The current state of advanced practice nursing education - thoughts

Palliative Care, DNP · Aug 20, 2014

Our exams are proctored at Loyola University New Orleans via the camera on the computer. Faculty makes a site visit to each student each semester for clinical evaluation. There is no free ride occurring here.

futureeastcoastNP · Aug 20, 2014

OP, you make the same mistake a lot of people on this board do: assuming the issue is "online" versus "brick and mortar" schools. I understand where this can be confusing, as most of the bad schools are online, but the line in the sand should not be drawn at online versus brick and mortar, especially when you consider the fact that some of the top NP schools in the country offer their programs online.

What I think you meant to imply during your post is the difference between FOR PROFIT and not for profit NP programs. That's where the huge divide in NP programs exists. My opinion: For profits exist completely out of greed, and the main goal is to collect tuition money. They have very low standards of acceptance, take in thousands of students per year that they pump out month after month, saturating the market. They hire adjunct professors who do little more than "administer" pre-canned classes, which focus on paper writing and responding to discussion posts. Thanks to these programs and their constant bombardment of advertising, every RN in the country is in some stage of an NP program, usually taking one class at a time at a for profit while still working as an RN, slowly buying their NP degree. Do you really believe all nurses are smart enough to be nurse practitioner? Should all nurses really be given the chance to be providers, making final decision on patient treatment plans? The resounding answer is no, because the reality is that there are a large number of nurses out there that don't have the critical thinking skills, intelligence, or knowledge to be APRN's...and yet thanks to the for profits, they too can be an NP for just 25 easy payments of $999!!

As for your other question: yes, I think residencies need to be mandatory at this point. Considering how many NP programs now rely on the "find your own preceptor" model (aka: the "we don't want to invest any actual money in your education" model) there needs to be some standardized way of training nurse practitioners. There is simply too much variability and absolutely no oversight of the vast majority of clinical rotations. You've got people now doing the vast majority of their rotations in the Minute Clinic under a for profit recently graduated NP...that's downright scary.

As for how it causes other professions to view NP's...it has ruined the NP professional image. Not only is it embarrassing that such programs exist (there are NO for profit MD or PA programs), but the quality of many of the graduates brings further shame upon the profession. Go to a PA or MD forum and look at the level of discourse there, the higher level vocabulary and correct grammar that is used. This is because their education process is complete and difficult. The NP model, especially when considering the for profit online programs, is set up in such a way that a complete idiot (as long as they have the tuition money) can become an NP. I literally cringe when I read some of the posts from current and already graduated nurse practitioners...written as if the last english class they took was in 3rd grade. Find any other "graduate" program where such knowledge gaps exist.

Sustainability: The schools themselves will last, as the majority of people in this country care about ease and price over quality. The profession, however, probably can't last on its current path for too many more decades unless something is done. Schools (both for profits and not for profits) are just educating too many nurse practitioners. If you look at a list of the number of graduating nurse practitioners each year, it's really scary. From data I could find from the AANP and Pearson report:

2005 NP graduates: 6,220

2010 NP graduates: 9,203

2012 NP graduates: 14,000

Not only is it increasing at an alarming rate, but the rate itself is actually increasing! I'm not sure how long this can sustain itself, as eventually there will be too many nurse practitioners and the wages will fall dramatically.

woofyrn · Aug 28, 2014

Excellent analysis, futureeastcoastNP.

queenanneslace, ADN, MSN, APRN, CNM · Aug 30, 2014

I've been enrolled in a number of advanced practice nursing programs, I've left them because they were woefully inadequate in the realm of academic rigor. At first, I'd thought I'd enrolled in a program that was an outlier - one that skidded by on reputation, not actual merit, and that other MSN/DNP programs had much higher standards for educating advanced practice nurses. I'm now getting a clearer picture of the the world of nursing education - and no, it doesn't meet my standards at all.

This thread has identified a number of problems with the current state of educating advanced practice nurses - and I'm glad others notice this as well.

Somewhere along the line I bought into the idea that NPs and APRNs are better providers because they provide more personalized and individualized care - they spend more time with the patient - they are up on their 'evidence-based' practices. This was very attractive to me - I didn't want to spend 3.5 minutes with a patient at appointments, I wanted to get to know my patients, I wanted to treat them as individuals with unique needs.

Doing all this is good - no, it's great. But providing individualized care shouldn't come at the cost of shoddy care, and incomplete education. I would like to learn from experts - not from a nurse who spent an additional semester or two to get a DNP - and who now is seemingly qualified to teach any topic under the sun: math, writing, epidemiology, research, chemistry, genetics, sociology.

This is where advanced practice nursing education falls short: colleges of nursing are invested in employing their nursing colleagues with "doctorate" degrees, and not actually employing true experts in the disciplines that are necessary to advanced practice nursing. I will pull my hair out if I have to listen to another doctorate nurse try to explain rudimentary principles of chemistry when he or she clearly does not understand it.

I would love an elevated level of discourse, as well, among advanced practice nursing classmates. But the bar for entry into these programs seems a bit low. Is "OMG, LOL" now considered to be a sign of innovative communication and advanced articulation in college admission essays?

There are incredible APRNs out there. And the premise of evidence-based, patient-centered, individualized care is very appealing. But I want to be challenged, I want to work among peers who are at the top of their class, and I want to believe that entry into NP, MSN, DNP programs requires students to meet high standards for academic success and intellectual ability.

Nursing would do well to tighten up their standards for entry to NP programs. Unfortunately, there seems to be too much money to make "educating" advanced practice nurses.

mwlude · Aug 30, 2014

That's a good observation. The bottom line seems to be that nurses are trying to practice medicine with a small portion of standard medical education. Has anyone ever spoken with an MD or DO that received their training online with no entry requirements or residency? I have not.

Also, APNs really don't get to spend more time with patients. I've heard doctorate prepared nurse justify the apn role as "who always knows more about the patient?" "The nurse right". Well the reason the nurse gets to spend more time with the patient is because they only have 1 to 7 in most cases.... This idea cannot be applied to Advance practice roles because you are now the primary care provider with a higher patient load (like that of a doctor...) who may very well have the same time constraints.

So now let's have nurses practice medicine after being prepared with highly variable, inconsistent and often inadequate academic curriculums with highly variable entry requirements and NO standardized residency requirement.... case in point, a fellow NEW nurse with a grand total of 4 months of bedside nursing experience gets accepted into a prestgious NP program based on academic performance alone with no other requirements, 2 weeks of onsite work and a "design your own" clinical experience with questionable oversight. Sounds rigorous......

Simplyroses · Aug 31, 2014

I am always amazed that people who have never worked one day as a professional RN are becoming Advanced Practice nurses. I have heard the arguments that the ARNP role is different than the nursing role. However, the original NP's were RN's first and acquired advanced skills and knowledge.

PA schools require sometimes 2000 hours of paid clinical experience prior to admission. They also offer 1600-2000 hours of rigorous clinical education in addition to didactic education.

NP schools that do not require any clinical nursing experience for enrollment and only require 600-700 hours of clinical rotation hours are not serving the public, the patients, or the profession.

allnurses Guide · Aug 31, 2014

It amazes me the judgements people make without any experience in the matter. It doesn't surprise me that the biggest hurdle novice NPs face in their transition to practice is the falsities perpetuated by other nurses.

futureeastcoastNP · Sep 3, 2014

It amazes me the judgements people make without any experience in the matter. It doesn't surprise me that the biggest hurdle novice NPs face in their transition to practice is the falsities perpetuated by other nurses.

People don't need to have firsthand experience in everything they wish to discuss. The fact of the matter is that it is quite obvious from the level of discourse from current NP students that the education system needs a drastic overhaul. It's embarrassing. And queenannelaces comments, which are coming from experience, echo the sentiment that many people have with nursing education. It seems to be almost entirely fluff and very little substance.

ryguyRN · Sep 3, 2014

future, that is true you may discuss but your opinions hold very little weight with no experience in the matter, we all know you are very passionate about this topic.

stickit34 · Sep 4, 2014

As I am progressing through my own NP education, I too feel that my education is not up to par. I am blessed to go to a school that also offers a prestigious PA program, and comparing the two curriculums beside one another, truly there is no comparison. They require not one, not two, but a THREE part pharmacology course, a three part pathophysiology courses, multiple classes on clinical reasoning, in-depth diagnostic testing and an entire year's worth of full time clinical rotations. And that's just the brim of it. Plus, the school promotes study abroad internships as well as the multiple residencies in the area. There truly is no comparison.

I understand that the role of a nurse practitioner is based upon a registered nurse's experience, but truly, how much can we base our education on this? The roles and responsibilities of a home care nurse is much different than that of an ICU nurse, and both roles do not provide any experience to fully prepare for a provider role.

Quite honestly, I am seriously considering switching. I want to be the absolute best provider that I can be for my patients. That means I want to immerse myself in the diagnostic testing and truly understand what test is best for a situation, or which drug will be the best for my patient's condition. I want a residency program who will guide me through that first year. I do not need any more fluff; I got enough of that in my BSN program.

/end rant

allnurses Guide · Sep 4, 2014

The PA program isn't based on a block schedule instead of a semester schedule?