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?

I think it largely depends on where you live. If you live in a rural, isolated area, most likely there is a nursing shortage. Urban areas are often either over-saturated or a severe shortage depending on the living conditions of the area and the cost of living. Where I live, which is your typical suburban area, it fluctuates. Some years there is a mild shortage, but most years it is pretty saturated.

It is so sad that so many do not have the faith for change! I wish there was something that we knew we could do to change things. I just finished reading a number of articles from a physician's viewpoint of NPs, and while there were some that were supportive of our role, there were numerous who were not in favor of our education and frequently point to the lack of science-based courses and the large amount of "theory" and "politically-correct" classes. While I don't agree with them, I can see their frustration, especially with very lenient admissions. A number of physicians also mocked our profession because we have a large amount of online programs. I can only hope that something will change for the positive! Thank you for taking the survey and letting your voice be heard!

Congratulations!! What a great accomplishment! I plan to take the FNP ANCC exam in August, and I am so grateful for your advice. I will definitely add it to my study plan.

I wrote the same comments! In my area, preceptors are paid pretty well for taking in PA students. Hence why they are more willing to precept PA students over NP students.

I completely agree with you, elkpark. I wish students would be more mindful of how their schools benefit them and their profession rather than what benefits their pocket and time. Thank you for your input!

Over the years I've read numerous posts and articles about nurse practitioner education - the pros, the cons and the absolutely unacceptable. One of the things I am passionately opposed to is schools that do not provide preceptors for their students. This is unheard of in physician and physician assistant education, and is degrading to the NP profession. Quality is not assured nor required, adequate experience is not assured and yet schools keep getting paid. If we are to be a profession to be reckoned with, we should start acting like one. Enter CCNE, the largest accrediting body of nursing programs, both baccalaureate and graduate, in the nation. They are currently revising the old standards for accreditation, and are open to comments about the concerns in the programs and about the programs they accredit. They are asking for your opinion. Instead of complaining, let's act! Here's the link to the webpage: American Association of Colleges of Nursing | CCNE Accreditation Please, please consider inputting your opinion! Every opinion counts, especially those that differ. Let's be a profession of quality, not numbers. Please put your opinion down below if you'd like, but please take the survey. It ends May 5, 2017.

This article is fantastic, and I love the discussion below. I am two months from completely my program that is a mix of brick and mortar and online, and they found preceptors for every single one of our students that not only met their needs but were near their homes. Not to mention that I live near Allentown and Philadelphia, PA, which is flooding with medical schools, nursing schools and PA schools. They had no problem finding preceptors for all 20 of us. That being said, it was 20 of us. A small cohort. Not 3,500, or 200, like some other schools have. With cohorts like that, absolutely, there is no possible way that they can provide preceptors for all of that locally. Nationally, absolutely, there's no excuse. To become a nurse practitioner is to enter a profession. A profession in which we handle patient's lives, mothers, sisters, fathers, grandfathers and children. Families, communities. We as a profession are shouting that we provide competent, caring care to patients that is the same, if not better than physicians, and yet we fail to provide even the most basic necessities for the students who are going to be taking care of them! It's embarrassing, unprofessional and degrading. My school is also linked with a PA school, and because of our affiliations we work together very well inter-professionally, sending a good message with them about nurse practitioners. However, I have had several friends, as well as NP preceptors who have had students from online schools who had to find their own preceptors, and have had horrible experiences with them. My women's health preceptor, an NP, said that a student in her final semester could barely compile a focused H&P, let alone differential diagnoses. From that experience alone, she now only takes students from my school and one other well known brick and mortar school nearby, who also provides preceptors. Situations like these probably don't help those who are struggling to find preceptors. While online schools, or probably more appropriately schools who do not provide preceptors to their students, have their place and need, I strongly do not feel they are needed in preparing professional nurse practitioners to care for the population. They certainly aren't providing quality clinical experiences, a requirement of CCNE, nor probably providing a sustainable faculty to student ratio, also a requirement by CCNE. Clinical faculty is also supposed to visit the clinical sites per CCNE What programs who do not provide preceptors are doing is feeding off of is people who want to be nurse practitioners at a convenience, whether it be a relaxed admission criteria, on-line format, or "finding preceptors near where I live". Like someone said before, those same students will be posting later begging for preceptors because everyone is flooded with requests, and turned off by bad experiences. As someone said before, people are willing to pay for convenience, and then complain later about quality. I highly suggest putting time into researching actual well-known programs (not just ones that tote that they are), who put your hard-earned money to work and actually provide you a quality education. It's not supposed to be convenient. Not every nurse is supposed to be a nurse practitioner. PAs take off a year or more for their education. Physicians invest immeasurable time and money into their educations. Both of their professions also treat their students well and provide preceptors. Most of their programs pay their preceptors, which is fantastic and well deserved. While we can all say that everyone should give back, the fact is that money talks, money attracts and money keeps people. Wouldn't you be more inclined to precept if you were being compensated? I noticed most people saying that nothing really will change. This topic couldn't have come at a better time. This link below is to CCNE, the largest accrediting body of nursing programs and the body that accredits most of the programs we are referring to. Right now, they are reviewing comments to their Current Standards for Accreditation of Baccalaureate and Graduate Nursing Programs - basically, all of the regulations that govern nursing programs. Voice your concerns - I already did! Took me 30 minutes (I had a lot to criticize, haha), but so worth it. Hurry, comments close May 5, 2017. Please share!! CCNE Website (Look under CCNE Initiatives, it's the first one): American Association of Colleges of Nursing | CCNE Accreditation Let's act like a profession and actually stand up for ourselves!

I had a job lined up before I graduated with my BSN. Graduated in May, passed NLCEX in June and started my job in July 2013.

It's not about compassion, it's about the safety of the public. The NCLEX is a test that helps determine minimum competency to practice safely. These are people's lives, including neonates, children and people who cannot protect themselves. If the person continuously is unable to prove that minimal competency, I would hope the person would realize that they are struggling in an area and take remedial courses to rectify it, or realize it may not be in both their best interest or the public's best interest to continue in this profession. Unfortunately, life is unfair and harsh. Take it from my brother who has failed the FE for engineering and chose a different career. I'm sure your aunt is a wonderful nurse.

I couldn't agree with you more. As a FNP student myself, I worked hard to be even able to apply to NP schools. I studied for half a year for my GRE, gained valuable floor, homecare and ambulatory RN experience, and worked tremendously hard in nursing school as well as doing extracurriculars and volunteer work just to get more than a glance at my schools. These online for-profit programs scare me and honestly frustrate me, because other nurses like myself have work our tails off to better ourselves and be the best potential providers while others literally just turn in their transcripts and three letters of recommendation and are instantly NP students. Look at other professions such as engineering, for example. Sure, they have online programs. Do they change or diminish the admissions process for them? Nope. Is it standardized? Yup. Is it selective? Absolutely. Rigorous curriculum? Yup. The end result is (for the most part) competent engineers who practice. Can the NP profession state that? Unfortunately not. And we care for PATIENTS, husbands, wives, daughters, sons! I'm sorry, I just went off on a rant there. I apologize. Back to the main discussion, yes, there will absolutely be a surplus in the NP profession if there is not action taken to control their numbers. Citing a future demand for NPs is not accounting for the future PAs and MDs who will also be entering the market to care for the aging population. I fear the NP market will soon face the same fate at the RN market, where salaries will decrease and workload will increase. Even if NPs go to rural communities, the market will eventually become saturated.