Becoming an NP with little to no nursing experience?? - page 23
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
Jun 10, '07My point is that diagnosing involves determining the cause of certain problems. For example, mechanics diagnose auto problems. They assess the vehicle (listen to sounds, inspect the parts) and determine to the best of their ability what is causing the reported problem.
Nurses in general aren't in the business of determining what is causing a problem. They need to recognize problems and be able to institute appropriate care to resolve problems (eg administer O2 if sats are low) but they don't formally diagnose the cause of the low sats. And I realize that nursing diagnoses are NOT medical diagnoses. A nurses may assess that a patient is having emotional difficulties and they can take steps to assist the patient in that area (therapeutic listening, remind the patient of chaplain services, psych referral, etc) without needing to diagnose anything. Assessing that the patient is in need of psychosocial support isn't diagnosing. Assessing that the patient might benefit from being listened to isn't diagosing. And so on.
Acute care nurses are in the business of assisting patients in overcoming known problems (by administering treatments, monitoring progress, helping them cope with change, etc) and avoiding known potential complications (pressure wounds, accidental falls due to an unsteady gait, ineffective coping). Nurses use their assessment skills to determine what nursing interventions the patient may be in need of.
Such nursing actions (assessing and determining interventions) are crucial to patient health and recovery but it doesn't really seem diagnostic in nature.
And Barbiegirlnurse, I appreciate your thoughtful and stimulating responses. These are enjoyable exchanges!!Last edit by jjjoy on Jun 10, '07
Jun 10, '07Quote from core0I was wondering about this myself. After I had done a few careplans on the Ackley Care Plan Generator [on evolve online], I was starting to get the hang of careplans and actually was starting to feel like they were useful in directing nursing care.At the risk of seriously derailing this thread. I find Nursing Theory intellectually dishonest. Nursing theory grew out of the desire to show the worth of nursing versus medicine. I have no problem with this and I think that nursing interventions have long shown their worth as a separate practice outside of medicine.
However, in developing nursing theory, nursing was force to use terminology to define itself separately from medicine. This resulted in developing a language which is almost impenetrable to both those within and outside the profession. Furthermore this is hampered by taxonomy that is even more difficult to comprehend. For example Alteration in comfort related to trauma as evidenced by patient reporting to discomfort. Or you can say patient reports pain from a broken leg. There are many nursing interventions that can address this and they work quite well. However, the amount of work that goes into documenting nursing theory is immense and in my opinion is wasteful.
My favorite is Alteration in cardiac output: decreased. Or you could say low blood pressure. In an effort to prove that they are outside of medicine they cannot "diagnose". Hence the language. There is no reason that nursing cannot use medical diagnosis and implement nursing interventions. There is no need to reinvent the wheel.
There actually was a group called nurses against nursing diagnosis. There is also a lot of nursing literature arguing against nursing diagnosis. I had a real problem taking classes and parroting information when I didn't believe in the concept.
David Carpenter, PA-C
Then I realized it would be much more efficient to take the medical diagnosis, have possible complications listed under the medical diagnoses, then tailor the interventions to fit both the medical diagnosis and possible complications.
Seems like it would still allow the nurse to direct and focus their care while eliminating the the nursing diagnosis step.
Jun 10, '07Quote from traumaRUsI agree with traumaRUs. How many of us would like a new APRN who has never worked as a nurse taking care of our love one? Or ourselves for that matter. I know we were all taught "how to" do a basic assessment, but it certainly did not mean we knew what we were assessing or being able to pick up any abnormalities. I learned very little in nursing school about actual patient care. Everything I have learned has been hands on experience at the bedside.Advanced practice nursing - still has the "nursing" part in it. Being an RN isn't about tasks like putting in catheters and/or IVs, its about having basic assessment skils to know when someone is sick. This is the most important tenet to take from being an RN. You have to know when you are out of your league or when you need to be a strong advocate for your patient. I just don't think that entry-level to practice APNs have the assessment skills. Its not something taught in school - it comes from years of experience.
I don't think traumaRUs is trying to put anyone down. There are very valid points in what traumaRUs is saying.
Jun 11, '07Quote from zozzy777I agree with this. While there may be some nursing programs that do graduate students with more exposure to the variety of "real-life" presentations and situations (versus text-book examples) and opportunties to put in to practice what they're learning, it seems that the norm is that nursing school is that when it comes to CLINICAL COMPETENCE, graduating and passing the NCLEX grants to license to START practicing what one learned in school. I've been comparing it to a driver's license lately. While you need a license to drive on a busy freeway you don't have to be competent in driving on a freeway to be granted a driver's license.I know we were all taught "how to" do a basic assessment, but it certainly did not mean we knew what we were assessing or being able to pick up any abnormalities.
Jun 11, '07Quote from zozzy777*** Then I would assume that you would also be uncomfortable with a PA caring for you. After all NPs and PAs do much of the same work and many PA schools graduate people who never touched a patient until their school clinicals. Of course PAs get more clinical time than NPs do and maybe that counts for something.I agree with traumaRUs. How many of us would like a new APRN who has never worked as a nurse taking care of our love one? Or ourselves for that matter.
Jun 11, '07Can I get both....?
To be honest, this is my experience....if I need some delicate surgery or other highly technical procedure, I'd like the experienced doctor please.
If I have general and/or vague complaints of unknown origin, I would prefer a PA, NP, or medical student. Yes, I said medical student.
The reason for this, in my experience, is that students, NPs and PAs generally spend for more time with you if you only have vague/generic complaints. I can recall the names and faces of all the NP's and PA's I have seen, while I cannot do that with the doctors.
I also enjoy being involved with students or any medical professional needing training. They need to start somewhere and in my opinion are overly cautious as they are new (which is a good thing).
Would I trust a new APRN or a new PA or a med student with my care? Yes, absolutely. I always seek out care within large teaching environments BECAUSE of the students and other professionals in training. I believe this gets me the best care. Also be assured that there are far more experienced people in the environment if they are required, but I have decided I am done with seeking treatment from doctors.....
I realize this is only my opinion, but I've had one doctor too many. I would certainly not trust my health to my mechanic, landlord, or a sous chef, but would definitely do so with any trained healthcare professional of any experience. After all, they know more than I do at this point.
And now back to our regularly scheduled topic.....
Jun 11, '07I do think the type of clinical education students have is important. It's my understanding that PA clinicals are more intensive than most nursing program clinicals.
My own experience with nursing school was that our clinical education only gave us an introduction to nursing. We had just two patients for each clinical day and often had to wait around for our instructor in order to do most anything besides AM care. Our lengthy case plan assessments demanded a detailed physical and psychosocial interview that we had hours to complete - no preparation for having to quickly assessment patient needs in just a few minutes. We were in each different area just 5 weeks, no more than 10 clinical days.
Two months of orientation, on the other hand, with one-on-one preceptoring and working a full-time schedule, was jam packed with learning. I still had TONS more to learn but I felt I learned more in that time than in the bulk of my nursing school clinicals. Of course, actually working will always be different from the student experience, but I personally don't think nursing students should have to wait until they have graduated and are employed to get this kind of intensive exposure.
Jun 11, '07You don't start a marathon by getting up and running 26.2 miles. You start by slowly jogging around the block. If you were to attempt to learn at break-neck speed, you'd have learned a lot less, I think.
Honestly jjjoy, I have no idea which side you are on. LOL!
Jun 11, '07Actually, starting floor nursing IS like being asked to run a marathon without any endurance training. In clinicals we had only a fraction of full RN responsibilities and had to scrounge around for opportunities to get basic skills checked off our skills list. But once you're hired on as an RN on a hospital unit, they generally give you 6-8 weeks to figure out how to handle the full RN responsibilities on a full patient load as well as scrounge around for opportunities to practice skills (such as IV starts). Once you're off orientation, the other nurses are there to help out, but they have their own full loads and generally don't appreciate having to teach too much to the newbies. Starting floor nursing is like going from practicing untimed miles to running a half-marathon while juggling flaming torches... okay maybe not that bad, but still.
My point is that the clinical component of many nursing programs don't give the kind of experience that would substitute for having worked as nurse for sometime.
Jun 21, '07I graduated from a school that had a graduate entry program. (Yale) I originally was very frightened at the idea of non-nurses becoming APRNs....and I still am for the most part....consumers do not know to inquire about this when receiving care. However, these programs have been around a very long time, so something about them must be working. You need to do whatever will make you happy regardless of what negative thinking people tell you about job opportunities - if you believe in what you are doing, the jobs will come. I think it is important that you have been a medic - I am a past ER nurse and I know what you guys do, etc.....I have worked with many ER techs that were far more capable than many of the nurses "supervising" them. Your title does not always equal your knowlege/abilities. You are more prepared to enter a program than the post-literature majors I went to graduate school with! Yale was very focused on their non-nurse students and the few RNs that WERE there, generally felt out of place and frustrated with the whole thing. As an RN, I would not choose to go to a school with such focus, but at the time....didn't know any of the right questions to ask.
Go For It!
PS- I heard after about 2 years experience, you mostly wouldn't be able to differentiate a non-nurse from an post-RN APRN - but I haven't researched that claim.
Jun 21, '07I must apologize first as I have not yet read this article. For the sake af at least one citation on this topic see below: I know this author has written more than one on this topic. She is a nurse in acute care and faculty in a direct-entry program. I'll try to get it in PDF and post a link if possible.
1: Am J Nurs. 2006 Jan;106 Suppl 1:32-3. Links
We'll Leave the Light On for You: There's no proscribed path to becoming a nurse.
Jun 21, '07Faculty in these types of programs may not have an exactly unbiased opinion of the activities they participate in.....like all of us.
Jun 21, '07Of course, that almost goes without saying. I did find the PDF and this is not a study, rather, a discussion. So take it for what it is worth.....