Question from a doc on NP education

Specialties NP

Published

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 noticed at many of the facilities I work at, a higher than average (in comparison to PA and other docs) the nurse practitioners often (not a total majority) seem to be oblivious to many aspects of ER level care. Some are unable to understand the interpretation of a basic set of lab panels, X-rays, and some are unable to suture well, if at all. There are a few that are Excellent at what we do (the term we used because we are a team and I dislike the dichotomy many use separating physician practice from other types of providers since it just stems unneeded conflict and perpetuates social gaps).

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.

I would feel rather rude asking my coworkers these questions, since they may take it as demeaning and I like to maintain great relationships with the other providers. So again, here I am looking for a bit of info on what type of education they provide nurse practitioners in school (we use mostly FNPs in er) to see what you all thought of the situation.

Hope I am not stepping on toes with this,,,, just looking to gather some information in an objective manner.

Best wishes

Np schools need to revamp their program if this desire to use np is going to work--

Well, this is one of the most depressing threads I've ever read on allnurses. I had no idea some of this stuff was not covered well in NP education. I am left wondering what they DO teach in some of these programs. I expected a stirring defense and explanation (along with a few buttons pushed that I could skim past), not general agreement. The reference above to APA style makes me shudder. This is definitely not a course of study I am ever going to pursue. Sometimes I have doubts as I watch colleagues leave the bedside for NP programs and $100,000 salaries.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Well, this is one of the most depressing threads I've ever read on allnurses. I had no idea some of this stuff was not covered well in NP education. I am left wondering what they DO teach in some of these programs. I expected a stirring defense and explanation (along with a few buttons pushed that I could skim past), not general agreement. The reference above to APA style makes me shudder. This is definitely not a course of study I am ever going to pursue. Sometimes I have doubts as I watch colleagues leave the bedside for NP programs and $100,000 salaries.

I can't speak for the others but my post wasn't meant as an expression of complete disapproval for NP education. After all, I am a nurse practitioner myself who will say without any hesitation that I've had a satisfying career choice given that at the time I was deciding on graduate school I could have also gone with the PA route. There are also many successful NP's out there who have achieved far greater leaps in their clinical skills than I have.

Before embarking on a career choice, you have the be aware of the pros and cons of the field you are getting into. Having this knowledge beforehand not only helps you with making the decision to pursue the career or not but should you decide that the advantages outweigh the deficiencies of the career choice, you should be able to navigate a game plan to increase the likelihood of your success.

I would say that the most sound advice having seen fellow NP's start from being a novice to confident provider is to start with picking a good school with a solid reputation for clinical training based on adequacy of resources for clinical rotation. Medicine is dynamic so you must keep up and brush up on your deficiencies by seeking opportunities to learn outside of NP training. It's also best to start out in a setting where you know your learning is going to be supported by mentors. Even physicians who graduate from residencies and fellowships must start at a junior attending level.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

And why would APA style alone scare someone? There is always a required "form and style" of writing in professional publications. This becomes important if you are to submit articles for publication. I feel that's a quibble I can live with. I also know everyone hates nursing theories. I personally feel that the emphasis on these in NP school is becoming less important at least from the NP students I come in contact with (I work at a university hospital with an affiliated school of nursing). After all, have you heard of any new nursing theory since the 1980's that has grabbed the attention of academics in nursing?

New nursing theory since the 1980.

http://www.fcm.unicamp.br/fcm/sites/default/files/whither_nursing_models.pdf

http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826119162/9780826119162_chapter.pdf

In order to submit any research as Thesis or PHD,the researcher needs to use a theory as a basic idea. As I wrote before just "google search" how many Principal investigators in National Institute of Nursing Research and Agency for Healthcare Research & Quality and other organizations. Since 1980 this "new nursing theories" changed guidelines, regulations and clinical pathways in treatment, management and prevention. As an example you could "google search" DNP Marry Moller CV.[h=3]Good Luck.[/h]

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
New nursing theory since the 1980.

http://www.fcm.unicamp.br/fcm/sites/default/files/whither_nursing_models.pdf

http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826119162/9780826119162_chapter.pdf

In order to submit any research as Thesis or PHD,the researcher needs to use a theory as a basic idea. As I wrote before just "google search" how many Principal investigators in National Institute of Nursing Research and Agency for Healthcare Research & Quality and other organizations. Since 1980 this "new nursing theories" changed guidelines, regulations and clinical pathways in treatment, management and prevention. As an example you could "google search" DNP Marry Moller CV.Good Luck.

I am not arguing that there aren't new nursing theories being thrown out nowadays. Sure, you guys use those theories as a basis for whatever research you are doing at the PhD level. I just don't see them causing a stir at least in the NP field. I don't see those names being invited as keynote speakers in NP-led conferences. As more and more NP's in practice focus on human physiology and the medical sciences as the basis of their actions, there will be less emphasis on the philosophical gobbledygook that these theories address and still be a holistic provider.

I did my ACNP in 2003 and had a clinical instructor do site visits while I was in a Cardiology rotation. She saw me present to the attending and discuss my assessment including differentials and plan on each of the patient I saw. After I was done she pulled me aside and asked me what nursing theory I used with each patient I saw. I played the game and blurted out whatever name came to mind with a little BS thrown in the middle and she totally bought my shpiel.

I now work in an ICU where we have ACNP students rotate to us and present to a team with physicians just like I did back then. Luckily, I don't ever see the same kind of clinical instructor asking the same question I was asked back when I was a student. Our ACNP students get pimped as if they were medical students and house officers. I think slowly but surely a lot of that nursing mumbo jumbo will go away at least in the way NP's are trained.

My anecdote was defined as a reminder about past events, it is often proposed to support or demonstrate some point and make readers and listeners laugh. While any professional person jokes regarding other professions( NP/PA/students/fellows/others) that they are less trained/ has loose skills and other "bushtit", NP/CNS are doing clinical research in ]National Institutes of Health (NIH) as Principle Investigators.( just "google" how many nurses are there...wow)

The fact is: physicians lost "control" for prescribing authority." It is not once upon a time" issue. All this only because of too many law suites, management policy changes and high cost to train MD and then to pay for MD/DO treatment.

NPs /CNS are chipper and much better in quality of care, preventative care specially for chronic patients in outpatient settings.

What can we do if patients like us, trust us and prefer to be treated by NP's/ PA's?

Jealousy, that NP's are so successful will not help to patient care.

I had not thought specifically about using anecdotes in my writing. I will from now on. They would work well in both fiction and nonfiction.

Thank you!

please attempt to check your spelling and grammar if you want readers to take you serious

fill....feel*

chipper... Cheaper*

suites ... Suits

and gather your thoughts before you throw a fit!

Specializes in Telemetry.
please attempt to check your spelling and grammar if you want readers to take you serious

fill....feel*

chipper... Cheaper*

suites ... Suits

and gather your thoughts before you throw a fit!

Eh, I'm usually pretty annoyed by poor spelling and grammar but I believe English is a second language for the member in question so I cut her plenty of slack. Especially compared to other posters who were born, raised, and supposedly educated in the USA.

It needs to be a standard across the board. Online schools with flimsy clinical requirements should not be tolerated.

I am presently finishing up my Nurse Practitioner education at one of the best NP schools in the South East, and I had to take a whole semester long class on reading general films (chest and abdominal), suturing (Simple interrupted, vertical/horizontal mattress, running suture, and figure 8 stitch) and interpreting diagnostic lab values. However, it is sad that this is not the general educational curriculum that is set around the country. At this present moment there are online schools where a nurse can get their Masters without ever having to show up on campus more than a few times.... How could they ever educate a competent provider is beyond me. Employers should definitely inquire about school, clinical experience, and RN experience prior to hiring.
Specializes in Psych.

As a nurse, the first thing I must say is wash your hands. We must never forget what Florence taught us all. Secondly, in any given situation, one's qualifications do not determine the patient's best outcome. Education is only as good as how well an individual can match their learning to the current circumstance. If all members of the team are not respected, then patient outcomes are compromised.

I was once a junior RN in small rural ED and we had a trauma patient who was operating a motor cycle and was involved in a collision with an automobile. He could not maintain his BP and his abdomen was distended. A junior doc was on call and he refused to call in the surgical Consultant. I was adamant that the patient had ruptured his spleen or had a liver laceration. I was hands on and pushing fluids and could not convince the senior nurse or the doctor to call the surgeon. Guess what happened?

I also have memories of a night shift with a junior doc who was at loss as to how handle a patient with acute CHF: acutely SOB, severely tachycardic and having a complete anxiety attack (trying to pull out lines and run) with a deteriorating PO2 on 6L NP. I wanted frusemide, morphine and GTN and he wanted "to think about it" and to consult his resident. Keep in mind that I am not a Nurse Practioner.

I am not aware of any data that would suggest that a specialist Nurse Practioner is any less competent or effective than a MD trained in the same field. I am happy to be enlightened.

Specializes in critical care.
I am quite unsure of the context on a few of the responses, mostly by yhthr. The context of his/her posts seems rather difficult to follow and am I not sure of the point he/she is trying to provide.

I'm not sure any of us understands yhthr. Whoever he/she is, this thread is a good one and I hate to see it hijacked.

clamchow, I appreciate you starting this thread and the way you are approaching this topic. If I were to generalize, FNP offers flexibility for specialty changes (it is generalized) and it is available at pretty much any university with graduate nursing programs. In fact, my alma mater ONLY offers FNP.

Obtaining an RN is severely lacking in thoroughness of education as well. We get it all thrown at us quickly and figure out after we graduate that our education was "baseline" only. Then hospitals get tasked with teaching us how to really be nurses.

In my experience, the best doctors to work with are willing to hear what others have to say, and are able to discuss things respectfully. I can tell you fit that description, and I assure you the nurses you work with appreciate it.

Specializes in critical care.

We do specialize, and we do not come out of medical school knowing everything. An example would be a farmer who has tended his field to all crops, is able to grow all crops in his field, but his field is not able to be excellent or practical at growing a specific crop, and thus is not economical for baseline use. Freshly minted docs prior to residency are as that, just minted fields ready to become accustomed to growing one crop to the best of his or her ability. The crop would be the product of a finished resident (the resident's work), the early field as of a newly graduated MD/DO, and the finished field as a resident who has completed residency. The farmer could be considered a conglomerate of those who have trained the doc/resident/etc.

This is an excellent description and I imagine it fits newly licensed NPs well. I'm not sure because I'm not there yet. [emoji5]️ But, it is definitely how I felt when I started as an RN.

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