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.
I guess my CRNA comment needed an lol. In my time in special procedures I had the pleasure to work with many talented Anesthesiologists and Anesthetists. My point was if all they had was book knowledge would you be comfortable not that they didn't have working experience. I feel strongly about work experience as I started as a Paramedic before there was an EMT-P designation. I wanted to learn so I took a bus man's Holiday to the Shock trauma institute at University of Maryland yes I'm that old. I know my lab values backwards and forwards, I read x-rays and Im, fairly competent at MRI's. I have assisted in the reattachment, of 3 severed fingers in the ER with the Chief Resident of Plast is and just little ole me. No one can ever present a case to me that a solid background round in nursing practice should be required for advanced practice. Call me a dinosaur if you like but hard work and thirst for knowledge gave residents and attendings alike enough faith in me to grant me a considerable amount of autonomy for the times
(For those who do not know, Ms. Tina Jones is a simulation patient used by Shadow Health, an online assessment training company used by many NP and medical schools for basic assessment training).
Ms. Tina Jones is in her mid-20th, AA, obese, hypertensive, with DM type II and mild asthma, and a slew of other minor ailments for which she "is seen" in urgent care-like setting. Family history of heart disease. No primary care provider. No regular treatment for DM and HTN.
Now, how many of just such Tinas come through ERs and UC centers daily in this country? Every health care provider, physician and down to possibly MAs, know how it all gonna to end. Tina is in her mid-20th now and feels just fine. If her health is continue to be "managed" like it is right now (i.e. no good glucose control, no weight control, no BP control, little if any exercise) she will get the first calls from her eyes and her kidneys in the next 15 to 20 years. She will have a pretty good chance to celebrate her 65th birthday being hooked to dialysis machine, and she will be lucky indeed if at this date she sees her birthday cake and still has both legs and not living in excrutiating pain. She will probably die from heart disease before or shortly after her 70th birthday.
We all know it. There are tons of evidence around to confirm this prognosis. We also all know what needs to be done to avert it and let Tina live long and healthy life. In short, someone of us needs to get Tina to understand the seriousness of her situation and help her to manage her own health. Tina needs to be seen in office at least once a month, for the beginning. She needs to be spoken with, encouraged, taught, motivated endlessly. One needs to call her once in a while to make sure she checks her BP and sugar. She needs info about communuty programs, affordable gym classes friendly for African American women, maybe even some grocery coupons for fresh produce.
Now, the health care provider who will do it all for Ms. Tina may not necesserily know the molecular mechanism of ACE inhibitors action. It would be nice addition, but not mandatory. What would be mandatory is his or her ability to connect, educate and motivate Ms. Tina, as well as willingness to speak and ability to answer questions the way Tina understands, because what we need is Ms. Tina taking her lisinopril DAILY as a prayer. Same (or worse than that) goes about Ms. Tina's diet, blood glucose control, etc.
Doing a quick physical and writing a half a dozen scripts in ER will not help Tina. Only long-term, systemic, relentless and thankless care will, and I do not foresee doctors standing in lines willing to do this kind of jobs.
This post was wonderful at pointing out the role of nursing in advanced practice (and nursing in general). Medicine treats disease, nursing treats individuals. Sure we can prescribe medication that will fix Tina's blood pressure but can Tina afford it, will she take it, what is her home situation like, etc? Nursing takes these into account to treat the individual, not just the disease. Nursing reaches out to solve roles that medicine just cant fix by taking in several factors that contribute to a person condition such as cultural, racial, socioeconomical, religeous, etc.
I loved this post because of the truth in it. I just hope that our strong cultural backgrounds in the US can be broken as they are the biggest barrier (in my opinion) to helping people towards better health. Good article here Toxic Food Environment | Obesity Prevention Source | Harvard T.H. Chan School of Public Health on several factors contributing to obesity and bad health. by linking this I'm just highlighting the things that nurses think about when treating a population.
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.
[TABLE=width: 424]
[TR]
[TD]NUR 802:[/TD]
[TD]Theoretical Foundations and Role Development for the Advanced Practice Nurse[/TD]
[/TR]
[TR]
[TD]NUR 804:[/TD]
[TD]Statistics for the Healthcare Professional[/TD]
[/TR]
[TR]
[TD]NUR 805:[/TD]
[TD]Pathophysiology for Advanced Practice Nurses[/TD]
[/TR]
[TR]
[TD]NUR 806:[/TD]
[TD]Research for Practice Nurses[/TD]
[/TR]
[TR]
[TD]NUR 807:[/TD]
[TD]Clinical Decision Making[/TD]
[/TR]
[TR]
[TD]NUR 809:[/TD]
[TD]Applied Pharmacology for Advanced Practice[/TD]
[/TR]
[TR]
[TD]NUR 814:[/TD]
[TD]Health Care Policy and Politics[/TD]
[/TR]
[TR]
[TD]NUR 820/835:[/TD]
[TD]Health Assessment[/TD]
[/TR]
[TR]
[TD]NUR 821/836:[/TD]
[TD]Primary Care Management I[/TD]
[/TR]
[TR]
[TD]NUR 822/832:[/TD]
[TD]Practicum I Primary Care[/TD]
[/TR]
[TR]
[TD]NUR 823/837:[/TD]
[TD]Primary Care Management II[/TD]
[/TR]
[TR]
[TD]NUR 824/834:[/TD]
[TD]Practicum II[/TD]
[/TR]
[TR]
[TD]NUR 838:[/TD]
[TD]Care for Aging Individuals[/TD]
[/TR]
[/TABLE]
Do you want someone just out of school with 500-600 hrs preceptorship from a program like that to treat your child if he/she got really sick? I certainly would not take the chance... To each their own!
By the way, this is from a reputable state university..
Do you want someone just out of school with 500-600 hrs preceptorship from a program like that to treat your child if he/she got really sick? I certainly would not take the chance... To each their own!
By the way, this is from a reputable state university..
That curriculum appears to be sufficient. Did you read the course descriptions or just the list? What do you feel is missing?
Do you want someone just out of school with 500-600 hrs preceptorship from a program like that to treat your child if he/she got really sick? I certainly would not take the chance... To each their own!
By the way, this is from a reputable state university..
I don't want any new person treating my really sick child independently.... That's why mentor ship is so important. That is with 600 or 5000 hours.
Specializes in Cardiac (adult), CC, Peds, MH/Substance.
English is clearly the second language. If you prefer, they could post again in their native language and you can reply with perfect grammar in that language.
please attempt to check your spelling and grammar if you want readers to take you serious
Topics are simply just pulled out into separate titles rather than included within one title. The only difference I see from what is covered in the PA program compare to FNP program are: "medical terminology", "life support procedures and skills", and "intro to the the PA profession", "microbiology", and perhaps some of "clinical surgery". The rest of the topics are all covered under different titles. That's the nursing model vs the medical model.
I would venture to argue that most NP programs require microbiology and A&PI/II as a prerequisite, and because all student NPs are first RNs they shouldn't need medical terminology or BLS/ACLS as a class.
I agree with BostonFNP, as an ASN nurse, then a BSN nurse and now in my last semester of grad school, it looks like the PA model pretty much covers what we had going through nursng school up to grad school.
For the ASN portion Med terminology was a pre req, as was anatomy and physiology. Bio, nutrition, genetics, pharma, patho, health promotion, electrocardiography,legal/ethical were covered in the ASN portion.
The BSN portion of my education was somewhat redundant as we took pharma and patho again, statistics, electrocardiography, legal/ethical and had interpretation of literature.
My grad program has patho and pharm, genetics, research and the clinical/role portion, along with the dreaded nursing theory
I have attended very reputable institutions that have been brick and mortar.
As an RN I have oriented new PA's who asked me for my advice numerous times on how to proceed with a pt and then take that advice
If you are bashing your grad program for lack of rigor, then it's on you for choosing an inferior program.
I see no difference in PA's and NP's in regard to how they are viewed in our facility, they are equally sought after and hired.
My peers who are in the FNP program have extensive ER, ICU, and neurology experience plus various other areas of expertise. I'd trust them with my life or my kids lives in the ER rather than a new grad PA.
A non-nursing person tomes in and posts a reputable question. People still get defensive, at least some. For all those who have gotten defensive... sorry, nursing is not the God of all professions, get over yourself.
He/she Did not ask about how "as such and such blah blah blah I have this much experience and I can do everything cuz I r sooper nurse" He asked about their education and people come in stammering off how they could go toe to toe with docs since they have been in the field for 20 years.
Get a life to those who are defensive, you are not a doctor and never will be and you need to realize that. our education is inferior, no way around that, and we can close the gap with time, but we are not doctors, and never will be. End of story. Thanks. Get back to being nurses and not doctor wanna bes.
Specializes in Cardiac (adult), CC, Peds, MH/Substance.
Most places around here hire FNPs for the ER, but the ones I know were all ER nurses first, some ER and ICU
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.
English is clearly the second language. If you prefer, they could post again in their native language and you can reply with perfect grammar in that language.
This is an English based website.. Have several auditorium seats my friend
.4**
19 Posts
I guess my CRNA comment needed an lol. In my time in special procedures I had the pleasure to work with many talented Anesthesiologists and Anesthetists. My point was if all they had was book knowledge would you be comfortable not that they didn't have working experience. I feel strongly about work experience as I started as a Paramedic before there was an EMT-P designation. I wanted to learn so I took a bus man's Holiday to the Shock trauma institute at University of Maryland yes I'm that old. I know my lab values backwards and forwards, I read x-rays and Im, fairly competent at MRI's. I have assisted in the reattachment, of 3 severed fingers in the ER with the Chief Resident of Plast is and just little ole me. No one can ever present a case to me that a solid background round in nursing practice should be required for advanced practice. Call me a dinosaur if you like but hard work and thirst for knowledge gave residents and attendings alike enough faith in me to grant me a considerable amount of autonomy for the times