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  • Writer's pictureRebekah Bernard

RN and former NP student exposes deficiencies in nurse practitioner education

There are over 400 nurse practitioner schools in the United States, with nearly HALF of these programs promoting online training—ranging from 50-100% of required academic training sessions. Some of these programs offer accelerated training, allowing students to become an NP in as little as 2 years, others offer flexible schedules with part-time programs allowing students to work full-time while they attend school. In contrast, there are just 179 medical schools producing physicians in the United States. None of them are online, and there are no part-time medical schools.

Why has there been such a proliferation of nursing schools, and with such a huge number and variability of program types, who are ensuring that these programs are producing qualified medical clinicians?

To help us explore these issues, we are joined by Rayne Thoman, a registered nurse who left nurse practitioner school when she discovered serious problems in the educational standards. Watch the video HERE. Get the book!


Rebekah Bernard MD 0:00 Welcome to “Patients At Risk,” a discussion of the dangers that patients face when physicians are replaced with nonphysician practitioners. I’m Dr. Rebekah Bernard, and I am joined by my co-host and the coauthor of our book “Patients at risk, the rise of the nurse practitioner and physician assistant in health care,” Dr Niran Al-Agba.

Niran Al-Agba MD 0:21 Good evening.

Rebekah Bernard MD 0:25 There are over 400 nurse practitioner schools in the United States, with nearly HALF of these programs promoting online training—ranging from 50-100% of required academic training sessions. Some of these programs offer accelerated training, allowing students to become an NP in as little as 2 years, others offer flexible schedules with part-time programs allowing students to work full-time while they attend school. For contrast, there are just 179 medical schools producing physicians in the United States. None of them are online, and there are no part-time medical schools.

Why has there been such a proliferation of nursing schools, and with such a huge number and variability of program types, who is ensuring that these programs are producing qualified medical clinicians?

To help us explore these issues, we are joined by Rayne Thoman, a registered nurse who left nurse practitioner school when she discovered serious problems in the educational standards. Rayne, thank you so much for joining us!

Rayne Thoman RN 1:23 Thank you for having me.

Rebekah Bernard MD 1:25 The first nurse practitioner school opened in 1965 at the Univ of Colorado and was designed to increase pediatric care to underserved populations. Nurse graduates of this first program were trained to perform well-child exams, provide immunizations, and promote health education to patients. Within just a few years, the number of NP programs had increased to 65, with programs training nurses to take on a more expanded role beyond working as physician ‘extenders.’ NP training has received huge funding from the federal government. The 2010 Affordable Care Act allocated millions of dollars to increase training programs. An unintended consequence of this funding has been a massive increase of private, for-profit training programs that fiercely compete for student tuition dollars, boasting 100% acceptance rates to potential students,[i] offering flexible options for nurses to work and attend school at the same time,[ii] and promising accelerated study tracks to become a nurse practitioner in just 2 years.[iii] Some programs even promoted ‘direct entry’ programs that allowed non-nurses to become nurse practitioners—no previous nursing experience required.

Rayne, you have had experiences with some of these programs. Can you tell us about it?

Rayne Thoman RN 2:29 So, I went back, and it was a brand-new program, and it was a local school, so I didn’t think anything out of the ordinary – when it was a brand new program. Kind of right off the bat it just didn’t feel right, and things just didn’t seem right. The way we are being instructed was kind of – we weren’t learning - we were just kind of going through motions, but we didn’t really understand what we were doing, especially health assessment. And so many of the classes were very easy, like our psycho pathophysiology and psychopharmacology - which are extremely important classes if you’re going to be a psychiatric nurse practitioner because you need to understand those things. They were online, open book. There were no lectures. There was no instruction for this, it was just, you’re going to take 4 exams, here are the dates for the tests, they are 25 questions, and they are not proctored. There’s no guidance here so you just are quickly looking things up but you’re not being taught anything.

There’s this idea that all it’s all self-taught – you hear that a lot with these nurse practitioners – then why do we have school? Why am I paying if I can just buy these books and learn it on my own what do we need these schools for? It’s just become a culture because that’s how these schools are, but we all know it’s not right.

Rebekah Bernard MD 04:01 Rayne, you were a nurse already in psychiatry, correct? A registered nurse before you started?

Rayne Thoman RN 4:07 I worked medical too.

Rebekah Bernard MD 4:11 How many years had you been a nurse before you started school?

Rayne Thoman RN 4:17 Five years.

Rebekah Bernard MD 5:09 And how did you select the school that you first started at?

Rayne Thoman RN 5:19 It was a local school that had a master’s program because my local university had a DNP and I just didn’t see why I was going to go into 6-figure debt. I didn’t know everybody was trying to push to be called doctor but back then, my thought process was, ‘why am I going to pay for this?’ Nobody is going to call me doctor. I don’t want to be called doctor. It was like, $120,000 at a state school and there’s no clinical, you know, it’s not like there’s more clinical knowledge to it.

I actually did start it start at that school in 2015. I started one class and I was like, why am I doing this? My friend was in it too. I dropped the class – like, I’m not doing this this – this is not nursing, I don’t even know what this is; it’s not going to prepare me for psych. And so, I as like, I don’t want a DNP, this doesn’t make sense.

Rebekah Bernard MD So, you picked the school that was in the right location, was convenient for you, and of course it was credentialed so you expect you were going to be getting adequate training.

Rayne Thoman RN Well and I got my bachelor’s there too, so it wasn’t an unknown school to me. It’s a small, local school.

Rebekah Bernard MD It makes perfect sense. And so, once you get started you start seeing some pretty serious problems and you start reporting these problems to the proper authorities. Tell us about that?

Rayne Thoman RN 5:34 Right, so there were a lot of issues. They were giving secret exams for people who failed health assessment. It was just insane. The straw that broke the camel’s back was, they didn’t set up my contract, but they sent me to clinical, they told me I could go there, so I went, and then HR called and said me ‘you can’t be there’ and I found out per NY state regulations you can’t even do clinical hours with a physician assistant. And then I was like, well, they either know and they are letting us do this or they don’t know, and they probably should know. Anyway, I was just done. I actually consulted with an attorney who said, report them and see where that goes. So, I reported them to the accrediting agency - a 25-page complaint with all the evidence. Because the CCNE - the complaint has to be a certain way, you have to find in the standards what’s being violated and put it exactly how did - they make it difficult I think so people don’t complain. I mean let’s be honest. You also can’t be anonymous, so students don’t – now you’ve got retaliation. I reported it to the state education department and the CCNE said there were no issues whatsoever. And as of right now the Department of Education told me that per many phone calls - which I have not talked to them since January last year - they have been in contact with the dean to make sure everything‘s OK. But that’s where were at as of December 16 of 2020.

Rebekah Bernard MD 7:09 Some of the things that you reported - I have them here - first of all, you’re supposed to be prepared as a psychiatric mental health nurse practitioner to care for patients “across the lifespan” which means all ages. So supposedly you come out with competency, but your program offered only one lecture on the care of children and adolescents - one lecture - and one lecture on the care of seniors or older adults. And provided no specific clinical hours in those populations. How are you supposed to be trained in that?

Rayne Thoman RN 7:43 That was another major point -they just say go do your clinical hours and a lot of them they wanted you to do in psychotherapy - because they actually didn’t even have a psychiatric nurse practitioner running the program, they had a clinical nurse specialist. They had her when I started. They haven’t been able to keep a psych nurse practitioner as a director. They don’t even have proper staff to run this. They just tell you ‘go do your hours.’ So people are graduating with no hours in child psych – and especially in child and adolescent because those hours are extremely hard to find.

Other programs - because I did get into a better program - they say - they give you –you have to do at least 100 hours – there are set requirements - and other programs – like, if you really wanted to do child psych you could do the majority of your hours in that, but you still needed to do them, they kind of work with you.

Rebekah Bernard MD 8:35 And your hours - you are supposed to be 500 clinical hours altogether?

Rayne Thoman RN 8:39 That’s the minimum - the program that I was in that I reported I think it added up to 540.

Rebekah Bernard MD 8:47 And of the 500 hours, you have to get 100 clinical hours with children to be certified to take care of mentally ill children.

Rayen Thoman RN 8:57 Well, that was the good program. The one I was in there were 240 hours. They were split into 3 classes – the first was 120 and you had to do 120 in a medical setting, and that’s where everything went wrong with me because I was doing it in an ER with a PA. And you had to do 240 hours - I believe those were in psychotherapy because the clinical nurse specialist set this up and she was really – that’s what she does, she does psychotherapy, so it was really heavy on that. And the 180 hours was supposed to be med management but it didn’t have to be across the lifespan – you could go to a practice they just said ‘go do the hours’ – it was kind of a free-for-all.

Rebekah Bernard MD 9:38 I don’t mean to laugh because it’s not funny. It’s actually extremely upsetting and sad because children are the most vulnerable patients that are out there and caring for them when they’re - especially mental illness. I’m a family physician and I can’t even imagine taking on that responsibility. Niran, as a pediatrician what are your thoughts on that?

Niran Al-Agba MD 10:00 Well, it’s interesting. I just had a med student working with me and she just happens to be applying in emergency medicine and had done three years a med school - so she’s in her fourth year. And she said she had no idea how much psych we do. And I would say it’s probably 25% of every pediatrician’s work. But again, there’s certain lines I won’t cross. There’s certain medications - there is only one or two antidepressants I’m comfortable using – I will use risperidone, which is one antipsychotic - I won’t use any of the others without psychiatric management to help or someone who is a psychiatrist weighing in. And so, it’s interesting though - we do have two psychiatric nurse practitioners in our town. One is really knowledgeable, really experienced, and really good. And one just loves lithium and every kid’s on lithium. And yes, it’s fascinating to me such a spectrum and I think that’s what I’m learning from Rayne that it depends on your program.

Rebekah Bernard MD 10:52 Well, Rayne complained about the hours, but she also reported to the accrediting organization that the courses that she was being taught - that all the students were taught - on psychopathophysiology (which is the study of the causes of psychiatric disorders) and psychopharmacology (the study of medicines used to treat psychiatric disorders) were online. There was no lecture material or slides, she says. There was no instruction, no discussion boards, basically, you had to look it up yourself in a textbook.

Rayne Thoman RN 11:23 There is no - you weren’t being taught in a lecture - there is no guidance. It was literally the syllabus just tells you – they give you the four dates for the exams and you sit down at your computer and you do it.

Rebekah Bernard MD 11:36 Then the exams are without proctors. You could work together with other students; you could look up information in the books if you wanted to.

Rayne Thoman RN 11:45 Right. I mean, I don’t know if people are doing that – I wasn’t but, come on.

Rebekah Bernard MD 11:51 Well, if there’s an opportunity there someone may take it and that’s not great.

Rayne Thoman RN 11:56 Of course. This is not how any education I’ve ever had is. And it’s like, what’s going on? Here’s the other thing. And I don’t think people understand this. Students don’t want to complain about this because this is easy. Like, you think, oh this is great, and you’re getting A’s so there’s this false sense that you know things – but you don’t. And when the reality sets in and you’re in clinicals – because I did start clinicals with a psychiatrist – and I’m looking at him as he’s talking to me and I’m like, ‘I don’t know what you’re talking about and I probably should.’ I should have more of a foundation, but we didn’t learn anything.

Rebekah Bernard MD 12:37 And you had the insight to realize that was a problem but unfortunately not everybody does. And that’s why you decided I can’t do this anymore; I am not going to put patients at risk.

Rayne Thoman RN 12:45 No, because when the door closes and you’re alone with them, I mean, I just don’t feel comfortable faking. The other thing is people are like, just finish, just finish because you’ll make so much money. And that’s why people stay because they’re also deep into it. And the debt. Ok, but how and I going to sleep at night? What if I hurt somebody?

Niran Al-Agba MD 13:05 You know it’s interesting - I hear so often that other – just depending on the programs - people will say - we get a lot of applications to our office. Both Nikki and I both - she feels the same way - she doesn’t want to help do the clinicals with the diploma mills - not the brick-and-mortar traditional schools. And you know, she says it’s amazing how little you realize what’s out there when you first come out. And they just have a false sense of it. And it’s this is sort of idea: I’ll just finish it and you’ll make this money. And I’ll tell you what my perspective: money is not the reason to do this profession. No matter who you are - I don’t even care if you’re a cardiac anesthesiologist making half a million a year - the money would not be worth the stress in my opinion for the level of care that you have to provide if you don’t have the training. And I’m fine being one of the lowest-paid specialties - I know we work hard, I’m not suggesting we don’t - but the money isn’t shouldn’t be the motivator.

Rebekah Bernard MD 14:03 You don’t go into medicine to make money. If you want to make money, there a lot of easier paths to do that. Although people are trying to make money and not always doing things the right way. We really need to take care of patients. So, Rayne you really are on a mission now and that is to expose these programs. Because you tried taking things through the proper channels and it didn’t get you anywhere. So what I see you doing now - I think it’s really important - which is shedding light on what’s going on. Sometimes we’ll hear people say: ‘well, that’s just one person’s experience’ or ‘I don’t really believe this is really happening.’ So, what you started doing is posting online information and tell us about why you’re doing that and how you’re finding out about these cases that you’ve discovered.

Rayne Thoman RN 14:50 I’d never been on these Facebook groups but when I got on them, I was like, oh, my gosh, this isn’t just happening here - like what is going on? And you start talking to people all over the country – I have all these nurse practitioner friends all over the country after this – and you’re like, what is going on? And they are having the same problems and reporting it too – they’re sending complaints to the CCNE – there’s this movement to send these complaints and nothing happens. We’re not supposed to talk about it outside of medicine, but we have some serious problems here and the people in power are not doing anything about this. And why? Then you start realizing - there is like, a lot of money. There’s something going on here, you know because it’s actively being quieted – just keep it in nursing – well, nursing isn’t fixing itself.

This is really harmful to society – because at the end of the day we are all human beings. Take my nurse hat off – I’m a person. This affects us all. If we end up in an emergency room ten years from now - this is not safe. Who is protecting the people out there who don’t know about this? We know about this so we can keep ourselves safe. But what about – this is not ok. This is not something I feel comfortable keeping - talking amongst ourselves isn’t working. Calling these people, emailing, filing complaints – you guys have been doing this for years.

Niran Al-Agba MD 16:27 So how do you exactly take matters into your own hands? I mean, what made you want to just start posting? I’ve seen a number of your posts which are fantastic.

Rayne Thoman RN 16:34 Because there are a lot of people who deny this happening. That’s kind of how this got started. You’ve got people like, ‘that’s not true.’ Hold on. Please hold. Let me go get you five things. There is ample evidence this is going on. People post about this every single day between schools or they don’t know what they are doing. And sometimes they genuinely don’t know what’s going on – but then there are some that seem to want to almost brainwash everybody. Keep it silenced. “Oh, that’s not happening.” Because if you say it over and over again. But there’s evidence.

Rebekah Bernard MD 17:13 Rayne has been posting a lot of screenshots, but she also posted some really interesting things which is that there are some actions being taken against some of the schools. Walden University- tell us a little bit about Walden – they are well known in the diploma-mill world.

Rayne Thoman 17:28 Walden seems to be - you know – when you think of diploma mill everybody wants to say Walden. Because they’re online and you see the posts, people say it’s easy - know it’s easy, you can get in like pretty much the same day. It just doesn’t have a great reputation. They post, I’m embarrassed I went there but now they’re finally being investigated.

Rebekah Bernard MD 17:53 They’re in trouble now. What’s interesting is that their trouble came when another company tried to buy them out. So, they’re supposed to be bought out by a private equity firm for 1.5 billion – with a B – billion dollars. When you talk about money - that’s a lot of money. So, Walden is in the process of being bought but during that, I don’t know if it was during due diligence that was being done, there were some allegations made. And there’s an investigation that Walden officials made some misrepresentations to the accreditor of the organization - the Commission on Collegiate Nursing Education – and that they falsely advertised aspects of the degree to students, including the availability of clinical site placements required to complete the program. So, Walden is definitely under investigation. And then, another sort of online school that lost its accreditation just this last year in November - that’s Lehman College. And they lost accreditation because their students were not passing the nurse practitioner exam at adequate levels.

So, there is some attention being paid but it’s very slow-moving. I have some screenshots here and we’re going to put these up on our YouTube video so that people can see them and know that they are real, and these are people speaking out. There’s a lot of people talking about the other online programs like Regis and Maryville. What I see written down is: ‘people seem to think that Regis is reputable‘ and someone else writes ‘I know it’s not reputable and that’s what I’m struggling with. Everyone says it doesn’t matter, but like, it does though!’ Is what somebody’s writing to another person. And so, what is the dialogue that you’re seeing here that people are talking about about the schools?

Rayne Thoman RN 19:51 It seems as if people are either like, oh, this is terrible, or people are like, no, it’s the greatest thing ever. And the people that I think are talking these schools up - that it’s the greatest ever - they have no other option – this is the only place they can go. Because they’ll defend it – they will aggressively defend these schools. But I think [that for] this caliber student it probably is hard because there are no standards. They’re probably letting people in that they couldn’t get into another school - because they wouldn’t be accepted - so it probably is on some level challenging to that individual but that doesn’t mean they’re going to be safe and competent once they get out.

Rebekah Bernard MD 20:33 Some of these people are looking for the easier program. So, I have a post here that says ‘I’m going back for my psych NP. Is there a school out there without proctored exams or camera monitoring exams? I prefer open book, open note exams. I graduated from Walden when they didn’t proctor exams and I still did extremely well on the boards. Any recommendations?’ And then another one that’s, ‘I’m looking for the absolutely easiest online MSN-DNP program. My MSN is from a very rigorous and locally prestigious program. It was hell, but I really think I’m a better NP for it. With that said, I am too old and have too many responsibilities to do a program like that again.’ So, there is a demand for some of this – it’s is bad programs, but also some people seeking those less quality programs.

Rayne Thoman RN 21:29 So, actually in my program – so, they’re like six of us cause it was brand new when we when I started -and then probably a year later, everybody, people are flocking to it with no psych experience because guess what? Word got out how easy this is and you can make a lot of money. And I even had a coworker - I was doing case management the time, I had to call her - and she said to me, ‘oh yeah, they’re all running to’ - she knew about that! She told me, ‘oh yeah, all the psych ER nurses are all doing it.’ I’m like, what? Other people know about this? Other people are catching on, they’re not even in the program. And then you see it on the Internet: ‘What’s the easiest, fastest way I can do this?’

Rebekah Bernard MD 22:22 And there are some really easy and fast ways. I mean that’s just the advertisements. You see how fast - online master’s degree or DNP - it pops up in my Facebook feed all the time. It’s really amazing - the aggressive marketing that some of these companies have done. So, one of the biggest challenges with these programs is not finding adequate preceptorship and you mentioned that one of the problems with your program was that they had you working with a physician assistant when that wasn’t even technically allowed as part of your hours, right?

Rayne Thoman RN 22:55 I didn’t know that - the school is approving and letting us do this. I don’t think they knew what they should have known.

Rebekah Bernard MD 23:04 And one of the things that you post a lot are desperately seeking preceptors and it’s really sad when you look at these. What are your thoughts when you see all of this volume of people looking for help?

Rayne Thoman RN 23:17 Well, I think, too, that’s like a motivating factor because when you see all these people that are fellow nurses, what are we doing to our own? How is this OK? This is not OK. I have friends that had to get out of those groups because all you see are preceptor posts. It’s nonstop every single day. I mean it’s nonstop.

Niran Al-Agba MD 23:35 We get requests every single day. It’s like even three or more - and they write us letters, they give us resumes. One of them, my actually my dad took care of the person as a child. It tears at your heart and we just - I’m on with a residency program so I have residents and Nikki only takes PNP candidates from her University of Washington pediatric NP program. That’s it. She is contracted with them and she’s just going to work with them. So, we kind of both of us have what we’ll do and we turn them down but I feel bad for them. There’s so many that just say I need 60 hours in peds. I need 30 more hours in peds to finish and it literally every day we’re getting these requests now.

Rayne Thoman RN 24:23 And they’re desperate. They’ll do anything and it’s sad.

Niran Al-Agba MD 24:29 They talk about working - actually even some of the letters will say- ‘I’ve been seeing patients at no charge for my family doc’ or whoever I’ve been with. ‘I’m more than happy to do nursing work at no charge to you to come and precept.’ I always think like, wow, this is… I mean, yeah, I feel really bad for them and I just, I don’t want to take on a student or anyone unless if I can devote the time to do my job which is teaching them clinical care. But it is sad to know that there are other people taking advantage out there.

Rebekah Bernard MD 25:00 And this is not just online schools. You posted one here that was a student from Yale - so Ivy leagues here - looking for a preceptor in the Bay area and hoping to get 120 hours in primary care and peds. And so, somebody said, ‘I thought Yale would get you your preceptor’ and they said, ‘well, they do usually but because of Covid they can’t, so they’re asking encouraging us to look out-of-state for a preceptor.’

Niran Al-Agba 25:27 Can you imagine? Yale. I mean, just think about that for a second. Yale nurse practitioner program is asking people to find their own preceptors. There’s no standardization. There is a preceptor in my hometown - I know I’ve spoken about her frequently. She has a PhD, so she goes by a doctor, and also actually refers to herself as a pediatrician. She’s anti-vaccine and she has signed so many medical exemptions - and it’s legal in the state of Washington. That’s almost every medical exemption in our community comes from that individual. And it’s shocking to me that this is allowed to go on and Yale! Which used to mean something.

Rebekah Bernard MD 26:05 So, Rayne another thing you have been posting a lot is because the education is really lacking what we’re seeing is a lot of nurse practitioners going on Facebook and other social media sites to ask clinical questions. And that’s something that you’ve been sharing a lot to just try to show the public or other people the quality of education. Tell us about why you’ve been doing that.

Rayne Thoman RN 26:28 Because there’s a lot of denial that this is going on, you know. They are, oh, it’s not – no, this is bad. This is really bad. This is every single day. This isn’t like, every once in a while. It’s not like looking for a needle in a haystack. It’s the whole haystack.

Rebekah Bernard MD 26:42 And it’s happening so much that Sophia Thomas, the American Association of nurse practitioner President, actually wrote an article begging people not to go to social media to discuss clinical cases. Saying, first, it’s not really good way to get information - there are valid resources where you can learn and not just asking people hey, how do you diagnose this or that. And also because it doesn’t make us look very good because people are pointing out our deficiencies.

Rayne Thoman RN 27:13 That article is at least a year old because I saw that when I was I was still in school. I remember seeing that and being like, shouldn’t she wonder why are they asking these questions? You know, I had a lot of lightbulb moments - that was one of them when I saw that article I’m like, what? Because I started noticing these clinical questions and I got in the groups too and I was like, as a registered nurse you should know this, some of these questions. It’s like, what is going on here? You feel like you’re in the twilight zone.

Rebekah Bernard MD 27:46 So, we have some examples that you posted, and there was a person that posted: ‘Is research and theory a huge part of most NP programs? I’m going to a great school and the grads say they leave feeling prepared, but I’d really love to dig into some practical, real-world aspects of practice and instead I’m doing a lot of research and theory assignments, and this seems to be the case for most NP programs.’ And so somebody else chimed in on the thread and said, ‘yeah it’s definitely an issue. We had one two-hour class on how to read an EKG – one. And then also one-two hour class on how to read a chest x-ray but yet we spent an entire semester writing a 38-page thesis on something I’ll never use.’ So is that the kinds of posts you’re seeing? A lot of people just really concerned about the deficiencies..?

Rayne Thoman RN 28:38 Yes. There is constantly – why are we doing theory? We should have more clinical and have more science and medical.

Niran Al-Agba MD 28:48 I do want to contrast that with - just as an example - we get two hours of class, let’s say, in our first two years of medical school on how to read an EKG. And what’s interesting is, I accumulated 40 hours reading EKGs – only - in my internal medicine rotation. And I would sit in the afternoons - I was there for 12 weeks - I would do about three hours a week, 3 1/2 hours, and we would go through hundreds of EKGs and sign off on them. And I found it fascinating. I thought it would be really helpful in the future. And so, that’s just reading EKGs in adults which I don’t even do. I mean I can read EKGs you know, OK, I would say I’m OK entry level with 40 hours reading adult EKGs as a pediatrician. So, just a contrast. I think that’s what people miss.

Rebekah Bernard MD 29:35 Yeah, we spent hours and hours and hours and hours reading EKGs. EKGs are very difficult and complicated. You can’t just read the interpretation of the computer says and that’s it. So, if you don’t know how to read an EKG - and that’s a really fundamental skill, but it takes a lot of skill and certainly cannot ever be learned two hours. That’s really egregious.

I think one of the things that I found really interesting Rayne that you posted was photographs of nursing projects that were done as part of like a final exam or final project. Tell us about why you found it interesting.

Rayne Thoman 30:14 So, I actually went to a – the school I was at they do like a showcase your project. And if you look at the actual photos of them - I went to it because my friend was graduating sooner than I was. And I walked in and I was like, what are we, in middle school? And basically, you stand by them and like, you’re like proud and I’m like what is going on? This is what we have to do? I was kind of stressed out about this final project thing thinking it’s going to be all this work, oh, my gosh, because this should be a big deal and you see these and you’re like, this is it? This is all we have to do? I could do this in an afternoon.

Rebekah Bernard MD 30:56 Yeah, they’re really, really basic. Like, one of them is an educational brochure on handwashing. One of them is taking care of a PICC line at home - which is an intravenous line, a special type of one. And that actually wouldn’t even necessarily a nurse practitioner duty to me it would be more of a nursing – a PICC line.

Rayne Thoman RN 31:18 The ones we have examples of here are like nursing base -like RN – I could see this for a BSN program OK if this is your final program awesome – but an MSN? these are mostly MSN I believe and what? I don’t know what we should be doing because I’m here to learn but I’m pretty sure it should be like a lot harder than us And there was one student who spent 2 semesters on hers, she actually did a research project, she did a phenomenal job she stood there and she could explain it to me and she said ‘Don’t do this” she’s like don’t waste your time doing all this work because it’s pass-fail. It’s not like she got an A and everyone else got a B. She’s standing there with this well-put-together research study she did feeling like an idiot because why did I spend all this time if I could have done an educational brochure on hand hygiene?

Rebekah Bernard MD 32:12 We know if this is the expectation then certainly it’s not enough to give nurse practitioners to competencies that they’re going to need to take care of patients and in fact a 2017 survey that was published in worldviews evidence-based nursing they asked 2300 nurses across 19 different health systems to assess their skills in 24 different practice competencies and it was really sad because overall the nurses reported that they did not feel confident in managing and meeting any of the indicators including collecting data, communicating evidence, implementing change to improve care, and they found a nurses with a master’s degree – nurse practitioner level had higher scores and bachelors but overwhelmingly they still did not write themselves as competent as competent to practice evidence-based practice skills so it’s that tells you everything you need to know right there that nurses are not assessing themselves as having the qualifications that they need and they know they need and the schools are the ones that are responsible for providing that and I think Rayne you’ve done a really good job of showing that they’re not meeting those

Rayne Thoman RN 33:22 Well, they admit they don’t know. I mean they post…they’re posting that.

Rebekah Bernard MD 33:29 There’s a lot of really sad and sketchy questions that come out. Like, I’ve seen questions that say ‘how do I learn how to interpret labs?’ ‘How do I learn how to’ - really basic - ‘how do I learn how to figure out how to treat colds?’ ‘How do I figure out what antibiotics give’ or ‘which antibiotic goes for which infection?’ Like, you’re going to Facebook and asking this question?

Niran Al-Agba MD 33:53 They are not taught that. That part I will tell you - they are simply not taught. They’re not taught what the penicillin class treats. They’re not taught about Gram-negative and gram-positive - I’ve never seen anyone that can really delineate those different bacterial types really well which is what we need in primary care. And Rayne, you do a tremendous job of exposing what’s going on behind the scenes which to me I’m just, you’re one of my heroes because every day I get on Twitter and I look at what you’re posting and I learned so much from you so I want to just say thank you. It’s just amazing.

Rebekah Bernard MD 34:29 We’re going to learn more. So, we’ve just scratched the surface and when we come back in our next episode with our discussion with Rayne Thoman we’re going to be talking about some of the other challenges that are occurring in Nurse Practitioner training. We’re going to explore the opportunism in healthcare in which some people are trying to use their education to pursue cash-based treatment that have questionable value. There’s a lot we’re going to get into in our second part. So, make sure that you don’t miss any episodes. Subscribe wherever you listen to podcasts and subscribe to our YouTube channel and of course, to learn more about this topic I encourage you to get our book “Patients at risk the rise of the nurse practitioner and physician assistant in healthcare” It’s available on Amazon and Barnes & Noble. And if you’re a physician and you’re interested in learning more about joining us please visit Thanks so much and we’ll see you on the next episode.

[i]Nursing Master's Programs with 100% Admit Rates. U.S. News & World Report. Accessed June 9, 2020.[ii]How Much Can You Realistically Work During Your NP Program? Retrieved from Published May 20, 2015. Accessed March 26, 2020.[iii] Staff Writers. Accelerated Online MSN-NP Programs for Registered Nurses. Published June 8, 2020. Accessed June 9, 2020.

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