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

Having been a nurse and having a daughter (RN BSN) currently working on her FNP I suggest you take into the consideration the (F) in FNP. Since I don't think you would expect a GP to do an ORIF you might be reaching a bit.

Since you are South Eastish, a visit to the University of Central Florida in the Orlando area might be helpful or even a Phone call to the Dean of the program might help.

Please don't take these comments as rude or sarcastic as they are not meant to be. I have been cared for by PA's since the Air Force in the 70s and I like them because I usually win the arguments and the medical director usually tells them not to argue because they won't win. As far as basic lab values I'd chalk it up to laziness because I had to learn them and on paper my daughter out ranks me lol

Good luck

I think a major issue that is being overlooked is practical experience. Jumping from RN to FN with no pause for working experience seems to be the culprit. School to school with clinical don't prepare anyone for anything but a piece of paper. Their has to be some work experience involved. In the case of my daughter it was 3 years on med-surg and 2 years at Hospice. In the olden days there where no GN's in specialties. You did your time on Med-Surg then moved from there. I understand there is a shortage of RN's but PT safety shouldn't suffer. Think carefully your going in for surgery and the Nurse Anesthetist was never a working nurse. I leave a trail of poop getting my butt out of the OR

Regretfully, nursing education has become a bit of a joke. It is more focused on paper writing than on learning useful knowledge.

It is no surprise to me that you find a PA better prepared. I only pray that the people that are destroying nursing soon retire and are replaced by people who understand that nursing education must change and that these papers and postings are a waste of time and are the wrong direction.

Just one small statement. In the late 70s BSN students were taught that they were going to be bosses. This I know as my college girlfriend was a student at Adelphi University perceived to be the top nursing school in the region. These 4 year RN'S didn't see a clinical until 3rd year. Meanwhile the Associates degree nurses were considered inferior and we're not hired by private hospitals but by county hospitals. If it was my choice an Adelphi Nurse wouldn't touch me unless I was unconscious. I was in the law eforcement time of my career and was assigned to ESB and it not only my preference but most of the residents also to work with a 2 year RN. Over the last 35 years I don't see much of a change in attitude although a dear friend of mine after 10 years as the Director of a large hospitals ICU department which covered all. Decided to get her Master's in Healthcare IT

Doc,

It really does depend on if your dealing with a Family NP or an Acute Care NP. As an Acute Care NP I did 3 of my semesters at Brook Army Medical Center in San Antonio with one of their ER docs along with splitting my time in the Trauma and Surgical ICU's. As you can imagine I saw a huge variety of cases that included intubations, line placement and management of problems, lumbar punctures, reading of xrays, vent management, interpreting labs(I spent 10 yrs in various ICU's and ER's as an RN before going back to school). Unfortunately, a lot of it was left up to the student to find their own experiences. I spent an entire day outside the OR's just to get intubation experience. None of my fellow students thought to do this. I had learned quite a bit before going back to school and felt pretty knowledgeable about procedures prior too going back as I would always try to find docs who like to teach and would help them place lines, chest tubes, etc. So I would say it depends on the NP or student and how much they want to get out of their program. The only down side to being an Adult-Geri Acute Care NP is I cannot legally see children. While working fast track the PA saw the kids and I saw most of the adults. Now that's not to say I didn't with my supervising physician while in the ER and I sutured a couple of kids up and helped cast another. In my Advanced Assessment course I had to have so many hours of children/women/geriatrics. As far as my didactic courses I did have an entire semester on procedures/labs/xray/chest tube placement, etc. Hope this gives you another perspective.

Specializes in Outpatient Psychiatry.

It seems clamchow has gone back to the bottom of the sea.

Specializes in critical care.
It seems clamchow has gone back to the bottom of the sea.

Nah, if he has shifts like the docs at my hospital do, it's a struggle fitting in sleep. He popped in again yesterday I think. (He? She?)

Specializes in Adult Internal Medicine.
I think a major issue that is being overlooked is practical experience. Jumping from RN to FN with no pause for working experience seems to be the culprit. School to school with clinical don't prepare anyone for anything but a piece of paper. Their has to be some work experience involved. In the case of my daughter it was 3 years on med-surg and 2 years at Hospice. In the olden days there where no GN's in specialties. You did your time on Med-Surg then moved from there. I understand there is a shortage of RN's but PT safety shouldn't suffer. Think carefully your going in for surgery and the Nurse Anesthetist was never a working nurse. I leave a trail of poop getting my butt out of the OR

I don't agree with you on this point, from personal and professional experience, I feel that is is overgeneralized when it comes to NP preparation.

As far as I know, there are no CRNA schools that don't require ICU experience.

Specializes in Adult Internal Medicine.
Regretfully, nursing education has become a bit of a joke. It is more focused on paper writing than on learning useful knowledge.

It is no surprise to me that you find a PA better prepared. I only pray that the people that are destroying nursing soon retire and are replaced by people who understand that nursing education must change and that these papers and postings are a waste of time and are the wrong direction.

How far have you gone in your nursing education? How would you change it?

To the OP: just curious, do you know if most of the NPs you work with went thru an acute care NP program or family NP? I have gathered that some places hire FNPs for acute care positions, which doesn't really make sense to me. As the market gets more concentrated with NPs jumping ship from bedside nursing, I would guess that organizations will be more choosy about the NP specialties they hire.

EDITED TO ADD: I just realized there are 5 pages on this thread, have only read the first one so I apologize if I missed the answer to the question I asked.

How far have you gone in your nursing education? How would you change it?

Have you ever taken a look at some NP schools curriculum? or was that rhetorical question?

Specializes in Adult Internal Medicine.
Have you ever taken a look at some NP schools curriculum? or was that rhetorical question?

I am very familiar with the cirricula at quality NP programs; I also am familiar with the fact that a glance at a list of course names on a website gives very little informaiton about what is actually covered in didactic and clinical. I wonder how familiar others are that are weighing in on the discussion.

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