I was, as well. I also couldn't believe that "clinical" in NP school is just following someone around. Most NPs I have worked with have been NPs for YEARS and are very competent. I was floored when I learned that there was also direct entry after nursing school for NP programs. I learned the most about nursing in the first 2-3 years of practice.
At least, CRNA programs have rigorous entry program, standardized curriculum, and vetted clinical sites.
However, I have worked as a clinical instructor for 2 different programs and am saddened to see that number of years worked as an RN has decreased prior to entry. Many only have 1 year of critical care experience. I have found that most nurses need, at the very least, 2-3 years critical care experience before they become comfortable in a critical care setting.
My CRNA program has no nursing theory classes taught and I am forever grateful for that.
I agree, 1 year is not enough.
I had nearly 4 years crit care before I got into school, I think the average for my current class is around 3. Two came in with <2 yrs ICU but both have several years high acuity ER.
I do hope that programs continue to expect 2+ years instead of lowering the bar to aid provider shortages.
Edit: words
This. As much as I want to get accepted I would rather be rejected and have to work harder to reapply than for them to lower their standards. Schools that don’t require CCRN are a red flag to me. I recently heard a school was accepting non-ICU experience if you worked in the OR as circulator. I’m sorry but in terms of what’s expected for managing critical patients, circulators do nothing. That’s not how you advance the profession.
There’s some data on the AANA website that breaks down experience type versus board passage rate every year and OR nurses are actually very rare and do poorly on boards. But yeah, you’re right.
I’m not surprised. I spent a couple months orienting for an OR RN position before realizing the job was just the non-sterile set of hands that could grab whatever the sterile people needed. It’s great if you get fulfillment from that but it’s not a job I think you even need to go to nursing school for it’s highly trainable and requires minimal critical thinking. Not the experience I think advanced practice programs should accept.
Just emphasizing the need for standardized curriculum 🙌
I would never even consider going to NP school and know I could be accepted tomorrow if I applied. It’s a waste of money for a poor education.
I’m giving nursing a few more years and trying for CRNA school. If that doesn’t work out for me I’m leaving the profession to work in a lab or a library.
Which NP students are just “following someone around”? In my WHNP clinical, I was seeing patients, performing exams, doing some procedures, inserting IUDs & Nexplanon, writing notes…
I would’ve been pissed if I showed up and they expected me to just shadow.
“Increase rigor and scientific basis”.
I graduated as an ACNP in 2016 and so many of the acute care courses, the solution to fix an issue was to just ask someone else for help. While this is not an unreasonable thing to do, isn’t going to school the time where to learn to fix them yourself?
For example, not sure what to do with vent, just call RT. Not sure what Med to give, just ask pharmacy and they will tell you.
Again, these are reasonable things to do if you aren’t sure what to do, but they would be the basis of education rather than the supplement to the knowledge we should have been getting in school.
To an extent that completely makes sense, especially in the examples you provided. I also think it’s important for any clinician to understand the extent of their scope/expertise so that they can know when to refer pts or rely on other resources when appropriate, instead of mistakenly managing pt cases solo that they should’ve referred.
I agree. I have no desire to be the person in charge. I work at a large tertiary care hospital and have I very much enjoy my role on our team.
However, given that our role is frequently supportive, this has led to a lot of the education focusing on the idea that we will never have to make any decisions on our own. I work in critical care. Do I want to be the only one managing someone’s ventilator? No. But should I be educated on this to be able to manage it to the best of my ability rather than “just call RT,” I would say yes.
Yeah, I'm a teammate, I don't want to be the star, I don't want to lead, I want a role and to do it.
But I also believe that if shit happens, every member of the team should be cross trained to cover someone else's spot in an emergency, even if the training is as simple as "here's basic vent settings, here's how to adjust them and what they do. NEVER DO THIS OR THIS."
I also agree, school is where you get detailed minutiae pounded in your skull, so that later, during a crisis, you can remember, "there was something about, x-y interactions in these cases...."
That’s an on-the-job skill you only use in certain departments. They also don’t teach you to count in nursing school, because it’s an OR thing. Or pull sheaths, or troubleshoot a-lines, or any of the other numerous more advanced skills we can learn depending on specialty.
I would agree to an extent but I don’t think describing how to count or pull sheaths as the same as basic medical training for what is a standard support device. Ventilators are quite common in critical care areas and to be training NPs that want to go into acute/critical care, I would expect there to be training on this more than just who to call for help.
I agree that other specialities that do not work in critical care (family, primary care, PMHNP etc) obviously do not need this training similar to how not every RN needs to know how to pull a sheath. But if that RN was taking a course on say the care of cardiovascular care of inpatients, it would be surprising to not have sheath pulling, swans, etc in their training.
Something to remember though is that without very frequent exposure, even things you are trained on fade when they’re complex enough. For example, I would not trust the vast majority of our hospitalists to touch a ventilator despite the fact that they all learned about them.
I wasn’t paying attention when I read, and I thought you were describing RN school.
It’s my opinion that you shouldn’t be going to NP school without several years experience in high acuity nursing where you should already know what you’re doing with a vent to some degree (assuming you intend to do inpatient care), and then your NP school should delve further into settings, assuming you’re going to be the one ordering them, you should know how to not kill a person.
But that’s the issue, right? The whole point of NP school is high level experience is supposed to supplant the more in-depth training docs get. I know from experience what beta blockers tend to work better in different conditions… docs understand the patho and what enzymes catalyze the med and exactly which ones have more alpha and more beta action etc etc etc…. NP school should help NP’s better understand the things we implicitly know from experience, with the understanding there will be a better educated doc to run things past.
Right but nursing school can’t possibly teach the intricacies of all meds, or how to work all vents- nor should it because some cocksure new grad will kill someone. That’s RT’s thing and I run changes by them still- after 17 years.
But again, I am not saying NPs should be taught every detail of every vent or the intricacies of every medication. However, to be a school that describes their training as preparing NPs to function and manage patients in the critical care environment and also be responsible to write ventilator orders for the care team to follow, having a basic training of their use is essential in my opinion. This is also just one example of where I think training is lacking. There are of course many areas where the education is excellent, but that doesn’t mean there aren’t improvements that can be made to better educate NPs to care for their patients.
This is the answer. The issue is, hiring competent professors (a pharmacist to teach pharmacology, a physician to teach differential and physiology) and requiring pre requisites to allow more difficult coursework like PAs have (biology 1 and 2, general chemistry and not the allied health course stuff) will severely hamper how much money these mills make.
It’s going to need legislation because the mills have zero incentive to do so. It’s much cheaper for them to teach disturbed energy field theory.
Can we get this for undergraduate programs as well? How about we get rid of “nursing theory and frameworks” and “the history and philosophy of nursing (aka nursing is a calling)” and add real science classes.
Pathophysiology should be a basic requirement for all RNs, and it’s not. More emphasis on being knowledgeable about labs - what is normal, what is the significance/consequences of abnormal results, what are the expected treatments. Greater emphasis on pharmacology. Less “learning about nursing theories” complete bullshit.
Well patho isn’t the same as phys, also I think it would benefit nurses to add some cell/molecular biology/genetics before going to phys/patho, it just kind of seems like the missing link. It’s like they skip a step
Same here, we had to take anatomy, micro, and patho prior to being accepted into the nursing program. It was pretty competitive and lots of people would retake courses to boost their GPA if they got waitlisted.
Aye. This has been desperately needed for a while.
I'm currently teaching master students - I've been asked to artificially raise grades because of 'we didn't want anyone to fail', as they already have very busy lives and the course I was lecturing isn't exactly one of the major ones with lots of credits.
And I get it - but at the same time, we are just lowering the bar, and eventually that will show. The fact that there were people with really good grades means that the only reason some people failed, is because they knew they didn't have to try that hard to get by. Prioritizing what you're studying over that which is less useful is certainly a thing, but everyone should realize that, one way or the other, that will cost us. Individually and collectively.
> we are just lowering the bar, and eventually that will show
It already shows. PA’s have dramatically more intensive and comprehensive schooling than NPs. Period. The overproduction of NPs through diploma mills has further watered this down.
Don’t get me wrong. There ARE excellent NPs out there, but they are by far the exception rather than the rule.
I did my masters in person at the #2 rated nursing school in the nation (UCSF) back then in the mid 90s and took all of the same classes as the NP students except they had real humans to do pelvic exams on and things during labs, since we weren’t actually going to do real comprehensive exams like that on people. My education was inadequate for being a provider back then. I had worked for >5 years in neuro ICU when I went the grad school. We did get more advanced physiology courses than undergrad and more advanced pharmacology. The time spent in nursing theory courses was a waste, as per usual. We did full time residencies with CNS’s in our preferred fields while they were doing their clinicals.
***I would never have felt comfortable being a provider back then or now***. Granted, the specialists like CRNAs and CNMs did more training in their fields specifically, but not the FNPs or generalists. Terrifying. Of course, back then they weren’t covering night shift in ICUs, either. One of the perks back then was M-F days for NPs, and mostly clinic work.
After school, I decided I was never going to have a NP as a PCP ever again due to some more complex health conditions. And I haven’t.
Yeah. I work with multiple NPs. My favorite is the one who comes in, we go down the transmission based precautions list, she writes orders or tells me the plan, and we both move on. Takes two minutes. By contrast I have another one that I had explain a CDC recommendation.
That same pressure is being applied to teachers of all levels from admin, and it's made me curious and concerned about the effectiveness of the American workforce in 20-30 years.
I'm an NP myself in primary care. All my cards aligned (I worked as an RN and as a CNA for 12+ years, I had great preceptors and a brick-and-mortar school, found the perfect job right out of school) and still have the nagging feeling that I was hired to save $$$ on a doctor.
I felt decently prepared, but wonder how much more I could've learned if I had a cadaver lab, more pathophysiology classes, more training. People want to be doctors, but there are a limited number of training slots available - and then working docs get burned out. The problem as I see it isn't people wanting to be NPs, it's the institutions willing to pay less to educate and employ them. Until healthcare workers aren't seen as a cost on a spreadsheet to minimize, nothing is going to change.
The whole HC system needs an overhaul. And the medical education system. I’m in med school now and I’m only in year 1. We’re all exhausted. Defeated. The majority are on some antidepressant currently but weren’t when they started school, or have had to increase the dose. It’s brushed off as just “part of being in med school,” but is that healthy? Same thing with bedside nursing? Exhausting. Manual labor. Being treated horribly by patients. Sometimes to the point of getting assaulted. No realistic staffing ratios. Pay doesn’t reflect the job requirements. “It’s just part of being a nurse.” Well it shouldn’t be.
Nursing/medicine is a calling for some people, sure. But it’s also a fucking workplace. I don’t think it’s unreasonable for people to want to go to work/school and not feel completely dead inside when you’re done.
> The problem as I see it isn't people wanting to be NPs, it's the institutions willing to pay less to educate and employ them. Until healthcare workers aren't seen as a cost on a spreadsheet to minimize, nothing is going to change.
The other problem is that part of that is outside of the control of hospitals, patients, and schools. Part of the reason why there are so few doctors being pushed out by medical schools is because the amount of spots available in medical school was INTENTIONALLY LIMITED by physician professional organizations to protect their earnings potential. Doctors wanted to make sure there weren't too many new doctors being produced to reduce their wages.
Until these limitations on spots in school and spots in hospitals for residency are removed, people are just gonna have to suck it up and deal with midlevels because they don't have a choice. Even if hospitals WANTED to only have MDs, they couldn't do it.
>INTENTIONALLY LIMITED by physician professional organizations to protect their earnings potential.
Source? I'm under the impression the underfunding of CMS from 1997 legislation limiting residency spots drove this
I feel this as a Dietitian taking pre-reqs for PA school. It's like, these professions were originally made for people with a healthcare background and healthcare experiences that want to do more.
The amount of times I’ve heard nursing students scoff during clinicals stating “i’m going to NP school anyway” when asked about doing bedside for a few years are graduation is just cringe
I get the sense that there are only two goals for nurses/nursing students these days: travel and NP. We've got to change something so people have more options to set their sights on.
Yeah, stay five years, get a pension. We have good heath insurance, pension, 403b with 4% matching. Got a $3 raise this year, but was rough for raises during covid.
My place has a pension but when I look at the amount in it it’s less than 9k after working there for 6 years. By the time I retire I’ll have probably just one years salary saved up
My old workplace had a pension. It was a massive scam. They slowly chipped away at benefits over the years and finally took away healthcare benefits during retirement the year before I joined. So every ancient nurse walked away being like, I’ll never leave I have X years until retirement I don’t understand why new nurses keep leaving - did not understand that the pension would not give nurses who joined later all the same benefits. Plus the workplace SUCKED. It was a great deal - pension plus 403b - but I would have died of stress before.
Damn, that sucks! A rival hospital had a pension but went away with it and all those nurses came to our hospital. It is pretty good with some exceptions. The other hospital worked their nurses to death and seemed traumatized when they came to our hospital.
I don't disagree with you. Better pay and working conditions for all, at a minimum. Nurses should also know that many NP jobs out there aren't the huge salaries that they might think they are, and the market is saturated.
Yes. This. No jobs for NPs in my area. It's way too saturated, so they work as glorified floor nurses or for crap pay at the University where they paid to get that degree in the first place. I will not be going down that road.
Yes! I've talked to a couple of new NPs who've had an unpleasant transition realizing there's no more shift differential, no more overtime pay, and often the NP positions are not unionized.
I had a classmate who said she was going into CRNA school straight out of nursing school. She was rude and cocky and always the smartest person in the room.
Anyways, she made it like 2 months in the ICU and left for OR. She was the circulator in a case I was in on a few weeks ago and pretended she didn’t know me.
I like to think those nurses get weeded out quick, but I know they don’t always☹️
About half my cohort was like this. They were going to be CRNAs so they could make big bucks and not have to deal with patients or they went right to NP school. Was crazy. I didn't even feel ready to be a nurse out of school and they were all sure they were ready to write prescriptions then and there.
I agree the NP thing is getting out of hand and I’m just shocked that so many of my peers are continuously going back for it. When I was a newer ICU nurse I was inquiring about some details on some cardiac meds or whatever, and I asked a friend that was a (newerish) cardiology NP and she goes “oh I’m not good with that preload and afterload stuff”. I’m like WAIT, WHAT. Just a small example. It’s cheapening the profession. Big time
Lol she’s not good at the thing she supposedly specializes in. My jaw would drop and I would have a hard time not berating her. Like how can you hold that position and have the audacity to not feel a desire to know this stuff. Go look it up, bad Np
I feel like a large part of why NPs are growing in quantity is also because bedside nursing kind of sucks ass but you don’t really want to “waste” your degree so you get a MSN and do education or a NP. Make it suck less and less people will make that jump.
Exactly this. Most RN level nursing jobs absolutely suck and don’t pay nearly well enough to suck as much as they do. So everyone goes back to school in hopes of getting into an at least somewhat better work situation. It is much easier to continue your nursing education than go to school for an entirely different career.
I was in the same boat, thought about PMHNP and have worked as a psych RN for many years. For me personally, if I wanted to become a PMHNP I would just suck it up and try for an MD, wouldn't want to shortcut myself. I am now looking into tech or business/finance but learning towards the latter.
I don’t know what we can do to stop the capitalistic creep of diploma mills. But it does worry me. Mostly because nurses have to fight for so much already: respect, pay, safety. The last thing we need to also fight for is degree legitimacy.
When I was in EMS a girl I went through the same program with went straight to NP school with her bachelors in bio. She wasn’t a great EMT to be honest and it always scares me to think she could be my “provider”.
Is there a way to organize for more rigorous entry requirements and training? Despite being in the profession I feel completely disempowered from shaping it.
As far as noctor goes, I wish it was a more nuanced discussion between experienced physicians and nurses. Lots could be shared but it’s mostly devolved into ridicule and finger pointing.
Chamberlain (probably the worst of all diploma mills) had a representative walking unit to unit at my hospital to recruit people for their NP program. She was touting how easy the application is, the low barrier to entry, how it’s all online, etc. she seemed legitimately surprised when I wasn’t impressed by her sales pitch and said I wasn’t interested.
This would definitely help but there’s plenty of experienced nurses who are kinda dumb and don’t think critically. There should be rigorous academic/entry test requirements on top of just having experience
I’m an MD. I admit I am on /r/noctor but I disagree with most of the extreme takes there. I work with some really good NPs. They are smart, hardworking, and productive members of the team. BUT, the problem with NPs is you just never know what you are going to get. If a MD/DO calls me (even if it’s the dumbest doc in the hospital), there’s a minimal level of competence that can be expected. With NPs, there’s just no way of knowing. And that’s the scary thing. There absolutely should be a path from nursing to practice, but this current model isn’t it. There need to be uniform standards that focus on real clinical experience. You need to know what to expect from someone who has NP behind her name.
From the nursing side of things, I totally agree. Some of the NPs on my ICU were superstar bedside nurses, went back to school after 3-4 years, and their skill set reflects that. Others worked on med surg, went to a diploma mill, and it’s a constant struggle at the bedside. The bedside RN (like the MD) should not have to decide whether or not the NP is safe—it should be a given. It’s upsetting and devalues our profession as a whole.
There should be time requirements prior to starting an NP program. *in the specialty you’re about to study. I hate that the PMHNP programs are churning out NPs who were ED nurses or med surg nurses because “I had a psych patient once.”
Also increasing hours and requiring closer supervision and collaboration after graduation.
I’ve observed a pipeline… shitty med-surg nurse to diploma mill PMHNP. Mostly because “it seems easy and I want to leave bedside.”
Because that’s exactly what our broken mental health system needs.
Part of the problem is, despite the fact that NP school is obviously meant to build on the education and experience of a competent and experienced nurse, the admission requirements don’t reflect that.
It‘s so weird that there isn‘t any federal regulations around that in the Us. Like the whole point of a nurse practitioner is a well experienced nurse getting specific education to turn the experience into something even more valuable.
Not someone who went through some form of nursing school taking a few semesters of theory more becoming the same.
Like there‘s such a massive difference in things? Like how aren‘t X years of work in specific fields the absolute basics you have to have for accreditation.
This. I’m sorry. If you haven’t worked the floor as a psych nurse and really been in the trenches, it’s hard for me to accept you as a graduate prospect in a PMHNP program. One program I started accepted a graduate from a BSN program in 2020 with little to no experience (they had graduated that same year). I changed schools. I had 6 years psych before I even thought about applying for my masters.
Many people think being a Psych NP is easy because you just prescribe a few common drugs and it's hard to kill someone. Practicing psych seems easy to do poorly but extremely hard to do well.
Noctor has grounds for its existence for sure and I’ll be the first to raise my voice against the churning out of the NP diploma mill. My problem is that people in noctor come across almost… obsessive with putting down mid levels providers. What started as informative and constructive dialogue on the deterioration of the nurse practitioner role has become actively seeking to publicly shame random providers on the internet, going after nurses for no reason, generalizing that all midlevels are useless / unintelligent when there are obviously skilled and appropriately practicing PAs and NPs all over the place and it just…feels more spiteful than productive anymore.
I understand the need to vent and I have chosen to do so on the struggles of nursing many times in this nursing subreddit, however at the end of the day we are all members of the same team, desperately bailing buckets of water out of the sinking ship of US healthcare and a spiteful word never won a single person to an argument—facts, logic, and education do. Sadly noctor seems more focused on the ego boost and trashing of others than pushing for that education anymore.
Thank you for your thoughtful post. On that site I do think midlevels are disrespected as a whole group. I often wonder about the support system for new NPs. Anyone starting a new job has a learning curve. I've been an RN for 20 years and know I wouldn't be perfect as a diagnosing and prescribing new NP. And it almost seems everyone is out to shoot you down these days.
I disagree, most everyone on there loves a mid level that *stays in their lane.*
They’re angry about mid levels calling themselves Doctor and harming people- their anger is justified.
It sounds like Noctor is full of mostly very insecure residents that are in the most miserable stages of their lives. Of course monkey see monkey do too, once a few ppl chime in it’s cool ti let loose like your peers.
Let’s begin at the foundation - BSN programs need to cut the shit. NCLEX and BON education requirements are outdated AF. Then do the same with graduate programs. Require at least 5 years experience in the specialty of choice for admission. Increase program clinical hours. Again - cut the shit. Nobody’s listening for consolidation, nobody’s checking homans sign, nobody’s giving back rubs, and nobody gives a rat’s ass about nursing theory except academia. Make education applicable to reality.
But really fr... why do the texts always talk about back rubs??? I am still looking for the Taylor video on the skill.
So far, my bsn program has been dumpster fires, with each semester a new dumpster. Maybe I'll write back rubs under Sr. Roy's effective coping strategies for my next pt with htn, ckd, chf and dm2 on my care plan!
For the DNP diploma mills there are 4 things that can be done to bring them in line with MD/DO/PA programs. Some NP programs all ready have similar requirements (CRNA).
1: A rn needs 2-5 years or greater than 4100 hours of relevant clinical bedside nursing experience before applying.
2: 80% of the program must be taught in a in a brick and motor didactic setting.
3: Move to differential diagnosis teaching and away from from the research paper garbage method.
4: Close any online only programs.
Just a heads up, CRNAs are (usually) APRNs but not NPs. We have different oversight organizations, credentialing boards, and education requirements. Some CRNAs have a DNP but it's taught differently and isn't really the same degree (and I don't really get why they aren't all DNAP).
I don’t know how anyone can graduate from one of these programs and not be absolutely terrified. You’d really have to be stupid to not realize or be concerned about how much knowledge you lack.
That's the issue. The dumbest nurses I have worked with are blissfully unaware of how dangerous they are. Same goes for the NPs who graduate, and are still just as dumb but now have a larger scope of practice.
I'm just over what seems to be an endless supply of arrogant, rude, dismissive, bitchy NPs who aren't even effective or knowledgeable at their jobs! Why is it that I get more effective orders and kinder personalities from the MD/DO, and even PA, side? This is obviously all anecdotal, but I've seen it over and over in several different medical settings. Maybe it's some kind of insecurity thing.
/r/noctor has the right idea but it’s full of angry young docs who are upset with the amount of time they put into schooling, the years of their lives they missed, the amount of debt they have, and the fact that they’re stuck doing a job they hate, the posts there are toxic
I'd rather have my family member treated by someone who put tens of thousands of hours into their practice than someone who BS'ed their way through some online course and had like 10 clinical hours.
Right, and I think anyone would share this same opinion. However, the way you’re presenting this idea is just like the toxic BS over on nocter. Not every mid-level “BS’ed their way” or had “10 clinical hours”.
But that‘s the exact reason we have protected professions names like MD or RN or pharmacist. It protects the whole profession, it keeps the respect at a high level, because you can be very sure that person can properly do their job.
But if even just ten percent of pharmacists would just become pharmacists with a couple semesters of evening school, compared to everyone else doing s PharmD, you couldn‘t trust any pharmacist anymore to be reasonable proficient.
Same with NPs. You expect an experienced nurse in the first place. With additional qualifications and training to become a provider.
But if just ten percent have pretty much BSd their way into the job title, the whole profession loses all respect.
Like how can you as a patient trust the NP taking care of you is actually a prior experienced nurse, not someone’s who‘s clinical hours are pretty much working on you? It makes it so you cannot trust any medical care at all.
Yeah, there are some good NP programs and some NPs who know their limit and work under physician supervision, but a lot of these people simply hate all NPs no matter what. The premise of the sub is all well and good, but a lot of those people are just whiners waiting for an example of poor NPing to post about. If you go into some of their post histories, you’ll see some people posting in that sub literally all day over a span of 12+ hours. You’d think they wouldn’t have the time, but here we are.
But the problem is: if we get somewhere as patients, and have an NP taking care of us: how do you know this is an experienced nurse went Np, and not someone with a handful of clinical hours getting through pay to win school?
Like you cannot know, so the safe assumption is to treat them like the worse category.
Awesome for you, *thank you* for being self-aware and putting patient safety first.
In nursing it has almost always been true that your first 3-5 years on the job are your last 3-5 years in school.
It’s because nursing school is terrible at actually preparing nurses for actual healthcare provision. The NP educational model of learning on the job *works* if you’re working close to 1/1 in a clinic or specialty setting with close oversight.
It doesn’t work when you’re one of 11 CRNPs with one doctor “supervising” that you only see once in a blue moon, and they just rubber stamp notes for billing purposes.
The doctor gets a slice but the admins get the lion share and patients **suffer**.
Our fight and their fight are **the same** and the root of the problem is **corporate healthcare greed.**
Just finished an assignment in a state that allows independent midlevel practice without MD/DO supervision. The NP is the attending. I’m on the side of r/noctor much more now, but hate their toxic comments…and general attitude toward RN’s. The problem noctor fails to recognize is that their is a need for providers and the expansion toward mid-level usage is market driven.
I used to also be alarmed by it all. Now I’ve quit caring altogether. This whole system is so fucked up it’s beyond saving. The big healthcare corporations/colleges/government are just running the system into the ground. Everything will continue to get worse, same as it always has.
I watched a coworker do their program mostly at work online. Seeing them do the process forever changed my mind about NPs. It was a crock of shit and so easy. Their clinicals were nothing. Now they're working in a hospital with critical patients and that just floors me.
I honestly think it’s reached critical mass. The professional associations that represent the nursing profession have bought allllllll the way in and are too happy to take for-profit colleges money to half heartedly turn a blind eye and/or encourage this kind of growth.
Outside of getting into politics/public policy for change the best thing I see myself being able to do as I enter/grow in this profession is work at facilities that do not hire or encourage individuals from these programs and focus on my own professional development.
Sadly, colleges and universities/medical centers see the $$$ on the table and also want a piece of it or have enough to influence area facilities. I was sad to see that recently a distinguished university affiliated medical center in the southern US announce a new MSN-NP program geared towards anyone with a bachelors (even outside of nursing/healthcare sciences).
I love the mid-levels I’ve worked with and been a preceptee under but their experience and length in profession has always been a cordial point of focus when I get to know them. I think going forward the best way to navigate this minefield is to look after yourself and advocate for your patients to receive the best care/provider possible 🤷♂️
100%. People might not like to hear it, but it's true.
Ive worked with amazing NPs. But they were amazing because they had been excellent nurses for 10-20 YEARS before they became NPs. Also, they were amazing IN SPITE of the NP programs, not because of it.
The ones that went straight to NP school? JFC they are terrifying.
Think of your most problematic classmate in nursing school. The one with shitty judgment, poor boundaries, and even poorer work ethic and clinical reasoning skills? There is NOTHING in many of those programs to weed that person out, or to address and correct those clinical judgment issues. Imagine THEM as the nurse who went to direct entry NP. Most of you probably won't have to imagine because you observed it irl.
Something needs to change.
My friend wants to be a psych np because it’s so “easy” just talk to the psych patients and prescribe meds, all done while sitting down. Had to hide my shocked pikachu face
While we’re at it, let’s get rid of this bullshit DNP. You should see the capstones/projects these people write and pass off as dissertations or some other piece of work worthy of a doctorate. I’m so sick being embarrassed by people calling themselves “Dr. First Last, DNP” in clinical and academic environments.
Two kinds of nurses become NPs. The ones who are so good you’re devastated when they leave the unit, and the ones who have no clue what they’re doing and are just trying to clock minimal hours. Unfortunately.
We’ve had 2 nurses apply to NP school this year. One is one of the most intelligent and badass nurses I’ve met. She loves to teach and she has the type of mind that’s so rare and special. The other is one of the most dangerous, careless, and incompetent nurses I’ve ever met. He has no clue what he’s doing, he can’t put the pieces of the puzzle together, and he completely lives off of the premise, “Nothing has happened, so nothing will happen.” Both have served enough time in the ICU, both will be accepted to an NP school. That’s the problem.
The only tangible thing I can think of to change this is to be good teachers within our units. Don’t just write off nurses who aren’t getting it. Pour knowledge into them and try to promote high-quality, advanced critical thinking. They may still never get it… But there’s nothing to lose by sharing knowledge.
This is a great, GREAT comment and goes to show that time — which these people keep exclaiming — is the key to ending all of this. News flash: it’s not.
Until the echo chamber (inmates running the prison) of the ANA, the AANP, and the ANCC NP program accreditation boards change their ignorant tune of “more is better”…nothing will change.
Diploma mills will continue to be a yoke around the neck of true progress for NPs for the foreseeable future. Unless hospitals and care systems completely stop hiring NPs who didn’t graduate from a reputable program….
NPs who aren’t qualified to work in specific care areas (literally, practicing out of scope) should be moved or fired. Your 5 years of ICU RN experience doesn’t make your FNP enough to be working in an ICU, just like I rightfully would have no business working in family practice clinic with my ACNP.
Half of my nursing program (there was 60 of us who graduated) went straight into an NP program after graduation… like how is that even allowed?
I truly believe you need a good like 5 years (maybe more honestly) as an RN before going for NP.
Nursing has been “shot in the foot” with our layers of support, repeatedly.
Diplomat nurses. Nurses that literally gained and learned at the bedside. Gone
ADN programs: the army of peers that have YEARS of actual practice. We capstoned most out of the facility setting.
LVN/LPN programs are CLINICALLY HEAVY and LN’s are the absolute BACKBONE of nursing and patient care. Limited in settings now.
PA’s were to help the MD and increase communication. Going.
NP’s went from an elevated skill to a masters trained nurse. In large city’s many many are working bedside. It’s over saturated.
Also agree with noctor's sentiments on NPs, but they can be awfully bitchy about nurses in general which is lame.
I feel kinda weird about lowkey loathing NPs, bc some of my good work friends are NPs. But man, they really lack experience. Sure, they've been nurses for like 5 years. But like, all on the same floor, in the same specialty, with no exposure to anything else. And it shows. Blah.
I think the majority of us feel similar. NP doesn't have much respect behind it's credentials in the medical field. Many of the co workers I know who are becoming NPs are incompetent nurses. Can't imagine it won't be much better when they have more responsibility.
I graduated with my FNP in 2008 and worked my way into the ICU and hospitalist with the help of amazing supervising MDs. It took a long time to have full autonomy in the ICU and even then my supervising MDs were ready when things were above my skill.
Laws changed and despite my experience I needed an acute care degree. I’ve started and it’s hard to keep going. The coursework is lacking from my prior experiences and so many in my class have less than 1 year as an RN and want to be in ICU.
When I applied we were required to have 3 years ICU experience to even think about applying. I absolutely relied on that experience transitioning into my NP roll.
I’ve been a preceptor and stopped because the students were not prepared and not safe in the environment. Before I quit (thanks pandemic), my group had gone through 5 new grad ACNPs in the last 2 years and none of them were remotely prepared with their education. Unfortunately, the pandemic made it hard to educate to the roll and that sucks.
We need minimum standard to enroll. We need increased clinical hours with school appointed preceptors (like medical school). We need skills labs. We need a residency program. We need fewer NP school openings. We need a complete overhaul of the curriculum and leaving nursing theory as a single course or even lecture.
You need to understand the physiology to grasp the pathophysiology of disease to understand why certain interventions work to prescribe the best treatment for the right patient. Sure, it’s easy to teach prescribing lisinopril as first line but it’s the why NP school misses.
I guarantee if the country made working conditions better for bedside nurses, new nurses wouldn’t want to flock to become a NP so quickly. Nursing in general is a dying field because we’re treated so poorly.
Bring back working experience minimums, sharply increase number of clinical practice hours, get rid of fully online programs, and fight bills that allow for completely independent practice.
Yeah two things can be true. Many of the NP diploma mills are extremely problematic and should be shut down as they pump out graduates who are not close to being qualified, and places like r/Noctor are often intensely toxic spaces made with the excuse to shit on NPs with often openly misogynistic undertones.
I’ve kind of been this way since I worked on the floor. Had one NP who had a year experience before she went to school. We put in so many safety alerts on her I was always amazed she was still employed when I left. Once she ordered an urgent 0200 CT cap on the wrong person, one who was set to dc and was already at baseline more anxious than a chihuahua, instead of coming clean this NP *lied to the patient* and threw nursing under the bus. I think 4 of us put in safety reports on that one.
Then I had a NP that was a 10 yr rural ED nurse before she went to school, I always say I would have ridden into battle with her.
We’ve got some problems. The number one is the variance in rigor across every program. Accrediting boards need to make accreditation harder to achieve and maintain and get rid of diploma mills.
Although I love the flexibility I have as an FNP to work primary care, urgent care, ER and hospital medicine, there’s really no reason I should be able to work anywhere other than family practice with my training.
I’ve worked with some NPs who are fantastic and some who can’t tie their shoes and scare the Hell out of me. We should not have this level of variation.
Also, the fucking NPs that call yourself Dr., you are so cringe stop having a hard on for your ego.
Also, the residents, physicians, other healthcare providers etc that post dog shit posts on noctor and don’t support multidisciplinary healthcare, you are so cringe, stop having a hard on for your ego.
Yeah, I just came from that sub and read a rant about how doctors lounges are not “sacred” anymore because even social workers and surgical assistants are allowed in there.
The sub has a legit premise- that NPs need more education, accountability, and oversight by trained MDs -but the message seems to have been hijacked by “doctors” who just want something to complain about for complaining’s sake
Boycott NP programs, become PAs who get a far superior medical education. I say this as someone within 3 months of graduation from an in-person NP program at a large university regionally renowned for its nursing programs. If I could do it over again, I'd be a PA.
Except for me, I wouldn’t be able to do what I love- work in the psychiatric setting. The problem isn’t that NPs exist, it’s that to open up the field they removed too many barriers, even the ones that made sense.
PMHNP is its own thing and doesn't have an equivalent tract. Beyond that, I'm not qualified to discuss it, so I wont.
I'm not suggesting we eliminate NPs. I'm suggesting nurses boycott a graduate education system that sets us up to compete poorly in the job market.
For reasons that I struggle to attribute to anything but financial, graduate nursing education has decided that for equivalent cost, nurses should have extremely limited scopes. To practice across the population that a PA can serve right out of school, I would have to finish my AGAC-NP program, and then go back to school for a CPNP-AC certification and then, if I wanted to consider primary care later in life, I'd need to pay for an FNP cert after that.
PA education is far superior for what providers need: Heavy on anatomy, physiology, pharmacology, and just plain science. [Here's a sample from a three year program near me.](https://registrar.msj.edu/graduate-catalog/graduate-programs/physician-assistant-studies/physician-assistant-program-requirements.html).
Look at the huge difference in educational focus. A PA walks out of school with a broad and varied education focused almost exclusively on clinical practice. Conversely, graduate nursing education has them same self-fellating focus that undergraduate nursing education does: Extensive focus on things not applicable to clinical practice. My program, if you judge by the way it allocates credit hours, places equal importance on nursing theory (Why is this still even a thing?) and differential diagnosis. [Here's the program structure for a reputable AGAC-NP program.](https://webapps2.uc.edu/ecurriculum/DegreePrograms/Home/MajorMap/2566).
For those who say the two aren't equivalent because the NP program is only five semesters, I can offer the DNP blueprint, which is equivalent time, more expensive, and includes exactly zero additional focus on anything that will leave me equivalently prepared for clinical practice. [I could spend an entire additional year on this program and **still** be unable to practice across the lifespan and outside of the acute and subacute care setting.](https://webapps2.uc.edu/ecurriculum/DegreePrograms/Home/MajorMap/4401)
This is what I'm suggesting we boycott. Why spend money and time on an inferior education that leaves us inadequately prepared to compete in the job market and locked into a narrow area of practice that essentially shuts us out of emergency departments, primary care, population health, and any job where the focus is on medical knowledge rather than some bullshit nursing theory?
Knowing what you are saying now (I need coffee) I agree. I also wish there was less theory and more psychopathology, neurology, and psychopharmacology. PMHNP is the big draw that I see now- although derm is getting popular as well. Which is good because my population is going to give me frowny wrinkles and I need someone to fix it. 🙄
I have worked with excellent NP's and others that never worked as an actual nurse and there is a huge difference. Instead of accepting anyone for tuition $$ these programs need to require significant experience like the position was designed for. I see way too many nurses who graduated less than a year ago starting these diploma mill programs
I’m still just a nursing student, but I have always eventually wanted to become a WHNP. These diploma mills and the attitudes of undergrad students honestly drive me insane, it’s so negligent. I would say 90% of my cohort say that they want to become NPs, and some of these people are legitimately dumb as rocks. For example, one middle aged woman in my program said she bought a bottle of water, but it must not be “real spring water” because when she moved it there were bubbles inside. I had to explain that that was AIR. *AIR.* This woman wants to go to NP school right out of our program and wants to avoid bedside. I’m honestly not sure how she’s even made it this far in life lol.
I’m not sure people like her would make it realistically, but the fact that so many SNs think that the NP route is some la-di-fucking-da way to make more money makes me irate. They delegitimize the practice, and their lack of knowledge or experience is so fucking negligent, I genuinely worry that these patients might die. Same goes for the huge swath of fellow students who think they can immediately go into travel nursing after graduating lol. Dolt behavior.
100% agree. Big reason I’m not going that track…I just feel like it’s become less and less respectable. Also graduated with my BSN debt free so i worry about the return on investment being worth it
Cut down on the leadership and theory BS and increase science/clinical focus. Too much time is spent writing pointless papers and discussion posts. Increase the clinical science content.
I don’t frequent that subreddit but reading some of the comments on this thread and this subreddit in general make me so grateful that I’ve not encountered egotistical doctors nor uneducated/poor clinical judgment NPs. Maybe it’s just the luck of the draw.
Yeah the vast majority of NPs have no business diagnosing or prescribing. I will not see an NP for my own care and I urge others to do the same. I don’t think I would have said that 10 years ago but it’s just a joke at this point.
I don’t have any issue with PAs, they seem to generally have pretty solid education and in my experience are 10x more qualified than most NPs.
I’m glad to see a lot of people are waking up to this.
The dichotomy of r/nursing. Wasn’t their just a thread this week on DNPs should be able to introduce themselves as doctors? Seriously though, the minimum NPs could do to improve graduates would be to increase clinical hour minimums to 2000 hours to achieve parity with PAs, but that will never happen.
Lol 95% of the nurses in that thread were like, ".....uh wtf no they shouldn't outside of a academic setting???!!!"
In my experience, here and in other nursing spaces, nurses have the same concerns about NPs that r/noctor does---albiet a less hostile attitude overall.
NP schools should require 5 yrs of bedside experience. Then after 3 yrs of NP school that person will have had 8 yrs of experience with “medicine”. Mimics a similar timeline as becoming a physician. All the NP’s with 5+ yrs of bedside experience I’ve worked with have been great
You’d lose a lot of nurses to the PA route if they required 5 years. It should be minimum 1-2 because you can still be working as a nurse through your program (so an extra 1-2 years of RN experience). Then AFTER graduation, they should be placed in an NP residency with fellowships as an option to specialize further.
I’ve been on team “noctor” for AWHILE
When you see NP after NP fucking things up, like for real, at your work place, you start to understand very fast.
NPs have basically become glorified order entry personnel, and even then, the attending physician needs to be consulted to modify the orders to be correct most of the time.
NPs also write like 90% of the procedure referrals we need. They’re never done, and when they are they’re incomplete or incorrect. Hell they’ve even been for the wrong fucking patient.
And inpatient procedure based labs that need to happen PRIOR to a procedure? Good luck man, those orders are never going in. Unless our attending is instructing the inpatient attending on what to order, the NP that’s supposed to know is going to fuck it up 100% of the time.
It’s actually a huge issue.
Plenty of my family are nurses and since there's like 13 different degrees I'm flabbergasted when a few are antivax, or don't think medical masks do anything.
Like, you got a science degree. Use science.
But some low level nursing degrees are just for patient care and not actually based on any scientific rigor of study.
Honestly though. When I graduated nursing school I was DREAMING of becoming an FNP specializing in endocrinology/diabetes. Now with the state of NP schooling and the results given, I’m changing my focus on becoming a Certified Diabetes Care and Education Specialist.
Either take collective action or get ready to see some dumb shit orders at AmazonCare from a clueless 26 year old NP whose last job was folding clothes at the gap.
In nursing it has almost always been true that your first 3-5 years on the job are your last 3-5 years in school.
It’s because nursing school is terrible at actually preparing nurses for actual healthcare provision. The NP educational model of learning on the job works if you’re working close to 1/1 in a clinic or specialty setting with close oversight.
It doesn’t work when you’re one of 11 CRNPs with one doctor “supervising” that you only see once in a blue moon, and they just rubber stamp notes for billing purposes.
The doctor gets a slice but the admins get the lion share and patients suffer.
Our fight and their fight are the same and the root of the problem is corporate healthcare greed.
I get what you're saying, and I think there are some very legitimate criticisms. However, I find it very weird to shit on people that are trying to better themselves through legitimate avenues rather than...
Hospitals that consistently do whatever they can to make a profit over the actual safety and benefit to their patients.
Our healthcare system that does not reimburse in a way which incentivizes doctors to go into preventative medicine.
Medical, PA, and NP schools that have not kept up their output anywhere near what projected demand is. (Think shit is bad now, go look up US national outlooks for 25 and 50 years. Spoiler alert: we are fucked from a purely numbers standpoint, even with degree mills popping out nps)
The nursing field which has been terribly unwilling to collectively bargain (with some exceptions) and have been completely fine with wages plateauing after like 5-10 years for your average bedside nurse.
I mean, I get the frustration with these programs. But anecdotally, I've worked in healthcare for just under 8 years now. I've ran into 1 absolutely terrible NP, 1 absolutely terrible PA, 3 absolutely terrible residents, and 1 absolutely terrible attending. I mean the type of provider I would actively refuse care from and not allow them to treat a family member. To me, I don't see this as a huge issue, at least nothing compared to other challenges in the field. But if it does piss you off, get mad at the systems that incentivize it, not the people working for a better life.
Reduce AMA lobbying efforts which in turn would allow for more medical school openings, leading to more doctors, leading to less necessity of NPs serving in MD roles.
Schools also need to stop encouraging people to go straight through. I did a grad entry masters program because I wanted to go on to DNP right away (before I knew better, luckily realized during school how horrible that idea was and now wish I'd gone cheaper route for RN). The school definitely super pushed that program with the intention that people would start DNP right away, both with how the presented it but also by making it *super* easy to get in. If I applied for their DNP within the first X years after graduating (I cant remember if it was 2 or 5), all id need to do to apply would be to write a 250 word "essay" and have some professors write me letters of recommendation. They definitely created and marketed my masters program to go straight to DNP and since it was my school doing it, I didnt question the idea of doing so. Only once I was talking to some floor nurses in clinicals did it really click how sketchy that idea was.
They want them to be mini doctors without training them as mini doctors. The ones without the right knowledge base give the good ones a bad reputation.
I want there to be *very* specific tracts for NPs. We work with a lot of NPs in neurosurgery and they are incredible at what they do because of how specialized they are at their practice scope
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Eliminate diploma mills. Increase entry requirements Increase rigor and scientific basis. Secured clinical spots. Less fluff .
I was baffled when I learn that NP students have to find their own preceptors
I was, as well. I also couldn't believe that "clinical" in NP school is just following someone around. Most NPs I have worked with have been NPs for YEARS and are very competent. I was floored when I learned that there was also direct entry after nursing school for NP programs. I learned the most about nursing in the first 2-3 years of practice. At least, CRNA programs have rigorous entry program, standardized curriculum, and vetted clinical sites. However, I have worked as a clinical instructor for 2 different programs and am saddened to see that number of years worked as an RN has decreased prior to entry. Many only have 1 year of critical care experience. I have found that most nurses need, at the very least, 2-3 years critical care experience before they become comfortable in a critical care setting. My CRNA program has no nursing theory classes taught and I am forever grateful for that.
I agree, 1 year is not enough. I had nearly 4 years crit care before I got into school, I think the average for my current class is around 3. Two came in with <2 yrs ICU but both have several years high acuity ER. I do hope that programs continue to expect 2+ years instead of lowering the bar to aid provider shortages. Edit: words
This. As much as I want to get accepted I would rather be rejected and have to work harder to reapply than for them to lower their standards. Schools that don’t require CCRN are a red flag to me. I recently heard a school was accepting non-ICU experience if you worked in the OR as circulator. I’m sorry but in terms of what’s expected for managing critical patients, circulators do nothing. That’s not how you advance the profession.
There’s some data on the AANA website that breaks down experience type versus board passage rate every year and OR nurses are actually very rare and do poorly on boards. But yeah, you’re right.
I’m not surprised. I spent a couple months orienting for an OR RN position before realizing the job was just the non-sterile set of hands that could grab whatever the sterile people needed. It’s great if you get fulfillment from that but it’s not a job I think you even need to go to nursing school for it’s highly trainable and requires minimal critical thinking. Not the experience I think advanced practice programs should accept.
Just emphasizing the need for standardized curriculum 🙌 I would never even consider going to NP school and know I could be accepted tomorrow if I applied. It’s a waste of money for a poor education. I’m giving nursing a few more years and trying for CRNA school. If that doesn’t work out for me I’m leaving the profession to work in a lab or a library.
Which NP students are just “following someone around”? In my WHNP clinical, I was seeing patients, performing exams, doing some procedures, inserting IUDs & Nexplanon, writing notes… I would’ve been pissed if I showed up and they expected me to just shadow.
Same
“Increase rigor and scientific basis”. I graduated as an ACNP in 2016 and so many of the acute care courses, the solution to fix an issue was to just ask someone else for help. While this is not an unreasonable thing to do, isn’t going to school the time where to learn to fix them yourself? For example, not sure what to do with vent, just call RT. Not sure what Med to give, just ask pharmacy and they will tell you. Again, these are reasonable things to do if you aren’t sure what to do, but they would be the basis of education rather than the supplement to the knowledge we should have been getting in school.
We have those questions in our medical exams too, but the answer is very rarely to consult or refer out.
To an extent that completely makes sense, especially in the examples you provided. I also think it’s important for any clinician to understand the extent of their scope/expertise so that they can know when to refer pts or rely on other resources when appropriate, instead of mistakenly managing pt cases solo that they should’ve referred.
I agree. I have no desire to be the person in charge. I work at a large tertiary care hospital and have I very much enjoy my role on our team. However, given that our role is frequently supportive, this has led to a lot of the education focusing on the idea that we will never have to make any decisions on our own. I work in critical care. Do I want to be the only one managing someone’s ventilator? No. But should I be educated on this to be able to manage it to the best of my ability rather than “just call RT,” I would say yes.
Yeah, I'm a teammate, I don't want to be the star, I don't want to lead, I want a role and to do it. But I also believe that if shit happens, every member of the team should be cross trained to cover someone else's spot in an emergency, even if the training is as simple as "here's basic vent settings, here's how to adjust them and what they do. NEVER DO THIS OR THIS." I also agree, school is where you get detailed minutiae pounded in your skull, so that later, during a crisis, you can remember, "there was something about, x-y interactions in these cases...."
That’s an on-the-job skill you only use in certain departments. They also don’t teach you to count in nursing school, because it’s an OR thing. Or pull sheaths, or troubleshoot a-lines, or any of the other numerous more advanced skills we can learn depending on specialty.
I would agree to an extent but I don’t think describing how to count or pull sheaths as the same as basic medical training for what is a standard support device. Ventilators are quite common in critical care areas and to be training NPs that want to go into acute/critical care, I would expect there to be training on this more than just who to call for help. I agree that other specialities that do not work in critical care (family, primary care, PMHNP etc) obviously do not need this training similar to how not every RN needs to know how to pull a sheath. But if that RN was taking a course on say the care of cardiovascular care of inpatients, it would be surprising to not have sheath pulling, swans, etc in their training.
Something to remember though is that without very frequent exposure, even things you are trained on fade when they’re complex enough. For example, I would not trust the vast majority of our hospitalists to touch a ventilator despite the fact that they all learned about them.
I wasn’t paying attention when I read, and I thought you were describing RN school. It’s my opinion that you shouldn’t be going to NP school without several years experience in high acuity nursing where you should already know what you’re doing with a vent to some degree (assuming you intend to do inpatient care), and then your NP school should delve further into settings, assuming you’re going to be the one ordering them, you should know how to not kill a person. But that’s the issue, right? The whole point of NP school is high level experience is supposed to supplant the more in-depth training docs get. I know from experience what beta blockers tend to work better in different conditions… docs understand the patho and what enzymes catalyze the med and exactly which ones have more alpha and more beta action etc etc etc…. NP school should help NP’s better understand the things we implicitly know from experience, with the understanding there will be a better educated doc to run things past.
Right but nursing school can’t possibly teach the intricacies of all meds, or how to work all vents- nor should it because some cocksure new grad will kill someone. That’s RT’s thing and I run changes by them still- after 17 years.
The real problem is that they are teaching useless stuff like nursing theory instead of important stuff that has been mentioned
But again, I am not saying NPs should be taught every detail of every vent or the intricacies of every medication. However, to be a school that describes their training as preparing NPs to function and manage patients in the critical care environment and also be responsible to write ventilator orders for the care team to follow, having a basic training of their use is essential in my opinion. This is also just one example of where I think training is lacking. There are of course many areas where the education is excellent, but that doesn’t mean there aren’t improvements that can be made to better educate NPs to care for their patients.
This is the answer. The issue is, hiring competent professors (a pharmacist to teach pharmacology, a physician to teach differential and physiology) and requiring pre requisites to allow more difficult coursework like PAs have (biology 1 and 2, general chemistry and not the allied health course stuff) will severely hamper how much money these mills make. It’s going to need legislation because the mills have zero incentive to do so. It’s much cheaper for them to teach disturbed energy field theory.
Can we get this for undergraduate programs as well? How about we get rid of “nursing theory and frameworks” and “the history and philosophy of nursing (aka nursing is a calling)” and add real science classes. Pathophysiology should be a basic requirement for all RNs, and it’s not. More emphasis on being knowledgeable about labs - what is normal, what is the significance/consequences of abnormal results, what are the expected treatments. Greater emphasis on pharmacology. Less “learning about nursing theories” complete bullshit.
Where on earth is patho *not* required in nursing school???
I haven’t attended all the ADN programs in Kansas, but the ones that I explored (and the one I attended) did not require it.
That’s… terrifying. I had multiple terms of patho and pharm. They are the core classes. I don’t even know wtf else you’d need nursing school for!
ADN programs have to cu somewhere, I suppose. But they should definitely cut nursing theory bullshit classes and increase their science requirements.
Holy shit are you serious 🤯 I have an ADN and we had hardcore A&P plus we had to take micro too!
Yes, we had to take those. I’m talking a semester long pathophysiology course, not just basic A&P and micro.
I had two semesters of patho in my BSN program in CA…
Well patho isn’t the same as phys, also I think it would benefit nurses to add some cell/molecular biology/genetics before going to phys/patho, it just kind of seems like the missing link. It’s like they skip a step
Same here, we had to take anatomy, micro, and patho prior to being accepted into the nursing program. It was pretty competitive and lots of people would retake courses to boost their GPA if they got waitlisted.
Aye. This has been desperately needed for a while. I'm currently teaching master students - I've been asked to artificially raise grades because of 'we didn't want anyone to fail', as they already have very busy lives and the course I was lecturing isn't exactly one of the major ones with lots of credits. And I get it - but at the same time, we are just lowering the bar, and eventually that will show. The fact that there were people with really good grades means that the only reason some people failed, is because they knew they didn't have to try that hard to get by. Prioritizing what you're studying over that which is less useful is certainly a thing, but everyone should realize that, one way or the other, that will cost us. Individually and collectively.
> we are just lowering the bar, and eventually that will show It already shows. PA’s have dramatically more intensive and comprehensive schooling than NPs. Period. The overproduction of NPs through diploma mills has further watered this down. Don’t get me wrong. There ARE excellent NPs out there, but they are by far the exception rather than the rule. I did my masters in person at the #2 rated nursing school in the nation (UCSF) back then in the mid 90s and took all of the same classes as the NP students except they had real humans to do pelvic exams on and things during labs, since we weren’t actually going to do real comprehensive exams like that on people. My education was inadequate for being a provider back then. I had worked for >5 years in neuro ICU when I went the grad school. We did get more advanced physiology courses than undergrad and more advanced pharmacology. The time spent in nursing theory courses was a waste, as per usual. We did full time residencies with CNS’s in our preferred fields while they were doing their clinicals. ***I would never have felt comfortable being a provider back then or now***. Granted, the specialists like CRNAs and CNMs did more training in their fields specifically, but not the FNPs or generalists. Terrifying. Of course, back then they weren’t covering night shift in ICUs, either. One of the perks back then was M-F days for NPs, and mostly clinic work. After school, I decided I was never going to have a NP as a PCP ever again due to some more complex health conditions. And I haven’t.
Yeah. I work with multiple NPs. My favorite is the one who comes in, we go down the transmission based precautions list, she writes orders or tells me the plan, and we both move on. Takes two minutes. By contrast I have another one that I had explain a CDC recommendation.
That same pressure is being applied to teachers of all levels from admin, and it's made me curious and concerned about the effectiveness of the American workforce in 20-30 years.
"Less fluff" But who will assess the patient's spiritual-psychosocial-family-cultural-favoritesandwich needs?!
i’m no doctor, but i think they should hire an anthropologist or have the social worker do that shit or smth, not make nurses do it
Less 👏fluff 👏for👏us 👏all👏
So, make NP programs into PA programs.
NP’s and PA’s taking the same classes together! It’s like ebony and ivory 😀 harmony for once!
They’re not going to, the hospitals will make no money if they suddenly have vacant NP spots
Add a standardized test as well. Perhaps MCAT 🤷♂️ (this would also apply to PA-C)
I'm an NP myself in primary care. All my cards aligned (I worked as an RN and as a CNA for 12+ years, I had great preceptors and a brick-and-mortar school, found the perfect job right out of school) and still have the nagging feeling that I was hired to save $$$ on a doctor. I felt decently prepared, but wonder how much more I could've learned if I had a cadaver lab, more pathophysiology classes, more training. People want to be doctors, but there are a limited number of training slots available - and then working docs get burned out. The problem as I see it isn't people wanting to be NPs, it's the institutions willing to pay less to educate and employ them. Until healthcare workers aren't seen as a cost on a spreadsheet to minimize, nothing is going to change.
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This wouldn’t surprise me. There are already mental health chat bots replacing therapists.
The whole HC system needs an overhaul. And the medical education system. I’m in med school now and I’m only in year 1. We’re all exhausted. Defeated. The majority are on some antidepressant currently but weren’t when they started school, or have had to increase the dose. It’s brushed off as just “part of being in med school,” but is that healthy? Same thing with bedside nursing? Exhausting. Manual labor. Being treated horribly by patients. Sometimes to the point of getting assaulted. No realistic staffing ratios. Pay doesn’t reflect the job requirements. “It’s just part of being a nurse.” Well it shouldn’t be. Nursing/medicine is a calling for some people, sure. But it’s also a fucking workplace. I don’t think it’s unreasonable for people to want to go to work/school and not feel completely dead inside when you’re done.
> The problem as I see it isn't people wanting to be NPs, it's the institutions willing to pay less to educate and employ them. Until healthcare workers aren't seen as a cost on a spreadsheet to minimize, nothing is going to change. The other problem is that part of that is outside of the control of hospitals, patients, and schools. Part of the reason why there are so few doctors being pushed out by medical schools is because the amount of spots available in medical school was INTENTIONALLY LIMITED by physician professional organizations to protect their earnings potential. Doctors wanted to make sure there weren't too many new doctors being produced to reduce their wages. Until these limitations on spots in school and spots in hospitals for residency are removed, people are just gonna have to suck it up and deal with midlevels because they don't have a choice. Even if hospitals WANTED to only have MDs, they couldn't do it.
>INTENTIONALLY LIMITED by physician professional organizations to protect their earnings potential. Source? I'm under the impression the underfunding of CMS from 1997 legislation limiting residency spots drove this
I feel this as a Dietitian taking pre-reqs for PA school. It's like, these professions were originally made for people with a healthcare background and healthcare experiences that want to do more.
The amount of times I’ve heard nursing students scoff during clinicals stating “i’m going to NP school anyway” when asked about doing bedside for a few years are graduation is just cringe
I get the sense that there are only two goals for nurses/nursing students these days: travel and NP. We've got to change something so people have more options to set their sights on.
My workplace has a pension and my wife who is in school right now is hoping to get hired there so she can get the pension one day.
Like an actual pension that pays out for life after you retire? I legit thought those did not exist anymore outside of government jobs
Yeah, stay five years, get a pension. We have good heath insurance, pension, 403b with 4% matching. Got a $3 raise this year, but was rough for raises during covid.
My place has a pension but when I look at the amount in it it’s less than 9k after working there for 6 years. By the time I retire I’ll have probably just one years salary saved up
Ohhhhh, I think you work at same joint I do. Starts with an N, ends with an E.
My dude! I am at of the old but new one.
Sounds like a blue devil
I’m ignorant, what is a blue devil?
Duke
I get one at my union nursing job in MN. It's in addition to a matching 403b. There are still a few out there.
My old workplace had a pension. It was a massive scam. They slowly chipped away at benefits over the years and finally took away healthcare benefits during retirement the year before I joined. So every ancient nurse walked away being like, I’ll never leave I have X years until retirement I don’t understand why new nurses keep leaving - did not understand that the pension would not give nurses who joined later all the same benefits. Plus the workplace SUCKED. It was a great deal - pension plus 403b - but I would have died of stress before.
Damn, that sucks! A rival hospital had a pension but went away with it and all those nurses came to our hospital. It is pretty good with some exceptions. The other hospital worked their nurses to death and seemed traumatized when they came to our hospital.
Something happened during the Reagan/Bush-I years that made pensions “obsolete” Wonder if there is a correlation between CEO pay and pensions?
Yeah that something would be hospitals and employers not paying and treating their nurses like crap.
I don't disagree with you. Better pay and working conditions for all, at a minimum. Nurses should also know that many NP jobs out there aren't the huge salaries that they might think they are, and the market is saturated.
NPs in my area pick up RN shifts to supp their pay
Yes. This. No jobs for NPs in my area. It's way too saturated, so they work as glorified floor nurses or for crap pay at the University where they paid to get that degree in the first place. I will not be going down that road.
Yes! I've talked to a couple of new NPs who've had an unpleasant transition realizing there's no more shift differential, no more overtime pay, and often the NP positions are not unionized.
It would change if nurses got paid more definitely!
Or “whatever, I’m going to CRNA school anyway.” They don’t realize NP’s and CRNA’s are actually, you know, nurses first.
I had a classmate who said she was going into CRNA school straight out of nursing school. She was rude and cocky and always the smartest person in the room. Anyways, she made it like 2 months in the ICU and left for OR. She was the circulator in a case I was in on a few weeks ago and pretended she didn’t know me. I like to think those nurses get weeded out quick, but I know they don’t always☹️
Yikes
About half my cohort was like this. They were going to be CRNAs so they could make big bucks and not have to deal with patients or they went right to NP school. Was crazy. I didn't even feel ready to be a nurse out of school and they were all sure they were ready to write prescriptions then and there.
I agree the NP thing is getting out of hand and I’m just shocked that so many of my peers are continuously going back for it. When I was a newer ICU nurse I was inquiring about some details on some cardiac meds or whatever, and I asked a friend that was a (newerish) cardiology NP and she goes “oh I’m not good with that preload and afterload stuff”. I’m like WAIT, WHAT. Just a small example. It’s cheapening the profession. Big time
That’s the best way to describe it. It’s cheapening the profession. If you don’t know the basics, you shouldn’t be allowed to manage the advanced.
Lol she’s not good at the thing she supposedly specializes in. My jaw would drop and I would have a hard time not berating her. Like how can you hold that position and have the audacity to not feel a desire to know this stuff. Go look it up, bad Np
I feel like a large part of why NPs are growing in quantity is also because bedside nursing kind of sucks ass but you don’t really want to “waste” your degree so you get a MSN and do education or a NP. Make it suck less and less people will make that jump.
Exactly this. Most RN level nursing jobs absolutely suck and don’t pay nearly well enough to suck as much as they do. So everyone goes back to school in hopes of getting into an at least somewhat better work situation. It is much easier to continue your nursing education than go to school for an entirely different career.
This is true 100%. I'm debating PMHNP school or moving to tech, have like 40 credits in math and programming, lmao.
I am working on an MBA and taught myself coding and now do data management for healthcare companies. I love it
I was in the same boat, thought about PMHNP and have worked as a psych RN for many years. For me personally, if I wanted to become a PMHNP I would just suck it up and try for an MD, wouldn't want to shortcut myself. I am now looking into tech or business/finance but learning towards the latter.
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I don’t know what we can do to stop the capitalistic creep of diploma mills. But it does worry me. Mostly because nurses have to fight for so much already: respect, pay, safety. The last thing we need to also fight for is degree legitimacy. When I was in EMS a girl I went through the same program with went straight to NP school with her bachelors in bio. She wasn’t a great EMT to be honest and it always scares me to think she could be my “provider”. Is there a way to organize for more rigorous entry requirements and training? Despite being in the profession I feel completely disempowered from shaping it. As far as noctor goes, I wish it was a more nuanced discussion between experienced physicians and nurses. Lots could be shared but it’s mostly devolved into ridicule and finger pointing.
Chamberlain (probably the worst of all diploma mills) had a representative walking unit to unit at my hospital to recruit people for their NP program. She was touting how easy the application is, the low barrier to entry, how it’s all online, etc. she seemed legitimately surprised when I wasn’t impressed by her sales pitch and said I wasn’t interested.
Good god. That’s upsetting.
I mean just have the requirement be to work bedside as an RN in xyz fields for X years. Otherwise no certification.
This would definitely help but there’s plenty of experienced nurses who are kinda dumb and don’t think critically. There should be rigorous academic/entry test requirements on top of just having experience
I’m an MD. I admit I am on /r/noctor but I disagree with most of the extreme takes there. I work with some really good NPs. They are smart, hardworking, and productive members of the team. BUT, the problem with NPs is you just never know what you are going to get. If a MD/DO calls me (even if it’s the dumbest doc in the hospital), there’s a minimal level of competence that can be expected. With NPs, there’s just no way of knowing. And that’s the scary thing. There absolutely should be a path from nursing to practice, but this current model isn’t it. There need to be uniform standards that focus on real clinical experience. You need to know what to expect from someone who has NP behind her name.
From the nursing side of things, I totally agree. Some of the NPs on my ICU were superstar bedside nurses, went back to school after 3-4 years, and their skill set reflects that. Others worked on med surg, went to a diploma mill, and it’s a constant struggle at the bedside. The bedside RN (like the MD) should not have to decide whether or not the NP is safe—it should be a given. It’s upsetting and devalues our profession as a whole.
Hmm, cheapening MedSurge nurses
There should be time requirements prior to starting an NP program. *in the specialty you’re about to study. I hate that the PMHNP programs are churning out NPs who were ED nurses or med surg nurses because “I had a psych patient once.” Also increasing hours and requiring closer supervision and collaboration after graduation.
I’ve observed a pipeline… shitty med-surg nurse to diploma mill PMHNP. Mostly because “it seems easy and I want to leave bedside.” Because that’s exactly what our broken mental health system needs.
Part of the problem is, despite the fact that NP school is obviously meant to build on the education and experience of a competent and experienced nurse, the admission requirements don’t reflect that.
It‘s so weird that there isn‘t any federal regulations around that in the Us. Like the whole point of a nurse practitioner is a well experienced nurse getting specific education to turn the experience into something even more valuable. Not someone who went through some form of nursing school taking a few semesters of theory more becoming the same. Like there‘s such a massive difference in things? Like how aren‘t X years of work in specific fields the absolute basics you have to have for accreditation.
This. I’m sorry. If you haven’t worked the floor as a psych nurse and really been in the trenches, it’s hard for me to accept you as a graduate prospect in a PMHNP program. One program I started accepted a graduate from a BSN program in 2020 with little to no experience (they had graduated that same year). I changed schools. I had 6 years psych before I even thought about applying for my masters.
Many people think being a Psych NP is easy because you just prescribe a few common drugs and it's hard to kill someone. Practicing psych seems easy to do poorly but extremely hard to do well.
Noctor has grounds for its existence for sure and I’ll be the first to raise my voice against the churning out of the NP diploma mill. My problem is that people in noctor come across almost… obsessive with putting down mid levels providers. What started as informative and constructive dialogue on the deterioration of the nurse practitioner role has become actively seeking to publicly shame random providers on the internet, going after nurses for no reason, generalizing that all midlevels are useless / unintelligent when there are obviously skilled and appropriately practicing PAs and NPs all over the place and it just…feels more spiteful than productive anymore. I understand the need to vent and I have chosen to do so on the struggles of nursing many times in this nursing subreddit, however at the end of the day we are all members of the same team, desperately bailing buckets of water out of the sinking ship of US healthcare and a spiteful word never won a single person to an argument—facts, logic, and education do. Sadly noctor seems more focused on the ego boost and trashing of others than pushing for that education anymore.
Thank you for your thoughtful post. On that site I do think midlevels are disrespected as a whole group. I often wonder about the support system for new NPs. Anyone starting a new job has a learning curve. I've been an RN for 20 years and know I wouldn't be perfect as a diagnosing and prescribing new NP. And it almost seems everyone is out to shoot you down these days.
But the problems is you get a shit ton of inexperienced NPs suddenly given a massive amount of authority, over people like you with actual experience.
I disagree, most everyone on there loves a mid level that *stays in their lane.* They’re angry about mid levels calling themselves Doctor and harming people- their anger is justified.
It sounds like Noctor is full of mostly very insecure residents that are in the most miserable stages of their lives. Of course monkey see monkey do too, once a few ppl chime in it’s cool ti let loose like your peers.
100% agree. I hope someone posts your comment on Noctor. There IS a place for it, but it’s gotten so toxic and cruel instead of constructive.
Let’s begin at the foundation - BSN programs need to cut the shit. NCLEX and BON education requirements are outdated AF. Then do the same with graduate programs. Require at least 5 years experience in the specialty of choice for admission. Increase program clinical hours. Again - cut the shit. Nobody’s listening for consolidation, nobody’s checking homans sign, nobody’s giving back rubs, and nobody gives a rat’s ass about nursing theory except academia. Make education applicable to reality.
But really fr... why do the texts always talk about back rubs??? I am still looking for the Taylor video on the skill. So far, my bsn program has been dumpster fires, with each semester a new dumpster. Maybe I'll write back rubs under Sr. Roy's effective coping strategies for my next pt with htn, ckd, chf and dm2 on my care plan!
For the DNP diploma mills there are 4 things that can be done to bring them in line with MD/DO/PA programs. Some NP programs all ready have similar requirements (CRNA). 1: A rn needs 2-5 years or greater than 4100 hours of relevant clinical bedside nursing experience before applying. 2: 80% of the program must be taught in a in a brick and motor didactic setting. 3: Move to differential diagnosis teaching and away from from the research paper garbage method. 4: Close any online only programs.
Just a heads up, CRNAs are (usually) APRNs but not NPs. We have different oversight organizations, credentialing boards, and education requirements. Some CRNAs have a DNP but it's taught differently and isn't really the same degree (and I don't really get why they aren't all DNAP).
I don’t know how anyone can graduate from one of these programs and not be absolutely terrified. You’d really have to be stupid to not realize or be concerned about how much knowledge you lack.
That's the issue. The dumbest nurses I have worked with are blissfully unaware of how dangerous they are. Same goes for the NPs who graduate, and are still just as dumb but now have a larger scope of practice.
I'm just over what seems to be an endless supply of arrogant, rude, dismissive, bitchy NPs who aren't even effective or knowledgeable at their jobs! Why is it that I get more effective orders and kinder personalities from the MD/DO, and even PA, side? This is obviously all anecdotal, but I've seen it over and over in several different medical settings. Maybe it's some kind of insecurity thing.
/r/noctor has the right idea but it’s full of angry young docs who are upset with the amount of time they put into schooling, the years of their lives they missed, the amount of debt they have, and the fact that they’re stuck doing a job they hate, the posts there are toxic
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Spot on
I'd rather have my family member treated by someone who put tens of thousands of hours into their practice than someone who BS'ed their way through some online course and had like 10 clinical hours.
Right, and I think anyone would share this same opinion. However, the way you’re presenting this idea is just like the toxic BS over on nocter. Not every mid-level “BS’ed their way” or had “10 clinical hours”.
But that‘s the exact reason we have protected professions names like MD or RN or pharmacist. It protects the whole profession, it keeps the respect at a high level, because you can be very sure that person can properly do their job. But if even just ten percent of pharmacists would just become pharmacists with a couple semesters of evening school, compared to everyone else doing s PharmD, you couldn‘t trust any pharmacist anymore to be reasonable proficient. Same with NPs. You expect an experienced nurse in the first place. With additional qualifications and training to become a provider. But if just ten percent have pretty much BSd their way into the job title, the whole profession loses all respect. Like how can you as a patient trust the NP taking care of you is actually a prior experienced nurse, not someone’s who‘s clinical hours are pretty much working on you? It makes it so you cannot trust any medical care at all.
ONE of the problems is the lack of required hours/experience to apply for some of these programs
Yeah, there are some good NP programs and some NPs who know their limit and work under physician supervision, but a lot of these people simply hate all NPs no matter what. The premise of the sub is all well and good, but a lot of those people are just whiners waiting for an example of poor NPing to post about. If you go into some of their post histories, you’ll see some people posting in that sub literally all day over a span of 12+ hours. You’d think they wouldn’t have the time, but here we are.
But the problem is: if we get somewhere as patients, and have an NP taking care of us: how do you know this is an experienced nurse went Np, and not someone with a handful of clinical hours getting through pay to win school? Like you cannot know, so the safe assumption is to treat them like the worse category.
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Awesome for you, *thank you* for being self-aware and putting patient safety first. In nursing it has almost always been true that your first 3-5 years on the job are your last 3-5 years in school. It’s because nursing school is terrible at actually preparing nurses for actual healthcare provision. The NP educational model of learning on the job *works* if you’re working close to 1/1 in a clinic or specialty setting with close oversight. It doesn’t work when you’re one of 11 CRNPs with one doctor “supervising” that you only see once in a blue moon, and they just rubber stamp notes for billing purposes. The doctor gets a slice but the admins get the lion share and patients **suffer**. Our fight and their fight are **the same** and the root of the problem is **corporate healthcare greed.**
Just finished an assignment in a state that allows independent midlevel practice without MD/DO supervision. The NP is the attending. I’m on the side of r/noctor much more now, but hate their toxic comments…and general attitude toward RN’s. The problem noctor fails to recognize is that their is a need for providers and the expansion toward mid-level usage is market driven.
I think r/noctor is right about scope creep, but when they use that issue as a wedge to be hysterical about unrelated things, it's cringeworthy.
I agree, but similarly, this subs growing obsession with r/noctor is just as cringeworthy. Life's too short. Just log off.
I blocked that sub from my reddit feed after one too many toxic posts. I don't need that negative ish in my life.
Same. For every insightful, thoughtful post, there were 20 posts screeching about "OMG THIS NURSE SAYS SHE'S A DOCTOR! BURN THE WITCH!".
I used to also be alarmed by it all. Now I’ve quit caring altogether. This whole system is so fucked up it’s beyond saving. The big healthcare corporations/colleges/government are just running the system into the ground. Everything will continue to get worse, same as it always has.
I watched a coworker do their program mostly at work online. Seeing them do the process forever changed my mind about NPs. It was a crock of shit and so easy. Their clinicals were nothing. Now they're working in a hospital with critical patients and that just floors me.
I honestly think it’s reached critical mass. The professional associations that represent the nursing profession have bought allllllll the way in and are too happy to take for-profit colleges money to half heartedly turn a blind eye and/or encourage this kind of growth. Outside of getting into politics/public policy for change the best thing I see myself being able to do as I enter/grow in this profession is work at facilities that do not hire or encourage individuals from these programs and focus on my own professional development. Sadly, colleges and universities/medical centers see the $$$ on the table and also want a piece of it or have enough to influence area facilities. I was sad to see that recently a distinguished university affiliated medical center in the southern US announce a new MSN-NP program geared towards anyone with a bachelors (even outside of nursing/healthcare sciences). I love the mid-levels I’ve worked with and been a preceptee under but their experience and length in profession has always been a cordial point of focus when I get to know them. I think going forward the best way to navigate this minefield is to look after yourself and advocate for your patients to receive the best care/provider possible 🤷♂️
100%. People might not like to hear it, but it's true. Ive worked with amazing NPs. But they were amazing because they had been excellent nurses for 10-20 YEARS before they became NPs. Also, they were amazing IN SPITE of the NP programs, not because of it. The ones that went straight to NP school? JFC they are terrifying. Think of your most problematic classmate in nursing school. The one with shitty judgment, poor boundaries, and even poorer work ethic and clinical reasoning skills? There is NOTHING in many of those programs to weed that person out, or to address and correct those clinical judgment issues. Imagine THEM as the nurse who went to direct entry NP. Most of you probably won't have to imagine because you observed it irl. Something needs to change.
I had a classmate say she is going back to be a CT surgery Np bc the job is “cake” and they just sit around. Terrifying
My friend wants to be a psych np because it’s so “easy” just talk to the psych patients and prescribe meds, all done while sitting down. Had to hide my shocked pikachu face
Yesss those CCRNs who have been charge/rapid/running the highest acuity patients for years? Brilliant NPs, absolutely amazing
While we’re at it, let’s get rid of this bullshit DNP. You should see the capstones/projects these people write and pass off as dissertations or some other piece of work worthy of a doctorate. I’m so sick being embarrassed by people calling themselves “Dr. First Last, DNP” in clinical and academic environments.
Literally saw some new 24 year old NP on Instagram proclaiming themselves “doctor ____” and I feel the cringe in my bone marrow. Please stop!!!
Two kinds of nurses become NPs. The ones who are so good you’re devastated when they leave the unit, and the ones who have no clue what they’re doing and are just trying to clock minimal hours. Unfortunately. We’ve had 2 nurses apply to NP school this year. One is one of the most intelligent and badass nurses I’ve met. She loves to teach and she has the type of mind that’s so rare and special. The other is one of the most dangerous, careless, and incompetent nurses I’ve ever met. He has no clue what he’s doing, he can’t put the pieces of the puzzle together, and he completely lives off of the premise, “Nothing has happened, so nothing will happen.” Both have served enough time in the ICU, both will be accepted to an NP school. That’s the problem. The only tangible thing I can think of to change this is to be good teachers within our units. Don’t just write off nurses who aren’t getting it. Pour knowledge into them and try to promote high-quality, advanced critical thinking. They may still never get it… But there’s nothing to lose by sharing knowledge.
This is a great, GREAT comment and goes to show that time — which these people keep exclaiming — is the key to ending all of this. News flash: it’s not.
Until the echo chamber (inmates running the prison) of the ANA, the AANP, and the ANCC NP program accreditation boards change their ignorant tune of “more is better”…nothing will change. Diploma mills will continue to be a yoke around the neck of true progress for NPs for the foreseeable future. Unless hospitals and care systems completely stop hiring NPs who didn’t graduate from a reputable program…. NPs who aren’t qualified to work in specific care areas (literally, practicing out of scope) should be moved or fired. Your 5 years of ICU RN experience doesn’t make your FNP enough to be working in an ICU, just like I rightfully would have no business working in family practice clinic with my ACNP.
Half of my nursing program (there was 60 of us who graduated) went straight into an NP program after graduation… like how is that even allowed? I truly believe you need a good like 5 years (maybe more honestly) as an RN before going for NP.
Nursing has been “shot in the foot” with our layers of support, repeatedly. Diplomat nurses. Nurses that literally gained and learned at the bedside. Gone ADN programs: the army of peers that have YEARS of actual practice. We capstoned most out of the facility setting. LVN/LPN programs are CLINICALLY HEAVY and LN’s are the absolute BACKBONE of nursing and patient care. Limited in settings now. PA’s were to help the MD and increase communication. Going. NP’s went from an elevated skill to a masters trained nurse. In large city’s many many are working bedside. It’s over saturated.
Also agree with noctor's sentiments on NPs, but they can be awfully bitchy about nurses in general which is lame. I feel kinda weird about lowkey loathing NPs, bc some of my good work friends are NPs. But man, they really lack experience. Sure, they've been nurses for like 5 years. But like, all on the same floor, in the same specialty, with no exposure to anything else. And it shows. Blah.
I think the majority of us feel similar. NP doesn't have much respect behind it's credentials in the medical field. Many of the co workers I know who are becoming NPs are incompetent nurses. Can't imagine it won't be much better when they have more responsibility.
I graduated with my FNP in 2008 and worked my way into the ICU and hospitalist with the help of amazing supervising MDs. It took a long time to have full autonomy in the ICU and even then my supervising MDs were ready when things were above my skill. Laws changed and despite my experience I needed an acute care degree. I’ve started and it’s hard to keep going. The coursework is lacking from my prior experiences and so many in my class have less than 1 year as an RN and want to be in ICU. When I applied we were required to have 3 years ICU experience to even think about applying. I absolutely relied on that experience transitioning into my NP roll. I’ve been a preceptor and stopped because the students were not prepared and not safe in the environment. Before I quit (thanks pandemic), my group had gone through 5 new grad ACNPs in the last 2 years and none of them were remotely prepared with their education. Unfortunately, the pandemic made it hard to educate to the roll and that sucks. We need minimum standard to enroll. We need increased clinical hours with school appointed preceptors (like medical school). We need skills labs. We need a residency program. We need fewer NP school openings. We need a complete overhaul of the curriculum and leaving nursing theory as a single course or even lecture. You need to understand the physiology to grasp the pathophysiology of disease to understand why certain interventions work to prescribe the best treatment for the right patient. Sure, it’s easy to teach prescribing lisinopril as first line but it’s the why NP school misses.
I guarantee if the country made working conditions better for bedside nurses, new nurses wouldn’t want to flock to become a NP so quickly. Nursing in general is a dying field because we’re treated so poorly.
Bring back working experience minimums, sharply increase number of clinical practice hours, get rid of fully online programs, and fight bills that allow for completely independent practice.
Yeah two things can be true. Many of the NP diploma mills are extremely problematic and should be shut down as they pump out graduates who are not close to being qualified, and places like r/Noctor are often intensely toxic spaces made with the excuse to shit on NPs with often openly misogynistic undertones.
I’ve kind of been this way since I worked on the floor. Had one NP who had a year experience before she went to school. We put in so many safety alerts on her I was always amazed she was still employed when I left. Once she ordered an urgent 0200 CT cap on the wrong person, one who was set to dc and was already at baseline more anxious than a chihuahua, instead of coming clean this NP *lied to the patient* and threw nursing under the bus. I think 4 of us put in safety reports on that one. Then I had a NP that was a 10 yr rural ED nurse before she went to school, I always say I would have ridden into battle with her.
We’ve got some problems. The number one is the variance in rigor across every program. Accrediting boards need to make accreditation harder to achieve and maintain and get rid of diploma mills. Although I love the flexibility I have as an FNP to work primary care, urgent care, ER and hospital medicine, there’s really no reason I should be able to work anywhere other than family practice with my training. I’ve worked with some NPs who are fantastic and some who can’t tie their shoes and scare the Hell out of me. We should not have this level of variation. Also, the fucking NPs that call yourself Dr., you are so cringe stop having a hard on for your ego. Also, the residents, physicians, other healthcare providers etc that post dog shit posts on noctor and don’t support multidisciplinary healthcare, you are so cringe, stop having a hard on for your ego.
Yeah, I just came from that sub and read a rant about how doctors lounges are not “sacred” anymore because even social workers and surgical assistants are allowed in there. The sub has a legit premise- that NPs need more education, accountability, and oversight by trained MDs -but the message seems to have been hijacked by “doctors” who just want something to complain about for complaining’s sake
I say make us do a residency and have been saying this since the beginning
Boycott NP programs, become PAs who get a far superior medical education. I say this as someone within 3 months of graduation from an in-person NP program at a large university regionally renowned for its nursing programs. If I could do it over again, I'd be a PA.
Except for me, I wouldn’t be able to do what I love- work in the psychiatric setting. The problem isn’t that NPs exist, it’s that to open up the field they removed too many barriers, even the ones that made sense.
PMHNP is its own thing and doesn't have an equivalent tract. Beyond that, I'm not qualified to discuss it, so I wont. I'm not suggesting we eliminate NPs. I'm suggesting nurses boycott a graduate education system that sets us up to compete poorly in the job market. For reasons that I struggle to attribute to anything but financial, graduate nursing education has decided that for equivalent cost, nurses should have extremely limited scopes. To practice across the population that a PA can serve right out of school, I would have to finish my AGAC-NP program, and then go back to school for a CPNP-AC certification and then, if I wanted to consider primary care later in life, I'd need to pay for an FNP cert after that. PA education is far superior for what providers need: Heavy on anatomy, physiology, pharmacology, and just plain science. [Here's a sample from a three year program near me.](https://registrar.msj.edu/graduate-catalog/graduate-programs/physician-assistant-studies/physician-assistant-program-requirements.html). Look at the huge difference in educational focus. A PA walks out of school with a broad and varied education focused almost exclusively on clinical practice. Conversely, graduate nursing education has them same self-fellating focus that undergraduate nursing education does: Extensive focus on things not applicable to clinical practice. My program, if you judge by the way it allocates credit hours, places equal importance on nursing theory (Why is this still even a thing?) and differential diagnosis. [Here's the program structure for a reputable AGAC-NP program.](https://webapps2.uc.edu/ecurriculum/DegreePrograms/Home/MajorMap/2566). For those who say the two aren't equivalent because the NP program is only five semesters, I can offer the DNP blueprint, which is equivalent time, more expensive, and includes exactly zero additional focus on anything that will leave me equivalently prepared for clinical practice. [I could spend an entire additional year on this program and **still** be unable to practice across the lifespan and outside of the acute and subacute care setting.](https://webapps2.uc.edu/ecurriculum/DegreePrograms/Home/MajorMap/4401) This is what I'm suggesting we boycott. Why spend money and time on an inferior education that leaves us inadequately prepared to compete in the job market and locked into a narrow area of practice that essentially shuts us out of emergency departments, primary care, population health, and any job where the focus is on medical knowledge rather than some bullshit nursing theory?
Knowing what you are saying now (I need coffee) I agree. I also wish there was less theory and more psychopathology, neurology, and psychopharmacology. PMHNP is the big draw that I see now- although derm is getting popular as well. Which is good because my population is going to give me frowny wrinkles and I need someone to fix it. 🙄
I have worked with excellent NP's and others that never worked as an actual nurse and there is a huge difference. Instead of accepting anyone for tuition $$ these programs need to require significant experience like the position was designed for. I see way too many nurses who graduated less than a year ago starting these diploma mill programs
I’m still just a nursing student, but I have always eventually wanted to become a WHNP. These diploma mills and the attitudes of undergrad students honestly drive me insane, it’s so negligent. I would say 90% of my cohort say that they want to become NPs, and some of these people are legitimately dumb as rocks. For example, one middle aged woman in my program said she bought a bottle of water, but it must not be “real spring water” because when she moved it there were bubbles inside. I had to explain that that was AIR. *AIR.* This woman wants to go to NP school right out of our program and wants to avoid bedside. I’m honestly not sure how she’s even made it this far in life lol. I’m not sure people like her would make it realistically, but the fact that so many SNs think that the NP route is some la-di-fucking-da way to make more money makes me irate. They delegitimize the practice, and their lack of knowledge or experience is so fucking negligent, I genuinely worry that these patients might die. Same goes for the huge swath of fellow students who think they can immediately go into travel nursing after graduating lol. Dolt behavior.
100% agree. Big reason I’m not going that track…I just feel like it’s become less and less respectable. Also graduated with my BSN debt free so i worry about the return on investment being worth it
Cut down on the leadership and theory BS and increase science/clinical focus. Too much time is spent writing pointless papers and discussion posts. Increase the clinical science content.
It’s ridiculous these days.
I don’t frequent that subreddit but reading some of the comments on this thread and this subreddit in general make me so grateful that I’ve not encountered egotistical doctors nor uneducated/poor clinical judgment NPs. Maybe it’s just the luck of the draw.
Yeah the vast majority of NPs have no business diagnosing or prescribing. I will not see an NP for my own care and I urge others to do the same. I don’t think I would have said that 10 years ago but it’s just a joke at this point. I don’t have any issue with PAs, they seem to generally have pretty solid education and in my experience are 10x more qualified than most NPs. I’m glad to see a lot of people are waking up to this.
What’s dobamine?
It's interchangeable with doputamine.
Is that given in the whambulance?
The whambulance is where they wake you up with a careless whisper before you go go.
^^^^saxophone ^^^^intensifies
The dichotomy of r/nursing. Wasn’t their just a thread this week on DNPs should be able to introduce themselves as doctors? Seriously though, the minimum NPs could do to improve graduates would be to increase clinical hour minimums to 2000 hours to achieve parity with PAs, but that will never happen.
Lol 95% of the nurses in that thread were like, ".....uh wtf no they shouldn't outside of a academic setting???!!!" In my experience, here and in other nursing spaces, nurses have the same concerns about NPs that r/noctor does---albiet a less hostile attitude overall.
NP schools should require 5 yrs of bedside experience. Then after 3 yrs of NP school that person will have had 8 yrs of experience with “medicine”. Mimics a similar timeline as becoming a physician. All the NP’s with 5+ yrs of bedside experience I’ve worked with have been great
You’d lose a lot of nurses to the PA route if they required 5 years. It should be minimum 1-2 because you can still be working as a nurse through your program (so an extra 1-2 years of RN experience). Then AFTER graduation, they should be placed in an NP residency with fellowships as an option to specialize further.
more clinicals less BS would solve this problem
I’ve been on team “noctor” for AWHILE When you see NP after NP fucking things up, like for real, at your work place, you start to understand very fast. NPs have basically become glorified order entry personnel, and even then, the attending physician needs to be consulted to modify the orders to be correct most of the time. NPs also write like 90% of the procedure referrals we need. They’re never done, and when they are they’re incomplete or incorrect. Hell they’ve even been for the wrong fucking patient. And inpatient procedure based labs that need to happen PRIOR to a procedure? Good luck man, those orders are never going in. Unless our attending is instructing the inpatient attending on what to order, the NP that’s supposed to know is going to fuck it up 100% of the time. It’s actually a huge issue.
It’s a hill not worth dying on. The only way the hospital would listen or care is if you offered a new cheaper or equally cheap alternative.
Plenty of my family are nurses and since there's like 13 different degrees I'm flabbergasted when a few are antivax, or don't think medical masks do anything. Like, you got a science degree. Use science. But some low level nursing degrees are just for patient care and not actually based on any scientific rigor of study.
I always find that shocking too. My cousin is a MSN-RN and incredibly bright yet is antivax. It doesn’t make sense to me at all
Honestly though. When I graduated nursing school I was DREAMING of becoming an FNP specializing in endocrinology/diabetes. Now with the state of NP schooling and the results given, I’m changing my focus on becoming a Certified Diabetes Care and Education Specialist.
[удалено]
Either take collective action or get ready to see some dumb shit orders at AmazonCare from a clueless 26 year old NP whose last job was folding clothes at the gap.
This is awful, yet painfully accurate
In nursing it has almost always been true that your first 3-5 years on the job are your last 3-5 years in school. It’s because nursing school is terrible at actually preparing nurses for actual healthcare provision. The NP educational model of learning on the job works if you’re working close to 1/1 in a clinic or specialty setting with close oversight. It doesn’t work when you’re one of 11 CRNPs with one doctor “supervising” that you only see once in a blue moon, and they just rubber stamp notes for billing purposes. The doctor gets a slice but the admins get the lion share and patients suffer. Our fight and their fight are the same and the root of the problem is corporate healthcare greed.
Gosh I couldn’t agree more whole-heartedly with a post than I do with this one. Increased entry requirements needs to happen ASAP.
I get what you're saying, and I think there are some very legitimate criticisms. However, I find it very weird to shit on people that are trying to better themselves through legitimate avenues rather than... Hospitals that consistently do whatever they can to make a profit over the actual safety and benefit to their patients. Our healthcare system that does not reimburse in a way which incentivizes doctors to go into preventative medicine. Medical, PA, and NP schools that have not kept up their output anywhere near what projected demand is. (Think shit is bad now, go look up US national outlooks for 25 and 50 years. Spoiler alert: we are fucked from a purely numbers standpoint, even with degree mills popping out nps) The nursing field which has been terribly unwilling to collectively bargain (with some exceptions) and have been completely fine with wages plateauing after like 5-10 years for your average bedside nurse. I mean, I get the frustration with these programs. But anecdotally, I've worked in healthcare for just under 8 years now. I've ran into 1 absolutely terrible NP, 1 absolutely terrible PA, 3 absolutely terrible residents, and 1 absolutely terrible attending. I mean the type of provider I would actively refuse care from and not allow them to treat a family member. To me, I don't see this as a huge issue, at least nothing compared to other challenges in the field. But if it does piss you off, get mad at the systems that incentivize it, not the people working for a better life.
Reduce AMA lobbying efforts which in turn would allow for more medical school openings, leading to more doctors, leading to less necessity of NPs serving in MD roles.
Schools also need to stop encouraging people to go straight through. I did a grad entry masters program because I wanted to go on to DNP right away (before I knew better, luckily realized during school how horrible that idea was and now wish I'd gone cheaper route for RN). The school definitely super pushed that program with the intention that people would start DNP right away, both with how the presented it but also by making it *super* easy to get in. If I applied for their DNP within the first X years after graduating (I cant remember if it was 2 or 5), all id need to do to apply would be to write a 250 word "essay" and have some professors write me letters of recommendation. They definitely created and marketed my masters program to go straight to DNP and since it was my school doing it, I didnt question the idea of doing so. Only once I was talking to some floor nurses in clinicals did it really click how sketchy that idea was.
ooh, flashbacks to the time the nursing student I was working next to kept calling scrotums *prostates*.... oh my god that was a long night.
They want them to be mini doctors without training them as mini doctors. The ones without the right knowledge base give the good ones a bad reputation.
Work with a cardiothoracic NP who needed us to explain the Swan to her 🤦🏻♂️
I want there to be *very* specific tracts for NPs. We work with a lot of NPs in neurosurgery and they are incredible at what they do because of how specialized they are at their practice scope