Becoming an NP with little to no nursing experience??

[Blurr156]

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 certain practical reasons (including my union not helping to pay for it) I have been looking at other options, nursing/NP.

I was very excited to learn of a school near me that has a combined BSN/NP program for people with non-nursing bachelor degrees. I was about to start looking deeper into this program when a good friend of mine who is a member of an interview committee at a nearby hospital told me that I shouldn't do the program because I would have trouble getting a job.

The reason stated was because I wouldn't have been seen as having "paid my dues" as a nurse first.

Is this true?

I could understand why someone might feel that way about someone who went through this type of program never having worked in healthcare before. However, I like to think that to a certain degree I've paid my dues (I know it isn't nursing, but from a time in healthcare perspective).

My friend did say that I might be considered an exception to that rule. The program is at a VERY well known school and I was told by my friend even then it wouldn't matter. I was wondering what people here thought regarding this topic.

Thank you for any guidance you can provide.

[sirI, MSN, APRN, NP]

Threads merged.

[Zookeeper3]

All I can say, being an RN for 16 years is that

I've learned :

Being exposed to diagnosis, the standard treatments of conditions, knowing the meds with the interactions.... knowing how to assess... talk to people about finances and compliance.... drug interactions and side effects... lab values... tests that are a standard to order for confusing presentations of symptoms in a mutli-system patient on 20 meds with multiple co-morbidities all conflicting with the standards of care for each diagnosis...knock yourself out. This is today's patient. And they want every med the see on the TV to quickly fix what ails them. Don't even dare bring up dieting and exercising.

If you think and trust a school will give you that knowledge with out having walked that walk... and never been an RN that knows how poorly you're trained to do the basics... have at it.

If you choose this path, and there is a way to... that will be your life 5 days a week 8 hours each day. Good luck with that. I wouldn't do it now with all my years in, but that's just IMHO. You'd need a VERY understanding mentor and doc to put up with your "fast tracking" health care.

[PMFB-RN, RN]

If one doesn't work as an RN first how will the NP learn that physicians don't know everything and when to question a physician?

[jjjoy, LPN]

If one doesn't work as an RN first how will the NP learn that physicians don't know everything and when to question a physician?

I'm not sure if that was supposed to be sarcastic or not. No one knows everything, even if they happen to think and talk as if they do. It may be difficult to confront someone who thinks they do know everything, but the concept that physicians don't know everything takes no time to comprehend.

The second part of the question interests me though. How does any novice practitioner learn when to question anyone more experienced than themselves? Again, the concept of questioning is easy enough. In practice, though, the newbie will often find themselves in the position of having to trust their colleagues. Outside of blatently obvious errors, the newbie isn't going to recognize something 'out of the ordinary' until they've had enough experience to have some grasp of what 'ordinary' is! In nursing, new RNs often carry a full patient load within 8 weeks. And there just isn't enough time in the day for the newbie to cross-check every unfamiliar order/suggestion given them by MDs, PAs, NPs, and even other RNs before taking action, is there?

[PMFB-RN, RN]

I'm not sure if that was supposed to be sarcastic or not. No one knows everything, even if they happen to think and talk as if they do. It may be difficult to confront someone who thinks they do know everything, but the concept that physicians don't know everything takes no time to comprehend.

The second part of the question interests me though. How does any novice practitioner learn when to question anyone more experienced than themselves? Again, the concept of questioning is easy enough. In practice, though, the newbie will often find themselves in the position of having to trust their colleagues. Outside of blatently obvious errors, the newbie isn't going to recognize something 'out of the ordinary' until they've had enough experience to have some grasp of what 'ordinary' is! In nursing, new RNs often carry a full patient load within 8 weeks. And there just isn't enough time in the day for the newbie to cross-check every unfamiliar order/suggestion given them by MDs, PAs, NPs, and even other RNs before taking action, is there?

*** It wasn't sarcastic. I have noticed a tendency among brand new nurses to assume that if a doctors ordered it it's correct. We who have spent some time in health care understand that everybody, including physicians, makes mistakes. If one of the physicians I work with orders something that makes no sense to me then they need to explain to me why they have ordered it either so I can learn or to point out the mistake which every the case may be. I have caught many mistakes this way and I am sure this is true for every experienced nurse here.

It is why our new nurses are assigned a mentor after they graduate from the residency program. They need an experienced person they can ask questions of and who keep their eye on them until they are skilled ICU nurses with highly developed critical thinking skills.

If one hasn't had this experience how are they going to know when to questions orders they receive?

[jjjoy, LPN]

It wasn't sarcastic. I have noticed a tendency among brand new nurses to assume that if a doctors ordered it it's correct...It is why our new nurses are assigned a mentor after they graduate from the residency program. They need an experienced person they can ask questions of and who keep their eye on them until they are skilled ICU nurses with highly developed critical thinking skills

My RN program HEAVILY emphasized that nurses are to never "just follow orders" but maybe some programs don't do that as much? As you noted, though, without experience, how can a newbie recognize if something were off? Ideally, a newbie RN does have someone "keeping an eye on them" for the first several weeks and maybe months. In the real world, a newbie RN in acute care may be pressured to take a full load without a preceptor in just a few weeks. In LTC, it may just a few days.

Ideally, a newbie NP similarly has someone keeping an eye on them for the first several weeks, if not months, do they not? Unfortuately, in reality, newbies sometimes may be more or less left to their own devices to sink or swim. Their colleagues may act more as lifeguards, as opposed to swim instructors, and if the newbie "sinks" they are simply tossed out of the pool while the patient is still, ideally, safe.

It sometimes seems that if the newbie can avoid any major disasters while getting their bearings (actively seek out assistance, constantly look things up, etc), even if they were incredibly ill-prepared for the position and had little support, they will be successful. In which case, schools needn't turn out grads "ready-to-hit-the-floor/exam room". I don't necessarily agree with this, but it's how it looks to me sometimes.

[Ruby Vee, BSN]

i cannot argue that it isn't possible to become an np with little or no nursing experience. i just don't believe it's in the best interests of the patient, the brand new nurses the new np will be working with or possibly to the new np herself. pas are educated on the medical model -- they get clinicals much as medical students/residents get. but nps are expected to have had some clinical experience before they get to np school. if they don't have it, they're behind the eight ball.

i just had a brand new np dress me down for not drawing a ptt until nine hours after the previous one had been drawn.

"it isn't due until 9am," i said. this was at 8:20 or so.

"what do you mean? the last one was drawn at midnight and they're supposed to be every six hours."

"the heparin change was made at 3 am. so it's due six hours after that. 9 am."

"oh, is that how it's done? i'll have to check with the doctor."

this guy had been an rn for a short while before becoming an np. managing a heparin drip is pretty basic for anyone who has worked in a hospital; especially an icu. if he doesn't even know how to manage a heparin drip, what other knowledge is he missing? i'm an experienced nurse, i can catch his mistakes. someone who has been off orientation for two weeks may not. it's frightening!

[FreudianSlip]

"or 2) you SHOULD have RN experience since NP is an advanced practice NURSE."

^^^^This.

Nursing school is not nursing practice. You need to work as a RN, see what you really like and what you don't. Actually get some expertise that you can bring to the table...I'm sure it will make your NP program easier to swallow as well.

Just my opinion, however, as a BSN who is preparing for MSN.

[tablefor9, RN]

Work. Get the experience. If you can continue to go to school, great.

Lecture & clinicals do not an expert make, and I can absolutely see where it would be much harder to get secure a NP position with zero exp.

For those who say RN exp does not matter for APNs, I have to respectfully disagree, based on having worked with both the limited exp (1-2 yr) & the very experienced. What sets NPs apart is the expertise they bring to the table.

[NPinWCH]

I think nursing experience is VERY important. As an RN you learn so much that, no matter what anyone says, will be helpful to you as an NP. A large part of being a good RN, NP or even MD, is learning how to actually "hear" what your patients are telling you. That takes time, no matter what initials are after your name, but being an RN first helps you put things together more quickly.

Communication is a really big part of the health-care field. As an RN, you learn how to communicate with patients, families and doctors and you learn how to empower your patients. You also learn how to advocate for them, which is important, especially when you're up against people with more "power" than you. As an RN, you'll learn how to provide education in a way that your patient and family can understand and use.

I also think RN experience helps you develop that intuition that helps guide your thinking and thought process. Honestly, that intuition is really just your brain processing information faster than you realize it, but it does exist. It helps you "see" things that less experienced people might miss.

As a novice in any field, you are very reliant on tasks and getting things done, this is where RN experience comes in handy as an NP. NPs with RN experience have already developed a method of assessment, they can already put a few pieces of the puzzle together, they've learned to recognize patterns and hopefully, they've learned when they need help.

Sure, you can still be a great NP with little to no RN experience since you'll eventually learn all this as an NP, but I think it takes more time. I know my RN experience was extremely helpful and I'm happy I had it.

[JeanettePNP, MSN, RN, NP]

Very nice to say "work," but you need to get a job first. If I can't find a job, my choices are a) languish until the job market finally opens up again b) walk away from nursing (heck no!) or c) go back to school. Maybe with a master's I'll at least be hireable as a floor nurse.

[Iridescence]

Although I would LOVE to work as an RN before finishing my FNP...there are absolutely no jobs anywhere for us.

Any suggestions on how to get this RN experience that everyone says is so vital to being a competent NP?

BTW- I worked as an Respiratory Therapist before starting this direct entry program...I had five years experience working in an ICU and I still can't manage to score an RN job.