NP w/no desire for RN? - page 24

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   markdanurse
    Jeez! In my humble opinion, all of you who have had no interest in becoming an RN before becoming an NP should have gone to PA school. PA school offers a no-nonsense approach to medical education instead of all of the advanced theory nursing fluff shoved down your throat during your graduate NP education. PA schools resemble the accelerated 3 year medical schools offered during WWII...27 straight months of theory and clinical...without all of the RN stuff. The NP was meant to be an extension of your basic nursing education. Someone offered the comment that all they learned during their one year of clinical experience was how to put in NG tubes and foley catheters. Wow! That's ALL you learned? And you want to be an NP? RN's know why a foley is put in, when the order from the physician is appropriate, how to tell when a foley may be the cause of the an infection, and even what antibiotics are usually ordered for the infection. Nurses learn many of the commonly prescribed drugs, what the usual doses are, what the frequencies are, what the side effects and adverse reactions are, whether or not the drugs are compatible with other drugs, and how long the drugs should be given for. I am sure you learned why you put in an NG, the complications that may arise from NG intubation, what different colors and different amounts of drainage could clinically indicate, and when a patient should have an NG tube discontinued. If you did not learn all that, then you were not paying attention during your clinical experience time and instead you were going through the motions to become an NP. I am currently an ER nurse. When a patient comes in with a specific complaint, I am able to make a presumptive diagnosis correctly about 90% of the time. I know what labs will be ordered, what medications will be ordered, what x-rays, CT scans, and MRI's should be ordered and why. How is this possible? Simply because I work with physicians every day, see what they do, ask why certain tests and meds are ordered, and see the outcomes of their orders. I administer the meds they order and monitor the outcomes. This experience will be invaluable when I go to NP school. I will have a very good understanding as to what is going on and why, as opposed to another nurse with NO or LITTLE previous experience, who will be lost when it comes to post NP school graduation. RN experience counts. Don't belittle it or deem it unnecassary. PAY ATTENTION during your clinical time as a lowly bedside RN...you just might learn something you can use later as an NP. P.S. I work with NP's who work as regular RN's to supplement their incomes...and almost all of them told me their RN experience has been invaluable to their practice as an NP.
  2. by   markdanurse
    Quote from brownrice
    Hey CGFNP..............congrats on being in the top 1% of the NP pay scale, and for recognizing you didn't need to spend the better part of your life taking orders, but rather thinking for yourself. This is definitely an accomplishment, and I believe anyone who thinks otherwise is simply green with envy....not just about a good salary, but that you didn't buy into the "I've got to be a hospital slave and work my way up, for I am not good enough or smart enough yet." Again, PA's aren't handed this line of thinking, why do NP's need to follow it? Oh, and if you add in the clinical hours for undergrad work, NP's and PA's come up with about the same number of clinical hours.
    BrownRice,

    So nurses aren't independent thinkers that simply take orders and never question them? PA's aren't handed the "slave mentality" line of thinking because their schooling is MUCH harder than NP school, is based on the old 3 year accelerated medical schools during the World Wars era, and train them to think like physicians. PA's go to school for 24 to 27 months STRAIGHT...no breaks, no graduate level nursing philosophy fluff, and no studying in just one area of medicince like the NP's do. By the way, PA's are taught to be independent thinkers too, and many are quite autonomous...i.e. working without a physician being physically present in the building all day long. I also strongly doubt that PA's and NP's log the same number of clinical hours, especially when the student is in an NP bridge program who get their BSN in only 12 months prior to completing their NP studies.

    Good luck to all of you NP students who were "bedside slaves" prior to enrolling in NP school. 'Cause the no experience newbies know way more than all of you...LOL.
  3. by   EastCoast
    I agree.
    If a nurse with crappy experience calls me during the nite and can't give me a 'gut' feeling of whether the patient looks good / bad/ or inbetween then in short my patient is screwed. I don't want a 'smart' nurse on the end of the phone. I want a 'good' nurse. There's a difference that only a nurse would understand.

    All of you who want to skip the nursing part in my opinion will make for marginal NP's. Good luck... you go against the very grain that many NP's are spending their time and energy fighting for in legislation.

    I suspect if you are taking the short cut to get your NP you will likely take the short cut when you deliver care. Holy cow. Next you'll be asking to do surgery cause there's a bridge program somewhere.

    If a doctor moves here from another country many times he/she is forced to repeat an internship. I believe this is often unnecessary. In comparission we allow individuals with no experience are allowed to sit for NP boards. This is a crazy system.
  4. by   zenman
    Quote from EastCoast
    I agree.
    If a nurse with crappy experience calls me during the nite and can't give me a 'gut' feeling of whether the patient looks good / bad/ or inbetween then in short my patient is screwed. I don't want a 'smart' nurse on the end of the phone. I want a 'good' nurse. There's a difference that only a nurse would understand.
    I don't really know how to take this. Should nurses only have a good sense of "intuition" and just be able to tell you we need your expertise? I not only have the intuition but "smarts" also. I'm smart enough to tell you what is wrong with the patient the majority of the time and have pulled quite a few from the gutter because of my smarts...and have been thanked later. If I'm reading you correctly, your post might be insulting to some.
  5. by   EastCoast
    Zenman, I think our thoughts are the same i just communicated mine differently. If you've been a nurse long enough you know what i mean.
    Not the 'smart' one who has thousands of letters after her/his name and has climbed the almightly clincal ladder with a beautiful portfolio, but has run off to so many meetings that the others have to cover.

    I mean the nurse who is and good both clincally and academically. Intuition, or even having been around long enough to know a sick patient versus a not so sick patient. I think intuition is very powerful but I also think that seeing patients day after day and learning 'nursing' at the bedside is key to being a successful np.

    I would like to think that I was also smart and good. See, IMO you can be smart but not good.
    It's difficult to pull off being good and not smart too.
  6. by   zenman
    Ok, I get you.
  7. by   ICRN2008
    Quote from EastCoast
    I agree.
    If a nurse with crappy experience calls me during the nite and can't give me a 'gut' feeling of whether the patient looks good / bad/ or inbetween then in short my patient is screwed. I don't want a 'smart' nurse on the end of the phone. I want a 'good' nurse. There's a difference that only a nurse would understand.

    All of you who want to skip the nursing part in my opinion will make for marginal NP's. Good luck... you go against the very grain that many NP's are spending their time and energy fighting for in legislation.

    I suspect if you are taking the short cut to get your NP you will likely take the short cut when you deliver care. Holy cow. Next you'll be asking to do surgery cause there's a bridge program somewhere.

    If a doctor moves here from another country many times he/she is forced to repeat an internship. I believe this is often unnecessary. In comparission we allow individuals with no experience are allowed to sit for NP boards. This is a crazy system.
    What a hostile post! I'll tell you, if my physician called me into her office and told me that she had a "gut feeling" that I had cancer and did not back it up with any evidence (lab tests, MRI scans, etc.), I would think that she was incompetent. I would be searching for a new physician pronto! Gut feelings have their place, but they don't substitute for a the knowledge base and critical thinking skills that a "smart" nurse possesses.

    Most of us who want to become NP's with very none or little RN experience are not trying to take "shortcuts". Instead, we are intelligent, highly motivated individuals who are interested in moving into a position of higher responsibility sooner. However, I think that most of us have the good judgement to know when we are in over our heads and to listen to those around us. For instance, if after I start my NP program I feel that I need more than one year of experience as an RN, I will simply continue working for longer and delay graduation.

    I think that it is presumptuous to proclaim that all of us with little experience will make marginal NPs. Experience is helpful in many cases, but it is not the only component of what makes a good health care practitioner. If it was, medical schools and PA programs would adapt an experience requirement in a nanosecond.
  8. by   EastCoast
    Clearly, you have yet to work as an NP and therefore you do not understand what I mean when you have to sort through things over the telephone in the middle of the nite and you have only the RN to help you. TO take it as a 'hostile' post is clearly defensive. It's stating an opinion based on 15 years as a critical care nurse followed by another six as an NP in a hospital.

    When you are an NP working in an acute care setting then you have a basis for opinion. To believe that my post actually suggested think a provider would call someone in and say 'i think you have cancer because I have a hunch' is ridiculous. If that is what you read in the post then you should reread it. It's talking about the middle of the nite call when you only have the RN on the phone and you are covering a doctor and have no idea who this patient is.

    Secondly, As far as the med schools and PA schools go...it's apples and oranges compared to NP schools. A NP student can not compare to a med student. Period. THeir clinical hours are entirely different and more intense for the med student. IT is the reason when a doctor becomes a doctor he doesnt' have anyone to 'fall back on'. In many states it is the requirement that an NP have a collaborating physician. That is not to say that many NP's are not as good as some docs out there. However, training is an entirely different subject. If you 'fast track' how many years of school is that and what are your clinical hours versus the medical student. Please, do not suggest that you're training in a bridge program is equivilant. THe reason it's called a NP versus a P is the Nurse part. It was the original intent of the position and the no experience required is taking away the very thing that made NP's different.
  9. by   EastCoast
    Let me sum up my thoughts exactly:

    As an NP you will be responsible for people's lives. It's not that easy. It's not about how motiviated one is in their desire to accept responsibilty. But oh boy, it's a big responsiblity that will sometimes wake you up at night and sometimes when you are driving in your car you will realize how important your job really is.

    In dealing with families, crisises, other providers, n and sick patients, your previous experience as a nurse will make a big difference. You will have seen different situations, and applied your knowledge and theory to the situation at hand.

    But...in this discussion.... if you never have worked as a nurse you will never understand so it is a futile argument.
  10. by   HealthyRN
    Quote from EastCoast
    I agree.
    If a nurse with crappy experiencecalls me during the nite and can't give me a 'gut' feeling of whether the patient looks good / bad/ or inbetween then in short my patient is screwed. I don't want a 'smart' nurse on the end of the phone. I want a 'good' nurse. There's a difference that only a nurse would understand.

    All of you who want to skip the nursing part in my opinion will make for marginal NP's. Good luck... you go against the very grain that many NP's are spending their time and energy fighting for in legislation.

    I suspect if you are taking the short cut to get your NP you will likely take the short cut when you deliver care. Holy cow. Next you'll be asking to do surgery cause there's a bridge program somewhere.

    If a doctor moves here from another country many times he/she is forced to repeat an internship. I believe this is often unnecessary. In comparission we allow individuals with no experience are allowed to sit for NP boards. This is a crazy system.
    I understand what you are saying about "intuition" and having a gut feeling about a patient. However, just as it takes time and experience to develop this intuition as an RN, why couldn't one work on developing it as an NP? If a new grad chooses a first position wisely and is in a supportive environment, this "intuition" will develop in time. Isn't the role of the NP different from that of the RN? I'm not saying that RN experience isn't helpful, but I believe that one can become an NP without lengthy experience. I am glad that your critical care experience has served you well, but remember that not all RNs who go on to become NPs will have similar experiences, even if they have practiced as RNs for several years. There are many types of nursing specialities. Futhermore, not all NPs choose to work in the acute care setting where this scenario would be an issue.

    It is a bit of a generalization to say that all direct-entry students will become marginal NPs. Direct-entry programs have been around for about 30 years. There are graduates from these programs who have been practicing for many years. If they had proven to be unsafe practitioners, don't you think we would have heard about it by now?

    If a doctor from another country moves to the United States, they are required to take additional measures because the educational system may vary outside of the US. I don't believe they always have to repeat an internship; it probably depends on the country and the specialty. I think that this is entirely reasonable, just as nurses who move to the US are required to take the NCLEX or pursue additional schooling.
  11. by   joyrochelle
    This seems to be a problem with the second Bachelors/non-RN's who go into advanced practice, i have found. Clinical practice has a huge impact on teh education of a nurse. no matter what level. Any adept professional will get value over time ( even a little) in actual clinical setttings, i feel.
  12. by   brownrice
    I support what you are saying KATRNBSN.

    I realize that you are not going to be hired as a hospitalist working independently as your first NP position~~Nor would you desire to do that. Rather, as you mentioned, you would seek a position that would be supportive of the learning curve you will be on...Your intelligence, education, and input from the team of professionals you choose to surround yourself with will all add up to your success.

    I personally know new grad NP's with little or no prior nursing experience who have just graduated, found great jobs that they love, and are doing well in their positions. {NOTE: one of our undergrad instructors actually pulled one of these students aside and told her she she drop out of nursing school, as she didn't have what it takes to be a nurse! This instructor was later fired, needless to say} But what if she had listened to this, instead of believing in herself? Well, for one thing, none of us would have gotten to see her graduate summa cum laude.

    So, KATRNSBN, keep your nose to the grindstone. You too will make a great NP. Hundreds of new grad NP's with little floor nursing exp are graduating each year.

    Are the new grad NP's with little nursing exp working as a providers in the ER? of course not. They probably do not desire to do this either. Do they insert IV's? Perhaps not...and if you asked most of the office-based MD's out their to insert an IV, they would tell you they probably haven't done it for XX number of years and don't know if they could. My point is that there are many different specialization areas in healthcare. One need not know how to perform every technique or to work in healthcare for a mathematically derived time period which is commensurate with experience as a floor nurse before they have the ability to make educated, intuitive, sound medical decisions for a patient as that patient's primary provider.

    A smart, assertive new grad NP will not deliberately place themselves in an area that is over their head. (ie, working in the ER with not prior exp).

    Whether the veterans like it or not, everyday new grad NP's are finding great jobs all over the place. They are prescribing medications and providing healthcare education as well as learning suturing and other minor office procedures. They are finding work in clinics, doctor's offices, derm centers, birthing centers, planned parenthood, surgery centers, dialysis , cardiac rehab, just to name a few. And this will only continue to grow.

    Somewhere down the line, mentors may offer to teach them a specialized skill sets. Then guess what? After a few years, that NP may find themselves working as the solo provider in a rural health care clinic. And they are totally prepared for the job.
  13. by   ICRN2008
    Quote from brownrice
    I support what you are saying KATRNBSN.

    I realize that you are not going to be hired as a hospitalist working independently as your first NP position~~Nor would you desire to do that. Rather, as you mentioned, you would seek a position that would be supportive of the learning curve you will be on...Your intelligence, education, and input from the team of professionals you choose to surround yourself with will all add up to your success.

    I personally know new grad NP's with little or no prior nursing experience who have just graduated, found great jobs that they love, and are doing well in their positions. {NOTE: one of our undergrad instructors actually pulled one of these students aside and told her she she drop out of nursing school, as she didn't have what it takes to be a nurse! This instructor was later fired, needless to say} But what if she had listened to this, instead of believing in herself? Well, for one thing, none of us would have gotten to see her graduate summa cum laude.

    So, KATRNSBN, keep your nose to the grindstone. You too will make a great NP. Hundreds of new grad NP's with little floor nursing exp are graduating each year.

    Are the new grad NP's with little nursing exp working as a providers in the ER? of course not. They probably do not desire to do this either. Do they insert IV's? Perhaps not...and if you asked most of the office-based MD's out their to insert an IV, they would tell you they probably haven't done it for XX number of years and don't know if they could. My point is that there are many different specialization areas in healthcare. One need not know how to perform every technique or to work in healthcare for a mathematically derived time period which is commensurate with experience as a floor nurse before they have the ability to make educated, intuitive, sound medical decisions for a patient as that patient's primary provider.

    A smart, assertive new grad NP will not deliberately place themselves in an area that is over their head. (ie, working in the ER with not prior exp).

    Whether the veterans like it or not, everyday new grad NP's are finding great jobs all over the place. They are prescribing medications and providing healthcare education as well as learning suturing and other minor office procedures. They are finding work in clinics, doctor's offices, derm centers, birthing centers, planned parenthood, surgery centers, dialysis , cardiac rehab, just to name a few. And this will only continue to grow.

    Somewhere down the line, mentors may offer to teach them a specialized skill sets. Then guess what? After a few years, that NP may find themselves working as the solo provider in a rural health care clinic. And they are totally prepared for the job.
    [S]Yeah that![/S] Thank you for your support, Brownrice!

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