Fabulous interview. Went to a respectd brick-and-mortar.. One of the other suspect aspects of nursing FNP graduate education is the grade inflation. In my class, I think that the majority of students garnered a 4.0 for the entire program, offering a false sense of mastery. Most of us were working full time, and frankly put in very little study time. Hardly any tests, lots of papers. I learned so much more as a ER nurse. What most of us discovered when out in the field was that family practice is difficult and takes years of serious training. Our program took the Mary Mundinger philosophy to heart in thinking that MDs are overqualified for family prractice. Such a dangerous position..
I am a colleague of Dr. Bernards in Physicians for Patient protection. YOU get it. NPs are prepared to be physician support because their education was designed that way in 1965. Nothing has changed except the AANP and their corporate sponsors have managed to lobby state legislators enough to get unsupervised practice of medicine laws (UPM.. which AANP calls Full Practice authority or FPA), passed in 26 states. It is ALL about the money - The AANP is run primarily by nurses who are part of academia. Academic nursing departments are making much money by increasing the NP output without limit. Unlike medicine, there is nothing that limits the number of students they can take in. Each student will pay from 25k to 100k in tuition, and costs the school virtually nothing to add a student. (think of it - most are online. All they have to do is give the student the passwords to get in). The sponsors of the AANP - like Aetna/CVS and UnitedHealth/Optum and the hospitals are the employers of the NPs. They charge patients 85 - 100% of a physicians fee and they pay the NPs roughly 1/3 of a physicians salary. They keep the difference. They are replacing physicians with NPs and the losers are the patients who think they are getting quality care. At times, NPs in hospitals are forced to fill roles they know they are not prepared for - like ICU physician roles, or hospitalist roles, and even though they are scared of their own lack of experience and capability, they have to do it because they have debt, and their employer tells them they must do this.
Many medical training just wastes. Np do need more anatomy training and residency trying. Middle level medical therapy is a skilled work.. unfortunate many Md is doing this
Loved this! I just started NP school and I think the DNP degree is such a waste! We need people to do research and teach and such, but we need more of the education that’s actually able to applied to medical care. Everybody wants to feel good about themselves, but nobody wants to work for it. I have even asked about doing additional observation hours outside of class requirements and been shot down several times and it scares me that nobody seems to care about this issue.
Thank you for talking about this. I am a new NP with 13 years of ICU experience prior and I agree on more clinical hours needed. Even with my experience, because it is so different to be in a clinic setting. Thank God I work for a Doctor who is always available.
RN for 30 yrs her. I’m out. Donzo. I will no longer shill and lie for corporate amurica. Nursing today is not what it was even 10 yrs ago. I’m starting an entry level job soon. Both my kids are in nursing and are leaning toward NP. I actively discourage them from this.
I agree with much of what he said, however, I disagree that there needs to be a mandate for a nurse to have 2+ years experience in critical care for NP school acceptance. This is great in a perfect world but for many of us, its not possible in our area. For example, I live in an area already inundated with RNs -either AD or BSN. There are not enough critical care units or jobs available to employ all our areas nurses...not by a lot. I know nurses who have wanted to get into ICU or trauma for YEARS while still slugging away at their med/surg jobs because not everyone can pick up move their families to somewhere else they could get an ICU job. Thats completely unrealistic. There are some excellent RNs who would make, or have made excellent NPs or PAs who have never spent even one working day in an ED or ICU...It depends on their area of expertise. Also...before you say a nurse should be required to have 2+ years of critical care experience, remember, many NPs are a highly valuable resource to the elder population. The boomer generation is about to deliver a tsunami of dementia and post-CVA people our way. If youve worked in critical care your whole career, youre not going to know what hit you if you need take your first NP job with a LTCF or memory care center. The skills are different - so please lets drop the old "critical care nurses are God's gift and are above everyone and can be good at everything" narrative, because its not true. It's not better or worse, its just different. PA programs admit people with ZERO bedside experience and who have english literature degrees so....where is that profession in demanding 2+ years of patient experience? 🤔 They are not demanding it. I think they should at least have an undergrad in something health or biology related, but unless that changes, why should NPs be expected to jump through more hoops (as this man in the video is proposing) than PAs are - and for roughly the same level of responsibility and pay ?? 🤔 That's unconscionable. Therefore, unless you make the education for undergrads incude longer clinical time in critical care areas, or hospitals are forced to open more nurse residency programs (after graduation), where are you proposing they train in critical care??? And secondly, while there are many of the same basic skills and knowledge all of us in healthcare need, a nurse practitioner's responsibilities (and I'd argue attributes) are very different (at least in an ambulatory office environment) than a bedside nurse on a regular floor. What I do agree with is yes, I think its dangerous for anyone allowed to enter either a NP program or a PA program without being a BSN prepared nurse, or for PA, there should be a specific PA prep route bachelor degree. This should absolutely apply to medical school too. I don't want to see a NP or PA or even an MD who has an undergrad degree in Elizabethan poetry!!!! 😮 So IMO, in terms of NPs, I think its less important how long a nurse has worked prior to NP education (as long as they are a RN), than it is that they have certain skills and attributes that are either innate, or have been taught with more clinical time (as this man states).
Excellent. I totally agree with everything. I have seen NP really struggling, and they can't give solutions to the problem. They don't know the basic and they don't listen. They react quick fix but they don't prevent. They are not seeing the patient as a whole. I believe NP should have at least 10yrs of experience as an RN. Otherwise, they are putting patients at risk.
Great discussion. It's refreshing to hear someone talking about these hard things. NP education does need to be revamped. Please keep this conversation going.
I am already looking into the NP DNP thing. but men, this is discouraging. Truth be told, I actually thought that minimum 2yrs critical care nursing experience is mandatory, but if its true that anyone from other fields without clinical experience is accepted on a direct entry bases and then become NPs with as few as 500 cloinical hours, that is really bad. Nursing in those days was hard enough at the associate and BSN level, so a doctorate should be a thorough process in order not to let nursing down among other fields.
It is not just in regards to nurse practitioners. This has to do with Medical training in general for nurses or doctors and for all medical professionals. Schools are aimed at getting as many graduated as possible. There are problems 100% with the education for all medical professionals but there are bad nurses, bad doctors bad lawyers. There are bad professionals in every field.
I have been saying the same since my first day of NP school. I tell my novice RN friends that they need at least 3-5 years of RN experience in as many layers of acute care as possible. Especially critical care and ER care. Then hone in on a specialty of choice and master it 2 years at least. Shadow all types of nursing positions and any MD/resident/fellow who wants to help you learn about the field type. Then return to school for NP. Choose a brick and mortar if possible and pay for your own procedual/skills course and do it before you start clinicals and again after graduation. Read up on billing/coding throughout the program. And also ask questions and always be hands on in all rotations as much as possible. Until these programs change we have to show we are prudent, critical thinkers, and lifesavers.
Thank you for speaking. I am an RN for 15 years. Some years back I noticed co workers pursuing APNs, most had little experience. I started to look at the programs, thinking it was something to pursue. I was shocked when I saw most did not require any RN working experience. Personally I feel you need no less than 5 years. I knew one very experienced nurse supervisor who completed her APN, and had to travel two hours for her first job. After realizing it was just a lot of paper writing and finding your own clinical I decided it was not a good option. The entry requirements do need to be standardized. I think a lot of nurses doing APNs are doing so because they don’t want to do bedside nursing and only interested for the money.
More people need to speak out an out these issues and these diploma mill institutions. These online schools are worse than big pharma that we all like to complain out…
This is so good! I plan to be a NP and have two decades of healthcare experience. I take pride in being competent in any position I hold. There has to be better streamlined processes. From CNA all the way to MD. Period.
That's just it... they all think they are super smart and special practitioners because they all got 4.0 grades. Same as giving trophies out to everyone. How did this happen to our medical system? It's FRAUD! GO TO MEDICAL SCHOOL TO BECOME A DOCTOR... NO SHORT CUTS... PERIOD
I went to a clinic because I had blisters around waist and that it was starting to wrap around my back. It was extremely painful and I felt like I was on fire. A NP examined me and said that it was poision ivy. I argued with her because it was in February with snow on the ground and poision ivy does not grow when there is snow on the ground. I told the NP I thought it was shingles because shingles cause blisters, extreme pain and you feel like you are on fire. I informed the NP that I have been a bedside ICU and med/surg nurse for over 20 years and I know what shingles look like and they are extremely painful. Then, the NP said that she only worked med/surg for 6 months prior to getting her NP. Also, the NP said that she has never seen shingles. I was shock and concerned because if she can't diagnosis the difference between poision ivy and shingles then what other assessment and critical thinking skills is she lacking. A doctor was not able to see me at the clinic so, I went to the ER. At the ER I was diagnosis with shingles. I was prescribed the appropriate medications and made a full recovery.
@@muirgirlThe NP was not only incompetent but lacked common sense because poison ivy doesn't grow when there is snow on the ground. Also, she was confident that it was poison ivy and not shingles even though she said that she has never seen shingles.
John is confused. Np training needs to improve. But not by being bullied by MD. I hope no money issue behind the fighting. Be honest. And take good care of patients. Md treated DO badly before also.
I think the NP schools assume the NPs will get trained on the job by the MD/DO. I’ve seen this at my PCP, fellowship training who also hire NPs, at my mother’s oncologist clinic.
What I have noticed is that all of these people have taken an industry wide unacceptable shortcut by going the NP route by way of a flim-flam school of opportunity vice taking the more arduous legitimate PA route. Their intent was to circumvent or cheat the system, and they knew it. These institutions should be shuttered, and their diplomas declared null and void. Those who got an illegitimate degree know they were in the wrong. Just like a major university will not accept transfer credits of head scratching or toe nail picking. They can't say they were unaware. When the PA school is twice the hours, twice the money, requiring twice the effort with one year clinical work and minimal accepted online classes. They were fully aware. Go figure... there are twice as many or more nurse practitioners as there are physician assistants in America.
Its concerning when the state university only accepts a handful of students while a private university in Pennsylvania is educating around 600-800 students at any given time. Its irresponsible and its harmful for students and consumers.
Very informative talk and so needed for public health. Calling self a “dr” and you have your doctorate - i have mixed feelings about calling dr. But im not sure if that is my own conditioning by society. Personally I have received better care and medicine from well educated nurse practitioners. They seem to know alot more other than book and memorization knowledge. I agree if in a healthcare clinical setting it is misleading and could be manipulated and cause harm. “Do no harm”. There are many more doctoral graduates out there than historically so that could be rethought and redesigned so that all people who have spent alot of time and money on education gets the credit and acknowledgement they feel they deserve.
Great discussion. And we need more women in medicine. I listened and I’m gonna keep my “women centered comments to myself”. “John” seems like a thorough dude and I wouldn’t as a 30 yr nurse let him near me. Sorry not sorry
Direct Entry FNP programs vary some give them a one year break to work as a nurse in an acute care setting, other can allow the student to take a break voluntarily to work and gain experience, others allow students to work during tbe program, and other dont motivate them to work as a nurse at all. So it depends on the program. But these are very similar to PA program models except they dont even work as nurses except dor the few that are nurses going in
But most , you are correct, do not work as a nurse. Although, I've found that acute care nurses is completely different from outpatient np work. But, nursing exposure in an acute care setting can be helpful to an extent.
If medical students and residents have regulations on amount of time for training- perhaps the NP field needs to do the same to assure that those people who rush into NP “for the money”. Mental Health counselors have to a minimum of 3000 hours before eligible for licensure. I have never heard of only 500-600 hours before having the authority and experience to diagnose or prescribe. It is dangerous, against best medical practices, and negligent for the states to allow this without more of a “residency” period where they can act as a RN salary until their supervised hours are much more.
On another note- I have had a wonderful attentive gifted nurse practitioners that I would much rather see than a typical amount of time today’s doctor will give. I feel more heard and cared for by NP than I have about 75 percent of physicians. Quality care.
My issue with the critical care component is the diversity component. Not many AA or other minority nurses are allowed into CC. I see you want positive change. But this podcast wasn’t a good platform.
Fabulous interview. Went to a respectd brick-and-mortar.. One of the other suspect aspects of nursing FNP graduate education is the grade inflation. In my class, I think that the majority of students garnered a 4.0 for the entire program, offering a false sense of mastery. Most of us were working full time, and frankly put in very little study time. Hardly any tests, lots of papers. I learned so much more as a ER nurse. What most of us discovered when out in the field was that family practice is difficult and takes years of serious training. Our program took the Mary Mundinger philosophy to heart in thinking that MDs are overqualified for family prractice. Such a dangerous position..
I am a colleague of Dr. Bernards in Physicians for Patient protection. YOU get it. NPs are prepared to be physician support because their education was designed that way in 1965. Nothing has changed except the AANP and their corporate sponsors have managed to lobby state legislators enough to get unsupervised practice of medicine laws (UPM.. which AANP calls Full Practice authority or FPA), passed in 26 states. It is ALL about the money - The AANP is run primarily by nurses who are part of academia. Academic nursing departments are making much money by increasing the NP output without limit. Unlike medicine, there is nothing that limits the number of students they can take in. Each student will pay from 25k to 100k in tuition, and costs the school virtually nothing to add a student. (think of it - most are online. All they have to do is give the student the passwords to get in). The sponsors of the AANP - like Aetna/CVS and UnitedHealth/Optum and the hospitals are the employers of the NPs. They charge patients 85 - 100% of a physicians fee and they pay the NPs roughly 1/3 of a physicians salary. They keep the difference. They are replacing physicians with NPs and the losers are the patients who think they are getting quality care. At times, NPs in hospitals are forced to fill roles they know they are not prepared for - like ICU physician roles, or hospitalist roles, and even though they are scared of their own lack of experience and capability, they have to do it because they have debt, and their employer tells them they must do this.
Many medical training just wastes. Np do need more anatomy training and residency trying. Middle level medical therapy is a skilled work.. unfortunate many Md is doing this
I'm shocked the the lack of in person schooling
Loved this! I just started NP school and I think the DNP degree is such a waste! We need people to do research and teach and such, but we need more of the education that’s actually able to applied to medical care. Everybody wants to feel good about themselves, but nobody wants to work for it. I have even asked about doing additional observation hours outside of class requirements and been shot down several times and it scares me that nobody seems to care about this issue.
Thank you for talking about this. I am a new NP with 13 years of ICU experience prior and I agree on more clinical hours needed. Even with my experience, because it is so different to be in a clinic setting. Thank God I work for a Doctor who is always available.
RN for 30 yrs her. I’m out. Donzo. I will no longer shill and lie for corporate amurica. Nursing today is not what it was even 10 yrs ago. I’m starting an entry level job soon. Both my kids are in nursing and are leaning toward NP. I actively discourage them from this.
I’m a sociologist with an interest in medicine and public health. this was so illuminating, I can’t wait to read the paper when I finish.
I agree with much of what he said, however, I disagree that there needs to be a mandate for a nurse to have 2+ years experience in critical care for NP school acceptance. This is great in a perfect world but for many of us, its not possible in our area. For example, I live in an area already inundated with RNs -either AD or BSN. There are not enough critical care units or jobs available to employ all our areas nurses...not by a lot. I know nurses who have wanted to get into ICU or trauma for YEARS while still slugging away at their med/surg jobs because not everyone can pick up move their families to somewhere else they could get an ICU job. Thats completely unrealistic. There are some excellent RNs who would make, or have made excellent NPs or PAs who have never spent even one working day in an ED or ICU...It depends on their area of expertise.
Also...before you say a nurse should be required to have 2+ years of critical care experience, remember, many NPs are a highly valuable resource to the elder population. The boomer generation is about to deliver a tsunami of dementia and post-CVA people our way. If youve worked in critical care your whole career, youre not going to know what hit you if you need take your first NP job with a LTCF or memory care center. The skills are different - so please lets drop the old "critical care nurses are God's gift and are above everyone and can be good at everything" narrative, because its not true. It's not better or worse, its just different.
PA programs admit people with ZERO bedside experience and who have english literature degrees so....where is that profession in demanding 2+ years of patient experience? 🤔 They are not demanding it. I think they should at least have an undergrad in something health or biology related, but unless that changes, why should NPs be expected to jump through more hoops (as this man in the video is proposing) than PAs are - and for roughly the same level of responsibility and pay ?? 🤔 That's unconscionable.
Therefore, unless you make the education for undergrads incude longer clinical time in critical care areas, or hospitals are forced to open more nurse residency programs (after graduation), where are you proposing they train in critical care???
And secondly, while there are many of the same basic skills and knowledge all of us in healthcare need, a nurse practitioner's responsibilities (and I'd argue attributes) are very different (at least in an ambulatory office environment) than a bedside nurse on a regular floor.
What I do agree with is yes, I think its dangerous for anyone allowed to enter either a NP program or a PA program without being a BSN prepared nurse, or for PA, there should be a specific PA prep route bachelor degree. This should absolutely apply to medical school too. I don't want to see a NP or PA or even an MD who has an undergrad degree in Elizabethan poetry!!!! 😮 So IMO, in terms of NPs, I think its less important how long a nurse has worked prior to NP education (as long as they are a RN), than it is that they have certain skills and attributes that are either innate, or have been taught with more clinical time (as this man states).
Excellent. I totally agree with everything. I have seen NP really struggling, and they can't give solutions to the problem. They don't know the basic and they don't listen. They react quick fix but they don't prevent. They are not seeing the patient as a whole. I believe NP should have at least 10yrs of experience as an RN. Otherwise, they are putting patients at risk.
Great discussion. It's refreshing to hear someone talking about these hard things. NP education does need to be revamped. Please keep this conversation going.
I am already looking into the NP DNP thing. but men, this is discouraging. Truth be told, I actually thought that minimum 2yrs critical care nursing experience is mandatory, but if its true that anyone from other fields without clinical experience is accepted on a direct entry bases and then become NPs with as few as 500 cloinical hours, that is really bad. Nursing in those days was hard enough at the associate and BSN level, so a doctorate should be a thorough process in order not to let nursing down among other fields.
It is not just in regards to nurse practitioners. This has to do with Medical training in general for nurses or doctors and for all medical professionals. Schools are aimed at getting as many graduated as possible. There are problems 100% with the education for all medical professionals but there are bad nurses, bad doctors bad lawyers. There are bad professionals in every field.
I have been saying the same since my first day of NP school. I tell my novice RN friends that they need at least 3-5 years of RN experience in as many layers of acute care as possible. Especially critical care and ER care. Then hone in on a specialty of choice and master it 2 years at least. Shadow all types of nursing positions and any MD/resident/fellow who wants to help you learn about the field type. Then return to school for NP. Choose a brick and mortar if possible and pay for your own procedual/skills course and do it before you start clinicals and again after graduation. Read up on billing/coding throughout the program. And also ask questions and always be hands on in all rotations as much as possible. Until these programs change we have to show we are prudent, critical thinkers, and lifesavers.
Thank you for speaking. I am an RN for 15 years. Some years back I noticed co workers pursuing APNs, most had little experience. I started to look at the programs, thinking it was something to pursue. I was shocked when I saw most did not require any RN working experience. Personally I feel you need no less than 5 years. I knew one very experienced nurse supervisor who completed her APN, and had to travel two hours for her first job. After realizing it was just a lot of paper writing and finding your own clinical I decided it was not a good option. The entry requirements do need to be standardized. I think a lot of nurses doing APNs are doing so because they don’t want to do bedside nursing and only interested for the money.
I thought you were grandfathered in and didn’t take an emergency room test so how was it easy?
More people need to speak out an out these issues and these diploma mill institutions. These online schools are worse than big pharma that we all like to complain out…
This is so good! I plan to be a NP and have two decades of healthcare experience. I take pride in being competent in any position I hold. There has to be better streamlined processes. From CNA all the way to MD. Period.
That's just it... they all think they are super smart and special practitioners because they all got 4.0 grades. Same as giving trophies out to everyone. How did this happen to our medical system? It's FRAUD!
GO TO MEDICAL SCHOOL TO BECOME A DOCTOR... NO SHORT CUTS... PERIOD
I went to a clinic because I had blisters around waist and that it was starting to wrap around my back. It was extremely painful and I felt like I was on fire. A NP examined me and said that it was poision ivy. I argued with her because it was in February with snow on the ground and poision ivy does not grow when there is snow on the ground. I told the NP I thought it was shingles because shingles cause blisters, extreme pain and you feel like you are on fire. I informed the NP that I have been a bedside ICU and med/surg nurse for over 20 years and I know what shingles look like and they are extremely painful. Then, the NP said that she only worked med/surg for 6 months prior to getting her NP. Also, the NP said that she has never seen shingles. I was shock and concerned because if she can't diagnosis the difference between poision ivy and shingles then what other assessment and critical thinking skills is she lacking. A doctor was not able to see me at the clinic so, I went to the ER. At the ER I was diagnosis with shingles. I was prescribed the appropriate medications and made a full recovery.
Ffs how can someone be such an incompetent nurse and healthcare support as to have zero clue about SHINGLES
// glad you are okay
@@muirgirlThe NP was not only incompetent but lacked common sense because poison ivy doesn't grow when there is snow on the ground. Also, she was confident that it was poison ivy and not shingles even though she said that she has never seen shingles.
It is simple illness.inexperienced md could make the same mistake
John do you have doctor degree?
John is confused. Np training needs to improve. But not by being bullied by MD. I hope no money issue behind the fighting. Be honest. And take good care of patients. Md treated DO badly before also.
I think the NP schools assume the NPs will get trained on the job by the MD/DO. I’ve seen this at my PCP, fellowship training who also hire NPs, at my mother’s oncologist clinic.
What I have noticed is that all of these people have taken an industry wide unacceptable shortcut by going the NP route by way of a flim-flam school of opportunity vice taking the more arduous legitimate PA route. Their intent was to circumvent or cheat the system, and they knew it. These institutions should be shuttered, and their diplomas declared null and void. Those who got an illegitimate degree know they were in the wrong. Just like a major university will not accept transfer credits of head scratching or toe nail picking. They can't say they were unaware. When the PA school is twice the hours, twice the money, requiring twice the effort with one year clinical work and minimal accepted online classes.
They were fully aware. Go figure... there are twice as many or more nurse practitioners as there are physician assistants in America.
Its concerning when the state university only accepts a handful of students while a private university in Pennsylvania is educating around 600-800 students at any given time. Its irresponsible and its harmful for students and consumers.
Very informative talk and so needed for public health. Calling self a “dr” and you have your doctorate - i have mixed feelings about calling dr. But im not sure if that is my own conditioning by society. Personally I have received better care and medicine from well educated nurse practitioners. They seem to know alot more other than book and memorization knowledge. I agree if in a healthcare clinical setting it is misleading and could be manipulated and cause harm. “Do no harm”. There are many more doctoral graduates out there than historically so that could be rethought and redesigned so that all people who have spent alot of time and money on education gets the credit and acknowledgement they feel they deserve.
Great discussion. And we need more women in medicine. I listened and I’m gonna keep my “women centered comments to myself”. “John” seems like a thorough dude and I wouldn’t as a 30 yr nurse let him near me. Sorry not sorry
Direct Entry FNP programs vary some give them a one year break to work as a nurse in an acute care setting, other can allow the student to take a break voluntarily to work and gain experience, others allow students to work during tbe program, and other dont motivate them to work as a nurse at all. So it depends on the program. But these are very similar to PA program models except they dont even work as nurses except dor the few that are nurses going in
But most , you are correct, do not work as a nurse. Although, I've found that acute care nurses is completely different from outpatient np work. But, nursing exposure in an acute care setting can be helpful to an extent.
If medical students and residents have regulations on amount of time for training- perhaps the NP field needs to do the same to assure that those people who rush into NP “for the money”. Mental Health counselors have to a minimum of 3000 hours before eligible for licensure. I have never heard of only 500-600 hours before having the authority and experience to diagnose or prescribe. It is dangerous, against best medical practices, and negligent for the states to allow this without more of a “residency” period where they can act as a RN salary until their supervised hours are much more.
The problem is allowing new nurses or student with no nursing experience. I had 18 years of nursing experience before becoming a NP.
America should stand up and say,
"I refuse to see a nurse practitioner"
On another note- I have had a wonderful attentive gifted nurse practitioners that I would much rather see than a typical amount of time today’s doctor will give. I feel more heard and cared for by NP than I have about 75 percent of physicians. Quality care.
My issue with the critical care component is the diversity component. Not many AA or other minority nurses are allowed into CC. I see you want positive change. But this podcast wasn’t a good platform.
I'm curious, in your experience, what are reasons they aren't allowed in?
This NP speaker is confused. He is experienced and concerned and honest. But he does not know what profession he is in. What people is like.
Always suspicious of doctors seeking to artificially limit those who practice Healthcare, even when the presented facts are confirmed true