Nurse practitioner training has changed

[Anonymous]

Anonymous wrote:I'm a doctor and this is something really disconcerting that I've witnessed both as a doctor and as a patient. There is not nearly enough attention given to this, and it will be the last nail in the coffin of American healthcare. Sorry about the paywall. https://www.bloomberg.com/news/features/2024-07-24/is-the-nurse-practitioner-job-boom-putting-us-health-care-at-risk

"Early waves of NP students were often experienced registered nurses seeking to increase their skills and responsibilities. But as demand spiked, more schools began offering “direct entry” programs that accepted students with a bachelor’s degree in unrelated fields. Today the fastest among them can prepare students for NP licensure exams in three years of education that encompasses a bachelor’s in nursing, registered nursing licensing (all NPs have to become RNs, even if they haven’t yet worked in the field) and a master’s in nursing. In 27 states, licensed graduates are allowed to treat patients and prescribe drugs with no physician oversight, even if they have no prior nursing experience...
...Students must obtain 500 clinical hours to graduate. That’s less than 5% of the amount required of medical doctors before they can practice medicine."

I'm an RN. We really need to tighten up NP training and education. An RN should have 5 years experience before starting NP school. Clinical hours should be more like 1500-2000.

NPs aren't intended to practice with the same deep and broad scope as an MD. They don't need as much as training as long as they stay in their lane.

[Anonymous]

Anonymous wrote:As a patient, the vast majority of my healthcare interactions are not complicated at all. This seems like more than enough training for a lot of healthcare roles.

Until it's not. You need someone with adequate training to see when a "simple problem" is not so simple and possibly serious.

[Anonymous]

I don't anyone who is rushing to make appointments with a NP. I always ask prior to making the appointment. No thanks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don’t understand how the qualifications can be less than for an RN?

There are problems with NP programs, but no one is saying that NP’s have fewer qualifications than RN’s.

Don’t most RN programs have real in-person training? Per the article these NP schools are all online and don’t provide their own clinical training.

I believe an online NP school is for people who already have an RN with the clinical training.

[Anonymous]

The worst is when you go to the ER and the only person on staff is a NP or PA.

[Anonymous]

I am amazed by the number of psychiatric NPs with degrees from for profit online schools. These are people prescribing controlled substances / schedule 2 drugs!

[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.

I feel like for that kind of thing it’s probably okay if you have no concerns. I think an NP or PA can do a Pap smear properly - that’s easy enough to learn. It’s stuff that requires being a diagnostician that really concerns me. I will say that they are often better listeners. I had a parent with some medical issues recently and some of what was needed was just taking enough time to come up with a good plan for easing up on pain meds, getting PT, etc and the PA was more helpful than the doctor.

I had a somewhat invasive procedure done by a PA that does that particular procedure a lot and that went well.

[Anonymous]

Anonymous wrote:I'm a nurse who has NPs in the family.

This is a downstream effect of caps to medical school admissions, driving costs of getting those degrees leading to student loans that can't be paid off by the low salaries your primary care doctor makes.

So, to fill those gaps, you get mid-level providers (NPs and PAs) who can do the primary care work.

It's fine if you only want to see a MD - but those will be increasingly filled by NPs and PAs as time goes on.

I'm lucky in that I've had excellent care delivered by the mid-level providers. I've had some duds, too. But I've had duds in the medical profession, too.

NP and PAs are not only in primary care. They are now in specialities and surgery.

[Anonymous]

I work in medical education and have first hand experience with testing 1st yr med students and NP students about midway through their training on the head-to-toe physical exam.

I’ll just say that I won’t see a NP voluntarily…and leave it at that.

[Anonymous]

Anonymous wrote:I work in medical education and have first hand experience with testing 1st yr med students and NP students about midway through their training on the head-to-toe physical exam.

I’ll just say that I won’t see a NP voluntarily…and leave it at that.

What have you seen with placement of medical students into clinical rotations? Is this a limiting factor in expanding medical school class size?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I work in medical education and have first hand experience with testing 1st yr med students and NP students about midway through their training on the head-to-toe physical exam.

I’ll just say that I won’t see a NP voluntarily…and leave it at that.

What have you seen with placement of medical students into clinical rotations? Is this a limiting factor in expanding medical school class size?

That’s a great question and I don’t know the answer. I can tell you that —at least at the two schools where I work—we would not have the resources for larger classes at the pre-clinical stage.

[Anonymous]

I’ll be honest, I’m an NP who went to a “real” NP program (Hopkins) after 5 years as a full time floor RN at Hopkins. I now have 15 years of experience in my speciality (pediatrics). Even with my “real” training and 5 years of experience, I struggled in primary care for the first few years because I wasn’t experienced enough yet. Common little rash that I just didn’t happen to have come across before in real life? I had no clue. Bad asthma exacerbation? I was great, because I worked with that all the time as an RN. Luckily the doc I worked with was fantastic.

I see new grad NPs now with less training and less experience than I had when i started as an NP, with less oversight, and it’s scary.

[Anonymous]

I’m not sure how to add an image here, but you can see a graphic showing the differences in training here: https://www.patientsatrisk.com/differences

[Anonymous]

I don't see anyone who is not an MD unless I already know for sure what is wrong.

"Something minor" isn't always actually minor, so that's a poor rule of thumb for this. Spotting a zebra requires having seen a zebra.

[Anonymous]

Anonymous wrote:I don't see anyone who is not an MD unless I already know for sure what is wrong.

"Something minor" isn't always actually minor, so that's a poor rule of thumb for this. Spotting a zebra requires having seen a zebra.

Whenever I’ve been sure I knew what was wrong…I was wrong. And I’m 0/4 on NPs getting it right. So I’ll avoid them.