In response many of the posts we find on here. What would be some of the biggest struggles that nurse practitioners, np students, new grads, vets, etc experience in this field? Does not have to be related to anything specific, but if you had one problem in regards to being a nurse practitioner, what would it be?
I guess to start mine would be something along the lines of attempting to understand what the future holds for nurse practitioners in this ever-changing world.
yet the psychologist that collaborates has literally put me down for being on the deans list (I didn't mention it, someone asked me and he heard the conversation, I do NOT brag) He is a concern to me if I work in the unit. He won't address me or include me in conversations with my preceprtor, even when he interrupts us and discusses the same case we had been talking about. sigh.
I have found some psychologists to be rather arrogant and almost defensive of our income and ability to prescribe. Thankfully in my area they are few and far between most often being hired to do specialty testing. We have none in the hospitals where I work.
I worry that MSN programs don't include enough clinical hours. I think it should be mandatory for NP students, like medical students, to have a residency of 1-2 years. It would definitely ease the transition from student to competent provider. I looked into residency programs, but there were very few and most of the deadlines had passed by the time I graduated. So it didn't make sense to start a job, and then leave for residency after 6-7 months. I think it's a serious issue because many employers think that you should be at the level of a physician who has just completed residency, but that's quite far from the truth.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I think everyone will have struggles regardless of what stage we are in our career. Without sounding pretentious, I like to refer to them as challenges because it has a more positive spin to it. Here are mine:
1. From a practice standpoint, certain patient populations scare me. I think as nurses, we all have a comfort level on certain aspects of Medicine based on our backgrounds (mine seem to be Cardiovascular and Pulmonary, areas I scored the highest in my CCRN!). Critical care requires a wide breadth of knowledge as it is. We get a fair amount of critically-ill Hematology-Oncology patients and they are very fragile, chronically sick, with a high tendency to develop multi-organ dysfunction. More recently, we've been staffing the ICU of a campus Women's Hospital where we get OB-Gyn patients in the ICU. They scare me too! It is one thing to admit patients with sepsis and multi-organ failure but when you add the fact that the patient is gravid with a fetus you're trying to keep viable, the nerves certainly set in. I'm glad to have a multidisciplinary team that is supportive behind me.
2. From an ethics standpoint, I always find the balance between advanced technology in healthcare to keep people alive and the futility of care difficult to reconcile. I think this is very much a reflection of the values we place as consumers of US health care. There has to be a point when we as providers say no more treatment and families, on the other hand, have to be educated enough to know when it's time to stop the suffering and focus on comfort. Critical care is expensive as it is and a lot of resources are poured into many cases that we know will not produce a favorable outcome yet we pursue them anyway. I think Palliative Care is still very much under appreciated in our system.
3. Four our field as nurse practitioners in general, I also worry, as many others, about the mixed message we're sending the public. We've come across a time when 21 states and the DC have independent practice laws and many more states have pending legislation to follow suit yet we haven't addressed the elephant in the room - the fact that there is a growing number of programs that do not impose strict admission criteria. I wouldn't even need to go into stacking our program admission stats against Medicine and Physician Assistant programs - our allied health colleagues in Pharmacy, Rehabilitation Sciences have maintained competitive standards of admission and have kept schools offering programs low in numbers, something our leaders do not seem to notice.
4. I always wonder whether venturing out of my setting of comfort would help me grow as a nurse practitioner. I've been in a teaching/academic setting all my career as an NP. I love the setting but wonder whether I could function outside of the safety net of academia.
I agree that the elephant in the room is getting rather large. Of course there are very competent nurse practitioners our there and such, but when people take a heuristic look at the cold hard stats of medicine, PA, PT, pharm, dental, OT, etc programs, it is not a difficult battle for the ama and other groups to place good looking charts, numbers, and other quantitative information out for the layperson to view which would provide a very good argument against our standpoint of deserving full practice authority.
In many cases our job is more complex (even though in some cases it may be comparing apples to oranges) than pharmacists, PT, OT, etc yet our education standards seem to be much more lax. I am hoping that they would at least provide a more difficult licensing exam. The layperson, when provided the fact that to practice medicine, excluding the certification of whatever specialty the physician choosing, must as we all know pass three separate exams. While I am not here to compare the education of NP to MD/DO, when these starts at provided to the public it leaves us very little wiggle room to try to provide a good rebuttal.
Oh what shall we do....
while this is also not true for everybody, it seems there are two different type of people that pursue a masters in nursing vs a doctor of medicine. It seems a lot of Np are simply going back for a raise and better hours (at least according to these forums). Then the complaint is that they cannot handle the increased responsibility of the position. I am sure this is present in both fields, but it seems to be rampant here on all nurses. While it may not be exactly the same, what we do is pretty much functioning as what a ''physician'' does, no matter how competent we may or may not be.
Food for though, looking forward to responses in regards to this subject, even though we may just be beating a dead elephant.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I would hate for this thread to highlight the shortcomings of our field but since you mentioned the certification exam, it is quite disheartening to say that we also don't stack up quite nicely with our provider colleagues in this area.
I've only taken ANCC's ACNP-BC exam once and it was a stressful experience at the time (I had a job lined up before I took the test) but looking back it wasn't such a tough exam to pass as long as you review ahead of time and get a feel of the kind of questions that come up on the test.
Maintenance of certification is where we aren't as strict compared to our PA-C and MD colleagues. PA's must take a recertification exam either every 6 or 10 year cycle. Family Practice physicians must take a recertification exam every 7 or 10 year cycle. Internal Medicine physicians must take a recertification exam every 6-year cycle. All require CME's. None of the national NP boards require a recertification exam.
Also, many MD specialty boards require oral boards in addition to computer-based testing.
I guess this does paint a picture of the NP field as a "nicer", "easier", and more "flexible" field - values that many of our NP peers probably wouldn't complain about...but at what expense do we want to sacrifice credibility for "easy, nice, and flexible"?
While our career isn't easy money by any means, as you said it is portrayed that way to the large number of RNs entering the field. Seems like If history repeats itself any easy form of income or anything portrayed as such never lasts forever.
My collaborating physician and I were just talking about the certification exams the other day. I mentioned that I was surprised that ANCC and AANP haven't moved towards re certifying by exam since that is the norm for PAs and physicians. Not that I want to go through that but it would help in making NPs a little more respected maybe.
I recently switched from working for a hospitalist group to working family practice and nursing home rounding. Even though I have only been a NP for a little over 2 years a lot of knowledge got rusty in my brain so my textbooks are getting a work out again!
I do really think they should require us to sit for boards again every 5-10 years. This and make initial boards much much more difficult. That would be the best way to let all the schools open as many programs as they want but have a filter at the end of the tunnel and once schools pass rates dropped the schools would most likely begin losing accreditation. For the amount of autonomy we have our boards should be extremely difficult, I mean a whole two more years of school and we get to prescribe a huge range of medicine, order 5000 dollar imaging studies, and dictate our patients lives through direct care? That is a lot more difficult than pushing IV meds, charting assessments, and titrating drips (which most of us did in our previous lifetime as nurses).
I honestly wouldn't mind taking a re-cert exam periodically. I think it would give us greater credibility, and most importantly, act as a motivator to stay abreast of current practice.
As far as my greatest struggle as an NP, I would say it is dealing with insurance companies. I spend way too much time doing prior authorizations for very common medications and arguing with the insurers to get my patients' meds covered.
Barnstormin' PMHNP
349 Posts
I guess that was more than one problem.