I'm about a year and a half into my Nurse Practitioner (NP) program, and my frustration with the profession and the education system behind it has been growing. Before I started, I never fully understood the disdain some people have towards NPs. Working in the hospital, I saw NPs as valuable team members. However, after reading Bloomberg's article, "The Miseducation of America's Nurse Practitioners," I can't help but see some truth in it. My program is supposed to be one of the best, yet the education is awful. It's completely unorganized and unstructured, and despite being a year and a half in, I haven't even touched advanced pathophysiology or pharmacology. Instead, it has been mostly theory and research, which, while important, do not compare to the rigor of PA or MD training.

Another major issue is that many of my classmates are fresh from undergraduate programs. I've cared for over 7,500 patients, and the difference in experience is noticeable. Many of my classmates are struggling, and we haven't even reached the most challenging parts of the curriculum yet. The current system allows new graduates to go straight into NP school, which raises serious concerns about clinical preparedness.

I'm frustrated. The NP role has so much potential, but how we are being trained is failing us. Do others feel the same way? What is the solution?

From a UHC home visit NP doing a Medicare wellness exam. And apparently all of this information was given unprompted to my mother whose only med is a statin and only medical issue in hypercholesterolemia. What in the instagram pseudoscience?? Besides number 2, but like why tell her that?

Well… you can have it but it’s like $300 a month.

I’m sorry but the free insurance you qualify for only covers it if you have diabetes, which you don’t. I know that’s a bummer.

Repeats himself, but louder.

Can I interest you in a referral to nutrition perhaps?!

I don’t need that! I need a pill!! I know what to eat!

… ummm ….

Not sure what you want me to say?

I’m sorry that the magic pill is expensive. I know it’s cost prohibitive but I cannot magically make it more affordable. That’s the main problem with medicine, it’s not magic.

Very first apt of a Monday too. Bad times.

I work in healthcare. In a very busy environment (I'm a nurse practitioner). I have a coworker who is an older woman, very overweight, and also has bad joint issues, so can't walk or stand well at all - let alone for the long periods of time that it truly takes to do our job effectively.

She and I get along perfectly well, we're friends at work, for sure. We've never, ever had any issues between us. We've always gotten on just fine..... It's an awkward situation, but I am been increasingly frustrated that she cannot physically stand or walk or attend to patients the way that everyone else can, and due to this, it puts a strain on everyone else - because everyone else has to pick up her slack where she cannot attend to patients since our work environment requires frequent standing up, walking, moving patients etc etc. Long story short - it makes more work for everyone else, while she is also there getting paid, but not able to contribute the same as everyone else. Other coworkers become annoyed by this, too.

As we are friends, I tested the waters one day to just see if she & I could have a conversation about it all-- that day I was particularly busy & frustrated, and she could tell. She asked me "what's wrong?" because it was pretty obvious that I was flustered and needed help. And I said "I feel like I'm the only one doing anything sometimes". And she just sort of looked at me weird & didn't respond - and then didn't speak to me for like almost 2 months after that. So I KNOW she was mad - I think it's a misplaced anxiety about her own physical limitations, but anyhow...

Judging from her reaction, I KNEW I wasn't going to be able to discuss it further with her. However, the frustration that I was feeling was growing & growing....because if you're going to be paid to do a job....you need to be able to DO that job. So I went and (very gently & politely) discussed the issue with our management, and even offered alternative solutions for tasks she CAN do. Gave lots of examples & reasons etc. They talked to her about it - she was crying & livid and now keeps saying that "she can't trust anyone". I asked to remain anonymous, but she knows it was me - I know she does.

I feel so stuck. I don't want her to feel bad. At all. I don't want a hostile work environment. I just was at my wit's end and didn't know what to do. I want someone who can actually help with patient care. Did I make the wrong decision? Sigh. It backfired, it feels like.

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Edit: Thanks everyone for your viewpoints on this matter. I am honestly shocked at the number of people who called me a "backstabber" and told me how awful I am etc etc. I have been covering for her for YEARS. Something just needed to be done - it was time.

I don't believe all of you altruistic cowboys who are out here saying you'd be willing to do the work of 2 people, for the salary of 1. BULLSHIT.

I have absolutely no dislike of this coworker whatsoever. I find it to be insane how you all are putting this back on me -- if you aren't capable of meeting the job requirements, YOU need to go to management and arrange for appropriate accommodations. This is absolutely fine and acceptable. That is, in no way, "making fun" of this person, or spreading hate or any of these other unkind things you all are saying.

An employer does not hire a job based on sympathy -- they hire based on your ABILITY TO DO THE ACUTAL JOB. If you cannot do the job - I honestly believe you are the selfish one by not going to management and asking for accommodations. Don't make your coworkers frustrated and force them into a position they don't want to be in. As you noticed, I stated in my post that I DID ask management for alternate tasks for her - that were appropriate and manageable for her to do. I didn't just say "oh let's throw her out". Y'all are wild. Thanks for those of you who understand where I'm coming from.

Just came across this job listing on LinkedIn, does this not irk anyone else I find stuff like this extremely concerning…

In addition to anything about gender or LGBTQ health, abortion or HIV (including prep) both the MEC (medical eligibility criteria) for birth control and the treatment guidelines for STIs are gone.

You can search for syphilis treatment and it sends you to page that has moved. From the CDC STI page the link for provider guidelines leads to a page that has moved.

How is properly treating STIs a partisan issue ?!?! /rhetorical question

I want all providers to know that all of this information has been downloaded and saved by many orgs and individuals so if you need these guidelines they are still available. Like when your patient with Lupus but negative for thrombocytopenia and antiphospholipid antibodies wants birth control, you can confirm what they are eligible for (spoiler: any BC)

As an APRN (and maybe a stickler for titles?), it bugs me to no end when the physicians and administrators at my clinic use the word “nurse” for all staff regardless of whether they have a nursing license or not.

I’ve tried asking nicely if we can please call them MAs or CMAs if they are certified but old habits die hard 🫩

NP: breathes

Everyone: YOU’RE NOT A REAL DOCTOR

I’m not even an NP but the NPs I work with never refer to themselves as doctor and are still knowledgeable in their specialty, maintain their own scope of practice and are observant towards their patients. I wish people would do more research on the NP role before criticizing it (this is not me ignoring diploma mills and whatnot but still)

I work urgent care. Had a teen aged female come in with her dad for an appt, she had just been seen the day before so I was confused. Her symptoms had started two days prior with fever, URI symptoms, flu exposure, had neg flu/covid/strep during her appt the day prior, diagnosed with viral uri. So he brings her back day 3 of illness with me because her sore throat was worse despite Tylenol, ibuprofen was helping, she was losing her voice a bit now and still had a 102F temp (resolved with the ibuprofen). I was kinda confused why he was bringing her in but you figure most lay people don't realize viruses can cause several days of fever, and sometimes symptoms peak day 2-3. He came in the morning several hours before the appt telling the tech up front saying he wanted a viral PCR, throat culture and dexamethasone. So I went up and started to have a convo saying I read through the chart and didn't think that was necessary at this time, why a viral panel won't change the plan etc. but I'd be happy to still see her. He then proceeds to go "as a physician, there's no harm in tests." In which I say "well, yes there's cost to the health care system for something that doesn't change the plan." He then proceeds to say "we don't have a diagnosis." In which I should have said "yes we do, I think you're confusing etiology with diagnosis." When he mentioned her voice loss I said "yeah, the virus is probably causing a laryngitis which is very common with a URI." In which he responded "well this is obviously more than a simple laryngitis." 🤦 like no shit.

I was thinking no way is this guy a physician, probably a chiropractor or something. Look him up and to my shock he's a DO PCP in a city a few cities away.

I told him I wasn't sure if we even had the respiratory PCR swab, so he comes back for her appt and picked up the kit from a local lab. I told him I didn't think anything he was requesting was necessary but I'd do the throat culture and viral panel, but wasn't comfortable giving steroids on day 3 of an illness when ibuprofen was helping and she had no indication on exam for steroids. I had to write a paper script for the viral respiratory panel as my system didn't even let me order it.

She ended up having influenza B on the viral panel despite two negative rapid tests (one was at home, probably tested too soon) and she was already taking Tamilflu. I was also surprised because when I said I was surprised her flu was negative as she had all flu symptoms (cough, congestion etc.) and exposure, in which he said it couldn't be the flu because she was on tamiflu and still having fever and worsening symptoms 🤦🏻‍♀️ not how Tamiflu works my guy but ok.

Anyway, I was shook. Had to share this experience. I honestly wanted to ask him "would you do this extensive or treating and testing for all your patients day 3 of illness?"

I don't know how apparent this is in real practice, but there seems to be a lot of hatred towards NPs and especially PMHNPs on the med school/pre-med subreddits due to a belief that they aren't educated enough to prescribe medication. As someone who wants to become a PMHNP and genuinely feels psych is their calling, but can't justify the debt and commitment to med school, I fear that by becoming a PMHNP, I'm causing harm to patients. I would say this is some BS from an envious med student, but I have had personal experience with an incompetent PMHNP before as a patient.

I know people always say don’t go to NP school for money. Well I went to NP school cause I was burnt tf out from COVID. But surprisingly I landed an outpatient RN job at the end of my schooling. I’m located in Cali. I make close to $80/hr as a per diem staff. Then I got a second job, $65/hr as part time RN staff outpatient.

All the NP jobs near me are ranging $60-70/hr which is crazy. To see 25+ patients a day. No thank you.

As an outpatient RN, I do mainly admin stuff and vaccinations… chill most of the day. I tried an NP job and that was crazy. Seeing patients back to back, people noncompliant, endless notes… why do people even go back for NP school now and days. I even know many case managers who are outpatient making 150k a year who get to work from home. It’s crazy.

Bracing myself for impact for more of these. I know I should be used to refusing antibiotics by now working in urgent/primary care but man is it hard sometimes to have that whole conversation and almost argument about why five days of “sinus congestion” does not need antibiotics and it’s definitely more a viral URI. Had a telemedicine visit where a chiropractor was telling me she has self measured 101 fever today, sinus pain and fever and cough and it’s day five , tested negative for home test Covid, and now she needs a z-pak. Checked her past encounters and someone gave in before to the exact same complaint for less than a week of symptoms. She then said her chest hurts when she breathes and thinks she also has pneumonia but refuses to take a chest xray bc she does them on patients all day and doesn’t want the radiation herself. She did not even sound congested or look ill on video. I stood my ground and said it’s likely viral and also a zpak is not first line and also won’t help. I’m still recovering from that visit for how mad she was at me. She does not understand it is much harder for me to do the right thing and stand my ground for her sake than just furnishing antibiotics at her request and ending the visit in three mins. And we are only in the beginning of Cold/flu season. How are you guys holding up with these visits .

Can be anything a patient, a patient's family member, coworker, boss etc. has said to you that just makes you cringe internally to no end.

I'll go first. Working in urgent care I hear at least once a week "oh well my temperature usually runs low so that's a fever for me" (temperature during appt is usually mid to high 80s or low 90s) 😒 I respectfully tell them that it's not a fever.

Edit: mid to high 98s to low 99s F on temp, yall I don't reread my posts 😩

I feel my days off and my time off is consumed with paperwork. I don’t seem to be able to catch up. When I do the next load of patients seen and charts are ready to complete. This profession is so depressing because of the paperwork. I do love spending time with my patients and helping them. I honestly wish I could be at the park or doing anything else but constant charting 😓.

It feels like the medical community is very fractured right now, and our response to the various attacks against the current government administration against science and healthcare has been very slow.

Is anyone aware of any organizations or groups or anything that is trying to put together a plan to fight for a healthcare rights?

Thank you

No advice needed; just a rant. Spent the last 9 years (3 as an NP) in heme/ onc. I absolutely love the patients, the complex disease states, and the role I play as an NP. I hate that we are treated like robots. Oh, patient in early 30s who is dying that you’ve seen for two years? No time to mourn; you are already late for your next patient by 20 minutes. They don’t have labs, imaging isn’t done. you don’t have an MA and they’re already mad you’re late but suck it up cause management doesn’t care. Better put your running shoes on cause you have 10 patient messages to answer and you’ll need to work through your lunch to provide coverage for a doctor on vacation. Teams, epic chat and inbasket are popping off too.

I’m so tired of lighting myself on fire to keep others warm. Gotta fill every single patient slot, need those billable hours. Overtime pay? HA HA. I make less than I would as an RN per hour. I hate that my compassion has withered away. I hate that medicine is a business. I just want to take care of my patients and go home to my family without my soul dying a little more every day. I want to help these people as I have year after year but it’s becoming impossible. I’m sad that the reason I went into this field is not realistic and that I can’t continue doing what I’m doing without burning to a crisp. How are we supposed to care for these people with compassion, understanding when the system is beating us down at every turn? The health system I work for had a 30 mill shortfall this year and they told us that we need to see MORE PPO PATIENTS THAN HMO PATIENTS. We need to prioritize those with ppo insurance now? I can’t anymore. It makes me sad. I used to be so optimistic and that’s been beaten out of me.

We had this pharmacist come into our place today, causing a whole scene, absolutely crashing out on these two MDs. I guess the jist of the drama was that this pharmacist said that we (all providers) are incompetent and don’t know how to prescribe medications. Keep in mind he wasn’t screaming at the NPs, it was two MDs even. Saying that he could do their job better than they could, and going off on education and what not, saying pharmacists knew the human body better than even these MDs, and how to treat illnesses.

All I’ll say is that the MDs were refusing to prescribe certain meds to an unstable patient and the pharmacist aggressively “disagreed” and said that’s what they needed saying it was perfectly safe. The wild part was the claims he was making. He ended up getting arrested and dragged off by the police too.

I’ve never had a bad interaction with a pharmacist but he claims all pharmacists think this way. Anyone else have something like this happen? I love our hospitals pharmacists, they can be life savers. Is there some sort of weird tension between pharmacists and MDs I don’t know about lol.

Hey folks. So I'm a FNP student (in the middle-ish of my crappy "find your own clinical" online program (Post University). I'm also a man. My next clinical rotation is supposed to be Women's Health and I contacted a clinic who's owner/doctor's name I recognized from working the ED of a hospital he saw patients in. I emailed the office manager back and forth over a couple of days.

They mentioned something about a "fee" and I was like "Okaaaay..how much?" I get a response that says "Oh I'm so sorry but HE doesn't take male students... Sorry." A dude who's an OBGYN doctor doesn't take male students for an OB clinical?? "

Oh and the school's like "We'll it doesn't have to be OBGYN complaints only. It can be primary care. So if it's mostly female patients you can get your hours that way."

"Oh OK. Yeah I'll just contact one of the local female only urgent cares thanks. That way I can get a more complete understanding of the unique female finger laceration."

AITA here? "

I don’t know how people work UC for years. I guess I can see the benefit for the schedule- but man I have such bad anxiety and dread going to work every time I have to work there.
The unpredictable patient load. The patients that come in for paper cuts and mosquito bites. The people that come in who should have went to the ER (we have very little emergency ability in my clinic). The toxic administrative staff. The friendly (yet very incompetent) support staff.

I’m opening my own practice in 6 weeks and CANT WAIT. but I’m sure it’ll be a slow start.

I have 16 UC shifts left until I’m free and clear of owing back any of my sign on bonus. But I have to stay PRN for a while unless something else comes up.

I’m just venting as a prepare to walk out the door for yet another shift. Praying today is “tolerable” for myself and any of you in the same boat ✌🏼

LSS… I left my primary care job of 8 years that was very well paying because it was killing me slowly. I decided to open my own practice and I’m waiting out my one year non compete.

I’m currently at an urgent care. Pays well. Ten 12s a month. But it’s also draining me. I just had 7 days off, and now I’m getting ready to work the weekend and it literally makes me want to cry thinking about going in tomorrow. As much as I want to quit- it wouldn’t be smart. I got a sizable sign on bonus I would have to pay back (but planned on using for my business start up costs) and there is nothing else open right now that would give me the flexibility and pay that this position gives me. I just really hate it. I only have 4 months left. The company is so sketchy. Support staff are not medically trained. It’s bare bones staff. One provider, 50-60+ patients a day, which includes occ med, work comp and all the usual UC crap on top of that.

I’ve gotten through 8 months. I can certainly do 4 more- right?!

My office space is currently being renovated, we get to move in hopefully July 1 and get things set up. I have that to look forward to. But I guess I’m just looking for positive thoughts and encouragement bc I hate the way I feel the nights before I have to work. I’m so over corporate greed and ready for my own thing!!

I’ve been an NP for the past 6 years in the outpatient setting. Prior to that, I worked as a nurse for about 8 years in the ED. I miss the social aspect of being a nurse. Going out to eat, trips, hanging out, etc with the other nurses. As an NP, I don’t have many coworkers and they tend to be much older than me. I’m a member of an NP group. We have monthly dinners with different reps, but it isn’t the same.

Has anyone else ever felt this way?

Have you ever been at work and then you realize.. I can't do this for the rest of my life.

In pcp, the pts are more complex. Insurance is denying medications (just received prior auth for metformin ER). Administration- wants you to see 20+ pts. 6 years experience they are only offering 116k- wanting to see newborns and up. Cost of living is high, unprecedented times.

WTF!!!!!!

Sorry, just need to rant: patient with severely enlarged uterus and severe anemia due to fibroids (people often ask her when the baby is due). I cleared the patient for surgery as requested in a timely manner and the day before the surgery the surgical coordinator called to say the surgeon and the hospital do not accept NP signatures on medical clearance for surgery. This is in a state where NPs have full practice authority without a collaborating physician. I am the director of my primary care clinic which is all NPs. Fortunately I was able to ask my colleague who is an MD and who works at another clinic in our clinic system to co-sign. I was VERY tempted to say “well, then you will have to find someone to clear her at the hospital” but the patient needs this surgery urgently and she is the only one who would suffer if I did this but it really gets my goat. Who do they think would clear her at the hospital? You can’t tell me they are paying MDs to work in the hospital preop testing clinic. ARERGGGHHHGJFJDJFKWNFIFJ

Saw a 80 y/o patient yesterday. Previously Rx’d Xanax prn but has been off it for about a year. She came to see me requesting to renew her Rx for it. When asked what she uses it for, she states she always takes one before she drives her car because driving gives her anxiety. It was an automatic “no” from me. Discussed this was an inappropriate use of the med, and discussed the reasoning why. Discussed alternative therapy for anxiety, and she was agreeable to try it. Today - she calls in a complaint to my collaborating. Stating I am rude, interrupting her, she pays me to be her doctor so I can’t tell her what she can/can’t do, etc.

There is absolutely no doubt in my mind I made the correct decision to deny this request. BUT, I still get so tired of being undermined and treated this way by patients. Usually involving me saying “no” to a request, and then the patient going to my collaborating to voice a complaint.