ADN NP's...?

I agree with MICU RN who said we need to come together and solidify the entry points to our world if we want to be considered professionals. I am a nursing student now (woo hoo finally) and we had this discussion briefly in my fundamentals class last week and my prof stressed how MDs, Lawyers, dentists, etc all need to go through a structured protocol to get the distinction. I am obtaining a BSN. I knew that to get an MSN you need to get a BSN first (such as RN-MSN bridges or entry to practice where the first year is spent getting the BSN) do you need experience first, I think so. SOme people continue str8 on and get their MSN and people will consider them academics without dust on their boots and hire accordingly, some will study pt/ work pt for the expereince, some will listen to the old guard who say you need 2 yrs med surg before going anywhere. Which ever way you decide, I thought that you need at least a BSN. 4 year college educated. It shows that not just ANYONE can be an advanced practice nurse. WHAT other professional do you know of that hold associates degrees. I'm sorry but there aren't many. Save the hate mail-- I'm not saying these people don't know their stuff but in this country- we are an academic society- don't hate the player hate the game. Yes, it is expensive at times. Yes it may mean travelling a distance for some programs. Yes you may have a family or a combination of all three but. . .what do you want the rest of us to do??? Med school requires sacrifice, dentistry requires sacrifice and they reap the rewards-- nurses work just as hard, if not harder so why not up the anty

Grandfathering, 15 years or not cheapens us all. It shows that the education is not as necessary and in this country-- you see how jobs that require little education are respected. Don't roast me here please, but we all know it's true. some say- what will this do to the shortage? Well, it will increase it most probably but to those who go for the full gold, we become indispensable and worth our weight in gold. Those with ADNs can keep working on their BSN and will get a time limit to finish it up How do we know it couldn't happen-- nurses have never seemed to come together long enough on anything to really try it out. How is it that nurses, the most populous members of the HC field can even at 1 facility be the least respected? We have the numbers to shut down the show?? I dunno. I'm still a student so I have a lot to learn but seems like there isn't a ton of solidarity here and that's the root of the problem. MDs may grouse at each other behind closed doors but to the rest of the world they protect their own for the conditions they feel they deserve. I don't think this is true of our profession.

Getting back to topic--I hope we are not now saying anyone can be an advanced practice nurse too? What's the deal. AND yet folks will complain about why the salaries won't go up or why the autonomy isn't always there. I just want to preserve the reputation. WE all know what the 15yrs on the floor in worth in terms of skill sets but the bottom line is that if that person is not willing to put the book knowledge with their hands on skill sets- they do not deserve the distinction of APN--they can be the best darn RN known to man but not necessarily an APN. Seem only fair. Don't like it? Change the policies.

I agree with MICU RN who said we need to come together and solidify the entry points to our world if we want to be considered professionals. I am a nursing student now (woo hoo finally) and we had this discussion briefly in my fundamentals class last week and my prof stressed how MDs, Lawyers, dentists, etc all need to go through a structured protocol to get the distinction. I am obtaining a BSN. I knew that to get an MSN you need to get a BSN first (such as RN-MSN bridges or entry to practice where the first year is spent getting the BSN) do you need experience first, I think so. SOme people continue str8 on and get their MSN and people will consider them academics without dust on their boots and hire accordingly, some will study pt/ work pt for the expereince, some will listen to the old guard who say you need 2 yrs med surg before going anywhere. Which ever way you decide, I thought that you need at least a BSN. 4 year college educated. It shows that not just ANYONE can be an advanced practice nurse. WHAT other professional do you know of that hold associates degrees. I'm sorry but there aren't many. Save the hate mail-- I'm not saying these people don't know their stuff but in this country- we are an academic society- don't hate the player hate the game. Yes, it is expensive at times. Yes it may mean travelling a distance for some programs. Yes you may have a family or a combination of all three but. . .what do you want the rest of us to do??? Med school requires sacrifice, dentistry requires sacrifice and they reap the rewards-- nurses work just as hard, if not harder so why not up the anty

Grandfathering, 15 years or not cheapens us all. It shows that the education is not as necessary and in this country-- you see how jobs that require little education are respected. Don't roast me here please, but we all know it's true. some say- what will this do to the shortage? Well, it will increase it most probably but to those who go for the full gold, we become indispensable and worth our weight in gold. Those with ADNs can keep working on their BSN and will get a time limit to finish it up How do we know it couldn't happen-- nurses have never seemed to come together long enough on anything to really try it out. How is it that nurses, the most populous members of the HC field can even at 1 facility be the least respected? We have the numbers to shut down the show?? I dunno. I'm still a student so I have a lot to learn but seems like there isn't a ton of solidarity here and that's the root of the problem. MDs may grouse at each other behind closed doors but to the rest of the world they protect their own for the conditions they feel they deserve. I don't think this is true of our profession.

Getting back to topic--I hope we are not now saying anyone can be an advanced practice nurse too? What's the deal. AND yet folks will complain about why the salaries won't go up or why the autonomy isn't always there. I just want to preserve the reputation. WE all know what the 15yrs on the floor in worth in terms of skill sets but the bottom line is that if that person is not willing to put the book knowledge with their hands on skill sets- they do not deserve the distinction of APN--they can be the best darn RN known to man but not necessarily an APN. Seem only fair. Don't like it? Change the policies.

i agree about standardizing the entry level at bsn for future nurses (for many reasons that DO NOT pertain to who is "better") however I have to disagree with you about grandfathering ADN and diploma nurses "cheapening" the degree. Physical Therapists, Pharmacists, and others have recently changed their entry to practice standards, but grandfathered in the exisiting practitioners and I feel that this is the right and ONLY thing to do! Entry to practice changes need to only affect future practitioners, not current ones as any other way would cause serious shortages (more so than we already have) and undue hardship for others. No one is going know who has what degree, and after the standard has been changed for some few years, the general public will assume that to be a nurse you must have "x" degree. Retroactively mandating nurses to return to school when the average RN practicising is in his or her 40's is just not practical. Again I do agree about standardization for the future though.

Well. . . .I had originally meant not grandfathering in people to APN and I still feel like their should at least be continuing education credits required for everyone . .all professionals must maintain those. I see your point though, I really do. Its just. . . we need some structure. Bottom Line. I hear this is an age old topic though and people poo poo it like it's not gonna happen. Its really sad - disappointing but I have some fire in my belly-- I wanna get involved.

i agree about standardizing the entry level at bsn for future nurses (for many reasons that DO NOT pertain to who is "better") however I have to disagree with you about grandfathering ADN and diploma nurses "cheapening" the degree. Physical Therapists, Pharmacists, and others have recently changed their entry to practice standards, but grandfathered in the exisiting practitioners and I feel that this is the right and ONLY thing to do! Entry to practice changes need to only affect future practitioners, not current ones as any other way would cause serious shortages (more so than we already have) and undue hardship for others. No one is going know who has what degree, and after the standard has been changed for some few years, the general public will assume that to be a nurse you must have "x" degree. Retroactively mandating nurses to return to school when the average RN practicising is in his or her 40's is just not practical. Again I do agree about standardization for the future though.

I am going to answer in a polite manner, though I take great offense at being referred to as a Pretend NP. Prior to 1999 the only requirements to become an NP were a license to practice as an RN and at least 200 hours in your area of specialty. This program is no longer available as it has been mandated that all NEW NP graduates must have a MSN ( the rest of us are grandfathered). The programs stil exist, but are for post MSN certificates only. If you take the time to research the history of the NP, you will see that the original NP's were trained on the job, following that, they developed programs such as the one I attended which was based at a major university and staffed by MSN and PhD instructors. The programs consisted of 16 weeks of intense didactic & clinical experience and a 5 month preceptorship, and the program was incredible. Training wise it was actually better than most of the MSN programs I have dealt with, especially in it's clinical experiences. To that end, I am one of those who was an ADN with National certification as a Women's health care NP, a DEA number and prescriptive privileges. For the record I am not uneducated, even though I had a ADN when I became an NP, I had close to 200 college credits to my name. It has taken some time to be able to afford (both monetarily and work wise) to return to school, but I am now finished with my BSN and pursuing my MSN. I have been practising for over 10 years as an NP at major teaching institutions, am well respected by my peers and the Physicians I have worked with. For the record, I have precepted and taught at four University MSN NP programs.

I have a friend who lives in PA. She is just finishing her RN (ADN/ASN) and is telling me something about a degree/certificate that would allow her to basically do what a NP does.

Does anybody know what this is? Its my understanding that you have to have a year of work expeirence, and after that you spend a year or so in some sort of training... then pooof. You get to hit the road. I'm thinking that they don't get to write prescriptions, but are about to be able to... or might already be able to. I don't know think they can actually "dx" anything w/o MD supervision. My thinking is that these people are some sort of major physician extenders.

Has my friend heard tale of some Earth shatter joke, or is there actually a way that you can assume a clinical role one year outside of an ADN?

If anyone has any information on this... if they exist, what their titles are (ANP, RNP PretendNP? :) ) and what their scope of practice is... please let me know.

Thanks,

David Adams, ARNP

-ACNP/FNP

No one should have written "pretend NP" but the simple fact that the other respondent didn't know about how an ADN nurse can become an NP without an MSN is EXACTLY the reason we need to create one standard point of entry into our field and stop vascillating. People are confused and they have a right to be-- nursing creates too many obstacles for itself by twisting and turning the requirements to suit each and every individual instead of saying -- a certain body of people who can meet a certain set of requirements (whatever they are) receive a certain distinction. 1999-- that wasn't that long ago

--what makes the NP governing body feel an MSN is needed now?

-- why should some have to get it and some not? what-- do you think the rest of us -younger or older people entering the field have all kinds of money for school and BSNs and MSNs-- not really and the hospitals I am looking at often say BSN req or preferred (MSKCC, Lenox Hill, Beth Israel NYC hospitals you'd actually WANT to work at)

--How much is hands on experience worth instead of education?? how much experience??? what areas?? which wouldn't count??

There are too many different answers to these questions, each person has a different life circumstance and story and since we can never create a circumstance that will be great for everyone, cut the fat-- create a standard and please make everyone follow it. That's where people get angry If people don't wanna keep with the standard then they won't and we'll all move on.

I am stopping now for good b/c it's clear that I am just outvoted on grandfathering. I like school, I think we need continuing education but I've said it enough and will stop oppressing my views on other folks. Again, I made no intentional remarks to anyone, their training or qualifications- I question only the reason for changing standards and why they don't apply to all.

dragging my soapbox back in the house. . .

i agree with prideofjuly28, there are too many entries into nursing/nursing specialties and it causes so much confusion among the profession and other healthcare professionals. i inquired about a dual msn/mba program recently and the advisor told me that i did not need any clinical experience to enter the program...just a bsn. another school wanted a year experience, another school wanted two years clinical experience. this leaves me confused because now i question the quality of education i will be getting. i have a bsn and don't plan to go back for a masters until 2006 but the different requirements make me leery about how well prepared i will be if i pick the school that do not require any clinical experience.

Hi Angel: I too agree we need to standardize things . I have been in nursing for close to 25 years, this is my second nursing shortage, and it feels worse than the last one already. The problem with standardizing things is complex, and unfortunately there is no easy solution. When I started my NP certification, there was a requirement that you have at least 2000 hrs IN YOUR SPECIALTY before you could even apply for school. It wasn't much, but at least it was something. I think I had about 15 years of nursing experience at some really big time institutions before I started my program and I think that the judgment and knowledge base you gain from working first is irreplacable. Getting back to the degree issue, We have successfully changed the advanced practice model, I'm changing with it- into my last 15 hrs of my MSN so it is possible to effect change, even with an old girl like me. What is hard is that it doesn't always happen overnight. The Diploma and ADN I am not sure how that will change, and I am certain it will not happen quickly. We have been trying to change that for as long as I have been a nurse. The best I can think is that make that the entry, then we set a limit to how high on a clinical ladder one can go based on your educational level. Unfortunately there are a whole lot of ADN and Diploma nurses out there and the numbers get larger every year we have a nursing shortage. I agree that we have a confusing profession. I don't know what schools you are applying to, but I can tell you that some very good MSN programs operate under the same premises of not requiring experience, and their grads do quite well, so who knows? I have taken to looking at it this way... PA programs are almost as confusing as NP and RN programs. have only a two year program at the AD, BS or Masters level and they do not have experience when they graduate either (although they are so competitive to get into that schools usually ask for some background as a volunteer or worker in the health care field before applying). I guess it is because we are a relatively new profession ( first NP was in the 60's.. not really that long ago when you compare it to Medicine), so we have come a long way in a short time. Remember professions evolve, they usually don't just appear intact and at full power overnight. We are all still in the process of developing our roles as APN's, over time it will clear up.good luck with whatever school yo choose.

i agree with prideofjuly28, there are too many entries into nursing/nursing specialties and it causes so much confusion among the profession and other healthcare professionals. i inquired about a dual msn/mba program recently and the advisor told me that i did not need any clinical experience to enter the program...just a bsn. another school wanted a year experience, another school wanted two years clinical experience. this leaves me confused because now i question the quality of education i will be getting. i have a bsn and don't plan to go back for a masters until 2006 but the different requirements make me leery about how well prepared i will be if i pick the school that do not require any clinical experience.

I really think that is sad AND scary!!! Here in California, starting 2008, NP's must graduate from a master's program or have a master's degree already when doing their post master's NP certificate.

http://info.sen.ca.gov/pub/bill/asm/ab_2201-2250/ab_2226_cfa_20040615_140033_sen_comm.html

I can understand an accelerated track... but this is...

WOA!

Why don't we just let anyone who's applied to nursing school be a NP? Or maybe... if your mom/dad/sister/brother/niece/nephew/ect... is a nurse, you can be a NP :-D....

It just amazes me that "NP" is now going to be so... whats the phrase? Cheapened?

David Adams, ARNP

ACNP/FNP

I am a Master's candidate with a concentration of ANP/GNP. For the admission, even though I have another master's, I had to fulfill all the prereqs.(BSN),one year recent clinical experience, then applied for the master's program and then was selected for an interview. I finally was accepted into the program after an interview with the 5 admission committee members. This was in MN. My understanding is that through some programs you could pursue a MS in nursing. These are mostly on-line options. If a candidate has a previous advanced degree(non-nursing), may be allowed to finish AAS in Nursing to MS in nursing/ NP programs. I am just surprised to hear about this ADN trained nurses allowed to work as an NP. It does question the validity of the program. I think the experience in the field can not be substituted. Neither can be the thepratical background of a master's level classes. I think it is crucial to maintain the high educational standards for nursing as well as NPs.

Oh, actually it just pisses me off. We can't decide whether an ADN or a BSN delivers better care and we have figured either way they can go into advanced practice. This is the equivilent if i decide to go to med school but feel i should skip the first 4 years of lecture and jump ahead to a junior resident position. It's foolish and I hope that the ANA, AACN, AANP will form a strong opionion. I am not politically active at any level but this is something that is directly related to how i have lived and trained over the 15 years to 'earn' my advanced degree. Nothing worth it is ever easy. This shouldn't be either. The degree of my practice is not something that I could have ever thought about back when i finished school. Even now there are so many facets to anything you do as an NP, much of which is based on good experience.

Exactly Eastcoast!

Makes me feel like my 13 years experience and all that money I spent on a BSN and now on a Master's NP program is just out the window! Why bother when you can go get a CERTIFICATE and DO THE SAME THING! Yeah, I'd want somebody with that level of education and experience taking care of me or my family, making all those vital decisions! In my opinion, there's no way a certificate program can replace all those years of real experience and education, I don't care if the person is an Einstein . They just don't have the background to be making those kinds of decisions. I also disagree with those programs that allow people to become NP's after a year as an RN and a couple of years in an NP program. Very foolish indeed! :angryfire

I definitely agree that a master's should be the minimum for nurse practitioners. Patients deserve the best and having a higher education is crucial. I do have to disagree with you though on the number of years a nurse should be before applying to an NP program. It's important, but what types of experience one has should also be taken into account. I had only 2 1/2 years experience when I started the program, some of my classmates only had 1. I have to say, we did pretty well. All of my classmates worked for major hospitals that sees very sick people. A nurse can have many years under their belt from a smaller hospital that don't see critical patients. That nurse may have a hard time in an NP program based on just not having that quality experience. I guess it's all individual. I just did not want to wait til I was in my thirties or forties to become an NP. I suppose I am just very fortunate to have finished earlier than later and I take that as a blessing. :)

Exactly Eastcoast!

Makes me feel like my 13 years experience and all that money I spent on a BSN and now on a Master's NP program is just out the window! Why bother when you can go get a CERTIFICATE and DO THE SAME THING! Yeah, I'd want somebody with that level of education and experience taking care of me or my family, making all those vital decisions! In my opinion, there's no way a certificate program can replace all those years of real experience and education, I don't care if the person is an Einstein . They just don't have the background to be making those kinds of decisions. I also disagree with those programs that allow people to become NP's after a year as an RN and a couple of years in an NP program. Very foolish indeed! :angryfire

It's really confusing to the public what a nurse does and what it takes to be nurse, because of the fact that there isn't a standardization of education. Until there is a standardization, until a person can see a nurse and have an idea of what her education was like (such as a Doctor), then I think the public will have a hard time respecting nurses. I'm in the camp that thinks BSN should be entry level and certainly MSN should be the entry level for NP!

More on my thoughts about the subject of nursing advancing itself as a profession here at my website.