PharmD to NP

[MidwestPAC]

I did a associates program initially, which was very expensive and direct entry. 60 students started, and 7 graduated on time. That’s the extreme of the failure rates. As a whole, about half of people who start the path to nursing fail.

You stated graduated "on time" so then the other 53 must have graduated. Nursing is like Physical Therapy Assistant or Dental Assisting, people apply and they let all these people in so they can get their money, but really don't weed them out so yes the failure rate is higher for the allied health careers, again PA school is not like this and I know that FNP is not like this cause they let you take your test without a proctoring system so everyone passes.

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[FiremedicMike]

Wow dude, you need to tone it down a bit.

For what it's worth, not all RN/NP programs are created equal. As an example the RN program I'm interested in requires full blown cadaver lab a&p..

 

[MidwestPAC]

Wow dude, you need to tone it down a bit.

For what it's worth, not all RN/NP programs are created equal. As an example the RN program I'm interested in requires full blown cadaver lab a&p..

That is the issue with RN and NP programs, not consistent. Your RN program "requires" cadaver lab only....I hardly doubt that...show proof buddy.

 

[FiremedicMike]

That is the issue with RN and NP programs, not consistent. Your RN program "requires" cadaver lab only....I hardly doubt that...show proof buddy.

Yeah, I'm not going to copy and paste the email from the admissions office where I asked if I could take the combined a&p course which uses prosection and relates it back to medical issues and they said no, so you're just going to have to take my word for it (or don't, I really have nothing to prove here)

I also don't respond well to condescension over the internet. Maybe you should take a few hours (or weeks) vacation from this thread and come back when you've chilled out a bit.

 

[MidwestPAC]

Yeah, I'm not going to copy and paste the email from the admissions office where I asked if I could take the combined a&p course which uses prosection and relates it back to medical issues and they said no, so you're just going to have to take my word for it (or don't, I really have nothing to prove here)

I also don't respond well to condescension over the internet. Maybe you should take a few hours (or weeks) vacation from this thread and come back when you've chilled out a bit.

I was not asking for the email, just the program where it states that it has to be a cadaver lab on the website. Maybe look up the word prosection first before you state your school states you cannot use it. It looks like they want to you split the A&P classes up which I agree with. A&P 1/2 is much easier then separate A&P. Anyways if you can't show proof that is fine, we understand why. Good luck to you!

 

[FiremedicMike]

I was not asking for the email, just the program where it states that it has to be a cadaver lab on the website. Maybe look up the word prosection first before you state your school states you cannot use it. It looks like they want to you split the A&P classes up which I agree with. A&P 1/2 is much easier then separate A&P. Anyways if you can't show proof that is fine, we understand why. Good luck to you!

You've made your closed-mindedness abundantly clear. I'm not sharing the college because you'll find some other reason to tear me down, so it's really not worth my effort. You can google programs that require anatomy and physiology if you like, I'm sure my school isn't the only one.

You are unable to even consider the fact that there are RN and NP programs that have different requirements than what you believe. You enter this thread insisting that no one here understands the intricacies of pre-PA coursework like you, because we didn't go to PA school. In the same breath, you insist you intimately understand the intricacies of pre-RN and pre-NP coursework, even though you didn't take that pathway.

Give it a rest, your credibility in this thread is blown.

As a side note, I know what prosection is. The courses available at my school are combined a&p 1/2 which utilizes prosection and I am unable to take it in place of the full blown cadaver lab split anatomy and physiology classes that are also offered at my school.

 

[MidwestPAC]

You've made your closed-mindedness abundantly clear. I'm not sharing the college because you'll find some other reason to tear me down, so it's really not worth my effort. You can google programs that require anatomy and physiology if you like, I'm sure my school isn't the only one.

You are unable to even consider the fact that there are RN and NP programs that have different requirements than what you believe. You enter this thread insisting that no one here understands the intricacies of pre-PA coursework like you, because we didn't go to PA school. In the same breath, you insist you intimately understand the intricacies of pre-RN and pre-NP coursework, even though you didn't take that pathway.

Give it a rest, your credibility in this thread is blown.

As a side note, I know what prosection is. The courses available at my school are combined a&p 1/2 which utilizes prosection and I am unable to take it in place of the full blown cadaver lab split anatomy and physiology classes that are also offered at my school.

Huh? Why would I google nursing programs that require anatomy and physiology as all nursing programs require this. I think you are lost in the difference of A&P and "full blown cadaver lab." As my post above states and you stated and I quote: Wow dude, you need to tone it down a bit. For what it's worth, not all RN/NP programs are created equal. As an example the RN program I'm interested in requires full blown cadaver lab a&p.."
I stated: Your RN program "requires" cadaver lab only....I hardly doubt that...show proof buddy.
There is not way that your RN program requires a cadaver lab is what was being discussed, NOT A&P course. You don't have the differences down yet, but you will understand once to take these courses.

I completely understand that all programs in nursing have different requirements that is why I stated above: That is the issue with RN and NP programs, not consistent. I know a lot about RN and FNP school because my wife went through those programs and I watched her go through all the stuff she had to go through. I quizzed her, studied with her, read her theory papers, answered questions for her, taught her, etc. Just like pre-PA and PA school, its not rocket science and you could understand it to if you read online about it and listened to people in the field. Please quit getting butt hurt over things that you are making a mistake on, it will happen to you throughout your career and it happens to myself as well. WE all cannot know everything, just live and learn. Good luck to you!

 

[762513]

That is the issue with RN and NP programs, not consistent. Your RN program "requires" cadaver lab only....I hardly doubt that...show proof buddy.

You know, instead of starting a flame war with your "first" post ever post on SDN, you could just drop it and we could help the OP with their question on going from PharmD to NP.

 

[FiremedicMike]

Huh? Why would I google nursing programs that require anatomy and physiology as all nursing programs require this. I think you are lost in the difference of A&P and "full blown cadaver lab." As my post above states and you stated and I quote: Wow dude, you need to tone it down a bit. For what it's worth, not all RN/NP programs are created equal. As an example the RN program I'm interested in requires full blown cadaver lab a&p.."
I stated: Your RN program "requires" cadaver lab only....I hardly doubt that...show proof buddy.
There is not way that your RN program requires a cadaver lab is what was being discussed, NOT A&P course. You don't have the differences down yet, but you will understand once to take these courses.

I completely understand that all programs in nursing have different requirements that is why I stated above: That is the issue with RN and NP programs, not consistent. I know a lot about RN and FNP school because my wife went through those programs and I watched her go through all the stuff she had to go through. I quizzed her, studied with her, read her theory papers, answered questions for her, taught her, etc. Just like pre-PA and PA school, its not rocket science and you could understand it to if you read online about it and listened to people in the field. Please quit getting butt hurt over things that you are making a mistake on, it will happen to you throughout your career and it happens to myself as well. WE all cannot know everything, just live and learn. Good luck to you!

My school offers Bio 1121 and Bio 1122 which are anatomy and physiology 1 and 2 and utilize prosected cadavers with the curriculum related back to disease processes
My school also offers Bio 2300 anatomy - which is gross anatomy and full cadaver dissection and Bio 2301 physiology which is obviously physiology.

The RN program that I will likely be attending requires Bio 2300 and Bio 2301 and will not accept 1121/1122 instead.

I used short hand in describing those courses because I was certain we didn't need to spend half a day and 10 posts discussing the nuances of a&p.

Stop acting like you're the only one here who knows anything.

As a side note, I do find it interesting that you are so strenuously arguing anatomy and physiology. It took me down a quick refresher track on the pre-PA route, which seems to be (as far as I can tell) the only route that requires anatomy and physiology and then immediately tosses you back into gross anatomy at the beginning of PA school. What an inefficient use of time.

 

[762513]

My school offers Bio 1121 and Bio 1122 which are anatomy and physiology 1 and 2 and utilize prosected cadavers with the curriculum related back to disease processes
My school also offers Bio 2300 anatomy - which is gross anatomy and full cadaver dissection and Bio 2301 physiology which is obviously physiology.

The RN program that I will likely be attending requires Bio 2300 and Bio 2301 and will not accept 1121/1122 instead.

I used short hand in describing those courses because I was certain we didn't need to spend half a day and 10 posts discussing the nuances of a&p.

Stop acting like you're the only one here who knows anything.

As a side note, I do find it interesting that you are so strenuously arguing anatomy and physiology. It took me down a quick refresher track on the pre-PA route, which seems to be (as far as I can tell) the only route that requires anatomy and physiology and then immediately tosses you back into gross anatomy at the beginning of PA school. What an inefficient use of time.

Hey man I suggest you give it up with this guy, he doesn't debate honestly I think he's actually a troll. Good luck on your own decisions regarding nursing, let the nurses here know if you run into any snags or questions, and ignore advice from people who aren't qualified to give it. Good luck sir

 

[Splenda88]

I did a associates program initially, which was very expensive and direct entry. 60 students started, and 7 graduated on time. That’s the extreme of the failure rates. As a whole, about half of people who start the path to nursing fail.

Some states have stand alone nursing schools in every corner like 7 eleven. Again, it's not about you; it's about a whole profession that is not policing itself.

 

[762513]

Some states have stand alone nursing schools in every corner like 7 eleven. Again, it's not about you; it's about a whole profession that is not policing itself.

Seems unlikely. In my state, you can get into the expensive school pretty easily, but it'll cost you 60k for an associates degree, and the failure rate is very, very high. As I said we started 60 in my cohort, only 7 graduated on time, and about 40 of the 60 failed the program. The public universities have petition systems and waiting lists that can last a few years. Once you finish your pre-reqs you petition for the program, and then get put on a list to wait for a spot to open.

 

[pamac]

Some states have stand alone nursing schools in every corner like 7 eleven. Again, it's not about you; it's about a whole profession that is not policing itself.

Go see how many PA programs are in Pennsylvania. I believe there are 23. I don’t know if that’s pertinent to the conversation because I haven’t been following it much today, but it’s the future.

 

[MidwestPAC]

Go see how many PA programs are in Pennsylvania. I believe there are 23. I don’t know if that’s pertinent to the conversation because I haven’t been following it much today, but it’s the future.

Yes it is crazy how many PA schools are in that state. The difference is all those schools require higher GPAs, GRE (not all), HCE, same pre-reqs as other PA schools, interview and highly competitive admissions. Your statement is correct, but also you need to finish your statement because you are implying just because there are a lot of PA schools in one area then it must mean those schools are easier to get into. That is what Splenda88 is stating about nursing programs, they are everywhere and you just meet the minimum requirements and you are in. Please stop comparing a masters level education to an associate or bachelors level. They are not the same.

 

[pamac]

So you didn’t read the third sentence of my statement there....

It’s actually pretty hard to get into nursing school. Ever tried to do it? It’s not “midlevel” anyway, so obviously it wouldn’t have to be as hard to get in to. Oh, and we already established that there is a lot of variability between PA schools on entrance requirements. And certainly for HcE. That’s not really a big thing for most PA schools now. Used to be their bread and butter. Not so much anymore. If you go become a CNA for a few months , you’ll have more than enough HcE for so many schools.

A big difference between NP school and PA school has to do with the fact that so many Pa school students have little or no HCE before hand. You could be sitting next to the English major who went back and got prereqs done so they could become a PA. Happens all the time. Far cry from back when they recruited mostly from your seasoned health care professionals with stellar HCE. Not a bad thing, just how it is now.

 

[MidwestPAC]

So you didn’t read the third sentence of my statement there....

It’s actually pretty hard to get into nursing school. Ever tried to do it? It’s not “midlevel” anyway, so obviously it wouldn’t have to be as hard to get in to. Oh, and we already established that there is a lot of variability between PA schools on entrance requirements. And certainly for HcE. That’s not really a big thing for most PA schools now. Used to be their bread and butter. Not so much anymore. If you go become a CNA for a few months , you’ll have more than enough HcE for so many schools.

A big difference between NP school and PA school has to do with the fact that so many Pa school students have little or no HCE before hand. You could be sitting next to the English major who went back and got prereqs done so they could become a PA. Happens all the time. Far cry from back when they recruited mostly from your seasoned health care professionals with stellar HCE. Not a bad thing, just how it is now.

Most PA schools require good HCE, but there are a lot of schools (new ones) that are requiring less HCE (2,000 hrs etc, some even 500 HCE of entry level stuff). I agree that there are PA schools out there with these requirements, but you still got to get good grades and go through a full time 100 weeks or more of 50 hrs+ per week of training. I think that English major (still has to have all the pre-reqs) having a very intense didactic and 2,500+ hrs of rotations in various specialties will have a big jump on most NPs coming out of school.

Every single NP that I know or work with (including my wife) had very little nursing experience prior to NP school, meet the minimum requirements, had NO interview, just was accepted for the next year. Went to school PART-TIME while working as a nurse so you cannot tell me that nursing experience (floor nursing, ICU, outpatient, L&D, etc) is going to prepare you better than a PA student to be a provider. Yes, that English major doesn't know the entire flow of a floor, but that is why we do 2,500+ hrs of rotations to learn this and that is not that hard to figure out in 1 week. That is where most of you nurses state set you apart from us, but is it really that big of a deal to learn that while on rotations? I don't think so cause that is not what sets the foundation as a provider, it is your attitude, wiliness to learn, and your training.

No, I was not a nurse prior to PA school, I was an RT with 10,000+ hours of HCE in a level 1 trauma center. When my wife went to nursing school (and she went to one of the best nursing programs in the state and a BSN program affiliated with one of the best medical schools in the world) she had no trouble getting in. It was quite easy, again, get the pre-reqs, meet the minimum requirement and your in. I don't see why you keep saying it is so hard to get in, cause I have 20+ friends that are nurses and they all got in 1st try most without an interview or anything.

 

[762513]

Most PA schools require good HCE, but there are a lot of schools (new ones) that are requiring less HCE (2,000 hrs etc, some even 500 HCE of entry level stuff). I agree that there are PA schools out there with these requirements, but you still got to get good grades and go through a full time 100 weeks or more of 50 hrs+ per week of training. I think that English major (still has to have all the pre-reqs) having a very intense didactic and 2,500+ hrs of rotations in various specialties will have a big jump on most NPs coming out of school.

Every single NP that I know or work with (including my wife) had very little nursing experience prior to NP school, meet the minimum requirements, had NO interview, just was accepted for the next year. Went to school PART-TIME while working as a nurse so you cannot tell me that nursing experience (floor nursing, ICU, outpatient, L&D, etc) is going to prepare you better than a PA student to be a provider. Yes, that English major doesn't know the entire flow of a floor, but that is why we do 2,500+ hrs of rotations to learn this and that is not that hard to figure out in 1 week. That is where most of you nurses state set you apart from us, but is it really that big of a deal to learn that while on rotations? I don't think so cause that is not what sets the foundation as a provider, it is your attitude, wiliness to learn, and your training.

No, I was not a nurse prior to PA school, I was an RT with 10,000+ hours of HCE in a level 1 trauma center. When my wife went to nursing school (and she went to one of the best nursing programs in the state and a BSN program affiliated with one of the best medical schools in the world) she had no trouble getting in. It was quite easy, again, get the pre-reqs, meet the minimum requirement and your in. I don't see why you keep saying it is so hard to get in, cause I have 20+ friends that are nurses and they all got in 1st try most without an interview or anything.

1: it takes a significant amount of time to learn how to integrate into a healthcare system. 1 week? More like a couple months, which isn't a big deal, but let's just stop trolling please.

2: I taught nursing at the university level. If you're wife got in with no problems then you are lucky or she was a very competitive candidate. You're just completely wrong in your statement, waiting lists and petitions can take years.

 

[pamac]

My ADN nursing program over 800 applicants for 38 seats. Plenty of folks don’t get in. Most programs have a hefty list of folks that didn’t make the cut. I’m really surprised that you suggest that nursing programs have seats for everyone.

I’m really surprised that ALL the nurses you know who become NPs had almost NO nursing experience before NP school, mostly because I don’t know any nurses who apply to NP school with no nursing experience. I don’t know how to square that. But in any event, a 3 year part time NP program will mean even a student with no experience will have... 3 years of great experience as an RN behind them when they start as an NP. It’s handy to have that kind of immersion. I know I appreciated doing school and then working in the field at the same time. Didn’t think much of it at the time, but now I look back and see the value of that.

 

[762513]

My ADN nursing program over 800 applicants for 38 seats. Plenty of folks don’t get in. Most programs have a hefty list of folks that didn’t make the cut. I’m really surprised that you suggest that nursing programs have seats for everyone.

I’m really surprised that ALL the nurses you know who become NPs had almost NO nursing experience before NP school, mostly because I don’t know any nurses who apply to NP school with no nursing experience. I don’t know how to square that. But in any event, a 3 year part time NP program will mean even a student with no experience will have... 3 years of great experience as an RN behind them when they start as an NP. It’s handy to have that kind of immersion. I know I appreciated doing school and then working in the field at the same time. Didn’t think much of it at the time, but now I look back and see the value of that.

Guy is a troll.

 

[MidwestPAC]

Guy is a troll.

Give it a rest man. You are sad to hear the truth and then try to degrade me, but we can all see through it. People do not know what they do not know. That goes with all professions, but I can see this is very true in the NP world as I live with one. She admits daily that she doesn't know nearly as much as I do and wishes her training was a lot better than what she got. It is very frustrating to her and she lets me know it. This is the same as myself when comparing myself to a physician.

Nursing experience is great just like my RT experience, but overall I hardly use much of it until I see an asthmatic or COPDer. If I was working in the ICU or ER it would help, but that is just the scratch of the surface when you are a provider. I agree the assessment skills are a HUGE plus, but learning to put in a foley or draw blood or run a pump doesn't help you clinically when you are dealing with a COPDer with DMII, A-fib, HTN, Hx of CVA, MI with CABG x 3, RA, bilateral OA of knees with left knee TKR and on a list of medications for RA, anti-coag for a-fib, insulin for DMII, inhalers and blood pressure medications. Me knowing the in and outs of all the inhalers and ventilators and bipaps are truly not going to help me manage this guy inpatient or even outpatient. The nurses that run pumps or know how the doctor likes his orders or how to get shots will not clinically help you with his guy. Knowing advanced pathophysiology, pharmacology, clinical medicine is what makes you have the knowledge to help this patient. This is where my wives NP school did a terrible job. Her patho and pharm classes were 1 semester, went over about 50% of what I learned in school and her test were all online. This is where your nursing experience means nothing to a PA as I have seen it first hand that she lacks a lot on just basic management of DMII, HTN, A-fib (and she worked on the cardiac floor/telemetry floor at the hospital, level 1 trauma center) and she still lacks basic knowledge of the disease process which is key to management. This is not even touching on the lack of curriculum or depth in NP school on laboratory/radiology interpretation, casting/suturing/biopsy labs, prostate/vaginal/breast exams (on real people), etc. There are so many fundamental things that I saw my wife not be able to experience or learn that it is really sad. She had a suture lab (online) and nothing else I listed above. They were told they learn that in rotations (700 hours of rotations) and she only rotated in family practice settings (with other NPs only) or minute clinics. She had no other rotations required. In my PA program I did 6 months of family medicine rotations, 5 weeks of ICU, 1 1/2 months of psych, 1 1/2 months of OB/GYN, 4 weeks of hospitalist rotations, 4 weeks of general surgery, 4 weeks of ER, 2 weeks of urgent care, 1 week of ophthalmology where I spent anywhere from 9 hours (outpatient rotations x 5 days a weeks) to 18 hour days (surgery). I rotated with other PA students, medicine students, residents, and fellows.

 

[pamac]

One and a half months of psyche! Wow! That’s a lot! You seem to have gotten the sampler platter of medical experience just like a little doctor.

It doesn’t surprise me that your RT experience helped you only with RT related issues.

PAs are well trained. I’m not disputing that. I’m actually a proponent of PAs. It’s not really my thing to crap on their skill set.

 

[MidwestPAC]

One and a half months of psyche! Wow! That’s a lot! You seem to have gotten the sampler platter of medical experience just like a little doctor.

It doesn’t surprise me that your RT experience helped you only with RT related issues.

PAs are well trained. I’m not disputing that. I’m actually a proponent of PAs. It’s not really my thing to crap on their skill set.

That would go be the same for nursing. The RNs experience would only help them with his/her experience, such as working on L&D, step down unit, cardiac ICU, how do those help you if you work in family medicine or urgent care, etc? Very limited scope one would learn as a nurse that would be hard to translate it over to an FNP. Now if you worked in pysch and then became a PMHNP then that would be helpful.

I did at least 9 hours per day x 5 days = 45 hrs x 6 weeks = 270 hours of pysch rotations for someone NOT going into pysch (if you want to then you get experience and take the CAQ for pysch as a PA or go to a pysch residency + CAQ).

Here is Dukes PMHNP: https://nursing.duke.edu/sites/default/files/new_msn_curriculum_requirements_pmhnp.pdf
616 clinical hours which I got about half of the clinical rotations in pysch as a PMHNP....

My wife, as a FNP, got ZERO pysch hours, but she is suppose to be a family NP? She worked on a cardiac floor as a nurse, how does she help anyone with psych issues in family medicine when she was not trained? This is the major issue, do you not see it?

 

[pamac]

So an RN working in the ER, or med surg, or ICU is so narrowly scoped that the experience there wouldn’t help with family practice? Meh. If you say so. You’ve never done it. Go ahead and put together a reply reminding us of your NP wife, blah blah. I’d suggest that you also probably refer out psyche issues as well if you don’t feel confident in your sparse amount of training in it.

Meanwhile, NPs gain independence in a couple states each year. We do just fine in our work. Our outcomes are great. I’m sorry that mystifies you.

 

[Stagg737]

I live in Arizona so my state allows for full autonomy which is great. Funny enough I was looking at psych, not necessarily for the money (though that sounds nice), but because I think it would be fulfilling to me. I wanted to be a psychiatrist originally, but I let my fear of physics get in my way(should have gone to community college); my college professor was a terrible teacher. I like your idea of getting it done in 3 years, but I don't see any "cheap" ABSN in Arizona. What would you say is cheap?

I'm not trying to crap on any professions, but please do not go the psych NP route is you're not going to be supervised. Too large of a percentage of my patients that I see come in because they're on some horrible plan and almost all of them come from psych NPs in the area. Some of the med lists I've seen I couldn't even begin to think up on my own...

I really like Psyche. You sit down and talk to people all day about their meds.

If this is what you think psych is then you're doing it very, very wrong.

Wow dude, you need to tone it down a bit.

For what it's worth, not all RN/NP programs are created equal. As an example the RN program I'm interested in requires full blown cadaver lab a&p..

And this is the emerging problem in the field. There are now programs which require no previous clinical experience, are completely online, and have 100% acceptance rates for NPs. The direction the field is heading in is legitimately terrifying and tbh a new Flexner Report needs to be done for these programs.

Seems unlikely. In my state, you can get into the expensive school pretty easily, but it'll cost you 60k for an associates degree, and the failure rate is very, very high. As I said we started 60 in my cohort, only 7 graduated on time, and about 40 of the 60 failed the program. The public universities have petition systems and waiting lists that can last a few years. Once you finish your pre-reqs you petition for the program, and then get put on a list to wait for a spot to open.

Do you not see the glaringly obvious problem with this kind of model? This is basically what Caribbean schools do on the MD side....

I’m really surprised that ALL the nurses you know who become NPs had almost NO nursing experience before NP school, mostly because I don’t know any nurses who apply to NP school with no nursing experience.

I know more than I'd care to admit as well, some of whom have a TOTAL of 500 clinical hours before practicing independently. Some of the questions they've asked me legitimately made me want to go to their clinics and tell patients to run.

So an RN working in the ER, or med surg, or ICU is so narrowly scoped that the experience there wouldn’t help with family practice? Meh. If you say so. You’ve never done it. Go ahead and put together a reply reminding us of your NP wife, blah blah. I’d suggest that you also probably refer out psyche issues as well if you don’t feel confident in your sparse amount of training in it.

Meanwhile, NPs gain independence in a couple states each year. We do just fine in our work. Our outcomes are great. I’m sorry that mystifies you.

The bolded is absolutely true. Same thing goes for physicians in those settings. I would not want my PCP to be a critical care physician and I wouldn't want my ICU doc to be an outpatient FM as they are completely different worlds. I've had to explain more than once to an ICU nursing team why a patient was on a certain treatment plan because they "would never do that in the ICU!!!" when it's the standard of care as outpatients. I have actually had to pull up UpToDate before because they refused to believe me and were flabbergasted to find out that the almighty ICU team was wrong. For some reason a lot of ICU nurses get big heads that they know everything because they're treating critically ill patients, when in reality they may be very good at what they do but very, very bad as soon as you move them out of an acute setting.

Given the crap treatment plans I see all the time, I'd love to see more clinicians referring psych issues to me so we can at least get them started in the right direction.

 

[MidwestPAC]

So an RN working in the ER, or med surg, or ICU is so narrowly scoped that the experience there wouldn’t help with family practice? Meh. If you say so. You’ve never done it. Go ahead and put together a reply reminding us of your NP wife, blah blah. I’d suggest that you also probably refer out psyche issues as well if you don’t feel confident in your sparse amount of training in it.

Meanwhile, NPs gain independence in a couple states each year. We do just fine in our work. Our outcomes are great. I’m sorry that mystifies you.

How does that help you with DMII management or RA or PMR or a felon or SCC or foreign body in eye and the list goes on...I am saying this because YOU insist that NPs do not need the same amount of clinical training as a PA because they have nurse experience. You are totally missing the point and I think you might be doing that on purpose....? I do keep reminding you about my wife because I see the severe lack of education she has gotten and it pisses her off daily as she is playing catch up. I could not image if I was not in the medical field, she would be screwed. Again, you don't know what you don't know. That is so true in my wife's training. Why would I refer psych issue out if I had training. Again, I did 6 months of family medicine rotations in a rural health clinic and saw ~30-40% psych so if I calculated those hours I would for sure be ahead of the 616 hrs Duke requires for the PMHNP. I did 1,100 hours of family medicine rotations and even if 1/3 had psych issues (which is more than that in my own practice) that would be 363 clinical hours + 270 clinical psych hours = 633 clinical hours in psych. I would not call that inferior to PMHNP training.

So you suggest all psych care in family/internal medicine be referred out when there is already a shortage of psych providers? What about other specialties such as neuro or derm or endo? Can I not do a punch biopsy or cryotherapy or Rx insulin causes I don't work in derm or endo.?

The BON is powerful and has lots of money, that is why you have "independence" which truly is not completely independent based on prescribing authority and other things such as hospice, etc.

You say your outcomes are great, but have zero proof of that except proof from research done by other DNPs or nursing lobby powers. That would be like Marlboro doing research stating that smoking is "not that bad" based off their outcomes and research.

 

[pamac]

Then get a sociology department to conduct a study to see if NPs are as bad as you suggest. Not that hard to do. Universities conduct research on everything under the sun. Surely if NPs are tarnishing the landscape, this should be on the forefront to protect the public.

And Stagg737.... N=1... for all that’s worth. Maybe I should mention the perceptions I have about some psychiatrists and have that treated as gospel here.

And what’s with the hyperbole of suggesting that my entire approach to psychiatric treatment is wrapped up in the statement “I like psyche. You get to sit down and talk to people about their meds.”? How delightfully condescending of you. What other gems of loaded advice do you have?

 

[FiremedicMike]

And this is the emerging problem in the field. There are now programs which require no previous clinical experience, are completely online, and have 100% acceptance rates for NPs. The direction the field is heading in is legitimately terrifying and tbh a new Flexner Report needs to be done for these programs.

I don't disagree with you, but it seems that every single NP thread quickly devolves into "NP programs are only 500 hours of clinical and 2 hours per month of online school" and then paint all NP programs with that broad brush, ignoring the fact that there are many quality NP programs out there cranking out (gasp) quality NPs.

It just seems disingenuous.

 

[Stagg737]

Then get a sociology department to conduct a study to see if NPs are as bad as you suggest. Not that hard to do. Universities conduct research on everything under the sun. Surely if NPs are tarnishing the landscape, this should be on the forefront to protect the public.

And Stagg737.... N=1... for all that’s worth. Maybe I should mention the perceptions I have about some psychiatrists and have that treated as gospel here.

And what’s with the hyperbole of suggesting that my entire approach to psychiatric treatment is wrapped up in the statement “I like psyche. You get to sit down and talk to people about their meds.”? How delightfully condescending of you. What other gems of loaded advice do you have?

Your statement painted an entire field in a grossly oversimplified manner which is just bad practice (I'm sure I can guess what you're thinking, but I've explained my thoughts in depth). If that's not what you intended sorry, but words matter (especially in psych) and it is not hyperbole to take your statement at face value. My N is far greater than 1 (>thousands), so worth quite a bit, especially to my current state's legislature given a recent vote. I'll fully admit that there are also terrible psychiatrists out there, but allowing those with the experience equivalent to 3 months of med school to practice independently is not the answer (I know this does not apply to many NPs, but this is moving closer to being the norm).

It is at the forefront, but the problem is the extensive power of nursing lobbies like the AANP which are able to brush the problems under the rug with marketing campaigns and weak studies which show irrelevant measures of outcomes. This is on the forefront to protect the public, it's why many physician groups, including the AMA (finally), are starting to push back including presenting data to state legislatures to prevent irresponsible practice models.

Other advice I have is that if someone wants to treat someone independently they should go to medical school and learn both the foundational and depth of knowledge needed to appropriately treat patients without supervision. NPs and PAs are very important to the US medical system and I've been happy to work with quite a few who were fantastic. However, their role is not and never was meant to see patients independently, but to act as extenders for physicians to allow a team to see a larger volume of patients by seeing simple cases and checking them out or following up to ensure patients are still stable.

I don't disagree with you, but it seems that every single NP thread quickly devolves into "NP programs are only 500 hours of clinical and 2 hours per month of online school" and then paint all NP programs with that broad brush, ignoring the fact that there are many quality NP programs out there cranking out (gasp) quality NPs.

It just seems disingenuous.

There are good programs out there and I'd urge anyone pursuing the NP path to do some hard research into the programs they're applying to if they actually want to receive solid training. The problem is that online diploma mills are expanding rapidly with few checks in place to stop them and these are the programs with 100% acceptance rates that are completely online and provide no consistency with clinical training. The NPs I've encountered who came out of those programs legitimately terrify with the things they don't know. Especially because many of them are just looking for a short-cut to treat patients independently without receiving appropriate training.

As I said above, I've worked with some great NPs (typically older ones) who are just as dismayed with the direction the field is heading as many of the seemingly anti-NP physicians (some of whom truly are). Many of us aren't really anti-NP though, we just see the direction the field is heading in and are afraid for what it will mean for the future of healthcare. When I have patients telling me that their NP prescribed them Nystatin for their cholesterol or patients who are on 5 antidepressants at the same time with their psych NP trying to add another serotonergic med, things which would get a physician reported to their state BOM and possibly lose their license, it makes me wonder if these individuals were taught anything in their programs (and I can give far, far worse examples than these).

 

[FiremedicMike]

The problem is that online diploma mills are expanding rapidly with few checks in place to stop them and these are the programs with 100% acceptance rates that are completely online and provide no consistency with clinical training. The NPs I've encountered who came out of those programs legitimately terrify with the things they don't know. Especially because many of them are just looking for a short-cut to treat patients independently without receiving appropriate training.

When I have patients telling me that their NP prescribed them Nystatin for their cholesterol or patients who are on 5 antidepressants at the same time with their psych NP trying to add another serotonergic med, things which would get a physician reported to their state BOM and possibly lose their license, it makes me wonder if these individuals were taught anything in their programs (and I can give far, far worse examples than these).

But honestly, you're kinda doing it again. We're not comparing bottom tier NP programs with bottom tier MD/DO programs. We're also not comparing below average NPs to below average physicians. I'm not saying NP = MD, but the entire fallacy of these types of arguments is that it ignores the fact that there ARE crappy physicians who practice crappy medicine, and we've ALL seen it. Hell, pull up your states medical license disciplinary actions as a reminder of some of the stupid crap that some doctors pull..

I've also always found it interesting that folks here immediately disparage online/blended NP education right next to threads where folks are lamenting about mandatory attendance at medical school, wishing they could instead sit at home and self-study..

 

[MidwestPAC]

But honestly, you're kinda doing it again. We're not comparing bottom tier NP programs with bottom tier MD/DO programs. We're also not comparing below average NPs to below average physicians. I'm not saying NP = MD, but the entire fallacy of these types of arguments is that it ignores the fact that there ARE crappy physicians who practice crappy medicine, and we've ALL seen it. Hell, pull up your states medical license disciplinary actions as a reminder of some of the stupid crap that some doctors pull..

I've also always found it interesting that folks here immediately disparage online/blended NP education right next to threads where folks are lamenting about mandatory attendance at medical school, wishing they could instead sit at home and self-study..

Doctors doing crappy things has nothing to do with their training, it has more to do with their attitude/drive for money/ethics, morals etc. So your statement has no meaning to this conversation. We are discussing the training aspect not personal morals.

Yes, we talk about NP programs cause most of them are online or blended and have very limited clinical rotations. Find a school that requires more than 1,000 hours of training. Most are 500-700 hours, which could be completed in < 4 months of time (at 40 hours per week).

There is no standard in NP education, there are regional and national accreditation institutions putting out NPs, you will not see that in PA schools or US medical schools. Also, I find it weird there are two accrediting bodies for NPs, ANCC and AANP. Two different boards with two different credentials (FNP-BC vs FNP-C).

 

[762513]

Your statement painted an entire field in a grossly oversimplified manner which is just bad practice (I'm sure I can guess what you're thinking, but I've explained my thoughts in depth). If that's not what you intended sorry, but words matter (especially in psych) and it is not hyperbole to take your statement at face value. My N is far greater than 1 (>thousands), so worth quite a bit, especially to my current state's legislature given a recent vote. I'll fully admit that there are also terrible psychiatrists out there, but allowing those with the experience equivalent to 3 months of med school to practice independently is not the answer (I know this does not apply to many NPs, but this is moving closer to being the norm).

It is at the forefront, but the problem is the extensive power of nursing lobbies like the AANP which are able to brush the problems under the rug with marketing campaigns and weak studies which show irrelevant measures of outcomes. This is on the forefront to protect the public, it's why many physician groups, including the AMA (finally), are starting to push back including presenting data to state legislatures to prevent irresponsible practice models.

Other advice I have is that if someone wants to treat someone independently they should go to medical school and learn both the foundational and depth of knowledge needed to appropriately treat patients without supervision. NPs and PAs are very important to the US medical system and I've been happy to work with quite a few who were fantastic. However, their role is not and never was meant to see patients independently, but to act as extenders for physicians to allow a team to see a larger volume of patients by seeing simple cases and checking them out or following up to ensure patients are still stable.



There are good programs out there and I'd urge anyone pursuing the NP path to do some hard research into the programs they're applying to if they actually want to receive solid training. The problem is that online diploma mills are expanding rapidly with few checks in place to stop them and these are the programs with 100% acceptance rates that are completely online and provide no consistency with clinical training. The NPs I've encountered who came out of those programs legitimately terrify with the things they don't know. Especially because many of them are just looking for a short-cut to treat patients independently without receiving appropriate training.

As I said above, I've worked with some great NPs (typically older ones) who are just as dismayed with the direction the field is heading as many of the seemingly anti-NP physicians (some of whom truly are). Many of us aren't really anti-NP though, we just see the direction the field is heading in and are afraid for what it will mean for the future of healthcare. When I have patients telling me that their NP prescribed them Nystatin for their cholesterol or patients who are on 5 antidepressants at the same time with their psych NP trying to add another serotonergic med, things which would get a physician reported to their state BOM and possibly lose their license, it makes me wonder if these individuals were taught anything in their programs (and I can give far, far worse examples than these).

If you think NP’s aren’t providing safe care, for whatever reason, post some studies that show disparate outcomes and we’ll go over them together to see if it’s solid methodology.

 

[MidwestPAC]

If you think NP’s aren’t providing safe care, for whatever reason, post some studies that show disparate outcomes and we’ll go over them together to see if it’s solid methodology.

You don't need studies to show prove that NPs care is inferior. First, who is going to pay for it and second do you need studies to prove to you that a Honda will out last a Chevy? You look at the proof such as how many miles are on the car or how many cars are left on the road at a certain mark (i.e. 10 years after the car was built). It is called common sense, look at the lack of clinical hours, the diversity in training and that nursing experience does not really help with being a provider (in very limited cases such as if you work on L&D and become a mid wife or work on psych floor and become a psych NP, etc), but that still does not replace the extensive hours MDs/DOs/PAs put into their learning and rotations. I know myself as a PA that I am limited in my scope of practice due to my lack of learning all the basic sciences physicians learn and the 15,000 hours of training they get, but I think our training does prepare us to at least have our feet wet and function some day 1. You can ask physicians/PAs/NPs that have worked together and you can tell a BIG difference in a new graduate PA vs a NP. There is a MASSIVE learning curve for that NP and a learning curve for the PA, but not as bad of one. I live with a NP that has been out 1 year and she still lacks a lot of information I knew from day one of graduating. I have worked with several NPs in practice and urgent cares, there is a lack of understand on certain topics that were not learned in school/rotations (with other NPs). At least PAs rotate with physicians and not like NPs where they want you to rotate with another NP. My wife never rotated ONCE with a physician. That is a disservice to the NPs. And don't get me started on NPs schools won't let the NPs rotate with PAs, but NPs will tell you that they would be happy to precept a PA student.

 

[Stagg737]

But honestly, you're kinda doing it again. We're not comparing bottom tier NP programs with bottom tier MD/DO programs. We're also not comparing below average NPs to below average physicians. I'm not saying NP = MD, but the entire fallacy of these types of arguments is that it ignores the fact that there ARE crappy physicians who practice crappy medicine, and we've ALL seen it. Hell, pull up your states medical license disciplinary actions as a reminder of some of the stupid crap that some doctors pull..

I've also always found it interesting that folks here immediately disparage online/blended NP education right next to threads where folks are lamenting about mandatory attendance at medical school, wishing they could instead sit at home and self-study..

Your first paragraph is shifting the goal posts, since you brought it up though the BON in most states is a joke, especially when it comes to disciplining NPs. I have numerous colleagues who have reported offenses to BONs only to find out the NP got a written warning to be more careful with their practices whereas a BOM would have suspended and possible taken the license from a physician. So if you want to make that argument, the number of physicians who are practicing in a dangerous manner is far less than that of NPs. This is something I hear from MD and NP colleagues alike.

To the bolded, that's a somewhat fair arguement (which I think is crap from med students btw), but the differences are in the extent of knowledge learned in those didactics as well as the rigor of the clinical experiences. I'm currently working with an NP (supervised, thank god) who had 3 months of nursing experience before starting her NP and then only had to do 600 clinical hours to complete her NP degree. That's literally about 2 months of residency for me. When their previous education was all online, many are basically walking into clinical experiences with no idea what they're doing, and oftentimes they're basically shadowing 1-2 days/week and then leaving (true of all the NP students I've encountered except 1). Meanwhile, med students go through about 5,000 clinical hours before even starting residency, and then another 10,000-15,000 in residency depending on the field. It legitimately blows my mind that some NPs think they're ready to practice independently right out of the gate and many I've talked to realized that mistake very quickly.

If you think NP’s aren’t providing safe care, for whatever reason, post some studies that show disparate outcomes and we’ll go over them together to see if it’s solid methodology.

I've read somewhere in the neighborhood of 50 studies which compare outcomes and I've only read 2 that I thought was conducted and interpreted decently, but it compared NPs to residents (which is dumb because residents don't practice independently) and another that was done decently but was far too short-term to actually show anything meaningful (looked at A1C in diabetics over the course of a single year). Since those studies haven't been bothered to be conducted by anyone other than the AANP and nursing groups, I'll let you post any of them and I'll tear them apart.

 

[Stagg737]

But honestly, you're kinda doing it again. We're not comparing bottom tier NP programs with bottom tier MD/DO programs. We're also not comparing below average NPs to below average physicians. I'm not saying NP = MD, but the entire fallacy of these types of arguments is that it ignores the fact that there ARE crappy physicians who practice crappy medicine, and we've ALL seen it. Hell, pull up your states medical license disciplinary actions as a reminder of some of the stupid crap that some doctors pull..

I've also always found it interesting that folks here immediately disparage online/blended NP education right next to threads where folks are lamenting about mandatory attendance at medical school, wishing they could instead sit at home and self-study..

Your first paragraph is shifting the goal posts, since you brought it up though the BON in most states is a joke, especially when it comes to disciplining NPs. I have numerous colleagues who have reported offenses to BONs only to find out the NP got a written warning to be more careful with their practices whereas a BOM would have suspended and possible taken the license from a physician. So if you want to make that argument, the number of physicians who are practicing in a dangerous manner is far less than that of NPs. This is something I hear from MD and NP colleagues alike.

To the bolded, that's a somewhat fair arguement (which I think is crap from med students btw), but the differences are in the extent of knowledge learned in those didactics as well as the rigor of the clinical experiences. I'm currently working with an NP (supervised, thank god) who had 3 months of nursing experience before starting her NP and then only had to do 600 clinical hours to complete her NP degree. That's literally about 2 months of residency for me. When their previous education was all online, many are basically walking into clinical experiences with no idea what they're doing, and oftentimes they're basically shadowing 1-2 days/week and then leaving (true of all the NP students I've encountered except 1). Meanwhile, med students go through about 5,000 clinical hours before even starting residency, and then another 10,000-15,000 in residency depending on the field. It legitimately blows my mind that some NPs think they're ready to practice independently right out of the gate and many I've talked to realized that mistake very quickly.

If you think NP’s aren’t providing safe care, for whatever reason, post some studies that show disparate outcomes and we’ll go over them together to see if it’s solid methodology.

I've read somewhere in the neighborhood of 50 studies which compare outcomes and I've only read 2 that I thought was conducted and interpreted decently, but it compared NPs to residents (which is dumb because residents don't practice independently) and another that was done decently but was far too short-term to actually show anything meaningful (looked at A1C in diabetics over the course of a single year). Since those studies haven't been bothered to be conducted by anyone other than the AANP and nursing groups, I'll let you post any of them and I'll tear them apart.

 

[762513]

Your first paragraph is shifting the goal posts, since you brought it up though the BON in most states is a joke, especially when it comes to disciplining NPs. I have numerous colleagues who have reported offenses to BONs only to find out the NP got a written warning to be more careful with their practices whereas a BOM would have suspended and possible taken the license from a physician. So if you want to make that argument, the number of physicians who are practicing in a dangerous manner is far less than that of NPs. This is something I hear from MD and NP colleagues alike.

To the bolded, that's a somewhat fair arguement (which I think is crap from med students btw), but the differences are in the extent of knowledge learned in those didactics as well as the rigor of the clinical experiences. I'm currently working with an NP (supervised, thank god) who had 3 months of nursing experience before starting her NP and then only had to do 600 clinical hours to complete her NP degree. That's literally about 2 months of residency for me. When their previous education was all online, many are basically walking into clinical experiences with no idea what they're doing, and oftentimes they're basically shadowing 1-2 days/week and then leaving (true of all the NP students I've encountered except 1). Meanwhile, med students go through about 5,000 clinical hours before even starting residency, and then another 10,000-15,000 in residency depending on the field. It legitimately blows my mind that some NPs think they're ready to practice independently right out of the gate and many I've talked to realized that mistake very quickly.



I've read somewhere in the neighborhood of 50 studies which compare outcomes and I've only read 2 that I thought was conducted and interpreted decently, but it compared NPs to residents (which is dumb because residents don't practice independently) and another that was done decently but was far too short-term to actually show anything meaningful (looked at A1C in diabetics over the course of a single year). Since those studies haven't been bothered to be conducted by anyone other than the AANP and nursing groups, I'll let you post any of them and I'll tear them apart.

I don’t disagree with some of your points, but if these problems in NP’s are effecting patient care then physicians have an obligation to perform studies proving this and use them in the state legislatures to keep our patients safe. So please post some studies where NP’s are found to have disparate outcomes and we can review the methodology together.

 

[Stagg737]

I don’t disagree with some of your points, but if these problems in NP’s are effecting patient care then physicians have an obligation to perform studies proving this and use them in the state legislatures to keep our patients safe. So please post some studies where NP’s are found to have disparate outcomes and we can review the methodology together.

As I said, other than 1 or 2 poorly conducted studies, they haven't been done by non-nursing groups because it's a problem that's been largely overlooked (inappropriately) by the larger medical organizations which have always focused on professionalism and a team-based approach or by private organizations because they know they can pay NPs less. Due to the limited sources of the data, the best I can do is show how the current research is poor and that more is needed.

That being said, this will hopefully be happening soon as the recent campaigns by NP groups (We Choose NPs and CRNAs: We Are the Answer) have caught a lot of attention by larger medical groups and will likely trigger some significant responses. The ASA already put out a response to the CRNA campaign and cited statements from the WHO stating that CRNAs should be supervised by anesthesiologists whenever possible. Idk what's in the pipeline, but I do hope that more comprehensive and long-term studies be addressed, especially with the new generation of NPs that are entering practice.

 

[Cryc_to_the_point]

I'm not sure you could even actually make a valid study of "equivolent care," unless you prevented mid levels from being bailed out by a physician. The difference would surely be small enough that you'd need to treat a large swath of patients to see a difference, but that wouldn't mean it would be insignificant. Honestly, I think we all see that as unethical.

 

[762513]

As I said, other than 1 or 2 poorly conducted studies, they haven't been done by non-nursing groups because it's a problem that's been largely overlooked (inappropriately) by the larger medical organizations which have always focused on professionalism and a team-based approach or by private organizations because they know they can pay NPs less. Due to the limited sources of the data, the best I can do is show how the current research is poor and that more is needed.

That being said, this will hopefully be happening soon as the recent campaigns by NP groups (We Choose NPs and CRNAs: We Are the Answer) have caught a lot of attention by larger medical groups and will likely trigger some significant responses. The ASA already put out a response to the CRNA campaign and cited statements from the WHO stating that CRNAs should be supervised by anesthesiologists whenever possible. Idk what's in the pipeline, but I do hope that more comprehensive and long-term studies be addressed, especially with the new generation of NPs that are entering practice.

If it was the public health emergency you’re making it out to be then physician scientists would have plenty of evidence to use to fight against NP’s. There hasn’t been a single study that shows NP’s are unsafe, and it’s plenty ethical to conduct with half of the states allowing complete independence. Likely, NP’s make physicians a lot of money, so neither side wants to conduct these studies. Either way, it’s the physicians who have either failed to protect the public, or NP independence is not the public health emergency you say it is.

 

[FiremedicMike]

Your first paragraph is shifting the goal posts, since you brought it up though the BON in most states is a joke, especially when it comes to disciplining NPs. I have numerous colleagues who have reported offenses to BONs only to find out the NP got a written warning to be more careful with their practices whereas a BOM would have suspended and possible taken the license from a physician. So if you want to make that argument, the number of physicians who are practicing in a dangerous manner is far less than that of NPs. This is something I hear from MD and NP colleagues alike.

I didn't mean to be moving the goalposts, my point was merely that these forums tend to compare crappy NPs to mid tier to excellent physicians as proof.. There is a trend here to point out NP mistakes without acknowledging that all healthcare providers do bonehead things sometimes..

To the bolded, that's a somewhat fair arguement (which I think is crap from med students btw), but the differences are in the extent of knowledge learned in those didactics as well as the rigor of the clinical experiences. I'm currently working with an NP (supervised, thank god) who had 3 months of nursing experience before starting her NP and then only had to do 600 clinical hours to complete her NP degree. That's literally about 2 months of residency for me. When their previous education was all online, many are basically walking into clinical experiences with no idea what they're doing, and oftentimes they're basically shadowing 1-2 days/week and then leaving (true of all the NP students I've encountered except 1). Meanwhile, med students go through about 5,000 clinical hours before even starting residency, and then another 10,000-15,000 in residency depending on the field. It legitimately blows my mind that some NPs think they're ready to practice independently right out of the gate and many I've talked to realized that mistake very quickly.

Online/blended education is the future, but it is not for everyone. I obtained my bachelors 100% online from a brick and mortar school and it took effort to learn the material. I'm now working on pre-reqs in a hybrid fashion which requires a significant amount of discipline to stay on track and absorb the material. We meet up weekly for labs which give us some brief time to discuss the chapters but really tend to focus on the experiments at hand and then "see yah".

Done right and with the right student, there's nothing wrong with online didactics.

 

[Stagg737]

If it was the public health emergency you’re making it out to be then physician scientists would have plenty of evidence to use to fight against NP’s. There hasn’t been a single study that shows NP’s are unsafe, and it’s plenty ethical to conduct with half of the states allowing complete independence. Likely, NP’s make physicians a lot of money, so neither side wants to conduct these studies. Either way, it’s the physicians who have either failed to protect the public, or NP independence is not the public health emergency you say it is.

As you said, previously it hasn't been as big of an issue since the rise of widespread FPA is relatively new and hospital systems are able to profit off of it so long as the specialists being referred to are within their system. I also find the bolded to be a bit hypocritical and pointing the fingers at physicians for this fault is just as ridiculous as saying we can curb the cost of healthcare in the US by decreasing physician salaries because we make too much. I'd argue the fault is more on the nursing lobbies and leadership organization for extending the scope of practice beyond what is appropriate.

The other issue is with the direction your field is heading. If the standard was still to go get 5, 10, or even more years of clinical experience as an RN, then going back to a well-established program, and then going back to the field they got their experience in then it would be different. The current trend though is moving more towards "How can I get to see patients on my own as quickly and easily as possible" which in most states that's the NP route. I'm far less concerned with the older NPs who took the longer route and legitimately scared of the new generation who come out of school with almost no clinical experience and a desire to practice at "the top of their scope" when they're woefully ill-prepared.

I didn't mean to be moving the goalposts, my point was merely that these forums tend to compare crappy NPs to mid tier to excellent physicians as proof.. There is a trend here to point out NP mistakes without acknowledging that all healthcare providers do bonehead things sometimes..



Online/blended education is the future, but it is not for everyone. I obtained my bachelors 100% online from a brick and mortar school and it took effort to learn the material. I'm now working on pre-reqs in a hybrid fashion which requires a significant amount of discipline to stay on track and absorb the material. We meet up weekly for labs which give us some brief time to discuss the chapters but really tend to focus on the experiments at hand and then "see yah".

Done right and with the right student, there's nothing wrong with online didactics.

Online can be done right, but it is often not. The difference with online NP schools and med students watching lectures online is that med students are on-campus and have access to professors to go ask questions to if the need help. This is not the case at many NP schools (see links below) and such a format is completely unacceptable for those who will be going into fields where patient's lives may literally be on their hands.

I'm not comparing the worst NPs to the best physicians though. I'm comparing the average to the average. I can ask the average physician the MOA of most psych drugs and the variations like different classes of anti-depressants (SSRIs, SNRIs, MAO-I, Tricyclics, Tetracyclics, etc). I cannot say the same thing for the majority of NPs I've worked with beyond SSRIs. Even some people in the new generation are recognizing the problem in the field, yet nursing leadership does nothing to change this. Here's some threads from AllNurses with some quotes to check out as this is a far more common problem than people entering the field (or even those in the field) realize. Keep in mind, this is the prime social media site for nurses with people who are both in school and have completed it recognizing it. It's This is what I'm talking about when I say nursing leadership needs to get it's act together and also when I say to do your research on the school you attend, even it if is an established program. @IknowImnotadoctor , thoughts on this?

“NP education (and apparently undergraduate nursing as well) is a smoldering dumpster fire.”
https://allnurses.com/disappointment-np-program-t697917/

“I honestly believe my training was absurdly and dangerously insufficient for the scope of practice I am now licensed to do”
https://allnurses.com/help-save-career-t678343/

“What do you actually do during a physical exam?”
https://allnurses.com/fnp-clinical-question-what-actually-…/

“For-Profit NP admissions... I thought they were joking!”
https://allnurses.com/for-profit-np-admissions-i-thought-t…/

“I am in a brick and mortar FNP program. I could go on for days about how inadequate it is.”
https://allnurses.com/augmenting-education-bad-np-programs…/

 

[762513]

As you said, previously it hasn't been as big of an issue since the rise of widespread FPA is relatively new and hospital systems are able to profit off of it so long as the specialists being referred to are within their system. I also find the bolded to be a bit hypocritical and pointing the fingers at physicians for this fault is just as ridiculous as saying we can curb the cost of healthcare in the US by decreasing physician salaries because we make too much. I'd argue the fault is more on the nursing lobbies and leadership organization for extending the scope of practice beyond what is appropriate.

The other issue is with the direction your field is heading. If the standard was still to go get 5, 10, or even more years of clinical experience as an RN, then going back to a well-established program, and then going back to the field they got their experience in then it would be different. The current trend though is moving more towards "How can I get to see patients on my own as quickly and easily as possible" which in most states that's the NP route. I'm far less concerned with the older NPs who took the longer route and legitimately scared of the new generation who come out of school with almost no clinical experience and a desire to practice at "the top of their scope" when they're woefully ill-prepared.



Online can be done right, but it is often not. The difference with online NP schools and med students watching lectures online is that med students are on-campus and have access to professors to go ask questions to if the need help. This is not the case at many NP schools (see links below) and such a format is completely unacceptable for those who will be going into fields where patient's lives may literally be on their hands.

I'm not comparing the worst NPs to the best physicians though. I'm comparing the average to the average. I can ask the average physician the MOA of most psych drugs and the variations like different classes of anti-depressants (SSRIs, SNRIs, MAO-I, Tricyclics, Tetracyclics, etc). I cannot say the same thing for the majority of NPs I've worked with beyond SSRIs. Even some people in the new generation are recognizing the problem in the field, yet nursing leadership does nothing to change this. Here's some threads from AllNurses with some quotes to check out as this is a far more common problem than people entering the field (or even those in the field) realize. Keep in mind, this is the prime social media site for nurses with people who are both in school and have completed it recognizing it. It's This is what I'm talking about when I say nursing leadership needs to get it's act together and also when I say to do your research on the school you attend, even it if is an established program. @IknowImnotadoctor , thoughts on this?

“NP education (and apparently undergraduate nursing as well) is a smoldering dumpster fire.”
https://allnurses.com/disappointment-np-program-t697917/

“I honestly believe my training was absurdly and dangerously insufficient for the scope of practice I am now licensed to do”
https://allnurses.com/help-save-career-t678343/

“What do you actually do during a physical exam?”
https://allnurses.com/fnp-clinical-question-what-actually-…/

“For-Profit NP admissions... I thought they were joking!”
https://allnurses.com/for-profit-np-admissions-i-thought-t…/

“I am in a brick and mortar FNP program. I could go on for days about how inadequate it is.”
https://allnurses.com/augmenting-education-bad-np-programs…/

I won’t question your integrity that you are seeing NP’s direct through school that have never worked as a RN, however, I’ve never seen it, not in my entire cohort, or any NP I’ve ever spoken to, and that’s a substantial number. Moreover, if we are really comparing the average NP to the average physician, then the average NP has been in practice for 10 years, with the average age 49, and this is not counting nursing experience. (NP Fact Sheet). These comparisons are always comparing the worst NP to the average physician, which is what you’re doing.

I appreciate you providing links and putting effort into the debate, but at the end of the day, these are just individuals opinions. I personally plan to be supervised for many years to come as I learn correct treatment, I specifically picked a job that would provide me with this support. I was speaking to an attending about the NP role, and we have the same conclusion; Independence out of school is most likely dangerous, but after 5 years in the trenches, it is probably safe to cut the leash. What are your thoughts on that @Stagg737 ?

 

[Stagg737]

I won’t question your integrity that you are seeing NP’s direct through school that have never worked as a RN, however, I’ve never seen it, not in my entire cohort, or any NP I’ve ever spoken to, and that’s a substantial number. Moreover, if we are really comparing the average NP to the average physician, then the average NP has been in practice for 10 years, with the average age 49, and this is not counting nursing experience. (NP Fact Sheet). These comparisons are always comparing the worst NP to the average physician, which is what you’re doing.

I appreciate you providing links and putting effort into the debate, but at the end of the day, these are just individuals opinions. I personally plan to be supervised for many years to come as I learn correct treatment, I specifically picked a job that would provide me with this support. I was speaking to an attending about the NP role, and we have the same conclusion; Independence out of school is most likely dangerous, but after 5 years in the trenches, it is probably safe to cut the leash. What are your thoughts on that @Stagg737 ?

I think that's a much more fair perspective, though I would still be hesitant even in that situation. Not because I think an NP would be lacking the experience at that point, but because of the lack of standardization in education (even after this) and would also be dependent on environment.

For example, I have worked with multiple NPs who had been practicing less than 2-3 years when I worked with them, yet they'd worked in 2-3 different fields (one was on her 4th field in 2 years, FM -> EM -> peds -> derm). That's another major problem I have with the FPA aspect of NPs. If one were going to enter a field and stay in that field for the rest of their careers, then I'd be less hesitant. That ability to jump from field to field is dangerous though and I recently had an NP tell me she was planning on entering psych and tried to show off her knowledge a bit by knowing a piece of trivia about one med, then didn't know what MOCA or SLUMS were. Then when I showed her what a SLUMS exam was and explained the basics, she performed one on her own and documented it with the wrong conclusion (asked how to break it to the patient that he likely had dementia after only a SLUMS when his score indicated MNCD a few days after quitting heavy drugs).

Do I think there could be potential pathways for some NPs to gain more independent practice? Sure. But given how lax the current legislation is, with worsening education and standards, no central accrediting body, and a new generation emerging which is woefully unprepared to practice clinically at ALL let alone unsupervised, I have a very hard time trusting an NP to practice independently, if for no other reason because I'd have no idea if that individual was appropriately trained or not.

I will also say that I feel like you're very reasonable with both your expectations and your goals and you'd fall in the more reasonable 1/3 to 1/4 of NPs I've worked with. That range includes one who I would absolutely trust to practice independently, several who I think are solid and would trust with supervision, more than I'd like who I would question even if they were supervised (which speaks as much to their supervisor as them), and a handful who I don't think should be treating with anyone in any capacity and I question how they ever became any kind of nurse at all.

 

[Stagg737]

I won’t question your integrity that you are seeing NP’s direct through school that have never worked as a RN, however, I’ve never seen it, not in my entire cohort, or any NP I’ve ever spoken to, and that’s a substantial number. Moreover, if we are really comparing the average NP to the average physician, then the average NP has been in practice for 10 years, with the average age 49, and this is not counting nursing experience. (NP Fact Sheet). These comparisons are always comparing the worst NP to the average physician, which is what you’re doing.

I appreciate you providing links and putting effort into the debate, but at the end of the day, these are just individuals opinions. I personally plan to be supervised for many years to come as I learn correct treatment, I specifically picked a job that would provide me with this support. I was speaking to an attending about the NP role, and we have the same conclusion; Independence out of school is most likely dangerous, but after 5 years in the trenches, it is probably safe to cut the leash. What are your thoughts on that @Stagg737 ?

I also tried to look up the data that the fact sheet was taken from and don't have access to the full report as I'm not an AANP member, but I'd be interested to know about the sample size and demographics of those who answered the survey, especially given that it says there were 26,000 new graduates the previous year, which makes up 10% of total NPs according to that factsheet.

 

[762513]

I think that's a much more fair perspective, though I would still be hesitant even in that situation. Not because I think an NP would be lacking the experience at that point, but because of the lack of standardization in education (even after this) and would also be dependent on environment.

For example, I have worked with multiple NPs who had been practicing less than 2-3 years when I worked with them, yet they'd worked in 2-3 different fields (one was on her 4th field in 2 years, FM -> EM -> peds -> derm). That's another major problem I have with the FPA aspect of NPs. If one were going to enter a field and stay in that field for the rest of their careers, then I'd be less hesitant. That ability to jump from field to field is dangerous though and I recently had an NP tell me she was planning on entering psych and tried to show off her knowledge a bit by knowing a piece of trivia about one med, then didn't know what MOCA or SLUMS were. Then when I showed her what a SLUMS exam was and explained the basics, she performed one on her own and documented it with the wrong conclusion (asked how to break it to the patient that he likely had dementia after only a SLUMS when his score indicated MNCD a few days after quitting heavy drugs).

Do I think there could be potential pathways for some NPs to gain more independent practice? Sure. But given how lax the current legislation is, with worsening education and standards, no central accrediting body, and a new generation emerging which is woefully unprepared to practice clinically at ALL let alone unsupervised, I have a very hard time trusting an NP to practice independently, if for no other reason because I'd have no idea if that individual was appropriately trained or not.

I will also say that I feel like you're very reasonable with both your expectations and your goals and you'd fall in the more reasonable 1/3 to 1/4 of NPs I've worked with. That range includes one who I would absolutely trust to practice independently, several who I think are solid and would trust with supervision, more than I'd like who I would question even if they were supervised (which speaks as much to their supervisor as them), and a handful who I don't think should be treating with anyone in any capacity and I question how they ever became any kind of nurse at all.

I don’t think we’re going to end up in the same place on this debate, but we are probably closer than we were before we had it. Thanks for a respectful conversation about NP’s.

 

[MidwestPAC]

Pathways to Independent Primary Care Clinical Practice: How Tall Is the Shortest Giant? Mantosh J. Dewan, MD, and John J. Norcini, PhD

Check out this article from the AMA.

 

[pamac]

Pathways to Independent Primary Care Clinical Practice: How Tall Is the Shortest Giant? Mantosh J. Dewan, MD, and John J. Norcini, PhD

Check out this article from the AMA.

That was a good read.

Here's the reason the different options for expanded practice rights would be difficult to establish: Physicians.

Physicians retain oversight of PA's, and over their own academic and professional pipeline in the case of medical students and those who aren't able to match. Its not in physicians best interest to extend independence to any of those alternate groups. The question arises as to why NP's seem to have disparate influence as far as independence given the training regimen that is suggested (very effectively) to be lacking. The answer to that is that nurses took control of their destiny, and aren't asking for permission. Where PA's are starting to show potential for obtaining greater freedom of practice is where they also have decided to take their destiny into their own hands and push for what they want. It won't be granted to them, only seized by them. So that work came really close to having all the pieces of the puzzle put together and stopped short.

I'm not anti physician. All of this is just nature. Its not a critique as much as an observation.

 

[KeikoTanaka]

That was a good read.

Here's the reason the different options for expanded practice rights would be difficult to establish: Physicians.

Physicians retain oversight of PA's, and over their own academic and professional pipeline in the case of medical students and those who aren't able to match. Its not in physicians best interest to extend independence to any of those alternate groups. The question arises as to why NP's seem to have disparate influence as far as independence given the training regimen that is suggested (very effectively) to be lacking. The answer to that is that nurses took control of their destiny, and aren't asking for permission. Where PA's are starting to show potential for obtaining greater freedom of practice is where they also have decided to take their destiny into their own hands and push for what they want. It won't be granted to them, only seized by them. So that work came really close to having all the pieces of the puzzle put together and stopped short.

I'm not anti physician. All of this is just nature. Its not a critique as much as an observation.

Just out of curiosity, In a world of complete independence of all mid-levels, how do you envision the need for physicians? What is the point of medical school? Do you think there would need to be a new Flexner report for mid-level schooling?

 

[pamac]

Just out of curiosity, In a world of complete independence of all mid-levels, how do you envision the need for physicians? What is the point of medical school?

Uh..... I live in that world of complete independence from physicians because I practice as a Nurse Practitioner in a fully independent state. There are still plenty of physicians here. Around half of all states have this.

 

[pamac]

KeikoTanaka, you are a medical student?

 

[KeikoTanaka]

KeikoTanaka, you are a medical student?

Yes.

I live in NY, so I rarely see independent mid levels here. I believe I see some FNPs that are independent, but only ever in small-town Appalachia. I can't say I've ever seen one practicing independently in more popular areas.

I guess since I rarely see it and don't know what goes into it, I have questions/concerns about it. If they are truly independent, therefore at liberty to succeed/fail just as a physician, is there malpractice just as high? Should it be higher, since they are technically at higher-risk for error due to their decreased training? Do patients deserve to know that their provider is less trained than a physician, so should understand the risks associated with that?

It's very hard to put together a study and look at the efficacy rates of Physicians vs NPs in private practice diagnosing various illnesses. Due to medicine being such an art, patients not being able to be controlled, and variability of illness presentation based on time, it makes it very hard to say like "Xyz, NP diagnosed it wrong but then Xyz, MD diagnosed it right" or vice-versa.

Many articles/anecdotes have already been shared, so I'm not trying to open that conversation up again, but simply due to the nature of the training differences from an objective stand point, it's clear that physicians should inherently have more medical acuity and therefore should in theory be less prone to error than a midlevel.

So, I'm all for midlevel independence if they want it that bad to "take hold of their profession", but I do believe that a hierarchy needs to exist and that it should be crystal clear to patients who/what their providers accreditations are and what the risks are associated with that.


This is what I believe: If you want more than just half of all the states to have FULL mid-level independence, nationally, I truly think that will only happen if one VERY important thing happens: The NP accrediting body perform a sweeping revamping of all the NP schools in the country, shut many down, re-open up many only after a true single consistent curriculum is instituted at every single school. I believe this is what PAs basically did already because they just copied a medical-school model and watered it down.

I believe this is imperative because if you can somehow verbalize exactly what the limitations are of an independent mid-level provider, I believe many Doctors would feel more comfortable performing next to people that they can trust won't get too deep in over their head, and will know when to refer out.

^ But, this does open up a whole other concern for me: Will this model truly result in a reduced healthcare spending? I believe there are two goals of NP independence: 1.) To aid in the doctor-shortage by offering alternative options for people to access care and 2.) to reduce the cost of healthcare by being a "less-costly option than hiring a physician" - But, if NPs have higher-referral rates, won't this ultimately increase the burden on the patient, and subsequently increase the burden on the healthcare system as a whole, especially specialists?

This is my concern I guess. The future of healthcare resides in Primary Care. People who don't get sick cost a hell of a lot less than people who are sick. Yet, it seems NPs are trying to take over Primary Care. This scares me, as I believe this could ultimately result in overall decreased health of a population if this deters future physicians away from Primary Care, giving it to lesser-trained practitioners who will become referral vendors, as opposed to a thorough physician that can diagnose/treat far more and perhaps not need to rely on as many referrals?


Interesting data looking at the referral qualities from physicians vs NPs/PAs:
Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners. - PubMed - NCBI


Granted this is a small sample size, I'd love to see a more current/larger study. But, in each measured data point, physicians seemed to always be about ~20% more effective.