Standardization of NP Education

Oldmahubbard · Jul 4, 2018

The following is my experience, and my opinion only.

Gross anatomy, or more cadavers will add zero value to NP education. The problem is virtually never lack of anatomical knowledge.

I was accepted into a well regarded B and M school 20 years ago. I think they accepted anybody with a BSN. I had virtually no experience in my chosen speciality, but I got that experience during the nearly 5 years it took me to get my MSN, while I worked full-time in the field , plus the year it took to get my post-Master's certificate as a Psych NP.

When I finished my Psych NP in 2003, I was fully good to go. Yes, I was still a novice, but I knew how to diagnose, and I was thoroughly acquainted with the relatively few drugs I would be prescribing.

Due to my experience and extensive self preparation, I was also quite knowledgeable about clinical issues in my field, ie drug and disability seekers, substance abusers, malingerers and personality disordered people.

I was well prepared because I knew from a previous profession that "school" teaches you squat. I knew people who had teaching certificates for a foreign language. They could count to 10 in that language, but not much more. But they still got jobs, depending on the political climate. It was downright embarrassing.

I did not want to be in that position when evaluating patients and ordering their medication.

My B and M school 2 decades ago did not arrange our preceptors. I was lucky enough to finally find a willing preceptor who ended up being "crazier" than most of the patients I have ever treated.

She was a narcissist who took advantage of my inexperience, and refused to give me credit for the course after I began to ask a couple of questions.

All that being said, the experience was essential to my formation as a NP.

For the big picture, we definitely need to produce higher quality graduates. I can't imagine how a Psych NP, an Acute Care NP or a Nurse midwife could be minimally prepared without significant RN experience in the specific field.

But not just RN experience, because the knowledge isn't by osmosis.

I am talking extensive self preparation. Going home every night and asking yourself what, what, what, and why, why, why. Until you make the information your own.

Being able to count to 10 and saying "hello" and "goodbye" is not enough. There is a degree of fluency that is required, or you are a danger to your patients. There are things that cannot be faked.

Primary care is a different matter. A brilliant person could probably do this job with little to no RN experience.

The DNP is utter bullcrap. We need to get rid of the nonsense courses at the MSN level.

The head of my MSN program 20 years ago was a Psych NP in name only. She referenced Freud on a regular basis.

If that doesn't frighten you, I am not sure what will.

End of rant.

djmatte, ADN, MSN, RN, NP · Jul 5, 2018

The following is my experience, and my opinion only.
Gross anatomy, or more cadavers will add zero value to NP education. The problem is virtually never lack of anatomical knowledge.
I was accepted into a well regarded B and M school 20 years ago. I think they accepted anybody with a BSN. I had virtually no experience in my chosen speciality, but I got that experience during the nearly 5 years it took me to get my MSN, while I worked full-time in the field , plus the year it took to get my post-Master's certificate as a Psych NP.
When I finished my Psych NP in 2003, I was fully good to go. Yes, I was still a novice, but I knew how to diagnose, and I was thoroughly acquainted with the relatively few drugs I would be prescribing.
Due to my experience and extensive self preparation, I was also quite knowledgeable about clinical issues in my field, ie drug and disability seekers, substance abusers, malingerers and personality disordered people.
I was well prepared because I knew from a previous profession that "school" teaches you squat. I knew people who had teaching certificates for a foreign language. They could count to 10 in that language, but not much more. But they still got jobs, depending on the political climate. It was downright embarrassing.
I did not want to be in that position when evaluating patients and ordering their medication.
My B and M school 2 decades ago did not arrange our preceptors. I was lucky enough to finally find a willing preceptor who ended up being "crazier" than most of the patients I have ever treated.
She was a narcissist who took advantage of my inexperience, and refused to give me credit for the course after I began to ask a couple of questions.
All that being said, the experience was essential to my formation as a NP.
For the big picture, we definitely need to produce higher quality graduates. I can't imagine how a Psych NP, an Acute Care NP or a Nurse midwife could be minimally prepared without significant RN experience in the specific field.
But not just RN experience, because the knowledge isn't by osmosis.
I am talking extensive self preparation. Going home every night and asking yourself what, what, what, and why, why, why. Until you make the information your own.
Being able to count to 10 and saying "hello" and "goodbye" is not enough. There is a degree of fluency that is required, or you are a danger to your patients. There are things that cannot be faked.
Primary care is a different matter. A brilliant person could probably do this job with little to no RN experience.
The DNP is utter bullcrap. We need to get rid of the nonsense courses at the MSN level.
The head of my MSN program 20 years ago was a Psych NP in name only. She referenced Freud on a regular basis.
If that doesn't frighten you, I am not sure what will.
End of rant.

Absolutely on point. Though I tend to disagreed with the primary care side. While a "brilliant"person could probably do this job, I find the few people are truly "brilliant" regardless of their gpa or ability to pass a standardized test. I believe that the experience that someone receives in any RN scenario serves them well in any NP role. If not then we marginalize primary care NPs as somehow less than in the grand scheme of expectations when often they are the front line of physical assessment and differential diagnosis. IMO that RN experience sets the stage for quickly recognizing/ differentiating things from normal and abnormal.

LadyT618, MSN, APRN, NP · Jul 5, 2018

Absolutely on point. Though I tend to disagreed with the primary care side. While a "brilliant"person could probably do this job, I find the few people are truly "brilliant" regardless of their gpa or ability to pass a standardized test. I believe that the experience that someone receives in any RN scenario serves them well in any NP role. If not then we marginalize primary care NPs as somehow less than in the grand scheme of expectations when often they are the front line of physical assessment and differential diagnosis. IMO that RN experience sets the stage for quickly recognizing/ differentiating things from normal and abnormal.

I'm with you on the primary care front. So many MDs out there don't even believe that NPs are good enough to provide primary care and it really doesn't help when there are NPs out there who make statements like the one made in the previous post ("Primary care is a different matter. A brilliant person could probably do this job with little to no RN experience."). I have seen quite a few posts on Allnurses.com saying the same thing about how it isn't necessary to have RN experience for primary care but for everything else, you should have RN experience. It's almost as if (and this is just how I'm perceiving things) primary care is getting the short straw in that you don't really need that much expertise to provide -- which is really a slap in the face to primary care providers everywhere, especially since they are the first line of defense in so many instances.

Oldmahubbard · Jul 5, 2018

I could certainly be wrong about primary care NPs not needing RN experience.

My experience is all psych, where an enormous amount of subjective clinical judgement is required.

Primary care seems much more cut and dried to me.

Back in my day, nobody would have dreamed of becoming an NP without substantial RN experience.

Then the schools got greedy. They didn't care about the long term effect of unleashing these graduates into the job market.

I am just glad to be done with it in the next 5 years:)

LadyT618, MSN, APRN, NP · Jul 5, 2018

Back in my day, nobody would have dreamed of becoming an NP without substantial RN experience.
Then the schools got greedy. They didn't care about the long term effect of unleashing these graduates into the job market.

And that's just it....the Nurse Practitioner role began out of the need for these Advanced Practice Nurses in primary care, a role which required RNs with clinical experience. Now it has morphed into a means of skipping the RN route (from a practice point of view) and jump straight ahead. It's like as if the "Nurse" in Nurse Practitioner has lost its luster and meaning.

Just my $.02 but I've always wondered if a Nurse Practitioner has never practiced as a Nurse, how can this individual be referred to as a true Advanced Practice Nurse (without ever having practiced as a nurse in the first place). Just something that I've always thought about.

lwsoccjs · Jul 5, 2018

And that's just it....the Nurse Practitioner role began out of the need for these Advanced Practice Nurses in primary care, a role which required RNs with clinical experience. Now it has morphed into a means of skipping the RN route (from a practice point of view) and jump straight ahead. It's like as if the "Nurse" in Nurse Practitioner has lost its luster and meaning.
Just my $.02 but I've always wondered if a Nurse Practitioner has never practiced as a Nurse, how can this individual be referred to as a true Advanced Practice Nurse (without ever having practiced as a nurse in the first place). Just something that I've always thought about.

100% agree with your last paragraph. Without the RN experience the advanced practice nurse degree is nothing more than a watered down PA. We wonder why many people in the know look down on us. Thankfully much of the public is still unaware.

allnurses Guide · Jul 5, 2018

And we're beating a dead horse again. Haven't we discussed the Direct Entry thing ad nauseum? Or do people think that is the only thing wrong with NP education?

As a DE grad, I don't think I'm "brilliant", but I'm pretty damn smart and hard working. I learned how to think critically in a previous profession, and was willing to go above and beyond the minimum clinical requirements of my programs to ensure that I would graduate with as much student clinical experience as possible. I think those factors weighed heavily into my success as a DE grad, and now an experienced NP. From what many say, there's no way myself or any DE grad could possibly be successful without RN experience. Well, here I am as evidence to the contrary. That being said, I think NP programs, whether they be DE or traditional, should only accept the best and the brightest, not just those who can pay. They should be selective, and they should have relationships with vetted and experienced preceptors. Curricula should be more standardized and should have an emphasis on science and evidence based practice, along with more clinical hours.

I do believe we need to up our standards for all NP programs and who is admitted to these programs, wheter they have RN experience or not. I am not convinced that prior nursing experience is essential. My experience, and that of many other DE grads tells me otherwise. RN experience can be valuable, but essential, maybe not. Many will disagree, which is their prerogative.

lwsoccjs · Jul 5, 2018

I do not believe anyone would agree that minimal to no RN experience is the "only" thing wrong with the profession. As evidenced by the current polling. It sure is a contributing factor but surely not the only factor. One persons anecdotal evidence of succeeding does not prove ones point either though. No one would take away the hard work that a DE put in to be successful. But, that person will thrive in spit of the schooling not because of it. This is just one of the many problems with the system, on top of the many you have already brought up.

lwsoccjs · Jul 5, 2018

Anyways to get back to topic:

I think the single most factor that could be changed to increase knowledge base for NP's is make the schooling full-time. Just like any other respectable profession make the course load a full course load. Like 18 credits just like our peer professions. This would require future providers to take the schooling serious and not half ... it.

djmatte, ADN, MSN, RN, NP · Jul 5, 2018

Anyways to get back to topic:
I think the single most factor that could be changed to increase knowledge base for NP's is make the schooling full-time. Just like any other respectable profession make the course load a full course load. Like 18 credits just like our peer professions. This would require future providers to take the schooling serious and not half ... it.

Schooling full time in most cases is a non starter. Might as well push for de only np grads because few to no RNs with work experience will be able to get into advance practice if they have to almost completely stop working. Most RNs who move into advance practice are well settled in life, often are home bread winners, and can't just stop working. Working part time or other doesn't discourage doing things well or facilitate better learning. Imo It's a combination of raising school entrance standards-based clinical experience standards, and np certification testing standards that will improve the profession.

My school for instance required 675 hours of clinical. While I don't consider this stellar, ours were right in the middle of most. But they set themselves apart in their specific requirements. They mandated that we see certain totals of clinical cases. 50 pap/pelvic exams. 25 wellness and 25 episodic exams for 5 different pediatric age groups. 300 adult episodic and 300 chronic adult exams. Not to mention numerous other ob and infant exams. So while the minimum hours were required, if you didn't hit your total you kept going.

Control and oversight of the clinical process imo is the difference maker in any advance practice school whether it's online or brick and mortar.

Jedrnurse, BSN, RN · Jul 5, 2018

If nursing experience isn't required, don't have nurse practitioners. PAs all around...

Standardization of NP Education

What immediate requirement will improve NP education