I think that I have been internally consistent. I have a tremendous amount of respect for the NPs that I work with. I have serious reservations about NP education and certification. This is echoed by state BONs and educators. I have even more reservations about direct entry NP programs. If NP education is based on previous nursing knowledge then how are direct entry NP programs any different than PA programs except they have less clinical and didactic hours. I have maintained this position both here and at allnurses. I am more strident here and indulge in more sarcasm since that is more the tenor of this board (it also lets me engage in more sarcasm). Over at the PA forum I have been told that I am the voice of reason at times
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In my opinion the nurse practitioner profession will come to rue the day that they moved to the DNP. The watchword of the educational section is accessibility. The proliferation of online programs speaks to this. By moving to the DNP you increse the length of the program from 2 years part time to 4 years or so part time. There is a lot of information that especially in self paced and online programs anything over two years leads to a higher dropout rate. In the end this will lead to a sharp decrease in NP students (my opinion). Also if history repeats itself there will be a move to make DNP a requirement for medicare billing. If there is no grandfather clause then this again has the potential to disenfranchise a tremendous amount of NPs. The thing that I wonder about is what is the impetus for the DNP. It won't bring in more money. It seems more about promoting the educational part of the profession at the expense of the NPs in the workforce.
The other portion of this is the implicit in the DNP is true independence. The CRNA drive for independence has made many anesthesiologists re-evaluate their relationship with CRNAs. Similarly, locally and to some extent nationally repeated attempts to loosen NP restrictions have led some physicians to re-evaluate their relationship with NPs. The one factor that will prevent any real moves is that there are lots of need for NPPs. Also the increasing move of PAs into specialty medicine will at least temporarily leave primary care positions open. The other interesting part is the current fight for inpatient positions between ACNPs and FNPs. This will probably be eventually decided by hospital credentialing committees not nursing.
While Taurus does not represent the majority of physicians, some of the opinions he expresses exist right under the surface.
David Carpenter, PA-C
You're pretty strident at allnurses, too. JMO. It's kind of a drag to have a thread where those of us interested in becoming NPs encouraging each other humming along nicely, and then you come along and throw the proverbial brick through the window. But I've come to recognize that that is your MO, and take it for what it's worth.
I'm one of those slackers or whatever you think of them, "people who take online classes." Why online? Because there is no local university for me to attend. Not everyone lives in an urban area. So, I've got to finish my BSN, which will take me about 2y, then do the NP gig. Again, online because there is no place for me locally and I'm getting tuition reimbursement. I'm being picky about which schools I'm looking at; I've already narrowed my choices down to about three programs. Would I prefer to do standard education (bricks and mortar)? Sure, but I have to work, and as I said, there's a lack of facilities to choose from. So I'm going to have to put the extra effort into it, plus hope that 22y of experience will help a little. I know I am going to have to do some learning on my own. I plan to pick the docs' brains (the nice ones) every chance I can get; take every opportunity to listen in when they're rounding with students; ask lots of questions of the residents. We are a teaching hospital, after all.
I have no desire to be an independent practitioner, but I have no desire to remain a bedside nurse for the rest of my life. It's not enough. While I'm not the smartest nurse in the world, I do know my stuff. I figure if it's something I can figure out, then there's no excuse for a doc not to know it. So I will be perfectly happy in a midlevel position, with supervision but some latitude. Pretty much the way most NPs in my area work.
I could e-mail you my #1 choice for where I want to get my NP, and I am sure you would have nothing to say that wasn't negative. I think you see nurses the way most docs do: little handmaidens who fetch for you and clean up after you, other than that, pretty useless unless they're good eye-candy. Definitely not intelligent co-workers, or, heaven forfend, "colleagues/peers." We're just not worthy.
The way people are being educated is changing. Maybe you need to accept that things aren't the way they used to be. And that change isn't always bad. The programs I'm looking at are accredited by the major organizations that govern nursing practice. I'm sure things could be improved, and will be improved, but I've worked with several highly skilled NPs (cardiology). They must be doing something right since the docs let them come to the ED, work up the pt and write the admit orders. They didn't all go to the same program, but they did have one thing in common: several years of experience as a cardiology nurse. Experience that you seem to think is irrelevant.
You and I have polar views on this matter. I have my own questions/concerns about PA education, but I don't whang on and on about it in an attempt to humiliate/embarrass someone. You, however, go on and on, like a dog with a bone. I think you'd only be happy if it was announced that across the country advanced practice licenses for nurses were null and void as of 060607 @ MN.
Physicians barely respect RNs; it's of no surprise to me that they would dislike APRNs.
What you're saying about CRNAs is not what I am seeing in my area. Perhaps these struggles are going on in more urban facilities, but where I live we couldn't function without CRNAs. Our docs seem to interact well with them, and we get pts who specifically request certain CRNAs for their surgeries.
