Brave or just stupid?

[Polly Peptide]

I am yet another mid-life career-changer. I've been afraid to even post on this board, as I believe I will get attacked by all the nursing traditionalists. But I would like the opinions of the experienced, and I can't get them without putting myself out there. Besides, if I am going to tread this path, I need to develop a thick skin.

I've wanted to work on the clinical side of healthcare for most of my life. Since I was a kid, I wanted to BE something – CRNA, radiologist, ER doc, pharmacist, nurse practitioner. The various options cycled through my mind, but I just KNEW I was going to grow up to be one of these. I've always been fascinated by the human body, disease processes, how the mind works, even down to nerve impulses and what causes that movement from neuron to neuron. I have always wanted to know the why.” Just what” has never been good enough.

I got to college and my dad didn't believe I could handle pre-med/medical school. It took the wind out of my sails. I didn't even understand I could apply for student loans. I did what he told me, got my business degree, and got out.

Within two years of graduating, I wanted to go back to school. However, I soon got married and my husband wasn't ready. Then I landed a lucrative job on the business side of healthcare, in a sales role. I liken this to golden handcuffs.” The money was great, but it made it more difficult for me to go back to school. I was the bread-winner.

Then we had children, making it nearly impossible to go back at that time. Sure, I could go, but it seemed extraordinarily selfish. Yet again, I put it off.

By this time, we had moved back home, to an area with a couple of very good nursing programs. In addition, there was a PA program and a very good B&M NP program, which included an option for those without nursing experience. That became very appealing to me, as the years flew by.

To make a very long story a little shorter, now that my children are a little older, I finally got it together and applied to that MSN program. I also applied to an accelerated BSN program. I quit my job and started taking pre-requisites. Ultimately, I got into both programs. I was torn: the MSN program was my dream (highly-ranked and I could start doing what I really wanted sooner); but I had heard that having a BSN could be more flexible and perhaps better for me as it relates to getting RN experience first. As of now, I plan to attend the MSN B&M school this fall.

Here comes the BIG BUT – I read this board and it scares me. Am I being completely irresponsible by becoming a nurse practitioner when I have not been a nurse? I recognize my lack of experience as a nurse, believe me. I am, however, not green.” I have been a working business professional for 17+ years. While I absolutely do not have clinical experience, I do have something of value, in both life experience and business acumen, to bring to the table. As well, my work was in healthcare and I've acquired a fair amount of knowledge along the way.

I have a lot of confidence in the school that I've chosen. They are one of the top-ranked institutions, as well as my specialty being extremely highly-ranked. My preceptors are selected for me; the clinical hours are high; I have the option to specialize further (which adds to my clinical hours); I believe if any school is going to prepare me, considering my lack of experience in this area, they are one of the best. I also fully expect there to be a large learning curve. But am I being completely naïve?

This is something I have always wanted to do. I am no longer in my 20s or 30s. I don't want to spend years and years starting over with a BSN, and then going back later for another degree. It seems to be not only additional time but additional money. Is it reasonable to think that I can gain experience as an NP and become competent, even without RN experience first? I am more than willing to work hard, ask questions, know what I don't know, seek help from peers, and put forth diligent effort. In fact, I look forward to it.

The last thing that I think about is: I see so much written on this board about salary. I am actually in a position where I do not have to work. However, I will say it again – this is something that I WANT to do. And even though I don't have to work, I am not looking to do this for charity. I would like to be paid what I'm worth. I recognize that I will initially be an inexperienced NP, but that won't be the case for long. Am I crazy to think I can make $150K at some point? I see $80-90K and it bums me out. It seems ridiculous for the work NPs do. I am in the Southeast. I can go back to my old profession and make $150K easy. I just don't want to.

Sorry for the length. Would appreciate your advice.

[SopranoKris, MSN, RN, NP]

OP: Yale (yes, THE Yale) just started a new online PA program. You get a degree from Yale Medical School as a Masters PA. You visit the campus a few times during the program for skills examinations. They locate your preceptors for you and it costs less than Vanderbilt. No relocation required.

First cohort starts in January and it's a 2 year program.

They're only approved in a handful of states until they graduate their first class because online PA is a new concept. This might be a great option for you.

Heck, I'd opt for it myself, but my state isn't included yet. Just a thought....

[Polly Peptide, BSN, MSN, RN, APRN]

OP: Yale (yes, THE Yale) just started a new online PA program. You get a degree from Yale Medical School as a Masters PA. You visit the campus a few times during the program for skills examinations. They locate your preceptors for you and it costs less than Vanderbilt. No relocation required.

First cohort starts in January and it's a 2 year program.

They're only approved in a handful of states until they graduate their first class because online PA is a new concept. This might be a great option for you.

Heck, I'd opt for it myself, but my state isn't included yet. Just a thought....

Interesting idea. Looks like there is some skepticism out there about online PA programs, not dissimilar to the reaction many here have to "fast track" NP programs. Not that the PA program is faster, but it's made more convenient.

Unfortunately, it's not approved in my state either.

I know they offer "immersion" experiences, probably to test lab skills, but I would hate to miss out entirely on the classroom. I learn best in that environment.

[Corey Narry, MSN, RN, NP]

Well, Yale also happens to offer direct entry NP programs including ACNP and I've worked with a couple of their direct entry ACNP grads as well as a few others from a handful of similar Midwestern, East Coast and West Coast programs. The general opinion from the nursing community is that these programs should not exist and goes against the very concept of advanced practice nursing.

Not all these programs are exactly the same though, some actually encourage students to take a break after completing the RN portion to gain some bedside experience prior to coming back for the ACNP portion. With a surplus of nurses in many areas of the country, that can be hard to accomplish. The local direct entry ACNP program here no longer exists as they now only accept experienced nurses to the track (though the option for direct entry in the primary care tracks are still open).

OP, you're not going to be able to change majority of people's opinions. Personally, it's hard for me to imagine having gone through my own ACNP program without having the years I've spent as a nurse at the bedside. It may not have been necessary for me to have spent as long as I have as an RN in various adult hospital units to reach my goal but I felt that the NP program (though adequate and not deficient in my opinion) was presented in a manner that assumes that students possessed enough confidence to walk into a patient room and know the medical lingo, be familiar with all types of medical equipment and devices including those seen in the ICU, and astute enough to eyeball a patient and know that something wrong is happening...I think those are qualities someone fresh out of a BSN program will not possibly have.

On the other hand, as I said, I do work with graduates of these programs. I met many after they have been ACNP's for a while so my assessment of their skills and knowledge does not take into account what they were like when they first started out in the role. I will honestly say that they are on par now with many of those who have been nurses at the bedside prior to becoming NP's. Transition to NP role in hospital based settings rely heavily on extensive orientation in the hope that this transition to practice period will detect knowledge gaps and fill in the holes that were not covered in the NP program. In my experience, physicians who work with NP's in hospitals take on a lot of the teaching and mentoring role and in many instances shape the NP they're working with to work exactly the way they practice.

You are an individual and no one here knows your innate potential to overcome the presumed and real challenges of a fast track ACNP program with no actual bedside nursing experience to draw upon. As a final note, I will say that a bunch of strangers in an online forum shoudn't be your go to in such crucial decisions but do take the thoughts expressed here into consideration.

[Ruby Vee, BSN]

So I'm guessing your program is the MSN PreSpecialty Entry at Vanderbilt University? Three semesters for the RN (70 credits), followed by three semesters (75 credits) for the MSN ACNP - Hospitalist Track. An estimated cost of $197K. 700 clinical hours for the RN, 630 clinical hours for ACNP, 1,330 hours total. No RN experience required. And then you can prescribe, diagnose,and manage the care of acutely ill patients! Yay!!!

For those you who say, "How is this different from PA school, they go in without prior experience?" let me explain. The OP will complete 1,330 hours, but only 630 hours are at the advanced practice level. The other 700 are just for the RN license, which is about average for a basic nursing education. And we all know how prepared new grad RNs are for practice following graduation.

PA schools have over 2,000 clinical hours, all at the advanced practice level (in addition to a more rigorous medical education).

Every time I see the header on this thread, I just want to post "STUPID!"

[Ruby Vee, BSN]

From reading your posts, I saw that you are planning to work as an RN while in the MSN program part time. That is great, but would it allow you to gain sufficient experience? You would not be able to work full time, and hospitals generally do not hire new grads part-time or PRN, especially not in critical care settings.

Maybe we don't think highly of people with no nursing experience being allowed (heck, encouraged) to become advanced practice nurses with only 600 clinical hours. I think very highly of competent nurses and NPs.

Most ICUs won't allow new grads to work part time until they've been on staff for at least a year. They feel it's too difficult to learn the job if you're not putting in the time. Oh, but you're working on a MSN, you say. That would make them less likely to hire you, knowing they'd be expending time and money to train you and you'd leave as soon as possible.

I think the issue is that we don't think highly of people with no nursing experience being allowed to become advance practice nurses with only 600 clinical hours.

As for the question asked in the header -- it's not brave, it's stupid.

[Polly Peptide, BSN, MSN, RN, APRN]

Every time I see the header on this thread, I just want to post "STUPID!"

Well, you just did.

[Skippingtowork]

I do totally understand this, and I expected the criticism when I posted here. I've reach MUCH criticism on this board of DE programs and NPs without RN experience and was beginning to question my methods...and rightfully so, I think. I understand the intention behind the original creation of the "Advanced Practice Nurse" role. The issue is, over time, the nursing field has made it possible to 'jump straight to the top', as you say, without requiring all of these stepping stones. At my age, it doesn't make sense for me to go through a two year ADN program, work a couple of years; get them to pay for my RN to BSN; work for a few more years; move to charge nurse or nurse manager and work some more years; as I would be into my 60s by the time I accomplish my goal.

My point in all of this is: if it's possible for me to attain competency - not just baseline, but to really be able to do a good job - then I would like to take advantage of the opportunities offered to me. But if it's truly a disaster waiting to happen, then I wanted to know. As I should have expected, I've gotten a mixed bag of responses, some saying I'm likely to kill people and others saying I will be fine with hard work.

I do appreciate your comments on the RN clinicals and how they compare to PA or even the MSN portion. I do believe that, straight out of school and all other things being equal, I would probably feel better prepared as a PA. I would have been exposed to more provider-type clinical hours in a condensed period of time. That SHOULD make me feel more prepared. However I pointed out in an earlier comment on this thread that it makes sense that PAs get more hours, sense they are trained as generalists vs NPs being required to pick a specialty. The disparity being ~600-800 vs ~2000...that's a bit hard to swallow. But let's just take my local PA program for instance.

They do eight 6 week rotations in the following: Family Med I and II, Peds, Behavioral Health, Emergency Med, Internal Med, and General Surgery. There is one elective rotation. That equates to about 250 hours per rotation.

I am pursuing the ACNP specialty in my NP program. When I consider the above rotations, 4 of them would not be included in my program. Family Med would be for the FNPs; Behavioral Health for the PMHNPs; Emergency Med for the dual ACNP/FNP program; and Peds for the obvious.

Two of the rotations (IM and surgery) would be included and I don't see any critical care. So if I am comparing, that's at least three rotations on the PA side to my ACNP side, which is 750 hours and about right. BUT...I have to say, when I think about the broadness of critical care...I sure as heck would like more clinical hours. Lots more.

FNP...when I compare it to PA, you could include Family Med I and II, maybe ER, maybe Peds. NP falls short there.

PMHNP...NP wins. But I do wonder what sort of training is mixed in so that co-morbidities are recognized, etc.

Peds...NP wins, sort of. But I would think general rotations would help, no matter what.

So I think we should consider the fact that NPs are specializing, but I do agree...PAs have the advantage in clinical hours. However, I would think (and I've been told this anecdotally as well), that even if initial disparities exist, there appears to be no real difference in practice abilities between the two roles over a fairly short period of time.

Something that I found very useful is the MD preceptor who precepts you the same way he/she would precept a medical student or intern. When you have to present cases in that manner, you really learn and think about what you do and your understanding of medicine deepens. You must stay away from preceptors who look at you as "help" and have you running around after them, not participating in the rotation in a meaningful way.

Also, you are not limited in the number of clinical hours you obtain. If you wish to obtain 2000 hours, go for it.

Despite educational differences, performance often depends on each individual and what they put into their studies. I don't know what kind of studies there are that reflect NPs kill or harm patients faster than MDs. Many, many physicians and PAs mismanage patients, some due to lack of knowledge and others due to inattention to details. I have seen NPs with many years of experience in nursing who were superb and who I preferred over MDs. I've seen the same performance level in NPs without much nursing experience. At first I was scared, but later realized these NPs were also performing at high levels, probably because of the training and effort. It's hard to jump to conclusions with so many variables.

As far as which profession wins at what, it all depends. A new FNP and a new PNP are not at the same level, as the FNP has very little clinical hours in peds.

Overall, go for your dreams. You can take into consideration what others have said and incorporate some ideas in your education path, but you do not have to alter your plans. Your best bet is to talk to a number of people who have taken the path you are looking into and solicit their input regarding difficulties they experienced in the program and with their first job.

[MierKat]

Ksisemo- I think you have adequately expressed your reasons for a DE program and have listened to feedback appropriately. If it is Vanderbilt and you want to work after the RN portion, I would think you'd have a good chance to be hired into their ultra competitive nurse residency program for new grads. Vanderbilt is one hospital that hires new grads directly into one of their multiple ICUs. Just as an aside many nurses think new grads shouldn't go directly to ER or ICU without med/surg experience but Vanderbilt does that too. Good luck!

[Polly Peptide, BSN, MSN, RN, APRN]

Ksisemo- I think you have adequately expressed your reasons for a DE program and have listened to feedback appropriately. If it is Vanderbilt and you want to work after the RN portion, I would think you'd have a good chance to be hired into their ultra competitive nurse residency program for new grads. Vanderbilt is one hospital that hires new grads directly into one of their multiple ICUs. Just as an aside many nurses think new grads shouldn't go directly to ER or ICU without med/surg experience but Vanderbilt does that too. Good luck!

Thank you. It is Vanderbilt.

They also have a Nurse Practitioner Critical Care Fellowship following graduation for ACNPs, something I will be very interested in.

[Dodongo, APRN, NP]

Also, you are not limited in the number of clinical hours you obtain. If you wish to obtain 2000 hours, go for it.

THIS.

[AZ-RN]

Short reply? Not what NP school was designed for.

PA school takes someone with no clinical background and provides them an excellent and regimented medical education in 2-3 years (plus pre-recs and undergraduate studies). That is what it is designed to do.

[MurseJJ]

Short reply? Not what NP school was designed for.

PA school takes someone with no clinical background and provides them an excellent and regimented medical education in 2-3 years (plus pre-recs and undergraduate studies). That is what it is designed to do.

From what I understand though, PA school was originally envisioned as being for people with healthcare experience as medics, nurses, RTs, etc.