Becoming a new grad NP at my current RN job?

Retired APRN, MSN, RN, APRN · Nov 5, 2013

It was a very long time ago, and NPs were thinner on the ground than they are now, but for what it's worth this is my experience. I was what we then called the head nurse of psych inpatient unit throughout my NP studies. As an NP I stayed at the same large, public hospital, but transferred to the outpatient clinic. I ended up treating many of the same patients I had cared for on the unit, and chronic psychiatric illness being what it is, I had to admit some of them back to the unit.

The patients generally related to me just as they had on the unit: those who had liked me, liked me. Those who had gamed me, gamed me; and those who had detested me, detested me. :)

The nurses with whom I'd worked on the unit were a mixed bag. I no longer had day-to-day contact with them, but the contact I did have varied. The younger ones were very friendly supportive, as a rule, as were some of the older ones. There was a core group of sour, resentful nurses, though, who engaged in the sort of gossip and backstabbing that gives nurses a bad name.

As for me, I found it a little awkward the first few times I came onto the unit to write admission orders. That feeling passed quickly as I grew into my new role.

I hope this is useful to you. It was so long ago that things might be entirely different now.

zmansc, ASN, RN · Nov 5, 2013

I don't have first hand experience, this is something I've been thinking about and discussing with a couple of FNP/NM friends of mine. Both are dual accredited but mostly work as midwives. One worked in L&D in our hospital prior to going to get her NM then her FNP, the other worked in the ER prior to going to get her FNP then NM.

Both now catch babies and one is an ER provider although she waited 5 years after graduation before she went to work in the ER. Both tell me that they have had very little problems from the L&D nurses and they attribute this to having worked in the unit before school.

We also have an ACNP who just graduated and went to work with our inhouse cardiologist. She use to be the director of the ER and now rounds in the ER and admits patients. I have seen no backstabbing or resentment towards her.

So, although I'm concerned about it, I have seen no evidence to believe that the RNs will treat a new grad from their ranks poorly. I'm sure there will be some isolated incident as there almost always are, but I'm hopeful as you are that I'll be able to go back to my old unit (ER) once I'm done with school if I choose to.

Trauma Columnist · Nov 5, 2013

My nursing exp is mostly ER so I decided to moonlight at a small community ER after I'd been an APN about 3 yrs. I knew most of the staff there because they had come from the level one where I worked as an ER RN.

It was lousy - the nurses were incredibly nasty and rude to me. I finally had my fill and hauled them in one by one and let them know that this was the meaner and nastier APN then the nice, polite RN that I used to be - lol!

After that - no problem!

BlueDevil,DNP, DNP, RN · Nov 6, 2013

I would not do it. I think the role transition from Nurse to Advanced Practice Nurse is challenging enough without throwing evolving personal relationships into the mix. As a APN, you are not going to be "one of the gang" anymore. The roles of RN and APN have virtually nothing in common, and you will have to leave your old role behind; with that, your peer relationships are going to change dramatically. You may be tempted to be too familiar, and if you are going to lead the team, you can't do that. IMO, best to start fresh someplace new.

PsychiatricNP · Nov 6, 2013

Hello,
I'm wondering if anyone here has returned to their current RN job in a new NP role? I love my current hospital and don't want to leave. I'm currently interviewing for a NP position but can't help but wonder, how will fellow nurses and physicians who previously worked with me as an RN see me? Is it easier to start "fresh " in a totally new facility? Thoughts ?

I would say that it largely depends. I started working on an inpatient psychiatric unit as a clinical social worker and continued to work on the unit as social worker while in nursing school. I took a position on the same unit as an RN and continued on the unit until I graduated from my psych NP program. After I graduated, one of the psychiatrists left and I moved into the role of attending provider on the unit and regularly continue to work on the unit admitting, rounding, discharging, etc. with the same psychiatrists who were on the unit when I started five years ago as a social worker. My experience was definitely positive and I am glad that I have had the opportunity to "grow-up" in the same system that I started in with peers that I am comfortable with. I find that I have a positive relationship with all of the disciplines on the unit and that I am well received and respected by nursing (perhaps even more so than the MDs because I understand their role and can be supportive of this). Never have I had an issue with being disrespected by any of the RNs that I formerly worked side-by-side with. The medical director of the unit has been supportive of me and has mentored me as I have opened my own practice. Overall, I have nothing negative to say about returning to the same unit / system as an NP and in fact, I really recommend it - it has been one of the best career moves that I have made.

VTach2013 · Nov 6, 2013

I would not do it. I think the role transition from Nurse to Advanced Practice Nurse is challenging enough without throwing evolving personal relationships into the mix. As a APN, you are not going to be "one of the gang" anymore. The roles of RN and APN have virtually nothing in common, and you will have to leave your old role behind; with that, your peer relationships are going to change dramatically. You may be tempted to be too familiar, and if you are going to lead the team, you can't do that. IMO, best to start fresh someplace new.

I agree ☝️

VTach2013 · Nov 6, 2013

I think in most situations transitioning into a new NP role where you used to work as an RN is not going to be beneficial to your practice. There are some exceptions such as in PsychiatricNP's case. The problem is that your coworkers are going to have a hard time realizing your new role. This added to the fact that you lack experience may be problematic. If you love where you currently work maybe apply to a unit where you don't know anyone or find a job somewhere else and come back once you have acquired experience and confidence.

lhflanurseNP, APRN · Nov 6, 2013

Have to agree with BlueDevil

Advanced Practice Columnist / Guide · Nov 7, 2013

Depends on the culture of the hospital.

I work with a group of ACNP's in an ICU setting and 7 out of 15 or so NP's used to be staff nurses in the same ICU. They were exceptional bedside nurses to begin with, all attended the university the hospital if affiliated with, and were smart/assertive by nature. No problems with the transition that they have noticed. In fact, some of their bedside peers were quite congratulatory upon seeing them wearing the provider garb the first time (different scrub color and long white coat).

My first ICU job as an NP was in a hospital I had previously worked in as an RN. However, I worked in their ER and not their ICU. I did recognize some of the ICU nurses I used to send my ER patients to including a few who were quite snappy when I brought patients to them. They got over the fact that I am one of the NP's in the unit pretty quick.