Writing the Prescription to Fix Broken Nurse Practitioner (NP) Education (Pt. I)

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by cjcsoon2bnp cjcsoon2bnp, MSN, RN, NP

Specializes in Emergency Nursing.

There are over 230,000 licensed nurse practitioners (NP) in the United States and I am proud to say that I will soon be one of them. NPs have achieved great advances in practice since the first education program began at the University of Colorado (UC) in 1965. NPs provide essential care for millions of Americans and now have full, independent practice authority in 22 states. However, despite these advances, our educational preparation is inconsistent, flawed and needs restructuring.

You are reading page 6 of Writing the Prescription to Fix Broken Nurse Practitioner (NP) Education (Pt. I). If you want to start from the beginning Go to First Page.

cjcsoon2bnp, MSN, RN, NP

Specializes in Emergency Nursing. 8 Articles; 1,156 Posts

In my opinion is is a central part of the current debate: APN programs which have stopped securing clinical sites, in simple terms, are telling every student that they care more about money than they do about their education. The quality of the clinical portion of NP education is vital to the overall quality of the novice NP that is produced and the fact that many programs have given up control of this astounds me. We can follow the money on that one and it is fairly clear why programs are doing this in increasing numbers.

That being said, you also have quite a ways to go and haven't really gotten into the major part of your advanced practice education, which in my opinion, begins with the start of clinical rotations and the associated didactics. It might get better for you shortly.

As usual I think that BostonFNP is right on target, programs that don't or can't secure sits for their students are sending a message that tuition dollars are valued above the quality of their students education. I am a FNP student who comes in with 5+ years of RN experience (5 part time in psych and 3 part time in ED) and I have decided as much as I like psych that I want to be an ED NP. I also love to teach and plan to obtain my DNP eventually just so that I can teach and help lead an FNP program. I am taking about these issues now because I really would like to be a part of the solution in improving NP education. I think that there are some really good points being made in this discussion and I'm glad we could get it back on track.

!Chris :specs:

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 30 years experience. 9 Articles; 4,338 Posts

Inappropriate self disclosure is probably my biggest complaint but one of the cherries on top was a colleague's student who didn't have the insight to know a knee length flowy dress sans nylons (or heck even with nylons) and strappy flats are totally inappropriate on a locked unit with known sex offenders who also happen to be psychotic. That was the first and last student my friend precepted from that school.

Thanks for that LOL moment! This thread sure needs some levity. There's a running joke around here about certain nurses who move away from wearing scrubs to knee high leather boots paired with short skirts and nice blouses which could mean they either got a management gig or have become NP's.

shibaowner

shibaowner, MSN, RN, NP

Has 1 years experience. 3 Articles; 583 Posts

As usual I think that BostonFNP is right on target, programs that don't or can't secure sits for their students are sending a message that tuition dollars are valued above the quality of their students education . . . I am taking about these issues now because I really would like to be a part of the solution in improving NP education. I think that there are some really good points being made in this discussion and I'm glad we could get it back on track.

!Chris :specs:

The best way to be part of the solution is to go to a school that provides preceptors and clinical sites. If potential students only applied to such schools, the free market would drive the less reputable schools out of business. The best approach is for the nursing community to educate potential NP students and warn them away from such schools.

shibaowner

shibaowner, MSN, RN, NP

Has 1 years experience. 3 Articles; 583 Posts

In terms of schools providing preceptors, even for a top school like Hopkins, preceptors are hard to come by. While Hopkins finds preceptors and clinical sites for everyone, the school also asks students to help find more preceptors by asking NPs, MDs, DOs, and PAs if they would like to precept. As an NP community, we can help recruit preceptors for the reputable schools. Even as an NP student, I was proactive in finding new preceptors when I was on a rotation in a large facility ( I got an NP and an MD preceptors for subsequent cohorts and I was just a student!). NP students - do a great job on your clinicals and that is the best way to get other healthcare providers at your clinical site to precept additional students.

lwsoccjs

lwsoccjs

Specializes in Neurology, Psychology, Family medicine. Has 5 years experience. 185 Posts

I still lol whenever I see a statement that is short sided like the residency idea. Yeah, it's a good idea but how do you suppose we make it efficient for the thousands of graduating students. Some easy math. There are approximately 350 NP programs in the USA according to AANP. Of course, more schools will continue to pop up as the credentialing obviously is not very rigorous. Let's say on the small side each program accepts 30 students per cohort. That is 10,500 student every year graduating. This does not include programs that accept many more or the programs that have rolling admissions. Each residency accepts between 1-5 students give or take. This allows a possible 1:100 chance of getting one at best. Residency is not going to save the current model we have.

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 30 years experience. 9 Articles; 4,338 Posts

It's a matter of finding a source of funding. GME programs for physicians are largely publicly funded by CMS. Our university/medical center has secured funding for post-graduate training for NP's in primary care in the past and we currently have a 1-year Adult Critical Care and Surgical fellowship for AGACNP's with 2 fellows accepted each year going on it's third year now. That's the available funding the university is able to currently secure. It currently attracts a good amount of applicants but one of the downsides of such program is that the monthly stipend does not come close to what a nurse in the Bay Area can potentially make in a month. That in itself, dissuades potential talented candidates.

shibaowner

shibaowner, MSN, RN, NP

Has 1 years experience. 3 Articles; 583 Posts

I still lol whenever I see a statement that is short sided like the residency idea. Yeah, it's a good idea but how do you suppose we make it efficient for the thousands of graduating students. Some easy math. There are approximately 350 NP programs in the USA according to AANP. Of course, more schools will continue to pop up as the credentialing obviously is not very rigorous. Let's say on the small side each program accepts 30 students per cohort. That is 10,500 student every year graduating. This does not include programs that accept many more or the programs that have rolling admissions. Each residency accepts between 1-5 students give or take. This allows a possible 1:100 chance of getting one at best. Residency is not going to save the current model we have.

I don't care how many NP schools there are. The crap graduates will not get hired. If there are too many NP schools, there will not be enough preceptors, so the crap schools won't get preceptors - no preceptors means no clinicals - no clinicals means students will not become NPs. Sometimes, doing nothing is the solution! We have a (somewhat free) market economy - supply and demand. If there are too many NP new grads, only the best will be hired. As other posters have indicated, there is funding enough for all the MD internships and residencies. If we can get funding for NP residences, these programs will increase. There is a glut of lawyers right now, but I doubt the new grad law students from schools like Harvard, Yale, Stanford, UCLA, etc have trouble finding jobs!

cjcsoon2bnp, MSN, RN, NP

Specializes in Emergency Nursing. 8 Articles; 1,156 Posts

I don't care how many NP schools there are. The crap graduates will not get hired. If there are too many NP schools, there will not be enough preceptors, so the crap schools won't get preceptors - no preceptors means no clinicals - no clinicals means students will not become NPs. Sometimes, doing nothing is the solution! We have a (somewhat free) market economy - supply and demand. If there are too many NP new grads, only the best will be hired. As other posters have indicated, there is funding enough for all the MD internships and residencies. If we can get funding for NP residences, these programs will increase. There is a glut of lawyers right now, but I doubt the new grad law students from schools like Harvard, Yale, Stanford, UCLA, etc have trouble finding jobs!

I understand the the idea of supply/demand and the concept that quality programs will produce quality graduates and only quality graduates will get jobs. However, I can't seem to get past my personal experience of seeing recently hired NPs in my faculty being poorly prepared to start in the role that they are hired for (Community ED/ER) and it is creating a preference for hiring PAs instead of NPs because it is felt that the PAs are better prepared. I think that when offices/facilities have a bad experience with a new provider because they feel like they are not well educated or prepared for their role then they tend to be quick to generalize the program where the person graduated and if it becomes a pattern then the entire profession gets blamed. The recent NP hires have come from schools with good/strong reputations, some havinf previous RN experience while others were accelerated/direct entry and they all seem equally unprepared for the role even as a novice practitioner.

I will openly acknowledge that this is only my personal experience and does not constitute as concrete evidence for anything. It is merely a single pattern in one facility, in one part of the country.

!Chris :specs: