So Glad I Found This Site (Literate NPs!!)

[RedCole]

Hello everyone,

I'm an RN, new to this website obviously. I'm very interested in becoming an NP, but have been doing all of my research on a very well known nursing forum. Needless to say, I've been terrified. I thought the NPs there were representative of ALL NPs, and I had pretty much decided to just skip the NP thing. I mean, they come across as extremely unintelligent, horrible grammar and spelling, and always clamoring on about the cheapest, fastest programs with no regard to quality (they all seem to LOVE for profit programs such as Walden and Phoenix as well).

I've been lurking here since this morning reading through threads, and the NPs that post here seem so much more informed. You guys seem to realize how bad the for profits are, you understand program quality, and you generally agree that NP education is not generalized enough, the exam isn't clinical enough, clinical hours need to be increased, the DNP is a joke, and residency needs to be more common. Right?

Anyway, just glad I found this place. I hope to find out some more information from you guys as I choose a program and go on to graduate school. For example, which programs are actually GOOD and not full of fluff nursing courses?

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[pamac]

Hello everyone,

I'm an RN, new to this website obviously. I'm very interested in becoming an NP, but have been doing all of my research on a very well known nursing forum. Needless to say, I've been terrified. I thought the NPs there were representative of ALL NPs, and I had pretty much decided to just skip the NP thing. I mean, they come across as extremely unintelligent, horrible grammar and spelling, and always clamoring on about the cheapest, fastest programs with no regard to quality (they all seem to LOVE for profit programs such as Walden and Phoenix as well).

I've been lurking here since this morning reading through threads, and the NPs that post here seem so much more informed. You guys seem to realize how bad the for profits are, you understand program quality, and you generally agree that NP education is not generalized enough, the exam isn't clinical enough, clinical hours need to be increased, the DNP is a joke, and residency needs to be more common. Right?

Anyway, just glad I found this place. I hope to find out some more information from you guys as I choose a program and go on to graduate school. For example, which programs are actually GOOD and not full of fluff nursing courses?

I don't think the DNP is a joke if you know what it's really geared for. If you are lookig at it from the outside and think its a way for nurses to replace doctors, then it would seem problematic. And if you are an NP who just wants to practice in a clinical role, then it probably seems unnecessary as well. I don't want to get one, and the np school I want to attend wont require me to pursue that path, but I see how it could be helpful to a career to have one.

Incidentally, I don't think many females post here much as opposed to all nurses. That could explain some of the differences in what you see, as makes and females sometimes view things differently. Maybe that's what you are seeing.

 

[AnnoyedByFreud]

Unfortunately, OP, you will find this forum isn't a good place for finding NPs or NP students. There are only a few of us here, and you will find a very heavy anti-NP and anti-nursing bias throughout this site. On the other hand, I agree with you about allnurses being a pit. Also, not all fluff coursework is useless, though I agree that there is too much of it in NP education. Classes on leadership and policy are actually beneficial, depending on your career goals and I think that the inclusion of such coursework is helpful for moving the field forward. One cannot overestimate the importance of being able to lobby and effectively change policy for you own benefit.

 

[RedCole]

Hm..so where do thoughtful, educated NPs go to have discussions? All nurses seems to attract illiterate Phoenix grads and this place is anti-NP..? Is there an NP forum somewhere? PAs have their own forum :/

Bleh. I do very much dislike the field of nursing. So much fluff, no substance. I've been looking everywhere for an NP program with even a gross anatomy component..or a skills lab...or..anything really.

I do think NPs and PAs are equal after about 3-4 years on the job (since you learn the most there) so I'm willing to go to NP school anyway based on that...but new grad NP vs PA is no contest..why has NO nurse practitioner program taken it upon themselves to make a quality program based on the PA model. Actual science courses, instead of 50% of the courses being research and nursing theory. I think it should be sort of like:

Semester 1:
Gross Anatomy
Pathophysiology I
Health Assessment I
Nursing Leadership

Semester 2:
Pathophysiology II
Pharmacology I
Evidenced Based Practice
Health Assessment II

Semester 3:
Family Practice: Adults
Family Practice: Adults Practicum (225 hours)
Pharmacology II
Physical Diagnosis I

Semester 4:
Family Practice: Pediatrics
Family Practice: Pediatrics Practicum (225 hours)
Skills and Procedures
Skills and Procedures: : Lab

Semester 5:
Family Practice: Women's Health
Family Practice: Women's Health Practicum (225 hours)
Physical Diagnosis II
Nurse Practitioner: Transition to Practice

Semester 6:
Family Nurse Practitioner Capstone Practicum (500 hours)


Isn't that sexy looking!? What I wouldn't do to find something similar to that...sigh. Instead I find:

NUR 603 - Nursing Theory (3) - CRAP
NUR 605 - Nursing and Information Technology (2) - CRAP
NUR 610 - Concept Analysis 1 (3) (*45) - CRAP
NUR 611 - Concept Analysis 2 (3) (*45) - CRAP
NUR 614 - Concept Analysis 3 (3) (*45) - CRAP
NUR 630 - Clinical Role (3)
NUR 632 - Pathophysiology (3)
NUR 634 - Advanced Health Assessment (3) (*90 clinical hours, 1 day per week average)
NUR 638 - Advanced Clinical Pharmacology (3)
NUR 672 - Role Expectations (4) (*225 clinical hours, 2 days per week average)
NUR 680 - Advanced Care of Adults (7) (*240 clinical hours, 2 days per week average)
Total - 37 credit hours

Family Nurse Practitioner Primary Care courses include:
NUR 682 - Primary Care of Children (4) (*120 clinical hours, 1 day per week average)
NUR 684 - Primary Care of Women (3) (*60 clinical hours)

 

[AnnoyedByFreud]

I'm surprised you can't find a NP program with a skills lab. My program has one (for both RN and NP level), though I suppose it isn't advertised. Also, the content of NP classes can be hard to tell from course titles. If I were you, I would call the schools I am interested in and inquire further about the didactic and clinical coursework to get an idea. Or just go to PA school if you don't want a nursing education. I disagree that there is no substance to nursing, though I do think the variability in education is a problem. There are great NP programs and then there are terrible ones. Definitely do your homework before deciding on a program.

Also, regarding AN.com, do keep in mind that 50% of nurses have an associates degree as their highest level of education. I took an issues in nursing course last spring (which was surprisingly meaningful and beneficial, despite the "fluffy" title) and I find the changing demographics of nursing fascinating. I had no idea that so many nurses only had an associates level education. It puts some of the inanity and grammatical errors on that forum into perspective.

 

[RedCole]

I see your point. But they don't advertise the skills labs and courses...and online NP programs have NO skills training at all...and considering a recent study found nearly 70% of NPs go to an online program it doesn't bode well..

I don't think all NP education is bad, just most of it. And as for the illiterate AN posters - I was talking about the people who are actually already NPs. *SIGH*

Freud, do you know of good programs? Wanna PM me?

 

[AnnoyedByFreud]

I'd love to see the study about online NP programs, if you have a link handy. In terms of good programs, it's hard to say since I am not in the FNP specialty, so I did not research those programs. I can PM you my program, because I believe it has an excellent reputation for FNP, from what I've heard.

 

[Divergent]

Just because you're a nurse doesn't mean you have to do NP. There are many nurses that go on to PA school because that's what they're interested in.

I personally considered PA and nursing, and will be applying to BSN programs next year. As far as the NP education, I think that you have to find programs that offer what you desire. For me, I've seen many Acute Care NP programs that have what I desire (required acute/critical care RN experience prior to entry, traditional on-site program, 1000+ clinical hours (these are DNP programs), and radiograph interpretation training, in addition to the other skills and procedures learned). I think you just have to do some research if NP is still on your radar. As already mentioned, many of the science courses are hidden under vague names. For example, at UPENN, in "Principles of Adult Gerontology Acute Care I", you cover the assessment, diagnosis, management and evaluation of diseases and disorders of the cardiovascular and pulmonary systems, infectious and prevention issues. In Principles II, you cover neurologic, gastrointestinal, renal, oncologic, and metabolic health problems. Etc. And that's in addition to the core of Advanced Physiology and Pathophysiology, Advanced Pharmacology and Therapeutics, and Advanced Physical Assessment and Clinical Decision making. UCSF has separate courses on Medical Genetics, Human Genomics, Genomics Skills Lab, Advanced Diabetes Management, Chest X-ray Interpretation, Clinical Electrocardiography, Infectious Diseases, etc. Johns Hopkins Advanced Diagnostics and Therapeutics course has skills training in interpretation of radiographs, EKGs, suturing, intubation, insertion of invasive lines, etc. Many if not most nursing schools have similar offerings at the APN level. So, find schools that you're interested in, look through course descriptions, and you'll see many that have similar offerings to PA schools, with different course titles.

As far as gross anatomy, yes, that would definitely be great to have. It seems that Nurse Anesthesia programs are the only APN programs that have gross anatomy, so maybe you could take it as an elective, not sure. OR, you can always do PA school if that's what you're really attracted to.

 

[deleted6669]

yup, there are some strong np programs out there like U.WA but you need to make sure they offer enough clinical hours(hopefully > 1000) and an adequate medical science background with coursework in physiology, pharamacology, etc.
I work with a few great NPs. none of them did online programs and all of them were actual nurses for 10+ years.
also, as above, PA is a great option as an RN and not as uncommon as you might think. lots of surgical pas were former surgical nurses.

 

[RedCole]

In my neck of the woods all the PA programs are insanely expensive...like 80-100K. The NP programs are 30-45K. Otherwise I'd do PA. And all the "good" NP programs are private or out of state, so also getting up in the 75K range.

Are there any affordable GOOD programs? With proper procedure training and education?

 

[zenman]

What NP specialization are you considering?

 

[RedCole]

What NP specialization are you considering?

FNP, with a practice goal of fast-track ED/urgent care center. I would get bored in a family practice (too slow), and want more of an acute setting where I would do more procedures (sutures, setting bones, etc) and see wide variety of patients. I don't necessarily want ED because it's a little TOO acute and I'd feel uncomfortable as an FNP in an ED setting.

So I think FNP, then possibly a residency in emergency care if I can find one, then on to an urgent care center.

 

[Makati2008]

FNP, with a practice goal of fast-track ED/urgent care center. I would get bored in a family practice (too slow), and want more of an acute setting where I would do more procedures (sutures, setting bones, etc) and see wide variety of patients. I don't necessarily want ED because it's a little TOO acute and I'd feel uncomfortable as an FNP in an ED setting.

So I think FNP, then possibly a residency in emergency care if I can find one, then on to an urgent care center.

I don't foresee a PA/NP setting bones in UC that's more of an ED thing or has that changed?

 

[acceptmeplease]

I'm surprised you can't find a NP program with a skills lab. My program has one (for both RN and NP level), though I suppose it isn't advertised. Also, the content of NP classes can be hard to tell from course titles. If I were you, I would call the schools I am interested in and inquire further about the didactic and clinical coursework to get an idea. Or just go to PA school if you don't want a nursing education. I disagree that there is no substance to nursing, though I do think the variability in education is a problem. There are great NP programs and then there are terrible ones. Definitely do your homework before deciding on a program.

Also, regarding AN.com, do keep in mind that 50% of nurses have an associates degree as their highest level of education. I took an issues in nursing course last spring (which was surprisingly meaningful and beneficial, despite the "fluffy" title) and I find the changing demographics of nursing fascinating. I had no idea that so many nurses only had an associates level education. It puts some of the inanity and grammatical errors on that forum into perspective.

I only have an ADN, but I have a B.S. in biology with a minor in chemistry. The BSN skill difference, however, is nonexistent. My program had nearly 200 more clinical hours than the local BSNs. I do agree that more GER classes should be required. Technical writing was probably one of the most useful classes I've ever had.

 

[deleted6669]

I don't foresee a PA/NP setting bones in UC that's more of an ED thing or has that changed?

I work some shifts in our affiliated urgent care and reduce boxers fxs, shoulder dislocations, simple distal radius fxs , etc there with regional and hematoma blocks. no procedural sedation there as we don't have R.T. around.

 

[deleted6669]

So I think FNP, then possibly a residency in emergency care if I can find one, then on to an urgent care center.

there are only 1-2 np em residencies that I know of and 19 for PAs with a few more opening every year....EM is strongly a pa dominated field, almost as much as surgery.

 

[Divergent]

An ER nurse I used to work with finished her Acute Care NP program and is now working as an Emergency NP at UMaryland (main ER and fast track). That would only make sense if the hospital you work at has separate adult and pediatric ERs. There are also a number of Emergency NP programs that seem to combine either the Family and Acute Care NP programs, or are a Family NP program with additional specialization in Emergency management, including clinical rotations focused on ED and urgent care.

After that, it does depend on where you work. As mentioned, Maryland has NPs in the ER. My hospital has PAs in the ER. Some hospitals may limit the NPs and PAs to fast track (which may be what you're interested in), or to certain types of presentations, while the others go to the residents or attending. Really depends on the hospital.

Sample programs:

http://www.nursing.vanderbilt.edu/msn/enp.html
http://sn.rutgers.edu/academics/masters/FHNPEmergency/
http://www.nursing.emory.edu/admission/masters/specialties/emergency_np.html

 

[deleted6669]

At our facility PAs work in main and fnps are restricted to fast track.

 

[RedCole]

At our facility PAs work in main and fnps are restricted to fast track.

Fast track/urgent care is what I want I believe. Fast track is typically non life threatening but still acute, yes? For example, foreign body removal, sutures, etc. Of course, I expect a fair share of sore throats and colds too, but acute stuff DOES happen in fast track, right?

If so, then I definitely am looking to do fast track or urgent care. Would an FNP work for this? I feel Acute care NP won't work because I will likely need to see children. If I do FNP, could I get this sort of position right out of school or is that unlikely?

 

[acceptmeplease]

Fast track/urgent care is what I want I believe. Fast track is typically non life threatening but still acute, yes? For example, foreign body removal, sutures, etc. Of course, I expect a fair share of sore throats and colds too, but acute stuff DOES happen in fast track, right?

If so, then I definitely am looking to do fast track or urgent care. Would an FNP work for this? I feel Acute care NP won't work because I will likely need to see children. If I do FNP, could I get this sort of position right out of school or is that unlikely?

At our ER FNP works fast track. Not sure about experience required though.

 

[deleted6669]

I think acute care NPs can see kids, right?
that or fnp would be ok.
for the most part if really sick folks end up in fast track(and it happens often) it is because of bad triage and as soon as you identify them as sick they get moved elsewhere.
urgent care can have higher acuity than fast track because pts self select to be there.
what they think is "indigestion" can easily be an MI. I worked an urgent care shift last week and had a pt with acute anaphylaxis, 1 with DKA, and 2 chest pains suspicious for angina.

 

[pamac]

At our facility PAs work in main and fnps are restricted to fast track.

And where I'm at, it was the opposite, until PAs were phased out altogether. They weren't "independent providers", and the docs weren't interested in supervising folks they never saw because of the rotation and scheduling. NPs mostly man the fast track now, and PAs were cut loose to find other employment opportunities.

 

[deleted6669]

And where I'm at, it was the opposite, until PAs were phased out altogether. They weren't "independent providers", and the docs weren't interested in supervising folks they never saw because of the rotation and scheduling. NPs mostly man the fast track now, and PAs were cut loose to find other employment opportunities.

as we have discussed before, there are places that use and prefer NPs in em but PAs outnumber nps NATIONALLY in em by probably 10:1 despite the fact that overall there are 3 NPs out there for every PA.
if we were looking at psych we would see 10 nps for every PA. yes, there are np jobs out there in em and surgery but the path of least resistance to these specialties is PA.

 

[badasshairday]

And where I'm at, it was the opposite, until PAs were phased out altogether. They weren't "independent providers", and the docs weren't interested in supervising folks they never saw because of the rotation and scheduling. NPs mostly man the fast track now, and PAs were cut loose to find other employment opportunities.

What part of the country is this? I can say from the midwest great lakes region and California this is very uncommon.

 

[RedCole]

So back to my original question:

for independent urgent care centers (my dream job) - does NP or PA make more sense? Keep in mind I'm already an RN

 

[pamac]

So back to my original question:

for independent urgent care centers (my dream job) - does NP or PA make more sense? Keep in mind I'm already an RN

They both are about the same there.

As far as the 10:1 pa vs np ratio, I'd like to see the hard numbers on that. I'm sure PAs are more represented in ER, but 10:1? But ultimately, both PAs and NPs are outnumbered by physicians in ERs across the country.

 

[pamac]

So back to my original question:

for independent urgent care centers (my dream job) - does NP or PA make more sense? Keep in mind I'm already an RN

They both are about the same there.

As far as the 10:1 pa vs np ratio, I'd like to see the hard numbers on that. I'm sure PAs are more represented in ER, but 10:1? But ultimately, both PAs and NPs are outnumbered by physicians in ERs across the country.

 

[deleted6669]

As far as the 10:1 pa vs np ratio, I'd like to see the hard numbers on that. I'm sure PAs are more represented in ER, but 10:1? .

I know for a fact that there are 10,000 EM PAs and that doesn't count PAs working in urgent care.
are there more than 1,000 em nps nationally?
I know there are pockets of NP strength like northern CA(specifically SF bay area), but even there PA jobs are available if you look outside of HMO's and look instead to hospitals that are staffed by independent em physician groups like at highland in oakland, etc

 

[Divergent]

yup, there are some strong np programs out there like U.WA but you need to make sure they offer enough clinical hours(hopefully > 1000) and an adequate medical science background with coursework in physiology, pharamacology, etc.
I work with a few great NPs. none of them did online programs and all of them were actual nurses for 10+ years.
also, as above, PA is a great option as an RN and not as uncommon as you might think. lots of surgical pas were former surgical nurses.

I agree. I think that with the growing number of post-bachelors DNP programs, it will be much more common for NP programs to have 1000+ clinical hours, thankfully. Also, I believe that all NP programs will have the advanced physiology and pathophysiology, advanced pharmacology, and advanced health assessment core courses, in addition to the medical science courses (frequently with ambiguous titles like "Adult Health I, II, III", "ACNP I, II, III", etc). The jury's still out on online/distance learning formats. I personally am not interested in such programs, but maybe it works (obviously clinical rotations and skills labs are done onsite in those programs)?

 

[deleted6669]

I personally am not interested in such programs, but maybe it works (obviously clinical rotations and skills labs are done onsite in those programs)?

all schools have in person clinicals but many of the online programs allow/require folks to find their own sites and preceptors. this can be good or bad. if you do all of your clinical time with your uncle fred the fp doc you probably don't get a well rounded clinical experience.
also some programs have VERY limited on campus time like 1 week/yr x 2 years.

 

[AnnoyedByFreud]

all schools have in person clinicals but many of the online programs allow/require folks to find their own sites and preceptors. this can be good or bad. if you do all of your clinical time with your uncle fred the fp doc you probably don't get a well rounded clinical experience.
also some programs have VERY limited on campus time like 1 week/yr x 2 years.

And this is what scares me. I don't care about coursework being online. Watching a lecture in class or in your home should make no difference. I know a med student who never attends class, he just watches lectures/reads the book/reads the powerpoint at home on his own time. He's doing just fine. However, having to find your own clinical preceptor is a nightmare. How does the university know if their student actually learned anything? Or if the preceptor is able to teach? I mean, what if they're completely incompetent? Just because you have a license doesn't mean you can teach. It seems hugely problematic to me and I'm shocked that NP programs get away with it.

 

[RedCole]

And this is what scares me. I don't care about coursework being online. Watching a lecture in class or in your home should make no difference. I know a med student who never attends class, he just watches lectures/reads the book/reads the powerpoint at home on his own time. He's doing just fine. However, having to find your own clinical preceptor is a nightmare. How does the university know if their student actually learned anything? Or if the preceptor is able to teach? I mean, what if they're completely incompetent? Just because you have a license doesn't mean you can teach. It seems hugely problematic to me and I'm shocked that NP programs get away with it.

I have to say, this is my biggest issue with online programs...and the problem is actually expanding. For most schools, nurse practitioner programs are simply cash cows. I don't see the same sort of student investment I see in PA and MD programs, but rather schools taking advantage of students and charging as much tuition as they can without adequate preparation. I mean, I've looked at schools where the cost per credit for an MSN-NP program is DOUBLE that of the PA program. How is that possible?? Especially considering PAs get such a better (and likely more expensive) education! Now, with so many online programs having students bust down the doors for admission, DESPITE not arranging clinicals, some brick and mortar programs are starting to do the same! In my area, I've looked at all the NP programs in a 50 mile radius: two of them say they do not arrange clinical rotations and that classwork is primarily online, even if the student lives nearby. Wtf?

I feel the reality, as I said before, is that most schools just want to make money off of nurses. They offer the classes online and don't arrange clinical rotations for students because these are cost saving measures. It's downright disgusting - in the end, an NP student is mostly paying for "access" to a bunch of posted online lectures and the ability to acquire an MSN after 2-3 years. What else does the school provide?? They barely want to do lab time at this point! I also feel the DNP (which is a useless research based degree until the beef it up) is just another way for schools to get tuition money.

Now, having had my mini rant, I will likely attend an online NP program myself. Why? Because many of the top 25 ranked NP programs in the country are now offered online. I do believe lectures at home vs in person don't make much difference, and considering the local schools seem to operate no differently than the online programs, yet cost 2-3x the cost of some of them, I will take my chances. Hopefully I will be able to find a very experienced NP who works in an urgent care or ED, as that is what I want to do upon graduation.

God help me.

 

[Divergent]

all schools have in person clinicals but many of the online programs allow/require folks to find their own sites and preceptors. this can be good or bad. if you do all of your clinical time with your uncle fred the fp doc you probably don't get a well rounded clinical experience.
also some programs have VERY limited on campus time like 1 week/yr x 2 years.

Completely agreed. Those schools seem to be money schemes. I think they say more about the money game than about online NP programs per se, but they probably ruin it for the actual good online programs. Georgetown, for example, seems to have a well-run online program that recently graduated its first cohort of students, and has a program-managed/approved clinical placement policy :

http://nhs.georgetown.edu/news/online-nursing-first-graduating-cohort
http://online.nursing.georgetown.edu/academics/clinical-placement/

 

[deleted6669]

a few PA programs are going to some online content. can't say I'm a fan of that either.
as other posters above have said, the clinicals make the program. make sure yours are good whether you do PA or NP.

 

[AnnoyedByFreud]

Completely agreed. Those schools seem to be money schemes. I think they say more about the money game than about online NP programs per se, but they probably ruin it for the actual good online programs. Georgetown, for example, seems to have a well-run online program that recently graduated its first cohort of students, and has a program-managed/approved clinical placement policy :

http://nhs.georgetown.edu/news/online-nursing-first-graduating-cohort
http://online.nursing.georgetown.edu/academics/clinical-placement/

The sad thing is that many non-for profits don't provide preceptors for NP students as well. This includes reputable schools, even brick and mortar ones! Depressing as hell. In fact, there are now businesses cropping up that charge NP students to help them find preceptors. Pathetic!

 

[ChillyRN]

Unfortunately, OP, you will find this forum isn't a good place for finding NPs or NP students. There are only a few of us here, and you will find a very heavy anti-NP and anti-nursing bias throughout this site. On the other hand, I agree with you about allnurses being a pit. Also, not all fluff coursework is useless, though I agree that there is too much of it in NP education. Classes on leadership and policy are actually beneficial, depending on your career goals and I think that the inclusion of such coursework is helpful for moving the field forward. One cannot overestimate the importance of being able to lobby and effectively change policy for you own benefit.

I was banned from AN. I never joined Clinician 1 because I can't remember my NPI number, lol. So when I have time for internet chatter, this is it. I ignore the NP/DNP bashing. I remember too, that I am probably 30 years older than a lot of the med students here and our age differences give us a widely different perspective on many things. I have children their ages, and I don't always agree with my kids either, but they often have good points sometimes and I do learn from them. The same can be said for SDN posters, even when we have opposing views.

I loved my NP education, and I loved my DNP education. There were so many interesting things to study! I loved it all: pharm, patho, policy, public health, leadership.- every bit of it. I went to a great school and had really great professors. I miss being in school and I wish I could go back and do it again actually. I told my husband I wanted to do a PhD just so I could go back to school, I miss it so much. He and the kids objected, rather strenuously. I didn't suffer through school, but truth be told, they all did. I just went to a family medicine conference that was really terrific, but it was only 5 days, and I missed more things than I attended, since there are so many concurrent offerings and you can only be in one session at a time. That just isn't the same.

I think being a college or graduate student is such a privilege that it is just a shame to squander the opportunity and not make the very most of it. Considering how few really get the opportunity! Going to Phoenix or the like just seems like going through the motions, doing the bare minimum. That is antithetical to the true purpose of post secondary education in my mind. I guess to me it was never about just doing what was necessary to get a degree, pass boards and become licensed so as to get "a job." It was always more about personal growth. It wasn't a means to an end; the journey was even more important than the destination. I still feel that way even though I'm no longer a formal student.

So I would say to you when choosing an educational path, choose the one that sings to you. Visit campuses, talk to faculty, students, staff. In the end, go to the school and program that feels right. Some things cannot be over analyzed, they just have to be experienced and felt in the gut to be understood in the mind and heart. I think picking a graduate school is one of those things.

Good luck!

 

[deleted6669]

you can look up your npi # online. clinician 1 is actually worth joining. they post lots of new research and everyone there is an actual licensed medical professional.
just do a search for chilly rn npi # and it will pop up. it's public information.

 

[AnnoyedByFreud]

I was banned from AN. I never joined Clinician 1 because I can't remember my NPI number, lol. So when I have time for internet chatter, this is it. I ignore the NP/DNP bashing. I remember too, that I am probably 30 years older than a lot of the med students here and our age differences give us a widely different perspective on many things. I have children their ages, and I don't always agree with my kids either, but they often have good points sometimes and I do learn from them. The same can be said for SDN posters, even when we have opposing views.

I loved my NP education, and I loved my DNP education. There were so many interesting things to study! I loved it all: pharm, patho, policy, public health, leadership.- every bit of it. I went to a great school and had really great professors. I miss being in school and I wish I could go back and do it again actually. I told my husband I wanted to do a PhD just so I could go back to school, I miss it so much. He and the kids objected, rather strenuously. I didn't suffer through school, but truth be told, they all did. I just went to a family medicine conference that was really terrific, but it was only 5 days, and I missed more things than I attended, since there are so many concurrent offerings and you can only be in one session at a time. That just isn't the same.

I think being a college or graduate student is such a privilege that it is just a shame to squander the opportunity and not make the very most of it. Considering how few really get the opportunity! Going to Phoenix or the like just seems like going through the motions, doing the bare minimum. That is antithetical to the true purpose of post secondary education in my mind. I guess to me it was never about just doing what was necessary to get a degree, pass boards and become licensed so as to get "a job." It was always more about personal growth. It wasn't a means to an end; the journey was even more important than the destination. I still feel that way even though I'm no longer a formal student.

So I would say to you when choosing an educational path, choose the one that sings to you. Visit campuses, talk to faculty, students, staff. In the end, go to the school and program that feels right. Some things cannot be over analyzed, they just have to be experienced and felt in the gut to be understood in the mind and heart. I think picking a graduate school is one of those things.

Good luck!

Thanks for this post, ChillyRN. I find what you have to say really inspiring. I'm at the very beginning of my MSN program, and I'm at a very reputable school as well. My goal is to get the very most out of it as possible. I was wondering if you have any advice for how to get the most out of a program? I'm particularly interested in integrative care (I'm in a psych NP program), especially regarding patients w/diabetes and mental illness. I'm hoping to get involved in that area of work and I think it would be a good topic for my thesis. Plus it seems to dovetail with where we are heading once the ACA is implemented...

 

[joeDO2]

Going to Phoenix or the like just seems like going through the motions, doing the bare minimum. That is antithetical to the true purpose of post secondary education in my mind. I guess to me it was never about just doing what was necessary to get a degree, pass boards and become licensed so as to get "a job." It was always more about personal growth. It wasn't a means to an end; the journey was even more important than the destination. I still feel that way even though I'm no longer a formal student.

thank you. wish more thought like this.

 

[priorities2]

And this is what scares me. I don't care about coursework being online. Watching a lecture in class or in your home should make no difference. I know a med student who never attends class, he just watches lectures/reads the book/reads the powerpoint at home on his own time. He's doing just fine. However, having to find your own clinical preceptor is a nightmare. How does the university know if their student actually learned anything? Or if the preceptor is able to teach? I mean, what if they're completely incompetent? Just because you have a license doesn't mean you can teach. It seems hugely problematic to me and I'm shocked that NP programs get away with it.

A few generations of NPs later, the majority will have gone thru random community, non-school sponsored clinicals...10 years from now, 20 years from now, it could be a completely unregulated bunch of NPs in terms of clinicals.

 

[RedCole]

A few generations of NPs later, the majority will have gone thru random community, non-school sponsored clinicals...10 years from now, 20 years from now, it could be a completely unregulated bunch of NPs in terms of clinicals.

Disagree. All newer professions go through growing pains. Ever heard of the Flexner Report? As recently as the early 1900s, Abraham Flexner examined medical school education in the US and found it woefully inadequate. He said schools were graduating too many physicians, the education wasn't long enough, the admissions standards were extremely poor, etc. This report caused a large number of MD schools to eventually close and established the medical school models we have today.

I think eventually, NP schools will have their own Flexner equivalent. Someone will "expose" the holes in the NP curriculum and the lack of well regulated clinicals. To avoid losing the public's confidence, the nursing boards will institute new accreditation standards requiring more science courses, more clinical hours (sponsored by the schools), etc. They may even outlaw online programs. I think this will cause many of the for-profits to close (due to lack of profitability) and leave the profession better off as a whole.

 

[pamac]

Disagree. All newer professions go through growing pains. Ever heard of the Flexner Report? As recently as the early 1900s, Abraham Flexner examined medical school education in the US and found it woefully inadequate. He said schools were graduating too many physicians, the education wasn't long enough, the admissions standards were extremely poor, etc. This report caused a large number of MD schools to eventually close and established the medical school models we have today.

I think eventually, NP schools will have their own Flexner equivalent. Someone will "expose" the holes in the NP curriculum and the lack of well regulated clinicals. To avoid losing the public's confidence, the nursing boards will institute new accreditation standards requiring more science courses, more clinical hours (sponsored by the schools), etc. They may even outlaw online programs. I think this will cause many of the for-profits to close (due to lack of profitability) and leave the profession better off as a whole.

I think you'd have to make the case that there is widespread malpractice taking place among NPs. I'm not sure it's out there to the degree you imply. It sounds good to rip on np programs, but take it another step and realize physicians can look to pas and do the same. They could shudder at a provider that trains two years and has a couple thousand hours clinical to their 6 years minimum and 10000 hours.

Many np programs are specialty focused. One psyche np program near me has over 1000 hours clinical in that area, so that's not a bad chunk of time when you are talking comparison to the psyche time from PA school. That's how the np world would argue against expanding standards for them. But then FNPs would turn that on its head because they take on a lot more scope without added clinical time.

 

[RedCole]

I think you'd have to make the case that there is widespread malpractice taking place among NPs. I'm not sure it's out there to the degree you imply. It sounds good to rip on np programs, but take it another step and realize physicians can look to pas and do the same. They could shudder at a provider that trains two years and has a couple thousand hours clinical to their 6 years minimum and 10000 hours.

Many np programs are specialty focused. One psyche np program near me has over 1000 hours clinical in that area, so that's not a bad chunk of time when you are talking comparison to the psyche time from PA school. That's how the np world would argue against expanding standards for them. But then FNPs would turn that on its head because they take on a lot more scope without added clinical time.

I think the specialties are fine for the most part. They have a large amount of clinical hours in one area - a psych NP, despite only 700 or so hours of clinicals, is far more prepared for psych than a psych PA, simply because they did ALL 700 hours in psych as well as having classes focused in psych.

FNP is really the main culprit - their scope is the same as a general physician or PA, yet they have very few clinical hours. I think PA training is adequate for what they do, and if NP training could meet the same standards NPs as a whole would be better off. Truly though, it is the coursework, not the hours, that tend to scare me. An NP can make up the hours with a residency or even on the job, but there is no way to fix the foundational education that consists mainly of research theory courses.

Despite this, I have meet many competent NPs and feel the potential is there for anyone who wants to try. An NP working in a specialty area for many years is typically as competent as the physician they work with.

 

[deleted6669]

I think the specialties are fine for the most part. They have a large amount of clinical hours in one area - a psych NP, despite only 700 or so hours of clinicals, is far more prepared for psych than a psych PA, simply because they did ALL 700 hours in psych as well as having classes focused in psych.

slippery slope. with lots of electives to chose from and a required psych rotation a pa student could easily end up with > 700 hrs and still do rotations in lots of other fields.
I had over 500 hrs of family medicine not including peds, ob, and IM and it wasn't even my specialty of choice.

 

[RedCole]

slippery slope. with lots of electives to chose from and a required psych rotation a pa student could easily end up with > 700 hrs and still do rotations in lots of other fields.
I had over 500 hrs of family medicine not including peds, ob, and IM and it wasn't even my specialty of choice.

Family medicine, yes, and I already admitted PAs are better prepared than FNPs. I was talking specifically about specialties such as PMHNPs or WHNP. They do ALL of their clinical hours in those settings, and typically take 6-8 specialized courses pertaining to their specialty. PAs are all trained to be generalists, despite electives and rotations, and while I feel they can quickly fall into any role, their training in some specialties doesn't compare to someone who did an entire 2-3 year graduate degree in that specialty and are trained for that role.

So, while I will concede PA training to be better when compared to an FNP, I don't accept that PAs are simply the all around best midlevel and perform better than an NP in every specialty - that's extremely presumptuous. Trying to argue that one course in psych and a 2 month psych rotation makes someone a better mental health provider than a PMHNP who has spent 2-3 years doing ONLY psych (including courses solely in psychopharmacoloy, therapy, etc) is about as ridiculous as an FNP claiming 700 clinical hours is equivalent to a PAs 2000 hours.

 

[deleted6669]

So, while I will concede PA training to be better when compared to an FNP, I don't accept that PAs are simply the all around best midlevel and perform better than an NP in every specialty - that's extremely presumptuous. Trying to argue that one course in psych and a 2 month psych rotation makes someone a better mental health provider than a PMHNP who has spent 2-3 years doing ONLY psych (including courses solely in psychopharmacoloy, therapy, etc) is about as ridiculous as an FNP claiming 700 clinical hours is equivalent to a PAs 2000 hours.

fair enough.....

 

[CounselortoMD]

Unfortunately, OP, you will find this forum isn't a good place for finding NPs or NP students. There are only a few of us here, and you will find a very heavy anti-NP and anti-nursing bias throughout this site. On the other hand, I agree with you about allnurses being a pit. Also, not all fluff coursework is useless, though I agree that there is too much of it in NP education. Classes on leadership and policy are actually beneficial, depending on your career goals and I think that the inclusion of such coursework is helpful for moving the field forward. One cannot overestimate the importance of being able to lobby and effectively change policy for you own benefit.

There is a similar dynamic within the mental health field, between its two major camps of "mid-level" psychotherapy providers (i.e., Licensed Professional Counselors, and Licensed Clinical Social Workers) about the appropriate balance, and relative worth, of pure clinical training (i.e., didactic coursework in core competencies like psychopathology, assessment methods, and therapy techniques, combined with hands-on internships in various treatment settings) versus the so-called fluff elements (e.g., classes about community leadership, agency administration, public policy, social change, etc.).

Master's programs in counseling (typically granting an M.A. or an M.S.) tend to place greater emphasis on the clinical nitty-gritty, whereas master's programs in social work (nearly always granting an M.S.W.) seem to focus much more on the community-oriented philosophical stuff.

Both are important aspects of graduate-level education for psychotherapists, but the ideal balance between these elements remains a matter of ongoing discussion and debate.

 

[zenman]

And this is what scares me. I don't care about coursework being online. Watching a lecture in class or in your home should make no difference. I know a med student who never attends class, he just watches lectures/reads the book/reads the powerpoint at home on his own time. He's doing just fine. However, having to find your own clinical preceptor is a nightmare. How does the university know if their student actually learned anything? Or if the preceptor is able to teach? I mean, what if they're completely incompetent? Just because you have a license doesn't mean you can teach. It seems hugely problematic to me and I'm shocked that NP programs get away with it.

Man, do you know how many physicians have told me they got nothing out of a certain rotation...and this is in medical schools? I selected my own preceptors to my benefit. My school had a list of preceptors but I still went my own way...at a Navy hospital in Okinawa and a VA mental health outpatient clinic in the US. Know what I wound up doing? Working as a very well paid military contractor with full benefits and loving almost every minute of my job.

 

[AnnoyedByFreud]

Man, do you know how many physicians have told me they got nothing out of a certain rotation...and this is in medical schools? I selected my own preceptors to my benefit. My school had a list of preceptors but I still went my own way...at a Navy hospital in Okinawa and a VA mental health outpatient clinic in the US. Know what I wound up doing? Working as a very well paid military contractor with full benefits and loving almost every minute of my job.

I'm not worried about you, ie: someone who clearly has access to excellent teachers. But what about all the NP students at these half-baked online programs who don't have a good network of excellent clinicians to teach them? The ones you see on AN constantly begging people to precept and can't find anyone to teach them? What kind of NP are they going to turn out to be? How does the school know whether or not they actually learn anything?

 

[CounselortoMD]

Hm..so where do thoughtful, educated NPs go to have discussions? All nurses seems to attract illiterate Phoenix grads and this place is anti-NP..? Is there an NP forum somewhere? PAs have their own forum :/

Bleh. I do very much dislike the field of nursing. So much fluff, no substance. I've been looking everywhere for an NP program with even a gross anatomy component..or a skills lab...or..anything really.

I do think NPs and PAs are equal after about 3-4 years on the job (since you learn the most there) so I'm willing to go to NP school anyway based on that...but new grad NP vs PA is no contest..why has NO nurse practitioner program taken it upon themselves to make a quality program based on the PA model. Actual science courses, instead of 50% of the courses being research and nursing theory. I think it should be sort of like:

Semester 1:
Gross Anatomy
Pathophysiology I
Health Assessment I
Nursing Leadership

Semester 2:
Pathophysiology II
Pharmacology I
Evidenced Based Practice
Health Assessment II

Semester 3:
Family Practice: Adults
Family Practice: Adults Practicum (225 hours)
Pharmacology II
Physical Diagnosis I

Semester 4:
Family Practice: Pediatrics
Family Practice: Pediatrics Practicum (225 hours)
Skills and Procedures
Skills and Procedures: : Lab

Semester 5:
Family Practice: Women's Health
Family Practice: Women's Health Practicum (225 hours)
Physical Diagnosis II
Nurse Practitioner: Transition to Practice

Semester 6:
Family Nurse Practitioner Capstone Practicum (500 hours)


Isn't that sexy looking!? What I wouldn't do to find something similar to that...sigh. Instead I find:

NUR 603 - Nursing Theory (3) - CRAP
NUR 605 - Nursing and Information Technology (2) - CRAP
NUR 610 - Concept Analysis 1 (3) (*45) - CRAP
NUR 611 - Concept Analysis 2 (3) (*45) - CRAP
NUR 614 - Concept Analysis 3 (3) (*45) - CRAP
NUR 630 - Clinical Role (3)
NUR 632 - Pathophysiology (3)
NUR 634 - Advanced Health Assessment (3) (*90 clinical hours, 1 day per week average)
NUR 638 - Advanced Clinical Pharmacology (3)
NUR 672 - Role Expectations (4) (*225 clinical hours, 2 days per week average)
NUR 680 - Advanced Care of Adults (7) (*240 clinical hours, 2 days per week average)
Total - 37 credit hours

Family Nurse Practitioner Primary Care courses include:
NUR 682 - Primary Care of Children (4) (*120 clinical hours, 1 day per week average)
NUR 684 - Primary Care of Women (3) (*60 clinical hours)

While earning my M.A. degree in Clinical Psychology, I had to complete over 600 hours of practicum/internship as a mandatory requirement for graduation. This initial exposure to real-life patient care was barely enough time to get my feet wet--to dabble in the clinical trenches, so to speak--and yet, it seems about equivalent to the total number of clinical hours required by most NP programs.

In the counseling field, however, there is one extremely important difference: After completing graduate school, a newbie M.A. still has lots more work and learning to experience before earning the qualification to treat patients independently. Specifically, in order to achieve professional licensure (i.e., LPC in most states) to practice psychotherapy as an autonomous clinician, an additional 3,600 hours of directly-supervised clinical experience is required. This usually amounts to working for two years in a high-stress and low-paying job, under the constant critical scrutiny of your licensed supervisor, who will hopefully still be around (and willing) to "sign off" that your 3,600 necessary hours have finally been completed. Oh, I almost forgot--you must also pass the national certification exam, which is another requirement for licensure--but this can be done at any point along the process.

So, ultimately, when all is said and done--and the official LPC credential is finally in your hand--you will have performed a bare minimum of 4,200 directly-supervised clinical hours (but in reality, it's always significantly more than 4,200 hours, because it takes at least several months for the state licensure board to approve your application--always after rejecting it several times because you forgot dot an "I" or cross a "T").

And after all that experience, sometimes you still feel like you have absolutely no idea what you are doing! Therefore, I really cannot fathom how so few clinical hours in NP programs could adequately prepare students for the complexities of their future advanced-practice role in our healthcare system, or why such a modest amount of practical experience would be sufficient to enable students for immediate entry into full professional status upon graduation.

But I also don't think that NP programs should necessarily start adding extra clinical hours to their required curricula. Instead, why not institute a structured period of post-MSN supervised clinical practice (perhaps similar to the LPC model) as a future prerequisite for NP licensure? I think an innovative new pathway for NP professional credentialing would help to standardize the training process and would really end up being beneficial for everyone.