Accelerated Masters with no Nursing background

roser13, ASN, RN · Jul 7, 2016

It's not really an illogical argument at all. The PP was discussing the provider role of APNs compared to MD/DOs. I think we all agree that practical experience is important, but ion the role you are functioning in not a different role. Do medical students need practical experience as nurses or aides or EMTs or techs prior to entering their residency programs?

Of course not. They need practical experience as doctors. Just as advanced practice nurses need experience as nurses.

And no, I'm not being dense - I get your point. But I disagree with your definition of the role of APN's. I firmly believe that nurses' advanced practice abilities are based upon experience. And I think that this belief is shared by the vast majority of patients who entrust their medical care and oversight to AP nurses. "Advanced Practice" means exactly that to most patients. I would guess that most patients would state "My APN has many years of decision-making patient care," not "my APN has taken many classes but has never laid eyes on a real patient."

Wile E Coyote, ASN, RN · Jul 7, 2016

More experience is always better, but honestly I doubt it is wholly necessary. Even with so many of these online programs and a growing number of direct entry programs that allow people with no previous nursing experience to enroll, the data remains the same. The qualitative difference between NP and MD's are nonexistent and this has remained consistent. I think it really speak volumes to the efficacy of MSN programs as well as the importance of on the job training and how you don't really even need nursing experience because the fact of the matter is that we are basically trained to function as independent MD's. And especially if you work in primary care, this shouldn't be a problem too big of a problem so long as you get some good years training working under an MD.
Let's face it. We all forgot a whole lot of stuff we learned from school. If medical students are not required to have previous clinical experience before enrolling and medical schools still churn out solid providers, there is no reason MSN program's can't do the same, especailly knowing how critical Residency is for doctors to actually learn how to practice and how important on the job training is for NP's.
All the nurses over here complaining about how you absolutely need previous nursing experience are overemphasizing the importance of previous experience as an RN.

This has been hashed out frequently on AN.

The absence of data does not automatically support one hypothesis over another when the test isn't measuring the right data in the first place. I'm not convinced we're making meaningful measurement of outcome. I also think that the data is too young on direct-entry NP programs to make the prima facie conclusion that the typical novice direct-entry NP has the same diagnostic chops as the typical novice MD/DO. I'm not ready to declare the thousands more clinical hours required of a new physician over a new NP useless without better data.

Rice_in_Space, ASN, RN · Jul 7, 2016

Here in San Diego they offer a combo of BSN and MSN (Azusa Pacific University), but you are required to have some form of a bachelors. Its about 4 years long and from what I was told, it consists a lot clinicals.

AAC.271 · Jul 7, 2016

This is not something only brought up on AN. All the major nursing organizations are in collective agreement with the data. the NP/Nursing model produces equivalent if not superior outcomes compared to the physician/medical model. Whether it's because we're better listeners or because our model is more effective, i'm not sure, but the outcomes are loud and clear.

djh123 · Jul 7, 2016

Sounds like getting a pilot's license without ever getting a car license first. Oh yes, I know things like this exist, I do, but...

belljar1995, PhD, RN · Jul 7, 2016

Of course not. They need practical experience as doctors. Just as advanced practice nurses need experience as nurses.
And no, I'm not being dense - I get your point. But I disagree with your definition of the role of APN's. I firmly believe that nurses' advanced practice abilities are based upon experience. And I think that this belief is shared by the vast majority of patients who entrust their medical care and oversight to AP nurses. "Advanced Practice" means exactly that to most patients. I would guess that most patients would state "My APN has many years of decision-making patient care," not "my APN has taken many classes but has never laid eyes on a real patient."

This is just silly. No one graduates from MSN/NP program without ever laying eyes on a patient! You do spend many hours learning (on real patients!) and then following graduation that learning continues in ...hopefully in the first job with excellent mentoring. Furthermore, MANY nurses NEVER work a day of bedside but go into other specialties such as school nursing, case management, pharmaceuticals, cosmetic medicine, private clinic...you name it. Are you saying that NONE of these other specialties produce excellent NPs? One of the biggest problems with the field of nursing is that it tends to be "one way or the highway"--there's a great deal to be said for alternative pathways and experience as excellent contributors to developing nursing skills--especially ANP skills. In my Direct Entry class we had amazing people with the most unique and interesting backgrounds and degrees. With all of the emphasis nowadays on genetics and genomic sequencing --I personally feel that the OP would have many excellent opportunities with her biomedical education + nursing--what a gift!. If I was younger (and could do well in Calculus), I would LOVE to study biotechnology---!

roser13, ASN, RN · Jul 7, 2016

This is just silly. No one graduates from MSN/NP program without ever laying eyes on a patient! You do spend many hours learning (on real patients!) and then following graduation that learning continues in ...hopefully in the first job with excellent mentoring. Furthermore, MANY nurses NEVER work a day of bedside but go into other specialties such as school nursing, case management, pharmaceuticals, cosmetic medicine, private clinic...you name it. Are you saying that NONE of these other specialties produce excellent NPs? One of the biggest problems with the field of nursing is that it tends to be "one way or the highway"--there's a great deal to be said for alternative pathways and experience as excellent contributors to developing nursing skills--especially ANP skills. In my Direct Entry class we had amazing people with the most unique and interesting backgrounds and degrees. With all of the emphasis nowadays on genetics and genomic sequencing --I personally feel that the OP would have many excellent opportunities with her biomedical education + nursing--what a gift!. If I was younger (and could do well in Calculus), I would LOVE to study biotechnology---!

OP cannot work at the bedside. Not as a nurse, not as a student. She wants to be a nurse without setting foot in a clinical.

And I'm being silly?

Rocknurse, MSN, APRN, NP · Jul 7, 2016

OP cannot work at the bedside. Not as a nurse, not as a student. She wants to be a nurse without setting foot in a clinical.
And I'm being silly?

Not saying I agree one way or another but there's a difference between clinical in a primary care office and doing clinical on a med surg floor. One requires seeing one patient at a time in a controlled office environment and one requires running around like a crazy person for 12 hours a day. I'm sure there are alternatives that the OP could legitimately do. I've done critical care for years and I'm entering the third year of an acute program and I've yet to see a real patient as a student NP. I have to say that if I was at this point without any clinical experience I'd be rather nervous, but having 25+ years behind me I'm not overly concerned about the clinical portion when it gets here. Acute care will be very physical though, compared to primary care. No reason the OP can't find out if it's at least feasible.

allnurses Guide · Jul 7, 2016

Of course not. They need practical experience as doctors. Just as advanced practice nurses need experience as nurses.
And no, I'm not being dense - I get your point. But I disagree with your definition of the role of APN's. I firmly believe that nurses' advanced practice abilities are based upon experience. And I think that this belief is shared by the vast majority of patients who entrust their medical care and oversight to AP nurses. "Advanced Practice" means exactly that to most patients. I would guess that most patients would state "My APN has many years of decision-making patient care," not "my APN has taken many classes but has never laid eyes on a real patient."

I understand that you "firmly believe it". Out of curiosity, how long have you been working as an NP? In acute care or primary care? In your practice experience, do you feel the role of an APN is more similar to the role of physicians or of bedside nurses?

The extant literature on the topic is surprisingly sporifice, however, the two major published studies on RN to NP role socialization found that RN experience was not a significant factor.

Having been involved in the didactic and clinical education of NP students for a number of years (as well as medical students) my professional/anecdotal experience has been that it's a mixed bag: some people seem to benefit from it while others don't.

roser13, ASN, RN · Jul 7, 2016

I understand that you "firmly believe it". Out of curiosity, how long have you been working as an NP? In acute care or primary care? In your practice experience, do you feel the role of an APN is more similar to the role of physicians or of bedside nurses?
The extant literature on the topic is surprisingly sporifice, however, the two major published studies on RN to NP role socialization found that RN experience was not a significant factor.
Having been involved in the didactic and clinical education of NP students for a number of years (as well as medical students) my professional/anecdotal experience has been that it's a mixed bag: some people seem to benefit from it while others don't.

As you likely well know, I am not an NP. I am speaking purely from a patient's standpoint on this subject. I want my healthcare to be managed by a practitioner who has extensive experience, whether it be a nursing background, internship, residency or fellowship. And I don't believe I'm alone in that expectation.

I also don't believe that I'm alone in my belief that APN's with little to no clinical background face a very tough, uphill battle in finding appropriate employment. That is evident from many posts on AN.com.

allnurses Guide · Jul 7, 2016

OP cannot work at the bedside. Not as a nurse, not as a student. She wants to be a nurse without setting foot in a clinical.
And I'm being silly?

I'm not getting the feeling that the OP wants to bypass student clinicals. I believe that he or she does not want to work bedside after graduation. That's a whole lot different than not wanting to do required student clinicals.

I am a graduate of a direct entry program. I've been working as a NP for over 7 years now. I've never had trouble getting a job despite my lack of bedside RN experience. Quite frankly, I don't use a whole lot that I learned during the RN portion of my program. It was a valuable educational experience, but my role is quite different from that of a bedside RN. My cohort consisted of 40 students, and we all were able to find good jobs after graduation. I precept both traditional and direct entry NP students, and find that nursing experience can sometimes get in the way of thinking like a provider. I've had some rock star students with no bedside experience and some with many years of experience just have not done well in the transition. The opposite has been true, too. Success is up to the individual, regardless of how much nursing experience they have.

macawake, MSN · Jul 7, 2016

As you likely well know, I am not an NP.

Hmm... I too would have assumed that BostonFNP was aware of that fact..

I am speaking purely from a patient's standpoint on this subject. I want my healthcare to be managed by a practitioner who has extensive experience, whether it be a nursing background, internship, residency or fellowship. And I don't believe I'm alone in that expectation.

I don't think that you're at all alone in feeling that way. I think that the majority of patients would agree with you if asked, that they would feel safer with a nurse with several years of nursing experience before becoming NPs/APRNs.

The question though if whether this stance based mostly on emotion (?), is also supported by facts. What does the evidence say? Does research show that NPs/APRNs with prior bedside nursing experience have better clinical outcomes than direct-entry NPs/APRNs?

How useful is the experience as a bedside nurse? As most of you know, I'm not in the US but I am a nurse anesthetist in my country. Before that I had brief experience in med-surg/telemetry (so brief it barely counts), several years in an ER and several years as a PACU nurse. In my own case (completely anecdotal) my particular experience has helped me. Not only have I developed some speed/dexterity when it comes to the "tasky" aspects of nursing, but more importantly I had previous experience of many of the cardiovascular, airway, neurological, metabolic and endocrine emergencies which can develop rapidly intraoperatively. So yes, for me my previous experience helped me take on my new role as a nurse anesthetist with more confidence than I think I would have had/felt without it.

However, anesthesia is (in my opinion) vastly different from being for example a primary care NP. My personal belief/guess (since I'm not one) is that the work they do is much closer to a physicians' rather than the job a bedside nurse does and the usefulness of beside nursing experience is likely more limited/less essential.