Are you a nurse practitioner without any nursing experience?

meanmaryjean, DNP, RN · Jun 22, 2017

There are such NPs. One posted here last fall/winter and lamented what a mistake she had made. I cannot find the thread but some will remember it.

allnurses Guide · Jun 22, 2017

I am "that" NP. I did a Direct Entry program and have not worked bedside, but went right into a NP position. That was 9 years ago. I've not had any issues working as a NP, and really don't use much of what I learned in the RN portion of my program. Some caveats-I had over 20 years of experience in a different health care role that had very little direct patient care, but I did have years of hospital experience in that role. I also work outpatient as a NP. I am not trained to do inpatient care. I think RN experience is very valuable if you are going to work in patient. I also went to a very rigorous and respected program, not an on-line, for profit, you're on your own program. Finally, I worked my butt off and did more clinical hours than were required. I knew I had more to prove, and I wanted to do the best I could for my patients. I've been very successful, and have been praised by patients, colleagues, and supervisors. I have no regrets taking this route.

I think people can be successful in the Direct Entry programs, and can also fail in traditional programs even if they've had years of RN experience. It's very individual. Critical thinking skills and experiences in other careers can translate into success for graduates of direct entry programs. I precept student NPs from both paths, and I have had stellar DE students and crappy students with years of RN experience. Some RNs have difficulty transitioning to the provider role. DE students (at least the ones I've precepted) tend to be overachievers and will go above and beyond to learn. That's not to say I haven't had some fantastic traditional NP students, too. I will only precept for a few reputable schools, and will not precept for any for-profit schools that have low admission standards.

Don't disregard Direct Entry grads. We're out there, we're not going away, and many of us are very competent and successful.

allnurses Guide · Jun 22, 2017

I know several and for the large part they are fantastic NPs.

DizzyJ DHSc PA-C · Jun 22, 2017

I have a friend who did direct entry NP. After the 1st year she completed her RN and worked like a few months on the floor, but not even a year and then finished her NP and went straight into an NP job.

elkpark · Jun 23, 2017

My graduate program included a direct-entry track (I was a traditional, experience-RN, student, but was in classes with the direct-entry students). The way the program was set up, the direct-entry students didn't even sit the NCLEX until the end of their second year of three (the first year of the specialty track), and the program was so intense that none of the direct-entry students I was aware of were working at all. Also, the DE students with which I had personal contact were v. open about the fact that they had no interest in working as a generalist nurse, and no intention of ever doing so -- they were there to become advanced practice nurses.

Advanced Practice Columnist / Guide · Jun 23, 2017

I work with a few direct entry ACNP grads...in the ICU NP role, if you can believe that. I met them after they have been ICU NP's for a few years. They all graduated from a number of well established programs. A few had "pre-med" degrees in the biological sciences and worked in healthcare not in a direct patient care capacity but in research. They are up to par with those who had bedside experience as an RN but I have no idea what they were like when they were fresh out of school as we hired them with NP experience in a similarly-sized academic hospital ICU. Our local ACNP program, however, no longer accepts direct entry candidates.

prelift · Jun 24, 2017

The rate limited step of pumping out a good provider, (excluding personal attention and effort to take care of the patient) is a rigorous education. Nursing experience may help but it does not replace the education being rigorous and relevant.

That being said having 10000 hours at the bedside is great, but does not equate to an actual resident's training. Writing the orders and performing in the provider role are the only hours that really count.

FNPNurseCA · Jun 24, 2017

Vanderbilt, UPenn, UCSF all have great NP programs for non-nurses. Check out each university to read accurate information on the programs. I have heard wonderful things.

FNPNurseCA · Jun 24, 2017

adailydoseofwellness.com has some good first-hand information as well from a student enrolled in a program at Vanderbilt. Its a new blog so info is being added by the week but I have found it helpful.

dubiousraves · Jun 25, 2017

I don't think bedside nursing experience is necessary if the direct entry program is rigorous and maximizes the number of clinical hours required for students.

In your first year or so as an NP, when your ability to do a good differential diagnosis and develop a treatment plan is still limited by experience, being able to do a nursing or functional assessment of the patient can help guide your practice. After that, nursing experience doesn't really help that much.

Jules A, MSN · Jun 25, 2017

I don't think bedside nursing experience is necessary if the direct entry program is rigorous and maximizes the number of clinical hours required for students.
In your first year or so as an NP, when your ability to do a good differential diagnosis and develop a treatment plan is still limited by experience, being able to do a nursing or functional assessment of the patient can help guide your practice. After that, nursing experience doesn't really help that much.

I like your points but would ask where in the hundreds of NP schools that are admitting and graduating anyone who can pay tuition are the rigorous programs and really how could a mere 500 clinical hours be maximized?

The first year or so is, as you noted, where our patient care backgrounds are in my word, crucial, to pull from as we find our sea legs. There definitely are outliers in everything but in my experience and specialty those with no RN experience vs those with RN experience in the specialty are in most cases far more ready to practice competently and to the full scope upon graduation.

It will be interesting to see how this unfolds and how our profession adapts. My guess is we will continue to see more of the SOS posts that have been cropping up here more frequently. Those who have no clue what they were signing up for, no idea how to manage their practice upon graduation, had no clue how to negotiate a contract, those who thought Doctors had cushy jobs that involved coffee breaks and golf.