Stop the preceptor madness!

Aromatic · Feb 6, 2017

idiocracy medical scanner - YouTube

lol best movie ever. I mean best prophecy ever.

Back to what jules said. The only way I feel we can get anything done is expose to the public how weak np education standards are, and incit a backlash of lawyers to come in and pick apart the practices of newly minted online crapU nps. We all know it usually takes outside backlash to get anything done (aka flint mich). So since they wont listen, we fight fire with fire, which of course I will once I am done with school since very few people go thru both NP and MD school, most people are wise enough just to pick one route and stick with it lol!

4 years from now maybe Ill be on the top 5 articles of kevinMD lmao

Also, why is myoglobin still ranting with his/her big wordisms that do not even make sense. You and ACC should really get together sometime and have a koolaid party, because both yall sucked the pitcher dry on these forums. But hey since you know it all and will probably be the best indebt, mediocre, Hawaii NP provider in the world hats off to you. Just quit with the cliche mission statement type posts that make no sense and have no direction other than to replicate stuff you probably read on waldens motivational "follow your dreams" homepage that gets people all pumped up to send them government debt dollars

myoglobin, ASN, BSN, MSN · Feb 6, 2017

I still don't understand the personal insults. I talk the way that I write. My son and significant other often mock me as sounding alternatively like an autistic robot or crazed television preacher. I don't really have any friends and my mom and dad (the only family I was close to) are deceased. My significant other and son see these debates as pointless. Her attitude is "why do you care so much what strangers think? Live your life rather than debating philosophy with others". While I respect her perspective, but that is not how I see things. There is existential truth or at least wisdom to be gleamed and the crucible of discourse can in some ways provide such wisdom. I do however feel passionate about these issues. Having been the victim of "horizontal violence" personally and seen it happen to scores of other nurses I do my best to oppose it in all of its forms.

Often things are a matter of perspective. Every year when we have to do personal evaluations of our nursing skills and abilities I always write "needs improvement" on every category. This year my manager called me into her office and said "maybe we need to find you a unit where you feel that you would be more adequate" my response was there isn't a single job or function in the universe where I would evaluate myself differently and that furthermore even if I worked as a Walmart greeter for seven years that I would evaluate myself as "needs improvement", its just my perspective. In the end she said that my coworkers had a more charitable perspective and made me repeat the form until it reflected a value minimally adequate (a process we go through every year). I also don't believe in competition so even if I actually believed I was better than mediocre, I wouldn't affirm it. I understand that these are strange and different perspectives from the vast majority of Americans/ and Nurses, but so what it's OK to be different.

I often appreciate differing perspectives even when I don't share them. This American Life is my favorite podcast/program despite the fact that it often approaches issues from a left of center socio/political perspective and mine is libertarian/right wing on most issues. In the final analysis ever since my parents passed away I've just wanted to live in Hawaii, keep to myself, go hiking, snorkeling, garden, read books, listen to my paranormal radio and other podcasts, play video games and enjoy life. I became an RN because I figured that it would be possible to get a job and at least eek out a minimal living there and I'm becoming a Psych NP now for the same reason. It's really the only thing I've ever really wanted in my adult life. Furthermore, as it stands my significant other has stated on more than one occasion that she will never move there (and given that I will never leave her, I've only been in two relationships in my 48 years, the last 26 with her it's frankly not likely to happen, I'll probably rot away right here in Florida an continue my mantra of "another day closer to death" to my coworkers when they ask how I'm doing). I believe in "living to work" rather than "working to live" a perspective perhaps more in line with the French or Greece.

Also, the program I attend is considered one of the better ones in the nation. No one has yet explained what "alternative process" they would propose for schools locating preceptors. As a matter of actual fact they would be "cold calling" local clinics in the same manner that I will be doing. The difference is that I could actually contact MD's and NP's that I actually know were it not for my categorical rejection of any possibility of rejection from people I know (I won't even ask or hint my SO for intimacy or my son for a hug and will go weeks without looking people in the face let alone their eyes as even the mere potential of an expression that reflected rejection is too much for me to handle if I know them. The back and forth of human interaction is beyond me outside of controlled, limited settings). However, approaching strangers, cold calling, and even giving public speeches and (confronting management) doesn't bother me very much. Passionate and crazed diatribes along with Socratic rantings are the emotional situations where I'm most comfortable. At least under the current paradigm I have the opportunity to find my own preceptor using the techniques I'm comfortable with (sending hundreds of letters, cold calling, and moving if necessary to a different city). Seriously, what specific proposal would you advocate be implemented either as a law or regulation that would address the problems to which you allude? Already, Master's programs are being phased out in favor of DNP's.

In reply to the assertion that I should work an extra shift I would rather borrow 300K additional (were it possible) and have to live in the backwoods jungles of Kauai than work a single extra shift at my place of employment. If the 80K that I earn there now isn't enough (with another 5K in tuition reinbursement) and the 70K my significant other earns as well (and she is about to earn 170K per year with the tele-psych offer she has received). I doubt the extra money from an additional shift would help much. Right now I'm in one of my 80 year old man back phases (from lifting the 400lb vented patients by myself since we don't have techs at night). We would just eat out even more (which is already about 80%). Also, my courses take a minimum of about 20 hours per week in study time and I wasn't kidding when I said that I get to see my significant other and sixteen year old son about four hours per week. When one of you works days and the other nights that's the way it is (plus I don't believe in texting or non urgent social phone calls certainly not at work, and I don't take lunch or breaks except to use the restroom or to take my 0200 600mg dose of caffeine pills).

Well, I would imagine that I've provided plenty of additional fodder with which to mock and insult me rather than deal with the salient issues so feel free either way. I would say these same things face to face (were we having that mythical cup of tea at the Kauai abode I will likely never know) and indeed have done so many times at work, and to my nursing school instructors both at the ASN, BSN and graduate levels.

LessValuableNinja · Feb 6, 2017

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Because this thread needs a joke.

Jules A, MSN · Feb 6, 2017

Well, I would imagine that I've provided plenty of additional fodder with which to mock and insult me rather than deal with the salient issues so feel free either way. I would say these same things face to face (were we having that mythical cup of tea at the Kauai abode I will likely never know) and indeed have done so many times at work, and to my nursing school instructors both at the ASN, BSN and graduate levels.

I very much appreciate in a strange way that you continue defending your stance although what I was interpreting as your concrete thought process and inability to consider other view points was frustrating me---totally my problem. I intended my posts to be sarcastic but thought provoking which I now see came across as mocking and I apologize. Best wishes to you and I have to agree that most of us are mediocre although I personally feel it is worth attempting to be the best we can which involves change and growth.

Nancyrn66 · Feb 7, 2017

Do med students have to find their own residency placement???? Finding a preceptor is more stressful than my course work. Also disappointed by how many NPs don't seem to know other NPs to refer you to. I have precepted countless numbers of BSN students in my 21 years of nursing and was hoping for preceptor karma......no such luck!!

Aromatic · Feb 7, 2017

Med students have core rotations which are assigned to you, then we can do electives which arent that hard to find at most places. I mean once I start clinicals I doubt I could get a rotation at MGH, but probably could at most other places just by asking. People are usually more than happy to take med students since hospitals are shooting themselves in the foot and killing future employment prospects if they deny us.

They didnt give two hoots about me when I was in NP school though, but where I went we had rotations assigned also but it was harder to get electives.

myoglobin, ASN, BSN, MSN · Feb 7, 2017

A few points to consider:

1. Medical school residencies are limited by congressional funding. Some allege that this reflects a deliberate attempt by physician groups to limit competition here is a USA today article on the subject that I read some years ago and may or may not still function USATODAY.com - Medical miscalculation creates doctor shortage . Also as a medical school resident you will be working 40 to 70 hours per week (it used to be even more) and the school/hospital will tell you when and where. Not to mention that the residency application process is quite competitive and it is not unusual for student to have to move to a different city. It is certainly not geared towards students with families who are "mid career" and who have families. Guaranteed, "clinical's" or in this case residency come at a price.

2. Here are some steps that may facilitate finding a preceptor:

a. Simply ask around work. My significant other had no problems finding a preceptor using this strategy alone. However, unlike me she wasn't a stubborn version of Rain-man, with the absolute inability to ask people he knows for anything or even engage in small talk.

b. You could utilize my "mass market" approach and sent personalized letters to every provider in a 100 mile radius. Followed up by a phone call and visit (if appropriate).

c. You could also join the AANP as a student and contact local members.

d. You could also contact your school to locate previous graduates in your area. Perhaps, they could either precept you or at least point you in the right direction.

e. You could provide prostitutes to providers in the area, secretly tape them and then blackmail them into doing your bidding. Then again that strategy is a bit redundant, trite and overused (not to mention probably expensive). Flexibility like liberty come with the price of an increased risk of failure, but it is at least more flexible.

elkpark · Feb 8, 2017

Also as a medical school resident you will be working 40 to 70 hours per week (it used to be even more) and the school/hospital will tell you when and where. Not to mention that the residency application process is quite competitive and it is not unusual for student to have to move to a different city. It is certainly not geared towards students with families who are "mid career" and who have families. Guaranteed, "clinical's" or in this case residency come at a price.

All of those factors are evidence of how much more seriously physicians take their education and their careers than most nurses do, and why they are more highly respected (and compensated) than nurses.

And, BTW, I work closely with residents in a top-tier academic medical center, and plenty of the residents have small children, and/or are second-career students. It's easy to say that medical school and residencies are "not geared towards" mid-career students with families, and, yet, the people who are sufficiently motivated and determined make it work. Plenty of them.

While I've never been interested in being a physician myself, I have great respect for the rigor of the educational process to become one and the focus and determination required of students. I wish nursing would at least pretend to have similarly high standards.

myoglobin, ASN, BSN, MSN · Feb 8, 2017

It is a different process not necessarily superior. Also physician residents do ER and ICU rotations where learning to place central lines and chest tubes are a required part of the process. Most of us have little aspiration to do even basic surgery. NP's have demonstrated equal or superior outcomes when it comes to primary care at a fraction of the cost and time to train.When it comes to specialty medicine and surgery physicians have an unchallenged dominance. Why are so many here down on nurses ? I expect this sort of treatment when I post at Studentdoctor.net but not here. Most of the nurses that I know are great and nursing remains the most trusted profession according to many polls. Of the ten or so residents that I've talked to at work at least half have told me that if they had it to do over they would go the NP or PA route.

Aromatic · Feb 9, 2017

All of those factors are evidence of how much more seriously physicians take their education and their careers than most nurses do, and why they are more highly respected (and compensated) than nurses.
And, BTW, I work closely with residents in a top-tier academic medical center, and plenty of the residents have small children, and/or are second-career students. It's easy to say that medical school and residencies are "not geared towards" mid-career students with families, and, yet, the people who are sufficiently motivated and determined make it work. Plenty of them.
While I've never been interested in being a physician myself, I have great respect for the rigor of the educational process to become one and the focus and determination required of students. I wish nursing would at least pretend to have similarly high standards.

Elk, i think you, jules, many others and I are on the same train. We all love NPs but the lack of regulation is killing us. The people who tout NP=MD are scary folk.... to think they can handle everything. its as if at the current state and time, NPs perform better than physicians at primary care.

By that logic, if i chose family medicine, I would perform worse and my patients would be less well taken care of in 6 years when i graduate residency in comparison to now. I mean I might as well drop out right? Med school is obviously making me less able...

myoglobin, ASN, BSN, MSN · Feb 9, 2017

Aromatic, you are either misunderstanding or being deliberately insulting:

a. No one maintains that NP's can "handle everything". Every NP organization calls for NP's to only practice within their scope and strongly encourages NP's to refer to specialists (almost always MD's) for cases beyond their training and abilities.

b. Lack of regulation are you serious? NP's are regulated by state boards of nursing just as MD's are regulated by state boards of medicine. Furthermore, they must go through licensing, and credentialing processes in every state in the union. They must also carry Liability Insurance, and maintain continuing education for both their RN and NP licenses in almost every state. Furthermore, they must maintain a DEA number in states with prescriptive authority. Many like my SO study PubMed, Cochrane's, UptoDate, and Harrison's like they are a Mississippi Baptist minster going to an extended revival where Jesus will be in personal attendance.

What additional regulation would you propose? You have yet to offer a single discrete, salient proposal that you would add to the litany of regulations, requirements and credentials that already exist or which are currently evolving (such as DNP as most programs are transitioning to). It's fine that you are going back to become an MD. I say God bless, education is beneficial and I wish you only the best. However, don't presume that your personal path is the only one or even the superior one. I would suggest that if you feel that you need additional education to offer primary care that it can be found within the domain of Nursing as well (probably at a more affordable cost and with a holistic emphasis which is possibly responsible for the excellent proven outcomes that NP's consistently produce). It is unfortunate given your seeming low regard to the educational standards of nursing in general and graduate nursing in particular that you didn't pursue a career in medicine to begin with. Also, while there are indeed valid reasons to criticize the multitude of studies that find equal or superior outcomes for NP's verses MD's in the primary care setting such studies still exist and there are many. In addition, no one with even the most rudimentary understanding of statistics would attempt to extrapolate the findings of a group to group comparison to a single individual or "point estimate". Of course an individual (or group) of NP's may suck and a given MD may be awesome (or suck). My significant other's OBGYN for example was one of the most respected in central Indiana and also taught at Indiana Universities School of Medicine, but he was a big giant member who came in and literally "broke her water" without warning in the hospital and also asserted that if she didn't have an abortion (if a test that they wanted to do, but she declined to have turned out to show fetal abnormalities) that she would face huge medical bills because her insurance (Medicaid at the time) wouldn't pay for the delivery. Which illustrates another possible reason why NP's produce positive outcomes. Even when physicians are clinically brilliant, they are often exhibit the emotional intelligence of an autistic shrew which may limit their ability to translate that knowledge into positive outcomes. I would also add that over the coming decade(s) AI facilitated/integrated "expert systems" will make any education/knowledge gaps between physicians and NP's even less relevant especially with regard to primary care medicine (here is an excellent article on the subject Forbes Welcome) . Why do you feel the need to criticize NP's and NP education in order to point out the benefits of medical education? If you really feel so negatively regarding NP's and NP education maybe you should spend more time on a forum such as Home - Student Doctor Network | A nonprofit educational organization rather than one started by and dedicated to nursing.

chulada77, ADN, BSN, MSN, APRN · Jun 17, 2018

Myoglobin, you need some Dave Ramsey in your life!! Holy Moly!