Becoming an NP with little to no nursing experience??

Psychaprn · Mar 2, 2007

Congratulations Morgan! As an old timer, I have no objection to the shortening in time of your academic path-rather I worry about your clinical experience. How much of your schooling is spent actually working with patients? How much is spent working with pts. in your specialty area? You cannot replace practical nursing/clinical experience with book learning!! I also don't think you can become an advanced practice nurse(NP) without first BEING a nurse(RN with work experience.)

There are many nuances of both pt. care and workng with others as a nurse that can't be taught-they have to be experienced. I just worry that NP's who start practicing without solid clinical experience will be thrown to the wolves! I shudder when I remember a BSN studuent from another school that I precepted. She was graduating in year and didn't know how to take blodd pressures!!

All your employer will care about is your credentials-you won't get any longer precepting/mentorship and orientation than a seasoned RN who become an NP. Be careful of what your school promises-remember-they're out to make money. If I were you I'd work at least part-time while you're in school as a nurse's aide or student nurse in the area you want to specialize in. I am sincere about my concern for you and am not resentful you didn't have to go the long way but consider this-I had four years of BSN education which was 8 semesters of clinical work and academics-including the last year being in my specialty. I worked inpt. for 5 years and had a 2 year clinical practicuum, including a thesis for my master's. I worked inpt. and out. settings while in school with various age groups. To be perfectly honest-90% of my learning came from working not school! I also had to cope with nurses older than me who resented that I had a BSN rather than years of working behind me. I then studied to be an APRN while working and honing my prescribing skills. I think short cuts are fine as long as they don't make someone "short" on experience, comfort or competency! I admire anyone seeking to increase their education, I just want you to be aware of some of the pitfalls-please keep us posted on how you're doing.

morganvibes · Mar 2, 2007

Hi, psychapn, thatnk for responding.

Obviously I am giving my opinion based on reading (a lot) online and talking to people - since I haven't even started yet.

That being said, this is what I have found:

Most of the 4 year BSN programs I looked into had 2 years of completely NON-nursng courses, and then the last 2 years of nursing classes. It sounds like your BSN prgram was completely different than that. maybe better.

Also I have read that the NP's job is totally different than the RN's job. Due to that, many say it isn't neccessary to work as an RN first. I'm not saying that an NP should not have knowledge of what RN's do, of course they should!

I will get my RN license of course before getting the NP license. I don't know what satisfactory amount of clinicals is, again I am a newbie, but here are the numbers for the Vanderbilt program:

700 hours of clinicals for the RN, I know that the last semester of the first year is almost all clinicals.

700 hours of clinicals for the FNP program.

Does that sound like a good amount? let me know what you think.

of course , this doesn't change the "on the job" experience, but at least it is not just "book learning".

I'm interested to see how that compares to other programs if anyone knows.

mvanz9999, RN · Mar 2, 2007

Well, the two I am looking at are different. One allows you to take the NCLEX after 15 months (but does not give you a degree). You then start working as an RN while completing the program over the next 4-5 years.

The other one gives you a MSN general degree, which qualifies you to work as an RN. After that, you re-apply for a post-master's certificate, while continuing to work as an RN.

So in each case, there is mandatory RN experience required before you get your NP.

Programs require 830 clinical hours.

Uberman5000 · Mar 3, 2007

I really don't understand where everyone is getting this "NP without experience" from. Maybe people don't understand how the programs work. Let me put it down:
There are two types that I've seen:
A). I go to the first 15 months of the direct entry program (Core nursing requirements). I then receive a "permission" to take the NCLEX. If I pass it, I am now an R.N., but I have not finished my degree. I then take a part time job as an RN while finishing the actual NP part of the program. This is expected to take 4-5 years. After I finish the second part (and pass the licensing exam) I am now a NP with 4-5 years of experience as an RN and then (and only then) I receive my degree. (University of Illinois at Chicago)
B). I get a general MSN, take the NCLEX and am now a masters-degree RN. I then must re-apply to the school for the post-masters certificate program, to obtain certification as a NP. (DePaul)
In neither case do I see anyone who graduates without stepping foot into a hospital or working first as an RN. Now, in the second case, you may say that a person could get the general masters and then immediately apply for the post-masters certificate, but one must remember that you will be competing with applicants that have 5 or 10 or 15 or 25 years of clinical experience as an RN, and the likelihood of being competitive without ever working as an RN is minute. It would be very unlikely that they would admit someone with ZERO experience, into the post-masters certificate program.
So I'm not sure where all these NPs are coming from that have literally NO clinical experience. I think what may be happening is that some posters are unaware of how the programs work. In Illinois, these are your two choices, and from what I have read and heard, it would be virtually impossible to become an NP without significant clinical work as well.

The problem is you have alot of people on this board that dont have a clue what they are talking about making broad based assertions that I are easily dispelled with logical reasoning and fact. There is a typical "good old boy" mentality amongst experienced nurses that they feel it is "ones duty" to do all kinds of BS work before one is able to enter into the "Higher auspices" of the nurse practitioner roles. That idea is all well and good however it is not necessary to follow the 30 year career path to NP lol, even though some may want you to because it damages their ego to realize that you can do it 2 years post grad BSN.

Uberman5000 · Mar 3, 2007

I'm not a new Grad but I hope to be by Fall of 2009.
I just got accepted to Vanderbilt's "Bridge" direct entry NP program (FNP) and I have no prior nursing experience.
To let people know what this program entails, as it seems some people think it is so incredibly short to get your MSN:
Although the program is only 24 months long, it is actually the equivelent of 3 years of college- it is 6 semesters which are completed in 2 calendar years. so it is not really only 2 years of schooling, it is 3 years. (we will attend full time semesters in the summer months).
Also, you cannot just walk off the street and get your MSN and NP with this program, you must have many pre-requisitie classes equivelent to 3 years of college (minimum is 78 credits) including all science classes that you would have been taking if you had been on a BSN track.
I will actually end up having over 100 college credits and I already have an Associates degree (non-nursing).
So in actuality, a person who graduates from this accelerated program will have a minimum of 6 years of college, which is the same as having gotten the BSN in 4 years and then the MSN in 2 years which is the "normal" route. The only way that this differs is that they let you do it faster calendar-wise and they give you credit for your previous college courses instead of making you jump through hoops for an extra year because you need to take a specific history or sociolgy class that they require. Many schools for BSN have such strict requirements for these non-nursing courses that they make it problematic for an older student to graduate in a reasonable amount of time.
These direct entry programs have obviously been created to fill a need for NP's that some of the posters here seem to think does not exist. But I have heard from friends in the program that last year's graduates all got jobs right after school and many had several offers to choose from. Maybe Nashville is a good market, but I don't feel at all that I won't be able to get a job right away after graduation.
I think some nurses are just annoyed by these programs because they didn't exist before and they had to do it the long way. But they are here now and since I am an older student and time is very important, and money is important, I have to do the best I can. I think some of us will be great NP's right out of school and some will need time, but that is like anything else. From the articles that were posted earlier in this thread, it seems that there is no data that shows that new grad NP's without RN experience were nay different than those with nursing experience.
I think it would be great to perhaps add one year of "residency" for new grad NP's. It sounds like that would make everyone on both sides happier and probably make us all more competent as well.
I am really excited and can't wait to start.
Morgan

Thank you for clarifying these things Morgan, you are a living example of why the naysayers are wrong. It doesnt take 20 years to learn how to take vital signs after all. Good luck in your NP program, you will do good things I assume..

Uberman5000 · Mar 3, 2007

Been scanning this thread with some amount of interest. I feel that some here are playing devil's advocate, shaking cages, pulling chains. But all in all there has been some intriguing debate.
There is one word that has bothered me Uberman and that is:
Is this intentional misspelling in order to proclaim your Uber-station in life? It just jumps off the page. The closest I could find to a definition of the P word is that of phallacea which is a family of fungi.
Meanwhile, I will return to my silent spot and read on.

Yeah it is a play on words like "Phear me" - nice job though.

Uberman5000 · Mar 3, 2007

"Personally I think the idea is ludicrous! I became an RN first, worked in my area for several years and went to NNP school."
If you think I've made that statement because I walked through three feet of snow 20 miles to school you're really out there.
Nursing is a profession. People build skills in nursing school, see how a hospital runs, what the different roles are, etc. I think this is all part of being a nurse. As far as people without this previous education being molded easily and don't have "bad habits", that sounds like crap to me. You think every nurse has bad habits or isn't able to be molded? I find this offensive to those of us that are nurses.
There may be direct entry programs that are working well and putting out decent NPs, but please get yourselves away from the thinking that "some people think you should have to eat crap because they had to back in the day. But it makes no difference really..." I personally don't buy this and time will tell. Best wishes for your success.

Well Ginger I am just having trouble understanding why some people are in such denial regarding the New direct entry APRN programs. I have stated that you dont necessarily need previous APRN experience to get a job as an APRN.....do BSN students need BSN experience to get a job as an RN? Answer = No. IT doesn't take someone 20 years to learn how to do blood pressure, give shots, put a thermometer in someones mouth, etc....At least it doesnt take me that long.

Uberman5000 · Mar 3, 2007

Everyone has an opinion and I respect those who differ from my own, so please show the same courtesy...
In MY opinion, experience as a bedside nurse should be required before entering NP school. I agree with the rationale of others who say, ADVANCED practice nursing is just that, ADVANCED. Meaning you have MASTERED basic nursing principles and can now ADVANCE not only your knowledge base, but your skill proficiency, and your scope of practice.

Hmm, sounds a lot like the 90% of the theories that I heard in grad school that went out the door when I entered the "real world". Like I keep saying 1000 times over and over again, why does it take someone 5 years to learn how to do vitals, give injections and meds? Do you not realize that most people that go into APRN programs right after BSN graduation are actually working as RN's in addition to going to school? Is that not "experience" enough? Or do you still think that you need at least 5 years of takign someones blood pressure before you can "get to the next level" of ADVANCED practice..how do you define that by the way..?

Passing the NCLEX only determines whether a nurse posesses the MINIMUM level of knowledge needed to provide safe bedside care. You have enough knowledge not to harm your patient, and hopefully enough knowledge to help the patient improve. To go directly into the NP program, although I am not disputing that it gives you a great wealth of information and you may feel confident in acting in such a role, you still haven't had enough patient contact and experience to have MASTERED basic nursing care and possess the proper competency to ADVANCE your practice into DIRECTING the treatment plans for your client in the EXPANDED scope of NP.

Right...and those nurses with "limited knowledge" are actually able to work as registered nurses right after graduation!!!! Kind of like how alot of direct entry APRN's get jobs as APRN's right after graduation!!!! As i said before, most people that are in a direct entry program are working as RN's so they are gaining experience while attending school, and even if they didn't they could would still get out of school, get jobs and do well, as most are now.

It has always boggled my mind why there were direct entry programs for NPs, and to hear students say that once they graduate they will not even look for a nursing job but go directly for NP.

It has always boggled my mind why people think it takes someone 10 years to learn how to take blood pressure, read medical records , follow doctors orders and give medications. If I dont have to get a job as an RN working for 5 years before I get my APRN, why should I? Because someone on the allnurses forum says I should? Come on you have to give me a better reason than that.

There are still areas of nursing that do require you to have a min 1 yr of experience before you can work as a new grad (some surgery/trauma/ICU/PACU units...etc.) To advance your degree to CRNA a minimum of 1 yr in critical care is required. So if I have to gain a year's experience out of school to be considered safe to recover a pt from surgery in the PACU, then why do I not have to have a year's experience before I am considered safe enough to diagnose and treat an illness?

Yeah, sad isnt it? Well, not sad for me because that is the way I did it but I can see how it causes people who disagree with this option such pain. NEWS FLASH --> If you are working as an RN you are not necessarily getting a great deal of experience diagnosing and treating illness. As far as I understand, the medical doctors are the ones that do the diagnose and ORDER YOU to do NURSING INTERVENTIONS and give medication. So you want me to work as an RN for a year before I go to a completely different setting in primary care as an FNP, doing completely different work, i.e., diagnosing and treating illness and this would satisfy you? Sorry it doesn't make any sense when one looks at it rationally.

You cannot ADVANCE without first having become proficient in the basic aspects of care.

One opinion that is obviously a minority, as evidenced by the direct entry programs currently abound and graduating NP's everyday.

It would BEHOOVE you to gain some working knowledge/experience, excercise your critical thinking ability, and master basic nursing concepts before attempting to take on more responsibility and expand your nursing role.

I do not find this advice practical or wise, at least in terms of the experience I have had. In life you only have a limited amount of time..why waste it doing something you dont need to do when you can do more in less time....

nurse4theplanet, RN · Mar 3, 2007

Hmm, sounds a lot like the 90% of the theories that I heard in grad school that went out the door when I entered the "real world". Like I keep saying 1000 times over and over again, why does it take someone 5 years to learn how to do vitals, give injections and meds? Do you not realize that most people that go into APRN programs right after BSN graduation are actually working as RN's in addition to going to school? Is that not "experience" enough? Or do you still think that you need at least 5 years of takign someones blood pressure before you can "get to the next level" of ADVANCED practice..how do you define that by the way..?

You crack me up...seriously. :rolleyes: I find your argument to be incredibly weak. You can keep repeating 1000 times more that it doesn't take someone 5 years to learn to do vitals, give injections, or meds because it's a mute point...certainly not the logic being used to support experience for entry into advanced nursing practice. For one reason, you're right...it takes about a day to learn those skills. A monkey could do it. However, you assume that is all the nurse is gaining in his/her experience that will influence his/her advanced practice. I assure you that the nurses role is far superior to your generalization and the experience gained is deserving of far more credit. Critical thinking is developed and sharpened over time through experience only...not found in books. And I am sure you agree that an APRN's worth is in their knowledge and ability to critically think, not their ability to perform a routine skill. Your argument is not only selling bedside nurses short, but APRNs as well.

Of course, I realize that APRNs work as RNs while they are finishing their degree and I never disputed that it does not count as experience. However, I still support a minimum of 5 years practice being allowed to advance. A standardized approach with clear levels of achievement and qualification is not only good for the practicing nurse and the patient population, but it is good for the nursing profession when you examine it from a wider perspective. 5 years does not seem like an unreasonable requirement to get to 'the next level' as you put it...how do i define it? I don't have to. It's defined in your state nurse practice act. Wider scope of practice. More professional responsibility. More liability.

I don't make the rules and you are free to move on to NP or CNS if you wish without any experience. I would not choose to do so. And it's not because I think every nurse should 'do their time' at the bedside, it's because I whole heartedly believe it will produce better APRNs and command respect for the knowledge/experience/skill of those who are advancing our profession.

Good Luck to you.

core0 · Mar 3, 2007

You crack me up...seriously. I find your argument to be incredibly weak. You can keep repeating 1000 times more that it doesn't take someone 5 years to learn to do vitals, give injections, or meds because it's a mute point...certainly not the logic being used to support experience for entry into advanced nursing practice. For one reason, you're right...it takes about a day to learn those skills. A monkey could do it. However, you assume that is all the nurse is gaining in his/her experience that will influence his/her advanced practice. I assure you that the nurses role is far superior to your generalization and the experience gained is deserving of far more credit. Critical thinking is developed and sharpened over time through experience only...not found in books. And I am sure you agree that an APRN's worth is in their knowledge and ability to critically think, not their ability to perform a routine skill. Your argument is not only selling bedside nurses short, but APRNs as well.
Of course, I realize that APRNs work as RNs while they are finishing their degree and I never disputed that it does not count as experience. However, I still support a minimum of 5 years practice being allowed to advance. A standardized approach with clear levels of achievement and qualification is not only good for the practicing nurse and the patient population, but it is good for the nursing profession when you examine it from a wider perspective. 5 years does not seem like an unreasonable requirement to get to 'the next level' as you put it...how do i define it? I don't have to. It's defined in your state nurse practice act. Wider scope of practice. More professional responsibility. More liability.
I don't make the rules and you are free to move on to NP or CNS if you wish without any experience. I would not choose to do so. And it's not because I think every nurse should 'do their time' at the bedside, it's because I whole heartedly believe it will produce better APRNs and command respect for the knowledge/experience/skill of those who are advancing our profession.
Good Luck to you.

I will agree with your statements on nursing. Nursing is far more than taking temperatures and passing medications. I usually talk to the nurse before seeing the patient in the hospital. This is an important data point on how a professional views the patients condition (someone who is going to spend way more time with the patient than myself). I also make it a point to listen to the verbal and non-verbal cues of the nurse (saved my happy butt more than once).

I'll play devil's advocate here. Is all nursing experience equally applicable or valuable? For example while a nursing administrator is still a nurse, is that experience relevant to NP school? Or another example if you do peds nursing is that experience as relevant to ANP as med/surg nursing? Some ARNP programs require a period of a certain type of nursing before school (CRNA comes to mind) but most do not. Just a thought.

One thing that makes this difficult to evaluate is that most schools do not publish their pass rates or employment rates (that would be difficult to track). So there is no real data on whether NP's with experience are any different than NP's without experience. We have a similar debate in the PA world. One of the differences is that with a centralized application system we can tie this data to graduation rates and pass rates on the certification exam. I think this is the data that you would need for NP's to answer this question.

David Carpenter, PA-C

Uberman5000 · Mar 3, 2007

You crack me up...seriously. I find your argument to be incredibly weak. You can keep repeating 1000 times more that it doesn't take someone 5 years to learn to do vitals, give injections, or meds because it's a mute point...certainly not the logic being used to support experience for entry into advanced nursing practice.
For one reason, you're right...it takes about a day to learn those skills. A monkey could do it. However, you assume that is all the nurse is gaining in his/her experience that will influence his/her advanced practice. I assure you that the nurses role is far superior to your generalization and the experience gained is deserving of far more credit.
Critical thinking is developed and sharpened over time through experience only...not found in books. And I am sure you agree that an APRN's worth is in their knowledge and ability to critically think, not their ability to perform a routine skill. Your argument is not only selling bedside nurses short, but APRNs as well.

Really? Hmmm, the evidence shows that you're argument is the weak one. Your argument is basically that direct entry programs should not exist, even if you aren't saying it directly, if you were in charge, that is what you're will would be as evidenced by what you are saying. You are stating that RN's need alot of real world experience before they can get to the next Uber Advanced Level Of "Advanced Practice Nurse". You further espouse that the "critical thinking skills" that you develop as an RN will be directly applicable to working as an FNP in a primary care setting. Hmmm, I have been in alot of different areas as a straight RN, you know what I did primarily? ASSESSMENT!!!!! Take vital, do blood pressure, clean someone up, give someone drug. I did not diagnose and treat disease get it? RN"s do not diagnose and treat disease I think that is what you fail to understand. Let me ask you a question, why do you think it takes someone say..oh, 10 years of being an RN before they are "advanced" enough for APRN - oh wait the "Critical Thinking Skills". The academic BS ivory tower buzz word which emanates throughout the halls of higher learning. I don't know about you, but I have always had the ability to think critically and utilize good common sense. Moreover, I can tell you that my experience as an RN has NOTHING TO DO WITH MY EXPERIENCE AS AN APRN, NOTHING. Unless of course you include taking vitals and the other psychomotor skills involved with with regular RNhood, all the things you said a monkey could do.

Of course, I realize that APRNs work as RNs while they are finishing their degree and I never disputed that it does not count as experience. However, I still support a minimum of 5 years practice being allowed to advance. A standardized approach with clear levels of achievement and qualification is not only good for the practicing nurse and the patient population, but it is good for the nursing profession when you examine it from a wider perspective. 5 years does not seem like an unreasonable requirement to get to 'the next level' as you put it...how do i define it? I don't have to. It's defined in your state nurse practice act. Wider scope of practice. More professional responsibility. More liability.

That is nice that you support a minimum of 5 years of practice to be allowed to practice as an APRN - However, this is not the reality and I am a very successful living example of that. The 5 years is not unreasonable to you because you seem to believe that it magically takes 5 years before you are advanced enough to become more powerful, others do not want to sit around in say a PACU, doing vitals q 15 etc for 5 years when they could be doing something more, SOONER.

I don't make the rules and you are free to move on to NP or CNS if you wish without any experience. I would not choose to do so. And it's not because I think every nurse should 'do their time' at the bedside, it's because I whole heartedly believe it will produce better APRNs and command respect for the knowledge/experience/skill of those who are advancing our profession.

LOL --> I mean, this is what the whole thing boils down to in my opinion. Can I ask you a question...deep down are you resentful of a nurse that goes into a direct entry program right after school because you didnt do it that way? I don't know about you, but as I have stated repeatedly, not everyone wants to "Do their time", doing assessments at the bedside WHEN THEY DON'T HAVE TO AND DONT NEED TO.

Good luck 2 u as well.

Editorial Team / Admin · Mar 3, 2007

Please........

Let's not make this personal as in, "you, you, you......I, I, I....."

Let's debate the topic of, "Becoming an NP with little to no nursing experience??", without personalizing the posts. This really serves no useful purpose other than to place the one being singled out - on the defensive.

We are all professionals; have advanced to the position of APN. We have come to this via many different avenues of education and experience.

So, in saying this, let's attempt to get along; keep it professional. Guide the ones along the way who are sincerely seeking information about this issue of, "experience or no", and stay away from the personalizations.

Thank you.