Becoming an NP with little to no nursing experience?? - page 19

Hello to all!!! I have worked as a parmamedic for 20 years, have a B.A. in Economics, and I wanted to advance my career in healthcare. I was originally looking to pursue the PA route, but for... Read More

  1. by   ksc0723
    Well said Jack. I am in complete agreement with you. April of 2008 is when the first round of baby boomers are eligible for retirement. That is less than a year away. We already have a huge shoratge in this country in most if not all health care professions. We should be trying to find ways to make it feasible for those who are willing to be on the front lines of health care and not jump through a ton of hoops.
  2. by   mvanz9999
    I agree with you as well Jack. Very nicely stated.

    In regards to the arguments both for and against, I think the entire medical conglomerate is very, very, very resistant to change. That isn't just nursing, it's all of it. I wouldn't argue that this is right or wrong. It just is.

    Ask any heath professional why they do a procedure X way, and they will tell you "because it's always been done that way". If you want to get into the philosophical aspect of it, you can troll through decades of history and eventually come up with the answer of why "this way" was ever started. Sometimes this is frightening (and trust me, it's true).

    There is always resistance to change in health care. I really don't know where it comes from, or why that is, but it's true. Look at anatomy. Gross anatomy has relatively little to do with medicine, and doesn't even need to be in the medical curriculum. Is it likely to be removed? NO. That class has always been taught...and so it goes.

    If you're a thoracic surgeon, you'll learn the anatomy of what you need to know. You don't need to know every muscle/nerve/artery/vein/tendon/bone/connective tissue/fat deposit in the foot or the hand if you're going to be working in the chest (just watch the cries of protest.......)

    As you said, nursing is going through some huge changes and there is a lot of resistance to that. There's also a great deal of protecting your turf. Mostly due to politics. Internist fighting alternative health care providers, nurse practitioners fighting physician's assistants, MD's fighting DO's. Everyone wants to protect their turf.

    Nurse Practitioners and Physician's Assistants are perfectly capable of doing essentially the same job equally well. That's all the really needs to be said. I also think direct-entry Nurse Practitioners will be just as capable of providing service as someone with 20 years nursing experience. They are different jobs, with different requirements and so on.
    Last edit by mvanz9999 on Apr 27, '07
  3. by   ProudGayRN
    Quote from mvanz9999
    I agree with you as well Jack. Very nicely stated.

    In regards to the arguments both for and against, I think the entire medical conglomerate is very, very, very resistant to change. That isn't just nursing, it's all of it. I wouldn't argue that this is right or wrong. It just is.

    Ask any heath professional why they do a procedure X way, and they will tell you "because it's always been done that way". If you want to get into the philosophical aspect of it, you can troll through decades of history and eventually come up with the answer of why "this way" was ever started. Sometimes this is frightening (and trust me, it's true).

    There is always resistance to change in health care. I really don't know where it comes from, or why that is, but it's true. Look at anatomy. Gross anatomy has relatively little to do with medicine, and doesn't even need to be in the medical curriculum. Is it likely to be removed? NO. That class has always been taught...and so it goes.

    If you're a thoracic surgeon, you'll learn the anatomy of what you need to know. You don't need to know every muscle/nerve/artery/vein/tendon/bone/connective tissue/fat deposit in the foot or the hand if you're going to be working in the chest (just watch the cries of protest.......)

    As you said, nursing is going through some huge changes and there is a lot of resistance to that. There's also a great deal of protecting your turf. Mostly due to politics. Internist fighting alternative health care providers, nurse practitioners fighting physician's assistants, MD's fighting DO's. Everyone wants to protect their turf.

    Nurse Practitioners and Physician's Assistants are perfectly capable of doing essentially the same job equally well. That's all the really needs to be said. I also think direct-entry Nurse Practitioners will be just as capable of providing service as someone with 20 years nursing experience. They are different jobs, with different requirements and so on.
    Exactly - And its also because the old crotchety RN's get mad when they see someone go directly into a graduate program without doing all the crappy work they had to do. If only they could have done it maybe they wouldn't be so bitter!!!!
  4. by   core0
    Quote from mvanz9999
    i agree with you as well jack. very nicely stated.

    in regards to the arguments both for and against, i think the entire medical conglomerate is very, very, very resistant to change. that isn't just nursing, it's all of it. i wouldn't argue that this is right or wrong. it just is.

    ask any heath professional why they do a procedure x way, and they will tell you "because it's always been done that way". if you want to get into the philosophical aspect of it, you can troll through decades of history and eventually come up with the answer of why "this way" was ever started. sometimes this is frightening (and trust me, it's true).

    most of this these days is based on ebm. now sometimes ebm changes what we do (watch what will happen with stents now).

    there is always resistance to change in health care. i really don't know where it comes from, or why that is, but it's true. look at anatomy. gross anatomy has relatively little to do with medicine, and doesn't even need to be in the medical curriculum. is it likely to be removed? no. that class has always been taught...and so it goes.

    if you're a thoracic surgeon, you'll learn the anatomy of what you need to know. you don't need to know every muscle/nerve/artery/vein/tendon/bone/connective tissue/fat deposit in the foot or the hand if you're going to be working in the chest (just watch the cries of protest.......)

    i'll bite. i think you have a poor understanding in what is involved in medical decision making. a good foundation in anatomy and physiology is essential here. does everyone need to spend several months dissecting their own cadaver? different question. i fall back on my anatomy every day. just because your a thoracic surgeon doesn't mean everything involves the chest.

    as you said, nursing is going through some huge changes and there is a lot of resistance to that. there's also a great deal of protecting your turf. mostly due to politics. internist fighting alternative health care providers, nurse practitioners fighting physician's assistants, md's fighting do's. everyone wants to protect their turf.

    nurse practitioners and physician's assistants are perfectly capable of doing essentially the same job equally well. that's all the really needs to be said. i also think direct-entry nurse practitioners will be just as capable of providing service as someone with 20 years nursing experience. they are different jobs, with different requirements and so on.
    depends on your perspective. the core of the np profession is to take a nurse and expand their practice (hence apn). if you value this expansion then you will be against direct entry. also you are changing entry into a profession. while you may feel that the direct entry is as capable shouldn't there be some outcome studies. other apn's still require specific experience as nurses before moving into an apn (for that matter some of the np specialties do also). so obviously you have a difference of opinion within the profession.

    note: this is dated 4-27 but this showed up as a new message

    david carpenter, pa-c
  5. by   subee
    Mvans, you're not even a nurse so how could you possible know ANYTHING, NOT EVEN ONE LITTLE TEENY IOTA of what a nurse knows or doesn't know. A person who doesn't know what he doesn't know may not always be dangerous, but will certainly never be anything but mediocre. Now, if that's alright for you, you go right ahead and become a "nurse"practitioner without any nursing experience. Than twenty years from the day you started, put a post up here and thank your lucky stars that no one as deluded as you were when you were starting out, was taking care of YOU. As a CRNA, I lose a medical neuron every day. Yes, I'm learning a lot about that "useless" gross anatomy (I've read many an intern's note that indicated they didn't know which side the spleen was on vs. the gallbladder). I have to admit that I don't learn much about pathology from the OR nurses, but the old timers that work in PACU and ASU all worked in other areas and I can always go to them with questions about dialysis and other nursing problems I don't know ANYTHING about. However, I'm humble enough to ADMIT it. This is Planet Earth and on our planet we weed out the idiots with courses like gross anatomy. I have to leave now to wipe the drool from my keyboard. Jeez!
  6. by   ProudGayRN
    Quote from core0
    Depends on your perspective. The core of the NP profession is to take a nurse and expand their practice (hence APN). If you value this expansion then you will be against direct entry. Also you are changing entry into a profession. While you may feel that the direct entry is as capable shouldn't there be some outcome studies. Other APN's still require specific experience as nurses before moving into an APN (for that matter some of the NP specialties do also). So obviously you have a difference of opinion within the profession.

    Note: this is dated 4-27 but this showed up as a new message

    David Carpenter, PA-C
    Hmm I dont know what you are talking about davey boy old chap....What is the problem with direct entry exactly? If someone can get a four year degree in biology and go to PA school, graduate and get a job as a PA..why should a registered nurse need to work for 10 years in a hospital doing bed baths and wiping bottoms in order to "qualify" to get their APRN. Sorry dave, doesnt make much sense to me. Hmmm what do you mean by, "specific experience" can you please elaborate on that? The majority of APRN programs dont require "specific experience" for enrolling. Maybe you are more familiar with nursing, being a PA, than a nurse is...care to enlighten us?

    Peter
  7. by   mvanz9999
    Whether you like it or not, direct-entry APN's are here to stay.

    I don't see anywhere in my post that makes any claim that I know what nurses or doctors or electrical engineers know specifically. But I will say that many of my friends as well as my own mother are all nurses, and that certainly counts.

    I do not believe that direct-entry students are any less capable than any other method of becoming an APN. I will also say that the programs I'm looking at....I don't see anyway to actually get certified as an APN without first working as an RN for several years. It's built into the program. Maybe it can be done elsewhere, but not in Illinois.

    Finally, I fully intend to become an APN. Am I somewhat deluded? Of course. Certainly not more (and probably less) than any pre-nursing student anywhere else. Did I just pick this profession out of a hat and decide to pursue it? No. Don't think I would have been accepted if I had.

    I'm not going to be the first direct-entry student, nor will I be the last. My hope is that I would be welcomed into nursing. If some choose not to do that, so be it. I have already made my decision, and I'll just have to find the place that DOES welcome me.

    For those that don't...what can I say? Good luck...
  8. by   CrufflerJJ
    Quote from mvanz9999
    <snip>
    I also think direct-entry Nurse Practitioners will be just as capable of providing service as someone with 20 years nursing experience. They are different jobs, with different requirements and so on.
    I dunno about that. I guess it depends a lot on the level of service to be provided. I am not an RN (give me another 15-16 months), but have been a medic since 1991, and an EMT for a few years before that.

    It's important to realize & accept the value gained by DOING, not just "knowing" theoretical factoids and passing certification tests.

    I've seen too many "shake-n-bake" paramedics. They've typically been very bright people, and have gone straight from the EMT program directly into the paramedic program without any field experience in between. They graduate as a certified paramedic, and may all too soon find themselves as the "person in charge" of experienced EMTs on a scene. Yes, they've got the certification & "book-smarts", but they have to work so very hard to stay on top of each & every little thing on the scene, and each & every little part of the patient assessment.

    A medic with even 2-3 years prior experience as an EMT, however, has already seen & done so much more. He's seen loads of patients, in all sorts of situations. Even as a newbie paramedic, he's more able to step back & look at the big picture (handling those routine items on "autopilot"), focusing his attention on stuff that will kill the patient quickly (sometimes apparently minor things until it's crash-time). Yes, the shake-n-bake medic and the EMT experienced medic hold the same certification (NREMT-P), but their abilities are very different. If I was the patient, I'd rather have somebody with some real world experience backing up their "book smarts."

    As you know, I'm going into an accelerated nursing program in another month. I had already paid big $$$ to do a distance learning program through Excelsior, but I still had nagging doubts. The distance learning (medic-->RN) program might have gotten me my RN, but I would have been lacking the clinical experiences needed to truly internalize new concepts & skills. I didn't want to be a "shake-n-bake" nurse - I wanted to be a nurse with strong clinical & intellectual skills. {NOTE: this isn't a slam against those that successfully took the distance learning path - I just didn't feel comfortable that it was right for me.}

    I'm benefiting from an accelerated pathway program, allowing me to enter the nursing profession after a 22+ year career as a chemical engineer. When I graduate, I will be a newbie nurse. I expect to be as skilled as a newbie RN who has gone through a standard 4 year BSN program, but we would both still be newbies.

    Before going for an advanced nursing degree, I would think that some period of working as a "regular" nurse is invaluable. If nothing else, to let me become more comfortable in my basic nursing skills and to be exposed to a wide range of patient experiences.
  9. by   zenman
    Quote from CrufflerJJ
    Before going for an advanced nursing degree, I would think that some period of working as a "regular" nurse is invaluable. If nothing else, to let me become more comfortable in my basic nursing skills and to be exposed to a wide range of patient experiences.
    I really think my 30 + years of experience will be invaluable even if it is not necessary. As an NP, I'll still be listening to heart sounds, breath sounds, bowels sounds etc but with years of experience to expand upon. As a bedside nurse, I actually handed out meds. I won't as an NP, but I'll already know my meds forwards and backwards. As a bedside nurse, I "played" NP by second guessing physicians and even agreeing or disagreeing with their plan of care...done it for years. I've seen 30 + years of patient conditions. I could say much more here. Now, the physician that I start my clinicals with in the Fall is a recent graduate but I'm already working with her some. I really hope I learn something new. It's funny; she'll sat down and start telling me stuff I knew a long time ago and I just smile and ask her questions. I've already taught her some things she hadn't thought of. It's going to be an interesting experience, lol! At least I'll get that signature I need for clinical.
  10. by   ProudGayRN
    Quote from CrufflerJJ

    As you know, I'm going into an accelerated nursing program in another month. I had already paid big $$$ to do a distance learning program through Excelsior, but I still had nagging doubts. The distance learning (medic-->RN) program might have gotten me my RN, but I would have been lacking the clinical experiences needed to truly internalize new concepts & skills. I didn't want to be a "shake-n-bake" nurse - I wanted to be a nurse with strong clinical & intellectual skills. {NOTE: this isn't a slam against those that successfully took the distance learning path - I just didn't feel comfortable that it was right for me.}

    I'm benefiting from an accelerated pathway program, allowing me to enter the nursing profession after a 22+ year career as a chemical engineer. When I graduate, I will be a newbie nurse. I expect to be as skilled as a newbie RN who has gone through a standard 4 year BSN program, but we would both still be newbies.
    Wow that sounds so admirable - but it is complete BS - You don't learn much of anything in clinical except having some ussually anal nutjob instructor break your chops for stupid things "Did you properly change the bed?" etc.. yeah, sorry pal but you dont learn much of ANYTHING in the beloved clinical experience. You learn by doing and working and being on the job -

    The salient issue is, depending on what type of advanced degree in nursing you pursue, it may be highly unrelated to what you are doing as a bedside nurse. Just use some common sense and think about it, how long does it take to be able to effectively learn how to do blood pressures, stick a thermometer in peoples mouth, read a temperature gauge - do a head to toe assessment -take some notes in a chart - Not long, well at least for me it didnt take that long to master some of those very fundamental basic skills - now please tell me what the hell wiping peoples A$$es and changing linens has to do with writing scripts or interpreting diagnostic tests as an FNP? Ummm...NOTHING - exactly - so what you learn as a bedside nurse might have some relevance to what you do as an APRN but it very well MIGHT NOT HAVE MUCH TO DO WITH IT AT ALL GET IT?

    Point being - some of the people, usually the real academic types on this forum think you should have 10 years of experience washing bottoms, changing sheets and taking blood pressure(electronically) before you are able to pursue an Advanced Practice Nursing degree - but like most academics, they are detached from the reality of the situation.

    So basically they can whine all they want and you should just turn the volume down on people like that, they tell you can cant do something because they didnt do it that way etc....

    When they fail in convincing you that you shouldnt get your APRN immediatley, the next route by those type of people is to say "well yes you can go to graduate school right away, but you cant get a job because you have no experience as an APRN." Sorry WRONG AGAIN - I know many people that have done it and are doing very well -

    Bottom line, dont let people from the Ivory tower tell you what you should and shouldn't do because they are usually wrong anyway

    Peter
  11. by   prairienp
    Quote from crufflerjj
    i dunno about that. i guess it depends a lot on the level of service to be provided. i am not an rn (give me another 15-16 months), but have been a medic since 1991, and an emt for a few years before that.

    it's important to realize & accept the value gained by doing, not just "knowing" theoretical factoids and passing certification tests.

    i'm benefiting from an accelerated pathway program, allowing me to enter the nursing profession after a 22+ year career as a chemical engineer. when i graduate, i will be a newbie nurse. i expect to be as skilled as a newbie rn who has gone through a standard 4 year bsn program, but we would both still be newbies.

    before going for an advanced nursing degree, i would think that some period of working as a "regular" nurse is invaluable. if nothing else, to let me become more comfortable in my basic nursing skills and to be exposed to a wide range of patient experiences.
    [font='times new roman']sounds as if you will be an outstanding member of the nursing profession. you are carefully thinking before proceeding into your new role. don't let the disenchanted distract you from the importance of theory in building your knowledge base. many will concentrate on the nursing theorists and how they are a waste of time. in reality you will be exposed to nursing theorist for a very minor part of your overall curriculum. there are a variety of other non nursing theories that will enable you to guide your knowledge and practice applications. with all that experience you may be tempted to do things as you always have, don't be afraid of change based on your new knowledge acquisition. i really liked your post!
  12. by   CrufflerJJ
    Quote from prairienp
    sounds as if you will be an outstanding member of the nursing profession. you are carefully thinking before proceeding into your new role. don't let the disenchanted distract you from the importance of theory in building your knowledge base. many will concentrate on the nursing theorists and how they are a waste of time. in reality you will be exposed to nursing theorist for a very minor part of your overall curriculum. there are a variety of other non nursing theories that will enable you to guide your knowledge and practice applications. with all that experience you may be tempted to do things as you always have, don't be afraid of change based on your new knowledge acquisition. i really liked your post!
    i had hoped that my post wasn't seen as too "lecturing" or "preachy". sometimes i tend to get a little (ok, big:spin case of verbal diarrhea.

    i hope that the nursing theory stuff won't seem like so much "fluff." the syllabus for our program has no obvious "nursing theory" courses, but the key concepts will likely be worked into all the other fun-filled courses.

    as to your comment "with all that experience you may be tempted to do things as you always have, don't be afraid of change based on your new knowledge acquisition.", that's a very valid concern. in every field, it's important to keep your "knowledge cup" half empty. it's hard to absorb new knowledge/concepts when your teachers are trying to pour their knowledge into an already full cup. experience is a good thing, but it's important to make sure that all that experience doesn't put blinders in front of your eyes. if you're not willing to do things differently, you will never achieve your best possible performance level.

    during my engineering career (especially in the latter years when i was mentoring/leading others), i tried to keep a healthy sense of self-doubt at all times. when you're convinced that you're absolutely right on an issue, you're probably blind to your own faults, and are overlooking something critical. when you're absolutely convinced that you're right, you may very well be wrong. this doesn't mean to helplessly waffle on each & every issue or decision, but try to maintain a healthy skepticism about what you hear/see/read/believe/accept/"know".

    openness is the key. extremism and closed-mindedness leads to evil deeds or painful mistakes. this seems to be the case with individuals, governments, and religions.

    as an experienced street medic, i'm already trying to give myself the "heads up" that doing things the hospital way will likely differ from doing things in the field. such is life! there are bound to be times that i'll be frustrated at the scope of practice limitations as a rn, thinking "if this happened on the street, i'd have the guy tubed or criced or chest-decompressed or...". such is life - i'll try to accept it & move on.

    at 45 years old, i feel lucky to be able to start a second career this late in life. i'm determined to do as well as i can in every school course, and to try & learn something from each & every patient interaction.

    that's the plan!

    <enough babbling for now...gotta study for a nutrition & disease test tomorrow...this past week was a&p3 (98% score), pharm (100%) & pathophys (97%) tests>
  13. by   mvanz9999
    Quote from CrufflerJJ
    Before going for an advanced nursing degree, I would think that some period of working as a "regular" nurse is invaluable. If nothing else, to let me become more comfortable in my basic nursing skills and to be exposed to a wide range of patient experiences.
    That's what I'm doing. While the program is labeled as Master's Entry, the design is essentially Accelerated Bachelor's plus Mater's courses. What will happen after 15 months is I'll take the NCLEX and go to work as an RN. Then over the next 4 or 5 years, I'll complete the Masters portion. I'll have 4-5 years experience as an RN, and then be ready to move up to NP.

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