Quality of Online NP Programs and Providers

[ProgressiveThinking]

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!

[BostonFNP, APRN]

1 hour ago, murseman24 said:

There are many hardworking, intelligent, clinically skilled nurses who go to NP school to end up having trouble finding a desirable job when they finish.

It's ludicrous to think RN experience is not applicable in primary care.

Experience is valuable, wether or not it is statistically significant in your studies.

1. If they are intelligent, clinically skilled, and hardworking then why do you think it is they can't find desirable jobs?

2. Honestly, have you ever worked in primary care as an RN or an NP?

3. Experience is valuable. All sorts of experience: education, RN, non-RN life experience, NP clinical, NP practice, etc

[murseman24, MSN, CRNA]

1 hour ago, BostonFNP said:

1. If they are intelligent, clinically skilled, and hardworking then why do you think it is they can't find desirable jobs?

2. Honestly, have you ever worked in primary care as an RN or an NP?

3. Experience is valuable. All sorts of experience: education, RN, non-RN life experience, NP clinical, NP practice, etc

1) Have you read this thread? Oversaturation of the market because some schools will take anyone with a pulse.

2) lol, no. Why would I work as an RN in primary care? What would you even do? I've only seen MAs in the offices of the docs I've seen. Does not mean I don't understand how primary care works on a basic level or the importance of understanding the disease process of patients. I personally know some very complex primary care patients that I wouldn't want to treat without having some experience with their care in the hospital.

3) Also, Pluto is no longer considered a planet. Is this supposed to be a valid point?

[FullGlass, BSN, MSN, NP]

3 hours ago, murseman24 said:

FullGlass, no offense, but I think the obvious reason you don't have a problem finding a job is because you went to Hopkins. Whether that education was truly better/worth it does not matter. You have a fancy name on your resume that shines above the gajillion other NP applicants and even I would be curious as to the quality of an Ivy league nursing school grad.

There are many hardworking, intelligent, clinically skilled nurses who go to NP school to end up having trouble finding a desirable job when they finish.

It's ludicrous to think RN experience is not applicable in primary care. Say you have a DKA or septic patient come into your office? You take some labs and send them to the ER or hospital to be admitted, fine. You don't have to know how to manage them when they are crashing in front of you or have the hands on skill set to perform the tasks required for stabilization which many critical care nurses understand first hand. But I do think it can give you a perspective on where their disease process can lead, and have a healthy respect for the severity of certain problems.

Experience is valuable, wether or not it is statistically significant in your studies.

You have never worked in primary care, yet feel you can lecture me on primary care NPs.

Please tell me how many NPs in California can't find a job in California. That number will be very low if they know anything about how to find a job and are reasonably flexible on location. Oh, so I guess all the EVIDENCE I sent you on the PCP shortage in California is wrong? There is another NP on this forum, who doesn't like me, but he did admit I was right about looking for a job in California - he wrote that he flew in to Redding for an interview and they were practically offering him the job as soon as he got off the plane. I can tell from his writing that he is smart and competent.

It's unbelievable that you think RN experience is required to diagnose a DKA or septic patient. All NPs get a BSN, where they are learn about, and are exposed to these conditions and then they all go through an MSN NP program, where we learn how to diagnose common primary and urgent care conditions. We also learn when to send patients to the ER. In primary care clinics, we do not have the equipment and many medications that hospitals have. Generally, we don't get life and death cases in primary care, but yes, I have had septic patients come in and even one with necrotizing fasciitis, and they were sent to the ER and did fine, thank goodness. There is not much we can do for them in primary care. I have personally not had a patient with DKA come in. I suggest you learn more about primary care and what primary care facilities can do before you presume to lecture me.

No one is denying that experience is valuable, but the point in question is what experience is necessary to be a competent primary care NP.

Yes, the Hopkins name opens doors for me, but that is all. I still have to go to the interview and do well in order to get the job. If I was an incompetent jerk, I wouldn't get the job.

I suggest you focus on how to get into a good FNP and/or PA program and work on being the best NP you can, as opposed to worrying about others over matters that you can't control. In addition, learn all you can about how to get a good job and develop those skills. A good NP program will offer help on this, so take advantage of this. Hopkins put a lot of time, for those who wanted help, into make sure each of us had a good resume and a very nice portfolio for job search. I took full advantage of all the help that was offered. In addition, everyone in our graduating class had a job offer on graduation from a clinical rotation. There are a lot of FQHCs in California that precept NP and PA students because they want to hire good new grads. There are also a lot of FQHCs and other health organizations in California that now offer NP residencies.

California has many excellent schools, both public and private. A California school has the advantage of having a bigger local alumni network, which can be very helpful. None of the NPs I work with, and most of them did not go to big name school, have trouble finding a job. And once one has experience, there is plenty of locums work available.

[BostonFNP, APRN]

10 hours ago, murseman24 said:

1) Have you read this thread? Oversaturation of the market because some schools will take anyone with a pulse.

2) lol, no. Why would I work as an RN in primary care? What would you even do? I've only seen MAs in the offices of the docs I've seen. Does not mean I don't understand how primary care works on a basic level or the importance of understanding the disease process of patients. I personally know some very complex primary care patients that I wouldn't want to treat without having some experience with their care in the hospital.

3) Also, Pluto is no longer considered a planet. Is this supposed to be a valid point?

1. Most markets are not oversaturated, and even in markets that are completely oversaturated, intelligent, experienced new grads from quality programs generally don't have much trouble finding work. Do you know these "many" nurses personally?

2. I am sure you have a basic level understanding of primary care and the disease process; likewise, I am sure you also have a number misassumptions about it. The truth of the matter is that the primary care approach to disease (and the patient's experience of it) is very different from the acute care approach, there are similarities, but one is predominately proactive and the other is predominately reactive. The same is true of RN role vs provider role: there are similarities but one is executing a plan of care and the other is formulating the plan of care. Can acute care experience benefit a PCP? Of course. I would argue that having experience as a case manager, social worker, or visiting nurse would have equal impact on practice.

3. The point is that experience is valuable, all experience, not just the experience you have.

[murseman24, MSN, CRNA]

19 minutes ago, BostonFNP said:

1. Most markets are not oversaturated, and even in markets that are completely oversaturated, intelligent, experienced new grads from quality programs generally don't have much trouble finding work. Do you know these "many" nurses personally?

Can acute care experience benefit a PCP? Of course. I would argue that having experience as a case manager, social worker, or visiting nurse would have equal impact on practice.

3. The point is that experience is valuable, all experience, not just the experience you have.

1) Yes, to be fair, most were acute care NPs though

2) valid point

3) agreed. IMO d/t the minimal amount of clinical hours during school, bedside care as an RN should be required to supplant the education for direct entry programs. Whether or not they are performing primary care, pharmacology, pathology, diagnosis and treatment modalities experience and exposure is gained as a bedside nurse. The BSN education alone is not enough.

[Tegridy]

I don’t see why in order to practice nurse practitioners don’t do a residency for a year or two just like physicians. I think many np would be for this as would hospitals and physicians. I know the problem is government funding but it would benefit everyone

[murseman24, MSN, CRNA]

10 hours ago, FullGlass said:

You have never worked in primary care, yet feel you can lecture me on primary care NPs.

Beauty of the internet and free speech sweetheart, anyone can say what they want, right or wrong, I don't need permission. I'm not "lecturing" you anyways, you are very defensive.

Please tell me how many NPs in California can't find a job in California.

Don't know, didn't ask any NPs in California.

That number will be very low if they know anything about how to find a job and are reasonably flexible on location. Oh, so I guess all the EVIDENCE I sent you on the PCP shortage in California is wrong?

Didn't say there wasn't a shortage. My issue is there are a ton of NPs who can't find clinical sites or good jobs because every one and their brother are NPs nowadays. Honestly, most of the people I know personally are looking into acute care. The fact the wide majority of them have trouble finding clinical sites to finish their program is telling though.

It's unbelievable that you think RN experience is required to diagnose a DKA or septic patient.

I think having experience actually treating them first hand is helpful in understanding their disease process, yes.

All NPs get a BSN, where they are learn about, and are exposed to these conditions

Really? I'm highly skeptical about the extent of the education and exposure part.

and then they all go through an MSN NP program, where we learn how to diagnose common primary and urgent care conditions. We also learn when to send patients to the ER. In primary care clinics, we do not have the equipment and many medications that hospitals have. Generally, we don't get life and death cases in primary care, but yes, I have had septic patients come in and even one with necrotizing fasciitis, and they were sent to the ER and did fine, thank goodness. There is not much we can do for them in primary care. I have personally not had a patient with DKA come in. I suggest you learn more about primary care and what primary care facilities can do before you presume to lecture me.

Noted, thanks so much.

No one is denying that experience is valuable, but the point in question is what experience is necessary to be a competent primary care NP.

I understand this and almost agree with your stance in this regard (I also believe this is the most important part of this discussion). For direct entry I still think you need some bedside experience for the pathology, pharm, diagnostic process and treatment experience. If you don't have bedside experience then there should be a residency period or something to increase the clinical hour requirements. If one is not willing to do this then they should go to PA school where you will be forced to gain the hours and the didactic portion allows for a deeper understanding of medical sciences. Also, the admissions for PA school is MUCH more selective, so this in itself would be a huge help to reduce the amount of subpar NP graduates from bad schools.

Yes, the Hopkins name opens doors for me, but that is all. I still have to go to the interview and do well in order to get the job. If I was an incompetent jerk, I wouldn't get the job.

Yes, you are not socially inept, congratulations.

I suggest you focus on how to get into a good FNP and/or PA program and work on being the best NP you can,

Nah, I'm good

as opposed to worrying about others over matters that you can't control. In addition, learn all you can about how to get a good job and develop those skills. A good NP program will offer help on this, so take advantage of this. Hopkins put a lot of time, for those who wanted help, into make sure each of us had a good resume and a very nice portfolio for job search. I took full advantage of all the help that was offered. In addition, everyone in our graduating class had a job offer on graduation from a clinical rotation. There are a lot of FQHCs in California that precept NP and PA students because they want to hire good new grads. There are also a lot of FQHCs and other health organizations in California that now offer NP residencies.

California has many excellent schools, both public and private. A California school has the advantage of having a bigger local alumni network, which can be very helpful. None of the NPs I work with, and most of them did not go to big name school, have trouble finding a job. And once one has experience, there is plenty of locums work available.

Just for the record, I'm sure you are a great practitioner and it sounds like you've found a great career path from FNP -> mental health, great job.

2 minutes ago, Tegridy said:

I don’t see why in order to practice nurse practitioners don’t do a residency for a year or two just like physicians. I think many np would be for this as would hospitals and physicians. I know the problem is government funding but it would benefit everyone

Just curious, are you a med student? You sound like a med student, or married to a physician.

[Tegridy]

20 minutes ago, murseman24 said:

Just curious, are you a med student? You sound like a med student, or married to a physician.

I was an np before and just finished my last rotation Of med school. waiting to graduate from med school and start residency (IM)

[murseman24, MSN, CRNA]

10 minutes ago, Tegridy said:

I was an np before and just finished my last rotation Of med school. waiting to graduate from med school and start residency (IM)

congratulations

[Tegridy]

31 minutes ago, murseman24 said:

congratulations

Five month vacation!!!!!!!!

[BostonFNP, APRN]

25 minutes ago, Tegridy said:

I don’t see why in order to practice nurse practitioners don’t do a residency for a year or two just like physicians. I think many np would be for this as would hospitals and physicians. I know the problem is government funding but it would benefit everyone

Nurse practitioners are somewhat stuck in trying to balance independent practice and cost-effective care: residencies would help with preparation and would make a better case for independent practice at a significant blow to cost effectiveness. Each medial resident costs $100-200k per year.

[Tegridy]

6 minutes ago, BostonFNP said:

Nurse practitioners are somewhat stuck in trying to balance independent practice and cost-effective care: residencies would help with preparation and would make a better case for independent practice at a significant blow to cost effectiveness. Each medial resident costs $100-200k per year.

That’s a good point. I think cost depends on which type of residency though. Primary care oriented residents are able to take the load off attendings pretty early on. For surgery and really subspecialized stuff they do cost more since there is more hand holding. Also depends on hospital and if attendings are lazy or not lol. NP residents may not cost as much since its primary care which shouldn’t require as much hand holding for that time compared to I guess ortho surg where residents walk in clueless

some places use residents as scut work and might profit on them. Mostly IMG heavy sweat shops