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.
Guys in PHD ( CNS/NP) level use those theories as a basis for the following research :
since 2008 National Council of the State Boards of Nursing together with 46 Nursing organizations endorsed the Consensus Model
Uniformity is a good thing in this case and those PHD researchers are changing the reality in global nursing and global patient care.
All programs require the 3 P's in their core, as well as the inclusion of health maintenance and health promotion
New national consensus based competencies developed for:
Adult-Gerontology Acute NP
Adult-Gerontology Primary Care NP
Adult-Gerontology CNS
These competencies can be accessed at American Association of Colleges of Nursing | Home
Legal Scope of practice
　
Allows NPs to perform at their level of education and training
Avoid any charges of practicing medicine without a license
Avoid imputation of liability for medical malpractice to someone other than the NP
Accountability
Provides a basis for inclusion of NPs in the legal definition of primary care
To establish that the NP is a professional entity-not a non-physician or physician extender
To get reimbursement for services when provided by the NP
"NPs provide some care once offered only by physicians, and in most States they have the ability independently to prescribe medications." HRSA-2008
The AANP defines scope of practice for NP as:
" Nurse Practitioners are primary care providers who practice in ambulatory, acute, and long term care settings. According to their practice specialty these primary care providers provide nursing and medical services to individuals families and groups."
additional recourses regarding NP education/ training/ whether x-ray is the most important in NP education will be found in the following.
Rosenberg, T. (Oct. 24, 2012). The nurse as family doctor. New York Times.
I'm really bummed this thread got hijacked. OP, if you haven't been chased off by... whatever in the world yhl is getting at, I'm sorry the thread was killed.
I'm really bummed this thread got hijacked. OP, if you haven't been chased off by... whatever in the world yhl is getting at, I'm sorry the thread was killed.
Good point...I see other students are participating, too, and this is a really important topic. This might be another hot issue on these threads, but I'm curious what folks think about the direct entry NP programs vs. going back to be an APRN after having experience as an RN -- it's almost as if there are two types of NPs since their backgrounds are so different. Obviously, individual schools will be different, but could this be a factor in a perception of NPs not being prepared enough?
(I forgot to add I'm applying to nursing school now, hoping to get into a local entry level FNP program, so people know where I'm coming from.)
Specializes in Oncology/StemCell Transplant; Psychiatry.
Clamchow,
I believe you have the general gist.
I'm going to throw in another tidbit about nursing. Nursing, as a body, wants to align itself with psychosocial disciplines rather than biological fields such as medicine. Much of the theory base for nursing is a sort of convoluted psychology-sociology-philosophy hybrid. Why this is, I do not know. I didn't know this was the case when I entered the field or I would've probably selected the PA route since I came to nursing after another career. The push in graduate nursing is to write papers in perfect APA (American Psychological Association) formatting. Egg on my face. It's hard to sell onself as a colleague of sorts to physicians, and even PAs, when our background is largely fluff.
Nursing, as body, has done a great disservice to working nurses by focusing on inapplicable theory rather than practical knowlege. Nursing wants to professionalize itself from physician handmaidens to that of scholarly, scientifically trained clinicians. Unfortunately, most programs have failed to adopt any essential science.
While my wife is napping, and I have nothing else to do I'm going to list my nursing program curriculum to give you an idea of what I took as a RN and then Psychiatry NP. I hold another BS degree (actually general science: biology) with some graduate training as well as prereqs to a MBA program I enrolled in some years ago without finding the impetus to finish the MBA. My first career was law enforcement. I later went back, and below is what nursing required.
Undergraduate Prerequisits (not counting typical bachelor's degree courses such as history, lit, etc.)
Human Anatomy/Physiology I and II with labs. 4 semester hours each
Statistics (either from psychology dept. or school of business) 3 sem. hours
Nursing:
Foundations 5 hours - how to interact with pts, wipe butts, change beds, take vitals, and address "core" health issues such as defecating, urinating, eating, and drinking
Health Assessment 3 hours - was actually a NP level course but for undergrads, included all the bells and whistles but not provided adequate practice hours
Gerontology 3 hours - learn about the psychosocial and physical elements of aging
Pharmacology 3 hours - half the course wasted learning calculations, the other have very rudimentary mechanisms of actions, common drugs, etc.
Pathophysiology 3 hours - interesting for the layman but still of insufficient depth
Mental Health Nursing 3 hours - essentially how to talk and walk with the mentally ill, very little psychopathology taught
Research Methodology 3 hrs. - basic research class akin to any BS degree research class
'Acute Care" 9 hours - cardiovascular, respiratory, gastrointestinal, renal, endocrine perhaps some other systems, focus on health teaching, prevention
Issues and Ethics in Nursing 3 hours - cakewalk class of no substance
Community Health 5 hrs - really have no idea what this was about but it wasn't epidemological, rotated in the health dept., STD clinic, VA, home health,
Women's and Children's Health 7 hrs - combined OB/Gyn, Peds course. Very little peds. OB far too indepth for the four weeks given. my greatest overall weakness in healthcare knowledge
"Complex Care" 7 hrs - ortho, neuro, review of acute care, and emergency/critical care-lite
Synthesis 1 hr - review for nursing board exam/ opportunity for military recruiters to hound us for the rest of the semester
Leadership & Management 4 hrs - very very base course in healthcare admin and some really theoretical leadership concepts
Master's/ NP
Research Methodology 3 hrs - exactly the same course and book as in undergrad
"Advanced Pharmacology" 3 hrs - one of the most practical courses I've ever taken although not in comparison to med school texts
"Advanced Physiology and Pathophysiology" 3 hrs - had high hopes for this one but was utterly disappointed, largely read the book and take online quizzes with a comp. final.
Intro. to Practice Management 1 hr - name says it
"Advanced Resarch Utilization" 3 hrs - more research centered around performing research and drafting policy/practice changes and implementing them in a practice environment (base)
Nursing Theory 3 hrs - gut wrenching, paper driven course somewhat traumatic to my education
"Advanced Community Concepts" 2 hrs - no idea what this was about really, but I had to draft a health promotion plan for heart disease in some BFE town I've never been to
Advanced Practice Mgmt 1 hr. - name says it
"Advanced Health Assessment" 3 hrs - basically learning assessment techniques, fairly in depth and comprehensive likely physician equivalent with anatomical models, however, after this semester little opportunity to go on practicing or utilizing new found skills; I do chase my wife, kid, and dog around with the otoscope and opthalmoscope from time to time
something like Intro to Advanced Practice Mental Health 3 hrs- largely devoted to psychotherapeutic communication, cultural diversity, human development, miscellaneous psychiatry-related theories
Psychopharmacology 3 hrs - one of the more useful courses I've taken, name says it. the epitomy of my present practice.
Mental Health Advanced Practice I or a similar title 3 hours - introductory psychotherapy, psychopathology, evaluation, and diagnosis
Some kind of title for a practicum course, I forget the credits - essentially psych evals, individual and group therapy (I detest group therapy)
Mental Health Advanced Practice II hours become vague here - continued psychopathology and diagnosis
Practicum hours divided between peds and adult/geriatric
Mental Health Advanced Practice III again credits are vague at this point - intrusion of family therapy into the education, more psychotherapy and counseling-oriented techniques and theories
Practicum hours devoted to running our own patient load, i.e. here's your patients, now treat them. (eval, referral, therapy, meds, CT/MRI, labs, sleep study)
I realize it's very psych oriented, but it gives you an idea of how fundamental NP training is. Unlike psychiatrists, I received no rotations in neuro or medicine. I'm grateful my training was with the VA system with staff who were kind enough to expose me to consult-liason psych, inpatient psych, outpatient, psych, addictions, and whatever else I wanted to learn about. My RN experience was in the ED and urgent care which gives me a perspective and insight many psych-dedicated RNs and NPs are oblivious to. I'm grateful for the primary care exposure and education I received in those settings usually from PAs although I wish I had more of it on a higher level, if you will. What you may not know is that NPs are not merely "specialized" generalists, i.e. we're very compartmentalized by specialty and related tradecraft. NP school does not include the broad coverage of MSIII and MSIV, and nursing school (RN) training in related environments is largely devoted to fetching water and wiping butts as well as the nursing academic coveted "care plans." If you want to be a psych NP, you get psych training only. If you want to be a neonatal NP, you only get neonates. Women's health spend all their training looking up the tunnel. Peds folks never seen an adult, etc. Peculiarly adult NPs are now spending all of their training focusing on geriatrics sans exposure to something like a 30 year old guy with lumbosacral sprain.
PsychGuy,
Based on the courses you listed, I think I am in the exact same Psych NP school as you were. The curriculum is identical. Did you attend school in the southeast?
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. 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 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.
My two cents about this, as someone who has worked in the provider role and been involved with both student NPs and MDs as well as novice providers:
You are investing in your education and training, heavily. You state that NPs have a duty to learn. You seem to feel that working full-time is holding you back. So why don't you cut down your hours and focus more on your education/training?
You will be perceived as a novice. You will be a novice. You will need to demonstrate your competence. MD/DOs do this a residents. NPs have to do this in practice. You the more prepared you are the quicker that transition will be. You are in control of that.
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.
Based on the courses you listed, I think I am in the exact same Psych NP school as you were. The curriculum is identical. Did you attend school in the southeast?
You are investing in your education and training, heavily. You state that NPs have a duty to learn. You seem to feel that working full-time is holding you back. So why don't you cut down your hours and focus more on your education/training?
Because I am the sole provider for my family. Hopefully by the time I start clinicals I won't be. Life continues, whatever the dream.
Specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.
Doc, I've got a different perspective being a different type of doc/RN/NP grad. In a nutshell, the programs are different but they do have national standards otherwise how could there be national boards. Right? I can tell you that the NP background is severely lacking in basic sciences way before graduate education. Nursing education upon which NP programs are based are more clinical and practical than science based. Some schools may be different but my graduate education had ZERO biochem. I had a year of biochem in my other profession as well as all the same pre-meds you had. NP's are not required to have any of that. So they are taught to diagnose and treat more as an apprentice than a scholar although some of the programs are heavy on research. Their backgrounds tend to be dictated more by their clinical preceptors (and experiences) than the college curriculum they completed. So in essence you may have a very competent NP who doesn't know "why" they are doing something but does know exactly "what & when" to do it. My preceptors were varied but I had physicians, PA's, and NP's. By far my most rewarding experiences were with physicians and PA's. However, I can say that one NP in particular was extremely competent but she was also the first NP ever in this state and still practices. In regards to x-ray interpretation I had over 30 credit hours of just plain film x-ray, more if including basic MRI/CT. I've taken thousands of films myself and interpreted them. My NP program had one semester that was divided b/t office procedures, suturing, and x-ray all rolled into one. I got credit for that one and just moved on. NP's understand the reports but will have difficulty reading, interpreting, and taking x-rays. However, in most situations they will never be required to do that anyway...refer, refer, refer. Except, of course, in the ER--that's not an option. I would say that those NP's that come out of Acute Care NP programs are much more suited to your environment then a FNP who just happened to get hired into your department. FNP programs tend to frown upon acute care preceptor experiences but yet graduates of their programs have to apply for acute care jobs. All in all I think PA's are trained to be a true extension of the doctor whereas NP's are trained to be what they are...advanced practice "nurses"...but still nurses at their core. So you, as a supervisor, should still be able to work well with both but knowing that NP's and nurses backgrounds are more homogeneous then compared to your's and a PA's medical background with will help you dictate what cases you need to step in on and which ones could be served just as well by either an NP or PA. Not being in your environment though, I would assume that either of the mid-levels should be equal after a few years on the job--really no excuse for that except lack of motivation or laziness. Thanks for asking the question as this has been informative for me hearing other NP's perspectives as well.
yhl1975
134 Posts
Guys in PHD ( CNS/NP) level use those theories as a basis for the following research :
since 2008 National Council of the State Boards of Nursing together with 46 Nursing organizations endorsed the Consensus Model
Uniformity is a good thing in this case and those PHD researchers are changing the reality in global nursing and global patient care.
All programs require the 3 P's in their core, as well as the inclusion of health maintenance and health promotion
New national consensus based competencies developed for:
Adult-Gerontology Acute NP
Adult-Gerontology Primary Care NP
Adult-Gerontology CNS
These competencies can be accessed at American Association of Colleges of Nursing | Home
Legal Scope of practice
　
Allows NPs to perform at their level of education and training
Avoid any charges of practicing medicine without a license
Avoid imputation of liability for medical malpractice to someone other than the NP
Accountability
Provides a basis for inclusion of NPs in the legal definition of primary care
To establish that the NP is a professional entity-not a non-physician or physician extender
To get reimbursement for services when provided by the NP
"NPs provide some care once offered only by physicians, and in most States they have the ability independently to prescribe medications." HRSA-2008
The AANP defines scope of practice for NP as:
" Nurse Practitioners are primary care providers who practice in ambulatory, acute, and long term care settings. According to their practice specialty these primary care providers provide nursing and medical services to individuals families and groups."
additional recourses regarding NP education/ training/ whether x-ray is the most important in NP education will be found in the following.
Rosenberg, T. (Oct. 24, 2012). The nurse as family doctor. New York Times.
Retrieved from http://opinionator.blogs.nytimes.com/2012/10/24/the- family-doctor-minus-the-m-d
Van Lueven, K. (2012). Population aging: Implications for nurse practitioners.
Journal for Nurse Practitioners, 8(7), 554-559.
Zaccagnini, M., & White, K. (2011). The doctor of nursing practice essentials: A new
model for advanced practice nursing. Sudbury, MA: Jones and Bartlett.