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?
When I graduated, I would say at least 75% of the class was planning on becoming NPs. This summer is my second nurseaversary, and while only a few went straight through and are finished, most are in school now. Most of my coworkers between 22 and 30 are in NP school now. If I stay at the bedside, who will be there with me?
I still don't know what I want to be when I grow up. But I don't think I need to know that at 27, right? Right??
Physicians have been fighting us on scope of practice for APRN's for years, warning that nurses did not have the same depth of experience and were going to kill someone. Now the gold rush is on and everyone is rushing to "credential up" to some kind of AP. So many awesome nurses with boatloads of experience made all the sacrifice of time and energy to bring nurse practitioners into being - and now my worry is that irresponsible NP programs churning out ill-prepared newbs are going to give the physicians grist for their mill.
Physicians have been fighting us on scope of practice for APRN's for years, warning that nurses did not have the same depth of experience and were going to kill someone. Now the gold rush is on and everyone is rushing to "credential up" to some kind of AP. So many awesome nurses with boatloads of experience made all the sacrifice of time and energy to bring nurse practitioners into being - and now my worry is that irresponsible NP programs churning out ill-prepared newbs are going to give the physicians grist for their mill.
Well said. I share your concerns and the most discouraging part imo is patients are likely to suffer in addition to our beloved profession.
Well said. I share your concerns and the most discouraging part imo is patients are likely to suffer in addition to our beloved profession.
It is disconcerting to say the least. People can say I am one of those "newbies" to jump shift to advance practice because I only have a few years critical care experience but I got my feet wet and calculative my next educational move.I chose a state school with a well-renowned reputation and textbook (med school with nursing texts)/class/campus visit load (8 total visits) that seemed to prepare me the most.
My biggest fear is that the lack of any regulation on NP schools seems to be uncontested. Sure we have regulatory bodies and one board exam for each specialty but that isn't enough when you compare the requirements with PA/MD.
There are thousands of students gunning for med schools every year but many are rejected due to lack of slots. Why? MD regulation bodies REGULATE how many seats and MD schools are open every year.
If you have your RN, a check and a 3.0 you are good to go for most NP schools.
I've met PAs who have gotten into school with phlebotomy experience. A friend of mine went to a local private school and had NO healthcare experience at all. He said the same went for most of his classmates. However, Their schools prepared them to be competent providers. This begs the question: is an NPs education inherently inferior to that of a PAs in that some nurses believe in order to be a a competent NP one must have bedside experience? PA school can prepare individuals without bedside experience to be competent providers. Why can't the same be said for NP school? Is there no uniform standard for NP education? Was NP education designed build upon bedside experience? If so, why are so many NP programs the same length as PA programs? Yet in order to be a competent NP, one must have bedside experience? What does that imply? Will the knowledge learned working in acute care really help an individual better manage non-acute chronic issues on an outpt basis as a PCP? I'm an ICU nurse, and other than the critical thinking aspect of the job, I'm not sure how my skills would translate into the outpatient world.
Not trying to step on any toes, I'm just trying to be as impartial as possible. I don't want NPs to be viewed in a negative light. If you go to the med student/md forums (not sure I can say their name dt TOS violations), a lot of them talk down on NP curriculums because of all of the extra nursing theory that is irrelevant to clinical practice..At first I was thinking "well, maybe MDs like PAs better because they are there to assist them, and cannot practice independently." Then I saw my buddy's syllabus (who got into a local brick and mortar NP program with a 2.5 GPA btw since the program waived the 3.0 requirement because of his bedside exp), and I asked him how any of the nursing fluff that he's learning is going to make him a better provider. He said it won't. It's just a hoop that he has to jump through because he hates the bedside. I really hope that schools don't flood the market with poor providers who only make the nursing profession look bad. I was CLOSE to starting the same NP program as my buddy(got a verbal acceptance), but decided to pursue anesthesia instead because I'm a little more confident that the science based curriculum will better prepare me to be an independent provider. I just wasn't sold on the NP curriculum (for the school I was about to start at least), and I feel that acting in the PCP role with minimal education would be a disservice to my patients and would not jive with my personal beliefs.
+This begs the question: is an NPs education inherently inferior to that of a PAs in that some nurses believe in order to be a a competent NP one must have bedside experience? PA school can prepare individuals without bedside experience to be competent providers. Why can't the same be said for NP school? *I'm not so sure its that the NP schools are inferior just that imo we are clogged up with a lot of nursing stuff that isn't clinical hours the PAs receive and again they are not practicing totally independently.
Is there no uniform standard for NP education? Was NP education designed build upon bedside experience? If so, why are so many NP programs the same length as PA programs? Yet in order to be a competent NP, one must have bedside experience? What does that imply? Great questions I'm not sure of the answers but overall just my opinion is we do not have enough clinical hours and would greatly benefit from a residency or fellowship type program. Although I love the hint of nursing I bring to practice I would have preferred a medical model where I had more classes on medicine and less on how important I am now that I'm an APRN. I'm sure I'll get some flack for this and I am published but "Nursing Research" is rather self-inflated and kind of embarrassing, imo.
+Will the knowledge learned working in acute care really help an individual better manage non-acute chronic issues on an outpt basis as a PCP? I'm an ICU nurse, and other than the critical thinking aspect of the job, I'm not sure how my skills would translate into the outpatient world. *The fact that you know the dose ranges, indications, adverse reactions and have seen them first hand with 100s of medications to me is a huge plus. That you are able to walk in a room and without anything really screaming "something is wrong" you can know more assessment is needed because something is just "off". You know a 1cm cut on the forehead will bleed like they are hemorrhaging and usually isn't a big deal but a belch that smells like feces is a huge red flag. Imvho it is the subtleties that I relied heavily on in my first year of practice as a NP and actually saved not only my butt but also several patients from having a less than desired outcome.
+I don't want NPs to be viewed in a negative light. If you go to the med student/md forums (not sure I can say their name dt TOS violations), a lot of them talk down on NP curriculums because of all of the extra nursing theory that is irrelevant to clinical practice. * I also don't want NPs viewed in a negative light and I worry that as more and more come into this field our reputations and outcomes will suffer. I have been fortunate to have worked with dozens of very generous and supportive physicians. Unfortunately even the most supportive feel that our education is very inadequate as compared to medical school and I agree 100%. Others will argue that we have all we need to do what we are doing but I would have liked a bit more courses designed to produce a true clinician and I had a very strong background in the specialty I pursued. What I can anecdotally add is that I know a fair amount of lame NPs who practice however I also know more than a few awful psychiatrists so I'm not sure where the education component leaves off and where the individual characteristics come into play. Naturally I'm more offended when it is a sucky NP because I feel they are a reflection on me.
+I was CLOSE to starting the same NP program as my buddy(got a verbal acceptance), but decided to pursue anesthesia instead because I'm a little more confident that the science based curriculum will better prepare me to be an independent provider. I just wasn't sold on the NP curriculum (for the school I was about to start at least), and I feel that acting in the PCP role with minimal education would be a disservice to my patients and would not jive with my personal beliefs. *Unless something has changed I think you are pursuing a field with very high admitting standards and a fairly long history of structured education that appears to be adequate. I appreciate your commitment to providing excellent care and that you have the insight to realize that just because some school is willing to give you a diploma doesn't mean you are capable of practicing competently. Best of luck with your CRNA.
Jules A, I'm not familiar with the NP programs, though familiar with their scope of practice. I assumed the programs were heavy on pharmacology and pathophysiology, but you're saying there are fluff nursing theory classes?
re above posters's questions re NP's needing bedside experience whereas PA's don't, I still question how a year or two in today's med/surg, which seems to be a lot of med passing and running one's tail off for a revolving door of patients just stable enough to transfer out is all that relevant to diagnosis and treatment experience but I know I am a greatly different nurse after years of assessing hundreds (I'm into the thousands by now) of sick and injured patients and participating in their dx and tx in my capacity than I was after my year of acute experience.
Jules A, I'm not familiar with the NP programs, though familiar with their scope of practice. I assumed the programs were heavy on pharmacology and pathophysiology, but you're saying there are fluff nursing theory classes?
re above posters's questions re NP's needing bedside experience whereas PA's don't, I still question how a year or two in today's med/surg, which seems to be a lot of med passing and running one's tail off for a revolving door of patients just stable enough to transfer out is all that relevant to diagnosis and treatment experience but I know I am a greatly different nurse after years of assessing hundreds (I'm into the thousands by now) of sick and injured patients and participating in their dx and tx in my capacity than I was after my year of acute experience.
Embarrassingly enough before I received my PsychNP I had 1 general pharmacology course with all NPs and one psych pharm course. I also had 1 general patho course and 1 on neuropath so in that area it wasn't bad but the pharmacology was pitiful, imo.
Thankfully and here is where I think you are selling yourself short, I was familiar with almost all the psych meds and many of the somatic meds thanks to as you said med passing. The fact that you can get a patient stable enough to transfer, know when they need to stay for more close monitoring etc. will be invaluable to your patients as a general practitioner. Look its not the ear infections or viral vs bacterial flu that I care about it is Grandmom who comes in with a DVT that gets treated as arthritis pain or a PE that gets written of as anxiety that your assessment skills will make the difference. I can spot potential etoh w/d in a patient with no know history of alcohol simply because I have seen it so many times. Will your skills make a huge difference every day? Maybe not but in the moments when you need it I'd rather have you assessing me than a brand new person who hasn't ever seen the above presentations.
On a side note what is interesting to me is that I normally love your posts and think you are extremely sharp but you repeatedly discount the experience, skills and gut instincts of working as a nurse. Seriously, you have intuition and skills that you aren't giving yourself credit for.
Embarrassingly enough before I received my PsychNP I had 1 general pharmacology course with all NPs and one psych pharm course. I also had 1 general patho course and 1 on neuropath so in that area it wasn't bad but the pharmacology was pitiful, imo.
Thankfully and here is where I think you are selling yourself short, I was familiar with almost all the psych meds and many of the somatic meds thanks to as you said med passing. The fact that you can get a patient stable enough to transfer, know when they need to stay for more close monitoring etc. will be invaluable to your patients as a general practitioner. Look its not the ear infections or viral vs bacterial flu that I care about it is Grandmom who comes in with a DVT that gets treated as arthritis pain or a PE that gets written of as anxiety that your assessment skills will make the difference. I can spot potential etoh w/d in a patient with no know history of alcohol simply because I have seen it so many times. Will your skills make a huge difference every day? Maybe not but in the moments when you need it I'd rather have you assessing me than a brand new person who hasn't ever seen the above presentations.
On a side note what is interesting to me is that I normally love your posts and think you are extremely sharp but you repeatedly discount the experience, skills and gut instincts of working as a nurse. Seriously, you have intuition and skills that you aren't giving yourself credit for.
I'm not explaining myself. I'm not discounting bedside experience in general and before I came to this board I had a different impression, but since reading post after post by first year nurses re a variety of issues and intentions, just grabbing that year before starting NP school doesn't seem adequate, it seems that they're doing more running around trying to survive and gets meds out on time than getting more deeply involved in their patient's condition. I don't think you can take it up to that level until you're efficient with general time mgmt and tasks and that has to take a good year to get dialed, I feel more so now from what I'm reading about some NP schools. But I may be off base in that thinking.
Solid nursing experience was never in question, I have meant to refer to still newish nurses and the gold rush to NP. This thread was about rushing directly to APRN without even 1-2 years of nursing experience, I'm questioning if the 1-2 years is really enough versus say 3-5 years as exampled above.
I just had another thought, and I haven't read through all the thread yet so maybe it's been said. CRNA programs require experience--in particular, adult critical care experience. Some years back I thought I wanted to be a CRNA when I grew up, so I'd done some preliminary research on the programs in my area; I remember 1 year being the minimum, but one of the programs said that applicants should generally have 3-5 yrs' to be competitive in that area.
Why should other APRN programs have lesser standards? NPs diagnose and prescribe after all...there's potential for a great deal of harm to be done by someone who is not at the expert level.
Solid nursing experience was never in question, I have meant to refer to still newish nurses and the gold rush to NP. This thread was about rushing directly to APRN without even 1-2 years of nursing experience, I'm questioning if the 1-2 years is really enough versus say 3-5 years as exampled above.
Excellent points and although I initially figured 2 years would be a good cutoff you are 100% correct in my 2nd year as a nurse I might have been even more disadvantaged because I was comfortable and yet not fully aware of what I didn't know yet.
Swellz
746 Posts
When I graduated, I would say at least 75% of the class was planning on becoming NPs. This summer is my second nurseaversary, and while only a few went straight through and are finished, most are in school now. Most of my coworkers between 22 and 30 are in NP school now. If I stay at the bedside, who will be there with me?
I still don't know what I want to be when I grow up. But I don't think I need to know that at 27, right? Right??