We Must Demolish NP Diploma Mills

[cprimavera]

What is AANP doing with those programs??? I think we should unite to take an action on such diploma mills.

[PsychNurse24, BSN, RN]

12 minutes ago, MentalKlarity said:

As mentioned earlier in this thread, thankfully that research has not been completed as it would be an embarrassment and ruin our profession. I don't even like to acknowledge that these diploma mills exist when speaking to colleagues, let alone have journals putting a spotlight on them.

I'll create a scenario though. Imagine you're about to have surgery and have 2 options of surgeon. Option one went to a traditional medical school and residency after taking the MCAT and excelling in undergraduate science courses. Option two couldn't be bothered with all that and went to an online program that waived the MCAT, doesn't do interviews and accepts students with 2.0 GPAs as long as they're willing to pay. They advertise their "24 month MD degree online!" on billboards and websites and the "admissions counselors" (salesman) are able to get potential applicants from phonecall to their first self-directed module within 4 weeks. 

 

If offered these choices would you say "Well either is fine until I see empirical evidence!" Or would you just realize that while option two MAY be fine, the standards just aren't strong enough to ensure someone incompetent didn't slip through the cracks and won't know what theyre doing.

 

 

Still everything you state is your opinion, not fact!  Doctors still have to pass their boards and NPs have to pass their board certifications.  My friend from childhood has been a doctor for 30+ years. And what she related to me was that even in her top-rated University medical program it was still pass and fail.  She said quite a few of the doctors barely slid by.  Who knows, maybe they didn’t pass their boards.  But, I might take a chance on a doctor from an online university that finished at the top of his or her class compared to a Dr. from a top 10 school that barely slid by.   A related question for you, how do you feel about Registered Nurses who graduated from a Community College versus those who graduated from, say, Duke?  I think you might make dangerous generalizations based on your, dare I say it, snobbish opinions.

[MentalKlarity, BSN, NP]

3 minutes ago, PsychNurse24 said:

Still everything you state is your opinion, not fact!  Doctors still have to pass their boards and NPs have to pass their board certifications.  My friend from childhood has been a doctor for 30+ years. And what she related to me was that even in her top-rated University medical program it was still pass and fail.  She said quite a few of the doctors barely slid by.  Who knows, maybe they didn’t pass their boards.  But, I might take a chance on a doctor from an online university that finished at the top of his or her class compared to a Dr. from a top 10 school that barely slid by.   A related question for you, how do you feel about Registered Nurses who graduated from a Community College versus those who graduated from, say, Duke?  I think you might make dangerous generalizations based on your, dare I say it, snobbish opinions.

The NP boards aren't that hard and aren't really a major obstacle to certification. Most questions are straight memorization and they test mostly on very elementary concepts.

 

As for your 2nd question - likely equivalent for two RNs. In fact, I'd almost argue in favor of the community college graduate. Most community college RN programs are very selective, and the hands on learning is usually top notch. Of course, that's not at all analogous to what were talking about. This has nothing to do with "snobbery" or brand name education, and simply the fact that some of these for-profits diploma mills are pumping out graduates like an assembly line and a large number of them don't have the preparation or intellect required to be a provider. Obviously a diploma mill graduate could take it upon themselves to really excel (extra self study, a residency program, top notch clinical placement) but that's just it, we have no way of knowing. Because of the completely lax (lack of) standards for admission and lack of oversight in didactic/clinical a graduate is just as likely to have done the bare minimum. Write a few papers, post some discussion postings, and get their hours signed off working as some physician's glorified MA for 500 hours and boom they're a provider! My goodness, they don't even require a hands on skills class! They're graduating NPs who have never done a pap smear, never done sutures, never done an I&D, never done a prostate exam! These are BASIC SKILLS and many of these for-profits don't care about teaching them because all they care about is their bottom line, not the future of our profession.

 

[PsychNurse24, BSN, RN]

1 minute ago, MentalKlarity said:

The NP boards aren't that hard and aren't really a major obstacle to certification. Most questions are straight memorization and they test mostly on very elementary concepts.

 

As for your 2nd question - likely equivalent for two RNs. In fact, I'd almost argue in favor of the community college graduate. Most community college RN programs are very selective, and the hands on learning is usually top notch. Of course, that's not at all analogous to what were talking about. This has nothing to do with "snobbery" or brand name education, and simply the fact that some of these for-profits diploma mills are pumping out graduates like an assembly line and a large number of them don't have the preparation or intellect required to be a provider. Obviously a diploma mill graduate could take it upon themselves to really excel (extra self study, a residency program, top notch clinical placement) but that's just it, we have no way of knowing. Because of the completely lax (lack of) standards for admission and lack of oversight in didactic/clinical a graduate is just as likely to have done the bare minimum. Write a few papers, post some discussion postings, and get their hours signed off working as some physician's glorified MA for 500 hours and boom they're a provider! My goodness, they don't even require a hands on skills class! They're graduating NPs who have never done a pap smear, never done sutures, never done an I&D, never done a prostate exam! These are BASIC SKILLS and many of these for-profits don't care about teaching them because all they care about is their bottom line, not the future of our profession.

 

Well I’ll let you know when I graduate from my diploma-mill PMHNP program!  But I can assure you that I’m getting a lot of hands-on experience with both Therapists and Psychiatrists.  They work at the same company where I work, and have expressed interest in hiring me when I graduate. They seem to believe that I am getting a good education. I also have a family member who is graduating this week with a degree in PMHNP and she will also be working for our same company.  One of her clinical Psychiatrists has even offered her a part time position in private practice with him.  We have both worked for this company on inpatient units and for the assertive community treatment (ACT) team for seven years.  It is insulting and distressing to hear you and others bash these programs.  We are real people with real feelings and have worked extremely hard in school.  Neither of us are inferior to other people in similar programs or even in your superior programs.  

[Ace Savanahh]

20 minutes ago, MentalKlarity said:

The NP boards aren't that hard and aren't really a major obstacle to certification. Most questions are straight memorization and they test mostly on very elementary concepts.

 

As for your 2nd question - likely equivalent for two RNs. In fact, I'd almost argue in favor of the community college graduate. Most community college RN programs are very selective, and the hands on learning is usually top notch. Of course, that's not at all analogous to what were talking about. This has nothing to do with "snobbery" or brand name education, and simply the fact that some of these for-profits diploma mills are pumping out graduates like an assembly line and a large number of them don't have the preparation or intellect required to be a provider. Obviously a diploma mill graduate could take it upon themselves to really excel (extra self study, a residency program, top notch clinical placement) but that's just it, we have no way of knowing. Because of the completely lax (lack of) standards for admission and lack of oversight in didactic/clinical a graduate is just as likely to have done the bare minimum. Write a few papers, post some discussion postings, and get their hours signed off working as some physician's glorified MA for 500 hours and boom they're a provider! My goodness, they don't even require a hands on skills class! They're graduating NPs who have never done a pap smear, never done sutures, never done an I&D, never done a prostate exam! These are BASIC SKILLS and many of these for-profits don't care about teaching them because all they care about is their bottom line, not the future of our profession.

 

Everyone cares for their bottom line. Stone cold said so

[MentalKlarity, BSN, NP]

14 minutes ago, PsychNurse24 said:

Well I’ll let you know when I graduate from my diploma-mill PMHNP program!  But I can assure you that I’m getting a lot of hands-on experience with both Therapists and Psychiatrists.  They work at the same company where I work, and have expressed interest in hiring me when I graduate. They seem to believe that I am getting a good education. I also have a family member who is graduating this week with a degree in PMHNP and she will also be working for our same company.  One of her clinical Psychiatrists has even offered her a part time position in private practice with him.  We have both worked for this company on inpatient units and for the assertive community treatment (ACT) team for seven years.  It is insulting and distressing to hear you and others bash these programs.  We are real people with real feelings and have worked extremely hard in school.  Neither of us are inferior to other people in similar programs or even in your superior programs.  

It's not personal. I'm sure you will be a great NP, you obviously have drive and if you're in a great clinical situation you can definitely succeed regardless of the school name on your diploma!

 

That said, you have to understand how distressing it is to watch our profession be undermined by so many schools out for nothing but recruiting as many students as possible and not instituting a single entry barrier other than the bare minimum and access to student loan money. It may not apply to you, but you are the exception. For every student like you there is another who did the bare minimum, finished some discussion modules on their downtime at work, and now calls themselves an NP. The lack of selectively and oversight at these schools hurts the graduates and the profession as a whole. It is incumbent on ALL of us to push this profession to be the best it can be, and a big part of that is demanding that schools SCREEN applicants to ensure they have the capacity to be a provider. The diploma mills aren't doing that.

[Phillip Flores]

One other thing to consider is age. The typical MD student is fresh out of a B.S. program and that is right after high school. The level of commitment to attend for a traditional student is higher on those with fewer responsibilities. I just finished my FNP program and I am preparing to sit for boards, but this is after a 28 + year nursing career and raising 4 children. My life is as complicated as ever but I chose to go back. BUT if it were required to not work, it would not have been possible. Most NP students begin later in life and the thought that only those who could afford not to work should be in at a university would be a serious blow to practitioner programs. Without eligible candidates in that paradigm, programs would shut down. I can't see that as a viable expectation.

[TheMoonisMyLantern, ADN, LPN, RN]

2 minutes ago, Phillip Flores said:

One other thing to consider is age. The typical MD student is fresh out of a B.S. program and that is right after high school. The level of commitment to attend for a traditional student is higher on those with fewer responsibilities. I just finished my FNP program and I am preparing to sit for boards, but this is after a 28 + year nursing career and raising 4 children. My life is as complicated as ever but I chose to go back. BUT if it were required to not work, it would not have been possible. Most NP students begin later in life and the thought that only those who could afford not to work should be in at a university would be a serious blow to practitioner programs. Without eligible candidates in that paradigm, programs would shut down. I can't see that as a viable expectation.

That's a valid point, and I believe there is certainly a place for online education for NP's, just not in the current method of delivery that seems to be utilized by some online programs. 

In balance, however, sacrifices have to be made when continuing education regardless of degree you pursue in order to devote enough time to learning. It's hard to juggle everything.

[TheMoonisMyLantern, ADN, LPN, RN]

1 hour ago, PsychNurse24 said:

Well I’ll let you know when I graduate from my diploma-mill PMHNP program!  But I can assure you that I’m getting a lot of hands-on experience with both Therapists and Psychiatrists.  They work at the same company where I work, and have expressed interest in hiring me when I graduate. They seem to believe that I am getting a good education. I also have a family member who is graduating this week with a degree in PMHNP and she will also be working for our same company.  One of her clinical Psychiatrists has even offered her a part time position in private practice with him.  We have both worked for this company on inpatient units and for the assertive community treatment (ACT) team for seven years.  It is insulting and distressing to hear you and others bash these programs.  We are real people with real feelings and have worked extremely hard in school.  Neither of us are inferior to other people in similar programs or even in your superior programs.  

I'm sorry it feels like we're attacking the students of these schools, I can honestly say that is not my intention nor do I think it is anyone else's. As I've stated, certainly there are students that excel and will successful regardless of where they go due to their own aptitude. 

What I find to be ironic is that schools are now requiring limited or no RN experience for NP programs with the justifiication that the roles are so different, and as we've heard from several posters that have become NP's their RN experience didn't really help with further their education, so that's fair enough. If however the roles are so different and the skillset so advanced why is more intensive instruction not required? Why not require more than 500-600 clinical hours? Why not include in person assessment and hands on skill evaluations? I just don't think we can have it both ways.

You, with all your psych experience, do you really think that a new grad RN with no nursing experience let alone psych experience that goes into one of these online programs to be a PMHNP is going to be as skilled of a clinician as you? Because this is happening, I've worked with them, and it sucks! Sure, eventually they may become competent but what about all the patients that get sub optimal care in the mean time. 

Look on this website, there are dozens and dozens of posts about nurses going through some of these schools with no barriers to entry with little to no experience and they're doing programs that have no instruction from professors and purely self directed courses and then do 500 hours of clinical time. Everyone wants to be an NP now, not a bedside nurse, and these schools are trying to let everyone become an NP but that's just not sustainable. 

[Phillip Flores]

Quote

In balance, however, sacrifices have to be made when continuing education regardless of degree you pursue in order to devote enough time to learning. It's hard to juggle everything.

Just out of curiosity, If you were required not to work would you be able to attend a NP Program? I have gone to nursing school 4 times (from LPN to MSN) all the while raising my family. If that were a requirement to not work, so many of us would have never gotten that opportunity. It was hard, but I managed (no social life) to go and make nearly all A's each time. I always wanted to go to med school, but that ship sailed long ago because the price of admission was not to work. I will be following my dream in a different path now, but I am glad I had the opportunity. If that were not so, it would all have been just a dream. 

[TheMoonisMyLantern, ADN, LPN, RN]

4 minutes ago, Phillip Flores said:

Just out of curiosity, If you were required not to work would you be able to attend a NP Program? I have gone to nursing school 4 times (from LPN to MSN) all the while raising my family. If that were a requirement to not work, so many of us would have never gotten that opportunity. It was hard, but I managed (no social life) to go and make nearly all A's each time. I always wanted to go to med school, but that ship sailed long ago because the price of admission was not to work. I will be following my dream in a different path now, but I am glad I had the opportunity. If that were not so, it would all have been just a dream. 

I would have to sacrifice a lot to make it work and would still have to work at least part-time. I'm not against people being able to work while attending an NP Program and as I said I think online learning has its place in NP education. But rigor and standards shouldn't be reduced for the sake of convenience. 

[djmatte, ADN, MSN, RN, NP]

5 hours ago, PsychNurse24 said:

Well I’ll let you know when I graduate from my diploma-mill PMHNP program!  But I can assure you that I’m getting a lot of hands-on experience with both Therapists and Psychiatrists.  They work at the same company where I work, and have expressed interest in hiring me when I graduate. They seem to believe that I am getting a good education. I also have a family member who is graduating this week with a degree in PMHNP and she will also be working for our same company.  One of her clinical Psychiatrists has even offered her a part time position in private practice with him.  We have both worked for this company on inpatient units and for the assertive community treatment (ACT) team for seven years.  It is insulting and distressing to hear you and others bash these programs.  We are real people with real feelings and have worked extremely hard in school.  Neither of us are inferior to other people in similar programs or even in your superior programs.  

Let’s be realistic on what we’re comparing here though. You’re graduating from likely one of the most book heavy and lacking hands on skill requiring nurse practitioner areas.  I don’t know what your clinical requirements are for graduation, but it likely no way compares to the skills needed for areas like primary care, acute care, or family NPs. So that perspective is key when we express concerns about the lack of educational or clinical rigor.  You didn’t have to do 50 Pap smears or have an itemized list of age related thorough head to toe exams or the range of invasive procedures required to be clinically competent in these areas.  So often when we get concerned and MDs complain about quality of NPs, it’s because the Walden’s neither set high expectations for actual hands on NPs and definitely don’t have the structure to ensure that student is actually safe in their clinic rotation.

And don’t be so sold on the “interest” your clinicians or company express on your program or your education. At the end of the day they see a clinician they don’t have to pay an MD salary and they can make huge profits off of.  

[TheMoonisMyLantern, ADN, LPN, RN]

25 minutes ago, djmatte said:

Let’s be realistic on what we’re comparing here though. You’re graduating from likely one of the most book heavy and lacking hands on skill requiring nurse practitioner areas.  I don’t know what your clinical requirements are for graduation, but it likely no way compares to the skills needed for areas like primary care, acute care, or family NPs. So that perspective is key when we express concerns about the lack of educational or clinical rigor.  You didn’t have to do 50 Pap smears or have an itemized list of age related thorough head to toe exams or the range of invasive procedures required to be clinically competent in these areas.  So often when we get concerned and MDs complain about quality of NPs, it’s because the Walden’s neither set high expectations for actual hands on NPs and definitely don’t have the structure to ensure that student is actually safe in their clinic rotation.

And don’t be so sold on the “interest” your clinicians or company express on your program or your education. At the end of the day they see a clinician they don’t have to pay an MD salary and they can make huge profits off of.  

From a distance I can see your point. However, PMHNP's can perform psychotherapy and bill for it legally, however they typically only receive one semester of education on psychotherapy by itself. Therapists, have a master's degree in either counseling, psychology, or social work and on average most states require at least 2000-3000 hours of supervised practice in addition to the clinical hours they receive in school. I've had multiple therapists tell me and have read online that they have concerns about online programs not requiring in person skills development for their professions because brick and mortar schools build their students skills by having them "practice" counseling techniques, and psychiatric assessments on each other to build familiarity before clinical practice. PMHNP programs that are online often don't require any in person sessions so they're potentially going into their 500 clinical hours conducting MSE's which are much more complex than what a PCP or family provider will perform, with potentially no familiarity in psychiatric assessment, because remember these programs no longer require specialty experience prior to admission. 

This may not seem like a big deal, but incompetent psychiatric providers do a LOT of damage and the mental health system is already in tatters as it is. 

I'm sure I'll get hell for this post from people but, oh well...