 9 months, 18 months when they only do one, which is fraudulent. I'm also having difficulty obtaining my CRNP license through the state (submitted 6 weeks ago, no word on when I will get it, and I do not have my prescriptive authority, NPI or DEA either yet). I told the office manager about this, and she said I'll just practice under the physician's name. I replied that I would not, because it's illegal. She replied that that's what they did with NP's before. She also said that the physician will have a bunch of pre-signed scripts for me to fill out until I get my prescriptive authority. I also refused to do this, because I am not comfortable with this! She got frustrated and rolled her eyes. I honestly don't know what to do. I need to know if this is truly questionable activity or if I'm just green to the business aspect of medicine. I live in Pennsylvania. This is also my first position, and I'd hate to leave already but I do not want my name associated with fraudulent activity. Please help me. I'm grateful for any advice. Thank you so much for your time.

This disturbs me. It's hard enough to promote the profession amongst other healthcare providers, but when you have schools like this accepting and pumping out students who should not have been accepted in the first place (not towards you, OP) is absolutely ludicrous. Not every nurse should be a nurse practitioner. The profession should organize their own accrediting body and separate from these other certifying bodies, because clearly they're doing a crappy job. And people wonder why they can't pass certification boards when they graduate from these programs...

I paid completely out of pocket by working overtime and living with my parents haha. It totaled to $42,000. Private university.

I have passed ANCC at 88%. While I agree that passing is passing in the eyes of the certifying body, do you still agree that practitioners are at the same degree of competency whether they passed at 65% or 88%? Personally having gone through several interviews, I do agree that all employers ask if whether or not you passed, but I do want to point out that a fellow student who had to take boards twice was asked more than once about how many times she took it. I'm guessing they noticed a gap between graduation and the time of her certification. But the question remains: Is 65% sufficient for safe practice? Where have they demonstrated that 65% proved minimum competency to practice and prescribe safely? While there are studies showing NPs provide safe care, there have not been recent ones for the most recent cohorts of student nurse practitioners.

1) Kids hate being sick. 2) They never give up (sometimes good, sometimes bad haha) 3) I love family-centered care and sometimes healing the whole family, not just the child. 4) I love the raw emotion that I get from them. Most of the time they don't hide their feelings or thoughts, it's just out there for the world to deal with. Much better than dealing with adults. 5) I just love it. I never thought I'd go into pediatrics because I was the youngest child and never really interacted with children. I thought I'd break them haha. But when I got my pediatric job I truly found my passion and place.

Hello everyone, I just recently graduated from my FNP program and just today passed the ANCC!! My RN resume consists mainly of pediatric primary care, and I truly desire to work in this population. I am fortunate enough to live near CHOP and Nemours, however, they all would like PNPs. Do you think it is a wise investment to obtain a post-master's certificate in pediatric primary care, or do you think I should continue to look for a position with my FNP? I truly appreciate your advice! Thank you!

I guess I find it disturbing that there is such a low passing score for both board certification exams for FNPs, and I see and hear so many students fail one exam or both exams. It makes me think about what quality of an education they're receiving at their programs, or if there needs to be further regulation as to the academic requirements for entry into programs. I'm not saying someone can't be a horrible test taker; I'm a person who scored below average on the SATs while having a 3.85 GPA in college prep in high school. But it definitely concerns me that a roughly 25% (according to Fitzgerald) of NP students do not pass their certification exams. Compare this to the 94% of PA students who passed the PANCE on their first try. It definitely makes us look inferior and unprepared. I wonder if the NP certification boards had to publicly post their results, how quickly the educational programs and regulations would change...

I do find that funny. My program required a B to pass, and anything less would result in dismissal from the program. But when it comes to national certification, a basically failing score is acceptable. I don't understand how it can be acceptable, or how it ensures the quality of nurse practitioners entering into practice.

Hello, I was speaking with family members the other day about my board certification exam. I plan to take the ANCC for FNP and have been studying diligently for it. A family member asked what the minimum score for passing was, and I said I was not sure, but I was pretty sure it was either 65% or 75%. This baffled them, and they stated that they sure hope that it's 75%, because it would be scary to have a practitioner that "barely" passed at 65%. This intrigued me, and I have be searching to see what the minimum scores are for other professions. For physicians, USMLE Step 1 minimum is roughly 55-60%, but then Step 2 and Step 3 increases vaguely in terms of the minimum score to pass. PANCE also comes out to be approximately 65% minimum score, but each question is weighed differently. What do you think? Do you think it is too low of a minimum score for the profession, or that it is appropriately scored and weighed?

We don't think highly of our training because it is severely lacking already without people entering into direct-entry programs getting ready to prescribe to human beings, especially the most critically ill. I've said it numerous times, and other have as well. We've submitted complaints to the boards, but you know, money will always win in the end. Do yourself a favor and do the PA route. You'll benefit from a rigorous curriculum and clinical experience. I myself am registering for my final classes for pre-requisites for medical school, because once you realize that you don't know enough, you don't want it to come at the cost of someone's LIFE.

I would highly suggest you pursue a PA path, and here's why. NP schools are already lacking in education in terms of pathophysiology, pharmacology, science courses, clinical hours, etc. Add to this the lack of RN experience and you have a recipe for disaster. NP schools, no matter the rankings, are businesses, and will do whatever they can to appeal to the consumer until they are limited otherwise. That's why PA and medical schools are fewer and stricter- their governing bodies restrict and regulate their education. Ours provides extremely vague dialogue for schools, allowing them freedom to do and admit whomever they please. Schools do not care about patient safety, they care about money. Nursing seems like it's all roses until you're in the trenches. Out of my nursing class of 20, only 10 are still nurses because they couldn't standing nursing in practice. Even fewer are still in the ICU. How do you know you will like nursing until you are exposed to what our profession is all about? The premise of the nurse practitioner is that it's an advanced practice nurse with years of experience. There are things that can't be taught with shadowing and classrooms - the chaos of a code (and you're running it), the sense that a patient is about to have an MI, diabetic ketoacidosis, encephalopathy, meningitis, etc. When you're responsible overnight solely for this patient and have to determine when to call the physician for help (just as an RN, not even an NP at this point). Keeping them stable or at least alive until help gets there. Coping with their deaths, and encountering the families in the morning afterwards. This is just a teaspoon of what I encountered in med-surg, and I am grateful for every moment! I can't even fathom what's to be expected in the ICU. With your background, you're more suited to be prepared in the PA role to get a full understanding and exposure in the clinical area. You can still have a practice that is warm and empathetic as a PA. That is not solely for NPs. Just of note, I am about to graduate my family nurse practitioner program in June. I have five years of experience in med-surg, pediatrics and emergency nursing, and honestly, I wish I did more. I've exceeded what was required of my clinical hours by 200 hours, and it's still not enough to have me feeling fully prepared for practice. Part of that could be imposter syndrome, but part of me sincerely believes it's the lack of exposure and training to the art of practicing medicine, because as an advanced practice nurse, that's what you're doing.

Thank you everyone for your response! Pro-student, I have to agree with you on some points in that there does seem to be a pattern with NPs. I have also noticed that a majority of NPs tend to specialize, just like physicians, and most tend to serve in metropolitan and suburban areas (hence, saturation in many areas). I believe if more NPs were willing to travel to rural and under-served areas, and there were studies regarding the care provided in a full practice authority state, that it could make a solid argument for full practice authority. It will only help promote the profession more. I also completely agree that the main reason why physicians are against full practice authority is a financial one. I can see their frustration though in regards to education and the length they take to achieve it as compared to our education, as well as a comparison of what our curriculum entails versus what theirs requires. It's easy to point and say that another's education is not enough when they don't fully understand the concept of our profession.

Please read this article: Nurses are not physicians What are your thoughts? I've seen similar posts and arguments on PA and physician forums as well as in their associations. What do you think helps or hurts our argument for full practice authority?