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.

[morganvibes]

not sure if that is some kind of a dig?

I'm trying to figure it out, not to ruffle feathers, that's the point of this forum isn't it?

Anyway, the things you mentioned are things we have been learning that ARE appropriate to our NP role, And we do need to learn those things. But, that is quite different than the things I mentioned such as making beds, hanging IV's, and such.

I have been asking and was told from different faculty that there are studies that show that after one year of practice, NP's from direct entry programs (non-RN's) are at the same level as those who were RN's before becoming NP's.

Just to be sure it's clear as well:

Direct entry programs require many pre-reqs. Some people seem to think that you walk in off the street and get an NP degree in 2 years.

Which would of course be ridiculous. That is NOT the case.

Like I said earlier, I am not discounting the RN role, it is just not the same role and has a different skill set. An RN is not diagnosing and prescribing, although they are doing lots of other important things and using critical thinking. Nurses I have spoken to have varying levels of knowledge, it usually depends on what area they have worked in.

[mvanz9999, RN]

Becoming a Nurse Practitioner without formal training as a nurse (and that means all of the skill sets) would be quite pointless. You are then not a "nurse" practitioner. You are a mid-level provider of some sort, but missing everything that makes a nurse practitioner different from similar professionals (mainly in that NPs have nursing theory and skills).

A RN education program would never be approved without teaching a given set of clinical competencies. A school wouldn't even have the option of teaching "IV insertion" and not "Bed-making" (at least not a school with a shred of academic integrity). Nor would there be a point. Regardless of how you get from A to B, you'll eventually have to take the NCLEX and experience is worth 100 textbooks.

You learn for more from doing than from reading something in a book. That includes bedmaking, measuring input-output, changing dressings, getting ice-water, feeding patients, and scores of other "non-NP tasks"

Regardless of where I end up in life, I wouldn't trade these experiences for anything. The thing I will always remember from this time in my life is sitting next to a confused elderly patient and feeding her. Nothing would be worth NOT having that experience (and all the others).

This is where you learn how to interact with patients in scores of situations. It's where you learn the skills that make you different than MD's and PA's and everyone else in the hospital. If a person is not interested in bedside nursing, then pursing an NP is the wrong route. We've had a couple of those in class, and they wisely dropped out and pursued other careers.

I've never once had the thought that making a bed was stupid, pointless, a waste of time, or was preventing me from doing "my real studying". Bed-making IS part of my education (and I do make a fine bed, at that!). I enjoy every second I am in the hospital, regardless of what I am doing.

Cutting out RN training and experience would only weaken a profession that is just beginning to grow and expand. And, if you remove RN training, then you ARE a physician's assistant. So if that's how someone feels, I recommend going that route. You might become an NP but you are still a nurse and will always be a nurse.

[morganvibes]

You are sort of making the point of my earlier post. Being that there should be a separate designation of a "mid level provider". That being said, I still don't think it has to be in line with being a P.A., since they are not based on the nursing model. I only made the point that they are having curriculum that is geared to the position they will hold. Also, Many of us that are not nurses, have cared for people in our previous jobs. Many of us have masters in public health and sciences or were biology and english teachers. Are those of us who have spent our lives in other capacities un-holistic? Based on what? Is being a nurse the only way to show that you cared about people? this is were the disconnect is.

I enjoy learning how to think through the nursing process and to think of the whole person when considering a plan of care. that is what makes NP's different than PA's. I consider the methodology of how you approach the patient to be the "nurse" portion of the "Nurse practitioner" heading, not simply that the person used to work as a nurse.

[mvanz9999, RN]

I actually think I don't understand your point. You are suggesting that there should be a mid-level provider of some name that is not "nurse practitioner" and that does not contain nurse training that is not needed, such as bed-making and changing IV bags. So really you are talking about something that is not a nurse practitioner, and something that would not really be in place on a nursing forum such as this.

I still think this would be a horrible idea. Getting the "nursing" part of training requires ALL aspects of RN training. That's what I'm saying. That includes bedmaking, changing IV's and so on. That's what makes good nurse-practitioners well rounded and differentiated from other providers.

Theoretically, where would anyone draw the line? Who would say training in IV insertion is necessary, but not emptying Foley bags. Or that dressing changes are required, but not range-of-motion exercises. Not only would that be impractical, it would be silly.

Why not then re-structure all of medical training. After all, a neurosurgeon probably doesn't need to know how to deliver babies, and it would certainly shorten the length of medical training. A gerontologist shouldn't probably bother with a pediatric rotation.

Part of an RN training (and medical training) is simply to expose you to different areas so that you can find what most intrigues you, without having to accept and quickly resign from a dozen jobs. The same is true of physician training. I actually WANT to rotate through surgery, pediatrics, OB/GYN, women's health, community health, psych, and so on.

In my opinion, the methodology of the nurse in Nurse Practitioner is gained through training as an RN. Even the most basic tasks need to be considered in a holistic approach.

What you are proposing is entirely different from current Direct-Entry programs. Therefore, all the evidence that says traditional and DE nurse practitioners are the same after one year is not relevant. You would first have to research whether traditional NP's and Mid-Level providers are equivalent. What you would base this on, I don't know.

Maybe I'm just not understanding what you are attempting to cut out. Or maybe we have different viewpoints and will have to agree to disagree.

[jjjoy, LPN]

Cutting out RN training and experience would only weaken a profession that is just beginning to grow and expand. And, if you remove RN training, then you ARE a physician's assistant. So if that's how someone feels, I recommend going that route. You might become an NP but you are still a nurse and will always be a nurse.

But you do realize that nursing schools are recruiting students to direct-entry MSN/NP programs?

And what about all those people who claim how nursing ISN'T about bedmaking or bedside care... that that's just one of many potential roles?

I just think nursing education and nursing as a profession is rather confused. There's definitely a push from many for nursing to encompass all the different roles nurses have come to play over the years... occupational health, community health, school health, infection control, case management, family nurse practitioners, acute care nurse practitioners, nurse midwives, nurse anesthetists, etc. As nurse recruiters tout all of these wonderful nursing opportunities, people come into nursing having been essentially promised that traditional bedside care was NOT a necessary component of the nursing profession.

And yet the bulk of the foundation of nursing school IS bedside nursing care. So it's very easy to get a mixed message as to whether or not bedside nursing care IS or is NOT fundamental to being a nurse.

[mvanz9999, RN]

I am aware of direct-entry programs because I am in one.

I'm not sure who all these "people" are that professing nursing is not about bedside care. I have not met a respectable nurse or nurse-educator that states this.

Bedside care is the foundation of nursing and it is from this that all other opportunities have grown. It is from this common foundation that you can grow into other opportunities. This is a base that all nurses should have in common, so that regardless of what a working nurse actually does, there is this training that all nurses have in common.

Nurses are far too fragmented and segmented as it is. I would think removing the common training of bedside care would only serve to further fragment nurses as professionals, and drastically slow growth.

I still don't see how this is different from any other profession. A lawyer whose goal is to have a practice focusing on personal injury cases must still sit through lengthy classes on tax code, real estate and corporate law. They have a common training base and specialize over time. Is the ability to argue a case in a courtroom a necessary component of the attorney profession? Absolutely not, yet they all learn to do it. How is this any different from nursing?

I am of the opinion that bedside care is fundamental to being a nurse of any level or specialty. If you are a NP that does pre-op assessments in a neurosurgery center, I expect that you know bedside care.

Is bedside care a necessary component of the nursing profession? Absolutely not. Is is a necessary component of nurse TRAINING? Absolutely YES.

[bluesky, BSN, RN]

I am aware of direct-entry programs because I am in one.

I'm not sure who all these "people" are that professing nursing is not about bedside care. I have not met a respectable nurse or nurse-educator that states this.

Bedside care is the foundation of nursing and it is from this that all other opportunities have grown. It is from this common foundation that you can grow into other opportunities. This is a base that all nurses should have in common, so that regardless of what a working nurse actually does, there is this training that all nurses have in common.

Nurses are far too fragmented and segmented as it is. I would think removing the common training of bedside care would only serve to further fragment nurses as professionals, and drastically slow growth.

I still don't see how this is different from any other profession. A lawyer whose goal is to have a practice focusing on personal injury cases must still sit through lengthy classes on tax code, real estate and corporate law. They have a common training base and specialize over time. Is the ability to argue a case in a courtroom a necessary component of the attorney profession? Absolutely not, yet they all learn to do it. How is this any different from nursing?

I am of the opinion that bedside care is fundamental to being a nurse of any level or specialty. If you are a NP that does pre-op assessments in a neurosurgery center, I expect that you know bedside care.

Is bedside care a necessary component of the nursing profession? Absolutely not. Is is a necessary component of nurse TRAINING? Absolutely YES.

I'm sorry but the problem here is that you are essentially a new grad who's been accepted to graduate school. Your opinions are not based on your own primary experience since you do not have bedside experience and therefore cannot directly speak to the relevance of bedside experience.

Now, does this mean that you haven't performed exhaustive research on the subject, no. Perhaps you are aware of a reproducible double-blind study which has shown that NPs with no bedside experience are just as competent as those without. Please feel free to cite those, or perhaps to cite the many counselors and professors who have influenced your decision. Perhaps you could suggest that even they should contribute to this thread.

So the complete mis-characterization of a bedside RN as merely someone who hangs IV's and delegates tasks to techs is the beginning of the proof to me that you have not truly done your homework. Clearly during the nurse training component of your education you didn't learn much about what bedside nurses really do.

QED

[mvanz9999, RN]

............

[jjjoy, LPN]

My opinion is that bedside care is what makes a nurse a nurse. It's not something you learn overnight, it comes slowly over time, and I am of the opinion that you need to learn bedside care in the process of becoming a nurse.

That's a reasonable opinion based on what sounds like a good deal of research into the field before starting nurse training. My personal experience as a pre-nursing student, a nursing student, a graduate nurse and member of the public at large, is that many influential nurse leaders and student recruiters are actively working to remove the association of nursing with bedside care. They emphasize that nursing emcompasses much more than that and that bedside care is just one of many possibilities, not that it is the foundation of those other possibilities. And the minimal, circumscribed bedside experience that one gets as a student in many nursing programs doesn't seem like it would be sufficient to create a strong foundation for other areas.

I could see where nursing might be able to differentiate itself from other health care providers by approaching patients "from the bedside" (comfort, hygiene, 24/7 dealing with illness) as opposed to "from the office" (diagnose, prescribe, send home). But the bedside nursing education an RN program gives goes into much more than that. Much of it is about working on an acute care hospital floor and the tasks and responsibilities therein. Thus, skills tests on bedmaking, bathing, hanging IVs, etc. It's one thing to teach the perspective of bedside nursing; it's another to train someone to be a bedside nurse.

I think this is where schools are confused about their purpose. Is it to train bedside nurses? Hospitals would say yes, schools might say no. Is it to train them to "think like a nurse"? The schools would probably say yes. But do you NEED to practice making beds and hanging IVs, etc in order to "think like a nurse"? And if you haven't practiced as a bedside nurse outside of as a student, will that suffice in setting a strong foundation as "nurse" as opposed to some kind of mid-level provider that isn't a nurse? I don't know. Just thoughts and questions!

Not related, but just a thought in regard to the comment about law school. Note that law students learn about different kinds of law in school but they do not actually practice the different areas of law while in school - as nursing students seem to be expected to - at least to some degree - that is getting skills checked off and taking on (often quite circumscribed) bedside nursing responsibilities for patients in various areas.

[mvanz9999, RN]

Ah! A nicely written post. And I see the confusion.

I would then go with the idea that it is important for nurses of any level to be trained to "think like a nurse". I perhaps incorrectly associate those bedside nursing skills with training to think like a nurse. Which I guess might or might not be the case, I have neither the experience nor the research to answer that question.

While basic skills may not be necessary or even helpful in training one to "think like a nurse", I find doing these immensely helpful to me. It is not the performance of skills per se, but it is interacting with patients in often intimate ways.

I have always felt that my training focuses less on skill performance and more on patient interaction. The focus of my clinicals has been on assessment and patient interaction while performing other routine tasks. The tasks have not really been the end goal.

As I have pointed out in previous posts, I cannot speak about any Direct Entry programs other than my own. In MY DE program, we spend 3-4 years working as an RN WHILE completing the NP portion of training. At the end I will have 3-4 years of experience working as an RN (not a student) and that should provide a great deal of perspective from an RN point of view. I also don't know whether this is necessary or not, but this is the path that I have chosen.

[amzyRN]

I am in a second degree accelerated BSN program. What I think would be most applicable to advanced practice is exposure to a vast array of persons with different illnesses. Assessment skills can also be applied as I think it is an art and takes time to acquire sharp skills. I think that nurses who have a couple more years experience may have better assessment skills, just b/c they've seen more. But an NP can also build those skills with practice also. I think the actual doing is important. Other skills like bed making, giving bed baths (which are delegated to CNAs lots of times) are irrelevant to practicing as an NP. The physical assessment, pharmacology, and patient contact gained as an RN are very valuable skills and very applicable to NP practice. I would say that RN experience would be relevant to PA or even MD practice if the person were entering any of those programs. I'm not convinced it is required though.

[yellow finch, BSN, RN]

Interesting comment from my current preceptor... she won't take students if they have never worked at the bedside because she feels that it is not her duty to "train" the NP student how to see and assess the patients. They should be ready to go without her having to teach them things they learn at the bedside because the NP student is an advanced practice nurse. If the school has a direct entry program she simply won't take the students... one such school in my area is Emory.

This preceptor is the best one I've worked with so far. She's highly competent and easy to get along with. I'm glad to have snagged her! I have to wonder if any DE students have come across this sort of stumbling block?

Just wanted to add this to the conversation since it came up the other day.