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To the APRN Curriculum Critics

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by Psychcns Psychcns (Member) Member

Psychcns has 30 years experience and specializes in Psychiatric Nursing.

3 Articles; 17,541 Profile Views; 859 Posts

There has been a lot of criticism and heckling of APRN education in this forum. This is an essay to inspire people with opinions to take constructive action

To the APRN Curriculum Critics

To the APRN hecklers, critics and malcontents.Many of you say that your MSN nursing education has too much "fluff", referring to classes like cultural competency, and management that have no relevance to your jobs. I have read very little about how you will address this with the people that accredit NP curriculums.

I am not sure of the credentialing process at all but I did find the American Association of Colleges of Nursing on the web and this seems like a place to start. In 2013 they developed NP competencies in which we are all expected to be proficient.

These competencies expect cultural competency, trauma informed care, as well as all the things you complain there is not enough of such as pathophysiology, pharmacology, physical assessment. I have been in nursing since the early 80's and have been through a few transitions in health care and in my own nursing career. Now I just try to keep up. I have no venom to toss at nursing leaders. I am very grateful to the nursing profession for my livelihood. I work locum tenens as a psychiatric APRN. My advanced practice nursing skills allow me to find work in interesting settings on a limited basis. This semi nomadic lifestyle is mine by choice. Everyone wants to hire me permanently.

The APRN role exists because of the dedication of nursing professionals with advanced degrees who have done the hard political work of fighting for the opportunity for all of us to practice to the full extent of our education. This means that our education prepares us to diagnose and treat illnesses in our respective specialties. We have a record of patient outcomes similar or better than MD's. We are not MD's and we are not junior MD's, we are nurses. If we were MD's we would be regulated by Boards of Medicine, physician extenders of some sort. As nurses, regulated by Boards of Nursing, we are eligible in many states for independent practice. There is an overlap between MD's and NP's and this is where a lot of NP's and MD's practice: Seeing patients one at a time in inpatient or outpatient settings. Since we are doing the same job as MD's in many cases we do need to catch up on their rich science background and the intense mentoring they get in residency.

Or we can wonder how much education do we or they really need to do this job? We probably do not need nursing theory at this stage of our development as a profession though I did like my theory classes. We probably do not need healthcare management classes though I learned in those classes also. In today's day to day NP jobs we need to keep our diagnostic and prescribing skills sharp to give patients the best care that we can. We often have MD role models and some are surprised we are doing the same jobs as them and many are happy to consult on cases and make use of their intense education. To my colleagues who are angry with the nursing profession that benefits you, I would encourage you to review the history of nursing (we were housecleaners one hundred years ago), and as science developed nurses had to fight the AMA to be professionals as opposed to handmaidens or servants.

At one time only an MD could take a blood pressure. Now we are fighting for the right to practice to the full extent of our education. We are nurses and we need to continue to define ourselves differently from physicians. That we are different from the medical profession has benefited us politically and gives us the responsibility to self-regulate our profession.The people with the energy and aptitude to criticize should learn to become political. Start by looking up the website I note above and figure out how to have input into curriculum development. You might have to join a committee. This is how hard work often starts. As in today's general politics it is possible the nursing leadership is losing touch with its base.

Those who see what needs to be done would benefit all of us by becoming active and help to maintain and improve standards and influence the direction of the nursing profession.Best wishes.

Advanced practice psychiatric nurse. Trained as CNS. Now do locum tenens. Licensed in MA NH CT MN and OR.

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lhflanurseNP has 40 years experience as a APRN and specializes in Adult Nurse Practitioner.

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My biggest complaint in regards to the "fluff" classes were the ones nestled in nursing theory. That being said...the first portion of the MSN program is for ALL nurses planning advanced education/career goals. This means one will need to take a variety of topics in preparation for the ARNP degree...what one goes into for the final portion of their MSN program is centered on that particular path. Back to the "fluff", I had enough of the nursing theories in my ADN program, then repeated in my ADN-BSN program, then AGAIN, in the BSN-MSN program. Nursing theory is an important BASIC element of nursing education, but not necessarily so important in the advanced nursing programs. Do I use nursing theories in my everyday practice? No...but I do rely on my nursing experience, grounded in nursing theory, in dealing with my patients on a day-to-day setting. Just my 2-cents

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PG2018 specializes in Outpatient Psychiatry.

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I think we should indeed keep fighting, and as we demonstrate clinical competence and educational rigor I believe we will better prove our merits. I do not feel that we can go toe to toe against physician lobbyists based on our "3 P's," and I truly do not feel our required education required to become RNs is remotely analogous to the -ologies and training in medicine, i.e. internal medicine, that all physicians get. We do not need total parity in education. We do, in fact, need enhanced education covering the myriad topics that we so badly need to know. For our purpose, we do not need 3+ years of residency or 4 years of graduate education in training, yet if being truthful to ourselves we may all concede that there is little to no uniformity in education and training. For the simple fact that you can study your entire NP degree online never even seeing the host institution and pick a preceptor of your choosing and become a NP, we demonstrate a weakness. We are competing against one of the most educated professions in America who have demonstrated commitment to rigorous study and assessment. I simply think we need to better demonstrate this in our own professional training. My certification exam was largely devoid of clinical content, and even at a state, medical school affiliated NP program I had to find my own preceptors.

I would love to continue sending emails and believe me I've thought about becoming the sacraficial lamb and doing doctoral work to examine the merits of a more biomedical curriculum. Two caveats, I'm not quitting my employment, and I'm not going in debt over it. Give me some funding ideas, and I'll be glad to field the legitimate ones.

Most of the naysayers, such as myself, don't really care so much about the history or theory of nursing (or medicine). I, personally, do read a lot of history and find the history of psychiatry to be rather interesting and something that should be indulged during our training to become psychiatric specialists. How many psych NPs can tell me something about Emil Kraepelin?

A general model for what I feel NP school should include:

1 year biochem if even biochem-lite perhaps even combined with cellular bio, prosected anatomy, physiology in a semester with dedicated training in medical genetics, pathology in a semester, NO combined pathophys junk, some type of combined micro/immuno course, neuroscience and psychopathology even if these latter two are also combined. training in clinical skills, i.e. deductive reasoning, diagnosis, physical examination using the tools of the PE, suturing, splinting, imaging, ECG, and other office procedures.

1 year combined medical training in medicine, peds, healthcare administration/practice management, psychiatry, and specialty focused rotations in OB/gyn, surg, critical care, primary care, neurology, etc based on your desired focus of training (ex, psych might include med, peds, neuro, endo, sleep, a primary care rotation; acute care might be more medicine, neuro, pulm, cards, surg, ID, _CU ), research metholdology and biostats or epidemiology, and journal reviews

1 year of solid training exceeding 1200 hours in your practice specialty during which time you participate in face to face or online presentations regarding your practice specialty (more examples with psych; human development, various psychotherapeutic modalities, psychopharm, forensic psych, child psych, neuro, etc)

That's three years. My master's required three years of coursework although light and fluffy. Most of it could've been compressed into a fall, spring, and summer as well as one semester of full-time clinicals.

We should all be licensed generalists, i.e. generally capable of doing what FNPs are presently trained to do. (The FNPs should get MORE training for that such as dedicated time in ENT, derm, sports med, medicine, et al). We should all be technically prepared and credentialed to prescribe or at least minimally refill anything. We should all have Schedule II prescriptive rights. We should all be able to declare disability, endorse death certificates, authorize emergency holds, admit patients to a hospital, etc. There's way too much state by state mess mirrored by the institution by institution eduational requirements. Whether we do all these things on our own or not isn't really a concern of mine. We could all be collaborative or all be independent. It doesn't matter to me as long as we can do what we're trained to do, and we definitely need more training - all of us.

I'm terribly disheartened when NPs suggest we get "enough" training.

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"We are nurses and we need to continue to define ourselves differently from physicians."

I am curious as to why you feel this is imperative?

I believe the NP is taking an educational and professional step into the role of diagnosing and prescribing, period, and it is incumbent that we are optimally, clinically prepared.

I do not believe that rehashing cultural competency, cultural competency and nursing theory is in the best interests of patients, providers, or our profession.

Yes, we need to be culturally competent and have some nursing theory -- however, I have not felt that any of the focus on this in graduate NP school has been of any benefit to me, whatsoever.

Yes, I am thankful to have the opportunity to advance my career and to diagnose and prescribe, but the focus of these fluffy courses is truly akin to jumping through hoops in terms of usefulness, has and does DETRACT from the beneficial aspects of the M:NP program.

Julia

Edited by Julia77
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synaptic has 5 years experience.

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I glanced through the posts. Good responses esp by psych guy. Will respond more later when I'm not at work but..... Clinical training is supposed to be a filter to make sure people are at least minimally able to perform medical duties. Most np schools do not do this. Yeah some people study more than they to be good at their work. But many don't and np school does not filter those out.

We also also don't need to separate ourselves from medicine. That is what weakens us. Avoiding science is a bad habit

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Psychcns has 30 years experience and specializes in Psychiatric Nursing.

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There was a time when nursing and medicine worked together. Then as medicine incorporated science and became more organized they were able to get laws in every state that everything related to medicine and surgery was under the board of medicine. Psychologists has to fight to do psychotherapy.

I went to a physical therapist who diagnosed a knee problem and she told me that for PT's diagnosing is fairly recent thing. Only the doctor ( meaning physician) could diagnose.

For us to diagnose and prescribe we are in territory that has has historically belonged to medicine by law. We had to lobby to be allowed to do these things. Part of the lobbying is arguing that our education prepares us to diagnose and prescribe within our specialty

And yes we need more eduction. Science continues to advance. And some say they are not comfortable with the basics.

Unifying the APRN profession is a recent state-by-state initiative.

I encourage people with ideas about improving curriculums become active on committees. Look into the Robert Wood foundation. They financed the APRN initiative. Having ideas is easy. Implementing ideas is hard.

I am neutral about how separate we should be from medicine. There is a large overlap of nursing and medicine as it is now . But I can't imagine being regulated by the Board of Medicine.

I love the APRN role and I learn from my patients and continue to study.

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GoodNP specializes in Cardiology, Research, Family Practice.

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I get the OP's point, or at least I think I get what they're saying. Basically "do something about it or quitcher ********".

Problem is, most of us are not wired that way. We went on to become APRNs because we enjoy clinical practice, whereas these programs are developed by those who enjoy academia. This disconnect between practitioners and academic types exists in many professions. Nonetheless, we the practitioners expected our programs to prepare us to be practitioners. We are dismayed by the waste of precious time and effort studying crap that does not benefit us clinically. This is one of the reasons I have not gone on to pursue a DNP. Doctor of Nursing PRACTICE? I want a program that will help me to advance my clinical skills. This is not evident in the curriculum of the DNP programs I have investigated.

I, too, am grateful for the nursing leadership and the advances that have been made for us. However, I do wish the academics would realize that we would have a better chance at securing more rights, e.g. independent practice nationwide, if we could demonstrate more relevant academic rigor in our APRN programs. (Oh, and don't get me started on the lax admissions processes...)

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Psychcns has 30 years experience and specializes in Psychiatric Nursing.

3 Articles; 859 Posts; 17,541 Profile Views

I went to a clinically focused program. I was immersed in clinical work before and after I got my degree. When I got my degree my state had just started prescriptive

Authority. For my first prescribing jobs I found places that gave a lot of support and supervision.

At my program I think everyone, faculty and students,saw the fluff courses as things to get through.

I never felt unprepared as a practitioner. Early on I needed more support.

I think as others have said that more could be done with undergrad and grad education. Lots of ways the knowledge can be divided. Lots of ways education will improve.

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Aromatic has 3 years experience.

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it would be helpful to have had an understanding of functional groups and biochem prior to APRN school. If anything at all is to be added it should be that and a basic anatomy course, since regular A and P was pretty distant for most of us.

Everything in medicine is molecule based (really everything in life) and nobody should have prescriptive authority without understanding at least to a fairly basic extent things at a molecular level. Gen chem 100 at the time would not have been enough. A 2 semester integrated gen/ochem/bio chem course would do wonders for our profession. Of course with a medical focus.

acid base chemistry

redox reactions

organic chem functional groups

carbohydrate, fatty acid, nucleic acid, protein chemistry

ions and the like

genetics

all that sort of stuff is pretty much left out and would have a bigger impact on patient care than nursing research 101

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Psychcns has 30 years experience and specializes in Psychiatric Nursing.

3 Articles; 859 Posts; 17,541 Profile Views

The nursing "fluff" courses could probably be condensed to one course and meet accreditation requirements. The big take away from research and evidence based practice is how to evaluate research and how to apply to individual situations. More science is always good. Genetics is huge and likely will have big impact on patient care.

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RunnerNurse09 is a BSN, RN and specializes in Med-Surg/ ER/ homecare.

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I currently am not an NP but am planning on applying for fall 2017. I am currently enrolled in an RN to bsn program. I absolutely agree that nursing curriculum, especially NP, should have courses such as biochem. I feel lucky to be enrolled in a school that has a curriculum that is constantly being tweaked to be ahead of the game. In this bsn program we had to take a pathophysiology course and a genetics and genomics course, which I found to be amazing and essential, especially considering the impact that genetics has on medication metabolism. Hopefully other schools will follow.

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MurseJJ specializes in Neurosurgery, Neurology.

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I've noticed a number of NP programs now include a course in genetics/genomics. One thing I've always wondered about is what about an advanced anatomy course?

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