Sick of the Certs!!!!! Just let 'em be an NP!

[bsnanat2]

Below is my response to the posts of others in another APN forum where a job was posted requiring ACNP and FNP certs. Some were quick to point out the wrongness of this job post. Is anyone else sick of this?

Threads like this are what make PA's laugh at us and makes me sad to be a APRN. No other profession would ever limit itself like NP's do and then fight one another over these small bits of turf. A primary care PA could easily move into pediatric inpatient and no other PA would make a peep, even though it is understood that the PA in question would have to gain some sort of additional training. NP's are so drunk off the kool-aid of a myriad certifications that it is simply sickening. All of these ridiculous certifications and everyone's insistence on pointing out everyone elses' "lack of qualifications" will indeed be the death of this profession. If an FNP wants to work inpatient, let them. They are surely smart enough to know whether or not their training or the training available to them will qualify them to do the job. That is what a professional is. CRNA's, PA's and PMHNP's typically don't have these issues, and they will survive. The rest of us? I don't know. All these alarms are set off by some imagined court action. Shut up and get out of one another's way. The consensus model, lace and the DNP should have taken care of this issue. Standard NP training and licensure should take into account primary and acute care across the lifespan, that way NP's, like CRNA's and PA's could choose where and with whom they want to work. Instead these idiotic online degree mills keep cropping up and the useless DNP focuses on more research. NP's need to get a grip or prepare to be the last generation of this great profession!

[nomadcrna, DNP, CRNA, NP]

I could not agree more. We need to reorganize our education and certs.

[FuturePsychNP]

Although I personally have no desire to work with pediatric medical issues or "female issues," I think all NP programs should start with a primary care-oriented curriculum and allow all NPs to "tend to" primary care medical issues as needed. An additional year of the NP program could should be oriented to the intended specialty, such as psych, for me. I think the NP programs could add a lot more education that deals with patho, pharm, etc., and do away with the excessive theory, leadership, and research classes. Yes, research, and EBP/EBM is important. I agree, however, no other medical curriculum (PA or MD/DO) will devote such a high proportion of credit hours to ancillary coursework.

[casias12]

I would agree that the profession of nurse practitioner is mired in certification disagreement. Much of this is as a result of the ANA and their subsidiary, that ANCC. Education and certification means money. In addition, some nurses and practitioners, more than other professions, seem to need the list of titles behind their name to validate themselves.

That being said. The model of the nurse practitioner profession that would probably be most efficient would follow the medical training model. Basic family training (equivalent to physicians becoming generalists). Follow this up with board certification for specialties of choice after finishing the basic education. Most physicians take the USMLE, then move on to residency. The reason for residency is to validate practice. A physician is a physician once they pass their boards, but hospitals will not grant even basic privileges without proof of at least one year of residency. Hard to be a physician without hospital access.

For nurse practitioners, this poses a problem. There aren't paid, one year residency opportunities equivalent. But a nurse practitioner is bound, at least collaboratively, in most states to a physician. Hours spent in this position with validation would act as the residency.

Physicians then move on to fellowship or surgical residency for their specialty, if they choose. Nurse practitioners with equivalent physician-collaborated experince could do the same. Sit for specialty boards to solidify mastery of that practice. Cardiology, Endocrinology, Pulmonology, etc.

This would absolutely validate the NP position, but unfortunately, our profession remains mired in educational stupidity. As a matter of fact, the upper right corner of my screen right now offers a DNP in LESS THAN TWO YEARS from some diploma mill.

Its an uphill battle.

[bsnanat2]

I am amazed that the academic leadership does not recognize how the creation and insistence upon all of these certs marginalizes NP's and limits our practice. The DNP is a missed opportunity to say the least. I am not political but will fight hard in my state to resist limitations to practice based on setting. It is ridiculous for one to have to possess a FNP, ACNP & PACNP to practice inpatient, while a PA does not. Nursing academics have sought to protect & justify their existence at the expense of those whom they supposedly serve. It is really problematic when practicing or student NP's don't see this and participate in the marginalization by insisting that FNP's stay out of the hospital or that ACNP's stay out of the clinic. "That wasn't covered in your program" they say. How much was actually covered in your RN program? I dare say many excellent ER, ICU or surgical nurses never had formal classes in those areas. We really need to wise up as a profession. It saddens me.

Towards some of the previous comments, I am currently working on creating a residency program in my health system for NP's. Since nursing leadership won't do it, we have to do it ourselves. I wish I had the time to create a new NP membership/leadership organization to create, sanction and monitor residencies and to create additional education since the schools are falling so short. Great business opportunity in that somewhere.

[Isabel-ANP-BC]

I am an ANP and I worked inpatient hospitalist until the beginning of this month. The NP on the opposite week was an FNP.

Never had an issue with it--learned a lot, now moving on to something different.

[FuturePsychNP]

I would agree that the profession of nurse practitioner is mired in certification disagreement. Much of this is as a result of the ANA and their subsidiary, that ANCC. Education and certification means money. In addition, some nurses and practitioners, more than other professions, seem to need the list of titles behind their name to validate themselves.

That being said. The model of the nurse practitioner profession that would probably be most efficient would follow the medical training model. Basic family training (equivalent to physicians becoming generalists). Follow this up with board certification for specialties of choice after finishing the basic education. Most physicians take the USMLE, then move on to residency. The reason for residency is to validate practice. A physician is a physician once they pass their boards, but hospitals will not grant even basic privileges without proof of at least one year of residency. Hard to be a physician without hospital access.

For nurse practitioners, this poses a problem. There aren't paid, one year residency opportunities equivalent. But a nurse practitioner is bound, at least collaboratively, in most states to a physician. Hours spent in this position with validation would act as the residency.

Physicians then move on to fellowship or surgical residency for their specialty, if they choose. Nurse practitioners with equivalent physician-collaborated experince could do the same. Sit for specialty boards to solidify mastery of that practice. Cardiology, Endocrinology, Pulmonology, etc.

This would absolutely validate the NP position, but unfortunately, our profession remains mired in educational stupidity. As a matter of fact, the upper right corner of my screen right now offers a DNP in LESS THAN TWO YEARS from some diploma mill.

Its an uphill battle.

I agree wholeheartedly with everything said. I think the amount of certifications that exist for nurses, let alone the fact that many people spell out every cert they have, is ridiculous.

I believe that NPs should be licensed to practice in the intended role of an NP - primary care and tend to primary care type issues. As we see, all physicians and physicians assistants are authorized by law to do whatever it is they do (or want to do) on their license. All NPs should have a NP LICENSE and not a ridiculous certification. Beyond the NP license with primary care training I believe all NPs should be required to choose a specialty: gero, psych, acute, family, etc and train it and receive a certification in the specialty. In my state, I'm a licensed RN and will become a certified FPMHNP APN (or perhaps APRN pending legislation).

In my instance, a lot of psych patients don't see other healthcare providers and are doing good to see a psych provider. If I were trained, and licensed, i.e. considered by government to be qualified, then I could tend to some other matters of the patients such as writing a script for a HCTZ refill, for example. I agree that this wouldn't be something one would do all the time, but in a pinch on as needed basis I think it would be prudent and reasonable if, as stated in the second sentence of this paragraph, I were adequately trained and licensed to do so. My state boards would technically prohibit a psych NP from prescribing something as simple as amoxicillin.

I'll say this again because it's an issue of merit to me; NP master's programs do not need two to three research courses, a course in nursing theory, or additional fluff like my one credit hour "design a community health promotion program course." All NPs NEED more biomedical training as I think we'd all agree that there are facets to healthcare that we're undertrained in and uncomfortable doing even in our own specialties.

[HumptyDumpty]

I couldn't agree more with everything said. Its ridiculous the amount of complete BS entails NP training and licensing. No one cares about all those letters behind your name. It doesn't make you look anymore important. What we need is more medical training. You can seek this out yourself, but it needs to be incorporated into programs. Nursing theory, teaching and research have there place, but the amount in most programs is down right retarded. Now with the DNP, its even more ridiculous. There is no way I am spending $20k for a degree that is not going to increase my salary or make me a better provider. That money could go towards CME's that would actually benefit my clinical practice instead of doing some "cap stone" project about how the health belief model impacts the Hispanic diabetic population in rural Nebraska.

[reddgirl]

Well where I went to school, they did away with the acute care NP role and made it a acute care geriatric role but it still has a foundation in family practice until about the last few semesters. Family is still offered and has the highest enrollment. Most jobs down here in Florida ask for but do not require you to be certified as a Family NP but your training must reflect that. Adult NP cert is fine too but for re-cert purposes you had better stuck to patient populations within your certification as per ANCC/AANP. Nursing as a whole just need some serious revamping! We are too busy worrying about too much this and not enough of that!

[NAP1986]

It would appear to me that both PAs and NPs are dissatisfied with limitations imposed by their professional organizations, legislation, and feel let down by their professional organizations.

[casias12]

To address some of the misunderstanding in this discussion, I want to start with physicians.

1) physicians are not able to practice wherever and however. Most physicians, even specialists, are board certified Internal Medicine Physicians. Specialists (cardiology, gastroenterology, surgeon.....) all go on to fellowship or residency to learn skills necessary for their chosen specialty.

An internal medicine physician cannot do heart caths, manage ventilators, perform stress tests, read echo's, do colonoscopies or bronchosopies, or surgery. Even within the specialties, some cardiologists are diagnostic only, and some can do intervention. Some surgeons can do pulmonary wedge resection, others cannot.

This comes down to payment and privileges. Many procedures will not be paid by medicare or private insurance unless the provider is trained in that procedure. Some procedures, skin suture, joint aspiration and injection, skin biopsy, can be done by internal medicine physicians. But then they have to pay insurance to cover those procedures. Often, the insurance cost is not worth it, so they just don't do it.

Hospitals will not grant privileges to do the procedures without specific training. It is so specific, in fact, that we had to look up the privileges of a physician on the intranet before they could do a particular procedure. We knew the common physicians, and their common privileges, but sometimes, you still had to look to see if they could do what they wanted to do.

2) PA's are board certified by the NCCPA, and sponsored by the AMA. They have to be certified, but they only have one exam, as far as I know. An example:

In Florida, the largest settlement ever $216 million, was awarded to the family of a man who visited an ER with headache and visual disturbances. He had a negative CT, and symptoms resolved so he was seen and sent home by a PA. All PA's, in every state, have to have their work cosigned. They are never independent of a physician. As it turns out, the patient stroked and became comatose. The ER physicians group was found to have let this PA work for many years in this ER, despite the fact that he had failed the certification exam, and never actually passed.

3) Physicians don't really know the difference. I rarely meet a physician who knows the difference between a PA, NP, ARNP, FNP, etc. They just assume that if you are doing the job, you must have met the minimum standards for scope of practice. In my area, there is a mixed-bag of NP's and PA's, all working inpatient and outpatient settings. But remember, PA's are never allowed to operate independently, while in many states, NP's are.

4) I, for one, chose Adult because it was the easiest, quickest, with the lowest enrollment. I have had no trouble getting privileges in hospitals with my colleague physicians, and I have never had a physician treat me as lesser. But it comes down to personality. I am a mid-level. I did not go to medical school. I do not have the education and experience they have. Never will. Even if I chose to pursue a Phd, it would be for personal reasons. I would never call myself "doctor" to a patient. They are already confused enough. I am a nurse.

5) I think PA's and NP's would be best-served to band together as a unified mid-level profession. It would decrease confusion and only further our cause.

[casias12]

Well where I went to school, they did away with the acute care NP role and made it a acute care geriatric role but it still has a foundation in family practice until about the last few semesters. Family is still offered and has the highest enrollment. Most jobs down here in Florida ask for but do not require you to be certified as a Family NP but your training must reflect that. Adult NP cert is fine too but for re-cert purposes you had better stuck to patient populations within your certification as per ANCC/AANP. Nursing as a whole just need some serious revamping! We are too busy worrying about too much this and not enough of that!

Actually, in Florida, you only have to be certified to receive license to practice. If you let your certification lapse after you are licensed, and remain active in Florida, you will remain licensed. The state really doesn't care if you stay in the scope of practice. Your practice physicians, and your malpractice insurance would be on the hook if you operated outside the scope of practice and had a claim.

But, if a claim were to be filed, the state would remove your license pending a board hearing.