Standardization of NP Education

allnurses Guide · Jul 18, 2018

It really seems that requiring a year long residency post graduation in your chosen field of practice (ED, primary care, OR, etc) would solve a lot of the problems fairly quickly.
For example, I was told by my provider that Mayo Clinic was no longer accepting student NP's from certain online/DE programs for preceptorship due to repeated past poor performance of other students from those programs.
If year long residencies became standard and you couldnt get into one due to having graduated from EZ University's NP program, people would quickly stop attending EZ NP's program and it would be shut down.

This option has some serious drawbacks that would need to be considered/addressed:

1. It would require some type of national oversight and coordination.

2. It would add time to NP preparation which results in added cost to the system and would reduce the cost-effectiveness of NPs in providing care.

3. It would make graduates of quality, long-standing programs do the same job they would have done otherwise for less money.

4. If you change from primary care to urgent care you'd need to redo a residency? That would be a huge impact to practicing NPs.

broughden · Jul 18, 2018

This option has some serious drawbacks that would need to be considered/addressed:
1. It would require some type of national oversight and coordination.
2. It would add time to NP preparation which results in added cost to the system and would reduce the cost-effectiveness of NPs in providing care.
3. It would make graduates of quality, long-standing programs do the same job they would have done otherwise for less money.
4. If you change from primary care to urgent care you'd need to redo a residency? That would be a huge impact to practicing NPs.

1. Allow either one or both of the board certifying agencies to act as oversight similar to how the AGCME does it now for MD's.

2. It would add one year and no cost. NP resident's would be paid similar to MD residents.

3. So? Harvard MD's still have to do residency same as Caribbean MD School graduates do. Residency is not just about driving out poor performing schools but raising clinical acuity.

4. Yes of course. MD's are required to (or more correctly I should say ethically should depending on the state's medical board and rules), why would we expect any less of a mid-tier provider?

Many surgeon groups and teaching hospitals now offer fellowships/residency for new NP grads in specialty areas. Rather than being an option for NP's who want to push themselves and excel it should be mandatory to being licensed, especially with the growth in independent practice states.

allnurses Guide · Jul 18, 2018

1. Allow either one or both of the board certifying agencies to act as oversight similar to how the AGCME does it now for MD's.
2. It would add one year and no cost. NP resident's would be paid similar to MD residents.
3. So? Harvard MD's still have to do residency same as Caribbean MD School graduates do. Residency is not just about driving out poor performing schools but raising clinical acuity.
4. Yes of course. MD's are required to (or more correctly I should say ethically should depending on the state's medical board and rules), why would we expect any less of a mid-tier provider?
Many surgeon groups and teaching hospitals now offer fellowships/residency for new NP grads in specialty areas. Rather than being an option for NP's who want to push themselves and excel it should be mandatory to being licensed, especially with the growth in independent practice states.

No cost? You have to be joking right? The GME spends more than 1 billion per year on this and that represents only 1/3rd to 50% of the cost of residency programs! That money comes from tax dollars funding a government agency; the AANP or ANCC or others aren't going to just pick this up and run with it without some significant funding from somewhere.

Are you a practicing APN? If it is about raising acuity, then you would be fine if you were required to do your job for 50% of the pay for a year to increase your acuity in your role?

I don't fully disagree with residency/fellowships in specialties for NPs but there are major hurdles to that.

djmatte, ADN, MSN, RN, NP · Jul 18, 2018

I think if residency was a standard part of the routine (regardless of the pay deficit), I would be OK with it since the end-goal is a more experienced provider. The problem is it isn't set up this way now and nobody in their right mind will ever endorse the idea. Reality is we are stuck with what we have and as much as we go back and forth about ideal solutions, AANP and ANCC make too much money certifying new NPs and padding their membership numbers hand over fist to make real changes. Schools want to continue to make money at the current rates of over-saturation. And even accrediting bodies (evident in other threads) aren't willing to hold schools to higher standards. The best we can hope for is practicing to the best we know how and hope nobody dies in the process. Because people are dying and NPs are being locked up/losing their licenses for substandard care. And we will see more of this in the future.

broughden · Jul 18, 2018

No cost? You have to be joking right? The GME spends more than 1 billion per year on this and that represents only 1/3rd to 50% of the cost of residency programs! That money comes from tax dollars funding a government agency; the AANP or ANCC or others aren't going to just pick this up and run with it without some significant funding from somewhere.
Are you a practicing APN? If it is about raising acuity, then you would be fine if you were required to do your job for 50% of the pay for a year to increase your acuity in your role?
I don't fully disagree with residency/fellowships in specialties for NPs but there are major hurdles to that.

You didnt say whose cost you were referring to so I assumed you meant the person in residency. Of course there would be costs in administering the program.

But $1 billion? Uhm medical residency is overseen by the ACGME and their operating revenue, which is fully public and available online is $57.4 million. That is the direct costs of the oversight organization.

Now what you may be referring to here is the annual cost that Medicare and Medicaid spend subsidizing the salaries and education costs of residents each year, and that payment is referred to as the DGME and IGME, which is in excess of $15 billion per year.

But quite frankly we dont need to publicly subsidize NP residency training. Residencies and fellowships are already up and operating without public taxpayer support. The hospitals get low cost help for a year and in exchange the NP resident/fellow gets additional clinical training from MDs and senior APRN's.

And no Im NOT a practicing APRN at the moment, but I am heading that way and I will voluntarily complete a residency/fellowship after school. Just as I am already voluntarily scheduling and paying for additional training, such as cadaver labs, during my summers right now as I finish my BSN. Sorry but I dont have a lot of sympathy for "oh my gosh a whole year at half pay?!"

MD's do it. NP's want the independent practice, then they need to put in the time and effort and sacrifice. You cant claim you want to improve the system but then balk anytime that means it might make the process a little harder to complete.

Link to ACGME's annual report and budget:

https://www.acgme.org/Portals/0/PDFs/2016-2017-ACGMEAnnualReport.pdf

Link to annual GME public costs report:

http://www.nationalacademies.org/hmd/Reports/2014/Graduate-Medical-Education-That-Meets-the-Nations-Health-Needs.aspx

Jules A, MSN · Jul 18, 2018

Here's some potential money because we don't need to allocate more funds for more lame programs to churn out more unprepared nurses. Is there truly even a shortage?

American Association of Colleges of Nursing (AACN) > Policy & Advocacy > View

wayemika · Jul 19, 2018

It really seems that requiring a year long residency post graduation in your chosen field of practice (ED, primary care, OR, etc) would solve a lot of the problems fairly quickly.
For example, I was told by my provider that Mayo Clinic was no longer accepting student NP's from certain online/DE programs for preceptorship due to repeated past poor performance of other students from those programs.
If year long residencies became standard and you couldnt get into one due to having graduated from EZ University's NP program, people would quickly stop attending EZ NP's program and it would be shut down.
Otherwise I agree with Myelin:
There are unfortunately a lot of nurses who graduated from questionable undergraduate programs and going forward with the same mentality into advanced practice. The sheer number of for profit RN schools that will accept students of questionable academic standing as long as they are able to pay the outrageous tuition prices, attests to this.
There are NUMEROUS threads on All Nurses from these failing students, who then manage to find positions in for profit schools, that attest to this.

I would love it if you could PM me what schools they mentioned :)

LilPeanut, MSN, RN, NP · Jul 23, 2018

I'm a DE grad (undergrad in spanish/international studies) and I'm an NNP, so I worked for 3+ years prior to going back to finish my NP portion of my program. I had far more neonatal pathophys than many of my colleagues who went to a different school. My program wasn't perfect, but I came out a good novice NP, and now am a good experienced NP.

Of course, my POV is that we should merge medicine, RT and nursing as disciplines and make RT, RN, NP, Attending all different stops/branches along the same pathway. It would provide more assessment skills and clinical knowledge for those at the "top", more camaraderie between the different levels and standardize some of the educational requirements. Most doctors specialize, and so they spend a lot of time in residency as cheap labor, with things they don't care about/are going to forget about, piling on more debt. If you want to switch specialties, I think it is reasonable to ask someone to go back to school. But the often adversarial relationship between nursing and medicine should stop - medicine needs to stop getting pissy about NPs trying to use their license. If they want to go back to strict delineation of what medicine and nursing are, then they shouldn't be talking to patients much or dealing with anything that isn't the disease. People want the more integrative care.

DNT Nurse · Aug 1, 2018

Yes, the PA, MD, DO's does not need to have an bedside experience. Yet when they apply for schools they need to have volunteering (so they volunteer in nursing homes, hospitals etc., I know MD student who worked as MA to get the extra points). Then they go to school and in case of an MD they are 3 years the residents. I do not know the physician assistants bed side, but I know nurse in different NP programs and their clinicals are MINIMAL. It will not teach much anyone with no previous experience. NP without any previous real nursing experience with patients is joke to me. Sorry. I can't take that person seriously. And if i would be the patient - I would run. That is for honesty. Do not hate me for it

allnurses Guide · Aug 1, 2018

It will not teach much anyone with no previous experience.

What does this mean?

Susie2310 · Aug 2, 2018

At least one poster on this forum has questioned the role of the nurse practitioner, in doing so meeting with great opposition and even ridicule from other posters. This poster made the point that NP's are neither physicians with physician education and training, nor do they perform the traditional role of the clinical/bedside RN, saying that essentially they are lesser trained providers relative to physicians, who provide care more cheaply than physicians (which is their main value to employers). I agree with this. Whether or not a NP has significant nursing experience upon being admitted to NP school, and the value to the NP and to their patients and colleagues of being an experienced nurse before becoming a NP, is another topic. As I remember this thread, this poster asked why we want the public to accept lesser trained providers. I think this is a good question. This poster also asked why we have NP's, saying that he/she thought that people should either become physicians if they want to practice medicine, or nurses if they want to provide clinical bedside nursing care. At face value this seems like a rather extreme statement to those of us used to a myriad of roles for nurses and who value and champion this diversity, but I think this situation is the crux of the problem. The role of the NP has expanded today from the role it was originally created to fulfill, and perhaps it is time to question/assess if it has largely outlived it's usefulness.

allnurses Guide · Aug 2, 2018

At least one poster on this forum has questioned the role of the nurse practitioner...
As I remember this thread, this poster asked why we want the public to accept lesser trained providers. I think this is a good question.

There was just a recent study that looked at patient preference in primary care providers. 55% of the population studied expressed a preference for a physician provider. The most commons reasons patients cited for choosing a provider is qualifications, personal/family past experience, bedside manner, and access/efficiency. Patients preferred NPs based on bedside manner and access/efficiency and preferred physicians based on qualifications. They were equal on personal/past experience.

We know from numerous studies that both the objective quality care provided by NPs and the patients subjective/perceived quality of care is non-inferior to that of MD/DOs.

Maybe the public thinks that having access to quality care with providers they trust is more important than the number of years spent in a classroom?

Standardization of NP Education

What immediate requirement will improve NP education