NP education: simulation hours?

[Kaepora]

I think the article is using studies conducted with prelicensure nursing students (which means prior to being an RN - not NP) and extrapolating that to APRN education.  So it is focusing on APRN education, but has absolutely no data to support its claims.  

My program used simulation, virtual case studies, standardized patients (real live people who let you practice on them (including pelvics and DRE/prostate exams...), etc, as did the medical students and PA students at my university.  This was in addition to 6 clinical rotations spanning 1.75 years (3 year program).  

One commentary article written in 2016 that has not influenced accreditation in any way, shape or form (as I stated the 2019 CCNE standards were just released) is hardly a strong piece of evidence and should not be the cinch pin for your argument.

[EMEDPA]

I am not arguing anything. folks asked about use of sim applications in np education and I found some articles. I like sim education. I just don't think it should replace standard clinical education( and I am not making a claim that it is).

[PACJD]

14 hours ago, lemurcatta said:

Yea, actually can the OP post their source?

I know I jumped on the bandwagon but also whether or not this is true, it doesn’t change the fact that their are NP and DNP programs around me that I know of requiring 750 cinical hours which is around 30-40% of the hours a typical student local PA student gets. 

LOL what?! 750 clinical hours?!!!!  My program required at least 1750 clinical hours in order to graduate!

[OTP4PA]

Mine required minimum 2000 and included these core rotations

Inpatient medicine, family medicine, inpatient psych, EM, Surgery, Peds, OBGYN inpatient, and other electives.

Needed to write an actual case report (15 pages each) with literature support totaling 10 during the clinical year. Also had end of the rotation exams that required at least 80 percent on each one of them. About 5 percent of my class failed at least one rotations and had to repeat an additional semester before  being allowed to graduate. Moreover, we had to complete a 30 page epidemiology research paper for master thesis before receiving our diplomas.

I heard there is NO FAIL for NP rotations, lol. Pathetic

Seriously, we do way more than DNP and physical therapy and optometry. We should be awarded doctor of medical science.

This one FNP I know only SHADOWED an MD I know at his clinic for 2 months and got her clinical satisfied. That physician thinks she cannot even identify and treat basic strep throat - when pimped she said we would treat with zpak lol 

[EMEDPA]

7 minutes ago, PACJD said:

LOL what?! 750 clinical hours?!!!!  My program required at least 1750 clinical hours in order to graduate!

I had about 2000 required and did around 3000. my first rotation in trauma surgery alone was over 600 hours.

[CoastalPalm]

1 hour ago, EMEDPA said:

"The current preceptor apprenticeship model is no longer sufficient to meet the growing demands for primary and/or acute care nurse practitioners. Developing or expanding the use of technologies, learning activities, and projects could promote innovation in the education of APRN students. Technologies such as simulation, which includes mannequin-based simulators, screen-based simulators, and virtual patients, standardized patients, and case studies can support competency-based education and offer possible alternatives to preceptor supervised clinical practice hours.1,2 Enhanced distance technology and pedagogies may also have a role in preparing nurse practitioner students. "

pretty sure we are talking about NPs in training here. pre-licensure = in training and not yet licensed as NPs. not trying to be argumentative, but the whole focus of this article(and the title) implies we are talking about np, not rn education via sim.

That is not correct.  Yes, the article is talking about APRN education, however the specific part that you quoted earlier ("a national simulation study by the National Council of State Boards of Nursing on replacing clinical hours with simulation in prelicensure nursing education concluded that up to half of traditional clinical hours could be substituted with high-quality simulation experiences and yield comparable end-of-program educational") is making a comparison to undergraduate (I.e. "prelicensure" in nursing parlance, which, as a nurse, I am aware of) nursing education to advanced practice education and the lack of evidence supporting simulation in APRN education in comparison to the extant research supporting it in RN education.  The referenced article to that statement is actually available here: https://www.ncsbn.org/JNR_Simulation_Supplement.pdf, and makes that clear. The article is on undergraduate, I.e. "prelicensure", nursing education.

[EMEDPA]

2 minutes ago, CoastalPalm said:

That is not correct.  Yes, the article is talking about APRN education, however the specific part that you quoted earlier ("a national simulation study by the National Council of State Boards of Nursing on replacing clinical hours with simulation in prelicensure nursing education concluded that up to half of traditional clinical hours could be substituted with high-quality simulation experiences and yield comparable end-of-program educational") is making a comparison to undergraduate (I.e. "prelicensure" in nursing parlance, which, as a nurse, I am aware of) nursing education to advanced practice education and the lack of evidence supporting simulation in APRN education in comparison to the extant research supporting it in RN education.  The referenced article to that statement is actually available here: https://www.ncsbn.org/JNR_Simulation_Supplement.pdf, and makes that clear. The article is on undergraduate, I.e. "prelicensure", nursing education.

thank you. I apologize for any confusion my misunderstanding may have caused.

 

[ProSpectre]

4 hours ago, Kaepora said:

I think the article is using studies conducted with prelicensure nursing students (which means prior to being an RN - not NP) and extrapolating that to APRN education.  So it is focusing on APRN education, but has absolutely no data to support its claims.  

My program used simulation, virtual case studies, standardized patients (real live people who let you practice on them (including pelvics and DRE/prostate exams...), etc, as did the medical students and PA students at my university.  This was in addition to 6 clinical rotations spanning 1.75 years (3 year program).  

One commentary article written in 2016 that has not influenced accreditation in any way, shape or form (as I stated the 2019 CCNE standards were just released) is hardly a strong piece of evidence and should not be the cinch pin for your argument.

I think you and CoastalPalm may be getting caught up on debating the articles, but there is evidence that replacement of clinical hours with simulation is at least allowed, if not actually happening. I posted earlier in the thread language directly from CCNE (with sources) that supports replacing some clinical patient contact hours with clinical simulation hours. The specific percentage the OP quoted was called into question, but the fact is that the accreditation standards do allow replacement of clinical rotation hours with simulation hours. 

Clinical simulation is a great tool and should definitely be used in medical education, but I think it is a tool that should supplement, rather than replace, actual clinical experiences.

As I noted in my other post, I am not here to denigrate NPs or their education, and I don't support those (like the OP) who seem to raise topics like this simply to bash NPs. However, facts are facts. I think this topic elucidates the fact that the quality of NP education is quite variable, and that stated hour requirements posted by schools may not always be what they seem; some NP programs likely use clinical simulation appropriately to supplement clinical patient contact experiences, but there are other programs that may not be so judicious in its use. 

[Reality Check 2]

Not an online or SIM fan for much. 

Nothing replaces hands on.

 

[EMEDPA]

33 minutes ago, Reality Check 2 said:

Not an online or SIM fan for much. 

Nothing replaces hands on.

 

I think it is great to practice skills you don't get to do much otherwise. I did the Team Health High Risk 3 day emergency med sim course in 2015. Incredible course with great, lifelike(read very expensive) mannequins that talk, bleed, breathe, etc. great for practicing difficult airway stuff, high risk difficult ob deliveries, chest tube placement, trauma and medical codes, etc

[karebear12892]

3 hours ago, EMEDPA said:

I did the Team Health High Risk 3 day emergency med sim course in 2015. Incredible course with great, lifelike(read very expensive) mannequins that talk, bleed, breathe, etc. great for practicing difficult airway stuff, high risk difficult ob deliveries, chest tube placement, trauma and medical codes, etc

Does TeamHealth still offer this course? Did a quick Google search and wasn't able to find it. 

[Boatswain2PA]

11 hours ago, Kaepora said:

My program used simulation, virtual case studies, standardized patients (real live people who let you practice on them (including pelvics and DRE/prostate exams...), etc, as did the medical students and PA students at my university.  This was in addition to 6 clinical rotations spanning 1.75 years (3 year program).  

How many actual clinical-training hours did you have? (ie: you are working with a preceptor seeing or working on real patients)  And how many were you required to have for your program?

 

[Boatswain2PA]

6 hours ago, Reality Check 2 said:

Not an online or SIM fan for much. 

SIM is great for the rare, acute, difficult, can't screw it up and YOU gotta figure it out cases.  

In the military I would SIM low probability-high consequence events, and I would SIM them pretty hard, just to make sure the trainee would sear these events in their brains, just in case they ever encountered such events.

SIM certainly has it's place.

 

[lemurcatta]

11 hours ago, PACJD said:

LOL what?! 750 clinical hours?!!!!  My program required at least 1750 clinical hours in order to graduate!

Not sure I understand your post. If you’re seeking clarification, then yes, I do know for sure if NP programs requiring 750, and yes, I do know for sure that is less than half of the hours local PA programs require. 

[Kaepora]

8 hours ago, Boatswain2PA said:

How many actual clinical-training hours did you have? (ie: you are working with a preceptor seeing or working on real patients)  And how many were you required to have for your program?

 

I, personally, had about 3500 hours over 1.75 years (3 year program). My program, a masters level acute care program, required a minimum of 1000. All of my classmates had over the minimum as well. They listed an hours requirement on the website but that's not truly how they counted time spent in clinical. What was counted was actual notes written for each patient encounter - either SOAP or consult/H&P. So 1 hour = 1 patient encounter and note written. So I rounded on all my preceptor's patients, but could only count the ones I personally did >75% of the work and wrote a note. And for surgery they required 120 hours, but only counted from cut to close. So I was there full time for months doing every aspect of a surgical APP including rounds and clinic, but I could only count a small fraction of that time. 

[Reality Check 2]

I am not procedure centric anymore in practice.

My practice is psych heavy and requires contact with the patient. Lots of body language, voice inflection and massive gut intuition. 

Combine heavy psych with intense poly internal medicine and there is no SIM for that.

Just my take on it. I know SIM helps some folks. I never want to see it replace more than it should, just like online.

So, not dissing it but pointing out it doesn’t fit every practice need or style.

We all have different needs and I don’t want to see technology just for the sake of technology.

[EMEDPA]

14 hours ago, karebear12892 said:

Does TeamHealth still offer this course? Did a quick Google search and wasn't able to find it. 

it is an in-house thing for those folks working in main EDs or solo settings. I was a team health employee already at one of my per diem jobs when they decided to implement the first pa staffed solo coverage ED in our state a few years ago(it has since closed when another organization bought the hospital). I was the first hire. they required 10 intubations in the OR with an anesthesiologist and completion of this course in order to get that job. they do it once/yr in feb for PAs from all over who work in high acuity settings. class by invite only. maybe 25 seats/class. course is held at the OHSU med school sim ctr. they bring in the sim team from chicago cook county hospital's em residency program.

[EMEDPA]

4 hours ago, Kaepora said:

I, personally, had about 3500 hours over 1.75 years (3 year program). My program, a masters level acute care program, required a minimum of 1000. All of my classmates had over the minimum as well. They listed an hours requirement on the website but that's not truly how they counted time spent in clinical. What was counted was actual notes written for each patient encounter - either SOAP or consult/H&P. So 1 hour = 1 patient encounter and note written. So I rounded on all my preceptor's patients, but could only count the ones I personally did >75% of the work and wrote a note. And for surgery they required 120 hours, but only counted from cut to close. So I was there full time for months doing every aspect of a surgical APP including rounds and clinic, but I could only count a small fraction of that time. 

sounds like a good program. I think many of the ACNP programs are solid. it seems like most of the questionable NP programs are the online didactic, 500 hrs of clinicals that can be self-arranged FNP programs.

[Kaepora]

2 hours ago, EMEDPA said:

sounds like a good program. I think many of the ACNP programs are solid. it seems like most of the questionable NP programs are the online didactic, 500 hrs of clinicals that can be self-arranged FNP programs.

I felt really well prepared. The specialty NP programs - psych, acute care, women's health, neonatal and anesthesia and midwives - , IMO, do a good job of educating their students. The FNP programs are trained in outpatient primary care. That's it. But they are taking jobs in these specialty areas. So of course they look ignorant. They are. Plus, these for profit, 100% online programs are God awful. There is currently a movement amongst NPs to try and shut down these programs. The CCNE (NP program accrediting body) had an open comment period prior to their 2019 standards and thousands of NPs wrote to them urging them to change minimum requirements. They met us half way I suppose. Hopefully these bad programs will be unable to function now and close. 

[EMEDPA]

what specifically did they change? I agree FNPs working in surgery or EM is a problem, unless they were previously surgical nurses or EM/ICU nurses. Also agree that ACNP, Psych NP, CNM, NNP,  CRNA, etc specialty-focus NPs do a great job. I have worked with many and been impressed with all of them.

[Kaepora]

2 hours ago, EMEDPA said:

what specifically did they change? I agree FNPs working in surgery or EM is a problem, unless they were previously surgical nurses or EM/ICU nurses. Also agree that ACNP, Psych NP, CNM, NNP,  CRNA, etc specialty-focus NPs do a great job. I have worked with many and been impressed with all of them.

The main change was that CCNE is requiring every program have preceptors available for each and every student.  Too many programs have put that responsibility on the student, which, as you can imagine, creates an abundance of problems.  This isn't going to change over night, and the NCSBN is urging NP students to report these programs to CCNE if they are not providing preceptors.  Certain programs, such as Walden, which accepts a new cohort every *month*, is 100% online, and requires the student to find their own preceptors, will most likely be forced to close.  Or at least severely restrict the number of matriculants they accept to a more reasonable/sane number.  The more we can bring NP education back into the realm of reason for these schools, rather than just cash cows, the better. 

[rev ronin]

A bit of investigation has confirmed that this thread was started by a repeat troll.  Since several posters in good standing are continuing to comment here, I am not closing the thread, but be aware: The original post was 100% trolling.

[Kaepora]

9 hours ago, rev ronin said:

A bit of investigation has confirmed that this thread was started by a repeat troll.  Since several posters in good standing are continuing to comment here, I am not closing the thread, but be aware: The original post was 100% trolling.

Haha, I called that.

[Reality Check 2]

Why do folks feel the need to be painful idiots? 

I enjoy a good conversation, but not one baited for contention, divisiveness and idiocy.

 

[Lexapro]

It surprises me how eager y'all are to jump all over NPs, such hysteria. I'm glad some level-headed people jumped in to suggest that perhaps people should bother checking sources before they raise their pitchforks. Yikes.