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]

Ubernurse - I gather from your posts that you are a direct-entry APN? These programs are still pretty new. Did you find it easy to get an APN position right out of school? May I ask in what area? I am neither pro or con direct entry APN, I'm just curious if these new APNs can readily find jobs.

I live in central IL and graduated from a CNS program last year. The job market is tight here for APNs. I got two job offers based on my RN experience of 14 years (this is what both practices told me). They had interviewed two other direct-entry APNs whom they (the prospective employers) weren't comfortable with their lack of experience.

So...before I come on board with an opinon - I'd like to know the job market. We can argue all day about this but in the end if you can't get a job with your degree, its only a piece of paper.

My next question is how did you negotiate a salary as an entry-level NP? (If that is what you are, of course). I was able to negotiate up $20,000 from what was initially offered by pointing out that I have already been published, have 14 solid years of acute care experience, have an excellent reputation with the MD staff that I work with, etc.. These are all things I would not have brought to the table as a new-grad entry-level APN.

[Uberman5000]

Ubernurse - I gather from your posts that you are a direct-entry APN? These programs are still pretty new. Did you find it easy to get an APN position right out of school? May I ask in what area? I am neither pro or con direct entry APN, I'm just curious if these new APNs can readily find jobs.

I live in central IL and graduated from a CNS program last year. The job market is tight here for APNs. I got two job offers based on my RN experience of 14 years (this is what both practices told me). They had interviewed two other direct-entry APNs whom they (the prospective employers) weren't comfortable with their lack of experience.

So...before I come on board with an opinon - I'd like to know the job market. We can argue all day about this but in the end if you can't get a job with your degree, its only a piece of paper.

My next question is how did you negotiate a salary as an entry-level NP? (If that is what you are, of course). I was able to negotiate up $20,000 from what was initially offered by pointing out that I have already been published, have 14 solid years of acute care experience, have an excellent reputation with the MD staff that I work with, etc.. These are all things I would not have brought to the table as a new-grad entry-level APN.

Hi -- I recall having this conversation with you previously. Refer to pages 7-8 on this topic. I have absolutely no interest in doing a research study or being "published". Rather than using that to market myself to someone who is going to pay me a salary, I create my own company and my own salary is based on the production from my company; I find this method works best for me because I have no ceiling. Although I didn't find school particularly challenging, I am not an academic....I am a business man first. My specialty is orthopedics/pain management but I really do everything I can if need be.

[nurse4theplanet, RN]

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).

Disregarding the advantage of previous nursing experience, or downplaying its benefit as merely useless (which some posters have done) is doing a disservice to the profession. I am glad that you support the value of bedside nurses. The more experience the nurse gains, the more efficiently he/she can recognize patient problems and intervene. Strong assessment skills would be a plus in advanced practice, I would think...although others seem to disagree. I wouldn't want an NP to diagnose/treat my condition unless I was confident in their assessment skills. Familiar working knowledge and hands on experience with a variety of disorders and their medical management gained from a few years at the bedside would also be a plus in advanced practice. Another advantage would be networking, with other physicians, nurses, and APRNs. I believe this experience is not only much more 'than taking a blood pressure', but incredibly beneficial when advancing into the higher levels of the profession.

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.

Excellent questions...all of which I have contemplated as well. The problem is that right now there is no standard. That is why I said previously that a standardized approach to the application and licensing process would do much for our profession. CRNAs, as you mentioned, DO have a standard and command great respect and a higher level of pay. Originally, advanced practices nurses were nurses with years of various clinical expertise that then were able to advance their knowledge and degree in order to perform higher level skills, even diagnose and treat minor illness/chronic conditions. It was a huge advance for our profession. Direct entry programs complicate things a bit, in my view. Now you have a pool of graduates with minimal experience to years of nursing experience. The "advanced" degree is merely a symbol of more education...not necessarily experience and expertise. There lies the problem. Because you need no previous experience, this also creates a larger pool of graduates for employers to choose from, those with less experience will command less pay...this leads to saturation in some areas of the country and lower levels of pay for all (unless you can do as another poster said and sell yourself and your experience well to command a higher salary).

So what type of experience should one have? Obviously, a school nurse, office nurse, and critical care nurse would not be on equal footing clinically...although all may be experienced nurses. Pediatrics vs. geriatrics is also very different. What's the magic number...how many years of practice is adequate (1, 2...5? more?) There should be a set standard that is dependent upon which route you take as an APRN. For CRNA, its one year experience in critical care. For women's health, it seems only natural that the requirement should be in that setting. Same for psych, acute care, etc. It makes perfect sense that your experience should be relevant to your advanced practice. My general suggestion of five years is just that...a generalized suggestion to express the importance I place on previous experience in reference to advanced practice nurses. In reality, there needs to be specific requirements with very clear parameters based on concrete data that supports the rationale for requiring certain experienced levels of clinical competence.

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

I agree. The lack of data on the subject is a major wrinkle in the system. Everyone's opinion, whether for or opposed to requiring previous experience, is merely subjective and is just as valid as anothers...until concrete data proves otherwise. I feel that if that data were available, it would clearly show a positive correlation between previous years of experience and the likelihood of the patient to experience a good clinical outcome.:wink2:

Finally, to answer Uberman directly...yes, I DO respect direct entry APRNs, even though I don't believe it is the most appropriate route into advanced practice. It's not personal to me, it's just my opinion. Like the mod pointed out, it is best to keep things non personal on these boards.

[mvanz9999, RN]

I have been reading this, and will offer my un-qualified opinion. Basically what I think is this: direct-entry programs are here to stay. Yes, they are new, but they have been around long enough that I believe they will become a permanent fixture in some schools.

Whether previous RN experience is required sort of becomes a non-issue as these pograms ARE here and ARE turning out graduates.

I think that it will be extremely difficult, but not impossible, to find work as an APN with no previous RN experience. Since I live in Illinois I am only considering the way the programs here work. I will have some years of RN experience in order to graduate.

As time passes, APN's will continue to be present in many or most settings. This is already starting to happen. I suspect that direct-entry APNs will be very suspect for a long time, but will eventually become accepted as any APN.

As has been previously stated, it is apparent that SOME physicians actually prefer RNs with less experience. These are the places that direct-entry students will find work. It will be difficult, but not impossible.

I have seen both sides of this debate, and I'm not going to argue for either one. I am going to be a direct-entry student myself, and I will find work. If I cannot find immediate work as an APN, I can still work as an RN. My opinion is that there are many, many paths to ANY career in life. Neither path is necessarily better than the other. Just different.

We are all on the same team, are we not?

[Uberman5000]

Finally, to answer Uberman directly...yes, I DO respect direct entry APRNs, even though I don't believe it is the most appropriate route into advanced practice. It's not personal to me, it's just my opinion. Like the mod pointed out, it is best to keep things non personal on these boards.

WHat makes you say I don't respect bedside nursing? Whoever said that? How am I minimizing bedside nursing by saying I DONT WANT TO DO IT. If I dont want to do something, I dont do it, its that simple. I dont want to be a meter maid or a postal worker, so I dont do it. Does that mean I dont respect them? No, its just I prefer not to do that type of work.

Yeah - I am just happy I didnt have to go through bedside nursing for 5 years prior to obtaining my NP degree...its better left to someone else who likes that type of thing. Oh and if one doesnt desire to go to an NP with less than 5 years of bedside experience then they don't need to. Actually I don't recall any of my patients asking me a question like that so its not a concern for me.

I will do whatever is in my power to encourage individuals who are getting their BSN to go immediately into the advanced degree program if they are so interested. As a matter of fact, this is my new passion in life.

[Uberman5000]

I have been reading this, and will offer my un-qualified opinion. Basically what I think is this: direct-entry programs are here to stay. Yes, they are new, but they have been around long enough that I believe they will become a permanent fixture in some schools.

We are all on the same team, are we not?

No - we are not, there are people that are really hoping that you fail because you are doing something that they didnt do. Its unfortunate but true. If they had their way they would do away with direct entry NP - I am sure you will do good things with your future and by your dialogue I can tell you are an articulate and intelligent person. Good luck

[nurse4theplanet, RN]

WHat makes you say I don't respect bedside nursing? Whoever said that? How am I minimizing bedside nursing by saying I DONT WANT TO DO IT. If I dont want to do something, I dont do it, its that simple. I dont want to be a meter maid or a postal worker, so I dont do it. Does that mean I dont respect them? No, its just I prefer not to do that type of work.

Please show me where I said YOU, Uberman5000, do not respect bedside nursing. I think you are taking things entirely too personal.:uhoh21:

Perhaps this thread needs a little cooling off period.

[christvs, DNP, RN, NP]

I've been reading this thread with interest for some time. I've been an RN for just about 2 years now (got my BSN in 2005) and I'm also now an acute/critical care NP student. I am in an NP program that mixes traditional BSN students who wish to go back to school for their NP (me) with Graduate-Entry Students who have completed their one year RN. I have changed my opinion from being skeptical of Graduate Entry programs/students to accepting them, as long as each individual student who is going through the program is truly competent and is able to handle it. The reason i've changed my mind is because I have been a preceptor to new RNs at my job, and have precepted both new BSN graduates and new RNs through this graduate entry program. I can honestly say that out of every new nurse I've precepted, the very best one with wonderful assessment and critical thinking skills was one of my graduate entry student peers. She to me seems like she has already been a nurse for years due to her level of maturity, top notch assessment skills, always asks for help if she is over her head, and is so good already at being an RN in just a few short months. I truly believe that graduate entry programs are not for everyone. I feel that it is up to the individual to decide for him/herself if she/he can handle the fast paced 3 year roller coaster and still come out competent, and somewhat sane because it is a lot of work. But even just sitting in class listening to my classmates speak about their work experiences...I hear a level of maturity and competence that I didn't realize was there before. I think there are going to be nurses at both ends of the spectrum (really great vs. barely getting it) no matter which way they become RNs...whether it be diploma, ADN, BSN, GEP, etc...And as for the thought that 5 years as an RN are needed before getting your NP, I again disagree respectfully by stating that too depends on the individual nurse, and how quickly or slowly she/he grasps new material and can think on her/his feet and demonstrates competence and critical thinking skills. I began my NP program just with one year as an RN under my belt. I have received nothing but As in every single graduate class I've taken so far (I'll have completed 8 graduate classes by May). But more importantly, I can truly say that there is nothing I have learned in class that I felt was over my head. I am a fast learner and feel comfortable with the knowledge I have gained so far. I also feel 100 % ready for my NP clinicals to start in August 2007 and am eager to move on to the next phase of my nursing career. :)

[Uberman5000]

I've been reading this thread with interest for some time. I've been an RN for just about 2 years now (got my BSN in 2005) and I'm also now an acute/critical care NP student. I am in an NP program that mixes traditional BSN students who wish to go back to school for their NP (me) with Graduate-Entry Students who have completed their one year RN. I have changed my opinion from being skeptical of Graduate Entry programs/students to accepting them, as long as each individual student who is going through the program is truly competent and is able to handle it. The reason i've changed my mind is because I have been a preceptor to new RNs at my job, and have precepted both new BSN graduates and new RNs through this graduate entry program. I can honestly say that out of every new nurse I've precepted, the very best one with wonderful assessment and critical thinking skills was one of my graduate entry student peers. She to me seems like she has already been a nurse for years due to her level of maturity, top notch assessment skills, always asks for help if she is over her head, and is so good already at being an RN in just a few short months. I truly believe that graduate entry programs are not for everyone. I feel that it is up to the individual to decide for him/herself if she/he can handle the fast paced 3 year roller coaster and still come out competent, and somewhat sane because it is a lot of work. But even just sitting in class listening to my classmates speak about their work experiences...I hear a level of maturity and competence that I didn't realize was there before. I think there are going to be nurses at both ends of the spectrum (really great vs. barely getting it) no matter which way they become RNs...whether it be diploma, ADN, BSN, GEP, etc...And as for the thought that 5 years as an RN are needed before getting your NP, I again disagree respectfully by stating that too depends on the individual nurse, and how quickly or slowly she/he grasps new material and can think on her/his feet and demonstrates competence and critical thinking skills. I began my NP program just with one year as an RN under my belt. I have received nothing but As in every single graduate class I've taken so far (I'll have completed 8 graduate classes by May). But more importantly, I can truly say that there is nothing I have learned in class that I felt was over my head. I am a fast learner and feel comfortable with the knowledge I have gained so far. I also feel 100 % ready for my NP clinicals to start in August 2007 and am eager to move on to the next phase of my nursing career. :)

Wow - Sounds great Christine, I am very happy for you and I am confident about your future success. Its fortunate that they have direct entry programs for those of us who were born ready for this role. I support you 100% - Keep up the great Work!

[Psychaprn]

How can you be an advanced practice nurse without first working as a nurse? Illogical!

[ksc0723]

Like most I have also been reading all the posts to this very important question for some time. I already have a bachelor's and a master's degree in psychology and am now pursuing nursing. I was originally looking at accelerated BSN programs and still am but then I came across MENP programs and thought what a great idea!

I have worked in healthcare for over 5 years as a CNA and currently work on an MICU. I was considering med school, pa school, nursing school, crna, you name it, I researched it. But, after working with all types of people in varying healthcare professions 12 hours a day 3-4 days a week, I know being a nurse practioner is where I want to be. I have talked to several people in all the professions I mentioned above, worked side by side with them in the hospital, and observed them working on a daily basis for quite some time.

I had come to the conclusion that in order to be a nurse practioner, I had to become a nurse first, work as a nurse for awhile, then go back to school (making my degree total 4 yikes!) to become a nurse practioner because frankly that is what I was told was the only acceptable route. For me, I have worked closest with the nurses and as much as I respect them and appreciate all they have taught me, I don't want to be a nurse, I want to be a nurse practioner and after seeing and hearing what I have seen in my job, I truly believe that you do not need experience as a nurse in order to become a nurse practioner. Even if these programs are new, if it were the case that being a nurse first was a vital and crucial step to becoming a nurse practioner (which most on this thread are claiming) then none would be accredited by the two major accrediting boards of nursing! I personally feel the reason they have instituted these programs is for people like me (whom they appear to be advertising to on the school websites) who have a non-nursing degree and want to become nurse practioners, but not nurses first. Again I feel like it is a false assumption to say you NEED to be a nurse first in order to be a nurse practioner. They ARE DIFFERENT PROFESSIONS. So what if the profession grew out of nursing, being a PA grew out of being a doctor in the military in the field. I think the reason why they have you study the core undergraduate level of nursing curriculum is to get you familairaized and trained in the mind set of the nursing model, not the medical model. They are ultimately two very separate professions with distinct job duties and responsibilities and scopes of practice. When you are working as an NP you aren't working or performing job functions as a nurse and vice versa. So why would it stand to reason that one MUST precede the other. The MENP provides a wonderful option to those of us with extensive education in another field that want to pursue a profession within healthcare, but feel it is a waste of valuable time and money (which if you already have BS and an MS you have already spent your share of both) to go through another profession to get there becasue that is exactly what you are doing becasue traditionally that is how it has been done and people get so freaked out about deviating from what was done before. Look at the PA profession, older PA's are having a fit that younger PA's are entering without any experience and they had like 15 years of it so how can they know what they are doing. Everyone brings something to the table when they are hired in a new job that other's don't have. Whether they gained their strengths through education, work experience, volunteering, life experiences, whatever it is really a shame for those to think that in order to do something you must have a background in X or your comeptency is and will always be lacking. Wow that is a pretty big assumption to make about someone. How can anyone pre-determine someone's skill level and how they will perform in a job based on them not having been a nurse prior to being a nurse practioner. Is being a nurse prior the only way in which they could ever gain the skills necesssary to be a nurse practioner? I firmly stand by my own beleif that becasue the two ARE TWO DIFFERENT JOBS, one does not need to precede the other.

With that said, I originally went to school to become a psychotherapist. I had NO training or work experience outside of my BS in psych. But, I knew even after I graduated I was going to take what I learned in school and apply that to the job when I was done and that I would hone my skills by working in that job. Now I feel good about having worked in healthcare for sometime in some capacity as it has helped me really see and decide where I want to be. But, I am equally confident upon my observations, discussions, and interactions with others in healthcare that I can have all the nursing experience in the world, but I will learn my job as a nurse practioner ONLY when I am working as one and don't feel I need to work as a nurse in order to be able to work as a nurse practioner.

I mean there are still schools out there that require you become a CNA en route to becoming an LPN, ADN, RN and work in that capacity for some amount of time before being accepted to the next level of nursing. Now I believe that nurses who became RN's without taking that step, had no healthcare experience at all before becoming nurses, and just took the classes and got their degrees would say it is a necessary and vital step that you start out as a CNA otherwise your competency will be and should be questioned. This exists on a different level, but it is 100% the exact same idea saying NP's should be required to work as nurses first. There are those that still beleive whole-heartedly that you aren't qualified to become a nusre if you haven't worked as a CNA. Those in CNA to RN programs begin their schooling learning basic nursing requirements just as MENP programs begin the same way in their core requirements. The more you learn in the classroom to develop an educational foundation to draw from the better, but as far as the experience goes, here is an example within the nursing model that has proven one does not need to precede the other in order for people to be competent!

[BerkeleyMom]

I have been following this thread too. Very well put ksc0723. Uberman5000--I have enjoyed your input, and definitely follow your line of reasoning. I will be starting a direct entry FNP program this Fall, so obviously I support this route education.

I, like many other direct-entry students, will come to the table with my own extensive education & experiences. Instead of sharing that with you, I would like to throw out a different kind of "exception" to the claims being made that more RN experience should be a necessary requirement.

I have worked along side 2 RNs--1 with an ADN and 1 with a BSN--both competent/great nurses that have worked in various parts of the hospital. 1 has 20+ years experience and 1 has alomst 30. In my opinion, neither of them would make a very good APN. They just do not have the gumption or critical thinking skills required. In their cases, I might actually argue that the more years RN experience, the more difficult it would be for them to pull out of their role and be able to work autonomously.

Sure, we all know that not every experienced RN has what it takes, or even wants, to be an APN. But, that same exception applies to non-nurses going the direct-entry route. We really can only be evaluated on a case-by case basis becuase we all have such different backgrounds. I think that is the reason that these programs are HIGHLY competitive and HIGHLY selective. They are screening for indviduals that have the experiences, motivation, and ABILTY to be successful in this type of program. I would agree that not everyone that has the minimum requirements to be admitted has the potential to be successful at it .... but, you can rest assure that they will pobably not get in with the stiff competition out there. ...

-berk