Requiring Bedside Experience for NP

Specialties NP

Published

There are quite a few NP programs without requiring bedside RN experience for admission. I think this should be mandatory, especially for online programs that admit 100,000 students every semester. I really wish advanced nursing programs were more standardized in a national basis. I wonder if this was ever a topic when formulating the Consensus Model...

Specializes in Adult Internal Medicine.

Let's hope someone with radiating chest pain, SoB, and diaphoresis gets triaged to the ED or EMS and not put in the office schedule!

Specializes in FNP-BC 2014.

I am new to the PCP game, (Graduated 1/22 with FNP post-master's cert. WHNP-BC in 2010) what I am referring to however, is the comfort level of the new NP upon graduation and certification as a clinician. I am appalled that NP residencies are not routinely offered. Of course NP's have been doing without them for years. But with the influx of substandard NP programs out there - it should be mandatory. The second statement was something I witnessed at the clinical site (as a student) before graduation. The NP was flustered and did not know how to interact with the pt (who was scared out of her wits!) The woman had been to UC the day before for the same complaint, and was told to f/u with PCP - I don't know what went on at the UC, but the woman told us that she had chest pain and heavy pressure and that it had increased from the day before. There was nitro at the clinic, but not readily available.

I am appalled that NP residencies are not routinely offered. Of course NP's have been doing without them for years. But with the influx of substandard NP programs out there - it should be mandatory.

Ummm, wouldn't it be a better idea to eliminate the substandard NP programs, instead of trying to "fix" people after they graduate from those programs?

Specializes in Emergency.

Interesting the the women went to the UC and saw a provider the day before for the chest pain and was not sent to an ER or a specialist for followup.

I worked for a cardiologist when I was going through my ADN program. A pt came in, 21yo F, had five syncopal episodes associated with weakness, dizziness, SOB in past few months. After each episode, pt had gone to ER and been discharged with no dx or tx, but told to follow up with PCP. None of the visits resulted in her being told to go to see a specialist. However, a friend of her's finally convinced her to come to the cardiologist and get a workup.

Initial workup was unremarkable, but cardiologist had her put in the schedule for an echo immediately because of hx, not because of anything from her workup. Cardiologist had been practicing for 20+ years, and was very good at what he did, he didn't want to mess around with her and miss something. He took one look at the echo and referred her to stanford, he told me "I've seen this 3 or 4 times in my career, no way I'm going to try to treat her here (we live in a very rural town). This case needs to be sent to where the best of the best cardiologists deal with cases like this every day".

I tell this story because, this woman was seen by several MDs, DOs, PAs and even an NP before a non-trained friend got her to go to a cardiologist. And even that "expert" didn't feel comfortable handling her day to day care.

I don't know the details of what happened between that pt of yours and that NP that was seeing her, nor do I know what happened between that pt and whomever cared for her at the UC but apparently didn't send her to the ER for further eval, so I can't comment on what should have occurred in your scenario or at the UC the day before. It is every provider's responsibility, even the cardiologist with 20+ years of experience to identify what patients "scare" them, and move them on to the appropriate level of care. Ultimately, this NP you talk about appeared to do that by getting another provider involved. I don't see a problem with that scenario.

Now yes, if that NP you mentioned had prior experience as an RN dealing with cardiac patients in an acute setting, he/she might have dealt with the situation differently. However, if that provider had years of RN experience in other roles, where they had never seen a cardiac pt, there is no guarantee they would have dealt with the situation any differently. So, all the story tells me is that the NP did recognize that further help was needed, and got that help. And apparently the provider at the UC did not recognize the need for further tx for whatever reason (might have been a different presentation, we don't know) or at least didn't feel the patient needed to see a specialist or go to the ED.

Specializes in Pediatric Pulmonology and Allergy.

Initial workup was unremarkable, but cardiologist had her put in the schedule for an echo immediately because of hx, not because of anything from her workup. Cardiologist had been practicing for 20+ years, and was very good at what he did, he didn't want to mess around with her and miss something. He took one look at the echo and referred her to stanford, he told me "I've seen this 3 or 4 times in my career, no way I'm going to try to treat her here (we live in a very rural town). This case needs to be sent to where the best of the best cardiologists deal with cases like this every day".

.

Now that you got us curious....

What did the echo show?

Specializes in Emergency.

Several things, all of which he thinks she had from birth. There were several small septal wall defects and the entire wall appeared to be developed with a large weakened section that he was concerned would possibly fail. The leaflets of the valves were malformed which concerned him that she may need to have valve replacements. And she had significant cardiomegaly.

Great post zmanac! I agree. Knowing when a patient needs more than what you can offer is NOT a sign of failure!

Specializes in Adult Internal Medicine.
Great post zmanac! I agree. Knowing when a patient needs more than what you can offer is NOT a sign of failure!

Actually I tell my students that this is the most important thing they can learn in NP school.

Specializes in FNP-BC 2014.

"Ummm, wouldn't it be a better idea to eliminate the substandard NP programs, instead of trying to "fix" people after they graduate from those programs?"

Ummm, you state the obvious.., but I don't see that happening..Too much easy money to be made from student loans. Until somebody throws the hammer down and shuts these "schools" down, there should be something in place that safeguards public safety. NP students need solid educations, not shortcuts, and that education should extend out to residencies.

Are you in NP school yet? Have you ever worked bedside as an RN? I think the reason that you have rankled some people's feathers is because you speak with great conviction about what you are assuming reality to be. I worked as an ICU RN and a psychiatric consult RN. If you think that nursing is just pushing pills, cleaning poop, and blindly following orders, then I doubt you would make a very good RN or NP. RNs save lives EVERYDAY...often from orders that pretentious prescribers who think they are smarter than everybody else make. You are assuming that a vast amount of NP students are not 'intelligent'. How do you know that? What are you basing this on? I am currently an NP student, I consider myself pretty damn smart, and I guarantee to you there is nothing easy about it. When you begin to work in healthcare, you will quickly learn humility and I promise you, you will constantly be surrounded by people who are 'smart' but nitwits and people who may not be the Einstein, but know what they are doing. GL!

Specializes in FNP-BC 2014.

Megan5183, who is your post directed at?

Specializes in Pain, critical care, administration, med.

I am a new NP with 30 yrs of clinical background as a nurse. NPs are not doctors and we practice differently. I can tell you I had 600 clinical hours in my NP program and without working as a nurse prior I don't think I could have gotten through the program or work now as a NP. I am a strong proponent of working as a nurse prior to advancement. We develop critical thinking that you cannot get in school or a residency program. I might agree that a NP residency might be helpful. It is important as a NP to keep current in the standards. As for dictating how much NP experience is needed to be a preceptor I can't say. Just having experience at any level makes you good.

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