Why You’ll Want to Know How Your Nurse Practitioner Was Trained

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Two years ago, John Canyon was working in Corpus Christi, Texas, and he still remembers the day he got a call that his seventy four year old dad had had an emergency about four hours away.

My mom called me and told me to him a dad fell and that they had went to the urgent care and they texted me the x ray read and they said they saw a nurse practitioner there and they said he had broken ribs.

The nurse practitioner sent John's dad home, but John was skeptical that his dad wasn't sent to the er. He knew broken ribs at that age could be dangerous, so John shared his dad's X ray results and the fact he was sent home with a trauma surgeon he knew to get his take.

I showed him the report. I'm like, I can't believe this, and he goes so I can't believe it either. He needs to go. He needs to be admitted.

John got in touch with his parents and he told them his dad needed a second opinion. He needed to go to the emergency room. So John's dad headed to the er and got checked out by another nurse practitioner and the.

Emergency department did test. They did a cat scan ofis chest and said he had multiple rib fractures and a pulmonary contusion, and then discharged from home.

But back at home, his dad only got worse.

So he three days later, he's in severe pain, goes back to the emergency department. They found that they had a ruptured spleen and ended up being life flighted to San Antonio.

John says his dad eventually got great care at the trauma center and ended up being okay, But he says the way this went down with his dad, two medical visits without the right diagnosis should never have happened. His dad's life should have never been put at risk in this way. And John would know because he's been a nurse practitioner for nearly twenty years.

You know, he shouldn't have been sent home from the urgent care. The person there didn't understand the severity of rib fractures, and an elderly person, and the person in the emergency department who should have known that didn't know that, and also discharged him home when he should have been admitted.

Then what went through your mind when you first heard that recommendation to send him home.

They didn't know what they were doing. They were obviously not trained well enough, and they needed more training and frustration and agitation and putting someone's life at risk unnecessarily.

Today on the show, a Bloomberg investigation into the increasing reliance on nurse practitioners and American healthcare and what the rapid growth of the profession has meant for their training and their patients. I'm Sarah Holder, and this is the big take from Bloomberg News. So, in the world of nurses, there are many different types, and as Bloomberg investigative reporter Polly Massen's explains, the kind most people think of are registered nurses.

So a registered nurse, for those who might not know, is what you'd most closely associate with, a bedside nurse or a nurse that you might encounter in a hospital. So somebody who you see when you're receiving care in a hospital environment is most typically going to be a registered nurse.

But the story Polly and Bloomberg's Caleb Melby have reported out over the last six months is about a different type of nurse, the nurse practitioner.

So a nurse practitioner is probably somebody that listeners have been seen more and more in their interactions with healthcare in the US. That's a registered nurse who went and got an advanced degree and an additional license.

The nurse practitioner or NP degree is a newer, more advanced nursing license. It was created at the University of Colorado in the nineteen sixties. Back then, much like today, there was a shortage of doctors, and the idea was to alleviate some of the pressure on doctors by creating a pathway for people with a nursing background to level up their skills.

Nurse practitioners can see patients the way doctors do. They can assign care regimens the way doctors do. They can prescribe medications in many cases is the way doctors do. It is essentially a parallel path for nurses to act as doctors often do in American healthcare.

From that first program at the University of Colorado, NP programs started to spread across the country. By the end of the nineteen seventies, there were about fifteen thousand nurse practitioners in the US. Today, there are more than three hundred thousand. The number of nurse practitioners is projected to rise by forty five percent by twenty thirty two. It's

There's a few things we're looking at here. First, the need for more providers. The weights for doctors are constantly expanding, they're growing, so we need more providers that patients can see on a shorter timeframe. But there's also economic and financial factors at play too. The time it takes to become a nurse practitioner is shorter and more affordable than

So there are a number of benefits to having more nurse practitioners, shorter wait times for patients, better profit margins for healthcare providers, and more career opportunities for registered nurses. But how has it been possible for a new category of healthcare professionals to grow so quickly? Where are they all getting trained? The answer, in part is the introduction of a new way to get a nurse practitioner degree called direct entry programs.

So for a direct entry program, you don't necessarily need any experience, and in fact, some of those programs are actually designed for folks who do not have any experience. So in those cases, you don't necessarily need any experience or estally any education experience, and you don't necessarily need any work experience. With non direct entry programs, they do expect you to have studied nursing.

And I will say too, there's something of a debate within the nurse practitioner community. You will talk to some of these nurse practitioners who were urns for decades before getting their degree, and they will say that experience is very important, that makes you a much better nurse practitioner. And then there's others who will say, well, actually, the job of diagnosing and prescribing that is at the core of the nurse practitioner's job, doesn't really happen for you

Those responsibilities are huge. In their reporting, Polly and Caleb came across a lot of stories, like the one John Canyon shared about his father. Some of them had different endings.

The case of Tiffany Dunbar is I think we can all agree as a tragic one.

Tiffany Dunbar was a mother of three and she was pregnant with her fourth child. She was experiencing discomfort and spotting, which are symptoms of an ectopic pregnancy. So she scheduled an appointment at a women's wellness center at a hospital in DC.

That was somewhere that she had had a medical doctor in her life, and she had had three children already, so she was pretty familiar with that clinic and with women's care.

She met with a nurse practitioner who had a bachelor's and a master's degree from the University of Cincinnati Nursing School. The university advertises the master's program as one hundred percent online Lawyers for the Healthcare Center said in a filing that Dunbar was told to come back for additional testing and that since she agreed to come back, the NP didn't want to frighten her with a prospect of dying.

Her death was ruled as catastrophic by the medical examiner on the autopsy.

In the court case that followed, a jury found that the nurse practitioner and the center failed to meet the national standard of care and their treatment, and that Dunbar's death was completely avoidable. The center appealed the decision, noting that Dunbar agreed to those follow up visits but didn't follow through, and the case was ultimately settled out of

When we talk about nurse practitioner education, many times we are talking about ad t LIM and its properties in Chamberlain University.

Devrai rebranded to ad Tillem in twenty seventeen as it faced lawsuits and government scrutiny over how it advertised its programs. Today, those two leading NP schools under ad Tolum's umbrella are responsible for training a growing number of nurse practitioners each year. But unlike for doctors. There's no one standard for how nurse practitioners need to be trained, and a lot of

They go out and they knock on doors, They drop cookies off at offices. They do all sorts of stuff to try to find those people, including paying them out of pocket pain to be taught, including paying third party matchmaking services to pair them with someone.

Caleb and Polly reached out to ad Talim, the company behind some of the fastest growing nurse practitioner programs in the country, to get their comment about how they ensured students got adequate training.

Ad to Lim, a spokesperson told Bloomberg it wants to support students who are not successful in identifying appropriate clinical sites.

The spokesperson also said in an email that ad talim quote is committed to ensuring students graduate prepared to pass required licensure and certification exams and enter the healthcare workforce end quote. Caleb and Polly spoke to dozens of nurse practitioners for the story who'd gone through a variety of training programs, and many said they didn't feel like their training set them up for success.

Some students didn't feel prepared, and in fact, some of them hadn't actually been able to complete their clinical hours, So of course they're not going to feel prepared. You can't expect them to.

They get very frustrated that this is their experience, and some of them get very scared about what it means for them to go and practice on their own after those experiences.

With their emphasis on online education and their challenging approach to on the ground learning, nurse practitioner programs are facing increased scrutiny from students, medical doctors, and a former NP program administrator who raise concerns about student faculty ratios and a lack of student support. When Caleb and Polly raised some of these issues with the country's largest lobbying group,

The American Association of Nurse Practitioners told us something that's fundamentally true, which is that millions of Americans are getting their health care from nurse practitioners right now. The association also believes that nurse practitioners are going to healthcare desert in rural areas and in cities to not just make sure that there's shorter wait times at any hospital, but also increasing access broadly in these geographic pockets where it's sometimes hard to come across care.

But the question Caleb and Polly were still grappling with was whether the problems that identified with nurse practitioner training were impacting the quality of that care. There isn't a ton of reliable data out there on nps and patient outcomes, but poll came across a working paper first released in twenty twenty two that looked at over a million patient records from forty four via system emergency rooms, and it revealed a troubling trend.

Those researchers noted that on average, nps used more resources but achieved worse patient results as compared to physicians. Now, this is still a working paper that does still have to go through the peer review process, which can be really lengthy, but it is an interesting finding, and it's particularly interesting because it does look at emergency where the stakes are going to be the highest.

Polly says. The Association of Nurse Practitioners took issue with that paper, in part because it was still being peer reviewed. The lobbying group also shared another study that looked at patients across five countries including the US, and found that nps can actually improve patient outcomes in an er setting. I asked Polly and Caleb what they thought the root of the issue here was n Like most problems with our healthcare system, there isn't just one answer.

I think it's everything that we've talked about kind of compounded on itself. There's a doctor shortage, there's an increase in these kinds of for profit educational programs, and there's a completely logical, understandable desire to move away from bedside nursing in some cases. So I think that all of those things, combined along with the many, many eccentricities of

A bad reading of the story would be nurse practitioners bad, which is not what the story says. The profession will keep blooming. That will not stop. We are all going to be getting more health care from more nurse practitioners in the future, and the students and professors and nurse practitioners we spoke to said there's things that need to happen with our education to prepare us universally for those increased responsibilities that they will be facing in the future.

John Canyon, the nurse practitioner we heard from earlier, says his dad's experience not getting the kind of treatment John thought he should have hasn't made him lose faith in nurse practitioners themselves. After all, John is two decades into his own career as a nurse practitioner, and he sees what he trusts for his own care. But John has

At the end of this, my dad ended up being okay. So while mom and dad were like, well, it's no big deal, they were nice to us. So you know, we don't want to and like, well, here's the thing. If we don't, if we don't at least talk to them and let him know what's going on and let him know you're upset, then nothing will ever happen, No one will ever get additional training. It'll continue to be a problem.

This is The Big Take from Bloomberg News. I'm Sarah Holder. This episode was produced by David Fox with Thomas Lou and Alex Sugiura. It was edited by Aaron Edwards, Caitlin Kenny, and Flynn McRoberts. It was fact checked by Thomas Lou and mixed by Blake Maples. Our senior producers are Kim Gittleson and Naomi Shaven, and our senior editor is Elizabeth Ponso. Nicole bumsterbor is Our executive producer. Sage Bauman is Bloomberg's