Advantages to having dual NP and CRNA degrees?

[chimichanga]

you decide

I know which one with whom I'd rather work...

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[PrinceVersed]

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.

1. I already said before you posted this that I am sure that MD's do in fact love NP's running around doing their scut work(H&P etc) while they(the MD) takes care of the pt.

2. I also agree that there are lots of sub par MD/DO. I agree that more education does not always mean a better provider. You are preaching to the choir. I too have about a billion stories of MD's flat out saying/doing stupid things. We are all human. None of us perfect. None of us can know everything. However, at least MD/DO schools seem to TRY and minimize the amount of dummies they get.

3. I know of a NP school right now that does not even interview applicants and accepts them with marginal to poor scores, and/or experience. The fact that even 1 school can get away without doing a personal interview just goes to show how competitive NP is not.

4. I do no make any of my statements based off of online postings. I have several years of health care experience. I know many NPs, MDs, RNs, CRNAs. I know people who have applied, been accepted and those who have completed NP school.

Sure lots of people talk big and never go through with it. But from what I have seen of NP there are very few deterrents that stop people from applying. I have seen many fill out their application at work, submit it to the school, and tell me a week or so later that they got in. They didn't have to prep for an interview to demonstrate their clinical knowledge, they did not have to score well on an entrance exam, they didn't have to spend money to fly off somewhere, they didn't even have to gain a minimum amount of experience. They only had to sign their name and mail it in.

The obstacles that would stop someone from flippantly applying to MD/DO, PA, CRNA, school are just not there, in my opinion, for NP schools. I don't know a thing about AA so I left it from the list so JWK won't get mad at me

 

[chimichanga]

An excerpt from a previous post (2008) from Sarj:

...about the DNP, it is an absolute waste of time for NP's. It is simply a way to, 1) generate revenue for the schools 2) give something to show legislators to expand APN scope of practice further and, 3) further the old, ongoing attempt to justify nursing as a profession independent of medicine.

The DNP is there simply to try to justify nursing as a practice/profession independent of medicine.

...but you do get relevant clinical exposure at the RN level, thus why the MSN is considered an extension of the RN. In a nursing, you get a lot of exposure to pharmacology, labs, therapies, treatment modalities, presentation/manifestations of disease, nonmedical management of illness, etc. all of which the smart RN can carry with them and build on in an advanced practice degree. In the end, however, it is advanced nursing practice....

...Likewise, when it comes to treating a sore throat, a URI, UTI, rash, etc., I don't think its that big of a deal...

I condensed some of this (old) post.

http://shine.yahoo.com/parenting/parents-11-old-died-sepsis-hospital-sent-son-183800609.html

 

[sarjasy]

The fact that even 1 school can get away without doing a personal interview just goes to show how competitive NP is not.

No, that would go to show how competitive 1 NP school is not.

Perhaps our definition of "competitive" is different. Competitive for me is a school that has more applicants than seats, by say, a 2:1 margin. I don't know how an interview has anything to do with that.

But from what I have seen of NP there are very few deterrents that stop people from applying. I have seen many fill out their application at work, submit it to the school, and tell me a week or so later that they got in.

A week?? Can't say I know of a single school than turns applications around that quickly.

 

[sarjasy]

An excerpt from a previous post (2008) from Sarj:

I condensed some of this (old) post.

http://shine.yahoo.com/parenting/parents-11-old-died-sepsis-hospital-sent-son-183800609.html

I really don't understand your point in quoting me in this thread. Nothing I said is relevant to the discussion at hand or is contradictory to anything I have said. You did, however, quote me completely out of context. You quoted me as saying...

"treating a sore throat, a URI, UTI, rash, etc., I don't think its that big of a deal."

...As if to imply that these are easy things to treat, after which you posted an article of a kid dying after a "simple" laceration. Next time you quote me, please put it in context an don't try to mislead other posters. Here is the full quote from which that phrase came.

"As for the use of 'doctor' in the clinical setting, I would never use it personally, but I don't see it as that big of deal. I don't know what standard practice is at eye clinics where opthamologists and optometrists work side by side, but I see a similar situation there. When it comes to refractions, who cares? Likewise, when it comes to treating a sore throat, a URI, UTI, rash, etc., I don't think its that big of a deal."

Look at the first sentence. I am saying use of the title 'doctor' is not that big of a deal. I am not saying treating a sore throat, a URI, UTI, rash, etc. is no big deal.

Ironic you posted an article in which two physicians missed the diagnosis. If the two were NP's, this board would blow up with everyone saying that the article is proof that NP's are poorly trained incompetent idiots.

 

[chimichanga]

The point I was making (though not clearly made), was that (seemingly) 'simple' (read: zebra) stuff can walk into anywhere, and a diploma mill NP is so much more likely to miss that kind of thing.

I know, as I have worked in ERs for 20+ years, and we have caught many a minute clinic's failure (read: solo NP staffed).

Have docs missed stuff in my experience?
Sure...

But in my (anecdotal, 22 years, in over 10 ERs) experience, solo, inexperienced NPs (versus collaboration, experienced ones) miss the (diagnosis) boat far more often than anyone else.

Just reading this thread, and then scanning some of your old posts, I got a sense of you wanting the fast track to the NP highway.
And no one can convince you otherwise.

What the hell do I know right, as you have said, my (years of) experience wouldn't help much when it comes to advanced practice

What, are you two years out of the RN program now?
I guess you have it figured out.

You chastise blue dog for his anecdotes, but you have your own ("Talking to 20+ NPs" is one of them, but I am too tired to find)

I have been teaching clinicals for many years (on the side), and have run into many students like you.

You probably have a great bedside work ethic, and I'd likely enjoy working alongside you (as a staff RN)
But you seem to despise the profession itself.

Interesting stuff, indeed.

Sorry for the out of context quote, but after reading this thread, and looking at your firsts posts, I felt a dichotomy in you, that's all, and a minimization for the importance (for future endeavors) that is bedside nursing.

May you be the exception (to the inexperienced NPs), not the rule.
Good luck in your future studies, and we can only hope you attend a traditional (not online) program, with a huge amount of valuable clinical time.
Peace

 

[sarjasy]

The point I was making (though not clearly made), was that (seemingly) 'simple' (read: zebra) stuff can walk into anywhere, and a diploma mill NP is so much more likely to miss that kind of thing.

The point that you were trying to make is that I think the "simple" is never more serious and is easy, requiring little training. That is the point you were trying to make, as evidenced by your lifting an out-of-context quote from one of my posts.

I know, as I have worked in ERs for 20+ years, and we have caught many a minute clinic's failures (read: solo NP staffed). It is the nature of the beast. The 2nd doc is always the smart one.

And in my 7 months of ER experience "we" have caught many a FP/urgent care/minute clinic's (read MD/DO) failure. What is your point?

But in my (anecdotal, 22 years, in over 10 ERs) experience, solo, inexperienced NPs (versus collaboration, experienced ones) miss the (diagnosis) boat far more often than anyone else.

And when have I EVER advocated for solo, inexperienced NP's? Please show me a post that I have argued for that (in context this time, please).

Just reading this thread, and then scanning some of your old posts, I got a sense of you wanting the fast track to the NP highway.
And no one can convince you otherwise.

Not surprising, considering how you have misread my previous posts. I don't care what you got a sense of, FWIW I will have 3+ years of RN experience when I graduate. My previous posts (if you will read them) state that there are certain NP specialties that benefit more than others from previous RN experience. My previous posts have outlined my belief that certain NP specialties benefit more from prior RN experience (e.g. acute care, psych) in that specialty more than others. But that experience is limited in its utility. There is only so much that one can learn as a med-surg RN that has any relevance whatsoever to being an FNP, for example, and it certainly doesn't take 10 years to gain it (as you have posted).

What, are you two years out of the RN program now?
I guess you have it figured out.

No. 7 months.

I have been teaching clinicals for many years (on the side), and have run into many students like you. You probably have a great bedside work ethic, and I'd likely enjoy working alongside you (as a staff RN)
But you seem to despise the profession itself.

Chimi, I'm sure you have forgotten more ER nursing experience than I will ever know. I am sure you are a fantastic nurse. And yes, I do have a great bedside ethic and in my limited 7 months of experience, I have had countless patients tell me so and even have a reputation in the ER as being the one to go to with the "difficult" patients (e.g. psych, pain med seekers, etc.). My point is, experience is limited - it only goes so far. As you well know, 80+% of the time you and I spend in the ER is task oriented and has little relevance to what a family NP (for example) does.

Experience is not irrelevant, and with some NP specialties, is highly relevant. But it is limited. Aptitude means as much - more actually. Ability. I can spend the next 10 years of my life going to an elite music school and playing in the New York Philharmonic, but I will NEVER be a good pianist. I don't have the aptitude. Likewise, someone with 20 years of RN experience may never be a good NP if that person doesn't have the aptitude. No amount of experience and training will fix that.

 

[AnnoyedByFreud]

meh

 

[AnnoyedByFreud]

1. I already said before you posted this that I am sure that MD's do in fact love NP's running around doing their scut work(H&P etc) while they(the MD) takes care of the pt.

2. I also agree that there are lots of sub par MD/DO. I agree that more education does not always mean a better provider. You are preaching to the choir. I too have about a billion stories of MD's flat out saying/doing stupid things. We are all human. None of us perfect. None of us can know everything. However, at least MD/DO schools seem to TRY and minimize the amount of dummies they get.

3. I know of a NP school right now that does not even interview applicants and accepts them with marginal to poor scores, and/or experience. The fact that even 1 school can get away without doing a personal interview just goes to show how competitive NP is not.

yeah and there are degree mills out there handing out doctoral degrees in psychology like they are candy. It doesn't make top psychology programs any less prestigious. I mean, I don't see how judging a field by its crappiest programs is helpful. I also have noticed that the market for NPs (especially around here) has seriously tightened up. Maybe it's because I'm in an area with several "brick and mortar" programs around, including a very prestigious institution. The online grads don't really get much of a chance. However, in the middle of nowhere Wyoming it might be a different story, especially if the individual has a lot of RN experience.

 

[chimichanga]

...My point is, experience is limited - it only goes so far. As you well know, 80+% of the time you and I spend in the ER is task oriented and has little relevance to what a family NP (for example) does...

You sound like me 20 years ago...

Believe what you will, but pt interaction (an art I used to really suck at- I actually believed a good ED nurse was defined by the skills alone) and so much more, far outweigh how well I can start an IV or triage quickly.

I now know better...And patients deserve more than a skill hound and a bookworm.

But good luck just the same. I'm sure you'll work it all out.

I left teaching and am going back to house supervision.

3 days a week, and a great paycheck. (No, the $$$ aren't what floats my boat. I loved teaching while making 48K, more than I ever loved ED nursing)

But house supervision (in most hospitals) pays better than staff NPs, and has no libility.

You can have the drug seekers and psych pts, whether they are in your ED bed, or 'your' clinic.
I gave them up for Lent


Late

 

[chimichanga]

And FWIW, I have an MS in psychology, and used to facilitate individual and group therapies (in my own clinic).

I have seen a lot of crazy **** (in my previous life, and in ER nursing).

I still don't feel I would be adequately prepared to see, diagnose, and treat patients.

Does it make me slow, or not ever equipped? (or without 'aptitude')

Hell no.

It's just that I believe, that's what medical school is for. To best prepare one to do those things.

Can (many) PAs and NPs do it?
Yes. But they're not the best at it.
That's all I'm trying to say.

My best friend is an FNP. He has said to me that, if able to do it over again, he would go to medical school. He wonders what he does not (or never will) know.

I have another friend who was an RN for 20 years,and is now an ED resident. He wanted to do it all the way.

Sure these are anecdotes, but it's all I got!

If I had a dime for every student (in my ten years of teaching clinicals) that was going to go to NP school right after their BSN, with little to no bedside experience, I would be a rich man. (I told every one of them to, at least, consider medical school, after working bedside as an RN for a couple of years)

And if I also had a dime for every NP that came back to the ER, to work as a staff RN (for various reasons, usually the better $$ at the bedside (registry, OT)..However, some states do not allow that anymore. It has become a one way door-something to think about)

In my (and for my family's) world, a physician is the only way to go, period.

And online NP education just cannot be the answer.

Standardization, and mandatory collaboration (after several years of bedside experience as an RN) are the only way to go.

Believe me, those 'difficult' drug seekers and psych patients at which you are so adept, will be a huge help as an FNP. Much more than you may realize now (of course the skills won't help at all, but that's not really the essence of a good (ED) RN.)

That's the stuff (in any kind of nursing, but seen so much in the ED) that experienced over and over, year after year, will make you a better NP. (coupled with thousands of clinical hours (not just work hours), and classroom education)

Bank on that one my friend.

 

[sarjasy]

I still don't feel I would be adequately prepared to see, diagnose, and treat patients.

Of course not. Not without additional training. But that's what an NP (or PA or MD/DO) program is for. 30 years of RN experience doesn't replace going through those programs.

That said, even after completion of such a program you may not be ready. That's not an insult. I can never be an award winning pianist or an NBA star, even with the finest training in the world. On the other hand, after training you may be top notch and surprise yourself.

Medicine requires a healthy amount of spatial and inductive reasoning, which are aptitudes which cannot be taught (you are born with them). They are not skills, which are learned. Nursing requires aptitudes as well. You yourself well-know that you can have 2 nurses, both who went to the same school together and have the same amount of experience, but one is the far better nurse. Why? Because the one has natural gifts (aptitudes) for nursing more so than the other one. All the experience in the world won't change that. Experience matters, but it is only a part of the whole.

Can (many) PAs and NPs do it?
Yes. But they're not the best at it. That's all I'm trying to say.

I agree. They're not supposed to be the best at it, MD/DO's are supposed to be. I am wholeheartedly opposed to mid-level independence (as I have stated repeatedly) except in very limited, specific settings in which I case I would still prefer some sort of physician oversight.

Sure these are anecdotes, but it's all I got!

Anecdotes are fine, so long as you are not trying to "prove" a ridiculous claim or make a ridiculous point.

 

[PrinceVersed]

Sarjasy, I hope you are the best NP in the world. Really. I hope they write books about you. Regretfully, I became a nurse. However, since I am one I would like for all of us (RN, NP, CRNA) to look good. As everyone knows it only takes a few bad apples to ruin all of the others. So I think we need to push for higher standards and more rigorous curriculum at all levels...especially NP haha.

And to stay on topic, NP/CRNA combo...I wouldn't

 

[deleted6669]

And to stay on topic, NP/CRNA combo...I wouldn't

the np/crna I know was an icu nurse for years, became an fnp and worked in the er for years, got burnt out and decided he liked people better who he didn't have to talk to so became a crna...seriously...he also works icu but most of his pts there don't talk either....

 

[PrinceVersed]

the np/crna I know was an icu nurse for years, became an fnp and worked in the er for years, got burnt out and decided he liked people better who he didn't have to talk to so became a crna...seriously...he also works icu but most of his pts there don't talk either....

Don't blame him at all. I don't mind them talking so much. Just not for 12hrs at a pop. Pre op and post op is just fine with me.

 

[jwk]

Perhaps our definition of "competitive" is different. Competitive for me is a school that has more applicants than seats, by say, a 2:1 margin.

That would be a pretty poor definition of competitive, unless you assume everyone that applies is qualified to begin with, which they won't be. Along with applicants who have stellar grades / test scores / LOR's will be the applicants at the other end of the bell curve that basically suck and weren't really qualified to apply, but took a shot anyway.

Competitive is when you start having to tell even your really good applicants NO, sorry, not this time. That happens frequently in good schools - it happens rarely in lousy schools, and even less in online-only programs.

 

[PrinceVersed]

That would be a pretty poor definition of competitive, unless you assume everyone that applies is qualified to begin with, which they won't be. Along with applicants who have stellar grades / test scores / LOR's will be the applicants at the other end of the bell curve that basically suck and weren't really qualified to apply, but took a shot anyway.

Competitive is when you start having to tell even your really good applicants NO, sorry, not this time. That happens frequently in good schools - it happens rarely in lousy schools, and even less in online-only programs.

+1. good call

 

[sarjasy]

That would be a pretty poor definition of competitive, unless you assume everyone that applies is qualified to begin with, which they won't be.

So, let me see if I understand. Per you, I'm assuming that the half that don't get in are competitive yet you know they are not? How is it that I am assuming, but you are not?

 

[sarjasy]

edit

 

[sarjasy]

However, since I am one I would like for all of us (RN, NP, CRNA) to look good. As everyone knows it only takes a few bad apples to ruin all of the others. So I think we need to push for higher standards and more rigorous curriculum at all levels...especially NP haha.

No disagreement from me. I think nursing (and for that matter, medical, PA, etc.) education needs to improve beginning at the undergrad level. In the last decade, two or three, health care and medicine has become increasingly complex requiring more and more knowledge and skill, yet so much of the provider's education is spent on nonsense while ignoring more important stuff. But the behemoth that is academia is slow to move and respond.

There was once a time that taking someone's blood pressure was considered to be the practice of medicine, and nurses weren't allowed (some things have never changed) . God forbid that someone other than a properly trained physician take a blood pressure! Now CNA's do it. At the same time, you can't get into med school without physics II (and studying the propagation of heat energy through a metallic surface) - that really helps dx bipolar or a patent ductus arteriosus, huh? At the same time, you have nursing talking about "disturbed energy fields" (an official nursing dx). Polar opposites, yet both are missing the mark.

It seems my existence and identity on this board has become to prove a need/role for NP's. That's never why I became part of this board. Yet so many have agendas, biases, and points to prove that they'd rather engage in pissing contests than fix problems and looks at things objectively.

 

[PrinceVersed]

Trust me, dude, if I could fix things I would. And I would most def start with my OWN field, which is not NP. ha

 

[deleted6669]

No disagreement from me. I think nursing (and for that matter, medical, PA, etc.) education needs to improve beginning at the undergrad level.

PA education at the undergrad level is already fairly streamlined to a future in medicine. most programs want bio, gen. chem, microbio, psych, and a+p. some want o-chem, biochem, and genetics. very little fluff in pa prereqs for most institutions. also very little fluff in a typical pa program these days. there are a few required touchy/feely courses but these are done by all health professionals nowadays. many pa students have done these courses in their prior training and just breeze through them the second(or third) time around...

 

[jwk]

So, let me see if I understand. Per you, I'm assuming that the half that don't get in are competitive yet you know they are not? How is it that I am assuming, but you are not?

Typical liberal assumptions - now I understand. Everyone is competitive because everyone deserves an A in class because they worked hard. Every kid deserves a trophy because they tried hard, even if they sat on the bench. There are no winners or losers in life.

Do you really believe that ONLY those who are competitive applicants apply to a given program, which would imply that all applicants are essentially equal? How does one choose whom to admit, or not?

 

[sarjasy]

Typical liberal assumptions - now I understand.

Please. I make George Will look like a leftist.

Everyone is competitive because everyone deserves an A in class because they worked hard. Every kid deserves a trophy because they tried hard, even if they sat on the bench. There are no winners or losers in life.

How you come up with that from my post is beyond me. FWIW, many of my professors in my BSN school adjusted the Bell curve from test to test to ensure that 10% or less got an A for the course.

Do you really believe that ONLY those who are competitive applicants apply to a given program, which would imply that all applicants are essentially equal?

Of course not. Do you really believe that none of the 50% denied would be qualified?