Becoming an NP with little to no nursing experience?? - page 20

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   ProudGayRN
    Quote from crufflerjj

    <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>
    thanks for telling us the grades you received on the 3 tests, after seeing the grades are high and confirming the validity of the scores with the university you attend, i will take what you say more seriously now. please let us know the grades you receive in the future as we are all very interested and it is highly relevant to this topic.

    peter.
    Last edit by ProudGayRN on May 15, '07
  2. by   ProudGayRN
    Quote from prairienp
    don't let the disenchanted distract you from the importance of theory in building your knowledge base.
    yes, dont let the disenchanted academics distract you with things you will never use once you get out of school. just get your bsn, pick up 3 12 hours and get your aprn immediately. than again, if you want you can always work for 8 years with a bachelors, writing 12 page care plans on each patient, inventing new nursing diagnoses, studying crap nursing theories and finally go for your aprn; you may lose a decade of your life but at least the academics won't be so bitter.
  3. by   Barbiegirlnurse
    To reply to the first comment on the forum-I don't think that there is anything wrong with doing the bridge program to become a NP. While getting your degree, you would do clinical rotations to become a RN. That would be a prerequisite to any NP training. As a new NP graduate, who has been a nurse for over 3 years, I still get the "she hasn't paid her dues" vibes from some nurses. Other professions in healthcare don't operate with that same mentality. For example,physicians don't practice medicine before they go to medical school, and pharmacists don't practice pharmacy before they go on to pharmacy school. I think that many of the people who feel you would need to practice as a RN, think that you would need to work on your technical skills. However, as a NP your skills become more integrated with your knowledge. You become more focused on synthesizing information to form a diagnosis, than the technical skills.

    In all honesty, I think that a lot of the "attitude" comes from nurses' own insecurities. Maybe they are threatened that someone who has been in the profession a shorter amount of time than they have, will have a more advanced nursing role. What they need to be reminded of is that the world will always need nurses who are involved with staff nursing at hospitals, health clinics, and in public health. The real "attitude" should be shifted towards the public, who don't value our nurses and reward their hard work as much or as often as they should. If you do work somewhere after getting your RN license, (even if it is just PRN) let the other nurses on the floor know how much you value their help and expertise. Sometimes a simple thank you goes a long way! And if you do have some bad times, just know that whatever negative experiences you encounter with such nurses, should only remind you of how you want to treat others in the profession and students that you may precept.
  4. by   zenman
    Quote from Barbiegirlnurse
    Other professions in healthcare don't operate with that same mentality. For example,physicians don't practice medicine before they go to medical school, and pharmacists don't practice pharmacy before they go on to pharmacy school.
    You know someone is really going to call you on this one, lol!
  5. by   Barbiegirlnurse
    I stand by my posting, as I am sure that those with differing views than my own, stand by their beliefs. This is supposed to be a discussion forum. If nurses can't discuss issues among each other and keep it friendly and professional, how are we supposed to be able to make actual changes in health care policies and reform? It is quite easy to make a "jab" at someone's comment and a much more complex process to read someone elses thoughts and opinions and empathize where they are coming from.

    I respect your views and am very sorry you are having a difficult time understanding where I am coming from. That said- let me elaborate some more on the topic of NPs entering the profession with little or no working RN experience. The traditional entry level into healthcare for other professions is usually the doctoral level, although now-more and more pharmacists and some in psychology are entering into patient care at the Master's level. No other health care related field that I know of, suggests that it's academically prepared individuals go into the field for a few years and work at the beginning level. They strongly encourage students to go straight through and get their masters degree or doctorate. It is only at these levels that they even begin to operate in clinically based settings and see patients. I think that it is so interesting that other professionals in healthcare (physicians, pharmacists, clinical psychologists, etc.) don't even see patients until they are in advanced degrees and in nursing, the entry level into patient care is the LPN, ADN, ASN, or diploma program. (When I say entry level into nursing, I am talking exclusively about nursing and not about assistive personnel such as CNTs, MAs, or other delegatory staff members.) I think that this says a lot for nursing, as traditionally we are clinically preparred at earlier training.

    Professional agencies are taking note of such factors and urging that the entry level into professional nursing practice (not to be confused with the entry level into clinical nursing practice) be the BSN and that the entry level into advanced nursing practice become the doctorate. Although these changes likely won't come for a few years, they will come. The thought behind the changes is to increase parity among healthcare professionals. Professional nursing organizations that set the standard of nursing care are supporting these changes. With their support, comes no urging of NPs to work as a RN before completing their education. While working as a RN can be fulfilling and helpful to some NPs, it is NOT necessary for all individuals to do so.

    I can see how the concept is very foreign and strange to many nurses, because you do learn so much working as a RN. You learn something new and perfect your assessment skills each time you work. So the idea of someone "skipping" this stage seems a bit, impulsive. However, what you must realize is that NPs will learn something new and perfect assessment
    skills each time they work, as well. It is still the practice of nursing, just in an advanced role. The two roles are interelated and in many ways overlapping, not disconnected as some would believe.

    In closing, I would like to say that I feel that all levels of nursing are integral to our healthcare. I have the utmost respect for all nurses, regardless of their educational or clinical backgrounds. It should be understood that NP practice was created to improve access to healthcare. Many NPs provide care to individuals, who might otherwise go without.( By way of, practicing in remote or rural areas; being able to accommodate more patients in a busy practice setting; etc.) If that type of caring is not a core concept of nursing practice, I don't know what is.
    Last edit by Barbiegirlnurse on May 31, '07
  6. by   jjjoy
    In this alternate model of training up NPs directly without previous related experience, the question is how much education is necessary? Certainly, a different approach would be needed than that for RNs pursuing the NP role in an area in which they have years of experience.

    I understand that FNPs generally learn to be holistic in regard to patient care, as opposed to just medically-oriented, however, they still will need some medical foundation. The training for a direct entry FNP would need to cover both diagnostic/treatment functions as well as the nursing angle. Though, since nursing theory is generally based on the premise that nurses don't make medical diagnoses, I'm not sure how that works into training up nurses who do in fact make medical diagnoses and can prescribe.

    Is the basic idea that given a basic foundation (either pre-reqs or a related bachelor's degree) any mid-level provider can be trained up in 2-3 years versus the 5+ years for MDs (counting from the start of med school)? That could be the case. And if so, that will constitute a major shift in how people enter the practice of medicine (meaning diagnosing and treating disease processes). Interesting times!
    Last edit by jjjoy on May 31, '07
  7. by   Barbiegirlnurse
    NP programs work to educate individuals to become safe to operate and enter the field. Each program begins with the assumption that everyone knows what they learned in undergraduate nursing school. BSN programs don't focus on one certain specialty. They are designed to produce a generalist nurse. So when entering a master's level NP school (not a bridge program), the curriculum is designed to teach students who are at the same level.

    When I went to get my MSN, I went straight through after my BSN. I did it over three years so that I could work some and make enough money to pay for school. However, many of my classmates had been nurses for many years. They reported difficulty in having to change their way of thinking from a nurse to a NP, whereas I had an easy time adapting. Now that's not to say that there weren't certain instances where they felt their experience was helpful, but I didn't feel behind in any way by not having their expertise.

    As for the comment on nursing theories not including the nurses making medical diagnoses, most nursing theories are either Grand theories or Middle range theories that are so broad in spectrum, they don't make the assumption that nurses are exempt from diagnosing. They are focusing on the bigger picture which is the health of the patient, the comfort of the patient, health promotion of the patient, etc. Although it is confusing there are still distinct differences in the practice of a NP and other healthcare professionals. The education of a NP and a physician is so vastly different.

    I never went to become a NP because I wanted to practice medicine. I did it because I wanted to practice nursing at an advanced level, which includes some similar interventions to medical doctors. With similar goals it is hard not to have overlapping interventions. The education of the NP does include learning diagnostic tools and criteria for usage and learning how to prescribe. These concepts are integrated into the course work and they fit quite nicely with the utilization of nursing theory. Also, it is important to note that professional nursing practice is based on evidence based practice, meaning that the interventions we use and goals we set, are empirically based. Much nursing research, uses nursing theory as the theoretical framework of the research. This is how we come up with nursing (advanced practice nursing or RN) interventions. That is the process by which our practice is lead. It is not simply just following medicine. It is an exciting time for nursing!
  8. by   core0
    Quote from jjjoy
    In this alternate model of training up NPs directly without previous related experience, the question is how much education is necessary? Certainly, a different approach would be needed than that for RNs pursuing the NP role in an area in which they have years of experience.

    I understand that FNPs generally learn to be holistic in regard to patient care, as opposed to just medically-oriented, however, they still will need some medical foundation. The training for a direct entry FNP would need to cover both diagnostic/treatment functions as well as the nursing angle. Though, since nursing theory is generally based on the premise that nurses don't make medical diagnoses, I'm not sure how that works into training up nurses who do in fact make medical diagnoses and can prescribe.

    Is the basic idea that given a basic foundation (either pre-reqs or a related bachelor's degree) any mid-level provider can be trained up in 2-3 years versus the 5+ years for MDs (counting from the start of med school)? That could be the case. And if so, that will constitute a major shift in how people enter the practice of medicine (meaning diagnosing and treating disease processes). Interesting times!
    This model has existed for 40 years as the physician assistant model. Historically it has been a condensed form of the the physician training model with emphasis on producing a generalized medical practitioner. A similar model the anesthesiologist assistant has existed for 35 years.

    The NP concept differs (at least in my opinion) because it has historically taken nurses with significant experience in the particular nursing specialty and given them additional instruction in diagnosis and treatment. This model started to break down in the 70's and 80's with the disappearance (for the most part) of the office nurse who had formed the backbone of the FNP program and the move toward shorter courses of instruction in the name of accesability. While some ANP fields such as the CMN, NNP and CRNA have kept a requirement for experience in the field for admission to their programs, others have not.

    The fundamental question then becomes if there is no value in nursing as a prerequisite for NP school then what is the difference between an NP and PA except that by requirements NP's have less didactic training and less exposure to clinical elements of medicine. There has been at least one study (from Canada) and a number of position papers that call for extending NP clinical and didactic hours. Keep in mind that most of these papers and studies were done before the increase in direct entry NP programs. If you are going to decrease the nursing experience further then to what extent if any do you need to increase didactic and clinical experience.

    The other issue is what amount of nursing experience is necessary. There are a number of studies on this mostly dealing with critical thinking (CT) skills. Leaving aside my own biases about critical thinking as a measure, the optimum amount of experience seems to hover around two years (with the exception of one study that showed a negative correlation with age and experience). Interestingly this correlates with anectdotal experience of nurse managers who frequently require (or desire) two years of experience for new hires.

    I would invite those with opinions on the lack of worth of nursing experience to look at this paper which summarizes the 2000 NONPF meeting. While it is 7 years old many of the same issue were revisited in the 2007 meeting.

    http://www.medscape.com/viewarticle/424117

    David Carpenter, PA-C
  9. by   mvanz9999
    But who EXACTLY is becoming an NP with less than 2 years of experience? If you read Barbiegirlnurse's post, she states "When I went to get my MSN, I went straight through after my BSN. I did it over three years so that I could work some and make enough money to pay for school."

    That's 3 years of experience.

    How about model-schmodel? This is the primary problem with change in healthcare. I have posted about this a million times before. Healthcare is a dinosaur when it comes to change. Statements like "this model has existed for 40 years" have no meaning, because they do not define whether that model is the most efficient or best method of training, but they do demonstrate the current paradigm of "we've always done it this way". Which is a ridiculous reason to continue doing something.

    The report you provide indicates that a task force recommends a minimum of 1-2 years of clinical experience for NEONATAL NURSE PRACTITIONERS. Does this translate to other NP specialties? I don't know, the question isn't addressed. (As an aside both myself and Barbiegirlnurse will have the 1-2 years of clinical experience prior to graduation anyway).

    The only other specialty addressed is Acute Care Nurse Practitioners, which speaks nothing about pre-admission clinical experience. It does recommend that more clinical hours should be incorporated into the training program.
  10. by   core0
    Quote from mvanz9999
    But who EXACTLY is becoming an NP with less than 2 years of experience? If you read Barbiegirlnurse's post, she states "When I went to get my MSN, I went straight through after my BSN. I did it over three years so that I could work some and make enough money to pay for school."

    That's 3 years of experience.

    How about model-schmodel? This is the primary problem with change in healthcare. I have posted about this a million times before. Healthcare is a dinosaur when it comes to change. Statements like "this model has existed for 40 years" have no meaning, because they do not define whether that model is the most efficient or best method of training, but they do demonstrate the current paradigm of "we've always done it this way". Which is a ridiculous reason to continue doing something.

    The report you provide indicates that a task force recommends a minimum of 1-2 years of clinical experience for NEONATAL NURSE PRACTITIONERS. Does this translate to other NP specialties? I don't know, the question isn't addressed. (As an aside both myself and Barbiegirlnurse will have the 1-2 years of clinical experience prior to graduation anyway).

    The only other specialty addressed is Acute Care Nurse Practitioners, which speaks nothing about pre-admission clinical experience. It does recommend that more clinical hours should be incorporated into the training program.
    Healthcare is a dinosaur because it is ultimately about patient safety. You can propose your new model and try it out. A few hundred bodies later you find out you are wrong. If anything there has been insufficent examination of these new NP training models. Are they producing competent safe NP's. Nobody knows. You really don't know how many direct entry NP's are practicing or how many are passing their certification exams because the NP certification and training is so fragmented. If you think that I am the only one that this this then you should take a look at this:
    http://www.nonpf.com/NONPF2005/Meeti...dayPlenary.pdf

    This is from the 2007 NONPF Conference

    Reasons Presented for a Future APRN Model:
    Lack of common definitions related to APRN roles
    Lack of standardization in programs leading to APRN preparation
    Initial accreditation/approval necessary
    Blended programs with variable clinical hours
    Inconsistent Master’s Essentials compliance
    Programs graduating students that cannot be licensed

    These concerns from what I have heard come mostly from the BONs who are concerned that in the light of day they cannot demonstrate that NPs meet the recommendations of the Pew commission:
    Emphasized the need for regulation to be evidenced based, consistent, and protective of patients.

    So your cavalier dismissal of the "model" is not evidence based. You have a feeling that you can provide care in a new model. Maybe you can, but proving it is another thing. Obviously at the very least the educators and the BONs are concerned with the product. An example of this is your "three years experience". While you will have been working for three years, three years of part time while going to school is not three years experience. From the educator side you can read this as the one of the major reasons for the DNP. From another point of view, you can make up for the greater experience that the early NP's had by extending NP training.

    David Carpenter, PA-C
  11. by   jjjoy
    Quote from jjjoy
    Is the basic idea that given a basic foundation (either pre-reqs or a related bachelor's degree) any mid-level provider can be trained up in 2-3 years versus the 5+ years for MDs (counting from the start of med school)? That could be the case. And if so, that will constitute a major shift in how people enter the practice of medicine (meaning diagnosing and treating disease processes). Interesting times!
    By this, I mean that PA and MD programs generally require a certain level of prereqs that nursing programs do not. While nurses may have taken a full year of O Chem, or upper division microbio, most programs only require a one term intro course, whereas PA prereqs more closely mirror med school requirements. Since an NP can work at the level of PA without having to take the equivalent coursework and without having to invest several years gaining experience as a nurse in a specialty area, then that's a major shift in how one qualifies to practice at that level.

    One can argue that those "weeder" courses are just that and not really necessary and I could certainly see that. Again, though, it's still a significant shift in required education to function in that scope as those courses are the ones that often disuade people from pursuing medicine (cuz if they don't perform well in them, they'll have a hard time getting into medical school.) Thus, if the direct-entry NP programs are successful, I imagine the competition for admission will only continue to grow.
  12. by   jjjoy
    My nursing school taught nursing theories involving nurses helping patients acheive a quality of life, or maintain the highest level of functioning, etc.

    Certainly, prescribing treatments fits in there. I'd imagine, though, that when a facility hires an NP or PA, they want someone who will quickly dispense with the basic cases leaving the more expensive doctors' time to deal with more complex cases. They aren't hiring an NP for them to practice more holistically. Diagnose that ear infection and move on. Of course, it's ideal if one can assess the parents' situation, if the child is developing appropriately, etc, but I'd think a good MD or PA would do the same - they don't take that time because of limited resources. Traditionally, NPs could take more time with patients as they were paid less than MDs, but as NPs become more commonplace, I can imagine they get constrained by the same limits that conscientious MDs and PAs do.

    Of course, bedside nursing doesn't fit the nursing school description either, does it? Nursing school acute care nursing is also about holistic care, therapeutic listening, etc when the reality is more about monitoring for changes in status and getting a slew of tasks done (medication administration, walking post-op patients, prepping patients for tests, etc) -anything else is cut out when time is limited (which is most of the time).

    I apologize for my less than linear postings. I do find such topics very interesting!
  13. by   Barbiegirlnurse
    In response to the comment that PA's require a certain level of upper level classes in their prerequisite training, so do nurses. For a BSN degree, I took two whole years of prerequisites including statistics, Anatomy and physiology, advanced A and P, Microbiology, and chemistry, among other classes. The last two years, I took only nursing courses. (They are by no means easy). I am offended that someone would compare PA preparation to undergraduate nursing work and incenuate that BSN course work is much easier. If we want to play fair, lets not get into comparing apples and oranges because a PA is clearly not a NP. There are so many differences.

    Additionally, when the paradigm shifts and all NPs move to the DNP, where will that leave PAs. Are there any professional organizations for PAs? To the best of my knowledge there are not. They are governed and protected by the AMA. Where will this shift in education level leave them. Nurses have their own professional organization, (ANA) that governs and sets the standards of practice. It is time for PAs to stop arguing with nurses and NPs and try getting some some autonomy from the AMA. This should be more of a concern for individuals in this field.
    Last edit by Barbiegirlnurse on May 31, '07

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