ACNP sans experience?

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Someone please tell me that I misread a post that ACNP programs are now accepting students with no acute care RN experience.

Specializes in NICU.

Wow...is it just NNPs and CRNAs left requiring experience? I know midwifery has direct entry but that's actually really common worldwide. The UK, for example doesn't even have them do a nursing degree, they just do a degree in midwifery.

The NNP boards don't actually require experience, but no school will let you on to the clinical portion without the requisite RN experience. I don't even see how one could pass boards without the foundation of knowledge...

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Specializes in OB.
Wow...is it just NNPs and CRNAs left requiring experience? I know midwifery has direct entry but that's actually really common worldwide. The UK, for example doesn't even have them do a nursing degree, they just do a degree in midwifery.

The NNP boards don't actually require experience, but no school will let you on to the clinical portion without the requisite RN experience. I don't even see how one could pass boards without the foundation of knowledge...

I believe so. And you're right about midwifery, it's a different animal so direct-entry programs aren't as bad of a thing as direct-entry NP jobs and midwifery programs in general are much more strictly overseen/accredited. However, as an experienced RN I admit I'm biased and think all nurse midwives should have some nursing experience.

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All APRNs should have RN experience. Otherwise we are no different than PAs - except without RN experience we are poorly trained by comparison.

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Specializes in Family Nurse Practitioner.
I believe so. And you're right about midwifery, it's a different animal so direct-entry programs aren't as bad of a thing as direct-entry NP jobs and midwifery programs in general are much more strictly overseen/accredited. However, as an experienced RN I admit I'm biased and think all nurse midwives should have some nursing experience.

I would think the experience of having worked L&D would be invaluable to see the many ways things can go downhill and develop that sixth sense for the inkling that something just doesn't feel right. In psych which generally is far less life and death that intuition has been an asset for me throughout my career.

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Specializes in Family Nurse Practitioner.
The NNP boards don't actually require experience, but no school will let you on to the clinical portion without the requisite RN experience.

Lets hope the word...yet... isn't inserted in this sentence. Psych programs also used to require psych RN experience. :(

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However, as an experienced RN I admit I'm biased and think all nurse midwives should have some nursing experience.

I would think the experience of having worked L&D would be invaluable to see the many ways things can go downhill and develop that sixth sense for the inkling that something just doesn't feel right.

The United States is unique in connecting midwifery and nursing. In counties where midwives provide a much higher share of materinity care and have far better MCH outcomes, it is a completely separate career from nursing. There are even 5 states in the US that license midwives who are not nurses at all (not CPMs but full fledged providers with the same scope of practice as CNMs).

It begs the questions, if people without nursing experience can and do rise to the challenge in one of the most scrutinized and litigious areas of healthcare, what limits are we imposing based solely on our biases?

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Specializes in OB.
The United States is unique in connecting midwifery and nursing. In counties where midwives provide a much higher share of materinity care and have far better MCH outcomes, it is a completely separate career from nursing. There are even 5 states in the US that license midwives who are not nurses at all (not CPMs but full fledged providers with the same scope of practice as CNMs).

It begs the questions, if people without nursing experience can and do rise to the challenge in one of the most scrutinized and litigious areas of healthcare, what limits are we imposing based solely on our biases?

I'm well aware of everything in this post. I've worked with many CMs and many direct-entry CNMs, having worked previously in NYC. I would actually prefer we all became CMs, and the background for nursing was optional, like in the UK. However, that's not currently the state of midwifery in the U.S. and it's unlikely to happen anytime soon. If you are going to go to a CNM program, I think the nursing part should be necessary. I work with Vanderbilt students now (another direct-entry CNM program) and some of the students, while amazing and brilliant and who I know will be great midwives, have trouble taking a manual BP. I'm not imposing any limits on anyone, and I acknowledged that it's my personal bias---just my two cents.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Traditional ACNP programs require acute care experience. However, there are direct entry ACNP programs that have been in existence for many years (Yale, Columbia, Vanderbilt, UCSF**). They all admit students with non-nursing degrees and train them as nurses first (with a BSN completion curriculum) followed by the ACNP Master's curriculum next. The second part is where these prograns are not set up the same way.

Some programs require students to take a leave from the program after the BSN completion part, get registered with the BON as a nurse, then find employment in the acute care setting. They typically work first them return to the program to complete the Acute Care portion later. I've worked with direct entry ACNP's and many have some experience at the bedside as RN's prior to completion of their ACNP. The question is what is enough experience and that's arbitrary because there is so much individual variation in how people learn and adapt.

**UCSF discontinued the direct entry ACNP a few years back and this may have something to do with the difficulty finding RN jobs in San Francisco after completion of the RN portion of the program or possibly the school also feels that success in the ACNP role is indeed dependent on having significant acute care experience as an RN first.

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Specializes in ER.

Everyone says the nurses need experience, but what kind? Someone working in a 9 bed ER in the middle of nowhere in New Mexico isn't going to have the same skills as a trauma nurse in NYC. The biggest problem with masters programs are the lack of hours that are required and the lack of education. If you have that you could easily train someone who wasn't an acute care nurse.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Everyone says the nurses need experience, but what kind? Someone working in a 9 bed ER in the middle of nowhere in New Mexico isn't going to have the same skills as a trauma nurse in NYC. The biggest problem with masters programs are the lack of hours that are required and the lack of education. If you have that you could easily train someone who wasn't an acute care nurse.

I think another point that needs to be made is what resources do schools have to train nurses in the ACNP role. Many of the direct entry ACNP programs (former and current) are housed in large universities with a well integrated tertiary academic medical center where there is a wealth of resources in making sure students are exposed to high acuity ICU's, acute care units, and ED's. It's different when you talk about a smaller school admitting direct entry ACNP students and asking them to find their own preceptors in the middle of rural America.

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Specializes in Family Nurse Practitioner.
I think another point that needs to be made is what resources do schools have to train nurses in the ACNP role. Many of the direct entry ACNP programs (former and current) are housed in large universities with a well integrated tertiary academic medical center where there is a wealth of resources in making sure students are exposed to high acuity ICU's, acute care units, and ED's. It's different when you talk about a smaller school admitting direct entry ACNP students and asking them to find their own preceptors in the middle of rural America.

I would have no problem with any of this if I felt our education was more stringent or the direct entry programs had additional requirements like the ACNPs mentioned above. And yet the accrediting bodies don't seem to make any distinction...at all.

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Specializes in ER.

I really don't feel like its the accrediting bodies fault. It's the board exams. For example, where are there so many different organizations that do the certification exams for APRN but when you become an RN you take a standardized test that everyone takes? There should be one organization that states the rules and as it currently stands there is really only a handful of requirement. The three Ps and the 500 clinical hours. That's it? then rest of it is up to the school and schools waste our damn time with theory and all of this crap that we don't need to know.

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