NP education - a rant

  1. I came to the site today and saw lot's of posts of wonderfully excited people interested in becoming NP's. The vast majority of the tones of education were: "I have the opportunity to become and NP through an advanced MSN program" or "I'm sales person at Target with a Bachelors in sociology, and with just one year of school I can become an RN then get my NP degree!!!"

    Sorry about this but....Being a nurse practitioner is more than just getting the degree. The job requires experience. Not a year of med surg, not a two year Master's, but some real NURSING experience. We are NURSE PRACTITIONERS, that's nurses with additional skill to allow the diagnosis and treatment of patient problems. It requires the inate skill that makes a nurse magnified to the 'nth degree. What makes good providers as NP's is the same characteristic that made them good nurses. It's experience.

    I'm not on a high horse, just an NP that has seen too many "rammed through the system, get their money" NP's. This job is serious. It's serious on several levels. First and formost, you are being entrusted with the care of people that put their complete fath in you to make good decisions and provide quality care.

    This IS different that being a nurse. How many times have you sat back as a nurse and berrated a provider about their choice of treatment plan or pushed for the provider to make a decision and get on with it. That all changes when you're the one with the RESPONSIBILITY for the decision. Yeah, it's an ear infection, yeah amox should do the job. Are you ready to commit fully to giving someones most honored item, their child, a drug that could kill them??? It's not cook book. It requires a base of knowledge, experience, reponsibility, and a committment to furthering your skills. It's a lifestyle!

    The second group you matter to is the professional community. As NP's, we let the schools go freaking haywire in putting out as much crud as they wanted. They saw dollar signs and began pumping out graduates without regard to job markets or the economy of NP's. Boom, a flood of NP's. Fully half of them are transfer's in from "associated science's". Read sociology, psychology, earth sciences...all able to take their bachelors in science, convert to an RN in one year, and complete their master's in two more. These people may ultimately make good NP's, but not in three years!!!! What makes anyone think that this is the way to put NP's on the map??? What kind of fodder is given to the medical community, especially, to denounce the practice of NP's as being amateurish, poorly skilled, etc. It really opens us up to all kinds of flaming by other medical groups.

    If you're an RN, thinking about becoming an NP, don't do it for the salary, chances are you're going to make more as an RN in the right setting. If NP is for you, go out and work, get a job, get several and work in areas like the ER(still, in my opinion, the best experience), community health care, critical care, etc. Then after a couple of years, think about going the MSN/NP route. You will be a better provider, it gives more credence to the profession, and ultimately the little kid with the OM will thank you for your skills.

    I know a rant, but it makes me nuts to think that being an NP is anything less than the greatest honor innursing you can become.
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  2. 193 Comments

  3. by   suzanne4
    Thank you for the wonderful posting. Those have been my feelings all along.
    What you learn in nursing school is only the beginnings of being a nurse, and how do you even know which area that you would like to specialize in? Being a student in an area and actually working in it are completely two different things.

    And I am sorry to others but those of you that post that you want to get your BSN and immediately go into a program to get your NNP. Are you crazy?
    It takes a year or two just to feel comfortable taking care of a little 500 gm. baby. Do you think that you are going to develop the confidence in making life threatening decisions on this infant so quickly? If you think so, then you definitely don't have a clue.

    Get some experience under your belt first.
  4. by   traumaRUs
    Catskill - you are right on the money. Even going straight from a BSN to MSN may not always be the best idea because of the expererience factor. Thanks
  5. by   lalaxton
    Amen CatskillNP!! I went back to school after being an RN for 15 years thinking this will be a piece of cake. I thought I knew how to treat my patients just as well as the docs I worked with. Once in school I realized how much I didn't know! And yes the responsibility is much greater. I can't imagine being an NP without having the experience of being an RN!
  6. by   Gompers
    EXCELLENT POST!!!

    During my senior year in nursing school we took a management class. One of the things the instructors drilled through our heads was that we should work for at least two years before we went any further into things like NP and such. Basically told us outright that while it might be possible to get a masters or practitioner's degree sooner than that, it would be a HUGE mistake. And I agree. I would have no respect for a nurse practitioner with less than two year's nursing experience - most of the people I work with are just getting into the groove of things after two years and finally getting clincal skills down pat - and forget about a nurse manager without work experience!!!

    I don't understand how you can even KNOW that you want to be a nurse practitioner or manager or CRNA or whatever UNTIL you've spent time working as an RN first. That alone is a huge responsibility! One step at a time!

    At first, I thought I wanted to get my NNP, but you know, I've since decided that I much prefer bedside nursing. I had stars in my eyes as a new grad, but time and experience has shown me just where I fit in. And that's something I'd never have known had I not taken the time to just enjoy my job as an RN first.
  7. by   SmilingBluEyes
    I so agree! The same goes for wanna-be CNM's. (certified nurse midwives).
  8. by   Annabelle57
    Okay, okay, I'll admit it: I was one of those stars-in-my-eyes tykes wanting to do a direct-entry NNP degree.

    I've changed my mind for a lot of the reasons already listed: though there may be prodigious NPs out there who did the direct-entry MSN route and did just fine, I didn't want to take the chance and possibly compromise a patient's right to quality healthcare because I wanted to take shortcuts. I mean, an accelerated-BSN already has me nervous; I didn't want to be a totally green, clueless NNP dependent on my staff (because then, I'm not much of a provider, am I?).

    I guess I put myself into a future patient's shoes (or booties, in this case): would I want me being responsible for my fragile preemie newborn's care without all that experience? Not a chance.

    Being an NP still appeals to me, not really for the money but for the care they provide. However, I think I will take the wisdom of those who have gone this path before me and let experience show me if grad school is the right path or not, after I've gotten some experience as an RN!
  9. by   Sadie04
    I agree with the OP, the roles of the NP and CNM are too important to be rushed through the training with lightning speed only to graduate with limited clinical experience. I wouldn't want to be under the care of one of these practitioners right out of school.
    A good friend had a BS in an unrelated field and decided to go back to school to get her FNP. She realized when she graduated that no one would hire her with no RN experience so she worked on my unit as a staff RN for almost a year and only recently got her first NP position.
  10. by   RN4NICU
    Quote from suzanne4
    Thank you for the wonderful posting. Those have been my feelings all along.
    What you learn in nursing school is only the beginnings of being a nurse, and how do you even know which area that you would like to specialize in? Being a student in an area and actually working in it are completely two different things.

    And I am sorry to others but those of you that post that you want to get your BSN and immediately go into a program to get your NNP. Are you crazy?
    It takes a year or two just to feel comfortable taking care of a little 500 gm. baby. Do you think that you are going to develop the confidence in making life threatening decisions on this infant so quickly? If you think so, then you definitely don't have a clue.

    Get some experience under your belt first.
    Please tell me it is not possible to do this. I am looking at NNP programs right now (been a NICU nurse for about 5 years now) and many of them require 1-2 years level III NICU experience, but I have not looked at all the programs available. I cannot imagine people going straight from BSN to an NNP program. Before they have ever functioned in a NICU environment?

    Every year my unit hires new grads. Every year we lose at least half of them because they did not realize that NICU is not just playing with babies - it can be really stressful. Imagine coming to that realization during/after a master's program.

    I am totally against any advanced practice program that does not require experience (including administration)

    IMO this is how the CRNAs have set themselves apart as professionals. They require at least one year of critical care experience before entry into the program. This is a main differentiation of the CRNA from the Anesthesiologist Assistant (anesthesia's version of a PA - no health care experience required to enter). There is no "fast track" to becoming a CRNA. You must get experience, there is no way around it - and actually working in nursing has a way of "weeding out" people who are just out for $$$.

    If NP programs set similar standards, perhaps the profession would enjoy similar recognition/compensation?
  11. by   suzanne4
    Quote from RN4NICU
    Please tell me it is not possible to do this. I am looking at NNP programs right now (been a NICU nurse for about 5 years now) and many of them require 1-2 years level III NICU experience, but I have not looked at all the programs available. I cannot imagine people going straight from BSN to an NNP program. Before they have ever functioned in a NICU environment?

    Every year my unit hires new grads. Every year we lose at least half of them because they did not realize that NICU is not just playing with babies - it can be really stressful. Imagine coming to that realization during/after a master's program.

    I am totally against any advanced practice program that does not require experience (including administration)

    IMO this is how the CRNAs have set themselves apart as professionals. They require at least one year of critical care experience before entry into the program. This is a main differentiation of the CRNA from the Anesthesiologist Assistant (anesthesia's version of a PA - no health care experience required to enter). There is no "fast track" to becoming a CRNA. You must get experience, there is no way around it - and actually working in nursing has a way of "weeding out" people who are just out for $$$.

    If NP programs set similar standards, perhaps the profession would enjoy similar recognition/compensation?
    Unfortunately, it can be possible. Though they will not be able to find employment when they finish. I wish they would do away with these fast-track programs as they are just trying to manufacture something that isn't there and won't be. Unless you have previous clinical skills to back you up, you are going to be sunk before you even start.
  12. by   CatskillNP
    Ufortunately, alot of the impetus behind the fast tracking came from scholastic need to fill seats. Additionally, NP's didn't put their foot down and say NO, WE won't treat this profession like this. Also unfortunately is that the reality is jobs are getting tighter, at least here in NY. I'm very involved with the NP organization for NY, The NPANYS.

    It's amazing how we as a profession see ourselves in two distinct lights. We are practicing at one of the highest levels of Nursing, yet we fold like cheap suitcases when we need to be organized to stand up to medical organizations that want us gone.

    An example: 10,000 NP registrations in NYS. 10K!!!! only 2300 have joined and support the only voice for NP's inthe state. Where is everybody??? Why isn't everybody out their at least supporting thier profession.

    I beg you, if you are in a state with a state wide NP organization, run, don't walk, to the computer/phone, call them and join. If you don't want/have the time to participate, still join, the monies are needed to provide every NP the opportunity to sit at the legislative table and deal with organiztions that want us gone!!!!

    WE are the profession, WE need to say we want better admission requirements, WE need to support eachother and move this profession on an ever increasing role in the health care of Americans.

    Hope your day goes well tomorrow. S
  13. by   lalaxton
    Here in Ontario, we have about 800 NP's, 600 or so Primary Care and 200 or so Acute Care NP's. Our professional organization, the NPAO, has almost 800 members!!(This includes student members or anyone interested, you con't have to be a member to join) Of course, it helps that we offer significant malpractice insurance as a benefit of membership.
  14. by   youngRNstudent
    Some people know what they want, yes even before they have R.N. experience.

    I will be graduating this December with my R.N. license, and already have plans to become an NP. The program I chose is a program where I will have 2 years RN experience before entering the program, and I can continue to work during the 3 years of schooling for the NP.

    So, when I do become an NP, I will have had 5 years nursing experience. I commend students who look beyond the RN license. I don't think it is impossible to know that you want to be an NP before becoming an RN!!!! The reason I went to nursing school was to become an NP.

    Experience is something you cannot get in school, and it is extremely valuable, but please do not think someone needs 10+ years of bedside nursing to have what it takes to be an NP.

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