Been doing what I have been doing for a long time, and I have had to take orders from them--and I remember when we didn't. So, midlevels have been in play for quite some time now. The expansion and push for more independence, that's been coming to a head in more recent times.
Well, especially if you are talking relatively simple, non-complex cases, that's just going to come down to the individual in a number of cases. Honestly, it's not like there aren't some S$!^^y docs. I've just been very fortunate to work with mostly really good to excellent docs over the years--but then the places I've worked weren't run of the mill.
Colleges/universities have been seeing how lucrative it is to run such programs, and as such, they don't necessarily require a lot of previous hours as an RN in clinical practice, which can make a difference. Used to be, years ago, RNs with loads and years of experience in critical care and acute care went to programs for advanced practice, and when they came out, stuff made sense. But today, so many just go through their nursing programs, work less than 2 years (which in reality, unless you are ahead of the curve, you are still quite novice), and then they apply and get into advanced practice programs--not even necessarily requiring a GRE. That's really screwed up.
So basically you end up with experientially glorified nurses' aids going into graduate level nursing programs--b/c they haven't toughed it out in the clinical fields, racking up the hours, actually learning stuff. You have some nurses that are into learning and going the extra mile, and then you have a number of barely interested, relatively disinterested nurses that can make more money as an RN than working at the Walmart. And so then later, these same nurses get to thinking, "Why shouldn't I make even more bucks and be a step up from other nurses?"🙄 They have **** for solid, clinical experience and have trouble putting variations and nuances of patient problems together, but, "Woo Hoo!" They've got at a 2.8 to 3.0 GPA, maybe a fair GRE, if required at all, and again, no substantial experience, and are not even close to being expert as RNs in terms of experience and insight. Its all good though, b/c they get some docs to write them some LORs, and schools see $$$$, and there you go. You have an "advanced nurse practitioner" in the making. Again,🙄
And I believe it is with this growing group of NPs that we may see that significant difference shift--b/c they don't even have enough baseline ward or unit or ED experience to know what they don't know--fundamentals of the pathophys and variations from what may be expected. But somehow the miraculous Masters or DNP program will make up for it. Once more, 🙄 Clinically, I don't believe it does. Now if they started stringent residency programs like physicians have, requiring MUCH more clinical hours, then I might have a different view.
But so much of education is about factory production--pushing it all along down the line. Sure, there are programs like U of Penn that are better; but I still would rather see people in programs with NO LESS THAN a solid five years, FT in acute or critical care at teaching or university-based medical center, CCRN certification, plus a high GRE, and then >3.2-3.5 GPA, especially in the sciences. Then after that, they still need to get a lot more clinical hours before they sit before their boards.
Do you actually think all of that will occur across the board? Heck, CRNAs are taking peoples' lives directly in their hands every day, and many of their programs don't require ALL of that--certainly not 5 years or> of FT RN practice in a busy, university medical center ICU. Sure, count some ED time, but mostly ICU, medical and surgical, in a university medical center. But nope. They don't require that. I've known a number of nurses go into CRNA programs that didn't have a clue about understanding basic hemodynamic indices and such, let a lone dysrhythmias. Some of them barely understand blood gas interpretation. This is stuff you should have worked with for years and know like the back of your hand before you enter into a program like that. But nope. Sorry. So much of EDU systems are all about money, money, money. People that work in them know this.
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