Becoming an NP with little to no nursing experience?? - page 33

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   jjjoy
    Quote from mvanz9999
    My opinion is that bedside care is what makes a nurse a nurse. It's not something you learn overnight, it comes slowly over time, and I am of the opinion that you need to learn bedside care in the process of becoming a nurse.
    That's a reasonable opinion based on what sounds like a good deal of research into the field before starting nurse training. My personal experience as a pre-nursing student, a nursing student, a graduate nurse and member of the public at large, is that many influential nurse leaders and student recruiters are actively working to remove the association of nursing with bedside care. They emphasize that nursing emcompasses much more than that and that bedside care is just one of many possibilities, not that it is the foundation of those other possibilities. And the minimal, circumscribed bedside experience that one gets as a student in many nursing programs doesn't seem like it would be sufficient to create a strong foundation for other areas.

    I could see where nursing might be able to differentiate itself from other health care providers by approaching patients "from the bedside" (comfort, hygiene, 24/7 dealing with illness) as opposed to "from the office" (diagnose, prescribe, send home). But the bedside nursing education an RN program gives goes into much more than that. Much of it is about working on an acute care hospital floor and the tasks and responsibilities therein. Thus, skills tests on bedmaking, bathing, hanging IVs, etc. It's one thing to teach the perspective of bedside nursing; it's another to train someone to be a bedside nurse.

    I think this is where schools are confused about their purpose. Is it to train bedside nurses? Hospitals would say yes, schools might say no. Is it to train them to "think like a nurse"? The schools would probably say yes. But do you NEED to practice making beds and hanging IVs, etc in order to "think like a nurse"? And if you haven't practiced as a bedside nurse outside of as a student, will that suffice in setting a strong foundation as "nurse" as opposed to some kind of mid-level provider that isn't a nurse? I don't know. Just thoughts and questions!

    Not related, but just a thought in regard to the comment about law school. Note that law students learn about different kinds of law in school but they do not actually practice the different areas of law while in school - as nursing students seem to be expected to - at least to some degree - that is getting skills checked off and taking on (often quite circumscribed) bedside nursing responsibilities for patients in various areas.
    Last edit by jjjoy on May 22, '08
  2. by   mvanz9999
    Ah! A nicely written post. And I see the confusion.

    I would then go with the idea that it is important for nurses of any level to be trained to "think like a nurse". I perhaps incorrectly associate those bedside nursing skills with training to think like a nurse. Which I guess might or might not be the case, I have neither the experience nor the research to answer that question.

    While basic skills may not be necessary or even helpful in training one to "think like a nurse", I find doing these immensely helpful to me. It is not the performance of skills per se, but it is interacting with patients in often intimate ways.

    I have always felt that my training focuses less on skill performance and more on patient interaction. The focus of my clinicals has been on assessment and patient interaction while performing other routine tasks. The tasks have not really been the end goal.

    As I have pointed out in previous posts, I cannot speak about any Direct Entry programs other than my own. In MY DE program, we spend 3-4 years working as an RN WHILE completing the NP portion of training. At the end I will have 3-4 years of experience working as an RN (not a student) and that should provide a great deal of perspective from an RN point of view. I also don't know whether this is necessary or not, but this is the path that I have chosen.
  3. by   amzyRN
    I am in a second degree accelerated BSN program. What I think would be most applicable to advanced practice is exposure to a vast array of persons with different illnesses. Assessment skills can also be applied as I think it is an art and takes time to acquire sharp skills. I think that nurses who have a couple more years experience may have better assessment skills, just b/c they've seen more. But an NP can also build those skills with practice also. I think the actual doing is important. Other skills like bed making, giving bed baths (which are delegated to CNAs lots of times) are irrelevant to practicing as an NP. The physical assessment, pharmacology, and patient contact gained as an RN are very valuable skills and very applicable to NP practice. I would say that RN experience would be relevant to PA or even MD practice if the person were entering any of those programs. I'm not convinced it is required though.
  4. by   yellow finch
    Interesting comment from my current preceptor... she won't take students if they have never worked at the bedside because she feels that it is not her duty to "train" the NP student how to see and assess the patients. They should be ready to go without her having to teach them things they learn at the bedside because the NP student is an advanced practice nurse. If the school has a direct entry program she simply won't take the students... one such school in my area is Emory.

    This preceptor is the best one I've worked with so far. She's highly competent and easy to get along with. I'm glad to have snagged her! I have to wonder if any DE students have come across this sort of stumbling block?

    Just wanted to add this to the conversation since it came up the other day.
  5. by   bluesky
    Quote from mvanz9999
    I will assume that you accidentally quoted me and this is not a response to me directly. If it is, you have grossly misread my posts or I am misreading yours.

    You state "NP's with no bedside experience vs. those without". You're comparing two of the same thing.

    My opinion is that bedside care is what makes a nurse a nurse. It's not something you learn overnight, it comes slowly over time, and I am of the opinion that you need to learn bedside care in the process of becoming a nurse.

    As far as characterizing RN's as "hanging IV bags and delegating tasks"...I have said no such thing. I only reference these as referenced by the OP. Is hanging IV bags and delegating tasks part of being an nurse? Yes. Is that basically all there is? NO! The OP wants to cut these types of activities out, and I'm asking where someone would draw the line.

    Would you like me to post logs of daily activities, or cite the Registered Nurse Scope of Practice? Or perhaps post summaries of all the time I spent shadowing or talking with RN's and NPs before entering nursing school?
    Sorry, hun, I wasn't in any way referring to your comments. I was directly speaking to the post that I will now quote verbatim;

    "As someone with no intention of working as a bedside RN , I feel that it is plain silly to be learning about bed-making and hanging IV's and learning how to designate to a care partner etc. Not because it is beneath me, but because it is taking time away from learning skills I WILL be needing and using as an NP. The point is, the time could be used to have classes on what I WILL be doing instead of doing this back door way of becoming a mid level provider"

    All my comments were directed to this post, not any of yours... ; )
  6. by   mvanz9999
    Oops! Sorry for the confusion.
  7. by   amzyRN
    I agree that hanging IV's an bed making (if it's still really done by an RN, I'm not sure, not on the day shift anyway!) will not contribute to skills necessary to becoming a mid level provider. But assessment skills of an RN and learning about different diseases and their treatments, working with MD, RTs, RDs, etc. can add a lot to the practice as a mid level. At least this is what I think.
  8. by   ANPFNPGNP
    Quote from jzzy88
    I agree that hanging IV's an bed making (if it's still really done by an RN, I'm not sure, not on the day shift anyway!) will not contribute to skills necessary to becoming a mid level provider. But assessment skills of an RN and learning about different diseases and their treatments, working with MD, RTs, RDs, etc. can add a lot to the practice as a mid level. At least this is what I think.
    It depends on what type of NP you're talking about. Hospital experience should be MANDATORY for an ACNP, but certainly isn't necessary for one working in primary care. I have precepted several NP students who have years of experience in the hospital and this has NOT helped them in the primary care setting.

    Just yesterday, I had an ICU nurse/NP student ask me what type of medication "Zyrtec" was and she didn't even know the difference between Decadron and Depot Medrol. In fact, she knew very little about any of the medications that we prescribe in primary care and she had just completed an Advanced Pharmacology class - what are they teaching these students??? The kicker was when she informed me that she had no intention of practicing in primary care, but was going to work in the hospital upon graduation! I told her that she would need to attend an Acute Care NP program in order to do that, because FNP's aren't certified/trained to do that! She was completely dumbfounded! Where are they getting these students nowadays?
  9. by   CraigB-RN
    Quote from ANPFNPGNP
    I told her that she would need to attend an Acute Care NP program in order to do that, because FNP's aren't certified/trained to do that! She was completely dumbfounded! Where are they getting these students nowadays?
    First of all there are just some people who don't have a clue, no matter what their background was. I've given plenty of Zyrtec and both decadon and depo to inpatients.

    I can't tell were you are from your profile, but were I'm at all the NP's taking care of inpatient are FNP's. Yes there are some states that are changing that, but as of right now they are in the minority. There are some liability carriers that are limiting that for certain hospitals.

    You should be careful what your telling your students, or at least how you tell them.
  10. by   ANPFNPGNP
    Quote from CraigB-RN
    First of all there are just some people who don't have a clue, no matter what their background was. I've given plenty of Zyrtec and both decadon and depo to inpatients.

    I can't tell were you are from your profile, but were I'm at all the NP's taking care of inpatient are FNP's. Yes there are some states that are changing that, but as of right now they are in the minority. There are some liability carriers that are limiting that for certain hospitals.

    You should be careful what your telling your students, or at least how you tell them.
    I live in Texas and that's where I went to school for my FNP certification. We were told time and again that FNP's are certified/licensed to work in primary care only. According to the TX BON, we have to practice in the scope set forth by the certifying entities, which is the AANP and ANCC. Both the AANP and ANCC clearly state that the scope of practice for FNP's is in primary care.

    This has been a major issue in Texas and several FNP's have been disciplined by the BON for practicing in a hospital setting. Even worse, in the case of a malpractice claim, those NP's insurance companies can & WILL refuse the claim and this exposes the hospital/SP to all kinds of liability issues. I'm surprised to hear that FNP's are being allowed to practice in the hospital setting in your state, because this is not within their scope of practice. Obviously, a lot of NP's/hospital administrators/doctors aren't aware of the various specialties, which is amazing to me, since there is so much to lose.

    I'm curious, does your Board of Nursing specifically state that FNP's can practice in an inpatient setting? As far as me needing to be "careful" about setting a NP student straight on her scope of practice...that's my JOB!
  11. by   CraigB-RN
    Quote from ANPFNPGNP
    I live in Texas and that's where I went to school for my FNP certification. We were told time and again that FNP's are certified/licensed to work in primary care only. According to the TX BON, we have to practice in the scope set forth by the certifying entities, which is the AANP and ANCC. Both the AANP and ANCC clearly state that the scope of practice for FNP's is in primary care.

    This has been a major issue in Texas and several FNP's have been disciplined by the BON for practicing in a hospital setting. Even worse, in the case of a malpractice claim, those NP's insurance companies can & WILL refuse the claim and this exposes the hospital/SP to all kinds of liability issues. I'm surprised to hear that FNP's are being allowed to practice in the hospital setting in your state, because this is not within their scope of practice. Obviously, a lot of NP's/hospital administrators/doctors aren't aware of the various specialties, which is amazing to me, since there is so much to lose.

    I'm curious, does your Board of Nursing specifically state that FNP's can practice in an inpatient setting? As far as me needing to be "careful" about setting a NP student straight on her scope of practice...that's my JOB!
    CO, KS, GA all allow, and those are the only states I can vouch for. As to that being your JOB, only if you were specic about that being TX rules. Onther places, other rules. From just soing a spot check, TX is in the minority right now in that it doesn't allow it, but that may change as other states and liability carriers are looking into it also. LIke anything in nursing, you have to be carefull in stating absolutes. In some states I was even allowed to start cenral lines, and intubate as a RN, in other states I would have ended up in jail for doing them.

    Personally I tend to agree about limiting FNP's, and ACNP. Having hired both in my role as CNO and Assistant Hosp Administrator and neither had the corner on a complete education. THe only one that was ready to hit the ground running was the FNP who had a post grad ACNP.
  12. by   core0
    Quote from CraigB-RN
    CO, KS, GA all allow, and those are the only states I can vouch for. As to that being your JOB, only if you were specic about that being TX rules. Onther places, other rules. From just soing a spot check, TX is in the minority right now in that it doesn't allow it, but that may change as other states and liability carriers are looking into it also. LIke anything in nursing, you have to be carefull in stating absolutes. In some states I was even allowed to start cenral lines, and intubate as a RN, in other states I would have ended up in jail for doing them.

    Personally I tend to agree about limiting FNP's, and ACNP. Having hired both in my role as CNO and Assistant Hosp Administrator and neither had the corner on a complete education. THe only one that was ready to hit the ground running was the FNP who had a post grad ACNP.
    TX isn't that different than any other state. All of them generally follow the State BONs recommendations. TX is unusual in that they actually enforce the recommendations for scope of practice. I found Georgia's new NP prescriptive authority interesting. Especially this part:
    "(c) adhere to a written nurse protocol agreement that is dated and signed by the APRN, the delegating physician, and any other designated physician(s); the APRN’s area of practice shall be in the same or comparable specialty as that of the delegating physician; the protocol shall specify the medical acts delegated to the APRN as provided by O.C.G.A. 43-34-26.3 and shall provide for immediate consultation with the delegating physician or a designated physician if the delegating physician is not available;

    Nobody knows how this will be interpreted. In addition the protocols have to be approved by the BOM so they can also interpret this. At least in the hospital environment there is a lot of talk about what this means. Interesting world.

    David Carpenter, PA-C
  13. by   ANPFNPGNP
    Quote from core0
    "(c) adhere to a written nurse protocol agreement that is dated and signed by the APRN, the delegating physician, and any other designated physician(s); the APRN's area of practice shall be in the same or comparable specialty as that of the delegating physician; the protocol shall specify the medical acts delegated to the APRN as provided by O.C.G.A. 43-34-26.3 and shall provide for immediate consultation with the delegating physician or a designated physician if the delegating physician is not available;David Carpenter, PA-C
    So, a pediatrician would hire a PNP, an internist would hire a ANP, a family practice doctor would hire a FNP...is that right?

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