Nursing students who want to be NP's

[Teaching the future]

Anyone else notice that many of their nursing students are becoming nurses as a stepping stone to being a nurse practitioner but have little interest in being a floor nurse? I'm worried we won't have bedside nurses before long.

[pro-student]

The only thing I said was not up for debate was in response to another poster who said the same thing (although she got her facts 100% incorrect). That was about top NP schools not requiring bedside experience. That fact is not debatable, you can look up the top ranked NP programs and see their admissions criteria.

I have no no intention of being insulting but I don't understand how a well educated nurse could claim they haven't even learned that they don't know everything. I graduated nursing school knowing that my education prepared me for the basic minimum competencies. I took aditional classes in my specialty before I even started my first job because I knew I wasn't fully prepared in that area (and never assumed classes alone could do so). I don't know how you justify it but to me there is something grossly wrong with someone who isn't self-aware enough to know the difference between what they know and what they don't. I do think the pressure of many nursing jobs leads newbies to feel they have to "fake it till they make it" but that doesn't mean they lack an underlying sense of their own shortcomings.

According to nursing theory and the concept of growing from novice to expert (Patricia Benner), a new graduate with no experience is not an expert. It is up for debate, regardless of how upsetting the opposing views may personally be to you. Patricia Benner's From Novice to Expert

I'm very familiar with Benner's work but she never consider advanced practice nursing at all. There are a number of criticism of the research base and generalizability of her theory however there is still zero REAL evidence that one needs to be an expert bedside RN to be a competent APN. Maybe only Benner's "competent" level is necessary. Or, most likely, expertise in bedside nursing is not necessary at all since the domains are vastly different.

I welcome a lively debate debate about this issue but please offer more than endless "I think ... because of some limited experience I had/heard about that happens to support my presupposition."

[SmilingBluEyes]

I'm very familiar with Benner's work but she never consider advanced practice nursing at all. There are a number of criticism of the research base and generalizability of her theory however there is still zero REAL evidence that one needs to be an expert bedside RN to be a competent APN. Maybe only Benner's "competent" level is necessary. Or, most likely, expertise in bedside nursing is not necessary at all since the domains are vastly different.

I welcome a lively debate debate about this issue but please offer more than endless "I think ... because of some limited experience I had/heard about that happens to support my presupposition."

I never said it had to be "bedside" nursing experience. It can be doctor office nursing, ambulatory nursing, o.r. experience, etc----any specialty where a nurse actually has to lay hands on a patient and really ASSESS from head to toe, what's going on is what's needed. I am not pre-supposing anything. I am speaking from experience. ( which clearly you don't respect). Assessment skills are not learned by never touching another human being. They are achieved by actually DOING it.

And while you say you welcome debate, you really don't when you insult other debaters, or declare an issue "non-debatable".

[Wuzzie]

BTW:

Exploring the Factors that Influence Nurse Practitioner Role Transition

among 352 NPs, there was only one factor associated with more or less successful transition to advanced practice role, and it was structure of orientation into that advanced role. Somehow, any previous experience didn't seem to matter that much - at least for non-highly specialized practices. If they would consider CNMs or NNPs, that would be probably another story.

This same study has been posted here on several occasions. The problem with it is that it uses the Likert scale to measure NPs opinions about their transition. I'm still not sure how this qualifies as solid support for the viewpoint that experience doesn't produce better clinicians. The only way to measure that would be to look at outcomes which I do not think has been done yet. I'm not taking one side or another just wanted to point out that this study is probably not the strongest evidence to support your argument.

[SmilingBluEyes]

This same study has been posted here on several occasions. The problem with it is that it uses the Likert scale to measure NPs opinions about their transition. I'm still not sure how this qualifies as solid support for the viewpoint that experience doesn't produce better clinicians. The only way to measure that would be to look at outcomes which I do not think has been done yet. I'm not taking one side or another just wanted to point out that this study is probably not the strongest evidence to support your argument.

I was just going to say that. I read the article. A lot of "opinions" there and little scientific study.

[Nurse SMS, MSN, RN]

And while you say you welcome debate, you really don't when you insult other debaters, or declare an issue "non-debatable".

In fairness, I had stated that the better schools require a student to have worked as a nurse as part of admission requirements and that wasn't really debatable. Pro-student then proceeded to retort that I am clueless and uneducated. but it was me who stated something was not debatable, not Pro-Student. He or she just reacted.... strongly?.....to my statement.

[Boomer MS, RN]

The only thing I said was not up for debate was in response to another poster who said the same thing (although she got her facts 100% incorrect). That was about top NP schools not requiring bedside experience. That fact is not debatable, you can look up the top ranked NP programs and see their admissions criteria.

I have no no intention of being insulting but I don't understand how a well educated nurse could claim they haven't even learned that they don't know everything. I graduated nursing school knowing that my education prepared me for the basic minimum competencies. I took aditional classes in my specialty before I even started my first job because I knew I wasn't fully prepared in that area (and never assumed classes alone could do so). I don't know how you justify it but to me there is something grossly wrong with someone who isn't self-aware enough to know the difference between what they know and what they don't. I do think the pressure of many nursing jobs leads newbies to feel they have to "fake it till they make it" but that doesn't mean they lack an underlying sense of their own shortcomings.

I'm very familiar with Benner's work but she never consider advanced practice nursing at all. There are a number of criticism of the research base and generalizability of her theory however there is still zero REAL evidence that one needs to be an expert bedside RN to be a competent APN. Maybe only Benner's "competent" level is necessary. Or, most likely, expertise in bedside nursing is not necessary at all since the domains are vastly different.

I welcome a lively debate debate about this issue but please offer more than endless "I think ... because of some limited experience I had/heard about that happens to support my presupposition."

Patricia Benner was one of my professors in graduate school for one of my core courses, and your comment that "she never considered advanced practice nursing at all" is perplexing and news to me. I respectively disagree. The previous comment from someone that all the top schools don't require experience and are mostly direct entry is just not true.

Whether you choose competent or expert as defined in Benner's theory, I am of the opinion that one needs to have a sound base of experience in order to be an Advanced Practice Nurse. And that experience means assessing and evaluating patients, many patients, over time. There are no shortcuts.

[SmilingBluEyes]

In fairness, I had stated that the better schools require a student to have worked as a nurse as part of admission requirements and that wasn't really debatable. Pro-student then proceeded to retort that I am clueless and uneducated. .

I stand corrected> My apologies to prostudent.

[Purple_roses]

I have CNA coworkers in nursing school who have told me they hate nursing and intend to be NPs. My response is always, umm....NURSE Practitioner. NURSE. You will still be a nurse who deals with people.

[pro-student]

Look, I said anyone who claims they don't even know what they don't know was poorly educated which I stand by. If you education instilled in you a sense that you know more than you actually do, I would argue that is a very poor education indeed. It was all of you who claimed you don't know what you don't know (which also makes me wonder how you would ever know something if you can't even tell the difference) who took offense. Hey, if you wear ignorance as a badge of honor, I don't know how you can reasonably get upset about the other side of that coin. Lets take another example. We all took A&P and learned a basic level. Hopefully, you clearly understand that you know some things and don't know others. If you can't make a simple distinction like that, they I don't know how one could call that anything but poor education. Nursing is the same way. We all learned the basics in school. If your education somehow predisposed you to not understand there were things you still didn't know and how to tell the difference then I would argue that is poor education as well. I would also question how credible you can be if you can't make a critical distinction between what you do and do not know.

My apologize about the Benner comment. I should have been more clear and stated that her published work, particularly the classic text which was referred to in this discussion does not consider APN. I did not mean to suggest that the woman herself never considered the topic. Nevertheless, the point remain that the only evidence offered that nursing experience is necessary for APN does not even address APN at all. Lets play this out though for arguments sake. So it has been suggested that before one is qualified to pursue education as a psych NP one should reach expert level as a psych RN. What does that mean? Most psych RN positions are specific to an age group (generally either adult/older adult and child/adolescent). With the Consensus Model, psych NPs are now required to cover the lifespan so do they now need to be experts in adult and child/adolescent? Certainly these are extremely different areas. How about a neonatal nurse, should he/she be qualified to study pediatric NP? If the experience is in acute care settings, wouldn't they need experience in primary care settings to be a primary care PNP? If, as it has been suggested, assessment experience is the key, would it be possible to carve out a way to gain assessment experience but no experience with meds, interventions, patient/family teaching, or any of the other myriad tasks RNs do and still be expertly experienced in order to pursue APN? The argument quickly fails under its own weight.

There are also a lot of false assumptions being made. Namely that there is a correlation (although none of you will offer any evidence of this) between RN experience or expertise and APN competency. Not surprisingly, you have also assumed that I am a student based on a SN and that I don't value experience. Neither of which happen to be true. I never said experience was evil and should be avoided at all cost. If you read carefully you would notice I said that I didn't believe it was unnecessary for APN. I value experience and consider it immensely important. But I also recognize that experience in one thing is not any measure of experience in another thing altogether.

There have been at least a decade and a half of APNs entering the field without a day of RN experience beyond what they got in school without any concomitant spike in medical errors, unsafe care, or malpractice claims. On the contrary, APNs are named as plaintiffs in a fraction of the cases that their physician counterparts are. Care by APNs has repeatedly been documented and studied as being at least as good if not better than care my physicians will much more training and experience. Many of these studies have included direct entry and other APNs with little or no RN experience. If they can perform on par or even better than physicians, I find it hard to believe the few anecdotes collected here about a single provider here or there are representative. But my all means, prove me wrong. Just please, come with something more than "I think..." and "I know someone once..." and "My feelings are hurt..." For what it's worth, in my anecdotal experience with dozens of APNs, length of experience as an RN correlates with overconfidence and poorer performance as an APN. But this, after all, is just my experience and does not necessarily a widespread pattern.

[becca65233]

My daughter is an one of the top 50 nursing schools in US. The school is constantly pushing the DNP (NP) program. I hear many schools of nursing are pushing for their BSN students to enter NP directly without any experience. Big mistake in my opinion!

[SmilingBluEyes]

My own daughter is applying for a BSN in the fall (she finished her associate's degree while in high school). Her end goal is NP or CRNA. Told her get experience first to be the best.

I am not backing off this opinion. She will be a better NP for it.

[fezz]

What I see is that many NPs lack clinical experience. I think acute care experience is so valuable. Yes I feel many jump on to the next step too soon. They don't get the same experience as doctors do in residency either.