Brave or just stupid?

Ruby Vee, BSN · May 7, 2017

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 · May 7, 2017

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 · May 7, 2017

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

Well, you just did.

Skippingtowork · May 31, 2017

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 · May 31, 2017

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 · May 31, 2017

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 · Jun 6, 2017

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 · Jun 10, 2017

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 · Jun 10, 2017

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.

Jules A, MSN · Jun 10, 2017

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

Then that makes our 500 hours even more pitiful.

AZ-RN · Jun 11, 2017

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

It was designed as a physician fastrack. PA's are only a semester or two short of medical school, and do get all the core curriculum. Plus the significantly more clinical time.

Years working as an RN and becoming the 'expert' RN is what allows you to jump into the NP program, not the other way around. The NP program is there to build upon an already strong foundation; to fill a few gaps and broaden your understanding so as to bring it all together. NP school isn't there to teach you how to assess someone, or to teach you what "sick" looks like, it's there to polish you up and add a few key elements. Which is why comments like this on the 12th page are just scary:

"absolutely, go for it. I am also a career changer (3rd career!) with zero RN experience. The RN experience is relevant but not critical, especially if you work in primary care. At our primary care clinic I do not do anything traditionally RN, in fact our jobs are completely different. I diagnose and treat and our RN takes triage, administers vaccines, etc. These are great skills to have but not critical to an NP."

To assume that you don't need quality RN experience (because the RN's where YOU happen to work function mostly as MA's) to be a strong NP is one of the craziest things I have ever heard. Am I saying that you can't be a good NP? Of course not. I am saying that you need years getting used to what "normal" and "abnormal" is in a clinical setting where your assessment skills actually decide patient care outcomes. Most of the best PCP's I know are nurses who spent years in the ICU or the ED, evaluating sick patients day in and day out and understanding the consequences of poor primary care.

But hey, just my opinion.

Skippingtowork · Jun 20, 2017

It was designed as a physician fastrack. PA's are only a semester or two short of medical school, and do get all the core curriculum. Plus the significantly more clinical time.
Years working as an RN and becoming the 'expert' RN is what allows you to jump into the NP program, not the other way around. The NP program is there to build upon an already strong foundation; to fill a few gaps and broaden your understanding so as to bring it all together. NP school isn't there to teach you how to assess someone, or to teach you what "sick" looks like, it's there to polish you up and add a few key elements. Which is why comments like this on the 12th page are just scary:
"absolutely, go for it. I am also a career changer (3rd career!) with zero RN experience. The RN experience is relevant but not critical, especially if you work in primary care. At our primary care clinic I do not do anything traditionally RN, in fact our jobs are completely different. I diagnose and treat and our RN takes triage, administers vaccines, etc. These are great skills to have but not critical to an NP."
To assume that you don't need quality RN experience (because the RN's where YOU happen to work function mostly as MA's) to be a strong NP is one of the craziest things I have ever heard. Am I saying that you can't be a good NP? Of course not. I am saying that you need years getting used to what "normal" and "abnormal" is in a clinical setting where your assessment skills actually decide patient care outcomes. Most of the best PCP's I know are nurses who spent years in the ICU or the ED, evaluating sick patients day in and day out and understanding the consequences of poor primary care.
But hey, just my opinion.

One thing we all agree on is that we want the best for patients, and the best means proper education and training. It appers there is a lot of misunderstanding about the training for PAs and NPs. While I prefer the PA training because they get to do rotations the same way as medical students and medical residents, I will say that I have trained right along side PA students, same doctor, same training.

Working as a nurse in a hospital does not teach you "normal." People are there because they are sick and if they are in an ICU, they are far from normal. If you want normal, you work in a primary care office, but as a nurse you won't be doing assessments. Bedside nursing indeed helps you assess and get use to medications and know what happens when your patient goes to the hospital. That's useful, but not "normal."

I don't think medical students would like to hear that a PA is a semester or two shy of medical school. Med school is 4 years, after undergraduate school. Unless the PA is getting a doctorate, there are a few years to catch up. Also remember that each profession is requiring more and more education as the years go by. There are highly respected PAs out there with associate degree.

Perhaps those who aspire to be employed in a hospital setting as an NP should be required to have hospital experience. It puts things in perspective and you don't look like a ghost when alarms go off, but if you're going to work in primary care, clinical time with a good preceptor is more important.

I continue to say that nurses should push for accountability of schools when it comes to training future NPs, but let's not waste too much time on what's left the gate.