Do you feel more people are entering nursing only to become APRN's?

Nurses General Nursing

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I am not a nurse yet, but I'm an EMT, have worked in and around the hospital, and I am currently finishing my last two prerequisite courses before applying for ABSN programs. It seems like 90% of my current classmates in nursing prerequisite courses, along with other prospective nurses I've worked with, are entering the nursing profession with the goal of become a Nurse Practitioner or CRNA.

Do you, especially those already working as nurses, feel a lot of new graduate nurses are entering nursing for the sole purpose of becoming an APRN? I feel like since APRN's are gaining more popularity, people are entering the nursing field to become an APRN and not a "nurse", in lieu of becoming an MD/DO or PA. I'm not saying more education is bad, but it seems like people want to be an NP, not a nurse, if that makes sense. Which leads me to believe (and I know it's been discussed before) a huge over saturation of APRN's is in the near future.

Thoughts? Again, I'm not a nurse yet, so I could be completely off base.

Specializes in ICU, LTACH, Internal Medicine.
It wasn't always this way. What do you think has changed?

I will reluctantly engage in this conversation again because I think there has been a blatantly obvious negative change - and it pre-dated the situation in which we now find ourselves by a long shot.

I very honestly and sincerely believe your basic premise is wrong. You are focusing on the fact that it may not matter as much now what we offer newer nurses - that no matter what we "invest" in them we can't get them to stay. That is because the tide has turned and the word has spread.

Nurses have already spent the better part of a decade or so (more or less depending on location) hearing things like, "The need to think critically is where errors happen. We must reduce this need. We are looking at all possible areas where we can eliminate your need to employ critical thinking." Yes, I have sat in group upon group where non-nurses told us this very thing and much more. Our nursing leaders went along with it. The direct result of this is that anyone who wanted to be a nurse for the art (heart) and science (mind) of it now finds this situation intolerable and unethical. It certainly doesn't compel anyone to aim for being an acute care bedside nurse.

The "best and brightest" nursing has to offer do not enjoy entertaining crazy ideas like scripting. An intelligent person does not find such ideas acceptable, generally-speaking. Do you think new and experienced nurses, alike, enjoy being told point blank that no one here wants them to employ critical thinking? What about any of the other countless bad or even unethical ways we are told to perform our jobs these days? What about "improvements" (barriers) that are thrown down just for the sake of "change" or "optimizing our value stream?"

I will assume you have seen the post here on one of the subforums where a non-nurse "guru" has come asking how he can make our lives easier and "reduce nurses' stress" by using technology to help us recognize which patient we are caring for and what room we're in and what kind of isolation precautions are needed, and inquiring about problems we might have with isolation signs. This sort of "thing" is going on everywhere now. But...nurses are intelligent people of ethics. I believe the crowd has spoken and they/we aren't buying it. In fact, nurses are fed up with it and done. As you are seeing. They now want to work at the bedside only as a means to get somewhere else. I think that's a pretty logical and expected reaction.

llg, with all due respect, I will implore you once more to see that you have this backwards. You are looking at the fall out of some very bad decisions and (I believe) coming to incorrect conclusions.

This doesn't matter for argument's sake, it matters because no correct interventions can be deployed without considering this angle/premise. Acute care units, generally-speaking, serve the sickest patients in the country. It behooves all of us to be painfully honest about this situation. Nurses' intelligence has competence has been completely de-valued.

I think you're absolutely right.

This is an overall tendency, as I can see. There are not many areas of well-organized human activities left in developed world where critical thinking, flexibility, creativity and strive to discovery and implementing new and non-standard things remain welcome and valued qualities. If a manager of fast food restaurant cannot use shriracha till The Big Fat Powers of Corporation tell him to do so, although every second customer is asking about it, it is the same story as when a nurse gets written up for using second pulseox on a leg of patient who is on watch for the limb ishemia because "we never do like this here". It is situation when policy-kissing substituted for common sense. It is when people continue to do the same things even if they are invariably lead to the same results. It is when requiremetns and conditions are clearly not possible to follow, yet enforced with draconian force. It is when whatever can be done with a human being as long as it could be made looking like "professionally".

I do not know when it will end, but 100000+ people dying every year in US hospitals due to "preventable" medical mistakes plus the fact that the population of the USA shares "general level of health" with some third-world countries look like quite a clear evidence that system is not working satisfactory on any level. I wonder why so many RNs are still hold on the worst parts of it like on the last straw.

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Specializes in Emergency.
Great. But are you willing to get that BSN? We need nurses with BSN-level knowledge to take care of the complex patients we have at our tertiary care center.

Let's see...enter a BSN program...pay 25-35k for said program...work another 10 years after that. I'd rather not since it doesn't pencil out well. Perhaps I will take the less glamorous job in your step down unit or telemetry. Med-surg sounds good too. (I use the word glamorous as a jest related to other subjects on this forum.)

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Specializes in CVICU, MICU, Burn ICU.
Good thoughts.

5. We can begin efforts to repair some of the damage done (from within) to the general respect given to the position of bedside nurse. Honestly - - why can't bedside nursing be a well-respected "goal" from within nursing - - at least as respected as other things like Infomatics, Infection Control, Unit Educator, etc. I think something is very wrong when you can't get very far on the "clinical ladder" or enjoy much respect for "merely" being an excellent bedside nurse. I admit it makes me a little flabbergasted (at the world, not at you, llg) because the need for nursing care is THE reason patients are hospitalized - [i'm simplifying but that is generally true] - and they need excellent care! How is Staff RN the lowest possible rung on some ladder?

6. We do need to figure out what happened to experienced bedside nurses - why they chose to go away or why they weren't wanted, however we want to look at it. Their absence affects many things like stability of the unit and especially teaching newer nurses to provide excellent care. The general situation we're discussing is going to grow bigger before we can get a handle on it merely by the fact that advanced intermediates or "competent" new nurses a) cannot adequately teach someone just a little less experienced than they themselves are and b) will have a very hard time trying to survive a "patient load" + precepting obligation. And they are starting to be the only ones left around to precept and orient others. I don't know, but I would think this only accelerates the hemorrhage...

yes, yes, yes! The bedside nurse being at bottom of clinical ladder is a problem, for sure. There needs to be incentive to continue in education -- especially hospital-based educational offerings/ and certifications for bedside nurses to grow into true experts. Nobody educates other bedside nurses like an expert who is still on the front lines. If you could keep experience at the bedside, you could have higher standards for preceptors. Honestly, there could/should be a certification for it with minimal clinical hour and continuing ed. requirements. Also incentives for staff RNs to participate in committees and have REAL input on unit policies, norms and culture.

Safe staffing is a HUGE aspect of respecting/protecting patients and nurses alike. Getting the consumer on board in getting safe standards to get passed, nationwide, is worth the effort.

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Great. But are you willing to get that BSN? We need nurses with BSN-level knowledge to take care of the complex patients we have at our tertiary care center.

BSN level knowledge needed to take care of complex patients at a tertiary care center?? May I ask what you perceive are the components in BSN nurses education that make nurses with a BSN better qualified to take care of complex patients than ADN/Diploma nurses? I ask genuinely, as a nurse with an ADN and a BSN. You do know that nurses with an ADN/Diploma take care of complex patients? Tertiary care isn't rocket science.

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BSN level knowledge needed to take care of complex patients at a tertiary care center?? May I ask what you perceive are the components in BSN nurses education that make nurses with a BSN better qualified to take care of complex patients than ADN/Diploma nurses? I ask genuinely, as a nurse with an ADN and a BSN. You do know that nurses with an ADN/Diploma take care of complex patients? Tertiary care isn't rocket science.

I guess they don't teach sarcasm in ADN school.

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Specializes in ICU, LTACH, Internal Medicine.
Good thoughts.

5. We can begin efforts to repair some of the damage done (from within) to the general respect given to the position of bedside nurse.

6. We do need to figure out what happened to experienced bedside nurses - why they chose to go away or why they weren't wanted, however we want to look at it.

7. We need to return NURSES to NURSING. Not to "customer service". Not to the heaviest, time-consuming part of their jobs which can be done by less-qualified professionals, but to clinical nursing which implies critical thinking. If it will mean going back to "team nursing", so be it.

Making pride of getting every patient under her care a bed bath every shift and completing every task right in time isn't good if one of these patients quietly slips into near-code while the nurse is busy with fluffing pillows or calling consults because she has no supporting staff.

8. Bedside nurses' voices have to be heard and listened to. For this, they have to be actively included in politics of healthcare, research and local management. There should not be such thing as purchasing or implementing equipment for a facility without getting it approved first by nurses if they are going to be the prime users of it. Those nurses who wish to become "testers" should be appropriately compensated for doing so.

9. All stuff, great and small, which obstructs educational and creative opportunities for bedside RNs must be eliminated. If a facility runs an ICU, they should have money to make all nurses able to reach everything on ANCC site for free. Nurses should be encouraged with more than words for obtaining professional certifications, and more than that $1/hour. Nurses cannot be forced to accept mandatory uniforms, devices, etc. unless they as a group prefer to do so.

10. All customer service measures which do not have strong evidence of its benefits done by research with no financial "support" must be eliminated at once, as well as all measures that support it, including paperwork. (little secret: there is very little to no such research existing).

11. Nurses' working time must be audited periodically. If they spend >30% of it doing paperwork/EMR, the facility should be required to implement measures to reduce documentation load or face repercussions in form of $$$$. Same for overstaying shifts or going with no assigned breaks too often.

12. All managers of units should be required to do 1 shift/month at bedside.

13. There should be efforts finally made toward solving dillemmas of "lateral violence". If other criminal acts which depend heavily on opinions and impressions of victim/perpetrator/witnesses, such as statutory rape, could be brought to more or less clear definitions of what it OK and what is not, then the border can be drawn between beneficial "constructive critique" and malignant behaviors. The latter ones should be codified and dealth with accordingly.

14. Last but not least: there should be finally a federal law making violence toward medical workers, including nurses, "equal" to one done toward polce. Yelled profanities on a nurse ->> welcome to jail.

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Specializes in CVICU, MICU, Burn ICU.
BSN level knowledge needed to take care of complex patients at a tertiary care center?? May I ask what you perceive are the components in BSN nurses education that make nurses with a BSN better qualified to take care of complex patients than ADN/Diploma nurses? I ask genuinely, as a nurse with an ADN and a BSN. You do know that nurses with an ADN/Diploma take care of complex patients? Tertiary care isn't rocket science.

Clinically speaking, you have a point here. But I would argue that being clinically proficient is not enough anymore in view of progressing nursing as a profession and knowing how to play with everyone else in the sandbox is important. And whether we like or not .... or see theoretical applications of nursing as a bunch of hooey ( I know plenty of nurses who think this), we now live in a climate where educational degrees matter in the professional realms of healthcare. And this is not unique to nursing.... it has happened across all disciplines.

I don't ever question the clinical proficiency of ADN/Diploma nurses based on degree status. In fact, I have known them to be more prepared as new nurses, clinically speaking, than many of their BSN peers. I, also, started as an ADN nurse.

But while taking care of tertiary level patients in an acute care setting may not be "rocket science", it most certainly demands strong patho/pharm and critical thinking skills along with sharp hands on ability. I have to admit, I don't understand nurses not feeling intellectually challenged by our work. I'm no Einstein -- and maybe those who don't feel challeged are -- they are just too smart. But, for me.... there is always. something. more. to learn. And sometimes it's stuff I already learned 10 years or more ago, but haven't used in a while. The "nursing-isnt-rocket-science" thing just never sets well with me.

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Clinically speaking, you have a point here. But I would argue that being clinically proficient is not enough anymore in view of progressing nursing as a profession and knowing how to play with everyone else in the sandbox is important. And whether we like or not .... or see theoretical applications of nursing as a bunch of hooey ( I know plenty of nurses who think this), we now live in a climate where educational degrees matter in the professional realms of healthcare. And this is not unique to nursing.... it has happened across all disciplines.

I don't ever question the clinical proficiency of ADN/Diploma nurses based on degree status. In fact, I have known them to be more prepared as new nurses, clinically speaking, than many of their BSN peers. I, also, started as an ADN nurse.

But while taking care of tertiary level patients in an acute care setting may not be "rocket science", it most certainly demands strong patho/pharm and critical thinking skills along with sharp hands on ability. I have to admit, I don't understand nurses not feeling intellectually challenged by our work. I'm no Einstein -- and maybe those who don't feel challenged are -- they are just too smart. But, for me.... there is always. something. more. to learn. And sometimes it's stuff I already learned 10 years or more ago, but haven't used in a while. The "nursing-isnt-rocket-science" thing just never sets well with me.

No-one is arguing that nurses don't need to be good critical thinkers, and have good knowledge of pathophysiology etc. But "progressing nursing as a profession" has nothing to do with the quality of nursing care a nurse delivers, and "knowing how to play with others in the sandbox" - are you actually suggesting that BSN trained nurses have superior communication abilities to ADN/Diploma nurses? Nursing requires intelligence, good critical thinking abilities, and for bedside nurses, a strong body. I agree with you not understanding nurses who don't feel intellectually challenged by their work, but saying that tertiary care isn't rocket science is simply stating a fact.

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Specializes in CVICU, MICU, Burn ICU.
are you actually suggesting that BSN trained nurses have superior communication abilities to ADN/Diploma nurses? Nursing requires intelligence, good critical thinking abilities, and for bedside nurses, a strong body. I agree with you not understanding nurses who don't feel intellectually challenged by their work, but saying that tertiary care isn't rocket science is simply stating a fact.

No. I am not suggesting BSN nurses have superior anything. I am suggesting the world has changed. BSN is quickly becoming the minimum nursing degree. Just a fact. And you're right nursing is not rocket science. That is a fact also. But when I hear that comment, it's usually in a dismissive way... even when it's said by other nurses. I guess we can all have different sensitivities.

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Specializes in Nursing Professional Development.
Let's see...enter a BSN program...pay 25-35k for said program...work another 10 years after that. I'd rather not since it doesn't pencil out well. Perhaps I will take the less glamorous job in your step down unit or telemetry. Med-surg sounds good too. (I use the word glamorous as a jest related to other subjects on this forum.)

1. I don't know why you would pay so much for a BSN. With tuition reimbursement, it can be done a lot cheaper than that in my neck of the woods.

2. We require new employees to go back to school for all RN jobs, not just the ones in ICU -- unless they have significant experience in pediatrics. They don't need to complete it before hire, but they have to be working towards. So it can be done cheaply if you take a few years to do it using tuition reimbursement. (I work for a children's hospital.)

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No. I am not suggesting BSN nurses have superior anything. I am suggesting the world has changed. BSN is quickly becoming the minimum nursing degree. Just a fact. And you're right nursing is not rocket science. That is a fact also. But when I hear that comment, it's usually in a dismissive way... even when it's said by other nurses. I guess we can all have different sensitivities.

Re a BSN quickly becoming the minimal nursing degree - I know many would like this to be the case. In actuality this appears to very much depend on which area of the country you are in and whether the facility you work at requires this or not. In my area ADN and Diploma nurses are sought after by employers.

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Specializes in Pediatric Critical Care.
Not kidding; not even a little bit. My manager had a call not long ago from an irate father who threatened to "have your job" if Susie wasn't given a pass on working the holidays because it was very important to HIS career to have a hostess for all of his holiday entertaining, and since his divorce, Susie was his hostess.

Wow. Poor Susie. I wonder if she has any idea how much of a disservice her father is doing to her.

I've had parents call me because they didn't want their precious babies to have to get immunizations prior to employment.

I've had parents come with their new grads for job interviews and be offended because I wanted to interview their baby privately.

I've had parents call as THEY tried to fill out the employment application for their precious baby.

Such parents are shocked when they are told that we need to deal directly with the RN applicant -- and if their precious baby is interested in the job, she should get in contact with me herself.

Same for these young adults. Whether they asked their parents to help them or not, their parents need to let/make them figure out how to be adults.

I remember when I graduated college and moved out of state to start my first job as a nurse. (A job that I had found and interviewed for all by myself). It SUCKED for the first six months and my mom knew I was miserable when I would cry on the phone. She said I could just come home. What?? I told her, "No! I'm not running back home! This is my job and my life, and I'm not moving back!" I think I might have actually hurt her feelings a little - oops :saint:

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