Question from a doc on NP education

twozer0, NP · Feb 21, 2016

To summarize and add:
1. Admission standards are way too low and thus there is a "boom" of RNs leaving the bedside to go to NP school.
2. Regulation of NP schools by national credentialing organizations is poor.
3. NP curriculum varies wildly from to school to school and specialty to specialty other than the basic classes. Some teach literally nothing while others teach chest tube insertion, CVC insertion, intubation etc.
4. Online and for-profit, while convenient, have led to overall a poorer education model for NPs. How man for-profit MD/PAs schools are there? Very very few.

Dranger nailed it. You ever see that commercial for hyundai (I think?!) where the guy is holding the trophy with his son and he gets a "participation" trophy after they won the championship. He then rips that off and writes "Champ" at the bottom. NP school like Dranger suggested just seems to be handing out participation trophies to anyone willing to tote them around. It's a total money grab by a lot of higher institutions and the standards for admissions are non existant. At least anesthesia has some competetive requirements and even they still get the occational bad CRNA. Just imagine how many bad NP's we'll be turning out because every Tom, Dick, and Harry went to NP school. BTW I'll do your taxes too!

mahaandai · Feb 21, 2016

Well doc, you have hit nail right over its head. Great post by you for your giving honest opinion in nursing forum.

I think you don't want to hurt the egos of know all NP program educators/professionals, who fail to see that how hard it is for fresh NP graduates to work shoulder to shoulder with doctors when they don't have necessary background and credentials to interpret, diagnose and treat patients. :yes:

All NP programs it should be necessary to complete coursework as electives from medical school which covers complete cadaver anatomy, X Ray interpretations, suturing, etc. In fact, ANCC and AANP boards should not give any certification to practicing NPs unless they have completed these basic courses and requisite clinical hours from medical schools.

Susie2310 · Feb 21, 2016

I have found that the best way to learn about the actual NP curricula various universities offer is to browse the web sites of NP programs in the Schools of Nursing at the various universities. You will be able to see the individual courses listed for each type of focus, i.e. FNP; with a short description of the course content. The programs I have looked at required 3 years of education for an RN with a BSN; entry requirements varied, and the number of clinical hours appeared to be around 600, which, as you stated, is significantly less than a physician's education/training.

If you are interested in learning more about NP practice regulations and scope of practice, I suggest going to the web site of the state Board of Registered Nursing in the state you are interested in, and looking for NP practice information. In my state this information is provided along with RN practice information.

yhl1975 · Feb 21, 2016

Hello, I am coming here to see if I can pick some information off of you all. I will state that I appreciate ahead of time the responses I will hopefully receive and hope to put them to good practice.
I am an ER physician in the southeast-ish area of the US, and usually do much travelling around. I work for various staffing agencies, usually just taking the most needed bids and such. I tend to work with many different nurse practitioners and physician assistants in the various locations, mostly in the bigger ERs. The smaller ones usually it is just me since the volume is low.
The reason I come here is because I am looking or some info on the education of nurse practitioners. Sine I occasionally lecture on ER topics at one of the local PA schools in front of medical students and Pas I have been able to get a thorough glimpse at the PA ED model, which really is not too much different than a condensed version of ours it seems. I did go to a med school here in the US which also has a PA program close by so I understand this aspect.
I have not noticed such a large gap in practice from the physician assistants that I work with though. Nearly all of them are able to suture, interpret labs, splint, suture, read most X-rays (abdominal X-rays can be very difficult to read at times, often we physicians consult rads on these). (I am also referring to flat plate x rays not CT/MRI and the such when providing the term Xray).
The gap is narrowed it seems between the PA/NP when it comes to diagnosing illness in the fast track though, I do notice it seems the PA do edge out slightly on better diagnosis (but my time is limited in the fast track, I am only there when they have a question about something, if something gets miss-triaged, or if family requests to see me, etc etc.)
But the whole point of me coming here is to ask if they teach nurse practitioners during their educational adventure how to read X-ray, suture, splint, read basic lab panels, intubate, and what not. I have looked through curriculums but course names often do not tell accurate stories in any aspect of education.
Hope I am not stepping on toes with this,,,, just looking to gather some information in an objective manner.
Best wishes

The discussion is crucial,MD asks other NP :"how can you fill comfortable to treat the patients after 700 hours clinical experience?" All this discussions regarding " I feel uncomfortable to ask NP questions about X RAY" are ridiculous.

All professionals need to work together for clients to improve health care. NP/CNS all over the world helped to improve quality care. Also guidelines and standards were changed with help of many NP /CNS in the past and now, since we are the best health educators.( were in the past, now in present and will stay in the future) Yes , may be in the ER , you fill uncomfortable with x rays.

But it is a joke!!

Best example:

Margaret Higgins Sanger was an American birth control activist, sex educator, writer, and nurse. Sanger popularized the term "birth control", opened the first birth control clinic in the United States, and established organizations that evolved into the Planned Parenthood Federation of America.Not only did Sanger live to see the realization of her "magic pill," but four years later, at the age of 81, Sanger witnessed the undoing of the Comstock laws. In the 1965 Supreme Court case Griswold v. Connecticut, the court ruled that the private use of contraceptives was a constitutional right. When Sanger passed away a year later, after more than half a century of fighting for the right of women to control their own fertility, she died knowing she had won the battle.

I feel a huge difference between primary care /outpatient clinical care and hospitals setting how management and MD'S treat NP's and PA'S.

In outpatient settings NP's /CNS are more respected and they advice and work together with all professions.

Just remember all professions just trying to do their job well, they are just like you, sweating, make mistakes, they can be annoying, they have a weakness and have power, they are not blind and deaf not more than ourselves.

Somehow physicians undead that there is no authority in front of client and his family, but still no "o"understanding other professions.

So, Patient is part of God/nature as other professions part of God/nature and we are in the same level. All are equal, there is no authority

evolvingrn, BSN, RN · Feb 21, 2016

I have seen some very incompetent new pas ( and doctors for that matter ) ..... We are all new at some point and to judge a profession as a whole based on your experience with a few is unwise. Nurses eat their own .....so I would take the feedback you have received with a grain of salt. [emoji16]

I am a new Np and I know I am new. I chose my current position because they have experience on-boarding new nps and pas successfully. I will say our FNP training is a little light for suturing and X-ray interpretation..... I did receive training but my clinical was limited to the clinic setting so very little opportunity to put it into practice

yhl1975 · Feb 21, 2016

These are some great responses. I do appreciate the help. Not having a centralized curriculum (if that is what is occurring) could be a concern. I am surprised they have not touched on such important topics such as the basic physical skills as presented above. I think we learned that in our first year of school and continued to do practice for the next 8 years until we could practice on our own.
700 hours does seem like a pretty quick route to be a provider also. I think by the time we graduated medical school we had around 5000-6000 hours of clinical experience, maybe a little less. But it was 50 or so + hour weeks for most of the year. We really did not count. Nonetheless much of our training was excessive, most of us could probably handle an ER (especially the non-trauma ERs) after our first year of residency.
I do not know much about profit organizations besides they probably, as other for profits, seek the approval of shareholders over all else.
I do not much much control over who we employ, I travel around too much, would rather not get involved, and also do not hold any administrative privileges.
The big dichotomy I notice though is the personality factor, which is present across all providers. I have met MD/DO/PA/NP that all seem to think they know it all, and then the ones who are more eager to learnâ€¦ the latter always succeed much more and get less lawsuits (at least our attendings told us that). I do enjoy working with nurse practitioners that like to learn, I let them do all the stuff they need to beef up their skills, especially on slow nights/days, because we were all new once. The ones that I work with that worry me are the ones that do not seem to want to bounce anything off of other providers or take constructive criticism. and this has a few times almost gotten me into trouble since my name is on all the charts. I did have to complain on one or two (which I do not like doing, and after multiple offences) and put my foot down stating I did not want them on my shift or I would go elsewhere/not resign my contract at that facility.
You all seem to have answered my question pretty thoroughly, but I am not sure how to adjust the problem though. As I said, it is not super-commonplace, but I have had a couple occurrences in the past year and I have only been out of residency a year also.
Again though, not to step on toes, most providers I work with are competent across all spectrums, but as you all said they may not do as good of a job sieging NP's brains (in all programs) with the needed information to provide safe care as they do pas or MD/DO. At least this is what I am hearing from the responses.
To those who are able to pull off being a provider in 700 hours that is an amazing hat-trick, btw.

NP's education is Competency-based learning refers to systems of instruction, assessment, grading, and academic reporting that are based on students demonstrating that they have learned the knowledge and skills they are expected to learn as they progress through theireducation.

There are competency based education programs for lawyers, pilots and other proffesions.

yhl1975 · Feb 21, 2016

It is ok,not to know everything, as new NP,nobody knows everything and if somebody will tell you "kill the Buddha", it is a lie.

Most important is to learn all the time, be updated as you could and feel comfortable to ask as much as you could.

All NP's that I had a chance to work with were knowledgeable,hamble and well trained. I never felt any "NP's eat their own".

Good luck and be proud about your education.

studentFNP16 · Feb 21, 2016

I've been searching for one of these schools! What school is this?

For anonymity if you really want to know just PM me. I am quite proud of my school but due to the size of enrolled students I could be inevitably giving away my name. Good luck in your program search.

Julius Seizure · Feb 21, 2016

yhl1975...huh??

Susie2310 · Feb 21, 2016

700 hours does seem like a pretty quick route to be a provider also.

I am an RN with a BSN, and I agree with you. Comparing 600-700 clinical hours in a NP program to the 5,000-6,000 hours of clinical training physicians commonly receive, and to the 10,000 hours of residencies family physicians receive, and to the rigor of medical school versus nursing school, reflecting on the large responsibility of the role of a provider left me in no doubt as to what I thought.

In my state NPs' have tried unsuccessfully to persuade the Board of Registered Nursing to remove the requirement that NPs' practice under standardized procedures; they have not been successful, as the Board's position has been that this would amount to practicing Medicine. The physicians in my state have strongly opposed the NPs' push for independence, which I agree with. I believe that NP's play an important role in health care as long as they work under physician supervision, and work under standardized procedures, commensurate with their education and training. I have often wondered at the NPs' who, with a fraction of the education and training of a physician, proclaim they are equally qualified to hold themselves out to the public, to diagnose, treat and prescribe unrestrictedly.

evolvingrn, BSN, RN · Feb 21, 2016

I am an RN with a BSN, and I agree with you. Comparing 600-700 clinical hours in a NP program to the 5,000-6,000 hours of clinical training physicians commonly receive, and to the 10,000 hours of residencies family physicians receive, and to the rigor of medical school versus nursing school, reflecting on the large responsibility of the role of a provider left me in no doubt as to what I thought.
In my state NPs' have tried unsuccessfully to persuade the Board of Registered Nursing to remove the requirement that NPs' practice under standardized procedures; they have not been successful, as the Board's position has been that this would amount to practicing Medicine. The physicians in my state have strongly opposed the NPs' push for independence, which I agree with. I believe that NP's play an important role in health care as long as they work under physician supervision, and work under standardized procedures, commensurate with their education and training. I have often wondered at the NPs' who, with a fraction of the education and training of a physician, proclaim they are equally qualified to hold themselves out to the public, to diagnose, treat and prescribe unrestrictedly.

While I don't care about independent practice, I don't think you have a true understanding of what a supervisory or collaborative agreement looks like and how that plays out in practice . There are only a few states that require standardized protocols..... So I cannot speak to that. With 20 states with independent practice, I think you will see more states going in that direction. Research looking at the quality of care NPs and PAs in comparison to MDs have consistent findings and provide a fascinating read

PG2018 · Feb 21, 2016

The discussion is crucial,MD asks other NP :"how can you fill comfortable to treat the patients after 700 hours clinical experience?" All this discussions regarding " I feel uncomfortable to ask NP questions about X RAY" are ridiculous.
All professionals need to work together for clients to improve health care. NP/CNS all over the world helped to improve quality care. Also guidelines and standards were changed with help of many NP /CNS in the past and now, since we are the best health educators.( were in the past, now in present and will stay in the future) Yes , may be in the ER , you fill uncomfortable with x rays.
But it is a joke!!
Best example:
Margaret Higgins Sanger was an American birth control activist, sex educator, writer, and nurse. Sanger popularized the term "birth control", opened the first birth control clinic in the United States, and established organizations that evolved into the Planned Parenthood Federation of America.Not only did Sanger live to see the realization of her "magic pill," but four years later, at the age of 81, Sanger witnessed the undoing of the Comstock laws. In the 1965 Supreme Court case Griswold v. Connecticut, the court ruled that the private use of contraceptives was a constitutional right. When Sanger passed away a year later, after more than half a century of fighting for the right of women to control their own fertility, she died knowing she had won the battle.
I feel a huge difference between primary care /outpatient clinical care and hospitals setting how management and MD'S treat NP's and PA'S.
In outpatient settings NP's /CNS are more respected and they advice and work together with all professions.
Just remember all professions just trying to do their job well, they are just like you, sweating, make mistakes, they can be annoying, they have a weakness and have power, they are not blind and deaf not more than ourselves.
Somehow physicians undead that there is no authority in front of client and his family, but still no "o"understanding other professions.
So, Patient is part of God/nature as other professions part of God/nature and we are in the same level. All are equal, there is no authority

What are you going on about? I infer that you believe the ER doctor was being condescending which I don't believe. And why the liberal diatribe-like anecdote?