The state of APRN education

[DrCOVID, DNP]

There is nothing novel here per say... just wanted to vent I guess. I just started this year and all I can say is no wonder NPs get a bad rap. I have had several patients come to me and tell me the previous NP wasn't listening to them or fill the meds they have been on for 10-20 years... pt this AM (the provider had diagnosed them with insomnia, GAD and a personality disorder) so that he could write them off as "crazy"... mind you this woman was very pleasant and everything she told me was congruent with what I found in the PMP for her state. Didn't even ask me for meds. The provider also clearly had no idea what elements to type in an HPI. She endorsed being bipolar and was stabilized on 5 medicine. Why would we not trust this information? Oh, because the patient uses 20mg of Ambien to sleep at night which is higher. That was what he wrote in the note. I find that amusing. She was using it properly according to the PMP!

I am ones I guess - I do a lot of extracurricular learning (MD psychopharm/psychology/psychiatry podcasts) to brush up on conditions I see frequently & I did rotations under some good NPs (other mid-horrible ones as well) and then a few psychiatrists in the inpatient environment. By in large the other NPs I have seen have no idea how to write a proper HPI or ask questions to lead to a proper diagnosis. This is the scary thing. How are you treating people properly when you FAIL to take a proper history? I have had multiple pts come to me and they were clearly BIPOLAR and were on SSRIs or did not have the right diagnosis (obviously, no clear history was taken). Seems like most other NPs aren't even asking what sleep has been like for the pt's entire history which is always telling and points to some diagnosis. My friend that works with the PsychMD in the hospital said the same thing about the other NPs. The MD doesn't want to hire ANY NP that doesn't train with them. Well yeah I agree with that from what I have seen!

HPI documentation - which by the way is published in a document from the APA - I literally had to teach my GRAD SCHOOL teacher how to do an HPI properly... and she was an FNP for YEARS. WOW! I don't know what the point of this post is, other than our profession is just really in a *** state. Schools need to up the requirements, online schools SHUT DOWN and better and clinical hours/training. Every time a see a new pt that had another provider I'm just like GOD D*#N what am I gonna find this time!? We really NEED to elevate our profession. I take pride in being an DNP now but Jesus. RNs are the most trusted profession but how will we keep that trust if we generally SUCK at essentials of the APRN?

[Guest1144461]

1. Eliminate for profit schools

2. Severely cut out the 100% online "1 visit a year" or if even that crap

3. Raise admission standards

4. Incentivize residencies

My hospital won't touch NPs with a 10 foot pole unless they did a residency. There is absolutely no one way you can hang as a hospitalist at a major medical center without SERIOUS support or structured formal training inpatient post-grad. Anyone who says otherwise is fooling themselves.

I did a year long residency training along MD interns and I got wrecked but so did they. But we all learned. The interns were graciously humble unlike many new NPs I meet who think they know everything.

[matthewandrew, NP]

I agree. I think at minimum nurses need 1 year of direct patient care experience to even be considered in an NP Program. I hate seeing online NP schools, I think that’s ridiculous. NP programs need to tighten up like CRNA programs. 

[MentalKlarity, BSN, NP]

It's the online for profit programs. I've actually seen how schools like this work, they basically have pre-canned modules that students go through and then post on a discussion board. Professors are more like facilitators. Everyone who applies gets in, there is basically no admissions standard to speak of. Do we expect a model like this to create anything other than joke providers who give the entire profession a bad name? 

The nursing boards seem to be too busy taking in cash from higher student flows to care they are making a mockery of their own profession.

 

I once precepted a for profit student who completed a new patient psych evaluation in about 7-10 minutes on average. It generally went "are you depressed, okay, so we will start an SSRI OK?" It's scary.

[matthewandrew, NP]

Standards for Quality Nurse Practitioner Education, 6th Edition

The National Task Force on Quality NP Education is working on a draft proposal. It includes requiring 1000 clinical hours for NP programs. I think it’s a good step forward if these standards are adopted. 

[DrCOVID, DNP]

7 hours ago, matthewandrew said:

Standards for Quality Nurse Practitioner Education, 6th Edition

The National Task Force on Quality NP Education is working on a draft proposal. It includes requiring 1000 clinical hours for NP programs. I think it’s a good step forward if these standards are adopted. 

The DNP programs are at least 1000, mine was 1200. I feel like this was barely enough. We were lucky to even find a good psychiatrist to precept us. Another huge problem is blind leading the blind. My teachers barely knew what they were doing. Didn't discuss any of the documents that govern practice and of course billing/coding (which is the basis for practice) is not discussed. 

[matthewandrew, NP]

1 hour ago, DrCOVID said:

The DNP programs are at least 1000, mine was 1200. I feel like this was barely enough. We were lucky to even find a good psychiatrist to precept us. Another huge problem is blind leading the blind. My teachers barely knew what they were doing. Didn't discuss any of the documents that govern practice and of course billing/coding (which is the basis for practice) is not discussed. 

I think this is specific to NP programs. Right now the requirement is 500. Increasing is to 1000 would improve the quality of NP education. Schools need to be accountable to find preceptors for their students. I think this will help weed out the degree mills that plague our profession.