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]

1 minute ago, MentalKlarity said:

We could instead look at how many diploma mill schools have shut down or "gone out of business" leaving their students high and dry? The number of preceptors who say they won't work with them due to incompetence? Or perhaps we could look into Walden University, the diploma mill poster child, and their current US Justice Dept Investigation for potentially misrepresenting their Master's in Nursing programs to students and regulators? 

A school cannot take anyone with a pulse and student loan check, stick them into self-guided online modules with monthly start dates, allow them to complete clinicals with no oversight, and then expect them to be equal to peers from more reputable programs. 

Hmmm, still no data or facts.  Just your opinions.  And if Walden University is the poster child, include all the preceptors that willingly precept their students. Must be tens of thousands by now!  Please show the proof that Providers from Walden are worse than other University-educated practitioners.

[MentalKlarity, BSN, NP]

6 minutes ago, PsychNurse24 said:

Hmmm, still no data or facts.  Just your opinions.  And if Walden University is the poster child, include all the preceptors that willingly precept their students. Must be tens of thousands by now!  Please show the proof that Providers from Walden are worse than other University-educated practitioners.

https://www.highereddive.com/news/justice-dept-investigates-walden-u-over-claims-of-misrepresentation/588521/

 

Luckily it's a moot point as Walden is unlikely to survive the investigation, or continue to have access to their cash-cow of federal loans.

[PsychNurse24, BSN, RN]

Time will tell!  But how does misrepresentation equate to poorly educated NP’s??  Do you have data comparing the board certification passage rate of Walden University graduates compared to other universities?  And again, how do you know the quality of providers after they graduate?   

[Neuro Guy NP, DNP, PhD, APRN]

43 minutes ago, PsychNurse24 said:

Time will tell!  But how does misrepresentation equate to poorly educated NP’s??  Do you have data comparing the board certification passage rate of Walden University graduates compared to other universities?  And again, how do you know the quality of providers after they graduate?   

Personally I'd be hesitant to do such a study as the ones you propose as I'd be extremely embarrassed if it were true and these results were published. Our profession would look so bad. I'd be mortified. 

[TheMoonisMyLantern, ADN, LPN, RN]

6 hours ago, JKL33 said:

NP education (supposedly) builds on a preexisting foundation that is no longer strictly required. Reference direct entry programs.

And that whole thing about the nursing foundation never made any sense anyway, since RNs' experience and expertise varies widely such that it wouldn't ever make sense to say that solely by virtue of having worked as an RN one has laid down the foundation for becoming a provider.

The foundation never had anything to do with diagnosing conditions and prescribing treatment plans, anyway. Knowing medications on a class level or knowing what they are generally used for is not the same as knowing which one to prescribe for an individual patient's situation.  Having heard of a condition before or provided nursing care to a patient with that condition is not the kind of foundation that is very useful in starting from scratch with undifferentiated patients and properly evaluating them and diagnosing their conditions and knowing what to do about them on a level that can be individualized to a particular patient.

I am commenting as an experienced RN who as recently as a couple of years ago thought it was ludicrous that some NPs would state that their RN experience didn't help them too much with their provider role. And now...here I am in the process of learning that while there is a lot that being an RN does help with (the basic familiarity with meds, the history of interacting with patients, the knowledge of basic tests and treatments, etc., the observation of various disease processes from a nursing standpoint), being a competent provider requires so much more knowledge than what is strictly required to get by as an RN. It requires a substantially different manner of thinking and differentiating than the RN role does.

It's the difference between being able to guess that a patient might probably have a kidney stone based on the fact that you've seen 100 other patients with kidney stones restlessly moving about on a stretcher or dancing at the bedside vs. seeing a patient with back pain and figuring out that they have a kidney stone vs. dissecting AAA vs. everything else it could be ad infinitum.

It's the difference between guessing that a patient with ear pain could have an "ear infection" vs. figuring out it's likely trigeminal neuralgia or the prodrome of herpes zoster. Or, again, any other thing including something mild that just requires reassurance and supportive care.

It hurts quite a bit to admit it (?), but the whole pattern recognition thing is actually a bit of a hindrance to learning the provider role. It hurts to admit that alllll my past experiences independently amount to me being able to make a few "educated guesses" about what something "could be." And that, outside of the education I am now involved in, I have very little experience with systematically using a significant body of knowledge to think (rather than guess) my way to a correct answer.

Certainly nurses don't have the knowledge base to formulate diagnosis, medical plan of care, etc. But I think the intuition that comes from hands on and lived experience should not be discounted as educated guessing. A novice nurse may see only one problem or diagnosis as the only possibility but an experienced nurse knows that multiple problems could cause the symptoms or problem being displayed. We learn with experience that there are no 100% in medicine and that a diagnosis could be any number of horses or zebras. Of course as nurses it is inappropriate for us to come to the conclusion of what the diagnosis is.

Once you become a provider and gain experience that intuition you have as a nurse is only going to grow and expand and allow you to more easily recognize conditions and complications on an even more complex and rapid level. So, I don't think that the intution from hands on experience is only utilized at the nursing level but also by providers as well.

Don't get me wrong, formal education is vital, but so is that twinge in your gut pointing you in a certain direction.

[TheMoonisMyLantern, ADN, LPN, RN]

3 hours ago, PsychNurse24 said:

I would like somebody to provide data that so-called “diploma-mill” prepared nurse practitioners are worse than other nurse practitioners. Oh wait, there’s no proof. It’s just all your esteemed opinions!  Why don’t you do some studies on nurse practitioners from your self identified diploma mills one year, five-years,  and 10 years after graduation and compare them to the nurse practitioners from other universities (That you approve of!) And then get that study peer-reviewed and then show the data.  Can you all say “Narcissistic Personality Disorder”??

I actually asked a while back in a different thread if there had been any more recent studies on NP effectiveness since the rise of for profit online schools, and I think the conclusion was that there haven't been. Of course, that's a fair point that there is no current "proof" that the way curriculum is execute in NP education can effect their competence. Right now, it's simply a combination of speculation, comparison, and people's personal experiences with NP grads from schools with few admission standards and lack of instruction in curriculum. As other posters have said, there are reports of healthcare companies refusing to precept or hire students from certain schools, there are certain states with licensure restrictions depending on what school you went to. So regardless of accreditation it should be concerning.

As NP programs continue to multiply, you can bet money that eventually new studies will be done, more than likely at the behest of AMA who would love nothing more that prove that NP's are a bunch of knuckleheads, and if the anecdotal experiences that people have had can be proven, it will not be a good omen for the NP profession. 

No one wants to be a bedside nurse anymore, and these schools are preying on that and making a fortune while not delivering an education that equals the cost, that is not fair to the student taking out the loans, it's not fair to patients the student will be treating, and it is not fair to the profession of nursing as a whole. If NP's want IP and to keep IP, the burden of proof is on the profession and the AMA is going to require that proof to be continually updated because of their poor opinion of NP's.

Look, I'm not an NP, and I'm not in an NP Program, and furthermore I don't even know if I have to desire to be an NP. I'm sure someone will throw that fact in my face, but I am an advocate for the nursing profession as a whole and I think NP's are vital members of our healthcare team and because of that I think that standards of education must be held high so that NP's can continue to fulfill the role they're needed to.

[MentalKlarity, BSN, NP]

9 hours ago, TheMoonisMyLantern said:

Look, I'm not an NP, and I'm not in an NP Program, and furthermore I don't even know if I have to desire to be an NP. I'm sure someone will throw that fact in my face, but I am an advocate for the nursing profession as a whole and I think NP's are vital members of our healthcare team and because of that I think that standards of education must be held high so that NP's can continue to fulfill the role they're needed to.

You don't have to be an NP to know that standards have to be higher than they are! And you're absolutely right - the much touted studies of NP parity were mostly completed back when we had a few thousand NP grads a year, all from reputable brick and mortar programs where they did daily hands-on skills classes and didactic. We haven't had an "update" since the thousands of online for-profit graduates have descended onto the healthcare system. If the comments from those precepting them are any indication, we could start to lose credibility or independent practice quickly.

For anyone advocating not upping our standards, please understand that the second we have a rash of major medical issues caused by an unprepared graduate, or a number of studies showing subpar care provided by all of these diploma mill fly-by-night school graduates, that is ALL the AMA is going to need to open up "studies" in state after state and try to roll back NP independent practice.

[Zyprexa_Ho]

16 hours ago, JKL33 said:

NP education (supposedly) builds on a preexisting foundation that is no longer strictly required. Reference direct entry programs.

Whether it is required or not is sort of irrelevant. The other poster was saying that RN experience has nothing to do with being an NP.

[Zyprexa_Ho]

22 hours ago, Neuro Guy NP said:

Well please explain the similarity in what NPs do and RNs. I don't find myself at the bedside doing Nursing care plans, assessments q4h in the ICU, doing ADLs, vitals, calling providers for orders, etc. Instead, I find myself rounding, writing orders, performing procedures, consulting other specialties,  leading multidisciplinary rounds, and talking about prognosis with families. 

Doesn't sound too similar from where I'm sitting. If the roles were so similar then we wouldn't have to work so hard on training RNs in NP school to present patients, formulate differentials, and shift their thinking towards making diagnoses, prescribing, and creating the medical plan of care. 

Very different roles and I stand by the position that the two in practice have little to do with one another other than NP being predicated on first having RN licensure. And there's nothing wrong with that! It's just a different avenue of nursing. But at its core advanced practice and bedside are dissimilar, yet equally important. It's akin to the difference between finance and accounting; accounting focuses on reporting of financial position according to government rules and finance concerns itself with generating money. Two different aspects of business. They're related but totally different fields, each of which has its own inherent value. Same thing goes from RN and NP. 

Of course RN and NP are different roles. If they weren't different roles, the job title wouldn't be different.

My point is that RN experience prepares you at least somewhat for advancing your practice. Does it teach you every little thing that an NP does? No. That's why it is called advancing your practice. It builds upon a foundation of healthcare experience.

This is why I said that an RN with experience is going to be more prepared for an NP Program than a grocery store cashier. It gives you something and to deny that is to ignore that RNs have a valuable position on the healthcare team. I can't believe this has to be said.

[Neuro Guy NP, DNP, PhD, APRN]

26 minutes ago, Zyprexa_Ho said:

Of course RN and NP are different roles. If they weren't different roles, the job title wouldn't be different.

My point is that RN experience prepares you at least somewhat for advancing your practice. Does it teach you every little thing that an NP does? No. That's why it is called advancing your practice. It builds upon a foundation of healthcare experience.

This is why I said that an RN with experience is going to be more prepared for an NP Program than a grocery store cashier. It gives you something and to deny that is to ignore that RNs have a valuable position on the healthcare team. I can't believe this has to be said.

Well, I can't believe you're missing my point. I didn't say RNs aren't valuable so don't put words in my mouth. I explicitly acknowledged I value bedside RNs, and I do. It isn't lip service. Otherwise, I wouldn't waste my time being an educator or in public service of our profession. I just don't think RN experience, except for a few areas really does much to prepare for NP school. Mind you, the areas in which it does prepare are quite important and 'weighty' but in my experience this doesn't account for even half the battle. Aside from that, we'll have to agree to disagree so no sense going back and forth any further on it.

[MentalKlarity, BSN, NP]

1 hour ago, Neuro Guy NP said:

Well, I can't believe you're missing my point. I didn't say RNs aren't valuable so don't put words in my mouth. I explicitly acknowledged I value bedside RNs, and I do. It isn't lip service. Otherwise, I wouldn't waste my time being an educator or in public service of our profession. I just don't think RN experience, except for a few areas really does much to prepare for NP school. Mind you, the areas in which it does prepare are quite important and 'weighty' but in my experience this doesn't account for even half the battle. Aside from that, we'll have to agree to disagree so no sense going back and forth any further on it.

I did not find RN experience to be helpful for NP school or practice. In fact, most of the people in my graduating program who struggled the most in coursework, clinical, and even boards were those with 20+ years experience as an RN. The BSN to one year beside to NP school students excelled. I think that makes sense as the more important "foundation" for medical thinking is science - biology, Chemistry, how the body works, etc. That stuff is much more "fresh" straight out of a bachelor's program. I think those that spend 15-20 years bedside forget a lot of that and it becomes harder to think like a provider and understand the pathophysiology.

[ThePrincessBride, MSN, RN, NP]

On 2/9/2021 at 7:26 PM, Neuro Guy NP said:

I think your program sounds wonderful. Sounds like Drexel if I had to guess. I like the connectedness with real faculty with real lectures. That's key for me.

It is a state university that always gets high rankings.