Seeking Advice: Direct Entry Blues

mmc51264, BSN, MSN, RN · Oct 30, 2017

I am still quite stunned at these programs. It is not doing you any favors with the lack of nursing experience. I personally would go back to the bedside for a while and get some experience. I am finishing an MSN in Informatics but not leaving the bedside until I find the job I want. I have been a nurse for 5 years and learn so much every day I work. What area do you want to practice in? I certainly would not give up on nursing!

mk989 · Oct 30, 2017

I am in peds, but open to exploring RN positions in the adult area as well.

jennylee321 · Oct 30, 2017

Thanks for sharing your story, I hope people see this post and rethink going into this direct entry MSN route.

allnurses Guide · Oct 30, 2017

I truly have no idea what to advise you and am hoping others more experienced and wiser than I will jump in. What you really need is a very extended internship with another NP that will give you the educational clinical experience that you came out of your program without. So unfair to you, because I suspect there are few, if any, employers out there willing to take on that expense and your program, like so many other direct entry programs, failed you.

I applaud your bravery in posting about your experience honestly. I suspect you are not anywhere close to alone.

JenTheSchoolRN, BSN, RN · Oct 30, 2017

I was in a direct-entry program a few years ago. I started working as a RN in a school setting while completing the MSN part of the program. I learned quickly that I needed RN experience before I could finish my MSN. I ended up leaving the program with my BSN. I do not regret it, even 3 years later, but I did also fall in love with school nursing and may return for a direct master's path in a couple of years.

This is why I think direct-entry MSN programs need to require their participants to work as a RN before graduation with their MSN. My program didn't require it, but strongly, strongly encouraged it. I have a friend who went part-time to take a med-surg RN position. She just graduated and is so much better prepared as a NP.

OP, worst you can do is apply to RN jobs and see where that takes you. Or maybe seek a different NP position that offers more training and support? (I know I may be seeking a diamond here.) I have a few NP friends who work in school-based health care centers, but not sure if the support you need is there, though it is different than a typical pediatrician's office.

Trauma Columnist · Oct 30, 2017

Moved to NP forum.

What about looking for a specialty that will offer an organized orientation? I currently work for a large nephrology practice and our orientation (for new grads and those without nephrology experience) is a combined didactic/clinical orientation with MDs/NPs and it is very individual ranging from 3 months to 5 months.

core0 · Oct 30, 2017

I am a graduate of direct entry accelerated MSN program for non nurses. I did very well in school with a 4.0 the whole time but am finding clinical practice as an APN to be quite challenging.
I came into the role of APN, specifically NP as a very green graduate. I have been in my present position for about a year and it is not going to so smoothly. Academic knowledge and clinical expertise are so so very different. I have been directed to seek a position elsewhere (due to lack of independence and overall knowledge gaps) but permitted to continue working for the next few months while I look. It was also mentioned I try to seek a specialty area instead of primary care so I can focus my knowledge development since primary care is so vast.
I'm looking at specialties but wondering if I should think this over before I make another career move mistake. I am not against applying to bedside RN positions, I actually miss that part of nursing and regret not having experienced that side of nursing as an RN. However, not having used bedside nursing skills since my BSN/nurse externship, coupled with my MSN being front and center on my resume makes me wonder if I'd even be a suitable candidate (also full disclosure I was never taught how to start an IV). I'm devastated by all of this and trying to figure out where to go from here. I worked so hard, but I feel a bit like I set myself up to fail.
Should I leave nursing all together?
Any guidance appreciated.

You don't really give enough information for guidance. You say you work in peds. Are you an FNP or PNP. Which certification you have will help determine what you can do.

Are you tied to the area (ie family etc). If you can leave the area options increase.

Two things to consider.

1. Are their any available post grad programs (re: residencies) available. There are a number of primary care programs around the country which would give you the additional training in an environment more conducive to learning.

2. Consider looking for a position associated with a teaching hospital. These institutions are used to dealing with learners. They may offer longer orientations. We routinely offer new grads 9-12 month orientation if they don't come from a residency.

I would avoid going back to bedside nursing if you want to continue as an APN. We have a strong rule that if any provider hasn't practiced in the role for 2 years we won't consider them. In most states physicians have to go back to a re-entry program if they have been out of practice for more than 2 years. Skills are very perishable and since you are still in the new grad stage this applies even more so.

good luck

Gentleman_nurse, MSN · Oct 30, 2017

Sorry, you're having a difficult time. I've seen this situation before. Places that expect high productivity without any investment in staff training. It has nothing to do with you being a directly entry NP. Any new grad NP placed in the same situation would have failed.

allnurses Guide · Oct 31, 2017

I am also a Direct Entry grad, and feel that RN experience is not related to success as an NP. What is crucial, IMHO, is finding a first position where you have a slow ramp up and have support from a mentor. That is true for any new grad, whether you have years of RN experience or not. As I have said a gazillion times, I rarely use the vast majority of what I learned in the RN portion of my program.

I'm going to assume you're an FNP as you said you might explore working in the adult arena.I wouldn't want to work in peds as a FNP as we did not get a lot of depth in pediatric clinical and didactic. Peds primary care is tough. I've never seen a peds office, as a NP student or parent, that wasn't crazy-busy and hectic. Perhaps looking at an adult NP job or something like Urgent Care (except if you would be the only provider on duty) might offer you an environment that is more conducive to getting acclimated to this role. I'd look at a large medical group practice where you would have other providers to consult with, and might have a more structured orientation process.

If you feel you have knowledge base deficits, then hit the books again, and brush up on the areas where you think you need to know more. Don't give up on nursing, or yourself. Not every job is a good fit.

Jules A, MSN · Oct 31, 2017

Sorry, you're having a difficult time. I've seen this situation before. Places that expect high productivity without any investment in staff training. It has nothing to do with you being a directly entry NP. Any new grad NP placed in the same situation would have failed.

Gee imagine employers expecting that educated, highly paid professionals are prepared to start work with the ability to practice to the full scope of their licensure without an extensive orientation? The nerve!

OP I appreciate your honesty and as someone else said I'm sure you aren't alone and definitely don't give up on nursing but do continue to share your experience and encourage others to require that our expensive schools start delivering the goods.

babyNP., APRN · Oct 31, 2017

Gee imagine employers expecting that educated, highly paid professionals are prepared to start work with the ability to practice to the full scope of their licensure without an extensive orientation? The nerve!
OP I appreciate your honesty and as someone else said I'm sure you aren't alone and definitely don't give up on nursing but do continue to share your experience and encourage others to require that our expensive schools start delivering the goods.

I'm going to poke the dragon. Docs have a minimum of a 3 year residency after school