Becoming an NP with little to no nursing experience??

[Blurr156]

Hello to all!!! I have worked as a parmamedic for 20 years, have a B.A. in Economics, and I wanted to advance my career in healthcare. I was originally looking to pursue the PA route, but for certain practical reasons (including my union not helping to pay for it) I have been looking at other options, nursing/NP.

I was very excited to learn of a school near me that has a combined BSN/NP program for people with non-nursing bachelor degrees. I was about to start looking deeper into this program when a good friend of mine who is a member of an interview committee at a nearby hospital told me that I shouldn't do the program because I would have trouble getting a job.

The reason stated was because I wouldn't have been seen as having "paid my dues" as a nurse first.

Is this true?

I could understand why someone might feel that way about someone who went through this type of program never having worked in healthcare before. However, I like to think that to a certain degree I've paid my dues (I know it isn't nursing, but from a time in healthcare perspective).

My friend did say that I might be considered an exception to that rule. The program is at a VERY well known school and I was told by my friend even then it wouldn't matter. I was wondering what people here thought regarding this topic.

Thank you for any guidance you can provide.

[traumaRUs, MSN, APRN]

Hi CoreO - the answer (IMHO) to whether you can be a good NP w/o experience has been discussed. It is interesting to note that many PA's go to PA school w/o any medical or nursing background also. Yet...we do not have many folks declaring that that is bad for business.

My other observation is that yes, an NP does have less clinical hours than a PA. However, for most of us who have done the NP/APN the old-fashioned way, we have years of experience assessing and caring for patients. That does give us an advantage.

I am not saying that the old-fashioned way is the only way - just that this is the route most other RNs and MDs are familar with. As we all know, progress comes quick and fast to medicine.

[mvanz9999, RN]

There is ample data on what happens to PA students after graduation. Their employment status is tracked, salary surveys are collected etc. There is no compareable data on what happens to NP's.

David Carpenter, PA-C

Yes there is. Here's one study -- American Journal of Critical Care:

Acute Care Nurse Practitioner Practice: Results of a 5-Year Longitudinal Study -- Kleinpell 14 (3): 211 -- American Journal of Critical Care

Although this article focuses more on the developing role of ACNP, it shows that data is definitely available regarding who is practicing as an NP, role interpretations and job satisfaction.

According to this article, "On average, 20% of those certified as ACNPs reported that they were not currently practicing as ACNPs"

...In year 1 of the study, 61 (37%) reported they were currently seeking employment; that number declined to 27 (18% ) in year 2, 13 (9%) in year 3, 9 (8%) in year 4, and 5 (4%) in year 5. When the ACNP role first evolved, finding a position was challenging in some demographic areas that were saturated with ACNP educational programs or in areas where the role was not recognized as a new area of advanced practice nursing. Nationally, advertised positions for ACNPs are now common, as recognition of the role has evolved.

[caroladybelle, BSN, RN]

i'll admit this was an extreme example. I can't remember all the details ,but the crux was that the board had tried an number of other methods including dictating etc and none of them had worked. He really wasn't a bad practitioner, it was just that his handwriting was so illegible that if he wrote anything down no one could figure out what was written. They go involved initially because a case turned into a he said, she said thing because no one could figure out what he wrote - so even though they didn't think there was a bad act, they were stuck with correcting it. When they went back and it still wasn't fixed, they finally came up with this. From a PA point of view we pointed out this wasn't very good medicine. I think he finally got the hint and retired. The problem was that they couldn't show he was practicing bad medicine (although you could argue that failure to document is bad practice) so what excuse do they have to suspend him?

Sorry, but it doesn't fly. If an MD cannot communicate adequately to do the job, then they are not practicing safely and within acceptable standards. One cannot be a safe, adequate health care practitioner, if no one can safely clearly understand your basic communication, unless he was responsible for giving all his own meds, tests, treatments to his patients and no one had to ever read his communications or orders.

It does not matter, that no one died. Anytime that others cannot understand your orders or notes, care is going to be delayed, incomplete or less effective due to loss of information.

And back to topic.

[Corey Narry, MSN, RN, NP]

as you stated your training is in the medical model, but the terminology used to describe what you do is a mystifying hodgepodge of medical and nursing phrases...i could point to the three nurses in my class that wanted stronger medical training and in the words of one "no more bs nursing theory". you professor was right if you are looking at advancing your nursing career. the students in my class did not care about their nursing career, they wanted to advance their medical career.

it is only mystifying to you because you have no idea whatsoever about what nursing is all about. as far as those nurses, they are entitled to their own opinion. as for me, if i wanted training in the medical model exclusively, i would have gone for an md or a do. at least, i will end up as a full-fledged physician and not a mere assistant.

you really need to slow down and read what i wrote. what i was comparing was the training of the pa student and an fnp student (sorry if that didn't come across). the pa student will have more exposure to cardiology through their inpatient medicine and em rotations as well as exposure to didactic material than an fnp student on the average. this goes with the statement that np training depends more on the student and pa training depends more on the program..

if i remember right i was talking about an rn with ccu experience vs a pa who relies on his training in the pa program. i am not even going to respond to this. i think the answer is quite obvious.

once again look at what was said. we are comparing training models. fnp and pa. the pa training is modeled on the intern year. i am not comparing this to training for md's. i am comparing this to the model of training for fnp's. to be honest the closest model to fnp training is the old medex pa training which was 3-4 months of didactics followed by an 8 month preceptorship with a single family medicine physician.

i don't buy this at all! as far as i am concerned, pa's are trained in a fast-track program similar to md training. md's come out of their program raw and clueless as to what to do in the clinical field. that's why they have to go through residencies. just ask any nurse working in a teaching hospital every year in july!

i swear i thought i will never respond again. however, i didn't realize that mr. core0 here had more to say about my posts. anyway, i hope you guys don't mind me chiming in again. i promise, this may be my last post on this issue.

[core0]

Yes there is. Here's one study -- American Journal of Critical Care:

Acute Care Nurse Practitioner Practice: Results of a 5-Year Longitudinal Study -- Kleinpell 14 (3): 211 -- American Journal of Critical Care

Although this article focuses more on the developing role of ACNP, it shows that data is definitely available regarding who is practicing as an NP, role interpretations and job satisfaction.

According to this article, "On average, 20% of those certified as ACNPs reported that they were not currently practicing as ACNPs"

...In year 1 of the study, 61 (37%) reported they were currently seeking employment; that number declined to 27 (18% ) in year 2, 13 (9%) in year 3, 9 (8%) in year 4, and 5 (4%) in year 5. When the ACNP role first evolved, finding a position was challenging in some demographic areas that were saturated with ACNP educational programs or in areas where the role was not recognized as a new area of advanced practice nursing. Nationally, advertised positions for ACNPs are now common, as recognition of the role has evolved.

This is an interesting study, and I have seen it. The problem I have with this is that ACNP represents 5% of NP's and this is limited in geographical area. It is a well done study, but I would be interested in a longitudinal study with a more established group. I find it telling that a substantial percentage of early adopters are not working in the profession. I think the fragmentation of the profession is a substantial barrier to looking at trends in the NP profession.

David Carpenter, PA-C

[core0]

Hi CoreO - the answer (IMHO) to whether you can be a good NP w/o experience has been discussed. It is interesting to note that many PA's go to PA school w/o any medical or nursing background also. Yet...we do not have many folks declaring that that is bad for business.

My other observation is that yes, an NP does have less clinical hours than a PA. However, for most of us who have done the NP/APN the old-fashioned way, we have years of experience assessing and caring for patients. That does give us an advantage.

I am not saying that the old-fashioned way is the only way - just that this is the route most other RNs and MDs are familar with. As we all know, progress comes quick and fast to medicine.

I guess that this paralells the discussion we are having in the PA profession (sorry to bring in the PA thing again). The average PA student is becoming younger with less health care experience than in the past. This is a consequence to the movement toward the master's degree (among other things). In the PA field, the measureable elements such as certification pass rate, average new grad salary, and time to employment haven't changed much despite the decrease of medical experience (time to employment has increased slightly, but it is difficult to differentiate this from the increase in students and programs). This is well documented and followed. For example programs are now required to publish their first time and overall certification pass rate.

In regards to becoming an NP without experience, I see a diversity of opinion. I also see a paucity of data not only on the students, but on the outcomes of the training. My understanding is that the direct entry and distance learning programs for NP's are relatively recent developments. If you look at the AANP workforce survey from 2004 the mean age for NP's is 50 and the average years in practice is 9. What is missing is data on NP's that are not in practice.

There are two measures of success for any student. One is completing the course of instruction and the other is succeeding in the profession that you are training for. This is where the lack of data is frustating. What if the majority of the NP's that are not working as NP's are those with little nursing experience? What if the employment prospects of those direct entry NP's are substantially less than those of experienced nurses? Surely this is important information to know when choosing an NP program. Finally data on certification pass rates should be easily available.

There is probably anectdotal evidence either way, but without more data it is hard to make an informed decision.

David Carpenter, PA-C

[BrandyNP]

I guess that this paralells the discussion we are having in the PA profession (sorry to bring in the PA thing again). The average PA student is becoming younger with less health care experience than in the past. This is a consequence to the movement toward the master's degree (among other things). In the PA field, the measureable elements such as certification pass rate, average new grad salary, and time to employment haven't changed much despite the decrease of medical experience (time to employment has increased slightly, but it is difficult to differentiate this from the increase in students and programs). This is well documented and followed. For example programs are now required to publish their first time and overall certification pass rate.

In regards to becoming an NP without experience, I see a diversity of opinion. I also see a paucity of data not only on the students, but on the outcomes of the training. My understanding is that the direct entry and distance learning programs for NP's are relatively recent developments. If you look at the AANP workforce survey from 2004 the mean age for NP's is 50 and the average years in practice is 9. What is missing is data on NP's that are not in practice.

There are two measures of success for any student. One is completing the course of instruction and the other is succeeding in the profession that you are training for. This is where the lack of data is frustating. What if the majority of the NP's that are not working as NP's are those with little nursing experience? What if the employment prospects of those direct entry NP's are substantially less than those of experienced nurses? Surely this is important information to know when choosing an NP program. Finally data on certification pass rates should be easily available.

There is probably anectdotal evidence either way, but without more data it is hard to make an informed decision.

David Carpenter, PA-C

The Gallop Poll shows that year after year, the general public recognizes nurses as being the most trusted/respected of all professionals. The only year we weren't #1 was in 2001 (9/11), when firefighters beat us out. I don't recall seeing Physicians' Assistant in the rankings. It all comes down to "whom do you trust?" The answer is NURSES!

Another thing, I read one of your posts in which you stated that NP's were often confused with nurses, but that doesn't happen to PA's. Very often, the general public believes that PA's are medical assistants. Hmmm, an "assistant" or a "practitioner." Who do you think the public will choose?

[mvanz9999, RN]

I'm not exactly sure where you are headed with this.

Here's another study, Dept. Health and Human Services:

Nurse Practitioners (NPs) included RNs prepared beyond initial nursing education in an NP program of at least three months. In March 2004, there were an estimated 141,209 RNs with credentials as NPs, indicating an estimated increase of 38,560 NPs from 2000. About 65.5 percent of NPs had completed a master’s degree program and an additional 10.5 percent had a post-master's certificate as their NP preparation. An estimated 87.7 percent of NPs were employed in nursing, with 65.7 percent of NPs employed in nursing reporting the position title as “Nurse Practitioner.” Of the nurses who were NPs, 74.8 percent reported being currently certified by a national organization in an APRN specialty.

Preliminary Findings 2004 National Sample Survey of Registered Nurses

****

Additionally, what you are saying about new students...in this area, the programs are so new that there is very little data to have, period (as compared to an older program with 40 years worth of graduates). I wonder how programs would survive if graduates were unable to find employment on graduation. Most of these have been around long enough to have graduates, and it would seem that word of mouth would quickly spread. Direct entry programs are not (hopefully) for the young or naive. They are for people who already have work experience and are making a career change. I doubt anyone enters these programs blindly.

You are correct that any prospective Direct-Entry students should consider their employablitity on graduation. However, whether a graduate works as an NP or an RN....they will be working. If I cannot work as an NP, I will be able to work as an RN, and the masters degree that I gain will certainly not hurt my employement.

So what if the employment prospects are less? With time they will increase. We still have to pay our dues, whether that is before or after certification as an NP. I certainly would receive less pay and less opportunities than someone with 15 years of experience, but that is irrelevant in this argument. It happens to anyone who is a new grad.

[core0]

the gallop poll shows that year after year, the general public recognizes nurses as being the most trusted/respected of all professionals. the only year we weren't #1 was in 2001 (9/11), where firefighters beat us out. i don't recall seeing physicians' assistant in the rankings. it all comes down to "whom do you trust?" the answer is nurses!

yep nurses not nurse practitioners. see your post below. i think that nurses (and np's) are trusted and respected for good reason.

another thing, i read one of your posts in which you stated that np's were often confused as "nurses," but that didn't happen to pa's. people often confuse pa's and medical assistants. i'm not being facetious, this is true.

i agree with you that this is a common problem and a constant source of debate over our name. however, what i was referring to was in the sense of employment, in my environment i see confusion over where the "nurse" role ends and the np role begins. there is considerable depending on the scope allowed nurses in your state, there is some overlap in the role. this is not the case between pa and ma. actually my bigger gripe is with offices that inappropriately use the term nurse to describe ma's. i think that the rn and the lpn are well earned titles that denote a defined level of professionalism and experience.

in an effort once more to go back to the original topic, i think this is an importan factor for an np to consider and an np with little nursing experience may be less able to understand this role difference and more likely to be underutilized (i'm trying siri ).

david carpenter, pa-c

[BrandyNP]

I agree with you that this is a common problem and a constant source of debate over our name. However, what I was referring to was in the sense of employment, in my environment I see confusion over where the "nurse" role ends and the NP role begins. There is considerable depending on the scope allowed nurses in your state, there is some overlap in the role. This is not the case between PA and MA. Actually my bigger gripe is with offices that inappropriately use the term nurse to describe MA's. I think that the RN and the LPN are well earned titles that denote a defined level of professionalism and experience.

In an effort once more to go back to the original topic, I think this is an importan factor for an NP to consider and an NP with little nursing experience may be less able to understand this role difference and more likely to be underutilized (I'm trying Siri ).

David Carpenter, PA-C

NP's are nurses with advanced training, so we're included in the #1 slot!

[core0]

It is only mystifying to you because you have no idea whatsoever about what nursing is all about. As far as those nurses, they are entitled to their own opinion. As for me, if I wanted training in the medical model exclusively, I would have gone for an MD or a DO. At least, I will end up as a full-fledged physician and not a mere ASSISTANT.

Yes I'm a mere ASSISTANT. I look at this from a systems point, studying the delivery of health care from a graduate level epidemiology and health care policy analysis background. Since you have decided to resort to ad-hominen attacks, I will not dignify your responses further.

Snip

David Carpenter, PA-C

[core0]

i'm not exactly sure where you are headed with this.

not sure where this is going either. this is the survey i referred to earlier. i did make one mistake. the correct figure is 40% of np's are not working as np's not 2/3's.

****

additionally, what you are saying about new students...in this area, the programs are so new that there is very little data to have, period (as compared to an older program with 40 years worth of graduates). i wonder how programs would survive if graduates were unable to find employment on graduation. most of these have been around long enough to have graduates, and it would seem that word of mouth would quickly spread. direct entry programs are not (hopefully) for the young or naive. they are for people who already have work experience and are making a career change. i doubt anyone enters these programs blindly.

well the beauty and the danger of distance learning is that there is little student to student contact that is not monitored by the program. unless a student found their way to an arena such as this, there would be little word of mouth.

you are correct that any prospective direct-entry students should consider their employablitity on graduation. however, whether a graduate works as an np or an rn....they will be working. if i cannot work as an np, i will be able to work as an rn, and the masters degree that i gain will certainly not hurt my employement.

so what if the employment prospects are less? with time they will increase. we still have to pay our dues, whether that is before or after certification as an np. i certainly would receive less pay and less opportunities than someone with 15 years of experience, but that is irrelevant in this argument. it happens to anyone who is a new grad.

you should probably look at this thread:

https://allnurses.com/forums/f34/can-nps-work-rns-195396.html

there is a diversity of opinion as to wether an np brings increased liability when working in the rn role. i will agree that any additional training is good in respect to nursing, but i would think that an np working in an rn role would find the limitations of the scope of practice somewhat frustating. as far as working as an rn after np school, i am not sure if this would help your employment prospects as an np. the one advantage to direct entry that i do see is that direct entry np's will not have the same salary demands as experience nurses. the np starting salaries are a major barrier to entry into practice in my market. transition from floor nursing to an fnp position usually entails a salary decrease here. this is different in the specialty market.

david carpenter, pa-c