NP w/no desire for RN? - page 10

Well, not so much NO desire...but are there any NP's out there that wanted to become (and had their sights set on being an NP from day 1) an NP with no real 'drive' to be an RN first? My cousin is... Read More

  1. by   danu3
    Quote from brownrice
    Long before established two year ADN programs were around, there was a such thing as a certificate or diploma in nursing. It was a program to basicallly learn how to fold down bed corners, change bandages, and minor things that delicate females with feeble minds were capable of. Making a decision that required any sort of critical thinking was left to the men, who were the doctors.
    .
    Interesting... I think I'll pass along the feeble mind comment to one of the nurses I know who went to a diploma school (She has a Ph.D. in nursing) and see her reaction (camera ready...)...
  2. by   elkpark
    Long before established two year ADN programs were around, there was a such thing as a certificate or diploma in nursing. It was a program to basicallly learn how to fold down bed corners, change bandages, and minor things that delicate females with feeble minds were capable of. Making a decision that required any sort of critical thinking was left to the men, who were the doctors.

    For reference, many of the BSN intro to nursing books discuss this type nursing certificate in the history of nursing section. Lets just say Microbiology, Statistics, and general Math skills were not a part of this program. It really is the humble beginnings of Formal Nursing Education. The two year nursing programs have not been around that long, relatively speaking.
    I am a proud graduate ('84) of a diploma (it's "diploma," not "certificate") school of nursing, and you are seriously misinformed. It was certainly not a "quickie" program -- it was a three-year hospital-based program, and by "three year" I mean THREE CALENDAR YEARS -- 36 months (well, actually, 33 months -- we got two weeks off at Xmas and two weeks off during the summer each year). Admission was quite competitive, and the program was certainly not "a program to basicallly (sic) learn how to fold down bed corners, change bandages, and minor things that delicate females with feeble minds were capable of." The non-nursing courses were taught through a local university, and included a year of organic chemistry (our classmates were the university pre-med and chemistry majors), microbiology (yes!! imagine that!!!), and A&P, in addition to sociology, statistics/research, psychology, nutrition, and English composition. The nursing content included management, critical thinking, ethics, and professionalism (and the school did a much better job of teaching these concepts than the BSN completion program I eventually completed, or the ADN programs in which I've taught since then). The full-time faculty all had at least MSNs (some of the part-time clinical instructors "only" had BSNs -- most had MSNs). The program was very rigorous academically (again, much more so than any of the BSN or ADN programs I have had experience with over the years), and the school rarely dropped below a 99 or 98% pass rate on the NCLEX (we passed the same board exam everyone else did -- no one has been "grandfathered in" :uhoh21: ). In addition to the academic content, we spent several times the amount of time in clinical that either ADN or BSN students do -- we didn't observe a surgery or two; we had four days a week of clinical in the OR, six weeks of passing instruments and six weeks circulating. We didn't observe for a day in NICU and ICU; we had four days a week of clinical for six weeks in each. Etc., etc., etc. ... When we graduated, we were prepared to practice nursingin nearly any setting in which nursing was being practiced, which is quite a bit more than one can say for new graduates these days ...

    Since then, I've completed a BSN (which I did only in order to get into graduate school -- it certainly did not teach me anything I didn't already know about nursing or make me a better nurse) and an MSN, and have taught nursing in a variety of settings in addition to my CNS practice. The longer I've been an RN and the more I've seen of nursing education, the more I appreciate what an excellent nursing education I got in my diploma school. I feel strongly that this is one of the (several) areas of nursing in which we've thrown the baby out with the bathwater.
    Last edit by elkpark on Nov 25, '05
  3. by   brownrice
    So, if this diploma was such a wonderful, varied and in-depth form of education, why has it gone by the wayside?
  4. by   rn/writer
    Quote from brownrice
    Krisssy,

    You missed my point! Being an RN who smokes, is obese, and of crankinees means that he/she cannot possibly serve as a credible role model/teacher to his/her patients in the name of promoting good health and well-being. In other words, healthcare providers must HEAL THYSELF before expecting to help heal anyone else.

    Buttons:
    Yes, this has everything to do with the original post by Pinoy: NP's basic charter is "holistic healthcare". Also, I have worked around many, many NP's and have yet to meet just one who smokes, is obese, or that has a really bad attitude. Many students are desiring to skip the tortuous journey of precept under the angry, cranky, obese RNs, to instead learn about being an NP. Afterall, why spend your time having a 50 year old nurse with a *"certificate of nursing" assigning you to empty urinals/reomve breakfast trays when your true interest is in learning about lab values...Go for it Pinoy, skip the RN hell and go directly to NP school!!

    *Yes, there are many of these "RN"s who never even attended a two year program. They attended a quickie program, and were grandfathered in to the profession. They are usually not too happy to be guiding a BSN.
    A couple of things concern me about your posts, brownrice.

    One is your tendency to categorize people for the express purpose of discounting and then dismissing them. Regardless of your opinion about their life decisions, if you can't look past the externals and see that there are still people inside the "unworthy" shells, ultimately, you will be the one to lose out. I'm not suggesting that you have to embrace the negativity, only saying that you do them and yourself a disservice to write them off as useless or as merely obstacles in your way. Wise folk understand that the lowliest can teach something to the mightiest if a teachable spirit is present.

    I wonder if you'll carry this condescending attitude into your practice. Will some patients feel the sting of your judgment and might that not make them decide they don't need the degradation? I'm guessing you either think patients are a different ball game or that you will be able to hide your the kind of feelings you've expressed above for those who smoke, overeat, get stressed out, etc. In either case, I'd caution you not to underestimate their radar. Most of us know when we are being disrespected. This is not a quality that inspires trust and cooperation.

    On another front, your information regarding diploma nurses is way off base. Other posters have addressed this, so I'll just bring it up as one more example of your willingness to look upon others with contempt.

    Could it be that attributes you possess (prejudice, condescension, an unhealthy kind of pride) might be speaking volumes to others and inviting some of the negativity you have received?

    Regarding the original issue of whether or not NPs need experience as floor RNs, I can see both sides of the argument, probably because I don't have a dog in this fight. What I DO see is that no matter what your experience level, no matter what letters follow your name and no matter what schooling went into earning those letters, if you want to be a complete and competent practitioner, you must start with your heart and not with your head.

    If you would lead, learn how to follow. If you would guide, learn how to respect. If you would heal, learn how to serve. If you would win the respect of your patients and co-workers, go beyond appearances and find a way to connect with the people inside the people. If you don't, you can have all the education in the world and still end up ignorant.
  5. by   zenman
    Quote from brownrice
    So, if this diploma was such a wonderful, varied and in-depth form of education, why has it gone by the wayside?
    Here you go: http://www.aacn.nche.edu/EdImpact/
  6. by   elkpark
    So, if this diploma was such a wonderful, varied and in-depth form of education, why has it gone by the wayside?
    "Death by political correctness" -- the ANA and the other PTB in nursing made a big push, starting in the '60s (starting, specifically, with a 1965 ANA position statement on differentiated levels of practice), to move all nursing education into academic settings instead of hospital settings. I have no disagreement with that principle at all -- I just dislike how it's been implemented. I'm shocked at how little new grads know about nursing today compared with what my peers and I knew (and knew how to do) when we graduated.

    The irony, to me, is that, in the big push to "professionalize" nursing education and try to make it an academic pursuit, we're going back more and more to "on the job training" (which is what nursing fought so hard to get away from a century ago!) -- all the extended "new grad" orientation programs, "externships," "preceptorships," etc.; hospitals now assume that new grads don't know how to do anything and they're going to have to teach them everything practical they need to know.
  7. by   Ventjock
    Quote from mango-lo-maniac
    Depending on the setting, there isn't much difference in the roles of NPs and PAs. If you do a web search for jobs, you will find many that advertise "PA/NP wanted," and there is no difference listed in the job or pay based on the educational background. My personal experience has been the same. I've seen PAs & NPs who work in specialty practices where a physician sees every pt behind them. I also know PAs who own their practices, something that NPs are able to do.

    I think your best bet will be to explore both professions, the educational processes, and the job settings you are interested in. Then chose the path that speaks most to you.
    true. when used in the same setting the NP and PA will most always have the same responsibilities and pay. and yes there are a *few* PAs that own their practices. they hire a supervising MD to do chart review. this is something a NP practice could do also with a collaborating physician, if state law requires.

    shadow both and see where you might fit in better.
  8. by   jhoonk
    [...read everything I could get my hands on...even outside my scope of practice, such as interpretation of xrays, etc.. I'd try to second guess what was going to be done on every patient and why. Couple of my friends did the same thing and the trauma chief asked them to stop ordering labs and tests so his residents could learn something, lol! ]

    Thank you, Zenman,
    That's exactly what I intend to do and the reason for
    getting this job before I start nursing school.
    CTs and X-rays can be accessed from computers now
    and so cool to look at. Just by standing there and listening to
    what Docs and nurses say, I learn new stuff almost
    every day. So, it would help whatever I do, RN or NP.


    Amitai.
  9. by   scooterRN52
    Quote from zenman
    PAs have much more clinical time than NPs, 2,000 hrs plus compared to 600 hrs or so so there is not quite an even comparison.



    When I was in the ARMY in 1970,the best officers and leaders were the ones who had the most experience. So who would you want in this life or death situation, a newbie right out of school or someone who had experience under their belt?

    If you go straight into NP school WITHOUT any experience, you're just plain dumb no matter how smart you are. You certainly don't have to have 31 years of experience like me, however, consider that I was "learning" along the way. I really don't consider it "punishment" but "educational moments" that others might love to have.
    I agree w/ you, how can anyone understand and assess a patients needs w/o
    having the experience of an RN, how can they possibly understand what is really going on. I knew one NP that had only nursing home experience, and she ended up doing staff developement in a nursing home. That is pretty sad, don't you think?
  10. by   scooterRN52
    Quote from elkpark
    "Death by political correctness" -- the ANA and the other PTB in nursing made a big push, starting in the '60s (starting, specifically, with a 1965 ANA position statement on differentiated levels of practice), to move all nursing education into academic settings instead of hospital settings. I have no disagreement with that principle at all -- I just dislike how it's been implemented. I'm shocked at how little new grads know about nursing today compared with what my peers and I knew (and knew how to do) when we graduated.

    The irony, to me, is that, in the big push to "professionalize" nursing education and try to make it an academic pursuit, we're going back more and more to "on the job training" (which is what nursing fought so hard to get away from a century ago!) -- all the extended "new grad" orientation programs, "externships," "preceptorships," etc.; hospitals now assume that new grads don't know how to do anything and they're going to have to teach them everything practical they need to know.

    You are so right!!! I see new grads every year in the hospital I work in and I
    wonder what they teach them, I went to an LPN hospital program and then 2
    years later I graduated from an ADN program. To be honest I learned more in the hospital program as far as skills went. The 2 year college program
    evened things out w/ the chemistry, A&P, and micro biology classes.
    These new nurses don't even know where to give an IM injection and why to give it there, among the other many things an RN needs to know.
    I think the orientation time and preceptorship time is too long, but considering how little they know coming out f school, I guess they need it.
  11. by   krisssy
    Quote from scooterRN52
    You are so right!!! I see new grads every year in the hospital I work in and I
    wonder what they teach them, I went to an LPN hospital program and then 2
    years later I graduated from an ADN program. To be honest I learned more in the hospital program as far as skills went. The 2 year college program
    evened things out w/ the chemistry, A&P, and micro biology classes.
    These new nurses don't even know where to give an IM injection and why to give it there, among the other many things an RN needs to know.
    I think the orientation time and preceptorship time is too long, but considering how little they know coming out f school, I guess they need it.
    Firstly, sorry to repeat certain things for those who have heard my story over and over !!!!!! As I keep repeating it and getting more and more feedback, it helps me a lot.

    When I graduated from college with a BSN in 1969, I DID NOT feel qualified to work in a hospital. So I took the easy way out and worked as a school nurse teacher for 2 years. I was then offered a teaching job and took it. I was a fabulous teacher . Although I did get my MA in ed. , I learned everything on the job. Upon retiring, I became very ill with PTSD and was hospitalized. At that time, I decided that I wanted to be a psychiatric nurse. I took an acute med surg refresher course with clinicals, and I loved it. I am starting NP school for my psych nurse practitioner degree in Jan. I have been actively taking part in this discussion thread, and I really see both points of view. Although I loved teaching at the time, there is a part of me that wishes I had gone to the diploma hospital based nursing school that I was originally planning on going to. I think I would have learned great skills there, and then I could have gone for my BSN. My upcoming program involves 42-45 theory credits and 500 hours in a supervised clinical practicuum. If I can find a manager that will hire me to work on a psych unit as a staff psych RN, I will do that part time while I am going to school. It is hard to get a job WITHOUT EXPERIENCE. At least in my clinicals, i will get EXPERIENCE. I did what I did, and I can't turn back the clocks. But right now I am doing what I really want to do, and I will never take a job that I am not qualified for. If I go all through this and don't feel qualified, I will be happy to be a staff psych nurse until I feel qualified to work as a NP. I want to help people with mental illness and chemical dependency and alcoholism, and that goal makes me very happy. Personally, I cannot get the experience first as I have just explained. Anyway, starting in Jan., and I am open to all suggestions. I think there is a grey area here, and as I have matured I do think in less black and white terms. There are two sides to this discussion and individual differences that need to be taken into consideration. These differences include goals, personality, type of NP you are looking to be, age, experiences, motivations etc. As I have already stated, we can help eachother by giving supportive advice and suggestions.
  12. by   Jayla
    Quote from scooterRN52
    You are so right!!! I see new grads every year in the hospital I work in and I
    wonder what they teach them, I went to an LPN hospital program and then 2
    years later I graduated from an ADN program. To be honest I learned more in the hospital program as far as skills went. The 2 year college program
    evened things out w/ the chemistry, A&P, and micro biology classes.
    These new nurses don't even know where to give an IM injection and why to give it there, among the other many things an RN needs to know.
    I think the orientation time and preceptorship time is too long, but considering how little they know coming out f school, I guess they need it.
    Just graduated inn 2004 from a BSN program and I actually do know where to give IM injections (among many other things). Besides, this thread is not about BSN vs. Associates degree vs. Dimploma nurses. It's about RN experience prior to starting an FNP program.
  13. by   rnmaven
    Quote from dkv
    I am in NP school right now. I worked as an RN first and loved it, but grew tired of not having any autonomy. It is my understanding that most schools require at least 2 years of ER or critical care experience before you apply. I may be wrong though. Another tidbit, several nursing organizations are pushing for the NP degree to be a Doctorate. It would be a Doctorate of clinical practice. They are pushing for this by the year 2015. Won' t the MDs be happy!

    I agree that in order to enter a NP school the RN should have a good solid foundation in experience at the bedside. That experience is invaluable in creating a foundation upon which an advanced practice is built. You will be a better autonomous clinician and more secure in your individual decision making abilities.

    Re: the doctorate degree. I agree that this should be the way to go. Look at Physical Therapy........also now a DPT for practice. If the profession's goal is autonomy and direct access then the clinical doctorate is the way to go. I'm all for advancing the profession and I believe that life experience (clinical) combined with education is the way to go! I've practiced at the bedside (in varying degrees) for 28 years. Just finished my MSN and am considering taking post masters courses for Geriatric NP. I would have no problem if someone encouraged me to also have a Doctorate. The more education I cram into my brain, the less room there is for Alzheimers to develop!:wink2:

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