Standardization of NP Education

djmatte, ADN, MSN, RN, NP · Jul 6, 2018

I've never understood why nurses will happily accept a PA who has no clinical experience whatsoever and starts to practice in their early 20s, but will chew apart a nurse that goes directly to NP school from their bachelors degree. Nurses need to calm down with the negativity towards others in their profession.

Because the entry requirements, training, and clinical requirements of PA programs are typically far more rigorous than the majority of np programs out there. They even need to recertify by reexamination periodically where NPs can't even get on board with that. The only thing nurses have to make up some difference and skill lacking is their experience. Past that, most NPs have inferior training at the same time that or governing bodies are pushing agendas like independent practice. Pushing for stronger requirements and expectations of our colleagues is the only way we safely and effectively move nursing practice forward.

M.S. FNP-BC · Jul 6, 2018

I respect your viewpoint. I may be biased. I graduated from a private university that had tough entry criteria, small class size, and many more than the required clinical hours. Plus clinical placements were well thought out and predetermined. I can't speak for the online NP programs... But personally my education was extremely rigorous and directly prepared me for clinical practice as an NP. I will agree with an earlier comment that called for more standardization of education requirements.

ThePTNurseGuy, DNP, NP · Jul 6, 2018

I'd like to weigh in on this, as this is always a topic I am very passionate about. I have my doctorate in physical therapy and my MSN. I am currently obtaining board certification for FNP. Having gone through both curriculums, I can honestly say that PT education is vastly superior to RN/NP education. One area that needs drastic improvement in NP programs is orthopedics/musculoskeletal education. I disagree with one of the earlier posters who said that gross anatomy is not necessary. Anatomy knowledge is lacking for every NP I have seen or worked with. I am not saying they have to be experts, but the knowledge base has to be better. Primary care sees so much ortho/MSK conditions: they need to be better with this specialty.

In regards to education, all the fluff has to exit the curriculum. These nursing care plans do not help anybody. I agree with everyone who mentioned that more education is needed beyond the 3Ps. Give students 2-3 pharmacology classes. Allow them to go in depth into each body system. Clinical hours should be bumped to 1000-2000 hours. Also, why do nursing programs ONLY use nurse educators? That makes absolutely no sense to me. They should be bringing in experts from other fields to teach specific areas of content. Bring in MD's/DOs, PTs, OTs, SLPs etc. Is it a pride thing? There is no reason for a nurse to be teaching a pharmacology class if their knowledge of pharmacology is poor.

lwsoccjs · Jul 6, 2018

You are preaching to the choir, and appreciate the perspective from someone who has been in a different field. I believe the only people that argue against your point are people that are either oblivious to their lack of knowledge or just stubborn with "pride".

allnurses Guide · Jul 6, 2018

I'd like to weigh in on this, as this is always a topic I am very passionate about. I have my doctorate in physical therapy and my MSN. I am currently obtaining board certification for FNP. Having gone through both curriculums, I can honestly say that PT education is vastly superior to RN/NP education. One area that needs drastic improvement in NP programs is orthopedics/musculoskeletal education. I disagree with one of the earlier posters who said that gross anatomy is not necessary. Anatomy knowledge is lacking for every NP I have seen or worked with. I am not saying they have to be experts, but the knowledge base has to be better. Primary care sees so much ortho/MSK conditions: they need to be better with this specialty.
In regards to education, all the fluff has to exit the curriculum. These nursing care plans do not help anybody. I agree with everyone who mentioned that more education is needed beyond the 3Ps. Give students 2-3 pharmacology classes. Allow them to go in depth into each body system. Clinical hours should be bumped to 1000-2000 hours. Also, why do nursing programs ONLY use nurse educators? That makes absolutely no sense to me. They should be bringing in experts from other fields to teach specific areas of content. Bring in MD's/DOs, PTs, OTs, SLPs etc. Is it a pride thing? There is no reason for a nurse to be teaching a pharmacology class if their knowledge of pharmacology is poor.

We had a nurse teach our undergrad pharm course, and a PharmD pharmacologist teach our grad level course. I learned so much more from the PharmD and came out with a better understanding of pharmacology. We were able to use MDs, DOs, PAs, and NPs as clinical preceptors, and it was helpful to get different perspectives and tap into their knowledge bases.

twozer0, NP · Jul 6, 2018

Firstly, as I browse on Allnurses occasionally, I see alot of hate towards NPs with no bedside experience. Despite being a nurse and a NP as completely different roles, several reviewers see this experience as mandatory. I can see how one can say that nursing experience can help you anticipate what to order and certain conditions but it's not an all-in-all experience to fall back on. Furthermore PAs, MDs, DO, hell even other allied health jobs don't absolutely require bedside care in order to be accepted into these programs so why be in a tizzy about NP school. I feel like is a personal matter. This notion also confirms that nurses dont even agree with the preparation that current NP schools provided.
With that being said, this requirement is at the discretion at the school but I wish there was just a straight-black-and-white standard of admission requirements so this argument can dissolve. ...

I felt my education my fairly good (I attended a very well known B&M program) but I had a lot of nursing experience to make up for some of the shortfalls. I'm not knocking direct entry applicants but I will say the barrier to entry for PA, MD, DO is a lot higher. For example, if you wanted to become a PA after being a nurse, you are likely required to take a few extra classes in order to meet entry requirements. Also, you have the MCAT for medical school. These are useful tools as they can weed out some of the candidates who likely will not perform well (some but not all). Nursing has none of these, just sign up and go. This is held over our head. Ultimately, its up to the individual to become competent at the job but often the choice to go to NP school is made for the wrong reasons. I commented in the past on this forum about someone who was looking into NP school but was unhappy for a myriad of reasons. A lot of prospective candidates don't even realize what goes down. If you don't like nursing due to the work/workload chances are you will not like being and NP as the workload just becomes more cumbersome.

My personal opinion and advice for people thinking of entering advanced practice is to really think it out. Write down pros and cons. DO SOME SHADOWING. See if this really is the life you want to lead or if your current situation maybe just needs a transfer in dept or organization. It took me several years to decide that this was the right path. Its not that I defiantly oppose direct entry, its just that I feel we have a unique opportunity that the others don't to learn some of the game before playing ball. Use that to your advantage and plan accordingly.

allnurses Guide · Jul 6, 2018

I felt my education my fairly good (I attended a very well known B&M program) but I had a lot of nursing experience to make up for some of the shortfalls. I'm not knocking direct entry applicants but I will say the barrier to entry for PA, MD, DO is a lot higher. For example, if you wanted to become a PA after being a nurse, you are likely required to take a few extra classes in order to meet entry requirements. Also, you have the MCAT for medical school. These are useful tools as they can weed out some of the candidates who likely will not perform well (some but not all). Nursing has none of these, just sign up and go. This is held over our head. Ultimately, its up to the individual to become competent at the job but often the choice to go to NP school is made for the wrong reasons. I commented in the past on this forum about someone who was looking into NP school but was unhappy for a myriad of reasons. A lot of prospective candidates don't even realize what goes down. If you don't like nursing due to the work/workload chances are you will not like being and NP as the workload just becomes more cumbersome.
My personal opinion and advice for people thinking of entering advanced practice is to really think it out. Write down pros and cons. DO SOME SHADOWING. See if this really is the life you want to lead or if your current situation maybe just needs a transfer in dept or organization. It took me several years to decide that this was the right path. Its not that I defiantly oppose direct entry, its just that I feel we have a unique opportunity that the others don't to learn some of the game before playing ball. Use that to your advantage and plan accordingly.

I agree with much of what you say. However, not all NP programs, be it Direct Entry or traditional, are sign up and go. Maybe that's changed in the almost 10 years since I attended. I had to submit transcripts, take the GRE, and have a face to face interview with all the programs I applied to (which were all on-campus B&M programs). The school I attended accepted approximately 10% of applicants. We should be concerned with those programs that accept anyone who can pay.

Jules A, MSN · Jul 6, 2018

I agree with much of what you say. However, not all NP programs, be it Direct Entry or traditional, are sign up and go. Maybe that's changed in the almost 10 years since I attended. I had to submit transcripts, take the GRE, and have a face to face interview with all the programs I applied to (which were all on-campus B&M programs). The school I attended accepted approximately 10% of applicants. We should be concerned with those programs that accept anyone who can pay.

I agree and in my view things have changed in the last 10 years with regard to the number of programs and lack of admissions criteria. Although I was underwhelmed by my well respected, high ranking state university at least there were stringent admission requirements. Only a few of the countless DNP programs I looked at required a GRE. Sad.

Oldmahubbard · Jul 6, 2018

It's been a long time since I applied to my program, but I know there was no GRE and I think they took anybody with a BSN GPA 3.0 or better. Considering grade inflation, that is almost meaningless.

I don't recall RN requirements, but I had no psych experience, I had been a HH RN, and I was admitted to the Psych NP program.

elkpark · Jul 7, 2018

It's been a long time since I applied to my program, but I know there was no GRE and I think they took anybody with a BSN GPA 3.0 or better. Considering grade inflation, that is almost meaningless.
I don't recall RN requirements, but I had no psych experience, I had been a HH RN, and I was admitted to the Psych NP program.

I'm in a medium-sized city with a state university nursing program that is well-known and highly ranked. A few years ago, my nurse manager accepted a psych NP student from the school (we are employed by the academic medical center affiliated with the university) to do one of her clinical practica with us (at the student's request) and assigned her to me to do the actual precepting. The semester of clinical was supposed to be focused on diagnosis, but I quickly found that her interviewing skills were so poor that she was incapable of gathering the data she would need in order to formulate a diagnosis, and we ended up spending the entire semester working on basic interviewing skills. I discovered that her entire career had been spent in a critical care setting and she had never worked in psychiatric nursing. I never did get a clear idea of why or how she had decided she wanted to be a psych NP.

My graduate program was (is) quite selective, and requires competitive GRE scores and grades, academic and clinical references, and a face-to-face interview. Only a relatively small percentage of applicants get accepted (most of the applicants don't even get invited for an interview). The program is quite rigorous. You get an excellent education, and are well-prepared to enter practice when you finish.

Dodongo, APRN, NP · Jul 8, 2018

I find it humorous how everyone gets on these threads and says, "Oh, well, my school was great. It was so good. I got a great education. It was so hard and the standards were so high. I don't know where these other people are going."

I mean, come on, school matriculation requirements and curriculum are objective measurements. There are far far far more schools that have little to no barriers to entry or graduation than those that do. So, I really don't care what school you personally went to. That's not the point of these threads. We need standardization. I also went to what I would consider a good school - I purposefully chose that. HOWEVER, more NPs choose sh*tty schools on purpose to avoid any semblance of hard work, than those that purposefully choose schools that will challenge them.

The problem is that option exists. There shouldn't be any bad schools to choose from, because we should have an accrediting body that holds each and every school to an acceptable minimum standard. Things like, minimum of 2 years "relevant" RN experience (can be determined by the program, so psych experience for PMHNP, ICU for ACNP, etc), minimum GRE scores, minimum gpa, in-person interview, gross anatomy at the graduate level, program arranged preceptorships and clinical experiences, etc.

djmatte, ADN, MSN, RN, NP · Jul 8, 2018

I find it humorous how everyone gets on these threads and says, "Oh, well, my school was great. It was so good. I got a great education. It was so hard and the standards were so high. I don't know where these other people are going."
I mean, come on, school matriculation requirements and curriculum are objective measurements. There are far far far more schools that have little to no barriers to entry or graduation than those that do. So, I really don't care what school you personally went to. That's not the point of these threads. We need standardization. I also went to what I would consider a good school - I purposefully chose that. HOWEVER, more NPs choose sh*tty schools on purpose to avoid any semblance of hard work, than those that purposefully choose schools that will challenge them.
The problem is that option exists. There shouldn't be any bad schools to choose from, because we should have an accrediting body that holds each and every school to an acceptable minimum standard. Things like, minimum of 2 years "relevant" RN experience (can be determined by the program, so psych experience for PMHNP, ICU for ACNP, etc), minimum GRE scores, minimum gpa, in-person interview, gross anatomy at the graduate level, program arranged preceptorships and clinical experiences, etc.

I think many schools have features that make them worthy in some areas and less than stellar in others. Frontier excelled in their clinical requirements and student skill requirements/tracking, but made us find a preceptor (though they had a thorough database of previous preceptors). Their entry was on the lower side (3.0) and no GRE, but meeting requirements didn't guarantee every as higher gpa would would be prioritized. Their instruction strived to do well in the online environment using a range of proctoring systems in my time and strict exam grade policies, but adding broader anatomy/physiology could absolutely have improved the course. All schools could benefit from more streamlined accreditation though.

I disagree to some degree with experience I a related area. Few to no RNs will ever work in a primary care or ambulatory clinic. Maybe those who have care managing experience, but with certification requirements in that field few would make the transition.

Standardization of NP Education

What immediate requirement will improve NP education