Nurse practitioner training has changed

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why would somebody choose a low paying profession like nursing?
You will always be a low income earner and it will take years to pay back your student loans. Unless you have family money and get a free ride from your parents, that is the worst choice

There are other options

2nd Career Nurse chiming in here - yes, nursing can be a tough road. With a few years experience, many options open up, however, including care navigation (aftercare planning) and work-at-home jobs, including utilization review.

Yes, but these are 80K jobs. They do not pay well at all. I know, I've worked in this field for years. You need a number of years of nursing experience to get the jobs and then they pay $80K, maybe $90K if you are really, really lucky. I was just offered $70K for a full time job doing care management/utilization review in the DC area. I didn't take it because that is insanity.

Care management is very underpaid so that doesn't surprise me. I am in a specialty role and earn 125k with 8 years experience in that role, over ten in nursing. It isn't a ton especially in DCUM world. But I love my job.

Generally basic RN pay is akin to teacher pay but with the ability to boost somewhat with OT, agency work, weekend differentials, etc.

[Anonymous]

It is for this reason I only go to physicians.

[Anonymous]

Anonymous wrote:80k is not a good paying job??

In an urban area it isn't a lot. But nursing pay really varies.. I believe CA nurses start around that. I am not sure what the starting base pay is for nurses in DC anymore. I think I earned around 55k my first year but that was 12 years ago so maybe DC nurses straight out of school are around 70k now? And what about Kaiser who supposedly pays better in DC?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My training was explicit that you had to see tens of thousands of normal to recognize abnormal reliably. Rashes don't often look textbook, and there is so much variation in presentation of the same diagnosis.

Without that large clinical database in your own mind, you can't reliably tell when to worry. Anemia that is not microcytic and hypochromic, or that doesn't respond as expected to treatment (as per PP)? Dig further. On the other hand, you don't order labs or antifungal treatment for pityriasis rosea when you can recognize it, even on the many varieties of skin type.

NPs can be fantastic. Old school NPs with many bedside years under the belt, or NPs who are well-trained in a narrow scope with good oversight (e.g., L&D) are more likely to be fantastic than others.

And you still need to see tens of thousands of normal before you can reliably pick out abnormal.

This is so important. You are going to have trouble hearing a murmur if you haven't heard a lot of hearts without one. Even something simple like distinguishing wheezing from rhonchi requires experience. I had a NP at a Minute Clinic listen to my lungs and tell me I had pneumonia and she gave me antibiotics. That seemed serious so I got in with my pcp the next day who sighed and said "You don't have pneumonia -- so those antibiotics aren't going to do anything and they shouldn't have been prescribed." The NP thought she heard rhonchi and panicked.

Medicine isn’t as simple as normal vs abnormal. Good practioners have to have an advanced understanding of pathology, pathophysiology, and pharmacology. This cannot be done in a 2 yr PA crash course. NPs are slightly better because they get some of this in nursing school, then again in NP school, but still no where near as in depth and complete as the education a MD receives in 4 yrs medical school, plus residency, plus fellowship. Their depth of knowledge is not even comparable and goes way way beyond normal vs abnormal. They are dealing with people with complex issues involving multiple organ systems, on multiple meds, and each situation is slightly unique and individual. There needs to be critical thinking happening and that cannot happen if you don’t have the solid foundation of knowledge

Well, yes, but did you really expect a full medical school training in a single post? That's silly.

Normal vs abnormal is the heart of it. I'd challenge you to propose a medical problem that doesn't rest on that distinction at the core -- and medical school training plus residency plus (hopefully) working in a supportive learning environment for the first few years is what gets you there, minimally.

But it’s not helpful or cost effective to have an NP decide something is abnormal and then turf it to the MD because they aren’t really sure how to manage it. And this is what happens A LOT. They just make more work for the physician instead of less

I think you missed the point of the post. NPs coming through diploma mills are NOT the old school NPs with tones of experience, and they cannot reliably distinguish normal from abnormal. That's why the stories of poor care are mounting.

Furthermore, you cannot just declare medical schools must now have a 10% increase in admissions, or whatever. Those slots need to come with clinical placements with skilled practitioners. Many, many current NP students are not in a structured clinical training, if they even are getting any clinical time -- they are having to go out and find people to "supervise" them, with little to no oversight. If you start expecting medical students to do that, you'll see their trainign tank, too.

No, I didn’t miss the point. Per the OP, the fast tract for an NP, has students that already have a bachelor’s degree in another field able to get complete an NP program in 3 years. I’m not seeing how this is any worse than all the PA programs, which are only 2 years, in addition to various bachelor’s degrees. And don’t bring up “the clinical hours” covered to get into PA school. They are not required at all programs and are BS anyhow. They aren’t significant medical experience.

What are you arguing against, exactly? That PAs and NPs don't have enough clinical training time to practice independently, at least without a long stretch of on the job training?

If that's what you think you are disagreeing with here, it's a figment of your imagination. You are yelling into a void, not arguing with the post that was quoted. You missed it.

You seem to only have a problem with NPs. You are angry that now there are now programs where training is 3 yrs with no prior RN experience. Whereas PA programs have always been no prior medical experience and their program is and has been always only 2 yrs. So what is your problem with NPs exactly?

It needs to be acknowledged that 2 year PA school is full-time. PA students are expected not to work for pay while they are committing themselves to full-time studies. In addition, they have completed 2 semesters of Chemistry, 2 semesters of Organic Chemistry, and 2 semesters of Physics before PA school. 1 semester of Chemistry is more typical for nurses. In addition, most nurses work full-time while attending NP school on-line. PA school is designed to be a shorter version of the medical school curriculum. NP school, unfortunately, contains a lot of nursing theory fluff. Do you understand the difference? By the way, I am an RN who graduated from a nationally well-respected BSN program.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My training was explicit that you had to see tens of thousands of normal to recognize abnormal reliably. Rashes don't often look textbook, and there is so much variation in presentation of the same diagnosis.

Without that large clinical database in your own mind, you can't reliably tell when to worry. Anemia that is not microcytic and hypochromic, or that doesn't respond as expected to treatment (as per PP)? Dig further. On the other hand, you don't order labs or antifungal treatment for pityriasis rosea when you can recognize it, even on the many varieties of skin type.

NPs can be fantastic. Old school NPs with many bedside years under the belt, or NPs who are well-trained in a narrow scope with good oversight (e.g., L&D) are more likely to be fantastic than others.

And you still need to see tens of thousands of normal before you can reliably pick out abnormal.

This is so important. You are going to have trouble hearing a murmur if you haven't heard a lot of hearts without one. Even something simple like distinguishing wheezing from rhonchi requires experience. I had a NP at a Minute Clinic listen to my lungs and tell me I had pneumonia and she gave me antibiotics. That seemed serious so I got in with my pcp the next day who sighed and said "You don't have pneumonia -- so those antibiotics aren't going to do anything and they shouldn't have been prescribed." The NP thought she heard rhonchi and panicked.

Medicine isn’t as simple as normal vs abnormal. Good practioners have to have an advanced understanding of pathology, pathophysiology, and pharmacology. This cannot be done in a 2 yr PA crash course. NPs are slightly better because they get some of this in nursing school, then again in NP school, but still no where near as in depth and complete as the education a MD receives in 4 yrs medical school, plus residency, plus fellowship. Their depth of knowledge is not even comparable and goes way way beyond normal vs abnormal. They are dealing with people with complex issues involving multiple organ systems, on multiple meds, and each situation is slightly unique and individual. There needs to be critical thinking happening and that cannot happen if you don’t have the solid foundation of knowledge

Well, yes, but did you really expect a full medical school training in a single post? That's silly.

Normal vs abnormal is the heart of it. I'd challenge you to propose a medical problem that doesn't rest on that distinction at the core -- and medical school training plus residency plus (hopefully) working in a supportive learning environment for the first few years is what gets you there, minimally.

But it’s not helpful or cost effective to have an NP decide something is abnormal and then turf it to the MD because they aren’t really sure how to manage it. And this is what happens A LOT. They just make more work for the physician instead of less

I think you missed the point of the post. NPs coming through diploma mills are NOT the old school NPs with tones of experience, and they cannot reliably distinguish normal from abnormal. That's why the stories of poor care are mounting.

Furthermore, you cannot just declare medical schools must now have a 10% increase in admissions, or whatever. Those slots need to come with clinical placements with skilled practitioners. Many, many current NP students are not in a structured clinical training, if they even are getting any clinical time -- they are having to go out and find people to "supervise" them, with little to no oversight. If you start expecting medical students to do that, you'll see their trainign tank, too.

No, I didn’t miss the point. Per the OP, the fast tract for an NP, has students that already have a bachelor’s degree in another field able to get complete an NP program in 3 years. I’m not seeing how this is any worse than all the PA programs, which are only 2 years, in addition to various bachelor’s degrees. And don’t bring up “the clinical hours” covered to get into PA school. They are not required at all programs and are BS anyhow. They aren’t significant medical experience.

What are you arguing against, exactly? That PAs and NPs don't have enough clinical training time to practice independently, at least without a long stretch of on the job training?

If that's what you think you are disagreeing with here, it's a figment of your imagination. You are yelling into a void, not arguing with the post that was quoted. You missed it.

You seem to only have a problem with NPs. You are angry that now there are now programs where training is 3 yrs with no prior RN experience. Whereas PA programs have always been no prior medical experience and their program is and has been always only 2 yrs. So what is your problem with NPs exactly?

It needs to be acknowledged that 2 year PA school is full-time. PA students are expected not to work for pay while they are committing themselves to full-time studies. In addition, they have completed 2 semesters of Chemistry, 2 semesters of Organic Chemistry, and 2 semesters of Physics before PA school. 1 semester of Chemistry is more typical for nurses. In addition, most nurses work full-time while attending NP school on-line. PA school is designed to be a shorter version of the medical school curriculum. NP school, unfortunately, contains a lot of nursing theory fluff. Do you understand the difference? By the way, I am an RN who graduated from a nationally well-respected BSN program.

These are not the requirements, not even close. Perhaps at one program you are familiar with? But these isn’t a consensus on these and it certainly isn’t standard. I have BSN friends that went on to PA school after working as RNs for a few years and they didn’t have to take any additional science classes to be accepted or before starting the program

[Anonymous]

Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

[Anonymous]

Anonymous wrote:Dear OP, I think advocating that nurses has 2+ years of bedside experience in the area of the proposed NP specialty (or interchangeably ICU or ER), and continue working bedside while studying, are solid.

We do need to get away from the idea that an MD is needed to do basic primary care, gyn care, or low risk specialty care. It is total overkill. While folks doing it around the world are called "doctors", their training is completely compatible with the NP training in the States.

With respect,
"old-style" nurse-practitioner

+1000

[Anonymous]

Bloomberg is doing series Called: The Miseducation of America’s Nurse Practitioners

“They don’t merely support doctors—NPs increasingly treat patients independently, including in specialty practices and emergency rooms. When they aren’t well trained, the results can be tragic.”

The make the point that NP programs typically have an acceptance rate of 100% and do not regulate where they get their training.

[Anonymous]

Has a pay wall but here’s an excerpt


“Steele, who ran Walden’s nurse practitioner programs for eight years, says she developed concerns as it grew. Before she left in 2020, the school had more than 15,000 NP students and fewer than 20 full-time faculty, she says, and made up the difference with hundreds of part-time teachers who weren’t always qualified: “Most of the people we hired had never taught before.” She says she was fired after raising concerns about Walden’s failure to mentor and train its part-time teachers.
The minimum undergraduate grade-point average for incoming students was 2.5—not high enough, in Steele’s view, to guarantee all applicants were of high quality. The school became “all about the money,” she says. “I don’t think we ever refused anybody.” Steele worries about the impact Walden’s graduates will have on America’s patients. “People’s lives are in our hands,” she says. “There are more opportunities for error when you have so many students and you don’t have very high requirements.” The school has bestowed more than 30,000 advanced nursing degrees in the past decade, or about 1 out of every 13 awarded, federal data show.”

https://www.bloomberg.com/news/features/2024-07-24/is-the-nurse-practitioner-job-boom-putting-us-health-care-at-risk

[Anonymous]

Anonymous wrote:I also try to not see NPs or PAs. But recent experience example - had to cancel a gyn appointment as I have irregular cycles and it started and is too heavy for exam. I was told I can see next available dr in four months or PA in three weeks. So I have to either delay my mammo and Pap smear four months or see a less trained professional. I have family histories that make a four month delay - assuming it even happens then since I’m irregular - very concerning. I feel forced into seeing a less trained professional.

Yeah - this is the problem. Even in a large metropolitan area like DC where you have many options, IF you are willing to drive, and IF you can find someone in your health insurance network. The few MDs are booked up months and months in advance. The MDs who aren't booked up - there's a reason for that (bad care, bad office staff, bad doctors). And the other MDs have all gone concierge.

So patients are really stuck. Personally, I have been seeing an AWESOME P.A. as my primary care provider. She is incredibly knowledgable, thorough, and competent. So there are some great ones out there. I've also seen some dismal MDs at urgent care.

[Anonymous]

Anonymous wrote:Has a pay wall but here’s an excerpt


“Steele, who ran Walden’s nurse practitioner programs for eight years, says she developed concerns as it grew. Before she left in 2020, the school had more than 15,000 NP students and fewer than 20 full-time faculty, she says, and made up the difference with hundreds of part-time teachers who weren’t always qualified: “Most of the people we hired had never taught before.” She says she was fired after raising concerns about Walden’s failure to mentor and train its part-time teachers.
The minimum undergraduate grade-point average for incoming students was 2.5—not high enough, in Steele’s view, to guarantee all applicants were of high quality. The school became “all about the money,” she says. “I don’t think we ever refused anybody.” Steele worries about the impact Walden’s graduates will have on America’s patients. “People’s lives are in our hands,” she says. “There are more opportunities for error when you have so many students and you don’t have very high requirements.” The school has bestowed more than 30,000 advanced nursing degrees in the past decade, or about 1 out of every 13 awarded, federal data show.”

https://www.bloomberg.com/news/features/2024-07-24/is-the-nurse-practitioner-job-boom-putting-us-health-care-at-risk

This thread started with the same exact link.

[Anonymous]

I think the article points out that education for NPs can be so inconsistent and vastly different depending on school. Georgetown NP program
is legit. Online diploma mill? Nope. I’m a nurse and I wouldn’t trust some of my peers currently in NP schools as even bedside nurses. I’ve also noticed that Mental health/psych NP is becoming popular with people who have no experience in mental health. It’s terrible. I think NPs can be very helpful-even in the hospital. It’s nice to call the NP vs the doc for that pain med or simple orders. In my area of the hospital, NPs and PAs are there to help out with orders, discharges, escalate issues, etc. They are not making major treatment decisions and physicians are involved with major concerns. Don’t discount all NPs but ask about experience and schooling.

[Anonymous]

Corporate medical America wants to cut costs and NPs and PAs cost way less to pay than MDs. The business of healthcare is brutalizing patients and healthcare workers alike.

This is not the fault of the NPs. Most all professionals want higher pay and more education and programs are more accessible now. Nurses and PAs know their limits. I go to NPs for annual screenings, to get a minor injury treated, etc. and MDs for anything else.

I work in a very well known academic medical institution. Many of the most critical patients are managed by NPs/PAs, with a responsible MD as part of a team. This shared co-visit model is excellent at capturing costs savings while preserving safety of MD level medical decision making and responsibility.

Signed,
+20 year veteran of nursing (and an FNP)

[Anonymous]

NPs are the worst unless it is an easy diagnosis

[Anonymous]

I had chicken pox in my 40s…NP thought it was a skin issue…Brother in law is a pen….diagnosed it in 5 minutes