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Advantages to having dual NP and CRNA degrees?

Discussion in 'Clinicians [ RN / NP / PA ]' started by HenryH, May 26, 2012.

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  1. HenryH

    HenryH

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    Just out of curiosity, are there any advantages clinically or professionally to being qualified to practice as both a CRNA and an NP? Or would someone holding both degrees be forced to "choose" one professional to practice as and toss the other degree to the side, so to speak?

    Thanks...
  2. Denatured

    Denatured

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    Not many people do this, but I know of two. One does something like 3 days OR and 2 days OR for an anesthesia group. The has a perm anesthesia job and then does a lot of locusts I think. Works in the ER mostly I believe.

    As a general rule, not much advantage except that you could do work in a clinic doing pain management without having to worry about prescriptive authority or laws regulating the practice of pain management.
  3. HenryH

    HenryH

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    Thanks. So I guess it would probably depend on the anesthesia group I'm interested in working for, then? I'm actually at a crossroads where I have the opportunity to pursue such a dual-degree arrangement, so it may be worth considering.
  4. Denatured

    Denatured

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    Yes, it would depend on the group, but it's pretty rare. More than likely you would have to create a position for yourself and sell them on the idea. Otherwise, just work two part time jobs, or one full time and the other part time. I know many PAs who do this to get money from one and personal satisfaction from the other.

    P.S. I highly recommend what you are thinking about. It's always good to have more than one cert or specialty experience. Both will make you a better clinician (you'll be the best intubating practitioner in the department for sure) and if things go south in one then you have the other.
  5. PrinceVersed

    PrinceVersed

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    Several people in my class are former NP's. From what they have told me very little, if any, of the NP training has helped them in CRNA school. Also, last I checked they had no desire to do NP once they were done. If you have tons of extra time and money then doing both couldn't hurt. But, if you are like most people and only have so many hours in the day and so much money, pick one.
  6. emedpa

    emedpa GlobalDoc2B2015

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    I have a friend who does this. He was an icu nurse for 15 yrs then became an np, then a crna. he does o.r. anesthesia, pain clinic, and covers the icu for his md lead group. great money and schedule.
  7. HenryH

    HenryH

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    Thanks for responding. I actually have a biology degree and was going to enroll in a BSN program (either traditional or accelerated) and then go to CRNA school, but now I'm looking at a few direct-entry MSN programs that will enable you to graduate with an MSN and be licensed as an NP. Apparently, the first year of these programs involves taking undergraduate BSN courses and becoming licensed as an RN, and the last 1.5 - 2 years are devoted to taking the NP classes while working as an RN. In other words, a student can actually obtain ~2 years of experience working as an ICU nurse during the last two years of the program. At the end of the program, students graduate with an MSN and are licensed as NPs.

    What surprises me about these direct-entry programs is that most of them actually cost just as much as a BSN program and aren't really much longer than most BSN programs (maybe 1-2 semesters longer).

    Do you know how common/likely it is to enter into an employment arrangement similar to your friend's? Then again, I imagine that since there are very few dual-licensed NP-CRNA's, anesthesia groups probably consider them on a case-by-case basis anyways. Hypothetically speaking, if I were to pursue this route, is there a particular NP specialty track you would advise pursuing? It seems like acute care would be a given, but that is just a hunch...
  8. emedpa

    emedpa GlobalDoc2B2015

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    yes, acute care makes the most sense. not a lot of these folks around. at that point you really should consider med school if starting from scratch.
    I know a few folks who are dual PA/AA folks who do exactly the same thing. the only downside to AA practice at this point is that they are only licensed in something like 18 states but that is improving every yr.
  9. zenman

    zenman Senior Member

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    I can see doing this out of boredom as a CRNA, but heck...
  10. HenryH

    HenryH

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    Thanks for your input. In regards to just going to medical school, it would actually be a significantly shorter path to pursue becoming a dual NP-CRNA (4-5 years) as opposed to going to medical school (min. 8 - 10 more years). I was originally considering AA school, but conversations with a number of anesthetists (both AA's and CRNA's) have made me seriously re-consider that route. In addition, it would only take about 2.5 more years to become an NP-CRNA than it would to become an AA.

    What is also worth noting is the fact that the total cost of tuition for both the direct-entry NP program and the CRNA program is almost exactly the same as the cost of AA school tuition alone. So really, if you look at it from that perspective, the only thing I would lose by becoming both an NP and a CRNA as opposed to just going to AA school is 2.5 years of time (since both routes would cost the same amount of money to pursue).

    Just out of curiosity, why do you recommend going to medical school over becoming an NP-CRNA? It sounds like an individual holding both qualifications would have an awesome deal in a professional as well as scope-of-practice/autonomy sense, so really, unless someone is just hellbent on being "the doctor," wouldn't you say that being an NP-CRNA is essentially one of the best gigs in medicine?
  11. Denatured

    Denatured

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    I must agree. Being a NP and CRNA is great because you can two different specialties. The more generalist style practitioner, the safer you'll be in any economy or market. NP will likely not help in anesthesia school. According to personal friends, NP school does not cover the depth of A&P/pharm. CRNA takes gross anatomy and usually two physiology courses. Pharm is usually 3 classes in anesthesia. NP certainly does not even approach the anesthesia/surgery specific stuff. You're assessment skills will be better, so will your basic pharm, but I've heard you have an advantage for about a few months. Then everyone approaches the learning curve the same.

    I would not want to be a AA. Too many limitations. Can't practice without an MDA nearby, so no rural off site settings. Restricted to major medical centers for the most part. Few states to legally practice.

    I hate to burst your bubble, but a prereq to CRNA school is one year acute care experience as an RN. Now the school can decide what is acute care (most say any ICU, some take ER), but it must be as an RN. Usually it has to be fairly recent experience as well. Who knows though, I've seen them bend the rules before. Only for really, REALLY bright students. I would call schools you want to apply for and ask.
  12. SouthSideSteve

    SouthSideSteve

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    :laugh:
  13. zenman

    zenman Senior Member

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    I worked locusts once but those suckers are hard to catch. I went back to picking grapes.
  14. HenryH

    HenryH

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    Actually, what is so nice about the program I've been looking into is that for the last 2 years of the program, you actually work as an RN while taking the NP classes online. So I would actually be eligible to work in the ICU during those 2 years.

    It occurs to me like this: if a regular BSN program would take about 2 years to complete, why not just add a third year and get qualified as an NP with an MSN, especially since, upon graduating from the NP program, I would already have 1-2 years of ICU RN experience and would be eligible to immediately begin CRNA school? It just seems to make so much more sense to do one of these three-year MSN programs and then go to CRNA school, rather than do a two-year BSN and have to work for a year anyways before going to CRNA school. In other words, the BSN route would still take three years when you add the required year of ICU work, so why not just get the MSN and be done in the same amount of time but be qualified to practice as both an RN and an NP?
  15. PrinceVersed

    PrinceVersed

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    I will preface this by saying I am not an NP but I do know and have worked with many.

    A lot of the skill and knowledge that you need to be a good NP, especially acute care, comes from good ICU experience. Have you ever stopped to think that you might need more than two years RN experience to be a quality NP/CRNA? Everyone wants to meet the minimum requirements but I am not sure that that is good for either field. Can you do it? Of course! Is it best for your patients? IDK...

    It just seemed to me that the sub par nurses were also the sub par NP's. And lord knows we don't need anymore sub par midlevels for MD's to slam constantly haha.
  16. chimichanga

    chimichanga misunderstood

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    well said
  17. HenryH

    HenryH

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    Well, in that case, hopefully the students who matriculate into these programs are fast learners, LOL. Some of these direct-entry MSN's don't even allow students to work during the program; they're accepted without any professional background whatsoever in healthcare and graduate a few years later as full-blown NP's.
  18. AnnoyedByFreud

    AnnoyedByFreud

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    Direct entry programs have existed for a long time and there are a lot of NPs out there walking around with minimal RN experience. shrug

    The only study that has looked at this matter found that RN experience did not contribute to NP competency as measured by physicians. I think the issue is that since RN experiences vary widely, as do NP roles, there isn't always an obvious relation between the two. Plus, direct entry NP programs are very competitive, which means that the people get in are typically driven, academically astute individuals.

    If we want to complain about NP education, I think the real problem is all the professional/for-profit institutions that are taking over the field. These programs have little-to-no barriers to entry, and it seems like they're very popular with RNs who want to get their NP "in their spare time". Too many people don't seem to care about the quality of their NP program (just hop on over to allnurses and see the 100+ threads started by someone looking for the cheapest, most flexible online program, that will allow them to work full-time, with no regard to its quality, reputation, etc). NP education shouldn't be easy and too many programs appear to be making it that way.
    Last edited: May 28, 2012
  19. PrinceVersed

    PrinceVersed

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    I agree. It is far too easy. The NP program in my state doesn't even interview applicants. You apply, you're in. It is sad.

    From what I was told by my NP friends is that NP school doesn't educate you or train you well enough to do the job. The only saving grace in their, and my, eyes was the knowledge and training that they acquired while being a nurse in a field similar to the type of NP they now were.

    We had to deal with an NP who had worked on the floor her whole RN career and got her NP part time, largely online. As a NP she worked with/for our CV surgeon. She was worthless as anything beyond doing the admission H&P or discharge. She didn't understand cardiac surgery, post op care, the medications we used, the dosages, she could not/would not even write orders for things like lasix or protonix because she honestly didn't know the indications or dosages. Any RN with a bit of sense that had worked in an ICU or CVICU could have ran circles around her. She made/makes all of us nurses look stupid and incompetent.

    It is crap like that that provides endless fodder for doctors and others to bash nurses. And if you will read my other post you will know that I am no nurse lover or apologist but I still don't like the fact that any yahoo can basically complete a NP program and never really treated a patient. You'd be amazed by the amount and level of things you can learn just from being in the unit and talking with doctors. That is not something that you should want to pass by if you want to be quality, IMHO.
  20. chimichanga

    chimichanga misunderstood

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    This is the prevailing thought supporting direct entry...

    sigh
  21. HenryH

    HenryH

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    This is the sentiment I've heard as well -- or more specifically, that the actual graduate courses/training itself determines clinical ability.

    Since it would take me about 2 years just to get a BSN and three years to do the MSN program where I'd graduate as an NP and gain 2 years of ICU RN experience during the program, it almost seems like I might as well do the extra year to become an NP. Heck, even the cost of tuition for both programs is about the same.
  22. AnnoyedByFreud

    AnnoyedByFreud

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    I honestly would rather see a NP who went to a top program with an excellent reputation as a direct entry student over a seasoned RN who did their NP part-time, online, at the University of Phoenix. The quality of the program matters. This was the prevailing attitude at the hospital where I volunteered, where NP job applicants that had attended online/for-profit programs were typically put at the bottom of the pile, and those with minimal experience (but who had attended programs with strong reputations) where preferred. Of course the top candidates were those with both experience and a solid education. It's weird, but most of the MDs and hiring managers at my hospital didn't care about the NP's RN experience, they treated all new NPs as the same, regardless of work history. It was the RNs who routinely complained about NPs with minimal RN work history.
  23. PrinceVersed

    PrinceVersed

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    Because there is clearly a difference in agenda and expectations between the two groups. A lot of MD's want NP's to do scut work (see my previous post where all she could do was H&P and discharge) while RN want NP to but as close to a full service provider as possible. If you take a moment to read almost any post on this site you will notice that most of them loathe NP's and would see them completely gone. However, since they have to coexist with them, they want their role as marginalized as possible. With a marginalized role, who would really care about their clinical skills, or lack thereof?
  24. zenman

    zenman Senior Member

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    Who, RNs or MDs?
  25. PrinceVersed

    PrinceVersed

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    Zen, really? ha. And I guess I shouldn't say the MD all do, though a fair portion of them do as well. Mostly, it is those aspiring to be MD's. And obviously the real life dynamics between the two are not so contentious, in my experience. My point being was that there doesn't seem to be a big push for better clinical skills for NP's. The schools don't seem to push it, the doctors seem to not care or be against it. All of this leading to, what I feel, is a sub par provider. There are exceptions and really good NP's. I just wish the distribution between the good and bad was a bit more evened out.
  26. AnnoyedByFreud

    AnnoyedByFreud

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    This is in an independent practice state where the NPs have complete autonomy. And yeah, I'm aware that many MDs (or seemingly, pre-meds and med students) appear to loathe NPs. Honestly, I could care less, since I won't be working for them. Also, remember, this is the internet. Most MDs that I know seem to actually, gasp, like NPs. And if they don't like them, it doesn't really matter, since it's an independent practice state.
    Last edited: May 29, 2012
  27. emtwannabe

    emtwannabe

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    Definitely!:thumbup:
  28. PrinceVersed

    PrinceVersed

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    No knock on you or what you will be doing. My point in bringing up the loathing was meant to highlight that there might be few (MD, schools, students) that have much incentive to be better providers. The MD's are fine with them being sub par because that is one step away from them not existing or being under tighter control. The schools let almost everyone in. And the students want to enter with the bare minimum of experience.

    IRL, I am sure most MD's do like NP. As an RN I would have loved to have someone run around and do all my charting (see: NP's doing H&P and discharges) so I could just take care of my patients. But that doesn't mean that I would have wanted those charters to actually take care of my patients. Only to do the junk I didn't want to do.

    As for independent practice, you're right. It doesn't matter what anyone thinks. But that wasn't my point. My point was that admissions and the education/training is inadequate. However, this is only the opinion I have formed from the NP's that I have known and worked with and it is no way universally correct. I could be wrong on every point. At the end of the day you can think and believe whatever you want :).
  29. SailorNurse

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    One disadvantage to being both NP & CRNA is keeping up the certifications for both specialties, including the required work hours to renew licenses.. CEUs etc. I have a friend who is RN/CNS and was EMT-P, he finally dropped the paramedic as he was not able to maintain requirements for both as he was mainly working as RN.
  30. sarjasy

    sarjasy I have action potential

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    Not going after you per se, PV, but the similar sentiments on this thread (though it is now a month old). First, if there are subpar NP's out there (and there are), why not hire them to do basic H&P and discharge stuff to save the physician time if they are qualified to do it, even if they aren't qualified to see patients directly? That is sort of one of the roles the NP was designed to fill - more than an RN but less than an MD.

    Second, there are tons of subpar MD's and DO's, and I've worked with some -- despite the rigor of the education. I hate anecdotes, but they are quite popular around here. FWIW, I work with two DO's who run circles around some of the MD's I work with. One MD spent four hours running diagnostics on a pt with a high temp and low BP, thinking possible sepsis but couldn't figure out the source. After me prompting the MD 3 times, he finally examined the obviously swollen/reddened post surgical wound on the patient that I had mentioned on admissions to the ER, but that he hadn't noticed on the his physical exam of the patient (despite being informed of the patients surgical hx). I could literally give a dozen more examples of this particular physician and many others, but it serves no purpose. Educational rigor does not ensure competence.

    Maybe a few years back, but most schools now are highly competitive.


    True to a certain degree, but I assume you make this conclusion based on online postings. These students will likely never get admitted or will never even apply. They are those that think they want to be NP's, but will never get in and/or make it through.
  31. jwk

    jwk AA-C ASA-PAC Contributor

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    As long as you can complete your NP education online, that claim will ring pretty hollow, because once you have it and have a license, one is no different from the other as fas as scope of practice.

    Anecdotes are fine - we all have plenty - I have quite a few about NP's. Should I post those here?
  32. sarjasy

    sarjasy I have action potential

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    What does online have to do with my statement about programs being competitive? If there are 15 seats and 70 applicants, what does in matter if it is on-ground or online. It's still "competitive" to gain entry.

    Do your anecdotes prove NP's are incompetent?


    Absolutely. As long as you are cool with me posting mine too.
  33. jwk

    jwk AA-C ASA-PAC Contributor

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    If you can pay for it, you're generally admitted. The number of admitted students for an online program is virtually unlimited.
  34. AnnoyedByFreud

    AnnoyedByFreud

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    I think that NP education is kind of becoming a two-tiered system. There are university-based programs (the top ones are highly competitive) and then there's a bunch of crap coming from for-profit "professional" schools. In my area, the NPs from the latter have a much harder time finding work.
  35. jwk

    jwk AA-C ASA-PAC Contributor

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    And yet their legal scope of practice is the same.
  36. zenman

    zenman Senior Member

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    I think there is still a faculty-student ratio that is required.
  37. sarjasy

    sarjasy I have action potential

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    That is 100% completely false. You are either embarrassingly ignorant, intentionally lying, trolling, or all of the above. Which is it?
  38. sarjasy

    sarjasy I have action potential

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    Examples?
  39. Denatured

    Denatured

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    4 years ago, before PA school, I was trying out NP school at UAB. The admissions standards were weak to say the least. The GRE was waived since I had over a 3.2 GPA, I had no experience at the time, and wrote what I consider a weak personal statement. I honestly thought I had no chance. Then I was accepted with no interview. There were also several other people with little or no experience (perhaps majority). There were about 60 people in each class, though this didn't account for the entire class since you were allowed to sign up for classes in various order. For all tracks (fnp, acnp, ect) the were 160 students around the same graduation timeline. Hard to say since there were the full time students who graduate in 2 years and the part timers that may finish in up to five.

    It was basically all the bad things about NP schools come true. However, it may have been the program. I've be involved with other that we're better. UAB didn't really have any health programs I thought were anything more than average and all them seemed to be out for more students and more money.

    NPs in general after time in practice are indistinguishable from PAs IMO though. They have many problems to work out, unlike CRNAs who I believe out of all non physician providers have it right as far as educational model and appropriate scope of practice.
  40. sarjasy

    sarjasy I have action potential

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    4 years ago, there were enough seats for almost all applicants at most schools. When a new PA school, for example, opens up, almost everyone who applies and meets the minimum requirements gets in the first few years because there simply isn't a high volume of applicants. NP programs now are buried in applicants and there aren't enough seats, so the stats for those admitted have gone through the roof. It ebbs and flows. Look at the stats for med school, dental school or pharmacy school or any other health profession 10-20 years ago - things have gotten increasingly competitive across the board, even at the undergrad level as you reference. The lowest GPA admitted at my BSN school the last semester I was there was 3.7.

    Yet somehow they are nationally ranked in virtually every program they offer from physical therapy to their medical subspecialties and are 3rd in NIH funding for research behind only Duke and Vanderbilt.

    And that's the key. Nursing education, from undergrad to grad, if full of psycho-babble nonsense, but the core and important classes are there and at the end of the day, the right student can become a very strong mid-level.

    I agree completely. NP schools should follow the model(s) of CRNA education.
  41. Denatured

    Denatured

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    National ranking in US world news is bogus and is simply a popularity contest done by the schools themselves. The only one I've ever seen correct is USGPAN was number one for CRNA schools. After that, the list fell apart.

    BSN is little helpful as a practitioner. I was there at a top university where the lowest GPA was 3.6. Actually practice is by seeing sick patients and the different work ups that providers orders and asking their reasoning, but not undergrad. Hence why direct entry is a bad idea and again where the CRNAs got it right by requiring one year experience. PAs eventually up the ante as well by requiring residencies a minimum a year in length, which will be even more relevant to practice.

    Online NP schools are still easy to get into. Their quality in education is what is variable. I've experienced it, I see it with our young nurses who leave at astonishing rates and ask for recommendation letters, and I'll probably experience again when eventually go back to NP school online so I can have the independent practice I've equally earned.
  42. AnnoyedByFreud

    AnnoyedByFreud

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    I'm all for residencies. I also think that when one is choosing an NP program they should focus on ones that are part of or affiliated with larger medical institutions/hospitals. I think that can make a huge difference in the training, clinical opportunities available, etc.
  43. SouthSideSteve

    SouthSideSteve

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    god this makes me cringe.
  44. emedpa

    emedpa GlobalDoc2B2015

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    fair enough but I think at this point that is the future for both pa's and np's.
    look at the hx of md's over the last 150 years: generalist training (even apprenticeship) to formal training at approved schools to residency requirements to board cert requirements. PA's are walking the same path today. it used to be in the early days that you could graduate from pa school and practice then the nccpa came along with a required national exam then degree creep snuck in and most programs began the change to an ms level then the aapa sanctioned the ms standard. last year the nccpa introduced "optional" caq exams in the specialties. how long do you think they will be optional and how long before you need a pa residency to sit for a caq exam? the # of pa residencies is taking off. In em alone the # went from 5 or 6 a few years ago to 19 today. I know of several others in the works and there must be some I don't know about.
    at some point in the future I believe the path to working as a pa will include a residency and a board certification. it happened to the docs. the same pressures that affected them then affect us today.
  45. sarjasy

    sarjasy I have action potential

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    It's not just them, but the high levels of NIH and other federal funding they receive, regarded by many in academia as a mark of achievement. I never said I agreed, I just stated what is.

    And by what objective criteria did you determine they were correct? ;)

    And I never stated it was. That was totally not my point in any way shape or form. My point was that all health profession schools have become increasingly competitive - that's all. My point about the BSN had nothing to do with how good or bad such a degree was, only that entry into most BSN programs are now highly competitive (as are ADN programs).


    Back your statement up with some facts. You are implying that as a whole, online NP programs are easy entry. Maybe some specialties, certainly not FNP. I have contacted no fewer than 8 NP programs, many of which are online, and in the last couple of years they have all been swamped with applicants wanting to get into MSN programs before the DNP becomes the norm.
  46. Denatured

    Denatured

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    So you stated a point you didn't agree with?

    I based on the fact they graduate CRNAs that from day one after graduation can work independently. Not too mention independently in a combat zone.

    Neither of will ever post anything other than anecdote because there is no data to show those applied vs those accepted with applicant stats. But if you don't mind survey data, just go to allnurses, in the NP section, in the thread "are online schools hurting our reputation." You'll see plenty of NPs cursing diploma mills and online schools.

    Otherwise, we'll just have to agree to disagree since there is no data out there to support either of us.
  47. sarjasy

    sarjasy I have action potential

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    No. I don't know that I agree or disagree either way. I just stated a point. What little I've looked at with US News methodology for their rankings it looks halfway decent as a means for ranking schools, but I know that it is roundly criticized. I've not, however, looked at it enough to form an opinion one way or the other. I tend not to form opinions on things for which I know little about.

    The schools I have spoken with have given me their numbers. Of the schools I have spoken with, on average over the last couple of years, they've admitted somewhere between 20 and 40% of their applicants. That's not as competitive as most med schools or PA schools, but it is far from what you and JWK have suggested.

    I'd rather have a root canal. At least I wouldn't lose as many brain cells. ;)

    There are some crap schools out there, no doubt. But online does not automatically equal low quality. I actually believe there are some on this board that think there are schools that offer entire NP degrees online. So when people bash NP education here, I assume quite of bit of ignorance behind their posts (not saying you are one of those).
    Last edited: Jul 14, 2012
  48. SRNANUPE18

    SRNANUPE18

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    I'm not sure why anyone in nursing or considering nursing feel the need to explain anything to anyone! Nursing is a great profession to be apart of! There are no short cuts when you are in the hospital arena! All nurses have to perform! No matter if you are ADN/BSN/MSN fast track/online/direct-entry! No one is going to hold your hand. You have to be responsible and accountable. So please stop explaining yourself to the haters and spectators! Most people I know could never walk a mili-meter in a nurses shoes! They just would not do it!!! NOT NOW NOT EVER!
  49. Denatured

    Denatured

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    Not bashing anyone. My point from the beginning that they have things to work on. So do PA schools, so do CRNA, so does everyone. NP needs an experience requirement related to the field they chose, PA should have a required residency, CRNA needs to up the neuraxial and PNB requirements for graduation. These are just starters and only limited to education. They all have certain legislation that's needs to pass to maximize their potential. Not that they aren't do a fine job already, but improvements can always be made

    I'm by no means the end all be all authority. I'm for the betterment of all advanced practice clinicians and just call things like I see them.
  50. chimichanga

    chimichanga misunderstood

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    one view

    yet another

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