Quality of Online NP Programs and Providers

ProgressiveThinking, MSN, CRNA · Jan 23, 2020

Prior RN experience. Sorry for the typo.

LadyT618, MSN, APRN, NP · Jan 23, 2020

I think this is a dead horse that seen it's last days, but I'll chime in. I recently finished my Post Master's program to become an AGPCNP after being a registered nurse for nearly 13 years (at the time I started the program). Even though I haven't actually started practicing in my new role, I have strong feelings about the state of the educational conundrum.

Call me ol' school or old fashioned but I believe that one should be an experienced RN prior to even entering an NP program, like many programs still require today (mine required minimum 2 years RN experience in a role related to the NP track chosen). The role of the NP was created to train experienced RNs in the advanced practice role to fulfill a primary care provider shortage. Dr. Ford and Dr. Silver did not pull Joe Schmo off the street to train them to be NPs. I do believe this influx of "diploma mills" to produce NPs is a slap in the face of the profession as a whole and further fuels the fire of those MDs who are firmly against the NP. This is just my $0.02.

Just an aside...are you a CRNA looking to do an online program to become an NP? That sounds bananas to me ?

ProgressiveThinking, MSN, CRNA · Jan 23, 2020

Thanks for the reply. Who regulates NP programs? For instance, the COA regulates CRNA programs by setting our minimum requirements, e.g. 2000 anesthesia hours, a certain number of specific cases, central line and arterial line insertions, epidurals, spinals, peripheral nerve blocks, etc. We have to log them all. If programs can't provide these things to students then they aren't in compliance with the COA and risk being shut down. Programs also have to get COA approval in order to become accredited and have to meet certain requirements (require applicants to have ICU experience, GPA minimum, not be online).

I just don't understand why NPs won't band together at the political level and work with their accrediting bodies to ensure that NP schools not only accept the correct applicants, but provide a quality education that prepares NPs to practice clinically as full service providers. The would probably result in a lot of the online diploma mills that exist to make $$ shutting down, but it would be good for graduates (public perception and clinical skills), and would most importantly be good for practicing NP salaries by preventing oversaturation of the market.

Yes, I am a new CRNA who has always wanted to get my FNP in order to increase my knowledge base, and switch things up at work maybe once a week. CRNA school was very very in depth and intensive, but was mostly limited to the perioperative area. It would be nice to broader scope as well. I figure since there's post master's programs that can be done in a year, why not?

Advanced Practice Columnist / Guide · Jan 23, 2020

I agree that we've been beating this dead horse of an issue forever. The NP world is more complex than the CRNA field. We have various NP tracks, various national NP boards that certify us, various educational formats and 2 different graduate degrees, and virtually every institution with a graduate level program in nursing offers at least one or any combination of multiple NP tracks.

Accreditation of NP programs is outdated and has not kept up with other APRN groups because of that very reason. Currently, NP tracks are accredited by AACN (Amer Assoc of Colleges of Nursing) - the very same body that accredits BSN, all MSN/DNP tracks, and PhD programs in nursing. AACN gives a blanket accreditation to nursing schools based on the degrees offered. AACN will say that a specific school's MSN or DNP programs are accredited and that would mean all tracks leading to NP, CRNA, CNS, or CNM if the institution actually offers it.

The difference with CRNA and CNM is that these particular APRN programs are not only accredited by AACN alone but they are also accredited by a national CRNA or CNM board as you mentioned whose standards are higher than those established by AACN and more specific to the training those specialties involve.

Various national NP boards have also complicated matters. While they all recognize AACN as the accrediting body for all NP programs, there is such an overlap and duplication in the certification exams. For instance, ANCC and AANP both offer FNP/AGNP certification and both ANCC and AACN offer AGACNP certification. Psych NP certification is only offered by ANCC. WHNP and NNP certification is only offered by NCC.

Those letters are confusing even for NP's so you can imagine how it is a mystery to someone on the outside. It would be ideal if all entities could sit together and come up with a unified NP board that would establish and enforce standards of accreditation as well as establish a single certification exam for each of the tracks. That would simplify matters and centralize what appears to be a jumbled group of entities at odds with each other.

So going back to you initial post...it's hard to answer your question based on such wide variables. A nurse who has good exposure to high quality clinical settings at work can potentially do well in an online program where clinical rotations are not arranged if the same nurse already possess an established network of high quality preceptors to train under - it is not inconceivable. On the other end of that, an inexperienced nurse can flourish and learn in a high quality NP program and have the basic tools to succeed.

That, to me, is what makes things so unpredictable in this field.

LadyT618, MSN, APRN, NP · Jan 23, 2020

Ditto on what @juan de la cruz said.

Also, may I say I admire your thirst for knowledge and desire to broaden your knowledge outside the arena of anesthesia/perioperative field. I just love to see people who love to learn more and more ? Kudos to you!

FullGlass, BSN, MSN, NP · Jan 23, 2020

Online in and of itself does not mean poor quality. Johns Hopkins has moved to an online format for NP education. It's actually far more convenient to have didactic content online. Hopkins does find clinical placements and some time on campus is required so students can be tested on their clinical skills. We are going to see more and more online education in all areas of higher education, as it represents a huge cost savings and is more convenient for students.

There are definitely some poor-quality NP schools, and these are mostly the for-profit schools that will accept anyone. I really wish our NP associations would crack down on these.

ProgressiveThinking, MSN, CRNA · Jan 24, 2020

Thank you for the responses everybody. I agree that online education is the way of the future. Especially in the form of streamed lectures.

Thanks @juandelacruz. It's unfortunate that there isn't more of a push from political organizations to homogenize the certification and accreditation process since it affects all NPs.

I mostly agree with everything you've said, but I think that experience prior to matriculation should be an absolute minimum, unless NP program hourly clinical requirements are increased. Sure, you can have a stellar student who excels and matriculates in the right program be successful, but I think the average new grad RN completing 600 hours of clinical in an average program (with average being watered down by diploma mills) just doesn't seem like it's enough to make the push for independent practice (which seems to be what a lot of NPs are doing in their states).

Advanced Practice Columnist / Guide · Jan 24, 2020

There were initiatives by individuals who were concerned about the lack of support to NP students in some schools when it comes to securing clinical placements. A group of individuals were successful in pressuring AACN to change their accreditation standards to require schools to make sure clinical placements are arranged by the program and not left for the student to take care of (see: https://sawyerinitiative.com/news-and-development/we-did-it/).

I don't know if we will see the result of that change yet since AACN accreditation remains active for many years (I think even up to 10 years!). But that's a big fish caught in a large swamp of issues that relate to NP education in general. That blog I linked to also has active discussions and resources for those interested in finding good NP schools that provide clinical placements to students.

FullGlass, BSN, MSN, NP · Jan 24, 2020

2 hours ago, ProgressiveThinking said:
I think that experience prior to matriculation should be an absolute minimum, unless NP program hourly clinical requirements are increased. Sure, you can have a stellar student who excels and matriculates in the right program be successful, but I think the average new grad RN completing 600 hours of clinical in an average program (with average being watered down by diploma mills) just doesn't seem like it's enough to make the push for independent practice (which seems to be what a lot of NPs are doing in their states).

Please note that RN experience IS required for admission to an acute care NP program. RN experience is generally no longer required for admission to a primary care NP program, including the best schools like Hopkins, because the studies that have been done indicate RN experience does not benefit primary care NPs. Most RNs do NOT work in primary care, while 90% of NPs are educated in primary care and 75% of them work in primary care. This issue has already been debated ad nauseum.

murseman24, MSN, CRNA · Jan 25, 2020

If your primary motivation is to "learn more" there is a new program in development at Wayne State University for a CRNA -> PhD in pharmacology degree. Either NP or something like this are better than a DNP to me.

allnurses Guide · Jan 25, 2020

On 1/22/2020 at 6:12 PM, ProgressiveThinking said:
Hello,
I'm curious to see how practicing NPs feel about the proliferation of online NP programs, especially the diploma mill NP programs that accept applicants without prior NP experience. Do you feel like this is watering down your profession and/or possibly causing physicians and the public to have a negative view of your profession? OR, do you think that this is the future of education, and the current method of training NPs should stay the way it is?
I have no dog in this fight, but I constantly read physicians bashing the quality of online NP education, including the lack of clinical hours (<800). I'm curious to see how practicing NPs feel about this.
As an aside, I'm considering doing one of these online programs, so this post isn't meant to bash a specific field, but rather create a discussion on whether or not practicing NPs like the direction that their field is headed in.
Thanks!

Poor vs quality is the main issue.

The real problem is the proliferation of poor quality NP programs and this is certainly not exclusive to online programs. There are some fantastic online and hybrid programs from quality universities. The problem that poor programs are further compromised by the online/hybrid model for two reasons: 1. they often have rolling admissions churning out poor graduates in greater frequency and, 2. they seem to cater to the students looking for the trifecta of cheap, easy, and fast.

Its the exact same with prior RN experience. There are longstanding programs with decades of history producing quality NPs with no prior RN experience, however, these program attract in the highest tier students. Now with poor quality programs attracting (often) poor quality students (again, cheap, fast, and easy) not having prior RN experience becomes magnified.

I don't have a particular problem with the number of clinical hours provided those hours are quality hours. Unlike the medical/PA model, NP hours are 1:1 direct supervision learning hours in a single clinical area. I would be happy if there were more hours required, and I am please that the accreditation boards are becoming more involved in clinical experiences of programs.

All said and done, if we eliminated poor quality programs and didn't address online vs hybrid vs brick and mortar or prior RN experience we'd be far better off than doing anything about the latter two.

My biggest gripe with online programs is that is does to nursing faculty.