Becoming an NP with little to no nursing experience?? - page 28

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   core0
    Quote from bree124
    honestly, i hear this argument on this board frequently, and it doesn't make sense. it is inaccurate.

    an advanced degree in nursing does not require experience as an entry level nurse. the experience might be helpful, and for some people necessary - but it is not required legally or, for the majority of people who choose a direct-entry option, intellectually.

    an "advanced practice nurse" is, by definition, a nurse who holds either a master's or a doctorate. it is not, by definition, someone who has been a nurse for _ years and then got a masters or a doctorate. you are advancing upon your education. you are an advanced practice nurse because you are practicing in a role that is, by definition, advanced beyond the role of an rn.

    actually an apn is an rn who has advanced education, knowledge, skills and scope of practice. there are requirements now for nps to have a master's but this is a relatively new requirement and more than 1/3 of the nps in practice do not hold a masters or doctorate. in fact there are still three schools that do not issue masters degrees.

    the development of the association of competence with the degree is has happened within the last 10 years. previously there were divergent degrees and practice was measured by clinical competence which built on nursing foundations. i would suggest that by disregarding the role of the rn you do not understand the foundations of the profession.

    i have the utmost respect for people working in the nursing field, but the cynical attitudes and downright disrespect for people who are non-nursing de msn majors is frustrating. the reason we are able to complete these de msn programs in three years is that we possess these skills already in another field, and are able to translate that experience into nursing and adapt quickly.

    while some graduates may have skills in other areas, others are applying immediately after a bachelors degree. it is difficult to see what skills in another field. just as you stated there is no requirement for nursing, there is no requirement to have any other life experience prior to a de np program.

    the fact is, these programs are here, and they aren't going anywhere. the nurses that graduate from these programs are prepared individuals who will, of course, still need on the job training. just as an np who was an rn will need. we are all united by the fact that we are nurses (or in the process of becoming nurses).
    bree
    you state you are united in the fact that you are nurses while stating that nursing experience is not valuable or useful (to paraphrase your initial statement). nursing is united by a common experiental framework. the de programs disregard this.

    you have stated that students are prepared but there are no studies that compare the preparation or post graduate experiences of de students vs. traditional students. that is the real question that needs to be answered (in my opinion).

    david carpenter, pa-c
  2. by   traumaRUs
    David - I agree with your post above. Also, there have been no studies that I am aware of that research the availability of jobs for the DE APN versus the traditionally educated NP.
  3. by   core0
    Quote from traumaRUs
    David - I agree with your post above. Also, there have been no studies that I am aware of that research the availability of jobs for the DE APN versus the traditionally educated NP.
    Little bit of a rant here. I will state that I have some interest in the NP profession in terms of competition but my concerns come from a medical delivery standpoint.

    The APN educational model has serious shortcomings for students as a consumer. Looking at the RN model for example, RN students know what the NCLEX pass rate is for all programs. Similarly medical students know what the step I and II pass rates are for their medical school. This information is not published for NP programs. Ideally an educational consumer needs at least two pieces of information when looking at a program. What is the completion rate of the program (ie. what chance do I have of completing the program) and what is the certification pass rate (ie what chance do I have of becoming certified if I graduate). You can infer the overall dropout rate from published statistics (it appears to be around 25-30%) but I am guessing that there is wide variation among programs. As to the certification rate there is absolutely no published data at all.

    The second issue with the APN educational model is the lack of validation in changes in educational model. The original model (ie Silver and Ford) was validated both as a delivery and educational model. Over the next 40 years a number of changes were made in the educational model (decreased didactic hours, online programs, direct entry programs) with no validation that these programs were producing equivalent providers. The move to the DPN promises to affect this even more profoundly. There has been little attempt to look at how this will directly affect the practicing NP. It seems that the educational model is moving without seeing how it will affect the profession.

    I think there a number of areas that need to be looked at. DE vs. Traditional is just one of them. The problem is that it is probably in the best interest of the NP programs that these studies not be done (my cynical view). In my opinion the APN profession (nurses working in the field) needs to take charge of itself. The only APN (in some states) that seems to have control of its destiny (in my opinion) is the CRNA. Their success in pay equality and independence is unequaled among APNs.

    David Carpenter, PA-C
  4. by   traumaRUs
    David - I do agree to some extent with your rant. I have always been interested in the PA field because it follows the medical model of care vs the nursing model. However, alas, life interferes, we age, life changes our decisions for us and voila...we are APNs - lol.

    While I won't say that the nursing model is the end-all to nursing education, I will say that with the standardized licensure (NCLEX) and the national certification requirements, it does provide somewhat of a bar for nurses.
  5. by   Bree124
    Quote from traumaRUs
    Sunnyjohn - that is correct. However, what Bree stated was:

    "An "advanced practice nurse" is, by definition, a nurse who holds either a master's or a doctorate. "

    This was w/o mention of licensure as RN and/or national certification. That is where the discussion centers.
    I have looked extensively into many DE MSN programs, and I have yet to come across one that does not have an RN component built in. I assumed that it was commonly known that the RN is obtained along with the MSN (at least in every program I've looked into, obviously I can't generalize that for every program out there).

    Also, Core0 - your "paraphrase" of what I said is not at all accurate. I think nursing experience is extremely useful, as well as valuable. However, I think there are areas of specialization that do not require years and years of RN work in order to be competent as an NP. I certainly would not think of becoming an acute care NP in a hospital setting without first working as an RN in ICU. However, there are other specializations where the scope that you practice in is just not the same as the scope your RN experience would be in. There are many NP's around here who work in "Minute Clinics," and I don't think years and years of RN work is essential to that particular position. Helpful, sure. However, I don't think a traditional MSN graduate would have a huge advantage over a DE MSN in this area.

    Also, as far as someone graduating with a BSN and going straight into an MSN program - yes, this happens, but it's not that common. For the program that I am planning to attend, the youngest student they have had was 24, which is still most likely at least a year or two after college graduation. The median age is early-30's. The application states that preference is given quite heavily to people who have succeeded in a first career, and are not choosing nursing simply because they don't like their current career.
  6. by   core0
    Quote from bree124
    i have looked extensively into many de msn programs, and i have yet to come across one that does not have an rn component built in. i assumed that it was commonly known that the rn is obtained along with the msn (at least in every program i've looked into, obviously i can't generalize that for every program out there).

    i have yet to come across a state practice act that would allow you to practice as an apn without an active rn license. also all the certifying organizations require an rn license. i think the point that both traumarn and siri were making is that the np is not defined by the degree but by the rn and training.

    also, core0 - your "paraphrase" of what i said is not at all accurate. i think nursing experience is extremely useful, as well as valuable. however, i think there are areas of specialization that do not require years and years of rn work in order to be competent as an np. i certainly would not think of becoming an acute care np in a hospital setting without first working as an rn in icu. however, there are other specializations where the scope that you practice in is just not the same as the scope your rn experience would be in. there are many np's around here who work in "minute clinics," and i don't think years and years of rn work is essential to that particular position. helpful, sure. however, i don't think a traditional msn graduate would have a huge advantage over a de msn in this area.

    personal note: personally i feel that minute clinic type organizations for a number of reasons are not the proper practice of medicine by any provider (just to get my personal biases out front).

    the rub is that there is no regulation or direction on what is appropriate for de. if you google [acnp direct entry nurse practitioner] the first page will show at least four de acnp programs. while you admit that this is poor policy there are others that apparently disagree. while there is sufficient latitude to allow acnps to work in non-critical care areas, the employment prospects of these particular de nps is unknown. the ability of these graduates to practice in critical care medicine is also unknown.

    looking at the minute clinic issue unfortunately (or fortunately) there is not currently a "minute clinic" np certification. if you are certified as an fnp for example you may work in a variety of situations which range from minute clinic to complex medical conditions. family practice involves much more complexity than algorithm driven episodic care (which i believe describes a minute clinic). the army uses medics (with 8 weeks of training) for similar positions.

    speaking with people that run these clinics they are not looking for new grads, but people with significant experience. not to denigrate lack of medical experience, but you don't know what you don't know. part of this knowledge base is medical experience (in my opinion). one of the advantages of nursing experience is to know what sick looks like.

    also, as far as someone graduating with a bsn and going straight into an msn program - yes, this happens, but it's not that common. for the program that i am planning to attend, the youngest student they have had was 24, which is still most likely at least a year or two after college graduation. the median age is early-30's. the application states that preference is given quite heavily to people who have succeeded in a first career, and are not choosing nursing simply because they don't like their current career.
    i would maintain that compared to traditional np programs this is young (at least from personal observation). whether this is good or bad i really have no opinion. the one good point of the de is that not having high base nursing salaries to compare to they may be more willing to accept lower salaries that are seeming to predominate the fnp market (actually not sure if this is a good point or not). the issue is that nobody really knows what is happening to these grads. i can show you anecdotal evidence that (for what that is worth) that these grads are not finding employment (based on comments here and other places).

    one final point. to paraphrase you once again, you stated that preference is given to people who have succeeded in a first career and are not choosing nursing because they don't like their current career. my thoughts are that people in de programs are not choosing nursing as a career but choosing nurse practitioner as a career. this is in contrast to those in the traditional model who first chose nursing as a career then chose nurse practitioner as a furtherance of that career. i think that this is a subtle but important difference between de and traditional routes.

    david carpenter, pa-c
    Last edit by core0 on Sep 18, '07 : Reason: hmm sentence didnt make sense
  7. by   traumaRUs
    And believe me, the Minute Clinic is not where you want to be as a new APN! You are by yourself with patients whom you do not know - everything is based on your assessment skills. This DOES indeed take years to develop. Its not just about looking in a child's ear and writing a script for amoxicillin - you must be aware of the true differential diagnoses.

    I'll come right out and say it: "DE APNs have no place in today's health care delivery system."

    The schools are selling a product (education) and they only care that you can pass the NCLEX and national certification. They are not realistic in producing APNs without RN experience.

    Nursing is a second career for me also - I was in broadcasting for 10 years. What would make me think that I could start off as Katie Couric's co-anchor?
  8. by   core0
    Quote from traumaRUs
    And believe me, the Minute Clinic is not where you want to be as a new APN! You are by yourself with patients whom you do not know - everything is based on your assessment skills. This DOES indeed take years to develop. Its not just about looking in a child's ear and writing a script for amoxicillin - you must be aware of the true differential diagnoses.

    I'll come right out and say it: "DE APNs have no place in today's health care delivery system."

    The schools are selling a product (education) and they only care that you can pass the NCLEX and national certification. They are not realistic in producing APNs without RN experience.

    Nursing is a second career for me also - I was in broadcasting for 10 years. What would make me think that I could start off as Katie Couric's co-anchor?
    You have obviously missed my cake and steroids lecture. If they come in sick give them cake (or steroids). If they come back give them the other one. This actually goes to the fact that most presenting symptoms are self limiting. The hard part is figuring out what is presenting as self limiting when it is not.

    The good part about minute clinics is that they work off algorithms. The bad part is that they work of algorithms. From what I have seen of the one clinic that I have looked at the NPP uses a computer algorithm to direct the care. We used a similar system in the army.

    It works like this:
    Primary complaint ST > can patient bend neck Y> next N> see PA. It goes on like this through the entire algorithm. At the end you usually hand them a cold pack and send them home. The problem is that in a minute clinic your patient base is not young and healthy.

    I think that this will not be a long lived phenomenon. Statistically there will be a problem. This is no different than any other practice making mistakes. The issue will be the publicity. There are any number of people that will be happy to say I told you so when something bad happens. Since there are more NPs working here than PAs statistically the most likely headline is going to be "CVS nurse kills child". At the first hint of bad publicity my thought is that the drugstores will drop this like the plague.

    My other thought is what is going to happen if a patient does not follow guidance. We all know that we are liable if a patient does not complete a test or course of action (our practice documents this with three calls and a registered letter advising this is a bad idea). What happens if a minute clinic NPP tells a patient to go to the ER and the patient does not with a bad outcome. I think the model has underestimated the liability here.

    I agree that the schools are only interested in selling the education. I am not sure that there is data to support the fact that they care if the student passes certification (or becomes gainfully employed).

    David Carpenter, PA-C
  9. by   traumaRUs
    lol David! My hubby was in the Air Force for 23 years and I was in the Navy for 3 years. My experience with mid-level practitioners has been for the most part very positive. However, I do agree that it is more than using a computer program to treat patients. If that were the case, we could just put our hand in the DVD player and get our medical care via hand prints!
  10. by   core0
    Quote from traumaRUs
    lol David! My hubby was in the Air Force for 23 years and I was in the Navy for 3 years. My experience with mid-level practitioners has been for the most part very positive. However, I do agree that it is more than using a computer program to treat patients. If that were the case, we could just put our hand in the DVD player and get our medical care via hand prints!
    Its like we used to say about Army medicine; its a good system if your not sick. It does well with self limiting conditions (those that respond to benign neglect). It also does well with acute conditions. What it has problems with is the ones that fall in the middle. Serious conditions that mimic self limiting conditions for example. There is just not enough continuity or urgency in the system to properly deal with this.

    My current situation is a little different. Today in clinic I saw six patients and admitted three (this has become known as "winning clinic"). I just assume that they are all going to crash and burn and plan accordingly. Also we have great nurses that are good at pointing us at the ones that are crashing and burning now as opposed to those who are going to wait til later in the day.

    This is where you really appreciate nursing experience. We have some new nurses that are getting better but I have some nurses that I like to eyeball the patient as they wander by and some that I just wait until they have the patient ready. I am not really sure what makes good nursing experience but to paraphrase Justice Stewart I know it when I see it.

    David Carpenter, PA-C
  11. by   traumaRUs
    And that nursing experience is what I fall back on. I have been an APN for a year and don't always know what is wrong with my patient. I do however, have the assessment skills honed by 13 years as an RN!

    Without those basic, I'd be scared of me - lol.
    Last edit by traumaRUs on Sep 29, '07 : Reason: clarity
  12. by   twirlbaby
    I graduated BSN school in 2001 and started MSN school in Fall 2002. I too, did not have a whole lot of nursing experience, but did have years of medical background. I started out as a surgical tech. I think if you feel emotionally, spiritually, and physically ready to commit, then you will be able to do it.
  13. by   Atl_John
    That makes me feel better twirlbaby.....I sent in my application to UAB SON one week ago for their ACNP/RNFA program. Glad to hear that not having so much experience with nursing but past medical experience was most helpful.

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