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.

[core0]

I've been thinking about this a little more and some of the responses. I think that in answering the original poster, some divisions have been exposed. When looking at this I think that I have heard a lot of anectdotal experience but no true studies that show a difference.

In examining this lets make a couple of (what I consider reasonable) assumptions:

1. There are no studies that show that direct entry nurse practitioners are worse as clinicians than NP's with nursing experience.

2. There are no studies that show that direct entry NP's have any other measureable diffences than NP's with nursing experience (patients seen, higher malpractice etc).

Now, I think that one of the main items that everyone seems to be dancing around is that to admit that there is no difference between direct entry and other NP's is to denigrate nursing experience as part of being an NP. If in fact there is no difference between direct entry and others then the logical follow on question is, is nursing school necessary for entry as an NP? While viscerally this takes one away from the origins of the profession, I would maintain that this is an outgrowth of the direct entry programs themselves and to a lesser extent the rise of direct entry BSN programs.

At some point a decision was made not to include nursing experience as one of the requirements for NP. If you look at the CRNA requirements there is a requirement for one year of acute care nursing experience prior to CRNA school. This is a clear example that this specific type of nursing is considered valuable for CRNA's. On the other hand the lack of such a requirement for NP's either indicates a tactit acknowledgement that this is not valuable or (more likely) an acknowledgement of the difficulty quantifying the value of previous experience. In addition NONPF seems to tactically acknowledge this.

With at least 24 direct entry programs this is a problem that nursing will have to address. There are relatively simple studies that probably could be done (for example compare certification rates for experienced vs. direct entry NP's). There is a growing body of research on the value of bedside nursing including at least one study that shows a link between nursing education level and death rate in hospitals. I have seen little or no outcomes research from NP's particulary in the various educational environments that have cropped up.

Just my thoughts from a non-nurse.

David Carpenter, PA-C

[traumaRUs, MSN, APRN]

I think that the experience one gets from being an RN, provides you a pathway to what type of NP you want to be. If for example, you work in an ER and decide you really like caring for kids, you migh want to get Peds ICU experience before committing to a PNP program. Likewise, if you think that L&D might be what you want to do, working in a busy L&D unit might prove beneficial.

This is not to say that all works out like we think it should. Most of my RN experience is in the ER. I really, really wanted to stay in the ER, but there were no positions so...I went with what was available. Nephrology had never even entered my head. However, my assessment skills and ability to handle emergencies very independently has helped tremendously. The staff know that even if I can't handle a dialysis machine issue, I can take care of the patient and know what I'm doing is the right thing in the right order. If I had no experience as an RN, I truly would be scared.

[PANurseRN1]

Also bear in mind that you will be held to the standard of care of an advanced nurse practitioner. A med-mal atty. or a BON isn't going to care if you went straight through a direct-entry program and didn't get experience first...they are going to hold you accountable for the level of knowledge and skill and advanced nurse practitioner should have.

Which did you learn how to do first, walk or run?

[PANurseRN1]

FYI: I recognize three posters here from SDN. Something to consider.

[PANurseRN1]

Been scanning this thread with some amount of interest. I feel that some here are playing devil's advocate, shaking cages, pulling chains. But all in all there has been some intriguing debate.

There is one word that has bothered me Uberman and that is:

Is this intentional misspelling in order to proclaim your Uber-station in life? It just jumps off the page. The closest I could find to a definition of the P word is that of phallacea which is a family of fungi.

Meanwhile, I will return to my silent spot and read on.

I noticed that, too, and that is definitely not the only related word. I believe the misspelling is very intentional, it's just that no one has called him on it yet.

[mvanz9999, RN]

I've been thinking about this a little more and some of the responses. I think that in answering the original poster, some divisions have been exposed. When looking at this I think that I have heard a lot of anectdotal experience but no true studies that show a difference.

In examining this lets make a couple of (what I consider reasonable) assumptions:

1. There are no studies that show that direct entry nurse practitioners are worse as clinicians than NP's with nursing experience.

2. There are no studies that show that direct entry NP's have any other measureable diffences than NP's with nursing experience (patients seen, higher malpractice etc).

Now, I think that one of the main items that everyone seems to be dancing around is that to admit that there is no difference between direct entry and other NP's is to denigrate nursing experience as part of being an NP. If in fact there is no difference between direct entry and others then the logical follow on question is, is nursing school necessary for entry as an NP? .......

Interesting post. I did want to point out the bold part...my understanding of the direct entry....the first part essentially IS nursing school. It's not until you finish that program and pass the NCLEX that you actually start the NP part of the program.

[mvanz9999, RN]

I think that the experience one gets from being an RN, provides you a pathway to what type of NP you want to be. If for example, you work in an ER and decide you really like caring for kids, you migh want to get Peds ICU experience before committing to a PNP program. Likewise, if you think that L&D might be what you want to do, working in a busy L&D unit might prove beneficial.

This is not to say that all works out like we think it should. Most of my RN experience is in the ER. I really, really wanted to stay in the ER, but there were no positions so...I went with what was available. Nephrology had never even entered my head. However, my assessment skills and ability to handle emergencies very independently has helped tremendously. The staff know that even if I can't handle a dialysis machine issue, I can take care of the patient and know what I'm doing is the right thing in the right order. If I had no experience as an RN, I truly would be scared.

This is a tremendously valuable and relevant point. The experience you get as an RN leads you to what type of NP you want to be. This is the exact dilmena I am in.

It states ON MY APPLICATION, that I must choose a specialty, on the application, and that I am applying for ONLY the program I choose (ie, Family Nurse Practitioner, Acute Care Nurse Specialist, Pediatric Nurse Practitioner), and that I will not be considered for any other type of program, nor can I change programs once I am accepted.

They had an info session where there was a current student, and he said to make SURE that we choose the specialty we really want, as all the above was true. He applied for and was accepted to the Pediatric Nurse Practitioner, but in order to achieve his goals, he realized he should actually be a Family Nurse Practitioner, but that the school would not let him change programs.

So how am I, a person with no clinical experience, excpected to choose a nursing specialty, when I have never had any nursing experience whatsoever?

The programs are not designed to allow you to rotate through specialties and decide which you prefer. You can say all you want about shadowing and volunteering, but I have a full time job and cannot spend months shadowing different types of nurses (and I don't even know if you CAN shadow NPs or CNS on account of HIPAA)

So I can choose one, I suspect I might like X, but I'm not really going to know that until I try it. And if I choose the wrong one today, I'm out $ 50K and many years.

[core0]

Interesting post. I did want to point out the bold part...my understanding of the direct entry....the first part essentially IS nursing school. It's not until you finish that program and pass the NCLEX that you actually start the NP part of the program.

Yes this is the way that it works. The discussion here is about becoming an NP without experience working as an RN. My point, if this is not necessary to have experience working as an RN, then the RN part of direct entry becomes "provider" experience and the logical next step is to look if this is necessary.

David Carpenter, PA-C

[Mission]

Not all programs lock you into a specialty once you are accepted, at least, my school didn't.

I really think whether or not you need experience as an RN depends on the individual. I know personally, if I was considering working in an acute care setting as an NP I would feel more comfortable if I had worked as a nurse in a hospital. However, since I want to work in a community health setting and I spent 2 years shadowing NPs (it was part of my job, but you can do it as a volunteer, depending on the organization, you just sign a HIPAA form) I don't feel it's necessary for myself. But I work, because I need the money

[ginger58, ASN, RN]

"Personally I think the idea is ludicrous! I became an RN first, worked in my area for several years and went to NNP school."

If you think I've made that statement because I walked through three feet of snow 20 miles to school you're really out there.

Nursing is a profession. People build skills in nursing school, see how a hospital runs, what the different roles are, etc. I think this is all part of being a nurse. As far as people without this previous education being molded easily and don't have "bad habits", that sounds like crap to me. You think every nurse has bad habits or isn't able to be molded? I find this offensive to those of us that are nurses.

There may be direct entry programs that are working well and putting out decent NPs, but please get yourselves away from the thinking that "some people think you should have to eat crap because they had to back in the day. But it makes no difference really..." I personally don't buy this and time will tell. Best wishes for your success.

[mvanz9999, RN]

I really don't understand where everyone is getting this "NP without experience" from. Maybe people don't understand how the programs work. Let me put it down:

There are two types that I've seen:

A). I go to the first 15 months of the direct entry program (Core nursing requirements). I then receive a "permission" to take the NCLEX. If I pass it, I am now an R.N., but I have not finished my degree. I then take a part time job as an RN while finishing the actual NP part of the program. This is expected to take 4-5 years. After I finish the second part (and pass the licensing exam) I am now a NP with 4-5 years of experience as an RN and then (and only then) I receive my degree. (University of Illinois at Chicago)

B). I get a general MSN, take the NCLEX and am now a masters-degree RN. I then must re-apply to the school for the post-masters certificate program, to obtain certification as a NP. (DePaul)

In neither case do I see anyone who graduates without stepping foot into a hospital or working first as an RN. Now, in the second case, you may say that a person could get the general masters and then immediately apply for the post-masters certificate, but one must remember that you will be competing with applicants that have 5 or 10 or 15 or 25 years of clinical experience as an RN, and the likelihood of being competitive without ever working as an RN is minute. It would be very unlikely that they would admit someone with ZERO experience, into the post-masters certificate program.

So I'm not sure where all these NPs are coming from that have literally NO clinical experience. I think what may be happening is that some posters are unaware of how the programs work. In Illinois, these are your two choices, and from what I have read and heard, it would be virtually impossible to become an NP without significant clinical work as well.

If someone knows of a program that allows you to complete the core nursing requirements and the NP requirements in one time frame, without having to re-apply, or without having to compete with experienced nurses, let me know. As I see it, this is just not possible. At least not in Illinois.

[ginger58, ASN, RN]

I really don't understand where everyone is getting this "NP without experience" from. Maybe people don't understand how the programs work. Let me put it down:

Thank you for the clarification