NP w/no desire for RN? - page 25

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   patrick1rn
    I dont see how a RN could go straight into a NP program with out some clinical experience to back you up. I mean an RN learns the basic assestment skills etc and advances and when they go to NP school it is assumed that the RN has some experience in some kind of clinical setting. what do you think ?
  2. by   EastCoast
    Patrick, I think that is what so many of us feel. However, those who have never really been nurses in the same way that we have, can not understand this.

    Very recently my famiy member called (who is a nurse) and asked as a favor that I precept someone who was doing a bridge program "rn to Pedi NP" that she had met while she was doing her clincal on the same unit as my family member. I flatly refused. I am not going to tarnish my reputation by allowing someone who has not established credibilty in the clinical arena to care for my patients just because by the time I would do this she would have her 'RN'.

    Honestly, I 'd rather take a strong LPN who has worked at the bedside and have them get a masters degree than take an RN with minimal training.

    This is the reason that the AMA continues to not support us. We have too many options and the criteria for getting your degree seems to dwindle daily.

    And as far as one of the previous posts that says 'as a smart new grad one will know when they are in over their head'...I tend to disagree in the realm of the NP setting. A smart new grad who is working as an NP with no strong background has no basis to differentiate exept when something goes terribly wrong.
  3. by   sirI
    A smart new grad who is working as an NP with no strong background has no basis to differentiate exept when something goes terribly wrong.
    Well said, EastCoast.
  4. by   markdanurse
    "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."

    I don't know about anyone else, but the thought of new grad NP's working with little or no floor nursing experience is unsettling and uncomfortable. Now, if the NP programs mirrored the PA programs, I wouldn't take issue at all. But being the whole idea of the NP is based on the idea of previous nursing experience, and hence the 680 clinical hours requirement of the NP's versus the 2000 + clinical hours PA's are required to have makes a new grad NP with little to no experience a very scary concept. I'm sorry if all of the new grad NP's with little or no previous nursing experience think that all nurses do all day is start IV's, put in NG tubes, and pass pills haven't gone far enough in their clinical practice to learn that nurses do so much more than that...perhaps if they worked in less mindless areas such as ICU or ER instead of med-surg, they would realize HOW an experienced nurse's learned clinical skills really can help them in the world of advanced practice nursing. Shame on this profession for allowing bridge programs that call for people with NO previous nursing experience to get their bachelor and master degrees in nursing back to back, instead of holding to the principle on which the NP role evolved...EXPERIENCED nurses go back to school to practice advanced practice nursing, NOT new grads. By the way, I have no problems with bridge programs that allow an RN to go straight into a masters program if they have an active RN license, a bachelor's degree in another area, and 3+ years of experience...these programs are much safer in my opinion than the programs that require absolutely no RN experience and a major in a field other than nursing, and then fast track the student through the BSN/MSN/NP program. If students do not want to do the time as nurses to learn something, then they should go to PA school. Leave the NP schooling to the experienced nurses who really can function well with only 680 hours of clinical training.
  5. by   hawaiianflowers21
    Do RNs and NPs do the same thing? Why is it so incredibly necessary to have nursing experience????? I'm not wondering if it is necessary, I am wondering WHY it seems to be necessary. Do you put meds in a med pump when you are an NP? Do you draw blood? Do you watch the patient at the bedside? Do you suction their trachs, draw up blood gases?? Take them down to CT scan? When I shadowed an NP in a clinic she did nothing that required previous working experience. She assessed the patient yes, but it definitely seems like one can learn that in the 6 years of nursing school and nursing experience. Through my nursing program and my externship I have learned how to do thourough assessments on high risk patients, how to give meds, etc. I also see what other RNs do (this is in an ICU) and they do nothing that NPs do that I have noticed. I plan to be working part time as a nurse while going to an NP program right after I graduate with my BSN (for tuition reimbursment reasons). Isn't that same amount of clinical hours as let's say a PA? Just wondering why anyone would suggest to put off their education for work...I may be wrong but that's how I view it. What do you think?
  6. by   Ventjock
    Quote from hawaiianflowers21
    Do RNs and NPs do the same thing? Why is it so incredibly necessary to have nursing experience????? I'm not wondering if it is necessary, I am wondering WHY it seems to be necessary. Do you put meds in a med pump when you are an NP? Do you draw blood? Do you watch the patient at the bedside? Do you suction their trachs, draw up blood gases?? Take them down to CT scan? When I shadowed an NP in a clinic she did nothing that required previous working experience. She assessed the patient yes, but it definitely seems like one can learn that in the 6 years of nursing school and nursing experience. Through my nursing program and my externship I have learned how to do thourough assessments on high risk patients, how to give meds, etc. I also see what other RNs do (this is in an ICU) and they do nothing that NPs do that I have noticed. I plan to be working part time as a nurse while going to an NP program right after I graduate with my BSN (for tuition reimbursment reasons). Isn't that same amount of clinical hours as let's say a PA? Just wondering why anyone would suggest to put off their education for work...I may be wrong but that's how I view it. What do you think?
    no. if that were the case RN's that go to PA school would be able to cut down on their clinical hrs. clinical hrs whether in NP or PA school, are not the same as working as a RN or EMTP.
  7. by   zenman
    Quote from hawaiianflowers21
    Do RNs and NPs do the same thing? Why is it so incredibly necessary to have nursing experience????? I'm not wondering if it is necessary, I am wondering WHY it seems to be necessary.
    Here's a repeat of what I posted earlier:

    1. I have lot's of experience dealing with patients, families and other healthcare providers.
    2. I have a working knowledge of how the healthcare system works.
    3. I know medications, including which ones are given for different conditions. I actually gave the meds and I'm the first to see the effects of them.
    4. I know how to assess patients and when a physician makes rounds can verify his findings with mine. I can even "play" like I'm the attending and see how correct I am when the physician makes his assessment.
    5. I really know how to set priorities in the care of patients.

    Do you see how this could be a rather long list? Startling how much you actually learn as a nurse that will transfer to NP!

    And yes, I've had to draw blood or give IV dig for example (or teach them to push that IV drug in the patient over 2 minutes and never do it again in 2 seconds!), or reinsert that trach the patient just coughed out because the resident didn't know how.
  8. by   markdanurse
    Quote from hawaiianflowers21
    Do RNs and NPs do the same thing? Why is it so incredibly necessary to have nursing experience????? I'm not wondering if it is necessary, I am wondering WHY it seems to be necessary. Do you put meds in a med pump when you are an NP? Do you draw blood? Do you watch the patient at the bedside? Do you suction their trachs, draw up blood gases?? Take them down to CT scan? When I shadowed an NP in a clinic she did nothing that required previous working experience. She assessed the patient yes, but it definitely seems like one can learn that in the 6 years of nursing school and nursing experience. Through my nursing program and my externship I have learned how to do thourough assessments on high risk patients, how to give meds, etc. I also see what other RNs do (this is in an ICU) and they do nothing that NPs do that I have noticed. I plan to be working part time as a nurse while going to an NP program right after I graduate with my BSN (for tuition reimbursment reasons). Isn't that same amount of clinical hours as let's say a PA? Just wondering why anyone would suggest to put off their education for work...I may be wrong but that's how I view it. What do you think?
    Okay, stop focusing on just the technical aspects of nursing and start looking at the clinical aspects. Stop assuming that all an RN knows is technical stuff. You get to see a disease process from start to finish as a nurse...not just for 15 minutes in a doctor's office. You work around multiple medications and learn about them...why they are given, how they are given properly, what the common dosages are, what the side effects are after seeing them first hand, what drugs mix and what drugs don't. You learn to work with doctors, PA's, PT's, OT's, RT(R)'s, RRT's, RDMS's,CNA's, etc. You learn why these professionals are consulted and what they do. You learn to do advanced assessments and when to act. You learn to read EKG strips and 12 leads and understand what changes mean what and why. What you've learned in your BSN program isn't anything compared to working in the real world as a nurse. Nurses know more than you think...especially experienced ones. When the NP programs first came out, you HAD to be an experienced nurse. Today, you can have a bachelor's degree in underwater basketweaving, have a 4.0 GPA, and go to school 3 more years and get a BSN and an MSN/NP. Then, with a mere 680 hours of actual clinical training, go practice as an FNP. Yes, the FNP and the RN are two different roles, but they really do relate. That is why most NP programs require previous clinical experience as an RN before you will be accepted...because your RN experience ENHANCES your NP experience. And yes, 680 hours of NP training doesn't even compare to the 2000+ hours of PA training...because advanced practice graduate level training is a different animal than undergraduate nursing training.

    Also, many RN's aspiring to be NP's have not "put off" their education to work...many NP's worked first to gain an understanding of a complicated medical system and therefore view this experience as part of their education...something that a bridge program never-worked-a-day-as-a-nurse graduate will never comprehend. Remember that when you become an NP, RN's are not just mindless robots doing tasks all day...they know much more than they are given credit for.
  9. by   EastCoast
    Well said Mardanurse.

    Again the posts from people who want to just go to NP school for the glory and authority (IMO) have little knowledge of the guts of nursing.

    A chimpanzee can draw an ABG and perform tasks. In fact many of the things that are procedure driven are now not done by the RN.

    However, it will be a nurse who can figure before the ABG is back that the patient is alkalotic based upon how they look.

    I will say it for the 10th time. Please, NP's without experience....stick to your minute clinics where a rapid strep willl make your diagnosis for you as opposed to clinical exam. Stay away from hospitals. You'll end up killing someone.
  10. by   sirI
    I know my opinion will not be well received, but I need to interject again ~ and, yet again...........

    Having RN experience prior to NP school is, IMHO, a must. I've had experience with NPs coming from both backgrounds, with and without RN experience prior to NP school.. The ones who possess the exceptionally higher critical thinking skills are the ones with adequate RN experience. This cannot be obtained with little or no experience and certainly not something one can sharpen in an NP program. It is always difficult to sharpen a blunt object without the proper tool.

    Yes, you will get a wonderful education as NP. But, the ones without any experience will not have that smooth transition as they "advance" their practice. And, that is the whole idea, to advance ones' practice.

    For example:

    As an RN, especially one seeking the NP career, one will gain much knowledge on the whys and hows of medicine. As an RN seeking the NP role, one should be able to logically and systematically obtain an adequate health history applicable to the disease process. If one has never done this prior to NP school, one will be less than prepared for the complex nature of the disciplined physical assessment tool.

    As an RN, one will obtain valuable knowledge on why certain diagnostic tests are ordered and how they apply to the disease process. How to interpret said diagnostic values and how these interpretations guide the health care provider (HCP) to tweak the treatment of the patient. This is something you learn in any NP program, but believe me, prior experience in this area allows for a better understanding during the learning process while in the NP program.

    As an RN, one will learn how to interact with members of the healthcare team and understand the valuable role each play in the management of the patient. The RN will learn how each develop and manage treatment modalities for the patient.

    As an RN, one will observe firsthand how the HCP consults and when, when referral is necessary and why; all necessary to the role of the NP.

    Again, this is siri speaking from years of experience as an NP. An NP who serves as mentor for newly graduated NPs coming from both backgrounds and is privy to the difficulties of each. An NP who believes the difference between a good NP and a great NP is a systematic process: the RN living and working in the world of advanced practice.
  11. by   bruinlaura
    Quote from markdanurse
    Today, you can have a bachelor's degree in underwater basketweaving, have a 4.0 GPA, and go to school 3 more years and get a BSN and an MSN/NP.
    Ok, I think if I see this posted one more time my head is going to explode.
    1. I don't believe a degree in underwater basketweaving exists. And implying that any degree other than a BSN is stupid and easy is offensive. I just finished up my BSN and it was 100x easier than my first bachelor's degree (and I'm not going to an easy school).
    2. The acceptance rates for the programs I looked into were in the teens, they are NOT EASY TO GET INTO.
    3. DE students have to complete the SAME PREREQUISITES AS ANY OTHER NURSING PROGRAM and have to do well in them to get accepted. So no, you can't just go straight from your fictional BA in underwater basketweaving into nursing. It took me a year to get all those classes out of the way and I have a sciencey degree.
    4. Most places look for healthcare experience of some variety (such as EMT, CNA, etc), employed and/or volunteer.

    BTW, I do agree that experience is important. In fact, most people work during the MS portion of their programs (so that's about 1.5-2 years experience before they are NPs). And those that don't work are usually in clinicals all the time instead and thus have way more than 680 clinical hours. My program originally had about 2000 hrs (hmm, isn't that about what a PA gets), clinicals were 4 days a week for 1.5 years (which would have made it impossible to work). They just changed the program and cut the hours in half which is why I'm now taking a year off to work. Also, I will be able to continue working when I start back up again so I'll have 3 years of experience by the time I'm licensed as an NP.

    So maybe all the DE students aren't as stupid and inexperienced as you think they are.
    Last edit by bruinlaura on Jun 12, '06
  12. by   EastCoast
    I think that Siri you sum it up logically via a process of learning and working and applying your previous knowledge to make decisions in an independent manner.

    But people continue to miss this holy point. Those who have no background and have not gone through the process will never understand the point and the utility of that type of learning. Ultimately it will be the patient who pays the price for textbook care and our profession as a whole will continue to be viewed as inconsistent and willing to give anyone a degree.
    I say this often..."NP's work 3x as hard as docs to get things right because when an NP screws up there will be someone there to say "see this happened because they're not a doctor".


    To me I don't care about how people pass their boards either. It is not that hard to pass boards if you study hard enough. I do not believe that a milllion clinic hours make up for basic experience. So what... you have 1200 clinical hours and you 'aren't allowed to work'. That's a pretty sweet ride. My last student was with me 2 days a week and wrote some paper on some subject that was interesting but that's as far as it went. I would have much rather she spent the time figuring out how to assess a patient within a reasonable time frame and still get a decent note written. And this was an experienced nurse who really was outstanding at the bedside. Funny, how she actually thought being an NP was a 'big deal' and understood what her nursing brought to the picture. It was here nursing that she brought forward to each an every patient. I was much more tolerant for her struggle to do it right and well versus just getting the job done.

    However, the proof will be in the pudding when you don't have the text or your preceptor at hand to bail you out. When you do not have the memory of a similar situation as a nurse and how the team as a whole handled the patient. When you are asked by a famliy to explain the whole nuts and bolts of a case and you don't have a Bates to rely on.

    I still have to ask...why are you going into nursing again?
  13. by   EastCoast
    Why do people always compare PA school clincal hours to NP clincal hours. A good NP program that requires nurses to be nurses first will likely require less clincal because the person brings the clincal with them. It doesn't mean it's a bad program.

    PA programs are different. They are medical model based and I think you would be better prepared in gross A/P and surgery than NP programs.

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