Becoming an NP with little to no nursing experience??

amzyRN · Sep 5, 2007

KatRn,BSN,

I found it helpful that you mentioned that the roles for RN and NP are different. I am just going to start an accelerated BSN program to get the RN before the NP. I thought I'd have more options for the Masters degree with the RN first. But I considered the direct entry

route. From what I learned was that a lot of programs are excellent, leading to very competent NPs. I think it may depend on the school as I'm sure some are better than others. I think it is a good option for a lot of people. If the roles and skills are different for RN and NP, albeit for the psychological component (from my understanding), then why should an NP necessarily have an RN first? What part of NP role depends on the RN experience? Any thoughts on that? Thanks much,

J

Trauma Columnist · Sep 5, 2007

The schools put out what the market will stand. In other words, one would hope the schools that have a direct-entry NP program would be fully aware of the market for their new grads. However, there are areas in the country where the job market for ANY APN is tight and in these markets, the experienced RN, new-grad NP will USUALLY be considered over the entry-level NP.

For instance, yesterday I interviewed for a palliative care APN position. Most of the one-hour interview focused on my experience with patients who are seriously ill and who are in various environments such as home, in-patient, out-patient, clinic. They repeatedly stated that they like my variety of experience. If I would have been a direct-entry NP my answers would have all been "well, in clinicals we did this or that."

Advanced practice nursing is just that....ADVANCED. Our next step is that you have to be able to do the basics prior to being an APN.

Just for the record, I've been an APN for one year. Much of what I do is based on my experience as an RN. Some of what I do is totally different: prescribing meds, interpreting test results. However, without the basic knowledge, I would still be floundering because so much of the APN model is built on the basics of being an RN.

HealthyRN · Sep 5, 2007

Despite TramaRUS' experiences, I still believe that one could be an NP without RN experience. It may be much more of a difficult transition, but it is possible.

An NP must also be an RN because that is part of the basic component of the profession. To understand that, you should look to the history of the profession. The first NP program was started in 1965. I believe that it was actually a pediatric NP program designed to improve children's access to health care in rural areas. RNs were chosen to fill this role because it would be an easier transition than expecting someone with no experience in health care to be able to provide primary care. Remember though, this was a different time and education was much different. The first programs were not degree-granting, but they were certificate programs. I would assume that the depth and breadth of knowlegde covered was much less than what you would find in an NP program today. Also, there were no standards or competencies to ensure that students had a basic level of knowledge required to practice safely.

The other midlevel provider role, one that does not require an RN, is the PA. This role evolved out of the practice of military medics. It is often said that the practice of NPs versus PAs is similar, although the major difference is in education.

I do believe that NP practice builds on knowledge acquired at the RN level. However, I also believe that it is possible to acquire this knowledge (through experiences in school) without practicing extensively as an RN. Certainly, any type of RN experience would be useful, but it is not required. With time you will acquire your own experiences as an NP, upon which to draw.

KatRn,BSN,
I found it helpful that you mentioned that the roles for RN and NP are different. I am just going to start an accelerated BSN program to get the RN before the NP. I thought I'd have more options for the Masters degree with the RN first. But I considered the direct entry
route. From what I learned was that a lot of programs are excellent, leading to very competent NPs. I think it may depend on the school as I'm sure some are better than others. I think it is a good option for a lot of people. If the roles and skills are different for RN and NP, albeit for the psychological component (from my understanding), then why should an NP necessarily have an RN first? What part of NP role depends on the RN experience? Any thoughts on that? Thanks much,
J

Editorial Team / Admin · Sep 5, 2007

Having RN experience prior to NP school is, IMHO, a must. I've had experience with NPs coming from both backgrounds, with and without RN experience prior to NP school.. The ones who possess the exceptionally higher critical thinking skills are the ones with adequate RN experience. This cannot be obtained with little or no experience and certainly not something one can sharpen in an NP program. It is always difficult to sharpen a blunt object without the proper tool.

Yes, you will get a wonderful education as NP. But, the ones without any experience will not have that smooth transition as they "advance" their practice. And, that is the whole idea, to advance ones' practice.

For example:

As an RN, especially one seeking the NP career, one will gain much knowledge on the whys and hows of medicine. As an RN seeking the NP role, one should be able to logically and systematically obtain an adequate health history applicable to the disease process. If one has never done this prior to NP school, one will be less than prepared for the complex nature of the disciplined physical assessment tool.

As an RN, one will obtain valuable knowledge on why certain diagnostic tests are ordered and how they apply to the disease process. How to interpret said diagnostic values and how these interpretations guide the health care provider (HCP) to tweak the treatment of the patient. This is something you learn in any NP program, but believe me, prior experience in this area allows for a better understanding during the learning process while in the NP program.

As an RN, one will learn how to interact with members of the healthcare team and understand the valuable role each play in the management of the patient. The RN will learn how each develop and manage treatment modalities for the patient.

As an RN, one will observe firsthand how the HCP consults and when, when referral is necessary and why; all necessary to the role of the NP.

Again, this is sirI speaking from years of experience as an NP. An NP who serves as mentor for newly graduated NPs coming from both backgrounds and is privy to the difficulties of each. An NP who believes the difference between a good NP and a great NP is a systematic process: the RN living and working in the world of advanced practice.

yellow finch, BSN, RN · Sep 5, 2007

As far as finding NP positions through your role as an RN, that may be the case if you are in an acute care NP program and you work in the hospital. However, it is less likely that you would be able to find a primary care position if you work in the hospital. The NP market seems to be highly variable throughout the country. In my area (and I also live in the midwest), there seems to be plenty of NP jobs and I have not heard of graduates having any trouble obtaining positions.

What I have discovered in my role as an RN both on the floor and in the ICU is direct contact with mid-level providers and MDs who round on their patients throughout my shifts. They have come to know me as a reliable, competent, and able nurse who is studying to be a FNP.

In preparing for my final semester I have already approached several of the different specialties to see about spending time with them in clinicals. One MD, who is the PA liason for his group practice, has actually expressed interest in hiring NPs after I discussed my interest in the field. He stated that a FNP can provide a service beyond what their current PAs do. Every individual so far has been very receptive to my inquiries. And each person has indicated their need to hire more mid-level providers with a comment to apply for a position once graduation is imminent. The variety of specializations range between pulmonary, neuro, infectious disease, and urology. I chose FNP so that I had options in fields upon graduation.

My point is that I wouldn't have this ease of networking were I not in the job I'm in. There's no guarantee that any of these folks will hire me, however, the possibilities are there.

mvanz9999, RN · Sep 5, 2007

The schools put out what the market will stand. In other words, one would hope the schools that have a direct-entry NP program would be fully aware of the market for their new grads. ....

As much as I really, really want to believe this, it just isn't so. You can go and get any number of degrees in which the jobs are scarce. Go get a degree in the arts (performing, graphic, etc, etc), advertising, certain sciences....and good luck finding ANY job, much less one in which you can earn enough to live.

I believe, for the most part, that schools are not looking at what the market will bear from an employer's perspective, but from a student's perspective. They will offer programs as long as students attend them. It is up to the student to decide about employment prospects after graduation.

I wish that were not the case, but I think it is.

jjjoy, LPN · Sep 5, 2007

Yes, you will get a wonderful education as NP. But, the ones without any experience will not have that smooth transition as they "advance" their practice. And, that is the whole idea, to advance ones' practice.

I do think there perhaps should be more distinction between primary care NPs and acute care NPs. I'd imagine that most of those interested in some kind of direct-entry NP training would be interested in being primary care NPs and not acute care NPs. I could be wrong there, so please correct me if that's not the case. I imagine this because for those outside of health care, the primary care NP role is the most visible. And it would seem to be a very do-able role - diagnosing and treating common ailments and refering on the more complex and obscure conditions.

Also, the primary care NP role doesn't seem to rely so much on other RN experience. There are relatively few office RN jobs in primary care these days, so it's not like one would be "advancing" their office RN nursing practice. To go into primary care for most RNs would be a complete shift. While any health care experience is always an asset, I don't see as much of the direct reliance on previous experience as with other NP roles, as opposed to, say, a former cardiac nurse training to work as an NP for cardiac patients.

Even then, I don't know if it is accurate to call any role of diagnosing and prescribing "nursing" at all since nursing traditionally (and specifically) does not involve those two roles. The nurse practitioner role as we know it today might be better understood as a medical practitioner with an educational foundation in nursing. Diagnosing and prescribing is practicing medicine. The nurse practitioner, then practices medicine AND nursing, not "advanced" nursing.

Just some thoughts!!

amzyRN · Sep 5, 2007

So what are the thoughts about prior RN experience relating to NP primary care? I think that is what I would like to do after working as an RN, is get into primary care as an NP. Do you really think that RN experience applies to the primary care NP role? If it does, then, how specifically? What part of RN practice applies to primary care NP practice?

And, technically speaking, only MDs and PAs practice medicine, in my understanding anyway. Thanks for all of the thoughts and info!

J

HealthyRN · Sep 5, 2007

I respect your many years of experience as an RN and NP and I agree with many of your points. RN experience can do nothing but help the prospective NP. You state that you have served as a mentor to both direct entry and traditional NP students and there are differences between the two groups. Have you followed the progress of any of your students after they have graduated? I would be curious to know if the differences that you note still exist a year or more after graduating. Also, do you believe that the differences really affect clinical outcomes? Direct entry programs have been around for many years and I would assume that graduates have been found to be safe and competent practitioners, or surely these programs would be eliminated.

Jjjoy brought up several good points as well. If RN experience is so important to NP practice, what type of nursing experience is needed prior to becoming a primary care NP? There are many different nursing specialities and all do not provide the same knowledge or experiences. As an example, one could be a L&D nurse for 15 years and still not know a great deal about the diagnostic testing for MIs or other cardiac conditions. So should prospective NPs be required to have a broad variety of RN experiences, such as med-surg, ICU, ER, psych, women's health, peds, etc?

I would be willing to bet that there are many RNs out there with years of experience who have no idea why certain diagnostic tests are ordered or how they apply to the disease process. For example, my preceptor in the ER was a nurse with 22 years of ER experience. When I asked why a lactic acid had been ordered on a particular patient, she had no idea what the actual purpose of the test was, although she had been drawing blood for it for many years. I still highly respected her and she was very competent and skilled. My point is that the ability to draw upon RN experiences and gain knowledge from an experience is dependent on the particular person. Some people are able to make connections and think critically easier and better than others. I believe that some may be able to learn these skills while in NP school, with no RN experience upon which to rely. Again, I am not saying that RN experience wouldn't be helpful in the process, just not absolutely required.

Also, I am a traditional NP student and I will have 4 years of RN experience when I graduate as an NP. How much of it will actually be useful in my practice as an NP, I have yet to find out.

Edited to add: I just recently started my FNP program and I found it interesting that we were told that those with several years of experience as an RN may have a more difficult time in the program than those with less or no nursing experience. The director of the program said that the reason for this is that RNs with more experience have a more difficult role transition and may have to "unlearn" things that they have assumed through years of clinical practice ("But that's the way that we have always done it."). It is not a direct entry program, but it does accept RNs right out of undergraduate programs.

Having RN experience prior to NP school is, IMHO, a must. I've had experience with NPs coming from both backgrounds, with and without RN experience prior to NP school.. The ones who possess the exceptionally higher critical thinking skills are the ones with adequate RN experience. This cannot be obtained with little or no experience and certainly not something one can sharpen in an NP program. It is always difficult to sharpen a blunt object without the proper tool.
Yes, you will get a wonderful education as NP. But, the ones without any experience will not have that smooth transition as they "advance" their practice. And, that is the whole idea, to advance ones' practice.
For example:
As an RN, especially one seeking the NP career, one will gain much knowledge on the whys and hows of medicine. As an RN seeking the NP role, one should be able to logically and systematically obtain an adequate health history applicable to the disease process. If one has never done this prior to NP school, one will be less than prepared for the complex nature of the disciplined physical assessment tool.
As an RN, one will obtain valuable knowledge on why certain diagnostic tests are ordered and how they apply to the disease process. How to interpret said diagnostic values and how these interpretations guide the health care provider (HCP) to tweak the treatment of the patient. This is something you learn in any NP program, but believe me, prior experience in this area allows for a better understanding during the learning process while in the NP program.
As an RN, one will learn how to interact with members of the healthcare team and understand the valuable role each play in the management of the patient. The RN will learn how each develop and manage treatment modalities for the patient.
As an RN, one will observe firsthand how the HCP consults and when, when referral is necessary and why; all necessary to the role of the NP.
Again, this is sirI speaking from years of experience as an NP. An NP who serves as mentor for newly graduated NPs coming from both backgrounds and is privy to the difficulties of each. An NP who believes the difference between a good NP and a great NP is a systematic process: the RN living and working in the world of advanced practice.

jjjoy, LPN · Sep 5, 2007

You state that you have served as a mentor to both direct entry and traditional NP students and there are differences between the two groups. Have you followed the progress of any of your students after they have graduated? I would be curious to know if the differences that you note still exist a year or more after graduating. Also, do you believe that the differences really affect clinical outcomes?

I'd imagine that no matter what program or background a person had, if they've been working full-time in their new role for two years, then they are functioning adequately. It might be more useful to see how many graduates actually make it to that two year mark and how difficult it was for them to get there.

In terms of outcomes, again, those who haven't been asked to leave or don't feel confident enough in their skills won't be working long enough for poor clinical outcomes to accrue to the graduates of any particular type of training.

Direct entry programs have been around for many years and I would assume that graduates have been found to be safe and competent practitioners, or surely these programs would be eliminated.

The older programs were so few and far between that they were probably even more selective than current programs are. Thus, the success of their graduates may be more a matter of the students admitted to the program than due to the training the program provided.

I just recently started my FNP program and I found it interesting that we were told that those with several years of experience as an RN may have a more difficult time in the program than those with less or no nursing experience

I'd imagine the two year rule would apply here as well. Initially, the experienced RNs may have a harder time 'unlearning' certain things or assuming that they already know something, but if they continue in the program, graduate and practice for two years, I'd imagine that their performance would match that of the direct-entry graduates.

Editorial Team / Admin · Sep 5, 2007

I respect your many years of experience as an RN and NP and I agree with many of your points. RN experience can do nothing but help the prospective NP. You state that you have served as a mentor to both direct entry and traditional NP students and there are differences between the two groups. Have you followed the progress of any of your students after they have graduated? I would be curious to know if the differences that you note still exist a year or more after graduating. Also, do you believe that the differences really affect clinical outcomes? Direct entry programs have been around for many years and I would assume that graduates have been found to be safe and competent practitioners, or surely these programs would be eliminated.
Jjjoy brought up several good points as well. If RN experience is so important to NP practice, what type of nursing experience is needed prior to becoming a primary care NP? There are many different nursing specialities and all do not provide the same knowledge or experiences. As an example, one could be a L&D nurse for 15 years and still not know a great deal about the diagnostic testing for MIs or other cardiac conditions. So should prospective NPs be required to have a broad variety of RN experiences, such as med-surg, ICU, ER, psych, women's health, peds, etc?
I would be willing to bet that there are many RNs out there with years of experience who have no idea why certain diagnostic tests are ordered or how they apply to the disease process. For example, my preceptor in the ER was a nurse with 22 years of ER experience. When I asked why a lactic acid had been ordered on a particular patient, she had no idea what the actual purpose of the test was, although she had been drawing blood for it for many years. I still highly respected her and she was very competent and skilled. My point is that the ability to draw upon RN experiences and gain knowledge from an experience is dependent on the particular person. Some people are able to make connections and think critically easier and better than others. I believe that some may be able to learn these skills while in NP school, with no RN experience upon which to rely. Again, I am not saying that RN experience wouldn't be helpful in the process, just not absolutely required.
Also, I am a traditional NP student and I will have 4 years of RN experience when I graduate as an NP. How much of it will actually be useful in my practice as an NP, I have yet to find out.
Edited to add: I just recently started my FNP program and I found it interesting that we were told that those with several years of experience as an RN may have a more difficult time in the program than those with less or no nursing experience. The director of the program said that the reason for this is that RNs with more experience have a more difficult role transition and may have to "unlearn" things that they have assumed through years of clinical practice ("But that's the way that we have always done it."). It is not a direct entry program, but it does accept RNs right out of undergraduate programs.

Hello, Kat,

I serve as mentor to newly graduated NPs. And, I've been doing this for quite some time. I have found, from my own personal experience, the ones who had some RN experience prior to their NP programs had an easier adjustment to their new roles as APNs than the ones who did their programs with BS in un-related field prior to NP. Those who did RN to MSN (with RN experience during their programs) seemed to fare better. And, those with at least 2-3 years RN experience prior to their NP programs adjusted with minimal frustration(s). And, this is my own experience as mentor.

As for how they've adjusted a year into their NP careers compared to those with RN experience, as you said, it is greatly dependent upon the individual. Following up on my new grads one to two years into their careers, they either are adjusting well or have completely left the profession, going back to the bedside. But, that holds true for those with or without previous RN experience.

As for what type of RN experience to seek prior to NP program? I would have to say it depends greatly on one's future goals. If desiring ACNP, it would stand to reason to seek ED/CCU experience. Med-surg, ED, ICU for the RN desiring FNP. OB - WHNP. PNP - peds/PICU.

My point is that the ability to draw upon RN experiences and gain knowledge from an experience is dependent on the particular person. Some people are able to make connections and think critically easier and better than others. I believe that some may be able to learn these skills while in NP school, with no RN experience upon which to rely.

I totally agree with you in that it is dependent on the individual. I do not dismiss the individual who enters into any NP program w/o RN experience. I do when asked my opinion, however, advise them to get some RN experience under their belt and then enter the NP program. It just benefits one to already have the first, second, third-year RN experience/adjustment out of the way before advancing their nursing practice.

we were told that those with several years of experience as an RN may have a more difficult time in the program than those with less or no nursing experience. The director of the program said that the reason for this is that RNs with more experience have a more difficult role transition and may have to "unlearn" things that they have assumed through years of clinical practice

Yes, this can be problematic. The RN who has "done things this way just because......", or the RN who developed "bad clinical habits" might have a difficult initial program adjustment as well. But, after the initial adjustment into the program, they should fare well. And, in my own area, they are the most sought-after for initial NP job placement.

core0 · Sep 5, 2007

i'd imagine that no matter what program or background a person had, if they've been working full-time in their new role for two years, then they are functioning adequately. it might be more useful to see how many graduates actually make it to that two year mark and how difficult it was for them to get there.
in terms of outcomes, again, those who haven't been asked to leave or don't feel confident enough in their skills won't be working long enough for poor clinical outcomes to accrue to the graduates of any particular type of training.
the two year mark is used in a number of medical fields. it would be interesting to see the difference between direct entry and not. historically less than 70% of nps work as nps. is there a difference between direct entry and traditional (for lack of a better term)? also while anecdotally i have seen traditional nps working at the bedside i have not seen any direct entry nps working at the bedside. this leads me to wonder if those direct nps that are unable to find a np position leave nursing all together.
the older programs were so few and far between that they were probably even more selective than current programs are. thus, the success of their graduates may be more a matter of the students admitted to the program than due to the training the program provided.
i'd imagine the two year rule would apply here as well. initially, the experienced rns may have a harder time 'unlearning' certain things or assuming that they already know something, but if they continue in the program, graduate and practice for two years, i'd imagine that their performance would match that of the direct-entry graduates.

i think that one of the points that has been missed in this discussion is who hires the nps. traditionally nps work for either a practice or a hospital. in the hospital the nps are usually hired through nursing. it would seem to me that unless there was a substantial cadre of direct entry nps that traditional nps would be preferentially hired. in the case of a practice it is usually the physicians that make the hiring decision. in this case they are accustomed to experienced nurses working at the hospital. again my assumption would be that traditional nps would be preferred since they are what the physician is exposed to. this is probably regional and would depend on the number of direct entry nps in the area.

just some thoughts,

david carpenter, pa-c