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.

[Zyprexa_Ho]

2 hours ago, umbdude said:

Intelligent people plan, make sacrifices, find scholarships, and do all the appropriate calculations to make things work in order to obtain the best education possible. Many of these folks do it for med, PA, PT, OT schools and all sorts of other full-time professional programs. The talk about accessibility and affordability is a cop-out common to many nurses who simply want to take an easy path. RNs want convenience, cheap tuition, ability to work full-time and complete education in 2 years, don't want to physically go in (at all) for on-campus skills, and then they complain about a sub-par education and don't feel ready.

I went to a 100% in-person reputable NP Program. People did fail out of classes because the exams were hard, and we were taught above what's required for the boards (which is the bare minimum). We were expected to role-play in therapy courses to demonstrate each modality's techniques; we had to take a full history with an actor (unknown person, without any information) and formulate differentials to pass our mid-term in Advanced Health Assessments; we had to demonstrate that we're actually percussing the liver span and we couldn't hide behind the camera because the professors stood right next to us; and we got tons of pearls from professors that weren't in the textbooks (real time back & forth dialogues and debates). Finally, I had my preceptor lined up 9 months before I even started clinical...didn't lift a finger. 

Was it a perfect program? No. But definitely worth my time, effort, and the $57k tuition. I had a great education that didn't break the bank. 

Maybe RNs don't realize this, but $100k+ salary a year is high by most standards. Many psychologists, MSW, psyD, MBA, OT etc. go back to grad school for much less earning potential. The only reason RNs think it's not good ROI is because many RNs already make near that amount. In that case, you must consider why you're going back to get your NP to begin with and what values you want to get from becoming an NP.

Youre also only replying to part of my comment. I also mentioned that NP programs build on a foundation of Nursing practice while many of those other programs do not. 

I'd rather schools be a bit more lax (allow someone to continue working) than only allow other rich people to become NPs. 

Also, you have to recognize that no matter how smart someone is, it may just not be financially feasible to ask them to not work for 2-3 years while they do their MSN. 

It sort of sounds like to me that you took on double the amount of debt that a lot of other NPs have and are looking for some way to justify that

[umbdude, MSN, APRN]

1 hour ago, Zyprexa_Ho said:

Youre also only replying to part of my comment. I also mentioned that NP programs build on a foundation of Nursing practice while many of those other programs do not. 

I'd rather schools be a bit more lax (allow someone to continue working) than only allow other rich people to become NPs. 

Also, you have to recognize that no matter how smart someone is, it may just not be financially feasible to ask them to not work for 2-3 years while they do their MSN. 

It sort of sounds like to me that you took on double the amount of debt that a lot of other NPs have and are looking for some way to justify that

$57k was my tuition after scholarship$, not my debt. I actually paid cash for parts of my grad school. I think a tuition of $60k-100k is reasonable for a great education and, in particular, for a degree that more than double my psych RN salary (in addition to increased job satisfaction). I have nothing justify for. In fact, I would've gone into more debt if I had to rather than half-*** my way through a cheap and low-quality program.

 

[Alain]

Here are my thoughts:

--> Standardize Quality of NP Education

Too variable. Should be more standardized. Should be standardized in the way of requiring direct interaction between proffs and students, requiring preceptors be arranged by the program (NP programs are a dime a dozen. Can't arrange preceptors for students? Too bad. It'll improve program quality through competition in this way as many struggle to get preceptors and shouldn't. Or maybe they should - maybe preceptors don't want students from said programs for a good reason - either way this solves the issue)

--> Standardize and Increase practical / in-program clinical requirements 

PA programs do about 2000 clinical hours of experience. In my opinion, as I'm sure many agree, this hands-on experience with a competent clinician interacting with patients is invaluable if it is of a high standard consistently throughout for all students. PA programs "piggy back" off MD/DO programs so many of the experiences form what I understand of quite similar and of a good quality as MD/DO programs have been doing their thing for nearly a century. Lots of time for refinement! Also the usual NP Program 600 - 800 hrs pales compared to 2000 PA hours. Yes PA don't have the prior clinical experience RNs do going in to it, and it should be valued and does help, but it's not the same at all as practice as a practitioner as your focus and role are totally different. A BIG thing is the hands-on aspect of doing procedures that RNs would never do (like pelvic exams, central lines, chest tubes, suturing, etc. as some random examples). 

So more clinical hours for NP programs but also more STANDARD experience. You can preceptor with whomever with little oversight and have a vast array of varied experiences from graduates of the same program : some having terrible experiences or minimally helpful ones while others got lucky and got amazing preceptors that taught them very well. This isn't fair to anyone. There should be some prior associations between the programs and specific clinics or hospitals or clinicians with payment to these stakeholders to make them motivated to be involved and active. Some formal relationships would be key. Med Schools and PA programs have this and it shows. 

--> Offer fellowships/post-grad certificate as a standard option

So in med school you can specialize in whatever area. All are quite distinct. As a fresh MD graduate sans residency you are pretty limited. However, NPs get didactic and clinicals (just like MDs) but no residency/fellowship. The latter solidifies and expands knowledge and breeds competent, confident clinicians. There are more and more fellowships. There are post-master's certificates (like the ENP Certificate after an FNP program). These can be offered more standardly and made known more broadly to students to facilitate excellence and competence that breeds performance and a command of a much higher salary. 

--> Basic Economic and Business Knowledge

So people are paid what the market deems they are worth. Not what any morals, virtues, or general opinion of their value deems. It's simple. An MD earns what he earns based on his speciality as he bills X dollars for Y and Z procedures that compensate so much (or not). Med Schools charge what they do knowing what an MD can make, and so they are aware it is still a good investment.

So an MD makes what he does as he brings that much money to a clinic or organization for billings. An NP would follow same economic laws unless they were being exploited due to ignorance of these facts. 

If an NP graduates and can't do much in the way of procedures, has minimal experience, requires much hand-holding, patience, teaching, guidance, and investment from a clinic or organization, and sees few patients per day (slow), then they command a much lower salary as all this investment from the organization costs money. The better prepared the NP, the more more they make as the more they make for their employer as well. 

A fellowship or post-grad certificate (like ENP from Emergency Specialists) is pursued as it DOES command a higher salary. This is obvious. You learn a ton of relevant procedures. These procedures are billed for. This earns employer more $. You can also care for more patients and need to rely less on Attending MDs. You can also be trusted with more responsibility given your developed competence, knowledge, and skills. This all translates to better patient care, more money for employer, and so of course they're fine with paying you more as well. It's all logical and viewed from an economic and business vantage point makes total sense. I feel many lack this awareness or knowledge and so are taken advantage of. You get what you're worth as defined by the above : patients per hour (obviously while providing skillful, competent, safe care), procedure you can do, scope of patients you're willing to see as major factors 

Yes no need to go back to "You're not an NP for money" well DUH! Of course. You're not an MD for money either ideally. Or an RN for money. But money is part and parcel to life and living and is a key factor and it's silly to ignore this and presume it is not. Life is economics and compensation is key. Why invest X Y and Z if payout is minimal - it won't happen. So that is a major consideration. The better we make NP graduates, the better they can earn as well as they will have that key leverage to command more. 

Money is not the devil. Nothing wrong with earning more. Very obviously those who earn more put a lot more into getting to that point, be it attending medical school and lengthy residencies, doing gruelling CRNA schooling and the GREs and not working 3 years, or doing an NP Program and working non-stop either with study or your day job for 3 years to get to the point where you can do advanced practice. 

My two cents

[JBMmom, MSN, NP]

6 hours ago, Hoosier_RN said:

Most professors don't make huge amounts from teaching. The educational institutions collect large amounts

Most professors have a side gig or 2 if they are the breadwinner/financial person in their household

I agree, though, that paying students deserve better

Point well taken. My complaint is with the professors that don't seem invested in their teaching job. For example, my professor last semester was teaching four sections, worked full time and was also in school for her DNP. I know she was trying to support herself, but she literally gave me NOT ONE bit of feedback that positively impacted my potential to be a competent practitioner. She took points away for an inaccurate APA citation, would write that I had misplaced commas and should have used bullet points. She did not once address the therapeutic interventions I proposed for critically ill patients.

 She chose to take on all those responsibilities, I did not choose to have a professor who was in it to check some box and make some money. I do realize not a lot of money, the school took plenty, but if someone decides to teach, I would hope they would take the time to do something that will benefit the students. 

[Hoosier_RN, MSN]

1 minute ago, JBMmom said:

She chose to take on all those responsibilities, I did not choose to have a professor who was in it to check some box and make some money. I do realize not a lot of money, the school took plenty, but if someone decides to teach, I would hope they would take the time to do something that will benefit the students. 

I agree. This exists in regular RN programs as well. 

[Neuro Guy NP, DNP, PhD, APRN]

7 hours ago, Zyprexa_Ho said:

Youre also only replying to part of my comment. I also mentioned that NP programs build on a foundation of Nursing practice while many of those other programs do not. 

I'd rather schools be a bit more lax (allow someone to continue working) than only allow other rich people to become NPs. 

Also, you have to recognize that no matter how smart someone is, it may just not be financially feasible to ask them to not work for 2-3 years while they do their MSN. 

It sort of sounds like to me that you took on double the amount of debt that a lot of other NPs have and are looking for some way to justify that

And if someone can't make the arrangements to do the curriculum, then they simply. Can't. Do. It. It's unfortunate, but that's what it should be. Do we see PA programs bending over backwards to accommodate folks? No. Either you take the time off to get through the program or you simply can't be a PA. I don't know why RNs can't grasp this. This is the attitude so many NP students have. They want me as the professor to flex on deadlines, clinical hours etc because they've got a baby, family, or work obligations. I won't do that. You have to calculate all costs - not just financial - before making the HUGE decision to go back to school. And if you can't balance it, then don't start the program. I don't believe nursing has less intelligent professionals than other fields.

We're simply suffering an ailment where watered down, convenient curricula or delivery options are permitted and it has to stop because it is leading to many people not putting forth the necessary effort. If you can figure out a way to work while in school, more power to you. But students can't expect that to mean something to the school or get an accommodation for it. I keep harping on this because if I had a nickel for every time a student hinted at this, I'd be richer than Jeff Bezos. We're not doing the right thing by making programs "more accessible". By the way, we should remember the basic economic concept of supply and demand. More accessibility = more supply. More supply = less demand, or at least less demand at the premium price.

[Neuro Guy NP, DNP, PhD, APRN]

On 2/7/2021 at 10:36 AM, umbdude said:

Intelligent people plan, make sacrifices, find scholarships, and do all the appropriate calculations to make things work in order to obtain the best education possible. Many of these folks do it for med, PA, PT, OT schools and all sorts of other full-time professional programs. The talk about accessibility and affordability is a cop-out common to many nurses who simply want to take an easy path. RNs want convenience, cheap tuition, ability to work full-time and complete education in 2 years, don't want to physically go in (at all) for on-campus skills, and then they complain about a sub-par education and don't feel ready.

THIS.

Many people are also going to NP school for the wrong reasons. They're not primarily motivated by the provider role so much as other factors. 

[Ace Savanahh]

On 2/7/2021 at 8:35 PM, Neuro Guy NP said:

THIS.

Many people are also going to NP school for the wrong reasons. They're not primarily motivated by the provider role so much as other factors. 

Most RNs are only doing if for the money and so are the students. They are very upfront about it, just like cops.  Anyways, If the NP programs weren’t good than they wouldn’t be approved.  
I can’t afford a private school but if it got me to where I wanted to quick, I would do it.  With that said, anyone have feedback on the University of Phoenix NP Program?  And brick an mortar schools are dead.  Look at Blockbuster video.  

[PsychNurse24, BSN, RN]

On 2/3/2021 at 5:48 PM, FullGlass said:

I just spoke to one my instructors from nursing school and she said she will only precept students from schools she knows are good quality, due to issues with students from these crap schools.

If people have to pass an ANCC Board certification before practicing, do you really care where someone got his/her degree?  

[Zyprexa_Ho]

4 hours ago, Neuro Guy NP said:

And if someone can't make the arrangements to do the curriculum, then they simply. Can't. Do. It. It's unfortunate, but that's what it should be. Do we see PA programs bending over backwards to accommodate folks? No. Either you take the time off to get through the program or you simply can't be a PA. I don't know why RNs can't grasp this. This is the attitude so many NP students have. They want me as the professor to flex on deadlines, clinical hours etc because they've got a baby, family, or work obligations. I won't do that. You have to calculate all costs - not just financial - before making the HUGE decision to go back to school. And if you can't balance it, then don't start the program. I don't believe nursing has less intelligent professionals than other fields.

We're simply suffering an ailment where watered down, convenient curricula or delivery options are permitted and it has to stop because it is leading to many people not putting forth the necessary effort. If you can figure out a way to work while in school, more power to you. But students can't expect that to mean something to the school or get an accommodation for it. I keep harping on this because if I had a nickel for every time a student hinted at this, I'd be richer than Jeff Bezos. We're not doing the right thing by making programs "more accessible". By the way, we should remember the basic economic concept of supply and demand. More accessibility = more supply. More supply = less demand, or at least less demand at the premium price.

I'm not really sure why you guys keep comparing NP school to MD/DO/PA/Etc. NP school builds on a preexisting foundation that those other programs don't. 

And accessibility issues don't only have to do with the quality of education. It also has far reaching implications such as only allowing financially well off people to advance their careers (decreased class mobility) and race issues. Without taking these into consideration, you're asking for more concentration of wealth and disparity between races. 

[0.9%NormalSarah, BSN, RN]

6 minutes ago, Zyprexa_Ho said:

I'm not really sure why you guys keep comparing NP school to MD/DO/PA/Etc. NP school builds on a preexisting foundation that those other programs don't. 

And accessibility issues don't only have to do with the quality of education. It also has far reaching implications such as only allowing financially well off people to advance their careers (decreased class mobility) and race issues. Without taking these into consideration, you're asking for more concentration of wealth and disparity between races. 

Seriously this. I’m starting to feel like a butthead for even considering advancing my career with an NP Program that may be online. A lot of nurses are settled in life and may own homes, have kids in school, etc and can’t pick up and move to where a school is located. That really doesn’t mean that they are whiny nurses looking for the easiest way to NP and not ready to make a huge commitment. The polarizing of the types of nurses that are looking to get their NP is not helpful. There are plenty of us in the middle who want to advance and take our education very seriously, but that also need to find a way to do it within the boundaries of our lives, to a reasonable degree.

[PsychNurse24, BSN, RN]

37 minutes ago, 0.9%NormalSarah said:

Seriously this. I’m starting to feel like a butthead for even considering advancing my career with an NP Program that may be online. A lot of nurses are settled in life and may own homes, have kids in school, etc and can’t pick up and move to where a school is located. That really doesn’t mean that they are whiny nurses looking for the easiest way to NP and not ready to make a huge commitment. The polarizing of the types of nurses that are looking to get their NP is not helpful. There are plenty of us in the middle who want to advance and take our education very seriously, but that also need to find a way to do it within the boundaries of our lives, to a reasonable degree.

Excellent points!  My daughter and I are pursuing PMHNP on line and are getting a good education. Everyone has to pass an ANCC board certification, so why does it matter where someone gets their education??