Quality of Online NP Programs and Providers

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Tegridy

583 Posts

Specializes in Former NP now Internal medicine PGY-3.
12 minutes ago, ProgressiveThinking said:

I wouldn't mind eventually trying out a semi rural location. Lots of autonomy, high pay (especially as a CRNA), low cost of living. WAY easier to get ahead financially. Locations like these would make becoming a FNP worth it as well. I also wouldn't mind getting out of California, but all of family is here. I say this as I'm about to start a job in one of the nation's most expensive California counties next week ?

I grew up rural hates it till moved to city then now I like it. I’m in an area w around 250k now in surrounding area. Prob best of both worlds. All depends what we used to. California taxes just so high that’s what’s painful

Specializes in ED RN, Firefighter/Paramedic.
On 1/26/2020 at 9:11 AM, Tegridy said:

I’ve been through both medical school and FNP school. The online or in person part doesn’t matter. I never went to class in either. As long as the hands on skills part are adequate. The problems are the following with NP edu.
1. Some don’t have closed book tests. Open book online quizzes don’t test knowledge.
2. Lack of clinical education. 500 hours isn’t enough. Not even close.
3. Board exam too easy.
4. No residency

some schools are good. Some are bad but no NP comes out fully prepared from FNP school as they should. 500 hours for such a broad job is not enough. Especially the low amount of ped and GYN hours. 120 each? Sheesh

It’s refreshing to hear you say this. One of the most blatant hypocrisies I read on other forums is the whole “NPs get online education, how dare they” on the same page with threads about how “I wouldn’t even consider attending a medical school with mandatory attendance”..

My entire bachelors degree is online through a respected brick and mortar school. My post-grad work in my pre-req science classes have all been blended, self study with a weekly in person lab.. Its what works for my schedule and my personality..

Online didactics are the future, I just wish I didn’t have to pay an absurd tech fee in top of tuition..

allnurses Guide

BostonFNP, APRN

2 Articles; 5,581 Posts

Specializes in Adult Internal Medicine.
18 hours ago, ProgressiveThinking said:

I wouldn't mind eventually trying out a semi rural location. Lots of autonomy, high pay (especially as a CRNA), low cost of living. WAY easier to get ahead financially. Locations like these would make becoming a FNP worth it as well. I also wouldn't mind getting out of California, but all of family is here. I say this as I'm about to start a job in one of the nation's most expensive California counties next week ?

Why consider FNP vs remaining CRNA?

Specializes in Home Health, Primary Care.
On 1/23/2020 at 1:31 PM, ProgressiveThinking said:

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.

I think the OP mentioned it early on in this thread. Don't think they are giving up the CRNA life, just adding to it.

Specializes in Anesthesia.
52 minutes ago, BostonFNP said:

Why consider FNP vs remaining CRNA?

A post master's FNP can be completed in 1 year, so I've been considering it just to switch it up every once in awhile. When you work at smaller hospitals having FNP also opens up doors to do things outside of the perioperative arena depending on the state. Odds are I'll stay in California at a level 1 or 2 trauma center in an area with no shortage of healthcare providers, but it's something I've always wanted to do.

I wrestled back and forth between NP and CRNA prior to CRNA school, and while I'm glad I took the route I did, I wouldn't mind doing urgent care work on the side to stay clinically sharp and use a different part of my brain. That, and I have a connection who owns an urgent care and they said if I got it I could pick up a day here and there to help out, which would be perfect for my situation.

I still wrestle with DNP vs DNAP, PhD, FNP, MBA, or a combination of them. Ideally, I wouldn't mind being a PhD, FNP, CRNA, MBA, haha. At what point is enough though...I probably won't go back to school for another couple of years. Odds are ill get a DNP (20k) first and then go for FNP (15k) or MBA (7-11k). A hard science PhD (90k) sounds nice, but there's just too much research involved.

Specializes in Anesthesia.

If I were 10 years younger I would just take the route Tegridy did, but as a CRNA going back to med school it just wouldn't make financial sense for me unless I matched into ortho or some other higher paying specialty and I wouldn't start making real money until I was 40. That, and I actually really really enjoy anesthesia. Plus I enjoy my life outside a work, so I appreciate the online options that nursing provides.

Specializes in Family Medicine.
On 1/31/2020 at 10:58 AM, LadyT618 said:

So wait...she asks the doctor how to give (something as basic as) an IM injection, but wants to preach to the physician about medical info she found in UpToDate? Has she no shame?? I'm surprised the doctor didn't rip her a new one for not knowing how to give an IM injection. This was too much for me to read ?

That's exactly what happened! I know, it killed me.

The doctor I work for is literally the sweetest individual I have ever met. She just let it ride.

FullGlass, BSN, MSN, NP

2 Articles; 1,726 Posts

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 2/1/2020 at 4:45 PM, murseman24 said:

Eh, Sacramento is probably the best place on that list. My comment was in response to your insistence that the job market is fantastic in California. It's not. It is in the places where most don't want to live, hence, your list.

You're quite abrasive yourself there sweetheart, and I can't help but notice the strong air of superiority coming your direction as well miss Ivy League Nursing grad, it's obvious you can't handle people disagreeing with you without getting upset. How does not wanting to live in a place of 100K people make you dull? Cause I don't want to hang out at the local TGI Fridays?

What you said is very rude. Do you think it is okay to go to someone's home and say their home is crap or "undesirable?" Yet, you think it is okay to call cities that are home to millions of people "undesirable." We all have places we'd rather live in, but that doesn't make other places undesirable to everyone else, and it's not an excuse to put down different locations. Just because I personally don't want to live in a city doesn't make it "undesirable" in general.

And how do you know where people want to live? Guess what, most of the country does not live on the coast or in the biggest cities. Furthermore, the most recent data on where people are moving to, especially young people, indicates that they are moving to more affordable cities.

What irks me in general is the constant whining by some people on this forum that the job market for NPs sucks. Yet, when provided with information on where the job market is good, they complain they don't want to live in those places. You can't have your cake and eat it, too.

I have had individual NP students send me private messages thanking me for providing positive and practical suggestions for job search and also telling me that reading the posts on this forum has scared the crap out of them. When I was an NP student reading this forum, I was convinced I wouldn't be able to get a job. We have a shortage of primary care providers in this country that is only going to get worse and that includes doctors and NPs. We need more primary care providers and I am sick of the Negative Nellies out there. Anyone who really wants to be an NP and is flexible on location will have no trouble getting a good job. That is why I try to provide real information that can help people.

Furthermore, most of the people who make rude comments about cities like Fresno have probably never been there or maybe went there 20 years ago. My advice to job seekers is to keep an open mind. I was invited to job interviews in cities like Fresno, Redding, Chico, Bakersfield. My "coastal elite" friends made all kinds of rude comments about those places and told me not to even go on the interview. Well, I went and was pleasantly surprised. Granted, those places aren't for everyone, but they have many positive aspects and there are millions of people who love those places and call them home.

In addition, I became an NP to help people, especially underserved populations. I didn't become an NP to care for people in Beverly Hills or La Jolla.

The NP job market in the Western US is quite good overall. That is a fact.

Here is why NPs, especially new grad NPs, should keep an open mind about location:

1. Affordability is very important. If you'd like to be able to have a decent place to live, save some money, and eventually buy your own place, it will be lot easier to do that in a city like Fresno or Bakersfield than in a city like San Francisco.

2. Due to supply and demand, NPs in cities that snobs consider "undesirable" often make MORE money than their counterparts in more expensive cities.

3. Areas with a shortage of providers have high HPSA scores, which mean providers who work there have the opportunity to apply for federal and state loan repayment.l

4. Working in an underserved area is providing a real public service and patients are extremely appreciative.

5. Working in a smaller clinic often provides more varied experience. Many bigger clinics have primary care separated from urgent care. Women's health may be in a separate area. Working in a rural clinic, I did all of those and it was great experience for a new grad.

6. Worst case, you decide you don't want to live in that area forever. Well, get 2 to 3 years of good experience, then it will be much easier to get a good job elsewhere, and you'll have some savings.

I personally don't have a trust fund and I have to work to live. So, I am going to go where I can get a good job and be appreciated. That is what all successful professionals do: doctors, lawyers, business executives.

People move all the time, so it is hardly an impossible task. A lot of people also just rent a room in the city where they work and go home on weekends. I used to commute from LA to the Bay Area.

On a personal note, I fail to see how urging people to keep an open mind and consider various locations, as well as working with underserved populations, indicates an air of superiority. Quite the converse.

FullGlass, BSN, MSN, NP

2 Articles; 1,726 Posts

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 2/1/2020 at 5:39 PM, ProgressiveThinking said:

okay karen

Resorting to insults indicates you are incapable of reasoned discussion.

Do you think it is okay to go to someone's home and say their home is crap or "undesirable?" Yet, you evidently think it is okay to call cities that are home to millions of people "undesirable," and you put me down for defending those places and calling out rudeness. We all have places we'd rather live in, but that doesn't make other places undesirable to everyone else, and it's not an excuse to put down different locations.

Specializes in Anesthesia.
1 minute ago, FullGlass said:

Resorting to insults indicates you are incapable of reasoned discussion.

Do you think it is okay to go to someone's home and say their home is crap or "undesirable?" Yet, you evidently think it is okay to call cities that are home to millions of people "undesirable," and you put me down for defending those places and calling out rudeness. We all have places we'd rather live in, but that doesn't make other places undesirable to everyone else, and it's not an excuse to put down different locations.

It wasn't an insult, but rather a comment to point out that it seems like you become upset and offended with people disagreeing with you. Your comments do come off as snarky and abrasive, which I think is why so many other people liked @murseman24 comment. In his defense I don't think he ever called any of the cities undesirable per se, he just asked how the cities you listed were desirable, and you took unnecessary offense to it, or it came off that way at least..

FullGlass, BSN, MSN, NP

2 Articles; 1,726 Posts

Specializes in Psychiatric and Mental Health NP (PMHNP).
5 minutes ago, ProgressiveThinking said:

It wasn't an insult, but rather a comment to point out that it seems like you become upset and offended with people disagreeing with you. Your comments do come off as snarky and abrasive, which I think is why so many other people liked @murseman24 comment. In his defense I don't think he ever called any of the cities undesirable per se, he just asked how the cities you listed were desirable, and you took unnecessary offense to it, or it came off that way at least..

"karen" is considered a derogatory comment. You should apologize to me. If I seem a bit upset by some comments about "undesirable" areas, it is because I also view that as being rude, as I previously explained. In addition, I also feel it is rather insulting to the people who live in those areas. Those are my "peeps" now and it makes me angry when people put down those areas, and by extension, the people who live in those areas. It is like someone telling you that members of your family are "undesirable." While I couldn't live permanently in a small remote rural town, my patients were awesome - just the nicest and most appreciative people. I miss them.

To be blunt, beggars can't be choosers. An NP that needs a job needs to go where the jobs are. End of story. Keep an open mind and they might just be pleasantly surprised.

verene, MSN

1,790 Posts

Specializes in mental health / psychiatic nursing.
On 1/27/2020 at 11:04 AM, BostonFNP said:

Any type of national formalized residency is going to be expensive, even if it was 25% the cost of a medical resident year, given the huge numbers of NPs being churned out it would be a big chunk of change.

Smaller independent programs have had some success with residency/fellowship programs. These tend to share the cost between the resident/fellow (in the form of a stipend that is below market rate for an NP) and the healthcare system (with some work commitment post-residency).

NPs need to be careful here because adding a residency to counteract poor preparation and poor quality programs is not the best solution. All NPs traditionally had a sort of residency in that all of NP practice was supervised/collaborative with physicians; the push towards independent practice (and perhaps the shrinking of oversight even in supervised practice) is starting to fore the hand on this.


This is definitely something to be mindful of - residencies are not cheap - and most MD residents little money compared to their end pay scale. For NPs out there pushing for residencies - what pay scale you would be willing to accept as a new grad - bearing in mind a MD resident may only be making 75K/year - are we willing to accept that or less for the first 1-4 years of practice?

Should the burden be on the employer to increase on the job training or on the schools to produce graduates who don't need a long-period of residency or fellowship? I can see the appeal for specialty practice to have a residency, fellowship, or otherwise more involved training as it is unlikely that a student will have the in-depth experience in this area -- however is it desired or necessary for all areas of practice?

I have mixed feelings about independent vs supervised practice - I live/work and studied in an independent practice state. I think knowing as a student that all the responsibility could fall on me one day was huge - it really forced the building of knowledge and awareness of full-scope of practice. That being said - I also intentionally chose a practice setting for my first position out of school where I would have support, and have an excellent supervisor (MD) to back me up on my difficult cases.

I'm wondering if a graduated level of independence would be good? Requiring supervision for first x number of hours of practice or x number of years and then moving into independent practice? But I think this also needs to be done very carefully with clear expectations for what supervision looks like and how much support is/is not present.

As I noted in my earlier post in this thread - I think one of the huge weaknesses of the NP profession and transition to practice is that there is almost no research around training, early practice, and long-term outcomes in terms of patient care, provider competence, and provider knowledge/satisfaction.

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