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.

[Atl_John]

Thanks David for that explanation on the medical model. I am glad that you put that NP's work off of the medical model. I know I will probably offend a NP by saying that, and they will point out that I'm still getting my BSN so I have no basis for saying that. So there I've already said it. However I still agree with you. Nursing theory I or I should say theories. There are quite a few of them, and some would say they are all different and that they are really all the same. To help explain nursing theory I can talk specifically about one that I use (I actually use two when I see a patient during clinicals). Its called Henderson's Model. And in Henderson's model she lists a bunch (theres like 25 or something along those lines) of key things that should be taken into account when planning your plan of care. When you start reading these things they are primarily based on Maslow's Hiarchy of needs. Things like ABC's are right there at the top, infections are on there, etc, its a big list. So after I've done a physicial (assessment as they would say here) I then take all the problems I've found and I use Henderson's Theory to prioritize which I do first. Thats basically a nursing theory. If you reallllly want more, I'll get out my Fundamentals book and i'll type out the couple paragraph blurb they have on her and I'll list thing things so you can see what it is. But thats only if you really want to know. Hope that helped

[core0]

Thanks David for that explanation on the medical model. I am glad that you put that NP's work off of the medical model. I know I will probably offend a NP by saying that, and they will point out that I'm still getting my BSN so I have no basis for saying that. So there I've already said it. However I still agree with you. Nursing theory I or I should say theories. There are quite a few of them, and some would say they are all different and that they are really all the same. To help explain nursing theory I can talk specifically about one that I use (I actually use two when I see a patient during clinicals). Its called Henderson's Model. And in Henderson's model she lists a bunch (theres like 25 or something along those lines) of key things that should be taken into account when planning your plan of care. When you start reading these things they are primarily based on Maslow's Hiarchy of needs. Things like ABC's are right there at the top, infections are on there, etc, its a big list. So after I've done a physicial (assessment as they would say here) I then take all the problems I've found and I use Henderson's Theory to prioritize which I do first. Thats basically a nursing theory. If you reallllly want more, I'll get out my Fundamentals book and i'll type out the couple paragraph blurb they have on her and I'll list thing things so you can see what it is. But thats only if you really want to know. Hope that helped

My only real experience with nursing theory was my one class that I took. That pretty much ended any desire I had to go into nursing.

As far as NPs in practice, pretty much everyone uses a SOAP format. This really folows a medical model in the Subjective, Objective, Assessment and Plan. Some of the older physicians use a Hx, PE, Impression, and Plan format. Pretty much the same thing.

David Carpenter, PA-C

[mvanz9999, RN]

My only real experience with nursing theory was my one class that I took. That pretty much ended any desire I had to go into nursing.

Why?.........

[Atl_John]

CoreO- Even in nursing we use SOAP, PIE, SOAPIE, SOAPIER......am I missing any others. Now while our S-what they say is wrong O-what we can physically see, are probably the same, the A I believe is where you do your diagnoses/ r/o's, and then P is your treatment, same in nursing.

I must say I HATED nursing theory I thought it was the stupidest crap I had ever had to deal with. I didnt' understand it I didnt' want to understand it all I wanted was a way of figuring out which problem the patient had was the most problematic using medical knowledge. Whats going to kill my pt. the fastest???? During the Peds Rotation in Atlanta, the NP there that was our preceptor showed me how Nursing Theories actually give us that ability if we just know how to use them. It kind of opened up my eyes to nursing theories. Dont' get me wrong I still find them pretttttty boring and at times particular ones are rather.....obscure but when theya re understood and used they seem to work rather well. I look forward to really being able to incorporate elements of both the medical and the nursing model in patient care, that way the patient gets the best of both worlds. :)

[core0]

Why?.........

At the risk of seriously derailing this thread. I find Nursing Theory intellectually dishonest. Nursing theory grew out of the desire to show the worth of nursing versus medicine. I have no problem with this and I think that nursing interventions have long shown their worth as a separate practice outside of medicine.

However, in developing nursing theory, nursing was force to use terminology to define itself separately from medicine. This resulted in developing a language which is almost impenetrable to both those within and outside the profession. Furthermore this is hampered by taxonomy that is even more difficult to comprehend. For example Alteration in comfort related to trauma as evidenced by patient reporting to discomfort. Or you can say patient reports pain from a broken leg. There are many nursing interventions that can address this and they work quite well. However, the amount of work that goes into documenting nursing theory is immense and in my opinion is wasteful.

My favorite is Alteration in cardiac output: decreased. Or you could say low blood pressure. In an effort to prove that they are outside of medicine they cannot "diagnose". Hence the language. There is no reason that nursing cannot use medical diagnosis and implement nursing interventions. There is no need to reinvent the wheel.

There actually was a group called nurses against nursing diagnosis. There is also a lot of nursing literature arguing against nursing diagnosis. I had a real problem taking classes and parroting information when I didn't believe in the concept.

David Carpenter, PA-C

[Atl_John]

At the risk of seriously derailing this thread. I find Nursing Theory intellectually dishonest. Nursing theory grew out of the desire to show the worth of nursing versus medicine. I have no problem with this and I think that nursing interventions have long shown their worth as a separate practice outside of medicine.

However, in developing nursing theory, nursing was force to use terminology to define itself separately from medicine. This resulted in developing a language which is almost impenetrable to both those within and outside the profession. Furthermore this is hampered by taxonomy that is even more difficult to comprehend. For example Alteration in comfort related to trauma as evidenced by patient reporting to discomfort. Or you can say patient reports pain from a broken leg. There are many nursing interventions that can address this and they work quite well. However, the amount of work that goes into documenting nursing theory is immense and in my opinion is wasteful.

HAHAHAHA................THANK YOU !!!!!!!!!! God I wish I could e-mail this to my professors. They would tell you David that the reason you have Nursing Diagnoses in the horribly obscure format that you do is so that you can prioritize your plan of care for the patient, organize the things going on with the patient, and it is a working example of evidenced based practice. I don't need a nursing diagnosis to tell me a patient is in pain if they have a broken leg or that they have decreased CO with CHF, etc. That came from applications of common sense and pathophysiology.

My favorite is Alteration in cardiac output: decreased. Or you could say low blood pressure. In an effort to prove that they are outside of medicine they cannot "diagnose". Hence the language. There is no reason that nursing cannot use medical diagnosis and implement nursing interventions. There is no need to reinvent the wheel.

They (whoever they are) would say that since we are nurses and dont' practice medicine we can't use medical diagnoses (unless your a NP obviously). That instead we use nursing diagnosies to actual or potential responses to illness or injury. I'm taking it that you havn't seen the Enhanced Readiness for (Spiritual Wellbeing, enhanced coping, etc).......Diagnoses yet? Those just make me cringe

There actually was a group called nurses against nursing diagnosis. There is also a lot of nursing literature arguing against nursing diagnosis. I had a real problem taking classes and parroting information when I didn't believe in the concept.

It seems that you only have nursing diagnoses in school from what I've been told the vast majority of nurses don't use nursing diagnoses anymore in the hospital setting. I have no idea if NP's use them, any NP's like to shed some light on that subject??? This is one of the reasons that I want my preceptors for my ACNP/RNFA to be either a PA or a MD. I want to experience the medical model by those who practice it on a day to day basis. Help incorporate it into the nursing knowledge that I have already.

[Barbiegirlnurse]

Wow, you all really dislike nursing theory! I can appreciate our difference of opinion and take no offense. We are on here to discuss, and if we all agreed--what would we learn? So, that being said--the topic of nursing diagnoses seems to be the second most popular dislike. While I'll agree that they can be viewed as troublesome, time consuming and worthless to some, they are actually beneficial to others. For instance, it sets a standard language with which nurses can relate patient information and develop plan of care. For instance Risk for Fall, related to unsteady gait, secondary to recent Right total knee replacement, gives a lot of information about what some of nursing's priorities for this patient should be. The diagnosis is much clearer than if in report the nurse gave the patient's medical diagnosis only and reported only medical findings. The nursing diagnosis is used as part of the nursing process. It is what guides patient care. For example, using the nursing diagnosis above- the nursing process would dictate that interventions be led to provide for patient safety (call light in reach, floor clear of clutter, making sure tolieting needs are met, not leaving the patient alone on the bedside commode, ROM exercises, etc.) These are all nursing interventions that are not spelled out anywhere by the medical team, yet if these things were not done, the patient would most likely suffer a fall, injury, or worse. And, yes I have used Nursing diagnoses in my practice at the hospital as a RN. We even have interdisciplinary careplan meetings twice a week with the medical staff, OT, PT, and speech therapy. We have to report our diagnoses and plan of care and organize our plan of care to fit in with other care the patient is receiving from other team members. As a NP, you may not do specific written care plans, but the same concepts apply when you are forming your treatment plan.

There is such a problem in nursing, with being able to communicate our language to those outside of the profession. Many feel that others will think that the Nursing process is unimportant or redundant to the medical process. It is, however, very important and necessary.

Now on nursing theories-- although they are thought to be useless, they ARE in fact important in research and practice. Nursing theories can provide rationale for conducting studies, as well as guide the research variables and questions. Additionally, theories can be used in practice to better understand patient behavior, suggest interventions, and provide for a way to look at the effectiveness of the intervention.

In the past, nurses used Nightingale's environmental model, the medical model, and borrowed theories from other disciplines as a basis for nursing research. In the 1960s-1970s several grand nursing theories and a few middle range theories were developed. In more recent years, nursing research has tended to use more middle range nursing theories, rather than grand theories, due to fewer concepts and the theory itself being more concrete. As nursing knowledge, scientific evidence, and philosophy are not static, nursing theory will continue to evolve and change to meet the needs for research.

While I can see how an average nurse may not find as much value in nursing theory, it is vital to the nurse researcher. The theories provide a framework with which to base the research (hypotheses, subjects, interventions, etc). This research can lead to better evidence based practice for nurses, by utilizing interventions that have shown in numerous duplicated studies to provide better outcomes (whether it be better understanding of a patient's feeling of isolation, self-concept, body image,etc. or providing a new intervention that can decrease a patient's hospital stay, increase positive health related behaviors, or increase compliance with therapeutic regimen, etc.).

Nursing theory is a relatively new concept. When you look at the grand scheme of things, modern nursing theory has only been around for less than a hundred years. Still, many scientific nursing research articles use borrowed theories from other disciplines. Nursing philosophy changes and knowledge evolves over time. With the growing interest in nursing research, nursing theory will likely continue to expand. Although some nurses find little to no value in nursing theory, others believe that it is a necessary concept, without which, much scientific knowledge about nursing would be lost.

[jjjoy, LPN]

You can have nursing theory without nursing diagnoses as they currently exist. And you can have nursing care plans based on medical diagnoses, presenting symptoms, and potential problems.

You have a patient with several issues and needs. First list the needs and issues.

Hip replacement (primary reason for admit)

Hypertension (continuing issue)

Etc

Then you list the appropriate interventions

fall precautions

ambulation with assistance

pain management

etc

In report, the off-going nurse says ".... 2-day post-op hip replacement, continue on fall precautions, up with assistance, ambulated with PT twice, pain being managed with XXXX at XXXX, etc..." Of course, the nurse does need to know the rationale for the interventions, but there's no need to spell it out in daily practice. Medical diagnoses are not "fractured tibia due to external mechanical force exceeding bone strength" or "myocardial infarction due to lack of oxygen to heart tissue."

As we know, nursing education needs to include the WHY and not just WHAT of nursing. Students will learn that the reason for assistance with ambulation is that there's an increased risk for falls due to an unsteady gait due to the hip replacment.

Thus, even without a formally constructed nursing diagnosis, the nurses can (and do) know that a given patient is "at risk for falls due to unsteady gait due to hip replacement." Maybe nurse researchers and theorists find nursing diagnoses in their current format a useful tool. But I think students and practicing nurses are not well served by them and that there are better, clearer ways of articulating and teaching the what and why of nursing.

[jjjoy, LPN]

Here's another thought on Nursing Dx.

I could argue that there's no reason for most nurses to "diagnose" at all. Diagnosing involves the presence of symptomatology with unknown etiology. Before you can fix the problem, you have to figure out what's causing the problem.

But nursing care doesn't involve figuring out what's causing the problem.

Acute nursing care is assisting the patient in the process of dealing with the problem. The nurse then needs to identify the best way to do this. That involves ASSESSING but not DIAGNOSING.

[Barbiegirlnurse]

Nursing diagnoses are not the same as medical diagnoses. Most nursing diagnoses give the diagnosis and a "secondary to" statement. The "secondary to" statement includes the etiology that is affecting the patient's homeostasis. Most times it is this part of the nursing diagnosis that includes the actual medical problem. It is NOT nurses making medical diagnoses.

Also with your list of patient needs there are plenty of reasons to use Nursing diagnoses when planning care. For instance, if someone has had a hip replacement--wouldn't you also consider body image issues? While not a medical priority, shouldn't nurses consider how the scar would affect someone's body image and overall self perception. Additionally, nursing diagnoses are a very integral part of providing continuity of care between nurses. In my RN practice I found I used nursing diagnosis every day! Even when it is not actually spelled out on paper, these are the things that NANDA has spelled out for nurses to diagnose and treat with NURSING interventions. (without medical orders). It goes along with teaching students and reinforcing to nurses, what nurses can and should do in practice, given a certain situation.

[jjjoy, LPN]

My point is that diagnosing involves determining the cause of certain problems. For example, mechanics diagnose auto problems. They assess the vehicle (listen to sounds, inspect the parts) and determine to the best of their ability what is causing the reported problem.

Nurses in general aren't in the business of determining what is causing a problem. They need to recognize problems and be able to institute appropriate care to resolve problems (eg administer O2 if sats are low) but they don't formally diagnose the cause of the low sats. And I realize that nursing diagnoses are NOT medical diagnoses. A nurses may assess that a patient is having emotional difficulties and they can take steps to assist the patient in that area (therapeutic listening, remind the patient of chaplain services, psych referral, etc) without needing to diagnose anything. Assessing that the patient is in need of psychosocial support isn't diagnosing. Assessing that the patient might benefit from being listened to isn't diagosing. And so on.

Acute care nurses are in the business of assisting patients in overcoming known problems (by administering treatments, monitoring progress, helping them cope with change, etc) and avoiding known potential complications (pressure wounds, accidental falls due to an unsteady gait, ineffective coping). Nurses use their assessment skills to determine what nursing interventions the patient may be in need of.

Such nursing actions (assessing and determining interventions) are crucial to patient health and recovery but it doesn't really seem diagnostic in nature.

And Barbiegirlnurse, I appreciate your thoughtful and stimulating responses. These are enjoyable exchanges!!

[Josh L.Ac.]

At the risk of seriously derailing this thread. I find Nursing Theory intellectually dishonest. Nursing theory grew out of the desire to show the worth of nursing versus medicine. I have no problem with this and I think that nursing interventions have long shown their worth as a separate practice outside of medicine.

However, in developing nursing theory, nursing was force to use terminology to define itself separately from medicine. This resulted in developing a language which is almost impenetrable to both those within and outside the profession. Furthermore this is hampered by taxonomy that is even more difficult to comprehend. For example Alteration in comfort related to trauma as evidenced by patient reporting to discomfort. Or you can say patient reports pain from a broken leg. There are many nursing interventions that can address this and they work quite well. However, the amount of work that goes into documenting nursing theory is immense and in my opinion is wasteful.

My favorite is Alteration in cardiac output: decreased. Or you could say low blood pressure. In an effort to prove that they are outside of medicine they cannot "diagnose". Hence the language. There is no reason that nursing cannot use medical diagnosis and implement nursing interventions. There is no need to reinvent the wheel.

There actually was a group called nurses against nursing diagnosis. There is also a lot of nursing literature arguing against nursing diagnosis. I had a real problem taking classes and parroting information when I didn't believe in the concept.

David Carpenter, PA-C

I was wondering about this myself. After I had done a few careplans on the Ackley Care Plan Generator [on evolve online], I was starting to get the hang of careplans and actually was starting to feel like they were useful in directing nursing care.

Then I realized it would be much more efficient to take the medical diagnosis, have possible complications listed under the medical diagnoses, then tailor the interventions to fit both the medical diagnosis and possible complications.

Seems like it would still allow the nurse to direct and focus their care while eliminating the the nursing diagnosis step.