So disappointed with on-line program

Nursing Students NP Students

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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.

Specializes in Family Nurse Practitioner.
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.

I can't speculate about your fellow students but remember "success" is fairly subjective. One could be successful at getting a job or keeping a job neither which is a great feat, imo.

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

I can respect that, but I do not want to be 50 y/o and just starting my new NP career. I am sure many have started their career at 50. It is just not what I want. I truly wish that I would have went back to school earlier, but such is life. I am proud that I've worked hard and have provided for my family. The NP is really something for me. I want to be able to help my patients in a different way. One that I believe will have a greater impact.

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

Quitting my job is not an option. It would be very hard to replace my income in another job. Even if my wife started working, it would not be enough to supplement my income or pay the bills. If I didn't have bills, that would be a different story. I would never practice if I believed that I wasn't competent; however, as I already stated, one is not limited by the curriculum of the university. Less fluff and more substance would be great...I feel the same about my RN education, actually. I believe that I will be a great NP...one that truly cares about improving the lives of my patients. I do not believe that online equals "lesser quality." I believe that there are quality online programs and ones that are not. I believe some need the B&M style of education with lectures and others...will excel at online. Not everyone learns the same, right? I believe my previous point is still valid. Make the standard to pass certification higher and the rest will take care of itself. Besides, it would be far easier to increase the testing standard than it would be to create whole new standards for schools to follow: length of program, mandatory courses, clinical length, etc. I am not saying that this could not be addressed and standards created. I actually believe that there should be a unified standard. But, increasing the standard to pass the test could literally be done from one day to the next. Thus, it would help solve the current problem while the powers that be work on standardizing the education. Of course, at some point, many would probably just go the PA or MD/DO route....I'd assume.

Specializes in Adult Internal Medicine.
I would never practice if I believed that I wasn't competent; however, as I already stated, one is not limited by the curriculum of the university.

No matter how self-directed of a learner you are, having a quality curriculum is important. This isn't Good Will Hunting and you can become a competent provider for a dollar in late fees at the public library. The core curriculum in your graduate program will be the foundation your practice is built on. Being self-directed in addition to that is a great asset to your ultimate practice, it's just not the be-all of it.

Less fluff and more substance would be great...I feel the same about my RN education, actually. I believe that I will be a great NP...one that truly cares about improving the lives of my patients. I do not believe that online equals "lesser quality." I believe that there are quality online programs and ones that are not. I believe some need the B&M style of education with lectures and others...will excel at online. Not everyone learns the same, right?

NP education has always had some fluff, and as much as we all complain about it, it may actually serve a role in making NPs more patient-centered than our colleagues. Actually, in some ways, that nursing fluff is the only think that ties APN education to actual nursing.

There are absolutely quality NP programs online, Georgetown is a great example. They require site visits for technical skills, coordinate and control clinical experiences, and have a top notch faculty that has a mix of synchronous and asynchronous coursework. They aren't cheap. They aren't easy. And they aren't fully flexible. There are also awful programs. You get what you pay for.

I believe my previous point is still valid. Make the standard to pass certification higher and the rest will take care of itself.

I know that superficially this seems like a good solution for the outside but it's not, in many ways. It would, at best, be a band-aid solution to the problem that would create a lot of downstream issues.

Quitting my job is not an option. It would be very hard to replace my income in another job. Even if my wife started working, it would not be enough to supplement my income or pay the bills. If I didn't have bills, that would be a different story. I would never practice if I believed that I wasn't competent; however, as I already stated, one is not limited by the curriculum of the university. Less fluff and more substance would be great...I feel the same about my RN education, actually. I believe that I will be a great NP...one that truly cares about improving the lives of my patients. I do not believe that online equals "lesser quality." I believe that there are quality online programs and ones that are not. I believe some need the B&M style of education with lectures and others...will excel at online. Not everyone learns the same, right? I believe my previous point is still valid. Make the standard to pass certification higher and the rest will take care of itself. Besides, it would be far easier to increase the testing standard than it would be to create whole new standards for schools to follow: length of program, mandatory courses, clinical length, etc. I am not saying that this could not be addressed and standards created. I actually believe that there should be a unified standard. But, increasing the standard to pass the test could literally be done from one day to the next. Thus, it would help solve the current problem while the powers that be work on standardizing the education. Of course, at some point, many would probably just go the PA or MD/DO route....I'd assume.

No. Have you heard of the Dunning-Kruger effect? You can't just say, "well I know I'll be a great provider because I believe I will be!" I mean, what? No. You need to prove it. You need to overcome obstacles and prove to the public that you learned an appropriate amount of knowledge in order to provide an appropriate level of medical care. It doesn't matter if you care about improving the lives of your patients or not. Did you learn what you need to learn in order to provide medical care? Plain and simple. I don't care how much you want it. I don't care how much you believe in yourself. People are surprisingly and shockingly bad at self appraisal sometimes. That's why there are GPAs. That's why there are entrance exams. That's why there are midterms and finals and board exams. Heck, the simple requirement of having a scheduled, mandatory class each week is an obstacle that SHOWS that you care. It's an action. Not a feeling.

And then I just can't believe your last sentence. You are admitting that NP education is way easier than PA and MD/DO. If NP education actually involved standards and there were real requirements, well, you might as well just go be a PA or MD/DO. Doesn't this say it all?

No. Have you heard of the Dunning-Kruger effect? You can't just say, "well I know I'll be a great provider because I believe I will be!" I mean, what? No. You need to prove it.

Did you actually read my post? I never said that "I know I'll be a great provider" did I? Please reread it. I stated that "I believe" that I would be one. And, I do not "prove it" by going to school or taking the route that you want for me. I prove it by passing the certification test and practicing safely with positive outcomes for my patients. It is solely what happens after school that "proves" I am a great provider. Period!! I get it. You think that you are right. I certainly do not have to prove anything to you. Fair enough?

It doesn't matter if you care about improving the lives of your patients or not. Did you learn what you need to learn in order to provide medical care? Plain and simple.

Well...this at least we can agree on!!

I don't care how much you want it. I don't care how much you believe in yourself. People are surprisingly and shockingly bad at self appraisal sometimes. That's why there are GPAs. That's why there are entrance exams. That's why there are midterms and finals and board exams. Heck, the simple requirement of having a scheduled, mandatory class each week is an obstacle that SHOWS that you care. It's an action. Not a feeling.

Oh come on....we were just in agreement. Now you're just messing with me, right? First you state that the thing that matters is "did I learn what I need to learn in order to provide medical care? Plain and simple." Now, you say what I learn isn't enough? It should encompass an entrance exam, GPA's, midterms, finals, scheduled mandatory classes. I mean...I agree with having a GPA. I agree with having midterms and finals. But, what does entrance exams and scheduled classes have to do with the curriculum that I learn? One assesses my knowledge prior to starting and the other proves that I can show up at a specific time...both of which have nothing to do with how rigorous is the content. If you concede that the content taught and thus learned is the most important, as you earlier implied, then what is wrong with an online program without an entrance exam or scheduled class times as long as the content is such that it will fully prepare one to be a competent, well educated NP? I mean...there are still deadlines...even in online programs. You just have to be disciplined enough to do your work without someone else scheduling your study time. And yes, I already stated that there are poor programs out there; so, I am not referring to those.

And then I just can't believe your last sentence. You are admitting that NP education is way easier than PA and MD/DO. If NP education actually involved standards and there were real requirements, well, you might as well just go be a PA or MD/DO. Doesn't this say it all?

That is not what I said. I was stating that AT SOME POINT...meaning increased clinical hours, no part time schools, no online school, increased cost, etc...then at some point...there will be a tipping point...when "many"...not "all"....not "I"...not "the majority"..."many" will decide as a personal choice to go the PA/MD/DO route. That is not to say that NP programs are not sufficient to produce competent NP's. I am proud of my nursing profession, but many are not. There are direct entry NP programs that have students that do not care one bit to be a nurse. So, you see, my statement was not saying, "you might as well just go be a PA or MD/DO" as you stated. It was me expressing my opinion of what would PROBABLY happen if you took away some of the things that attract people to NP programs...such as reduced cost and flexibility. The fact is I only have two choices...either go to an online school or no school at all; therefore, to obtain my NP, I must go to an online school. I do not have a third option of quitting work and going to a B&M school.

It seems that we both agree that the program should be rigorous and fully prepare NP's to practice competently!! It seems we disagree on mandatory class times, as if that will make me a better NP. I also do not believe an entrance exam has anything to do with how competent you will be after graduation. It is a test that tries to ensure that the school is not "wasting a seat" on a student that can't handle the curriculum. It has nothing to do with how you will practice after you become an NP!!! I think we both agree that there should be more clinical time. It also seems that your hostility creates an obstacle to you seeing every word that I type...such as "believe," "many," and "probably." If missed, these are words that completely change the meaning that I intend. We seem to agree on more things than disagree. Relax!! It will be o.k.

No matter how self-directed of a learner you are, having a quality curriculum is important. This isn't Good Will Hunting and you can become a competent provider for a dollar in late fees at the public library. The core curriculum in your graduate program will be the foundation your practice is built on. Being self-directed in addition to that is a great asset to your ultimate practice, it's just not the be-all of it.

I agree. I do believe that the program should have quality curriculum. I am for higher standards. I just believe that one can get a quality education online. It seems some think online equals poor quality. And yes, I admitted that there are poor online programs out there. Oh yeah....I'm no Will!!!

NP education has always had some fluff, and as much as we all complain about it, it may actually serve a role in making NPs more patient-centered than our colleagues. Actually, in some ways, that nursing fluff is the only think that ties APN education to actual nursing.

I didn't think of it that way...but yes, I agree. Thank you.

I know that superficially this seems like a good solution for the outside but it's not, in many ways. It would, at best, be a band-aid solution to the problem that would create a lot of downstream issues.

Would you mind expounding upon this? I did say the program standards could be increased and standardized across the nation. I was just saying that in the immediate time, the standard to pass could be increased in order to ensure that the NP graduates truly know their stuff. I'm not sure what downstream issues you believe might come up, but I am interested in hearing what you think.

Specializes in Adult Internal Medicine.
Would you mind expounding upon this? I did say the program standards could be increased and standardized across the nation. I was just saying that in the immediate time, the standard to pass could be increased in order to ensure that the NP graduates truly know their stuff. I'm not sure what downstream issues you believe might come up, but I am interested in hearing what you think.

My own thoughts on this have evolved as I have been more heavily involved with these conversations at the local and national level. Here are some of the considerations that have evolved my thought process:

1. There is no evidence that the national board exams don't do their job of ensuring a minimum competency for practice. The first time pass rate for these exams is in the 80% range (in comparison, look at the USMLE pass rates of 94/95/97 for the steps, or ABFM pass rate of 95%). The exam is weeding out those which do not meet minimum standards and has fallen slightly in the past 10 years.

2. The solution to poor quality can't start at the end. Allowing poor quality programs to continue to churn out graduates that can't practice results in a ton of debt. The ultimate solution needs to stop the existence of these programs from the beginning.

3. It could potentially be a short term solution if coupled closely with accreditation: if the failure rate drops to X amount less than the national average the program gets put on warning and if not corrected in 12 months the program loses accreditation. The problem is that mechanism right now takes 5+ years and increasing the difficulty may actually prevent a fair amount of otherwise competent graduate NPs from practicing.

4. National board exams aren't designed to separate the cream from the crop, in fact, most competent graduate NPs will find the board exams are not challenging. They are minimum competency exams designed to identify those that are not competent.

If I had a dollar for every RN that came on this board thinking the provider role is easy and that they are "excellent self learners"

Make NPs take usmle step 1 before clinicals and pass = a solution for the didactic part lol

Specializes in New Critical care NP, Critical care, Med-surg, LTC.
If I had a dollar for every RN that came on this board thinking the provider role is easy and that they are "excellent self learners"

Make NPs take usmle step 1 before clinicals and pass = a solution for the didactic part lol

If you're referring to my initial post, at no point have I ever stated that the provider role is easy, that is one of my concerns when education seems less rigorous than I expected. I'm not touting myself as an excellent self-learner, time will tell whether my efforts are sufficient to supplement my education.

My own thoughts on this have evolved as I have been more heavily involved with these conversations at the local and national level. Here are some of the considerations that have evolved my thought process:

1. There is no evidence that the national board exams don't do their job of ensuring a minimum competency for practice. The first time pass rate for these exams is in the 80% range (in comparison, look at the USMLE pass rates of 94/95/97 for the steps, or ABFM pass rate of 95%). The exam is weeding out those which do not meet minimum standards and has fallen slightly in the past 10 years.

2. The solution to poor quality can't start at the end. Allowing poor quality programs to continue to churn out graduates that can't practice results in a ton of debt. The ultimate solution needs to stop the existence of these programs from the beginning.

3. It could potentially be a short term solution if coupled closely with accreditation: if the failure rate drops to X amount less than the national average the program gets put on warning and if not corrected in 12 months the program loses accreditation. The problem is that mechanism right now takes 5+ years and increasing the difficulty may actually prevent a fair amount of otherwise competent graduate NPs from practicing.

4. National board exams aren't designed to separate the cream from the crop, in fact, most competent graduate NPs will find the board exams are not challenging. They are minimum competency exams designed to identify those that are not competent.

I thank you for your reply. It is an interesting thought. So, are you saying that you believe that the real issues are the debt created and that minimum competency is not enough? I ask because point 1 & 2 seem to suggest that you believe the certification test does it's job, and point 2 is about debt.

I thank you for your reply. It is an interesting thought. So, are you saying that you believe that the real issues are the debt created and that minimum competency is not enough? I ask because point 1 & 2 seem to suggest that you believe the certification test does it's job, and point 2 is about debt.

I haven't seen any evidence it doesn't do it's job. Have you?

As for the debt, it's an issue, but there are more downstream effects from that too: poor programs continue to exist, more graduate NPs can't pass, they take lower paying RN jobs and that dilutes APN practice, the poor programs continue to make money and exploit. No real problem gets fixed.

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