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.
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.
Thank you! English is my language number 3. And I need to improve my grammar.
Part of the reason medicine takes a long time is because physicians want to control the market. Residency slots are limitedand as a result you can only churn out a capped number of attendings per year. This of course puts demand much higher than supply. A urologist that I work with told me that his field is going to be taking a hit. He used the term "sobering" when explaining to me that over half the urology workforce is over 50. Now thats not a bad thing but considering you can only churn out around 170 per year, how is that going to fullfill the duties of providing care to those who need it? It certainly wont be met by 170 attendings per year. He said they are looking at ways to combat the future problem in his specialty (one I plan on doing).
So this raises some questions.
1. Does medical school really need to be 4 years? Like I mentioned in another post, does that class in embryology really translate to how an orthopedic surgeon fixes bones? Does the pathologist even remember the cranial nerves and what they innervate (possibly?). I see a society now that is relying on specialist for virtually anything. You have chest pain you see cardiology, you cant pee you see urology, my sugars are high you see an endocrinologist. I know that its helpful to have a good background, but 4 years of it seems like 1. a waste of money and 2. a waste of time to be educated on something else that is useful
2. Removed the federal funding for residency and make it private. Several university hospitals could support this without a problem. The government could too they are just cheap and like to waste money on stupid crap.
3. Also mentioned in my previous post is how RN experience can help the future NP to become aware of situations experienced. I know an RN's job is to not order or interpret tests but this often overlaps for some. For example a doc orders a cbc, ptt/inr, chem panel, serum hcg, pelvic ultrasound on patient with lady partsl bleeding. Would the nurse understand this situation the same as how the doctor understands it? I mean if they are going to be taking care of the patient, I would assume they would know why we are ordering these tests as also what is abnormal with them. Sure they arent going to be reading the ultrasound (thats what the radiologist is for) but I would hope they could interpret the labs as abnormal and report to the attending (something you will also look at and make your next move). Say they now have a threatened abortion, OBGYN will now be consulted. I fail to see how an NP could not perform this same action.
NP's can be trained the same as how a physician can be trained. The bulk of your knowledge is from residency and having a "lived experience". Mistakes will make you stronger, like missing that first headbleed from a lucid patient who signs out AMA, lessons learned and archived for future use. A lot of NPs get it, we have been there before and we know where we are going to the future. Physicians have more knowledge on a broad spectrum, albeit a lot of it useless depending on what they specialise in. Also comparing and attending to a new NP is apples to oranges. You have had 4+ years of provider experience in ordering the wrong tests and making bad judgement calls to get it sorted by the time you come out. NP's might have a nursing background to help, but they havent shouldered that responsibility the same as you for the same amount of time. Compare an NP five years out with an attending and see how similar they are.
I agree with a lot of the previous posters in that some of our education is total garbage (theory, research, etc). Unless you plan on doing it for a living, why would I need to learn how to set up a research study. I really could care less about that. Sure I can read the litterature and see if its viable but I dont need a class to explain how to do these things, its just wasting my time. Also one of my biggest gripes about nursing research is that a lot of it really doesnt apply. For example I was reading a study about Kolcaba's theory of comfort in where psych patients were offered warm blankets to see if they would have enhanced comfort and decrease their irritability or sway depression. Does this really freaking matter in the grand scheme of things? What type of knowledge that was created by this study could be found useful? A lot of it sounds like common sense.
I'm in an FNP track, and I don't get a lot of training in acute illness and injury. There is more recognition of abnormality and when to warrant referral to specialty care or for emergency treatment. FNP programs specialize in management of primary care patient populations. When I finish, I will be able to suture and do some GYN procedures, but if I want to continue in ED (where I currently work), I would likely take a longer orientation or NP residency (which are scarcely available and pay peanuts). Or, I could pay out of pocket for courses in Xray interpretation.
As some other nurses have specified, it depends on what you bring to the table. I have worked as a nurse for 6 years, and I am relatively comfortable with chest x-rays. I know my labs. I am comfortable with the meds, labs, and imaging for the differential dx we order in the ED. Personally, I feel that one year as an RN is not long enough for NP training, but I digress...
Dr. clamchow, thank you for starting this conversation so politely and insightfully. It's one we need to have. What I will say however, is that this topic touches a bit of a nerve among nurses. Mainly, I believe, is because we've spent our whole professional lives being told we're not good enough. Just a diploma nurse? Get an ADN. Just an ADN? Get a BSN. Just a BSN? Get an MSN. You're an MSN? Well, your education is insufficient and lacking in comparison to PAs. We're treated appallingly on all levels and so nursing collectively has become a big open sore to many of us. That said, I take absolute pride in the fact I have clawed my way to where I am...a second year Acute APRN student. I'm doing my best to learn to be the very best provider I can, and it's tough, especially when I'm working full time. If the education is lacking then it's a shame that NPs are the ones who have to take the brunt of that by being viewed as inferior. All new NPs have a duty to learn and seek out information, which we do, but I had hoped to finally get some autonomy and respect once an APRN and this looks like it isn't going to happen.
I believe that APRN education needs to be standardized and the entry criteria made stricter. I am concerned for my future and sometimes I wonder if I should have signed up for this. I am concerned I will be unprepared to perform at a provider level, not because my education is lacking, but because of how I will be perceived by MDs once I graduate. I've been a nurse for 25 years and a critical care CCRN nurse for 10. I have seen the disdain that some doctors (and some PAs) have for nurses (present company excluded) and I worry about being made to feel inadequate or stupid on rounds because of what I've experienced. I just want to be respected and to understand my job and how to treat a patient at the very highest level and have the opportunity to ask questions and learn. I'm tired. It's been a long road to get here. I hope I have the energy to continue as I don't want to be a bedside RN anymore. I feel like I have a fairly good understanding having worked in critical care for so many years. I want to insert chest tubes and place arterial lines. I want to run a code. I want to order epi gtts and pushes of bicarb. I've assisted millions of times and it's time. I want to learn to read xrays better. I have been quite shocked at how my very prestigious and highly ranked school has mostly left me to teach myself. I had hoped for more. I hope that clinicals will give me that deeper experience but time will tell. Be kind to nurses. It's tough.
Specializes in FNP- psych, internal med, pediatric.
Hi Doc,
You ask a pivitol question IMO. As a Nurse Educator, now, Post-MSN FNP certificate seeker, I asked this myself! I worked ER and saw what you saw and I worked med/surg, community, pediatrics, and women's health and asked myself why are skills so BROAD from specialty to specialty or in some cases, lacking. What is going with schools is that there is a general consensus and agreement that all FNP focus should be directed to outpatient family care/AKA fast track. The only time you really see a FNP with ER skills like suturing and x-ray knowledge is IF the hiring agency sends them to a quickie med class for these specialized ER/trauma skills. The only place these skills are commonly acquired in school for practitioners is if they request an ED experience when they can pick a specialty during clinicals or if these are Acute Care Nurse practitioner students. Hope this helps! There are VERY real differences in schools and syllabi for that matter! Some NP schools do not even require contact with OB patients or geriatrics so again, that lack of expertise is more apparent until they (FNP's) get the exposure in practice. Best to all and hopefully this was not distasteful to anyone. My intention is to be objective on the matter of education.
Hi I'm just a student. I found this discussion really interesting though since I intend on obtaining my ACNP in pediatrics (that may change when I have more experience as a student nurse/future nurse, but that's what I want right now). How I feel is that it's too easy to become a PA (besides being accepted in a school), not an NP! I think theory is very important, and lacking in the PA programs. And I want to see more clinical hours for NP programs. Some of these replies made me want to say though, "Not in my school!" because they ARE teaching us more than just check vitals before giving meds and we are going deeply into pathophysiology. Our patho class is the same one that premed majors are taking. And we spend a great deal of time on Assessment, using clinical data from labs and diagnostic tests, with a great deal of emphasis on how important it is and a reminder that "most of the time you won't do this until you're an NP."
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 mean the opposite of what it sounds like: APA style is so basic that the fact anyone would even MENTION it as being an important part of NP school makes me think I would be miserable there. I got a BA at a liberal arts college before I studied nursing. We used APA or other formats, depending on what was standard in the particular field of study, without any particular emphasis or class time being spent on it. You use the style guide, you write the paper. In contrast, the class I had to take in writing during nursing school was mostly about practicing APA style, which the instructor, an MSN/WHNP, did not have a good handle on. I wouldn't want to waste my time with similar classes or with instructors who weren't qualified to teach writing.
In many NP programs I wouldn't really expect suturing to be a big emphasis--that's one of those things anyone can learn, like starting an IV, not a higher thinking skill. What I'd expect from an NP program is a really thorough education in assessment and diagnostics. Is that present? At the best schools? At the ones churning out FNPs?
Kopp, Sheldon (1972). If you meet Buddha on the road kill him! NY: Bantam Books. There are a variety of examples that show a dogmatic guru. Read the book and you will understand: weather x-ray interpretation is the most important in NP education/traning .
Free facts don't change people's attitudes (examples are: Renaissance, Paracelsus ,updated clinical research by DNP's PHD's NP after 1980. It is easy to write "correct you spelling"!!!
Hi I'm just a student. I found this discussion really interesting though since I intend on obtaining my ACNP in pediatrics (that may change when I have more experience as a student nurse/future nurse, but that's what I want right now). How I feel is that it's too easy to become a PA (besides being accepted in a school), not an NP! I think theory is very important, and lacking in the PA programs. And I want to see more clinical hours for NP programs. Some of these replies made me want to say though, "Not in my school!" because they ARE teaching us more than just check vitals before giving meds and we are going deeply into pathophysiology. Our patho class is the same one that premed majors are taking. And we spend a great deal of time on Assessment, using clinical data from labs and diagnostic tests, with a great deal of emphasis on how important it is and a reminder that "most of the time you won't do this until you're an NP."
You have no idea what you're talking about. Premed majors? Who gives a crap about what they're taking? As a RN, you are seeking professional training. Premed majors are checking boxes for admission requirements and struggling to get the knowledge to pass the MCAT and pray every day about being accepted into a medical school somewhere. I'm so sick of nurses saying they took the same thing as premeds. Big deal. As a NP, you don't want to EVER tell anyone that a required course of your study was the same premed kids were taking. You're looking for comparability to medical school - not undergraduate biology and chemistry.
I took the same stuff because I wanted to. My faux pas was that I selected a different major and took several geology courses in places of organic chem, but I wasn't on the med track back then. I was just a kid on an academic scholarship with no direction - I took what sounded fun. Then I left and entered an entirely unrelated field before coming back to healthcare.
Btw, it is not too easy to get into PA school. There are less PA programs thus more demand over supply. Competition is fierce. My wife's little sister is trying to get into PA school and jetting around the country to interview without any acceptance thus far. I filled out an online application and was accepted into a state NP program without so much a question.
In economics, the demand curve is depicting the relationship between the price of a certain commodity and the amount of it that consumers are willing and able to purchase at that given price. It is not easy to get to PA school true - true. Your relative should "shadow PA's" and ask references from them. Also any experience in research ( clinical biology/ chemistry lab) could be helpful too, just like for MD/DO school. The research experience could be short 3-4 weeks in summer program like Brookhaven National Laboratory or National Institutes of Health Marc U-STAR some research programs are free. Good luck to your relative in PA training. Wonderful medical career pathway.
yhl1975
134 Posts
Thank you! English is my language number 3. And I need to improve my grammar.
Will be done!