Becoming an NP with little to no nursing experience?? - page 54

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   GM2RN
    Quote from zmansc
    Than I guess you wouldn't feel comfortable with NPs who went through direct entry programs either, as they are designed to take a non-nurse college graduate through RN and NP training. Some do require some number of hours of RN work during the program, others do not.

    The fact is there are many NPs who do not have extensive RN experience who end up as good of NPs as those with many years of RN experience. I have seen no evidence that proves otherwise.

    I have seen students with many years of experience struggle and not make it, and I have seen them do very well. I have also seen both extremes from students with little to no experience. It really depends more on what you do with your time, how well you study the concepts and the underlying principles, and how good you are at applying what experience and knowledge you do have than some number of years.

    That is correct, in general, I would not.

    The keywords to your statement in the second paragraph are "end up." There is no way that a brand-new NP with no nursing experience is going to have assessment and judgement skills as good as those of a new NP with some years of experience behind her will have. Period. Will those with no nursing experience "end up" as good as those with some experience after they have practiced for a few years? Perhaps. Some will and some won't.
  2. by   BostonFNP
    Quote from GM2RN
    That is correct, in general, I would not.

    The keywords to your statement in the second paragraph are "end up." There is no way that a brand-new NP with no nursing experience is going to have assessment and judgement skills as good as those of a new NP with some years of experience behind her will have. Period. Will those with no nursing experience "end up" as good as those with some experience after they have practiced for a few years? Perhaps. Some will and some won't.
    Have you read the literature on the topic?


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  3. by   edmia
    Quote from GM2RN
    That is correct, in general, I would not.

    The keywords to your statement in the second paragraph are "end up." There is no way that a brand-new NP with no nursing experience is going to have assessment and judgement skills as good as those of a new NP with some years of experience behind her will have. Period. Will those with no nursing experience "end up" as good as those with some experience after they have practiced for a few years? Perhaps. Some will and some won't.
    I actually agreed with you on this before starting my NP education. I don't anymore. There is very little correlation between my extensive RN experience and the role of NP. It's a totally different ball game and all students are equal. Nurses do not diagnose and manage patients; NPs do. I'm learning just as much as my classmates with very little experience -- sometimes, I've even found my nurse brain hindered my learning. Never expected that!


    Sent from my iPhone -- blame all errors on spellcheck
  4. by   Ruby Vee
    Quote from NucRN
    I don't think I am a good test taker. Wish I was a good test taker. It just means I was able to learn how to do a thorough head to toe physical assessment and do it in a way that allowed me to get an OK grade.

    I'm not sure how it is with other NP programs, but at our university, students work one on one with their preceptor for almost two years( 3 if you are in a DNP program) They are able to make decisions with an NP behind them. I think this is a great way to learn.
    It's becoming increasing clear that you don't know what you don't know. While I hope you correct this knowledge deficit before graduation, I realize that's extremely unlikely. If you want to be a passable NP (not saying great, just passable), you will start with an air of humility and a willingness to learn from EVERYONE you encounter at work. You will also develop the certainty that you don't know as much as you think you did -- hardly anything in fact -- and will grow from there. I hope your attitude changes before graduation.
  5. by   BostonFNP
    Quote from Ruby Vee
    It's becoming increasing clear that you don't know what you don't know. While I hope you correct this knowledge deficit before graduation, I realize that's extremely unlikely. If you want to be a passable NP (not saying great, just passable), you will start with an air of humility and a willingness to learn from EVERYONE you encounter at work. You will also develop the certainty that you don't know as much as you think you did -- hardly anything in fact -- and will grow from there. I hope your attitude changes before graduation.
    Exactly what did the PP say that makes you assume that he/she doesn't know what he/she doesn't know? Probably even more important is that at that stage of graduate education the PP indicated I wouldn't expect them too. That goes for brand new out of the box RNs and "seasoned" RNs. In my professional experience teaching and precepting APN level students, the overconfidence is more often a problem with experienced nurses.

    The PP is at the start of their path to advanced practice. The fact he/she is investing in their education and working hard toward exceptional grades prior to the start of their clinical education is quite promising to me.

    I am not about the NP school you attended but every NP school I have been involved with has placed great emphasis on distinguishing normal from abnormal and reinforcing collaboration and support in practice when starting out.




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  6. by   NucRN
    Definite hot topic with lots of opinions. I enjoy reading these comments, even if some are less positive than others. Good luck to those who still wish to pursue a graduate program.
  7. by   NucRN
    Quote from GM2RN
    Agreed, it is a good way to learn, but it doesn't replace the experience that comes with bedside nursing. You don't have to answer but something to think about: All else being equal, do you think an employer is more likely to hire a new NP with practically no acute care nursing experience or one with several years of acute care experience when competing for a position?
    I actually put my two weeks notice in when I got accepted to grad school. My employer asked me to stay and work part time with hopes of me working for them as NP when I pass my exam. I am sure your assumption is correct with regards to who would get hired based on RN experience.
  8. by   GM2RN
    Quote from BostonFNP
    Have you read the literature on the topic?


    Sent from my iPhone.
    I have not read any literature on the subject. It does not affect me personally so I don't have a great interest in it. I'd be willing to read an article or two though, if you care to post them, but unless they are seriously going to conclude that every single new grad NP without nursing experience will have the same level of assessment and judgment skill as the new grad NP with several years of nursing experience, I don't see how their opinion can possibly differ from mine.
  9. by   GM2RN
    Quote from edmia
    I actually agreed with you on this before starting my NP education. I don't anymore. There is very little correlation between my extensive RN experience and the role of NP. It's a totally different ball game and all students are equal. Nurses do not diagnose and manage patients; NPs do. I'm learning just as much as my classmates with very little experience -- sometimes, I've even found my nurse brain hindered my learning. Never expected that!


    Sent from my iPhone -- blame all errors on spellcheck

    Nurses cannot LEGALLY diagnose, but I don't know of a nurse that has not used their knowledge and experience, however much that may be, to come up with a diagnosis for their patients, at least in the ER. Maybe not so much with floor nursing, but I work in the ER and we do this all the time, and on occasion we get it right when the doc is wrong. The difference is that nurses cannot act on a diagnosis without an order, even when the doc is wrong.

    Do you consider NPs to be better able to manage patients than residents? How many times have you experienced residents who don't know what they are doing and you roll your eyes at them behind their back when they give you orders? Happens all the time in the ER at least. Not to mention that I know ICU nurses who call the doc when they need something for their patients and the doc tells them to order what they want because they have that much confidence in the nurse to know how to treat that patient. I'd be willing to bet you'd be hard pressed to find a new grad NP with no nursing experience that can do that. I just don't see how anyone can seriously believe that an inexperienced NP can measure up to the NP that has that kind of nursing experience.
  10. by   BostonFNP
    Quote from GM2RN
    I don't know of a nurse that has not used their knowledge and experience, however much that may be, to come up with a diagnosis for their patients, at least in the ER.

    How many times have you experienced residents who don't know what they are doing and you roll your eyes at them behind their back when they give you orders?
    You realize, I trust, that taking a stab at (or making the correct) medical dx as an ED RN is different from being the provider that needs to consider that differential and make the final decision and order to treat is a subtle but important difference. I didn't fully appreciate it until I changed roles.

    Residents are learning. Just like novice NPs. As are experienced MDs and experienced NPs. Everyone makes mistakes. If you take a peek behind the curtain, there are plenty of providers that role their eyes at nurses who request inappropriate orders. The good nurses and good providers don't do either.


    Sent from my iPhone.
  11. by   edmia
    Quote from BostonFNP
    You realize, I trust, that taking a stab at (or making the correct) medical dx as an ED RN is different from being the provider that needs to consider that differential and make the final decision and order to treat is a subtle but important difference. I didn't fully appreciate it until I changed roles.

    Residents are learning. Just like novice NPs. As are experienced MDs and experienced NPs. Everyone makes mistakes. If you take a peek behind the curtain, there are plenty of providers that role their eyes at nurses who request inappropriate orders. The good nurses and good providers don't do either.


    Sent from my iPhone.
    I completely agree. Until I started my graduate education, I did think diagnosis of a problem was something I did as an ED and an ICU nurse. But it is very different as Boston states, when diagnosing involves differentials and deciding on proper treatment. The shift from thinking as a nurse to thinking as a provider is a big one and I'm excited to do it.

    The only thing my nursing experience gives me is having been exposed to a lot of stuff. I have classmates who have only done pediatric nursing for 15 years for example, and they are learning the adult now and having to study more as it is new information. I've at least dealt with all kinds of ages and populations.


    Sent from my iPhone -- blame all errors on spellcheck
  12. by   zmansc
    Quote from BostonFNP
    You realize, I trust, that taking a stab at (or making the correct) medical dx as an ED RN is different from being the provider that needs to consider that differential and make the final decision and order to treat is a subtle but important difference. I didn't fully appreciate it until I changed roles.

    Residents are learning. Just like novice NPs. As are experienced MDs and experienced NPs. Everyone makes mistakes. If you take a peek behind the curtain, there are plenty of providers that role their eyes at nurses who request inappropriate orders. The good nurses and good providers don't do either.


    Sent from my iPhone.
    We have a very experienced ED nurse, who is great at guessing the dx. He loves to do it too. He comes back to the nursing station after his initial assessment and tells anyone there, providers and nurses alike, what his dx is. He's usually right too.

    When I told him I was going back to school for my NP he said, "No way I could do that". I asked why, he said, it's so much easier to guess the dx than to have to actually make a dx and treatment plan, and be responsible for the their accuracy. Up to that point, I had never made that distinction, but it is a very big one.
  13. by   PMFB-RN
    Quote from BostonFNP
    If you take a peek behind the curtain, there are plenty of providers that role their eyes at nurses who request inappropriate orders.

    It's OK. There are plenty of nurses rolling our eyes when NPs and physicians give inappropiate orders.
    Just a couple weeks ago, during a code, we had a resident who kept ordering Ativan when atropine would have been the appropiate drug. To be fair english isn't his first language and he was excited to be "running" his first real code. We ignored his orders and gave the appropiate drug, just as nurses have been, and will continue to do when recieving inappropiate orders.

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