Brave or just stupid?

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.

umbdude, MSN, APRN · Jun 14, 2018

@simcc

Have you take pre-reqs yet? If not, start there first because it could play a role in your decision making. DE programs generally require very high GPAs.

First off, OP applied to a Acute-Care NP program. ACNPs are trained to work in pretty much the same environment as acute-care nurses with many similar procedures, monitoring, and diagnoses. The roles of a psych RN and psych NP are much more different. Furthermore, the kind of experiences you get as a psych RN vary widely depending on where you work (some are good, others just aren't useful for advanced practice). If you PM me I can give you some of these examples from my own experience.

I am a PMHNP student working as a psych RN. I did not choose a DE program for a couple of reasons: 1) I wasn't entirely focusing on NP when I was making a career change from finance to nursing; and 2) although I had a gut feeling that I wanted to work with the psych population, I had zero exposure to this specialty. I worried that I would end up liking another specialty more because I was fascinated by medical sciences in general. I ended up going through a traditional BSN program (5 semesters) and worked as a psych tech during my BSN.

Although I don't regret my choice based on my situation, in retrospect if I had the exposure to psych (knowing that it's the right specialty for me) before applying to nursing school, I would have chosen a DE program in a heart beat. No doubt, I have learned a lot as a psych RN even in a short time, and I've become comfortable with meds, medical comorbidities, and working with this population which will help me as a provider. However, there is much more to practicing as a psych NP than what you'll learn as a psych RN, and no amount of psych RN experience will truly prepare you to be a PMHNP. My view is that if you want to be a psych NP, get the most relevant experience right away, which is psych NP experience. But having psych RN experience is valuable and is an advantage when you look for job.

More options to consider if you decide on a DE program: (1) some DE programs allow students to become part-time NP students (thus, work PT or FT) after the RN portion, or even take time off in between BSN and MSN to work as a RN. If you go part-time, in the first 1-2 years (non-clinical courses) you can work as a RN for 16-40 hours while in school (it's hard, but doable and financially beneficial); (2) There are New-Grad Psych NP residencies (eg, VA hospitals and weitzman institute) that I think are ideal for those who want more practice and supervision; (3) One of the DE PMHNP students I worked with was uncertain about her abilities, so she found a job within a hospital with supervising psychiatrists who love to train new PMHNPs and are always available to answer questions, and that made her feel much more comfortable. These might be good options for you if you are concerned about not having enough "medical" knowledge.

In the end, I think since you are already familiar with the psych population and might have some years of work experience as a LMHC, DE-PMHNP program might be a better option. Applying to an NP program separately after your BSN can be a pain and time consuming. Ultimately, you have to consider your own comfort level and circumstances when making that choice. Good luck.

JellyDonut · Jun 14, 2018

Experience as an RN is still experience and helps to broaden the depths of knowledge the person has. I attended NP school and it was much easier because I had the experience of being a critical care nurse for 100 years (at least it felt like it). NP school only scratches the surface to get you into an entry level role but the experience does help fill in some of the gaps along with a good mentor and hours upon hours of self study.

There are many ways to get to the entry level role of NP but to state that RN experience is not benefit is just sadly incorrect. It plays a role and depending on the experience and the individual it may play a larger or smaller role. Most NPs come out of school and do not know jack, the best ones know that and work to make up the difference.

Jules A, MSN · Jun 14, 2018

No doubt, I have learned a lot as a psych RN even in a short time, and I've become comfortable with meds, medical comorbidities, and working with this population which will help me as a provider. However, there is much more to practicing as a psych NP than what you'll learn as a psych RN, and no amount of psych RN experience will truly prepare you to be a PMHNP. My view is that if you want to be a psych NP, get the most relevant experience right away, which is psych NP experience.
.

Dude I usually like your posts but I have to disagree with this one. The actual role is different but a strong psych RN in most cases has the experience and insight, although not the authority, to formulate an accurate diagnosis and could probably recommend a reasonable medication regimen with a good grasp on anticipated side effects. The gut instinct for the subtle signs is the real pearl of experience and not something easily gotten from a few hundred hours sitting in an outpatient clinic.

I can only hope your program has instructors with actual experience and not just the minimal requirement to keep their NP license active. The instructors and most preceptors at my school were not impressive, few had significant experience and many were recent graduates of that program. Another perk of having RN experience is I had professional contacts and secured my own skilled physician preceptors.

guest769224 · Jun 14, 2018

by spreading misinformation out of a position that really boils down to jealousy.

Where's your evidence for that? Is this another opinion?

allnurses Guide · Jun 14, 2018

Where's your evidence for that? Is this another opinion?

Yes they did a three arm double blind RCT on RN-NP intraprofessional dynamics and socialization. It was done by 100,000 nurses taking basic research methods. You haven't read it?

All one has to do is read this very thread (or any one like it here on AN) to get a pulse of the issue. If you think that there isn't a degree of "you haven't paid your dues so I don't respect you" at play here then please explain to me exactly why so many non-NPs have such passionate opinions about the quality of NO education and the role of prior RN was experience in novice NP role socialization.

It's a natural thing. We all value our prior experience. It's called implicit bias. If you think it doesn't exist then that is an issue.

guest769224 · Jun 14, 2018

I envy your mind reading skills Boston!

Jules A, MSN · Jun 14, 2018

If you think that there isn't a degree of "you haven't paid your dues so I don't respect you" at play here then please explain to me exactly why so many non-NPs have such passionate opinions about the quality of NO education and the role of prior RN was experience in novice NP role socialization.
It's a natural thing. We all value our prior experience. It's called implicit bias. If you think it doesn't exist then that is an issue.

Obviously I value my RN experience and feel others would benefit from it also but that doesn't make me jealous. I always consider that it seems many of those who aren't DE but are supporting it happen to be employed by universities. Perhaps another bias due to where their bread is buttered?

allnurses Guide · Jun 14, 2018

I envy your mind reading skills Boston!

Its taught only in 500+ level theory courses.

Jules A, MSN · Jun 14, 2018

Its taught only in 500+ level theory courses.

Literally just blew sparkling water out my nose. I'm jealous now, that would actually be worthwhile a theory class, lol.