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.

[Neuro Guy NP, DNP, PhD, APRN]

9 hours ago, RN/WI said:

 

I do not know any brick and mortar schools or online NP schools that place students in clinical. It is the responsibility of the student to obtain placement. Before entering the program, the student should prepare and be certain they have secured a clinical spot. Don't believe any school that promises a clinical placement. Even before COVID, I knew of students that were having difficulty finding clinical placement.

 

 

My clinical placements were arranged for me. I wouldn't make such a sweeping statement. 

[djmatte, ADN, MSN, RN, NP]

5 minutes ago, TheMoonisMyLantern said:

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...

I was trying to be exceptionally liberal in my presumption of what clinical requirements exist for PMHNPs. I presumed the clinical portion incorporated *some* therapy related incite. But if their main focus is diagnosis based on a few more in depth standardized tests and medication administration and no consideration or focus on actually therapy then perhaps that is an area of concern for PMHNPs of the world as well. 

[TheMoonisMyLantern, ADN, LPN, RN]

4 minutes ago, djmatte said:

I was trying to be exceptionally liberal in my presumption of what clinical requirements exist for PMHNPs. I presumed the clinical portion incorporated *some* therapy related incite. But if their main focus is diagnosis based on a few more in depth standardized tests and medication administration and no consideration or focus on actually therapy then perhaps that is an area of concern for PMHNPs of the world as well. 

You're very right it is an area of concern. It's been discussed in other threads, and my opinion and the opinion of a couple other posters is that either more education needs to be provided for PMHNP's regarding psychotherapy, or maybe they should leave that to the therapists. That opinion proved to  be quite unpopular here on AN.

The problem is that in the yonder days of CNS's in psych, they were actually provided extensive education in psychotherapy, and when the psych NP role emerged they had this education as well as the psychopharm component. Well, CNS's in psych went adios (sadly) and psych NP programs shifted education to focus more on pharmacology than on psychotherapy. Billing requirements haven't really caught up with this.

Most PMHNP's don't practice just therapy sessions for patients because their intended role is med management and diagnosis, however they can still technically bill and provide psychotherapy. But just because you can doesn't mean you should, imo. 

[JKL33]

6 hours ago, PsychNurse24 said:

But I can assure you that I’m getting a lot of hands-on experience with both Therapists and Psychiatrists.

Are peers in your program doing the same? I'm not trying to challenge you in an argumentative way, but the answer to this does matter. A system where an individual student may come out with reasonable competence on the other end solely because of their own resources, their own effort and the good will of their particular preceptors is not the same as a situation where the program is required to take the steps that would make it likely that every student would have this same kind of experience or else not successfully complete the program.

Know that my comments are speaking about any program of any reputed caliber that graduates students from a nurse practitioner program, and are not limited to alleged "degree mills." I personally think we have bigger problems than degree mills and should be very concerned about our basic standards separate from that issue.

 

5 hours ago, Phillip Flores said:

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.

The problem is that having a family or life responsibilities really doesn't have anything to do with the need to become adequately prepared to diagnose medical conditions and prescribe treatment plans to patients if that is the work one wishes to do.

The bottom line is that the nurse practitioner profession probably should exist for the idea of providing healthcare to patients, not for providing opportunities to nurses with responsibilities so that they can become providers without dealing with the significant inconveniences that other providers endure in order to become prepared.

Also, your assertion doesn't really make sense to me. How can you be less financially prepared to handle 2-3 years of no income than a 22 year old? I can guarantee you that patients don't care if you have bills or a mortgage or are saving for retirement or are putting children through college or anything else. Nor should they. They deserve competent care. And although some students who have other responsibilities can attend good programs and find ways to devote themselves to significant study, having a bar where no one has to do that unless they are personally driven to do so or where less is expected because the students are non-trads who already have xyz responsibilities....is something different.

[djmatte, ADN, MSN, RN, NP]

16 minutes ago, JKL33 said:

Are peers in your program doing the same? I'm not trying to challenge you in an argumentative way, but the answer to this does matter. A system where an individual student may come out with reasonable competence on the other end solely because of their own resources, their own effort and the good will of their particular preceptors is not the same as a situation where the program is required to take the steps that would make it likely that every student would have this same kind of experience or else not successfully complete the program.

Know that my comments are speaking about any program of any reputed caliber that graduates students from a nurse practitioner program, and are not limited to alleged "degree mills." I personally think we have bigger problems than degree mills and should be very concerned about our basic standards separate from that issue.

 

The problem is that having a family or life responsibilities really doesn't have anything to do with the need to become adequately prepared to diagnose medical conditions and prescribe treatment plans to patients if that is the work one wishes to do.

The bottom line is that the nurse practitioner profession probably should exist for the idea of providing healthcare to patients, not for providing opportunities to nurses with responsibilities so that they can become providers without dealing with the significant inconveniences that other providers endure in order to become prepared.

Also, your assertion doesn't really make sense to me. How can you be less financially prepared to handle 2-3 years of no income than a 22 year old? I can guarantee you that patients don't care if you have bills or a mortgage or are saving for retirement or are putting children through college or anything else. Nor should they. They deserve competent care. And although some students who have other responsibilities can attend good programs and find ways to devote themselves to significant study, having a bar where no one has to do that unless they are personally driven to do so or where less is expected because the students are non-trads who already have xyz responsibilities....is something different.

I think you’re failing to consider the whole point of nurse practitioners in the first place. They weren’t just some additional option to throw into healthcare. The point was to capitalize on a wealth of experience to fill gaps where access to care is limited. Many nurses have life responsibilities.  But that doesn’t mean patient care suffers as a result.  It’s evolved beyond that, but the basic idea still remains and is valid.  
 

Now working full time through a clinical rotation imo isn’t feasible or realistic. But I don’t think anyone actually does. When my clinical got heavy I swapped to working less hours to accommodate. But I had a job that could account for that easily. Most don’t and anyone pursuing some advanced practice should expect either going to part time or hoping for extreme job flexibility. 

[djmatte, ADN, MSN, RN, NP]

54 minutes ago, Neuro Guy NP said:

My clinical placements were arranged for me. I wouldn't make such a sweeping statement. 

I have less concern about who finds the clinical site than I do the follow through of evaluating that site. And that’s coming from someone who has multiple fall through at last minute and had to get a nursing license in another state just to expand my range.  At the end of the day, the quality was there because my school was focused on setting hard standards and actively showed up to verify progress throughout the process. Many brick and mortar do this. Some online do this. But not all from both categories do. 

[JKL33]

12 minutes ago, djmatte said:

I think you’re failing to consider the whole point of nurse practitioners in the first place. They weren’t just some additional option to throw into healthcare. The point was to capitalize on a wealth of experience to fill gaps where access to care is limited. Many nurses have life responsibilities.  But that doesn’t mean patient care suffers as a result.  It’s evolved beyond that, but the basic idea still remains and is valid.  

I'm not failing to consider that point. But given that things have evolved beyond that and the bases on which the profession is being advocated seem to be somewhat different than that, and certainly other entities (large healthcare systems, etc.) see NP utility as something beyond that, there are some things that seem rather incongruent at this point.

[Phillip Flores]

The problem is that having a family or life responsibilities really doesn't have anything to do with the need to become adequately prepared to diagnose medical conditions and prescribe treatment plans to patients if that is the work one wishes to do.

You have completely taken this out of context. In responding to the previous poster who suggests that students should not work, I argue that for some that is the only means to attend school. My comment has NOTHING to do with wishing to be accommodated. To say that only those who don't work be allowed to attend university is preposterous.

Also, your assertion doesn't really make sense to me. How can you be less financially prepared to handle 2-3 years of no income than a 22 year old? I can guarantee you that patients don't care if you have bills or a mortgage or are saving for retirement or are putting children through college or anything else. 

Why do you assume that the problem is strictly financial? I raised my family and intentionally did not go to be a better parent. 

This is a forum for professionals.....If you want to be a troll, just go to Reddit. Please add something more substantial than that

[TheMoonisMyLantern, ADN, LPN, RN]

10 minutes ago, Phillip Flores said:

The problem is that having a family or life responsibilities really doesn't have anything to do with the need to become adequately prepared to diagnose medical conditions and prescribe treatment plans to patients if that is the work one wishes to do.

You have completely taken this out of context. In responding to the previous poster who suggests that students should not work, I argue that for some that is the only means to attend school. My comment has NOTHING to do with wishing to be accommodated. To say that only those who don't work be allowed to attend university is preposterous.

Also, your assertion doesn't really make sense to me. How can you be less financially prepared to handle 2-3 years of no income than a 22 year old? I can guarantee you that patients don't care if you have bills or a mortgage or are saving for retirement or are putting children through college or anything else. 

Why do you assume that the problem is strictly financial? I raised my family and intentionally did not go to be a better parent. 

This is a forum for professionals.....If you want to be a troll, just go to Reddit. Please add something more substantial than that

JKL has been a member on AN for quite some time and has given many users great advice over the years. Disagree with her if you want, but to get so bent out of shape over a different point of view is unprofessional in and of itself. 

[JKL33]

12 minutes ago, Phillip Flores said:

You have completely taken this out of context. In responding to the previous poster who suggests that students should not work, I argue that for some that is the only means to attend school. My comment has NOTHING to do with wishing to be accommodated. To say that only those who don't work be allowed to attend university is preposterous.

 

It was not my intention to take your comments out of context.

A program that that is set up to allow participation around all of the students' other existing responsibilities is certainly an adjustment to the usual course of professional preparation. This is the case for all of these asynchronous programs that are the way they are so that students can turn in assignments around the demands of a full-time job plus whatever other responsibilities they have. If I implied any other kind of accommodation, that was not my intent.

 

22 minutes ago, Phillip Flores said:

Why do you assume that the problem is strictly financial? I raised my family and intentionally did not go to be a better parent. 

I'm sorry, I'm not following your train of thought. I wasn't trying to make assumptions; I was working with your phrase "afford not to work."

Part of this issue of whether people can/should work during NP school or not also has to do with what transpires over time on the schools' ends when they can find any angle to ease their burden in providing high quality instruction. The example would be the asynchronous nature of instruction many of them prefer to deliver--which they market as being a good thing so that NP students can get their education online while accommodating their other responsibilities. Regardless of what you think about it or what I think about it, I am willing to bet that it works out very well for programs that want to make money churning out NPs--don't you think? Can you really not see how it could be a bit of a problem? I do think it is going to become a problem that this mode of education is acceptable for neither physicians nor other non-physician APPs (I.e. physician assistants).

[djmatte, ADN, MSN, RN, NP]

50 minutes ago, JKL33 said:

 

It was not my intention to take your comments out of context.

A program that that is set up to allow participation around all of the students' other existing responsibilities is certainly an adjustment to the usual course of professional preparation. This is the case for all of these asynchronous programs that are the way they are so that students can turn in assignments around the demands of a full-time job plus whatever other responsibilities they have. If I implied any other kind of accommodation, that was not my intent.

 

I'm sorry, I'm not following your train of thought. I wasn't trying to make assumptions; I was working with your phrase "afford not to work."

Part of this issue of whether people can/should work during NP school or not also has to do with what transpires over time on the schools' ends when they can find any angle to ease their burden in providing high quality instruction. The example would be the asynchronous nature of instruction many of them prefer to deliver--which they market as being a good thing so that NP students can get their education online while accommodating their other responsibilities. Regardless of what you think about it or what I think about it, I am willing to bet that it works out very well for programs that want to make money churning out NPs--don't you think? Can you really not see how it could be a bit of a problem? I do think it is going to become a problem that this mode of education is acceptable for neither physicians nor other non-physician APPs (I.e. physician assistants).

I think the mode of education is fine so long as the checks are rigorous. Especially since with Covid, even brick and mortar schools are incorporating flexible online schools. The question is how detailed the individual schools are willing to go to develop such programs.
 

At frontier, they had opportunities of learning for the learning styles; audio, visual, and interactive.  Every subject has some form of lecture access for each. Exams were accessible in a window, but we had for a while an external 360 degree proctor camera/audio system which turned to a webcam system that made you scan your room periodically to limit cheating.  To top that, they had a mix of group projects, papers, and exams to Round out the education. The hard stop was their exam requirements. If you didn’t have an 80 average for exams regardless of your total average, you failed. Their thought was if you need to pass board, you need to do well on exams. I’m sure most online schools aren’t hitting these levels. But imo that’s the level most should hit 

[umbdude, MSN, APRN]

On 2/8/2021 at 3:08 AM, TheMoonisMyLantern said:

How long ago did you complete your education? To me, it sounds like you went to a school with the ideal method of instruction, especially for PMHNP.

I just completed it last year. The school I went to is pretty "old school" and don't rely heavily in online education (obviously we had to for a couple months due to Covid).