So disappointed with on-line program

[JBMmom]

There were a number of reasons that my only option for APRN education was an on-line program. I'm the primary wage earner in our household of five and have to be able to keep working full time during school. Proximity to a brick and mortar program was also an issue. I've taken on-line classes before and I very much believe that you get out what you put in. So, it is my intention to make myself prepared to practice competently, and I've lined up some people that I really think will be excellent preceptors to help me in that respect. However, I have to say that the quality of the education is poor at best. The "advanced" pathophysiology and pharmacology courses largely consist of multiple choice exams and a lot of meaningless busywork assignments that I find to be on par with any undergraduate course I have taken over the years. I have found my own resources for lectures and information, but I think it's a sad state that this is the level of education I'm paying for from an institution, which I researched ahead of time and found was decently rated as an on-line program. I'm in the AGACNP program, and conceivably I could be hired as an acute care hospitalist. The same position that physicians with four years of medical school, residencies and advanced training, hold in our local hospitals. When I started, that was one end goal I was considering as a career path, but now I have concerns about my own readiness for that position when I finish. And it scares me for patients. I still have my clinical courses to complete, so maybe it's just too early to say, but the academic courses I have taken so far are a joke. And I have seen posts from many classmates that are struggling, which makes me wonder about the admission process, which I found a little lacking and probably should have been my first red flag.

I'm not trying to insult all on-line programs and students, and again, I know that in this learning format I'm responsible for making sure that I will be a competent APRN. But the lack of lectures, or interactive experiences from faculty, make it feel like they're just taking my money. (For example, I handed in an 8 page paper and 8 hours later had a 100% with no feedback other than "excellent". Did the professor even read it?!) I think as a profession, we are doing a disservice to well trained APRNs by turning out potentially unprepared APRNs. I understand that everyone still has to get licensed, but if you know how to take standardized tests, I think many people can pass a multiple choice exam with less than comprehensive knowledge of any subject.

I'm not sure how to wrap this up. Looking for other people's experience, thoughts, and maybe whether any practicing APRNs (if they check this board), found that the on-the-job training after school really filled in the gaps to lead to competent practice. I think we all know that coming out of nursing school we weren't really prepared to be nurses right away, so is this the same thing and I'm just being a little paranoid? Any thoughts appreciated.

[Spadeforce]

The studies don't say NP=MD/DO. They do show that on many quality indicators, and in a variety of settings, there is no significant difference in the quality of care. These include major landmark studies by multidisciplinary research teams published in journals like JAMA, the Annals, BMJ, Lancet, NEJM, etc.

In fact, rather than the nursing propaganda party googling basic stuff, why don't you cite some major peer-reviewed studies which show physicians have better outcomes?

I am not arguing that NP is equivalent to MD/DO, especially in regards to education and formal training. Outcomes are a completely different issue, and have been studied in depth for almost 50 years. To outright deny the existence of (or attribute to the "nursing propaganda party") a considerable body of research that shows the care provided by NPs is on-par with that of their physician colleagues is laughable. If the argument is in regards to the validity of those studies, then that is up for debate, but you can't deny that the data exists because it does, it has since the late 1970s, both domestically and abroad.

There are tons of nursing propaganda websites that say APRN>> docs. One is truthaboutnursing. All of those studies on JAMA, etc, they where still run and organized by nursing organizations.. bias much?

I am assuming it would be unethical to continue a study in which patients were obviously receiving substandard care, and if one actually reads these studies, (as I have said previously) they really dont give much on the controls of # of referrals, physician interventions, etc. And LOTS of them are physician vs physician +APRN, which some tend to hide that fact.

Its a giant political movement by the nursing community to get more independence off the backs of the docs.

The other big question is- if a physician trains the APRN during school, then works with an APRN during orientation to train it, and finally the APRN, follows guidelines written by physicians, is it really APRN outcomes? Sounds more like coasting down the already cleared path then taking all the credit for it.

Obviously outcomes would be similar if the aprns in these studies worked with physicians for years prior to being included in the studies, it makes no mention of this.

Lets see a study of new grad APRNs who never trained with a doc vs newly minted fp docs graduated from residency.

That would be the only legit type of primary care study. Otherwise APRNs are bending the truth saying their outcomes are the same when it was probably docs that trained them in the first place...

[l.a.m.b, ADN, RN]

CAN you tell us what program this is so we can avoid it? or the state this program is in at least?

[jboogs49, ADN, BSN, RN]

Obviously outcomes would be similar if the aprns in these studies worked with physicians for years prior to being included in the studies, it makes no mention of this.

Lets see a study of new grad APRNs who never trained with a doc vs newly minted fp docs graduated from residency.

That would be the only legit type of primary care study. Otherwise APRNs are bending the truth saying their outcomes are the same when it was probably docs that trained them in the first place...

I don't even know what you are trying to say my friend. So for APRNs to be able to legitimately state their outcomes are on par or better than docs they have to completely separate from the medical community? The NP can't ever train with a doctor in clinicals or work for or with a doctor. And on top of that can't use any of the guidelines created by the medical/health care community. Then only then will the study be legit regarding NP primary care vs MD. But you missed key aspect what if the new NP trains under an experienced NP who first trained with a Doctor and uses medical guidelines for their clinical judgement. Everything is tainted. What came first the chicken or the egg. You my friend might be my new favorite human with this logic. i guess you didn't like the study from that nursing propaganda sector the VA as well.

[BostonFNP, APRN]

There are tons of nursing propaganda websites that say APRN>> docs. One is truthaboutnursing. All of those studies on JAMA, etc, they where still run and organized by nursing organizations.. bias much?

I am assuming it would be unethical to continue a study in which patients were obviously receiving substandard care, and if one actually reads these studies, (as I have said previously) they really dont give much on the controls of # of referrals, physician interventions, etc. And LOTS of them are physician vs physician +APRN, which some tend to hide that fact.

Its a giant political movement by the nursing community to get more independence off the backs of the docs.

The other big question is- if a physician trains the APRN during school, then works with an APRN during orientation to train it, and finally the APRN, follows guidelines written by physicians, is it really APRN outcomes? Sounds more like coasting down the already cleared path then taking all the credit for it.

Obviously outcomes would be similar if the aprns in these studies worked with physicians for years prior to being included in the studies, it makes no mention of this.

Lets see a study of new grad APRNs who never trained with a doc vs newly minted fp docs graduated from residency.

That would be the only legit type of primary care study. Otherwise APRNs are bending the truth saying their outcomes are the same when it was probably docs that trained them in the first place...

You don't seriously believe all that do you? This is the same kind of junk argument we see from the anti-vaxxers: all the studies are flawed and done by shills, therefore I will believe what I want to believe.

There is no nursing conspiracy. There is no "nursing political movement" that could hold any candle to the the political sway of the AMA ($11 million per year compared to much less than a million in lobby dollars). There are plenty of "propaganda" sites that say MD>NP too, one of them by that definition is the AMA.

Yes some studies use data from NP only care, other use data from mixed teams of MD/DO and NP, the point is the results are consistent across multinational studies. It is very difficult to study NP outcomes in the US based on the billing model used by most medical practices and the relative lack of independent practice by NPs. There will be continued studies as that dynamic changes I'm sure and maybe that data will look worse for NPs are more poorly prepared NPs enter practice with less collaboration, but we haven't seen that shift in the data yet (at least to my knowledge).

As far as "following guidelines made by physicians", anyone that's worked a day as a provider understands there is more to practice than following a flowsheet, if there wasn't we could just have MAs do the majority of care. You cool with that? It's a silly petty point.

[JBMmom, MSN, NP]

CAN you tell us what program this is so we can avoid it? or the state this program is in at least?

It's funny that since I wrote this initial post I have run into three graduates of the same program who expressed that it set them up well for their current success as APRNs, so I will refrain from posting it here because my opinion may be in the minority. Specifically, I did not find pathophysiology and pharmacology to be as rigorous as I expected, but they expressed the opposite. And the paper that no one read was in the role development class, which is all fluff anyway. I'm not saying I don't stand by my opinion, but I guess everyone experiences things their own way. I will be starting the clinical rotations next semester and have lined up at least four really good APRN/MD colleagues as preceptors, and that's where I will know whether these classes that I have maligned may actually have taught me more than I thought.

[Dodongo, APRN, NP]

It's funny that since I wrote this initial post I have run into three graduates of the same program who expressed that it set them up well for their current success as APRNs, so I will refrain from posting it here because my opinion may be in the minority. Specifically, I did not find pathophysiology and pharmacology to be as rigorous as I expected, but they expressed the opposite. And the paper that no one read was in the role development class, which is all fluff anyway. I'm not saying I don't stand by my opinion, but I guess everyone experiences things their own way. I will be starting the clinical rotations next semester and have lined up at least four really good APRN/MD colleagues as preceptors, and that's where I will know whether these classes that I have maligned may actually have taught me more than I thought.

That would make me concerned for those APRNs. If I thought those classes were cake and they thought they were difficult... perhaps not the brightest bulbs?

On Monday I was talking to a new grad PA and NP and the NP said sometimes when the physicians are talking she feels like a lay person, but she doesn't need to memorize things because she can just look it up. The PA disagreed, as did I obviously.

[algae1492]

It's funny that since I wrote this initial post I have run into three graduates of the same program who expressed that it set them up well for their current success as APRNs, so I will refrain from posting it here because my opinion may be in the minority. Specifically, I did not find pathophysiology and pharmacology to be as rigorous as I expected, but they expressed the opposite. And the paper that no one read was in the role development class, which is all fluff anyway. I'm not saying I don't stand by my opinion, but I guess everyone experiences things their own way. I will be starting the clinical rotations next semester and have lined up at least four really good APRN/MD colleagues as preceptors, and that's where I will know whether these classes that I have maligned may actually have taught me more than I thought.

My patho course was extremely difficult, taught by a phd in physio who is well-respected in the field from ivy uni, proctored exams, and there was a heavy emphasis on organic and biochemistry throughout.

[algae1492]

That would make me concerned for those APRNs. If I thought those classes were cake and they thought they were difficult... perhaps not the brightest bulbs?

On Monday I was talking to a new grad PA and NP and the NP said sometimes when the physicians are talking she feels like a lay person, but she doesn't need to memorize things because she can just look it up. The PA disagreed, as did I obviously.

I attend lab hours every week for insight into real world practice and scenarios. There is so much that needs to be learned that we need baseline knowledge prior to utilizing the expansive resources available online or through mobile devices.

[Oldmahubbard]

I went to a private B and M school 20 years ago. Patho was not exactly easy, but mostly a refresher of the BSN level class. Little if any organic or biochem in it, as I recall. The exam was an essay.

[BassCatchingNurse]

If you wouldn't mind...as someone that is not an NP...I have some thoughts. I am currently an RN with 12 years of ER experience; however, I am at that point where I am tired of trying to "educate in passing" a patient population that is more concerned with getting their discharge papers, work note, and/or narcotic Rx than hearing about their disease process and how to help themselves. I believe that I should be in primary care. As an FNP, I would be able to build a relationship with patients and help them to understand and be compliant with their diabetes meds...to use diet and exercise to prevent diabetes or get off of their HTN meds...to maintain a healthier lifestyle in general. Yes, I am aware that many will still want a pill to fix it, but there will be victories...and I look forward to those moments!!

That being said, I will need to attend an online university. My wife is a stay at home mom, and we home school our children. Thus, I am the only source of income. I do very well, especially for the south!! My point is...I have to work!! Online works for my needs. I understand that there are substandard online schools out there, but all NP's must pass a standardized test to get their license, right? Isn't the test suppose to mean that one is competent to practice? If truly incompetent NP's are passing this test, maybe the test is the problem and should be changed. I for one do not need hand holding and lectures. I do not view that as a measure of quality. I went to a very good RN school. I did not take notes. I did not ask questions during lecture. I studied!! I never understood why people wanted to know what exactly was going to be on the test. I mean...don't you want to know all of the material...not just what is on the test? I think the path to my success will be to study in depth, no matter the assignment, and to select quality clinical sites. Even in a "substandard school," one is not limited to what is the curriculum for that program. There is a wealth of information out there...books, internet, people. I am sure that there are people in substandard schools that can not pass the certification test. But again, maybe the standard to pass should be increased? As far as NP vs MD, if I understand correctly, the NP fulfills a role. It is a role which has a scope of practice that is smaller than that of a physician. If one practices within that scope, in which one has tested and been deemed competent, I bet that the patient outcomes will be on par with that of physicians. Or...maybe I just don't know what I don't know. Either way, I will find out. I think the OP recognized that the curriculum should be more rigorous. She doesn't seem to disagree that the standard should be increased. So why are some so hard on her? She started a program that she researched and believed to be a quality program. She is disappointed it is not, but she stated it will not stop her from becoming a competent NP. What is the problem? She feels stuck, at this point, with that program. I get it. Not everyone can just pick up and move to an area with a brick and mortar school. Not everyone can financially "take the hit" and start a new program. Not everyone can quit work while going to school. I do not want to see online education go away. Increased standards for schools would be nice, but I believe having a more challenging certification test would ensure more competent NP's and eventually force schools to have higher standards as schools with low certification pass rates would see a decline in admissions. IMHO, of course!!!

[Oldmahubbard]

I worked in NP school. I usually took one class a semester. It took 5 years.

[algae1492]

If you wouldn't mind...as someone that is not an NP...I have some thoughts. I am currently an RN with 12 years of ER experience; however, I am at that point where I am tired of trying to "educate in passing" a patient population that is more concerned with getting their discharge papers, work note, and/or narcotic Rx than hearing about their disease process and how to help themselves. I believe that I should be in primary care. As an FNP, I would be able to build a relationship with patients and help them to understand and be compliant with their diabetes meds...to use diet and exercise to prevent diabetes or get off of their HTN meds...to maintain a healthier lifestyle in general. Yes, I am aware that many will still want a pill to fix it, but there will be victories...and I look forward to those moments!!

That being said, I will need to attend an online university. My wife is a stay at home mom, and we home school our children. Thus, I am the only source of income. I do very well, especially for the south!! My point is...I have to work!! Online works for my needs. I understand that there are substandard online schools out there, but all NP's must pass a standardized test to get their license, right? Isn't the test suppose to mean that one is competent to practice? If truly incompetent NP's are passing this test, maybe the test is the problem and should be changed. I for one do not need hand holding and lectures. I do not view that as a measure of quality. I went to a very good RN school. I did not take notes. I did not ask questions during lecture. I studied!! I never understood why people wanted to know what exactly was going to be on the test. I mean...don't you want to know all of the material...not just what is on the test? I think the path to my success will be to study in depth, no matter the assignment, and to select quality clinical sites. Even in a "substandard school," one is not limited to what is the curriculum for that program. There is a wealth of information out there...books, internet, people. I am sure that there are people in substandard schools that can not pass the certification test. But again, maybe the standard to pass should be increased? As far as NP vs MD, if I understand correctly, the NP fulfills a role. It is a role which has a scope of practice that is smaller than that of a physician. If one practices within that scope, in which one has tested and been deemed competent, I bet that the patient outcomes will be on par with that of physicians. Or...maybe I just don't know what I don't know. Either way, I will find out. I think the OP recognized that the curriculum should be more rigorous. She doesn't seem to disagree that the standard should be increased. So why are some so hard on her? She started a program that she researched and believed to be a quality program. She is disappointed it is not, but she stated it will not stop her from becoming a competent NP. What is the problem? She feels stuck, at this point, with that program. I get it. Not everyone can just pick up and move to an area with a brick and mortar school. Not everyone can financially "take the hit" and start a new program. Not everyone can quit work while going to school. I do not want to see online education go away. Increased standards for schools would be nice, but I believe having a more challenging certification test would ensure more competent NP's and eventually force schools to have higher standards as schools with low certification pass rates would see a decline in admissions. IMHO, of course!!!

I could have chosen a lesser quality education, but I quit my job and found a schedule that works around my uni's.