I was having lunch with several NP colleagues and as we were lamenting the lack of actual nursing experience in so many of the students we get asked, and refuse, to precept one of them shared something that of course I had always suspected but to know that it is a blatant direction makes me sick. Apparently his university, which is part of a very well known, enormous teaching hospital is pushing the direct entry programs because the philosophy is to keep the money coming in while the student is there rather than take the chance they will graduate and for whatever reason not return to grad school or go to another grad school. No consideration for the value of actually working as a nurse.
Not that I didn't suspect this with the whole push for DNP which is only at this point is only being driven by the universities not my board of nursing. Good business I guess but I'm worried about the quality of NPs going forward.
Your thoughts and experiences with direct entry practitioners?
My question is more about the grandiose manner people mention their "life skills" from other professions as if they justify a lack of nursing experience. Being adept at administrative, managerial tasks, being a responsible, collegial, mature adult really doesn't impress me, knowing that a patient with asthma might not have audible wheezes in severe crisis and what to do with that does.
The only thing working higher education administration prepared me for in school nursing was dealing with teachers and parents. The actual nursing side? I thank my awesome senior preceptor on a very busy med/surg floor that taught me how to not be afraid to ask questions, multi-task, really do a focused assessment, and write great nursing notes. You can't learn that in an admin job.
I was a nursing sub before becoming a full-time school nurse. Invaluable experience; I would have not succeeded at my current job without it. Therefore, I personally feel I could not succeed at being a good NP without first being a good nurse.
I think no matter where you stand, it is a fact that NP's and PA's are being hired interchangeably in the world right now, especially in hospitals. The PA's don't have a nursing background. Both of them are going to assess and diagnose and prescribe. Maybe it's time for that role of NP/PA to be redefined as a new role that blends the best of both worlds. It doesn't make sense to day that nurses are taught all this nursing then when they get to NP role they are diagnosing like a medical doctor/PA. Does it?
Both of them are going to assess and diagnose and prescribe. Maybe it's time for that role of NP/PA to be redefined as a new role that blends the best of both worlds. It doesn't make sense to day that nurses are taught all this nursing then when they get to NP role they are diagnosing like a medical doctor/PA. Does it?
Don't all NP programs teach differential diagnosis and how to diagnose?? It's not just nursing stuff that is taught. In my program we are treated a lot like medical students (same books, similar rotations, etc). I don't feel that my program is deficient in medical stuff. But maybe they aren't all the same?
Don't all NP programs teach differential diagnosis and how to diagnose?? It's not just nursing stuff that is taught. In my program we are treated a lot like medical students (same books, similar rotations, etc). I don't feel that my program is deficient in medical stuff. But maybe they aren't all the same?
I do think it varies from school to school but in general NP school is more heavy with nursing stuff and less focused on prescribing and diagnosing, imo. I had 1 course on diagnosing and as I mentioned earlier 1 general pharm and 1 psych pharm which is nothing compared to the prescribing courses physicians get.
I think no matter where you stand, it is a fact that NP's and PA's are being hired interchangeably in the world right now, especially in hospitals. The PA's don't have a nursing background. Both of them are going to assess and diagnose and prescribe. Maybe it's time for that role of NP/PA to be redefined as a new role that blends the best of both worlds. It doesn't make sense to day that nurses are taught all this nursing then when they get to NP role they are diagnosing like a medical doctor/PA. Does it?
Right now PA's cannot practice independently. They are not interchangeable with NP's. However, they surely do have a more challenging education and it's probably only a short time before they will gain independence. In my experience their sphere of practice is more limited than ours but they are permitted to do move invasive, potentially fraught procedures than the NP's. But the NP's carry the load of more chronic care. Just my humble 41 years of experience.
My opinion on NP's, from personal experience is that I do not want them treating me or my family!! Every time I have seen one they just seem inept. Recently, and I have no clue why, I went to see my doctor and an NP came in to see me instead. She had not looked at my history and asked me all kinds of questions about my history and care and when we got down to the reason I was there (Thyroid disease and issues with my medication) she completely contradicted what my doctor and I had previously spoke about. Quite frankly, she made me angry and I told my doctor that I didn't want to see this NP again. Ever.
Again, just my personal opinion, I do NOT want someone diagnosing me or prescribing medications that hasn't gone through medical school and residency.
I do believe that a great deal can be learned through nursing experience, I know I have learned a great deal in my CNA experience but does that mean my 10 years in LTC makes me an automatically knowledgeable RN? No way! I think the same applies for NP's.
I think the blame for this lies heavily with the schools. Of course they are trying to get as many people in the door as they can to keep the funds flowing and there are so many schools offering so many options these days I think the actual education has fallen quite short.
One school I was looking into for my BSN when I finish my RN has students claiming they have finished their Bachelors in 6 months!
It's a competitive world with competitive people all trying to better themselves and their pay grade but what does it really cost some in the end?
ETA: I feel like I should explain my experience with NP's. Perhaps the ones I have seen were not experienced enough with patient care and that is why I felt that they were inept?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Here is what I notice about the DE APN students. They don't yet know that the physician isn't always right. They never seem to question anything said or ordered by the physician. Doing so is a standard nursing function when something is questionable, but is a skill usually learned in the trenches of direct bedside care.
I also notice a lot of superior attitudes among them while they are still in the RN portion of their program.
My opinion on NP's, from personal experience is that I do not want them treating me or my family!! Every time I have seen one they just seem inept. Recently, and I have no clue why, I went to see my doctor and an NP came in to see me instead. She had not looked at my history and asked me all kinds of questions about my history and care and when we got down to the reason I was there (Thyroid disease and issues with my medication) she completely contradicted what my doctor and I had previously spoke about. Quite frankly, she made me angry and I told my doctor that I didn't want to see this NP again. Ever.
Again, just my personal opinion, I do NOT want someone diagnosing me or prescribing medications that hasn't gone through medical school and residency.
I do believe that a great deal can be learned through nursing experience, I know I have learned a great deal in my CNA experience but does that mean my 10 years in LTC makes me an automatically knowledgeable RN? No way! I think the same applies for NP's.
I think the blame for this lies heavily with the schools. Of course they are trying to get as many people in the door as they can to keep the funds flowing and there are so many schools offering so many options these days I think the actual education has fallen quite short.
One school I was looking into for my BSN when I finish my RN has students claiming they have finished their Bachelors in 6 months!
It's a competitive world with competitive people all trying to better themselves and their pay grade but what does it really cost some in the end?
ETA: I feel like I should explain my experience with NP's. Perhaps the ones I have seen were not experienced enough with patient care and that is why I felt that they were inept?
So your ONE experience with ONE person is bad and you tar an entire profession with one brush? Do you realize how judgmental and unaware you sound? I've been in nursing for nearly 25 years and I've known some incredible NPs that I would rather have take care of me than most doctors. Mainly because they are smart, have tons of experience, have seen just about everything, have a deep nursing instinct, and they are actually interested in their patients. I've been seen by tons of doctors that only care about writing you a prescription and getting you out of the door so they can make a few more bucks. I know who I'd rather see. The dean of my grad school used to be the NP in the ICU I used to work with and she is one of the smartest most competent practitioners I've ever known. I was so happy when I walked in the door for my interview and saw her because I knew this was a program worth being in. I'm afraid your comment merely reflects how little you know about NPs rather than a valid well thought out response.
This is an interesting thread but I don't think the answer can be cut and dried, taking into consideration that each practitioner is an individual and we all know people can vary vastly in their professionalism and dedication. I've been a nurse for nearly 25 years and have worked in critical care for half of that. I have three certifications and a ton of experience with critically ill patients. I know that I will be grateful for that experience when I graduate as an NP because it gives me confidence knowing I can look at a patient and immediately have some kind of clue about what's going on mainly because I worked for many years in critical areas which prepared me for patients going down the tubes quickly and suddenly. My program (which is at a prestigious state school) was difficult to get into. There were only 12 places for this acute program, and hundreds, if not thousands, of applications. My experience, credentials and resume got me that place and I feel like I earned it, but I don't think anyone walking off the street would have had a chance quite frankly, because the competition was stiff. I think there is a huge delineation between a bricks and mortar recognized school, and a mail -order for profit online school. I know my program will leave me very prepared, will organize all my clinical rotations for me at excellent medical centers, and pretty much guarantee me a job because it will be recognized that I have graduated from a good program. I will spend most of next year immersed in 24 hours a week of clinical, which on top of my job is a LOT of hours. I feel confident that I will be prepared, although have a lot to learn, but feel that I am in a good place. I specifically did not want to go to an online school because there is no place for that in an acute setting in my opinion.
I think that there are individuals out there who are smart enough to make the most of their clinical experience, and lucky enough to have the right preceptor, that can be great practitioners right out of the box, but knowing all I know, I'd be feeling ill prepared if it was me. I think a lot can be said for good clinical experience, especially if it takes place in a good teaching hospital, but I'm sure that the primary care track must be a very different experience. I've only ever done acutes and will be an acute practitioner. I'm not knocking those who do, and I would happily work with anyone and give them a chance, but I feel like there should be some standards set. There is also a big difference between acute and primary practice in that acutes can be very intense and require many hours in an inpatient setting. My program wouldn't even accept anyone that didn't have at least a year of critical care background.
I've seen lots of experienced PAs be very smart, precise and hard working, but lacking in interpersonal or critical thinking skills. They were never able to look at a patient and just "know" there was something wrong. I can't count how many times my nursing instinct has saved mine (and my patient's) butt. I shared my instinct once with a doctor who trusted me, and luckily the patient ended up in the ICU because he listened to me. Good team work. Another time the PA refused to listen to me and a young man died. Experience does count. As long as the nursing experience sucks on the floor, and as long as schools make it easy to sign up, things will continue to go downhill. There should be incentives for nurses to stay on a floor, and incentives to climb the ladder slowly. When I got my certification, I was given a $5 coffee card. Seriously. I studied an entire summer, got letters after my name, and ended up with a coffee and no extra pay. This is not going to keep smart nurses in a unit. It's going to encourage them to go back to school and get out of there.
So your ONE experience with ONE person is bad and you tar an entire profession with one brush? Do you realize how judgmental and unaware you sound?
I didn't say my experience was based on ONE interaction. I did explain my LAST interaction which was about a month ago. I have seen a total of 5 NP's for various visits over the last 20 years and every one I encountered I had a bad experience with over my doctors.
I'm not saying that ALL NP's are inept, I was simply stating that my experiences with them were not something I would care to do again.
What I DO know from my own personal experience and preferences in my OWN medical care, I would prefer to see doctors or oncologists rather than NP's when I am dealing with ongoing health issues, rather that NP's who have contradicted what my doctors have said and what has worked for me.
I apologize if my opinion of my personal experience with them isn't well thought out enough for you...
This is an interesting thread but I don't think the answer can be cut and dried, taking into consideration that each practitioner is an individual and we all know people can vary vastly in their professionalism and dedication. I've been a nurse for nearly 25 years and have worked in critical care for half of that. I have three certifications and a ton of experience with critically ill patients. I know that I will be grateful for that experience when I graduate as an NP because it gives me confidence knowing I can look at a patient and immediately have some kind of clue about what's going on mainly because I worked for many years in critical areas which prepared me for patients going down the tubes quickly and suddenly. My program (which is at a prestigious state school) was difficult to get into. There were only 12 places for this acute program, and hundreds, if not thousands, of applications. My experience, credentials and resume got me that place and I feel like I earned it, but I don't think anyone walking off the street would have had a chance quite frankly, because the competition was stiff. I think there is a huge delineation between a bricks and mortar recognized school, and a mail -order for profit online school. I know my program will leave me very prepared, will organize all my clinical rotations for me at excellent medical centers, and pretty much guarantee me a job because it will be recognized that I have graduated from a good program. I will spend most of next year immersed in 24 hours a week of clinical, which on top of my job is a LOT of hours. I feel confident that I will be prepared, although have a lot to learn, but feel that I am in a good place. I specifically did not want to go to an online school because there is no place for that in an acute setting in my opinion.
I think that there are individuals out there who are smart enough to make the most of their clinical experience, and lucky enough to have the right preceptor, that can be great practitioners right out of the box, but knowing all I know, I'd be feeling ill prepared if it was me. I think a lot can be said for good clinical experience, especially if it takes place in a good teaching hospital, but I'm sure that the primary care track must be a very different experience. I've only ever done acutes and will be an acute practitioner. I'm not knocking those who do, and I would happily work with anyone and give them a chance, but I feel like there should be some standards set. There is also a big difference between acute and primary practice in that acutes can be very intense and require many hours in an inpatient setting. My program wouldn't even accept anyone that didn't have at least a year of critical care background.
I've seen lots of experienced PAs be very smart, precise and hard working, but lacking in interpersonal or critical thinking skills. They were never able to look at a patient and just "know" there was something wrong. I can't count how many times my nursing instinct has saved mine (and my patient's) butt. I shared my instinct once with a doctor who trusted me, and luckily the patient ended up in the ICU because he listened to me. Good team work. Another time the PA refused to listen to me and a young man died. Experience does count. As long as the nursing experience sucks on the floor, and as long as schools make it easy to sign up, things will continue to go downhill. There should be incentives for nurses to stay on a floor, and incentives to climb the ladder slowly. When I got my certification, I was given a $5 coffee card. Seriously. I studied an entire summer, got letters after my name, and ended up with a coffee and no extra pay. This is not going to keep smart nurses in a unit. It's going to encourage them to go back to school and get out of there.
Very well written, thank you, and best of luck as you continue with your education. It sounds as if you will be a clinician I would trust my patients to and enjoy working with.
I feel an NP glut in the future. NO RN I work with has plans to stay at the bedside for more than 2-3 years. Most have their sites on NP school. It will be interesting to see how the market adapts.
I'm feeling the same way. Recently came across someone who told me she was entering a nursing program in the fall "But I'm not going to stay as an RN, I'm going to be a Nurse Practitioner". Ummm...ok. "So you're going to work for a few years before going into the NP program, right?" "oh, no, I'm going to go straight into the NP program after I'm done with XX school. I don't want to waste any more time before opening up my own practice". Hmmm....and at the moment she was handing me my dry cleaning. No healthcare background whatsoever. But hey, maybe her customer service skills at the dry cleaners will translate into an awesome diagnostic approach! :)
JenTheSchoolRN, BSN, RN
3,035 Posts
The only thing working higher education administration prepared me for in school nursing was dealing with teachers and parents. The actual nursing side? I thank my awesome senior preceptor on a very busy med/surg floor that taught me how to not be afraid to ask questions, multi-task, really do a focused assessment, and write great nursing notes. You can't learn that in an admin job.
I was a nursing sub before becoming a full-time school nurse. Invaluable experience; I would have not succeeded at my current job without it. Therefore, I personally feel I could not succeed at being a good NP without first being a good nurse.