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 ACNP-BC, Adult Critical Care, Cardiology.

It's both accreditation and certification. NP programs are being granted accreditation at a concerning pace without regard for controlling the number of NP's being cranked out in a seemingly "diploma mill" fashion in some schools. These accreditation bodies establish minimum standards for clinical hours which the national certification boards pretty much just follow. The current fact is, only those schools with accreditation (CCNE or ACEN) can have their graduates sit for national certification. So really accreditation is one step in stopping the flood of oversaturation in our ranks.

I agree that our national certification boards can be redundant (i.e., AANP and ANCC offering similar exams) and the exams themselves do not seem challenging. So, my solution would be to tighten accreditation standards and create specific and dedicated national examination boards for each of the NP specialties (i.e., FNP, AGNP, AGACNP, etc). These boards must be represented by NP's in the specific specialties and not be part of a general nursing umbrella (such as ANCC) or an NP association only vested in their own certification programs (such as AANP).

Think of it like a designated National Board of Certification for Family Nurse Practitioners and then another one for Psychiatric and Mental Health Nurse Practitioners, and so on. We actually already have this system with NNP's and WHNP's via the NCC and the PNCB for PNP's. These are separate specialty based national boards not connected with AANP or ANCC.

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

I think that the trend is moving away from direct entry ACNP's actually. The law of natural selection has made it so that more and more employers are asking prospective ACNP candidates about relevant RN experience and those whose past RN experience are unrelated to the specialty they are applying to or have no RN experience at all are being turned away.

I also see a trend where some of the schools that used to offer a direct entry ACNP have revised their offering as simply a generic Master's entry program in nursing with graduates coming out merely qualified to be RN's. They have the option to pursue the ACNP portion later as a post-Master's or a MSN to DNP. People may view this as a form of "degree inflation" strategy that only helps the schools' bottom lines. But the silver lining is that there is extra effort required to get to the goal of ACNP.

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I think that the trend is moving away from direct entry ACNP's actually. The law of natural selection has made it so that more and more employers are asking prospective ACNP candidates about relevant RN experience and those whose past RN experience are unrelated to the specialty they are applying to or have no RN experience at all are being turned away.

I also see a trend where some of the schools that used to offer a direct entry ACNP have revised their offering as simply a generic Master's entry program in nursing with graduates coming out merely qualified to be RN's. They have the option to pursue the ACNP portion later as a post-Master's or a MSN to DNP. People may view this as a form of "degree inflation" strategy that only helps the schools' bottom lines. But the silver lining is that there is extra effort required to get to the goal of ACNP.

I agree. In my area you'd be hard pressed to find a job as a direct entry applicant because the hospital systems want the ACNP + relevant RN experience. When there are a ton of applicants hospitals can be choosy and I think they are exercising that ability.

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Specializes in Rheumatology NP.

I was admitted to a well-respected direct-entry ACNP program. I have a bachelors degree in another field and have worked many years in a different career (though medical-related, on the business end). I decided not to attend because I was very concerned about being able to get the job I truly wanted post-graduation, considering I would have no RN experience (I live in a saturated area and won't be moving, at least as far as I know). This program does not award a BSN, and it does not require (nor provide time for) its students to work prior to moving onto the Masters portion.

I have friends who graduated from this program and they do have jobs as ACNPs. However they do not work in ICUs or even critical care. And they did end up having to find a job as an RN (one I know worked in a nursing home for several months after getting her masters), just to get something on the resume'.

While I felt that this program would give me the skills and competencies I needed to enter the workplace, I simply wasn't comfortable. I had never been a nurse, so how could I be absolutely certain ACNP was right for me? As well, I felt that I could only benefit from the experience of working as an RN, no matter which specialty I entered. I also just didn't want to be that NP at the hospital who had never gotten her hands dirty. And at the end of the day, I could still go back to that well-respected school...just after getting some time under me.

If I was going into primary care, I think it would/could be different. Although I still feel that any experience is worthwhile and useful.

I am now almost done with my BSN program and STILL don't know which NP to pursue. If that tells you anything!

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

Well, and I do know a few direct entry ACNP's as well. A couple had no RN experience at all and are colleagues in a high acuity in-patient practice! That said, I met them after they have been NP's for at least 5 years and I can honestly say that they are competent that you wouldn't be able to tell that they had no experience as RN's. They may not be able to obtain an EKG or insert a naso-jejunal feeding tube but they sure can read an EKG or interpret that the KUB shows that the feeding tube is in the jejunum. Their clinical judgment and decision-making meets standards. In the last 5 years, have we hired someone in an ACNP role with no RN experience? absolutely not. I think these direct entry guys are more of an exception than a trend.

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Specializes in Rheumatology NP.
Well, and I do know a few direct entry ACNP's as well. A couple had no RN experience at all and are colleagues in a high acuity in-patient practice! That said, I met them after they have been NP's for at least 5 years and I can honestly say that they are competent that you wouldn't be able to tell that they had no experience as RN's. They may not be able to obtain an EKG or insert a naso-jejunal feeding tube but they sure can read an EKG or interpret that the KUB shows that the feeding tube is in the jejunum. Their clinical judgment and decision-making meets standards. In the last 5 years, have we hired someone in an ACNP role with no RN experience? absolutely not. I think these direct entry guys are more of an exception than a trend.

It seems like once you HAVE that ACNP experience, then the RN experience is less critical to landing a job. It's that first job that's a problem...that and simply being comfortable in your skin on the floor.

Being in a highly-saturated area, I just didn't feel safe going that route. Well, for that reason and others.

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Specializes in Family Nurse Practitioner.
I was admitted to a well-respected direct-entry ACNP program. I have a bachelors degree in another field and have worked many years in a different career (though medical-related, on the business end). I decided not to attend because I was very concerned about being able to get the job I truly wanted post-graduation, considering I would have no RN experience (I live in a saturated area and won't be moving, at least as far as I know). This program does not award a BSN, and it does not require (nor provide time for) its students to work prior to moving onto the Masters portion.

I have friends who graduated from this program and they do have jobs as ACNPs. However they do not work in ICUs or even critical care. And they did end up having to find a job as an RN (one I know worked in a nursing home for several months after getting her masters), just to get something on the resume'.

While I felt that this program would give me the skills and competencies I needed to enter the workplace, I simply wasn't comfortable. I had never been a nurse, so how could I be absolutely certain ACNP was right for me? As well, I felt that I could only benefit from the experience of working as an RN, no matter which specialty I entered. I also just didn't want to be that NP at the hospital who had never gotten her hands dirty. And at the end of the day, I could still go back to that well-respected school...just after getting some time under me.

If I was going into primary care, I think it would/could be different. Although I still feel that any experience is worthwhile and useful.

I am now almost done with my BSN program and STILL don't know which NP to pursue. If that tells you anything!

Excellent insight and judgement. I wish you well with your nursing career.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
It seems like once you HAVE that ACNP experience, then the RN experience is less critical to landing a job. It's that first job that's a problem...that and simply being comfortable in your skin on the floor.

Being in a highly-saturated area, I just didn't feel safe going that route. Well, for that reason and others.

You are right, one of the NP's I'm referring to was hired after having worked as an NP in the ICU in a large academic medical center on the East Coast (the program was based there) and the other one was just really lucky to be hired at a time when the need was there and yet there weren't enough applicants for the job. This person was hired years ago when there were probably not many ACNP's as there are now.

I wouldn't recommend the direct entry ACNP route now knowing that the market does dictate that in terms of being a new ACNP, you will be judged by employers based on your previous nursing experience. I think that you are very cognizant of the "what if's" in terms of what career paths to take and you weighed the pros and cons well. No one has a crystal ball obviously but it's always good to be on the safe side which is what you chose.

I have a lot of anecdotes about this actually. I have another colleague who was in a direct entry ACNP program on the East Coast back when the programs granted a BSN then an MSN. This person was required to take a leave from the program after the BSN to get registered and work as an RN first. Guess what? she did that and ended up loving the RN role and never returned for the ACNP portion. Later on the school stopped granting BSN's to minimize the risk of attrition from similar students. This person ended up becoming an ACNP anyway but did it at another program.

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I think that the trend is moving away from direct entry ACNP's actually. The law of natural selection has made it so that more and more employers are asking prospective ACNP candidates about relevant RN experience and those whose past RN experience are unrelated to the specialty they are applying to or have no RN experience at all are being turned away.

I also see a trend where some of the schools that used to offer a direct entry ACNP have revised their offering as simply a generic Master's entry program in nursing with graduates coming out merely qualified to be RN's. They have the option to pursue the ACNP portion later as a post-Master's or a MSN to DNP. People may view this as a form of "degree inflation" strategy that only helps the schools' bottom lines. But the silver lining is that there is extra effort required to get to the goal of ACNP.

I don't consider that degree inflation. I consider that placing more value on the dnp and appropriately places the bs courses in a master's degree where they belong. It also gives a nurse a broader perspective to choose alternate courses at the masters level if they decide on education or other areas as they aren't feeling compelled to go straight into a provider program as if that is the be all end all.

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Theoretically, it is possible just like new grad MD without experience but with good rotation. It is ideal to have ICU experience to be a good acute care NP.

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Theoretically, it is possible just like new grad MD without experience but with good rotation. It is ideal to have ICU experience to be a good acute care NP.

A new grad MD has a residency. Haha. They don't face the same pressures we do in that regard.

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