Why don't more NPs advocate for better training?

[Angeljho]

I've seen a lot of complaints on this forum about the quality of NP education and training. However, while I mostly see complaints here, other forums and media defend NP education. If NPs feel that their training is inadequate, why not tackle this issue at a higher level to advocate for better training (or a better model of care)?

[Oldmahubbard]

All I know is I personally needed every last minute of my 4 years working as an RN in the mental health field before I became a Psych NP.

I doubt anyone can get psych out of a book. Too many confounding diagnoses and malingerers.

[direw0lf, BSN]

On 2/26/2019 at 10:29 AM, Hyperflycemia said:

What makes you think that the problem is solely related to online education?

There are quality online programs. There are junk online programs. The same is true of brick and mortar programs. I have never seen compelling evidence that a junk online program is any better/worse than a junk brick and mortar program.

The problem of having junk professors is not isolated to online programs either, in fact the online programs might have more incentive to have quality faculty. To make matters worse, students and prospective students don't seem to have any qualms about sitting in front of junk professors because these students want the advanced degree and they go to whatever junk school will accept them with the minimal amount of effort/cost. The free market is not doing anything to correct this problem; the solution needs to be at the regulatory level.

I think you underestimate millennial students. Part of our "charm" is that we do speak out more and do demand quality professors if we are faced with junk ones. Contradictory though we also will go to "whatever junk school will accept" us --- that's why I think online schools should be out. Yes there are some good ones like Duke but imagine how much better it would be if those good online programs weren't online? All I know is that it's viewed as impossible for PA programs to be online, yet it's OK for nursing and I personally don't agree with that.

[Dodongo, APRN, NP]

7 hours ago, direw0lf said:

All I know is that it's viewed as impossible for PA programs to be online, yet it's OK for nursing and I personally don't agree with that.

There are a handful of online PA programs - not 100% online, but still mostly. But they are still more stringent and difficult. It's not necessarily the online component that's the problem. It's the 100%, no on campus skills, no proctored exams, student found preceptors w/o oversight, etc.

[direw0lf, BSN]

On 3/8/2019 at 8:57 PM, Dodongo said:

There are a handful of online PA programs - not 100% online, but still mostly. But they are still more stringent and difficult. It's not necessarily the online component that's the problem. It's the 100%, no on campus skills, no proctored exams, student found preceptors w/o oversight, etc.

good point and clarification - I def agree!! How many on campus visits for skills do you think is necessary?

[Dodongo, APRN, NP]

Probably a couple weeks worth at least. My program had 4 on campus intensives. We had real, live patients/actors that we would do workups on, ultrasound, central lines and a-line insertions, intubations, chest tube insertions, multiple simulations, lectures, suturing, I&Ds, etc. I can not imagine attending a program without this. I don't know why anyone would attend a program without this unless they were desperate and unqualified for anything else.

[MierKat]

On 2/21/2019 at 3:19 AM, Spadeforce said:

They know the soccer moms out there love the easy couch curriculum and if they make it harder people will take the PA route instead and it will hit their pockets.

That's a really negative slur and misogynist to boot. I'm sure that most NP students are not soccer moms. Rather they are working professional RNs - MALE OR FEMALE - that want to support their families, contribute to their medical institutions, care for their patients and obtain more knowledge. The fact that some have to work or some stay home with children doesn't cause NP education to be lacking. It is likely a constellation of forces.

You sound bitter and poorly informed.

[blondenurse12, MSN, NP]

I'm surprised no one has commented on the fact that many brick and mortar schools are phasing out master's programs entirely. I'm disturbed by this. I know it's all about the dollars and to go from undergrad straight through to doctoral student is great for their pocketbooks. But to have zero nursing experience and then become a NP?

These programs don't have as much clinical because in the past, it was expected that you have a solid nursing foundation from practicing. My university was great in the fact that they found preceptors for us but sometimes this didn't work out well. My last year, I had two very different preceptors. One who was a MD that let his patients run HgA1c's of 9 and the other was a NP who would do a million dollar work up on a patient with viral gastroenteritis who just wanted a damn work note and Zofran. Thankfully I had enough nursing experience to deal with these two wildly variant practice styles but someone who had no bedside experience may have struggled.

I feel like many of us want things to change but how? No one listens. Universities want to make money, people just want a better life and are sold this dream.

[FullGlass, BSN, MSN, NP]

14 hours ago, blondenurse12 said:

I'm surprised no one has commented on the fact that many brick and mortar schools are phasing out master's programs entirely. I'm disturbed by this. I know it's all about the dollars and to go from undergrad straight through to doctoral student is great for their pocketbooks. But to have zero nursing experience and then become a NP?

These programs don't have as much clinical because in the past, it was expected that you have a solid nursing foundation from practicing. My university was great in the fact that they found preceptors for us but sometimes this didn't work out well. My last year, I had two very different preceptors. One who was a MD that let his patients run HgA1c's of 9 and the other was a NP who would do a million dollar work up on a patient with viral gastroenteritis who just wanted a damn work note and Zofran. Thankfully I had enough nursing experience to deal with these two wildly variant practice styles but someone who had no bedside experience may have struggled.

I feel like many of us want things to change but how? No one listens. Universities want to make money, people just want a better life and are sold this dream.

Studies have shown that RN experience makes no difference for primary care NPs. Are you working in primary care or acute care? Reputable Acute Care NP programs DO require RN experience, as they should. There is no reason to require RN experience for primary care.

Also, I don't understand your anecdotes. How can an MD "let" his patients run A1C1 9+? He can't force them to be compliant with DM2 tx. As for gastroenteritis, a GI panel should be run to r/o microorganisms. Since we don't know the pt's sx, we don't now if these tests were warranted. I personally would not just give someone with gastroenteritis a Zofran and send them on their merry way.

Your answer demonstrates why RN experience may not be an asset to a primary care NP. I've seen numerous posts on this forum by former RNs who are unhappy with being an NP because it is difficult for them to make the transition to provider. There is a thread now somewhere about an FNP student who hasn't even graduated who wants to do RN work on the side when she gets her first NP job!

Let me give you my own anecdote: our clinic had to fire an FNP who had 10 years RN experience, including ER and ICU. She was incompetent and dangerous. She didn't want to do pelvic exams and told female pts to take the swab, and swab themselves!!! She refused to provide pain medications, even to established patients who were stable, even to dying cancer patients! She made a woman over 90 years old who took literally maybe 20 tramadol in an entire year for arthritis flares drive over 20 miles down a windy mountain road to see me for her tramadol refill because the bad FNP couldn't be bothered to write a refill. She told many patients that veganism would cure all their problems, including GERD, ulcers, etc. She told new moms that they should put their infants on a vegan diet! Another FNP with RN experience told a shingles patient with open blisters to use capsaicin cream on it!

So just stop with the primary care NPs need RN experience. I didn't have any RN work experience and I am doing just fine, thank you. My patients love me and my management is very happy with me. The RNs and LPNs in our clinic send their family and friends to see me and request me by name.