Brave or just stupid?

simcc · Jun 12, 2018

Found this thread a year later, but it has been so helpful! Wondering what the OP has decided, and how it is going. I've been looking at DE programs for non-nursing programs, but I admit I've been on the fence about actually trying to get into one. This thread has helped put things into perspective a lot. I'm a newbie mental health counselor associate, thinking of going into Psych NP (PMHNP). Since my job as such will mainly be diagnosing and prescribing meds (among other things, I know it's not this shallow of a scope, but mainly), I am thinking I'd need a lot more training than initially included in DE programs. I may know my talk therapy well, but meds, health, and interactions between everything is no joke. As a counselor, I've often been exposed to my clients' difficulties regarding access to and the efficacy of medical treatment, and, also being that I am totally Type A, I would really want to make sure I am super prepared so I don't make someone's live even more miserable. Anyway, I don't mean to put anyone or any program down, as I am sure there are wonderful DE PMNHPs out there, but mental health populations are fragile enough, the last thing I'd want is not know my stuff well enough. DE programs are soooo attractive, I admit, the temptation is huge, but, ultimately, this thread helped me understand a few things about me personally that I would find challenging as a DE PMNHP, I think... I'll keep researching. Thanks so much!

Polly Peptide, BSN, MSN, RN, APRN · Jun 12, 2018

Found this thread a year later, but it has been so helpful! Wondering what the OP has decided, and how it is going. I've been looking at DE programs for non-nursing programs, but I admit I've been on the fence about actually trying to get into one. This thread has helped put things into perspective a lot. I'm a newbie mental health counselor associate, thinking of going into Psych NP (PMHNP). Since my job as such will mainly be diagnosing and prescribing meds (among other things, I know it's not this shallow of a scope, but mainly), I am thinking I'd need a lot more training than initially included in DE programs. I may know my talk therapy well, but meds, health, and interactions between everything is no joke. As a counselor, I've often been exposed to my clients' difficulties regarding access to and the efficacy of medical treatment, and, also being that I am totally Type A, I would really want to make sure I am super prepared so I don't make someone's live even more miserable. Anyway, I don't mean to put anyone or any program down, as I am sure there are wonderful DE PMNHPs out there, but mental health populations are fragile enough, the last thing I'd want is not know my stuff well enough. DE programs are soooo attractive, I admit, the temptation is huge, but, ultimately, this thread helped me understand a few things about me personally that I would find challenging as a DE PMNHP, I think... I'll keep researching. Thanks so much!

Hi there...I'm the OP.

I didn't read back through the whole thread, but I'd like to. It would sure be interesting considering what I chose to do.

I was admitted to a very good DE school, however, I turned it down. I had multiple reasons for doing so, and one of them was my concern regarding my lack of nursing experience, in particular for the specialty I would be entering (AG-ACNP). I know that ultimately, if I want to be a provider, experience as a provider will trump nursing experience. BUT...if I want to work in acute care, I believe that nursing experience will be invaluable. Also, because I've never been a nurse, how can I truly know what I want? There are SO many varied areas of nursing that I've never been exposed to. I wanted the opportunity to see what was out there before making these important decisions.

So...I chose an Accelerated BSN program instead. I am in my third session and working my tail off. I am in clinicals now and am finally seeing what working as a nurse is really like. I am blown away by the vast amount of information I am trying to stuff into my head in a short amount of time. My goal (as of now) is to get into a good nurse residency program when I get out, hopefully in an ICU. THEN consider furthering my education when I'm ready, if that's what I still want.

That was my decision. Other people make different ones.

simcc · Jun 12, 2018

Hi there...I'm the OP.
I didn't read back through the whole thread, but I'd like to. It would sure be interesting considering what I chose to do.
I was admitted to a very good DE school, however, I turned it down. I had multiple reasons for doing so, and one of them was my concern regarding my lack of nursing experience, in particular for the specialty I would be entering (AG-ACNP). I know that ultimately, if I want to be a provider, experience as a provider will trump nursing experience. BUT...if I want to work in acute care, I believe that nursing experience will be invaluable. Also, because I've never been a nurse, how can I truly know what I want? There are SO many varied areas of nursing that I've never been exposed to. I wanted the opportunity to see what was out there before making these important decisions.
So...I chose an accelerated BSN program instead. I am in my third session and working my tail off. I am in clinicals now and am finally seeing what working as a nurse is really like. I am blown away by the vast amount of information I am trying to stuff into my head in a short amount of time. My goal (as of now) is to get into a good nurse residency program when I get out, hopefully in an ICU. THEN consider furthering my education when I'm ready, if that's what I still want.
That was my decision. Other people make different ones.

Hi there, oh my gosh! I am so happy you wrote back. I read every single bit of this thread, so even if I don't know you, I thought of what you ended up picking. Thanks so much for providing an update when you didn't have to. Honestly, I love that you chose that because I was thinking myself that taking no shortcuts is probably best, even if it could potentially work out, but at what cost you know? I know people will still make their own decisions based on their own beliefs and circumstances, but after reading the thread you helped to create, it helped me to decide that I want to do it the right way rather than rushing into it. It must have been crazy hard to turn down such an amazing program, but they say that, often times, the hardest decisions end up being the right ones in the long run. Well, congratulations, and I wish you the best of luck with it all. Sounds like you are beyond busy and learning a lot. Again thank you for coming back with an update! I am so happy for you because it sounds like you are totally on the right path for making your dreams come true the right way. Woohoo!

Polly Peptide, BSN, MSN, RN, APRN · Jun 13, 2018

Hi there, oh my gosh! I am so happy you wrote back. I read every single bit of this thread, so even if I don't know you, I thought of what you ended up picking. Thanks so much for providing an update when you didn't have to. Honestly, I love that you chose that because I was thinking myself that taking no shortcuts is probably best, even if it could potentially work out, but at what cost you know? I know people will still make their own decisions based on their own beliefs and circumstances, but after reading the thread you helped to create, it helped me to decide that I want to do it the right way rather than rushing into it. It must have been crazy hard to turn down such an amazing program, but they say that, often times, the hardest decisions end up being the right ones in the long run. Well, congratulations, and I wish you the best of luck with it all. Sounds like you are beyond busy and learning a lot. Again thank you for coming back with an update! I am so happy for you because it sounds like you are totally on the right path for making your dreams come true the right way. Woohoo!

My opinion is that there is no one right way. I do think there are some people capable of going through a DE program and being a very competent provider. But I also think that nursing experience is NEVER a bad thing and almost always a very beneficial thing. So if you have the time, I would suggest it.

One con of DE programs is that they are typically VERY expensive. And if you are in a saturated market, a good school is beneficial, but not having experience is definitely NOT.

One realization I've come to as I am being introduced to nursing is that learning the "nursing process" is not in line with how providers think. My own brain is having some trouble staying in the nursing lane. So I can see how some who have been nurses for a very long time have trouble making the transition to provider, not only for that reason, but also simply for being the ones to make the calls. Because of this, while I think gaining some experience is valuable, I will probably go onto graduate education sooner rather than later.

Dodongo, APRN, NP · Jun 13, 2018

One realization I've come to as I am being introduced to nursing is that learning the "nursing process" is not in line with how providers think. My own brain is having some trouble staying in the nursing lane. So I can see how some who have been nurses for a very long time have trouble making the transition to provider, not only for that reason, but also simply for being the ones to make the calls. Because of this, while I think gaining some experience is valuable, I will probably go onto graduate education sooner rather than later.

I agree with you here. I think RN experience is helpful - specifically ICU, ER, etc. Where you work closely with providers, participate in rounding, have a high level of responsibility, etc. This translates well to NP school. However, there is a point of diminishing returns. I think that 2-5 years is a good amount of time. I have seen nurses with more than that struggle as NPs (unbeknownst to them, often times). They think they know more than they do, and their ability to think as a provider and develop a Ddx list is limited.

simcc · Jun 13, 2018

My opinion is that there is no one right way. I do think there are some people capable of going through a DE program and being a very competent provider. But I also think that nursing experience is NEVER a bad thing and almost always a very beneficial thing. So if you have the time, I would suggest it.

Love this. You're right we often get stuck on one right way, when sometimes maybe there is a right way for each of us depending on so many unique individual factors. What you said about the nursing process is really interesting too... along with how experience is never bad. I'll keep these things in mind. I have no doubt you'll be phenomenal. From the way you express yourself in your posts, you are "on it": determined and well informed! :-) Thanks so much again. Little did you know a year ago, you were going to help someone in the future by posting about your decision making process.

Polly Peptide, BSN, MSN, RN, APRN · Jun 13, 2018

Love this. You're right we often get stuck on one right way, when sometimes maybe there is a right way for each of us depending on so many unique individual factors. What you said about the nursing process is really interesting too... along with how experience is never bad. I'll keep these things in mind. I have no doubt you'll be phenomenal. From the way you express yourself in your posts, you are "on it": determined and well informed! :-) Thanks so much again. Little did you know a year ago, you were going to help someone in the future by posting about your decision making process.

I'm glad that the conversation helped someone else!! I certainly appreciated each person's contribution, as it helped me make my decision.

Polly Peptide, BSN, MSN, RN, APRN · Jun 13, 2018

I do want to add this, though.

While I think there are smart people out there who can become competent providers through quality DE programs (we have several on this board and I know some in real life), I DO see a breakdown in graduate nursing education (across the board) and a lack of consistency. That was expressed several times on this thread. Because of this reason, I think having some years as an RN becomes even more important, especially in certain NP specialties. I think the nursing profession is doing itself a disservice by watering down its education AND in some cases allowing non-nurses to become nurse practitioners in just two years.

Some have made this point...if we are going to do DE programs where one goes from BS or BA in another degree to MSN in two years, then the curriculum and clinical hours should look more like a PA program. Ironically, most PA programs that I'm familiar with require some form of HCE as well (though it sometimes amounts to less than 6 months of work).

So while I believe there is "no one right way", I do believe for most, in the current educational environment, it is best to get experience first.

allnurses Guide · Jun 13, 2018

I do want to add this, though.
While I think there are smart people out there who can become competent providers through quality DE programs (we have several on this board and I know some in real life), I DO see a breakdown in graduate nursing education (across the board) and a lack of consistency. That was expressed several times on this thread.

Where have you run into this in your experience/personally?

Because of this reason, I think having some years as an RN becomes even more important, especially in certain NP specialties. I think the nursing profession is doing itself a disservice by watering down its education AND in some cases allowing non-nurses to become nurse practitioners in just two years.

Is the solution to a breakdown and lack of consistency in graduate education to require more RN experience? That implies that RN experience is a substitute for quality graduate education?

Some have made this point...if we are going to do DE programs where one goes from BS or BA in another degree to MSN in two years, then the curriculum and clinical hours should look more like a PA program.

How would didactic block schedules and a more diverse but less in depth clinical experience help non-nurse NPs become more like prior-nurse NPs?

Polly Peptide, BSN, MSN, RN, APRN · Jun 14, 2018

Where have you run into this in your experience/personally?
Is the solution to a breakdown and lack of consistency in graduate education to require more RN experience? That implies that RN experience is a substitute for quality graduate education?
How would didactic block schedules and a more diverse but less in depth clinical experience help non-nurse NPs become more like prior-nurse NPs?

I take it you disagree?

From my postings, I think it's clear that I haven't entered grad education yet, so I can't say I've experienced it personally. I've had to make an important decision before starting my education, so I've done a lot of research. However, I think the general consensus is that there are far too many online and for-profit NP schools popping up, and that the education is not rigorous enough (across the board). That doesn't mean it isn't rigorous in some schools and that there aren't good programs out there. But from what I've gathered from the community in general, and the sheer number of nurse practitioners being churned out of the system, is that the standards are not high enough.

Of course, even if I DID have personal experience, it wouldn't be more than a sample of one, which is pretty much true of most people who have a masters degree.

No - I do not think nursing experience is a substitute for a good graduate education. But without a change on the immediate horizon, this is the next best thing, prior to entering school. I am not necessarily in the club that says the only way to be a competent APN is to be a nurse first. I think I said that in one of my posts. But for me - because I want to work in a hospital setting - I DO feel it would behoove me to get some RN experience.

As far as your last question - I think didactic block schedules work just fine. That's how my ACNP program is set up. I don't think that's the main issue. My real point was that add'l clinical hours would be hugely helpful in advancing NP education, as well as more focus on the pharm and patho courses. I made the point earlier in this thread that perhaps PAs had more clinical hours because they had to train as generalists and NPs specialized. But I don't think that accounts for the difference in our 500-600 clinical hours and their 2000. No, I don't think our clinical hours should be more diverse necessarily. I think the clinical hours should be more AND focused in the area of specialty.

There is some reason that the standard has been set for NP education to include far fewer clinical hours. I just wonder if it's something that needs to be reconsidered.

I was not poking at DE by posting what I did. I respect you Boston, and many others. I thought I made that clear. I would be surprised if you didn't think the whole process, DE or not, didn't need at least some shoring up.

allnurses Guide · Jun 14, 2018

I take it you disagree?

I agree on some things and I don't agree on some things.

From my postings, I think it's clear that I haven't entered grad education yet, so I can't say I've experienced it personally. I've had to make an important decision before starting my education, so I've done a lot of research. However, I think the general consensus is that there are far too many online and for-profit NP schools popping up, and that the education is not rigorous enough (across the board). That doesn't mean it isn't rigorous in some schools and that there aren't good programs out there. But from what I've gathered from the community in general, and the sheer number of nurse practitioners being churned out of the system, is that the standards are not high enough.

I agree there are 1. poor quality programs and 2. that there are too many graduates for the system to support, which in turn and often via lack of quality preceptorships, is further reducing quality. I have seen this and been involved with this professionally for a number of years.

I disagree with 1. a number of issues all being lumped in together (online, DE, for-profit, etc) and 2. that at times the nursing community is doing most of the damage to NP authority and professionalism by spreading misinformation out of a position that really boils down to jealousy. I think it is ridiculous, as I have said before, that one of the biggest challenges to a novice NP is other nurses.

Of course, even if I DID have personal experience, it wouldn't be more than a sample of one, which is pretty much true of most people who have a masters degree.

A sample of one perhaps, but it definitely gives the individual perspective. Additionally, many practicing NPs also function in clinical education roles. My personal perspective on a number of issues has shifted over the years. It seems yours has too as you have gone through school, correct?

No - I do not think nursing experience is a substitute for a good graduate education. But without a change on the immediate horizon, this is the next best thing, prior to entering school. I am not necessarily in the club that says the only way to be a competent APN is to be a nurse first. I think I said that in one of my posts. But for me - because I want to work in a hospital setting - I DO feel it would behoove me to get some RN experience.

We agree here. I mentioned it because, as I said above, these issues tend to be lumped together and the solution to one is not the other: graduate NP preparation and prior RN experience are two independent things. The solution to poor quality education can't be prior RN experience, but it often seems to be suggested as some kind of stop-gap.

As far as your last question - I think didactic block schedules work just fine. That's how my ACNP program is set up. I don't think that's the main issue. My real point was that add'l clinical hours would be hugely helpful in advancing NP education, as well as more focus on the pharm and patho courses. I made the point earlier in this thread that perhaps PAs had more clinical hours because they had to train as generalists and NPs specialized. But I don't think that accounts for the difference in our 500-600 clinical hours and their 2000. No, I don't think our clinical hours should be more diverse necessarily. I think the clinical hours should be more AND focused in the area of specialty.

I don't necessarily disagree with you here, but you are making pretty strong statements here and I am not sure what exactly they are based on. I just find it curious that you think adding clinical hours or changing pharm or patho courses is important in NP education but you haven't taken a graduate class or done graduate clinicals. Again I don't entirely disagree I just don't understand where it is coming from for you.

There is some reason that the standard has been set for NP education to include far fewer clinical hours. I just wonder if it's something that needs to be reconsidered.

There are far more factors at play than just the number of clinical hours.

I was not poking at DE by posting what I did. I respect you Boston, and many others. I thought I made that clear. I would be surprised if you didn't think the whole process, DE or not, didn't need at least some shoring up.

I don't feel disrespected at all, and I hope you don't. I think this is important dialogue, and I do thinks changes need to be made (some significant changes) but I also feel the need to challenge some of the whispers I hear floating around from other nursing colleagues.

Polly Peptide, BSN, MSN, RN, APRN · Jun 14, 2018

I agree there are 1. poor quality programs and 2. that there are too many graduates for the system to support, which in turn and often via lack of quality preceptorships, is further reducing quality. I have seen this and been involved with this professionally for a number of years.
I disagree with 1. a number of issues all being lumped in together (online, DE, for-profit, etc) and 2. that at times the nursing community is doing most of the damage to NP authority and professionalism by spreading misinformation out of a position that really boils down to jealousy. I think it is ridiculous, as I have said before, that one of the biggest challenges to a novice NP is other nurses.
I don't necessarily disagree with you here, but you are making pretty strong statements here and I am not sure what exactly they are based on. I just find it curious that you think adding clinical hours or changing pharm or patho courses is important in NP education but you haven't taken a graduate class or done graduate clinicals. Again I don't entirely disagree I just don't understand where it is coming from for you.
I don't feel disrespected at all, and I hope you don't. I think this is important dialogue, and I do thinks changes need to be made (some significant changes) but I also feel the need to challenge some of the whispers I hear floating around from other nursing colleagues.

I appreciate your post, and of course I have plenty to learn as I am just entering the profession. But I've gathered my information systematically over many years. I've considered making this career change for many years, and in so doing, researched the options available to me. My original desire was to go the PA route, as I wasn't a nurse. I liked how the curriculum was structured and REALLY liked the number of clinical hours. Personally, I was also interested in the medical model instead of the nursing model, which at the time I didn't totally understand. Frankly, even as I'm learning, I still don't.

However, I was concerned about the lack of autonomy PAs had and the fact that there was no other role they had to fall back on. My primary issue though was that there was only ONE PA school in my area. I have kids and a husband with a long career here and we aren't moving. There are probably 15 schools for nursing and one PA school. There was one school that had a very good DE program. Its reputation out of all the nursing schools was better than the PA school's was (out of all the PA schools)...however it accepted FAR more students each year than the PA school. I looked at the curriculum...the classes themselves did not look as interesting or straightforward as the PA school. I evaluated the clinical hours for each specialty. They ranged from 600-700, vs the PA school's 2000. That seems pretty consistent with many others I checked out. The truth is...I didn't love the path I saw, but it seemed more likely that I would get into it than the PA option. At the end of the day, PAs and NPs practice in much the same roles (with some preferred in certain areas over others). So I decided I would just deal with the path to get to my goal.

I ultimately decided to go the BSN route because I wanted to be an ACNP and I feared not having hospital nursing experience first. Additionally, my area is pretty saturated, so if I am competing head to head, and all else being equal, having some experience would benefit me. Also, I thought, what if I get into the program and decide that ACNP is NOT the right thing for me? What if I get exposed to a variety of things and prefer a different aspect of nursing? And the cost was exorbitant. I still imagine I will go to that same school for my masters, because their ACNP program is excellent.

I didn't intend to lump DE together with the online/for-profit education issues...not at all. I think that many DE schools are excellent and have quite high standards. That is why I chose the one I did, when I was wanting to go that route.

I do think it's important to refute some of the negativity out there. You are right about that. I agree that much of it is jealousy-related. I had a poster on this very thread tell me I was going to get to the top of the nursing profession off of his hard work. That's ridiculous. Ultimately, you are responsible for yourself, and if you want to do something - go make it happen.

One way I think the NP profession could advance its education, if not during school, would be through residencies, in particular for hospital-based NPs. I would leap at that kind of opportunity. They are just few and far between.

Anyway, these are just my opinions and I am learning as I go. I want to be a safe nurse and provider someday, and am trying to make the best decisions I can.