Brave or just stupid?

Jules A, MSN · May 2, 2017

I honestly think this is a gap that may be able to be closed in a relatively short period of time. Even those programs that require experience before going on to advanced degrees (MSNs and CRNA programs) only need a year or two.
I am playing devil's advocate, because I still believe experience is better. Which is why I think I will work after getting my RN, and do the MSN portion part-time. The program does not let me take time off in-between, though. I have to plow through.

I'm hoping those in your specialty will respond because at least in psych it is very possible for a lousy prescriber and diagnostician to remain that way their entire career. I see it all the time with both NPs and MDs. In the cases of outpatient, where most NPs with their desire for Mommy Friendly hours land, they are the sole provider operating in a silo with zero checks and balances until their patients, repeatedly, wind up decompensating and being admitted to my inpatient acute unit. Thankfully its fairly hard to actually kill someone in psych but should the bar be that low for this vulnerable population? Very sad and again just because the schools allow it doesn't mean it is the right or ethical thing to do.

Again while it doesn't sound to me as if you are playing devil's advocate so much as justifying your intent I do appreciate that you continue posting and think working while in school is a solid decision. I'm not sure about the rigors of ACNP program but having been through PMH and FNP I can say it is laughable that schools would assert or anyone would feel they were unable to work at least part-time and complete these relatively easy programs. I'm sure there will be protest and perhaps mine just sucked, despite consistently being rated in the Top 10? :)

Polly Peptide, BSN, MSN, RN, APRN · May 2, 2017

I'm hoping those in your specialty will respond because at least in psych it is very possible for a lousy prescriber and diagnostician to remain that way their entire career. I see it all the time with both NPs and MDs. In the cases of outpatient, where most NPs with their desire for Mommy Friendly hours land, they are the sole provider operating in a silo with zero checks and balances until their patients, repeatedly, wind up decompensating and being admitted to my inpatient acute unit. Thankfully its fairly hard to actually kill someone in psych but should the bar be that low for this vulnerable population? Very sad and again just because the schools allow it doesn't mean it is the right or ethical thing to do.
Again while it doesn't sound to me as if you are playing devil's advocate so much as justifying your intent I do appreciate that you continue posting and think working while in school is a solid decision. I'm not sure about the rigors of ACNP program but having been through PMH and FNP I can say it is laughable that schools would assert or anyone would feel they were unable to work at least part-time and complete these relatively easy programs. I'm sure there will be protest and perhaps mine just sucked, despite consistently being rated in the Top 10? :)

Hi Jules - I just know the MSN portion of my program, when full-time, is 40 hours per week for the didactic part, in addition to the time for clinical hours. I have heard of some people being able to cobble together PRN hours over weekends here and there, but between actual class/lab time, getting in clinical time, and studying, it is really difficult to find time to work as an RN...not to mention working enough to develop and maintain skills to be safe in that kind of scenario.

But this seems to be specific to those who did not have RN experience before coming into the program. My specialty (which is a bit different than the others), if you fall in this category, does not allow any distance learning. So you are required to complete everything on campus and in this area (no clinicals on your own, etc.). Other specialties are a bit more flexible.

If you have prior experience, you can complete the MSN portion on a block schedule format and therefore are more likely to be able to continue to do some work. It is just highly unlikely for those without experience...unless you change to part-time.

Maybe I am justifying...because I am struggling with my options! I actually went online yesterday to look at applying to two accelerated second-degree BSN programs in my area. In fact, I got all the way to the end of the NursingCas application, including writing my personal statement, and hit a wall when it asked me for references. It's not that I can't obtain them, but I've already tapped my references for getting into my MSN program, and they know I'm in. I just feel uncomfortable going back to them and saying, hey, I might be changing my mind here at the last minute. And my most desired program's deadline was yesterday.

I've also thought, I could stop dead in my tracks and get some HCE, take my chem pre-reqs and apply to the PA school. But how crap would that be if I don't get in? Their acceptance rate is lower than our med schools. I mean, I will have wasted another two years of my life, more money in pre-reqs, and turned down this opportunity. I'm just concerned about watching these things walk out of my life....when they could be perfectly fine, even really good.

Ruby Vee, BSN · May 2, 2017

She is going to do it anyway. She came here to get us to say what she was planning is a good idea. We don't, (we who are NPs with actual real life NP experience,) so she keeps trying to refute what we say. She is just annoyed that we don't think her high-dollar school can make up for real-life nursing experience. The only thing I will say (and I mean this totally sincerely) is I hope she does not kill or seriously damage someone due to lack of real-life nursing experience. We all make mistakes, but experience can allow you to mitigate those mistakes somewhat.

This post deserves to be "Liked" a few dozen times. Unfortunately, I can only like it once.

Ruby Vee, BSN · May 2, 2017

Unfortuately, you have never yet even set foot on a critical care unit. You have NO IDEA what it's really like and just how much knowledge you need to have in order to keep these unstable patients alive. I went from a step-down unit to the ICU thinking it was going to be a few more drips to titrate and participating on the code team. Boy, was I wrong. You have to have extensive knowledge of pathophysiology and how your interventions will affect this patient and what could possibly go wrong. Not only that, but you need to know what you'll SEE in the patient when complications arise. You can't wait until late signs appear to take action.
I, too, am a career changer in my 40s. I would strongly suggest getting your RN at a community college and then work as an RN while you're doing NP school. That way, you're getting some experience on the actual floor. If you've never seen a patient start crumping, how are you going to recognize it as an NP? It's all fine to try to justify not getting RN experience until something adverse actually happens. I want to keep my patients safe. I want to feel secure that I have a good, solid foundation before embarking on NP. 2 years in the grand scheme of things isn't an insanely long period of time. There are RN to MSN programs out there, so you needn't put off pursuing NP. The only reason why I did the BSN right after the ADN was that it was a requirement of my employer and they paid for it. It only took me a year to complete (I took a 6 month break from school inbetween getting the ADN and starting BSN).
If you were going more on the FNP office setting side, I'd have less concerns. Most reputable ACNP programs require a minimum 1 to 2 years experience in ICU before starting the program. I can't understand why they'd allow DE in to ACNP. For those of us who actually work in the ICU, it's scary to us because we are with these patients every day. We see firsthand what happens when knowledge is lacking. I work at a teaching hopsital for a Big 10 university and do you know how often the nurses catch the residents making incorrect orders or prescribing a drug in the wrong amount? Quite often. If we didn't know what we were doing, those patients could be harmed. They're still "puppies" learning how to be doctors and they've had MANY more clinical hours that you'd ever get in a DE NP program. That's why there are so many people concerned about this route of education. You simply to do not have the baseline knowledge you need never having been an RN on the ICU. You can't learn ICU experience from a book, you simply can't.

As an ICU nurse who has worked with NPs with no bedside experience, I'm frightened for the patients the OP will encounter, for all of the reasons you state.

Ruby Vee, BSN · May 2, 2017

You're right, I've never been an RN in the ICU. But I HAVE been lucky enough to shadow an ACNP in the ICU, who was also on the Rapid Response team for the hospital. So saying I've never "stepped foot" in a critical care until is inaccurate. Don't get me wrong, I know shadowing gives no actual experience.
I can't quite figure out why people are ignoring my comments about working during my MSN year. I'm saying that I'm now considering working during that portion, so that I CAN gain at least some experience.
People are also making the assumption that I want a job in a critical care right when I come out of school. This is faulty. I would like to be trained in this area, but I don't necessarily feel the need to work there. ACNPs are employed in a variety of settings, not just ICUs.
Last but not least, my school is in the top 3 for ACNP programs. I am trying not to give TMI, though not sure if it matters. So when you say you can't see a top program allowing this...they actually do.

If you came here looking for consensus that what you're doing is a good idea, you didn't get it. Yes, you did get some folks saying that they did it and they're doing great. I'm wondering what their colleagues think about how "great" they're doing. I'm not saying it's impossible to take the short cut and still (eventually) become a competent NP. I'm just saying it's unlikely in the extreme that it will happen without a few patients along the way coming to harm; even to great harm. You still want to take the short cut. I'm am profoundly grateful that I won't be working with you when you graduate from your "top school." My department (in a large, famous teaching hospital) makes it a policy not to hire NPs who took your short cut after some truly horrifying experiences with NPs who did.

Ruby Vee, BSN · May 2, 2017

So if a tree falls in the forest, and no one is around to hear it...
Let me ask you this: is there not a point at which a practicing with NP with no prior RN work can feel that they, too, are experienced? Let's say you have an NP with 10 years of experience, all as an NP; and another NP with 10 years of experience; 5 as an RN and 5 as an NP: do you believe that the former is less competent than the latter? Or actually, is it vice versa? Or are they equal? At what point does the lack of RN experience no longer matter? Or will you guys argue that it will ALWAYS matter?
I don't believe you can fairly say that having RN experience will always matter. In the beginning, certainly. Over time, these things must level out. Perhaps if you are an RN that happened to gain experience in a variety of settings, and now as an NP you will use that background in a single specialized area, then the advantage may always exist. But what if your RN experience was limited to OP clinics and your NP specialty requires critical care skills? Your NP experience will be the more important of the two.
I honestly think this is a gap that may be able to be closed in a relatively short period of time. Even those programs that require experience before going on to advanced degrees (MSNs and CRNA programs) only need a year or two.
I am playing devil's advocate, because I still believe experience is better. Which is why I think I will work after getting my RN, and do the MSN portion part-time. The program does not let me take time off in-between, though. I have to plow through.

You don't know what you don't know. Experience matters. The gap may be closed in a decade, but how much harm will you do to your patients in the mean time? You don't know what you don't know.

You're an articulate writer, and possibly quite intelligent. But you don't know what you don't know and you don't get that.

Jules A, MSN · May 2, 2017

You don't know what you don't know. Experience matters. The gap may be closed in a decade, but how much harm will you do to your patients in the mean time? You don't know what you don't know.
You're an articulate writer, and possibly quite intelligent. But you don't know what you don't know and you don't get that.

But the real problem, imo, lies with the schools telling her and a bazillion others "absolutely just pony up $50,000 and you too can be a NP." It will be interesting to see how this all shakes out a decade or so down the road. Remember Alina Health's ad?

"Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health's standards due to the minimal oversight of the student's clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum."

Ruby Vee will you be sharing your concerns with the CCNE? There is only a few days left for the survey.

https://allnurses.com/advanced-practice-nursing/np-programs-preceptors-1099548.html

allnurses Guide · May 2, 2017

But the real problem, imo, lies with the schools telling her and a bazillion others "absolutely just pony up $50,000 and you too can be a NP." It will be interesting to see how this all shakes out a decade or so down the road. Remember Alina Health's ad?
"Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health's standards due to the minimal oversight of the student's clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum."
Ruby Vee will you be sharing your concerns with the CCNE? There is only a few days left for the survey.
https://allnurses.com/advanced-practice-nursing/np-programs-preceptors-1099548.html

Not all schools will take any paying customer. Some are like that, but there are respectable programs who do adhere to national standards and have a rigorous admission policy. I know of several who accept less than 10% of applicants. So, you can't make sweeping generalities.

Jules-I've also seen you disparage the so called "Mommy Hours" in several posts. What's wrong with wanting to have a balance between life and work? Not all of us want to be at work either physically or mentally 24/7. You can be an excellent provider and keep up with new advances without trying to mimic a resident's schedule. Those that want their lives to be all work may be better off at medical school.

stickit34 · May 6, 2017

I would highly suggest you pursue a PA path, and here's why.

NP schools are already lacking in education in terms of pathophysiology, pharmacology, science courses, clinical hours, etc. Add to this the lack of RN experience and you have a recipe for disaster. NP schools, no matter the rankings, are businesses, and will do whatever they can to appeal to the consumer until they are limited otherwise. That's why PA and medical schools are fewer and stricter- their governing bodies restrict and regulate their education. Ours provides extremely vague dialogue for schools, allowing them freedom to do and admit whomever they please. Schools do not care about patient safety, they care about money.

Nursing seems like it's all roses until you're in the trenches. Out of my nursing class of 20, only 10 are still nurses because they couldn't standing nursing in practice. Even fewer are still in the ICU. How do you know you will like nursing until you are exposed to what our profession is all about? The premise of the nurse practitioner is that it's an advanced practice nurse with years of experience. There are things that can't be taught with shadowing and classrooms - the chaos of a code (and you're running it), the sense that a patient is about to have an MI, diabetic ketoacidosis, encephalopathy, meningitis, etc. When you're responsible overnight solely for this patient and have to determine when to call the physician for help (just as an RN, not even an NP at this point). Keeping them stable or at least alive until help gets there. Coping with their deaths, and encountering the families in the morning afterwards. This is just a teaspoon of what I encountered in med-surg, and I am grateful for every moment! I can't even fathom what's to be expected in the ICU.

With your background, you're more suited to be prepared in the PA role to get a full understanding and exposure in the clinical area. You can still have a practice that is warm and empathetic as a PA. That is not solely for NPs.

Just of note, I am about to graduate my family nurse practitioner program in June. I have five years of experience in med-surg, pediatrics and emergency nursing, and honestly, I wish I did more. I've exceeded what was required of my clinical hours by 200 hours, and it's still not enough to have me feeling fully prepared for practice. Part of that could be imposter syndrome, but part of me sincerely believes it's the lack of exposure and training to the art of practicing medicine, because as an advanced practice nurse, that's what you're doing.

bnw6385 · May 6, 2017

Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.

Wuzzie · May 6, 2017

Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.

I find it difficult to believe, given how shockingly arrogant you sound when describing your fellow nurses (especially floor nurses), that you are capable of respectfully correcting anyone.

Ruas61, BSN, RN · May 6, 2017

Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.

You are miles beyond for sure.