Brave or just stupid?

GGirll22 · Apr 25, 2017

If you can dream the career you want go for it. It won't be easy but it is in your heart.

Polly Peptide, BSN, MSN, RN, APRN · Apr 25, 2017

I'm an APRN myself, so it's not as if I'm crowing about it, but no, I'm not insinuating PA training is better, I'm stating it directly. I work with both PA's and NP's and as unpopular as it sounds, where I am (surgery) the PA's are head and shoulders above the NP's in skill and knowledge. Taken as a whole, head to head comparisons of PA v NP programs would not be very complimentary toward the NP side. That's why it is absolutely critical for NP schools to be very persnickety about meaningful nursing experience before advanced practice. Individual practices can make up for the short fall, but that takes at least a year and a half, IME.
PA programs are taught in the medical model with more active participation of physician instructors, which is just not the case otherwise. In fact, nursing model and nursing theory is a mainstay of too many NP programs.
Before I find a severed horse's head in my bedroom, of course I'll say that there are plenty of very talented, smart, skilled and knowledgeable NP's that practice everywhere, but that is in part because of the experience they bring to the table and in spite of the short comings of NP training as a whole.

I agree with much of what you say. The problem is, here I am, admitted to a well-respected school, that is willing to open the door to what I want. It's like, do I go for it, even knowing that - OVER-ALL -

NP education might be lacking compared to its peers? That I could be better prepared if I spent more time or took a different path? But none of that is actually guaranteed. And it doesn't consider my personal abilities and motivation. It's a conundrum for sure.

Another notch on the side of NP, is that, in my area, the one PA school is not highly-ranked at all. It doesn't make the top 100 programs. I don't know if I am comparing apples and oranges, but the NP program I've been accepted to is very good. Considering my current lack of experience, I really am looking to find the best education possible...all paths to a similar end.

But as the title of my post says...I don't want to do something stupid either.

Polly Peptide, BSN, MSN, RN, APRN · Apr 25, 2017

The almighty dollar.

Serious question, because I think you are right - do you know if there have been any studies done on the safety and/or efficacy of NPs both with RN experience and without?

I am certain these types of things are studied or tracked when compared with MDs/DOs. Of course, insurance companies watch "evidence-based medicine" practice like a hawk and will reimburse based upon those practices, which are supposed to be founded in safety and efficacy. But I am wondering if there are any real, controlled, peer-reviewed studies published on the track records of NPs based upon level of experience.

I wonder, though, if this might be hard to nail down, because NPs with RN experience might have obtained that experience in an area entirely different to their NP specialty.

??

Polly Peptide, BSN, MSN, RN, APRN · Apr 25, 2017

OP, I was a career changer, too. I originally wanted to be a PA and decided to go to a community college to get my RN so I could quickly get hands-on patient care experience. The ADN only takes 2 years (3 if you don't have any pre-reqs, like Anatomy, Physiology, Micro, etc.) and it was affordable, so I was able to pay using my own savings. Once I became an RN, I started learning more about NPs and their scope of practice. I am now an ICU nurse. I can honestly say, in my area, the ICUs & ERs only want to hire ACNPs who already have an ICU/ER background as an RN. You've never been a nurse on the unit. There is so much you learn in the ICU that is beneficial to your education as an NP later. Just being around the patients and knowing that raspy sound is a cuff leak in an endo trach. When to start titrating pressors. How to effectively manage multiple drips along with CRRT. How to interpret ABGs and see how changing vent settings affects the patient. Getting ACLS certified and actually participating in codes. Being able to assist when your patient is having an art line inserted, central line, intubation, managing chest tubes, etc. These are all things that are difficult to learn from simply reading in a book. Nurses are at the bed side a full 12 hour shift. Even in your NP clinicals, you aren't going to get the deep, hands-on, in-depth experience you would get as a nurse with your patients. I personally feel having some experience as an RN first will make you a better provider. Just my personal opinion and what I see in the real world.
Now, that is not to say that you can't or won't be successful. As previous posters have stated, there have been good direct-entry NPs with no prior RN experience. I just know that it's difficult to land that first job without any ICU/ER experience if you're trying to break in to the ACNP field. I would put out some feelers with the hospitals in your area to see if they hire direct-entry ACNPs. You don't want to go through all that time & money and not be able to land the job you want.
As far as salary, new NP grads don't earn as much as experienced NPs. The NPs in our area average any where from $98K to $120K, depending on the type of acute care practice. Cardiology seems to pay a higher salary than the other specialties in our area (midwest). The hospital when I work takes in to consideration your prior RN experience if you're a new grad NP seeking your first job. Something to keep in mind.
I definitely don't want you to feel discouraged. It's great that you're getting a chance to pursue what you really want to do. I'm glad I made the career change decision. I just want you to realize what you might be facing in real world when you're ready to start looking for your first ACNP job. Research your job market, call some local hospital HRs and see what they have to say about direct-entry NP grads.

Thanks for your reply. I see that you now have your BSN...so did you first get your ADN and then your BSN? I wondered about that, because many hospitals won't hire RNs unless they are BSN-prepared, to work in the ICU. If that is the path you took...ADN, to BSN...are you happy you went that route? If you were going to be a PA, did you already have a bachelors degree in something else? At my age, it just concerns me to get all these additional degrees.

I should confirm with our hospitals...I THINK they have relaxed on the BSN requirement, that if you have a bachelors degree and an RN, you are okay. But some still might be hanging on to the BSN, no matter your other bachelors degrees. Ironically, I will be sitting here with a BA, RN, and an MSN...so for some hospitals both over- and under-qualified.

I do not necessarily want to be an ACNP in the ICU. My program has an intensivist specialty in which I can get even more clinical hours, but I don't think that's where I want to work. I certainly agree that I would need RN experience in the ICU first. I got to shadow an ACNP in the ICU who was also the Rapid Response team for the hospital. I loved the fast pace, but I don't necessarily need to be in critical care. I am interested potentially in a hospitalist role or perhaps working in surgery. But I also know I may not walk out of school with my dream job. I am willing to do the work. I just want to make sure I CAN.

Ruby Vee, BSN · Apr 25, 2017

Why? Are you insinuating that PA school is superior? Or because most PA schools require x number of patient care hours before applying?
I would like to know why well-respected B&M nursing schools across the country are continuing to make a path for non-nurses to become "advanced practice nurses," if it is so wildly inappropriate. Either it is all about the money (and there just aren't enough nurses to recruit from, which I don't believe), or it is a misnomer at this point.
Most likely, the profession should require something similar to PA schools (prior experience and/or add'l clinical hours). But for some reason, they have not done it.
I was interested in PA school. I like the education model as well as the amount of required clinical hours. However, I cannot move and we have just one in this area that accepts about 40 students per year out of 1000 applicants. It simply was not feasible. My choice at this point was to make the best of the options available to me.

The PA role isn't superior, but it also isn't based on the idea that you already have basic nursing experience and are looking to "advance" your practice. Schools are continuing to make a path for non-nurses to become "advance practice nurses" because it's all about the money.

You will do as you think best, of course, but you're going to have an uphill battle working with nurses who have been in ICU or ER and know and have experienced things you've only read about. Taking the attitude that "I have an advance degree so I'm better than you" is going to make your working experience (presuming anyone will hire you without experience) miserable. If you go into the job very, very humble it's possible to learn the job and forge good working relationships, but you don't come across as humble.

And here's more food for thought -- the people who know better -- nurses -- aren't going to want care provided by an NP with no nursing experience.

Ohm108, MSN, NP, CNM · Apr 25, 2017

Hi Op,

What you have written resonates quite a bit with me as well. I am in the middle of applying for my own NP programs and I am also a career changer. I have around 10 years of experience in financial services before deciding to pursue nursing. I have/had many of the same concerns that you have with regards to becoming a NP and coming out and finding work and whether the other experienced nurses will say that I haven't "paid my dues" before becoming an AP nurse.

That being said, everything we do is a risk and change is always risky but my philosophy is that unless we actually bite the bullet and go through with the program, we won't know whether we will "make it" as a nurse. That being said I have volunteered at a hospital for over 2 years now and the nurses I have had a chance to work have been very nice and answered many of my questions. They were all very supportive of my goals but there were a few that took a while to warm up to me because (my personal feeling here) they felt that I didn't belong on that unit. The difference is that I don't plan on going into acute care and in the programs that I am applying to, I can't apply to the acute care specialties unless I have had prior experience as a RN so that rules out those programs for now unless I want to get the experience and then apply for a post masters certificate a few years down the road which is an option that we all have if we want to go into acute care and lack the experience.

My programs also recommends not working during the pre-specialty year and some of the programs that I am applying to will not grant me a BSN once I graduate; only a MSN once I complete all 3 years of the program. I have heard that it is hard to be hired once you complete the program because magnate status is something that is important to hospitals these days. But again, based on the different people I have talked to, I can definitely say that every person's experience is different. Some were very lucky and did become a per diem nurse after obtaining their RN right after they passed the NCLEX and worked part time to pay off loans and gain more experience as they completed their 2nd and 3rd specialty years. On the other side of the spectrum, I have talked to people who have graduated with a MSN and couldn't find work in their specialty because of the lack of experience so they either had to 1) move out of the state and find a institution willing to hire them with little or no experience or they went and gained experience as a RN first either in LTC etc and then slowly worked their way back to the area that they were interested in.

I know that is not ideal and since I assume from your post that you are older like me, we don't want to work in an area that we are not interested in or what our goal is given that this is our second career. But I tell myself that I need to be flexible, go find the work and get the experience even if it isn't in the area I would like to be in and then go from there. Who knows where it might lead or what new paths you might discover?

Do you mind me asking which NP specialty you are going into? Is it in one of the AC specialties?

Just my two cents based on what I have seen in my own professional career

Jules A, MSN · Apr 25, 2017

Serious question, because I think you are right - do you know if there have been any studies done on the safety and/or efficacy of NPs both with RN experience and without?
I am certain these types of things are studied or tracked when compared with MDs/DOs. Of course, insurance companies watch "evidence-based medicine" practice like a hawk and will reimburse based upon those practices, which are supposed to be founded in safety and efficacy. But I am wondering if there are any real, controlled, peer-reviewed studies published on the track records of NPs based upon level of experience.
I wonder, though, if this might be hard to nail down, because NPs with RN experience might have obtained that experience in an area entirely different to their NP specialty.
??

Excellent question and there are a couple of articles out there indicating there isn't an issue, "nursing research" of course, however I believe it is too early in this new initiative to have enough data. Unfortunately the trend is now to admit anyone who can fog up a mirror held under their nose and pay the tuition so my guess is the next 5-10 years is where we will see the problems although I consider negative outcomes, short of death or extreme disability, difficult to quantify. And patients LOVE their NPs because they hold their hands, and mop their brows with little concern of their actual skill set.

I've posted about this in the past but how would one discern if a patient saw NP with c/o ear pain, received antibiotics and actually didn't have an ear infection? Or a patient who comes in with a rash that gets treated for eczema without effect, then tinea corpus, then finally scabies which they had from the onset. The patient didn't die or likely suffer disabling harm so would this even be documented or monitored? Would the insurance companies pick up on this eventually? In psych I frequently see egregious regimens for people with substance use disorder and bipolar disorder. Bipolar is a common train wreck that inexperienced clinicians seem to favor for people with SUD, personality disorders and most concerning children who have trauma hx and horrible home lives NOT bipolar disorder. Do your first intake on a NP's patient who is 9yo with a bipolar disorder diagnosis on a stimulant, alpha blocker and lithium, which has blown out their thyroid, minimal therapy and living in an unsafe home and get back to me on how dangerous inexperienced prescribers can be.

My opinion and one that clearly isn't shared by the universities who are interested in retaining students and therefore tuition is overall the odds of being a better clinician would be more favorable if the person actually had nursing experience which if anyone cares to remember is why our short nurse practitioner education was originally approved. PAs and of course physicians have significantly more clinical hours.

Overall I think its too early in the new trend of everyone and their poodle becoming a NP for us to tell exactly how things will go but one thing is certain, our wages are going to continue to tank as the supply exceeds the demand and those with zero business sense accept lame offers. Like you and others have said there are certainly outliers however I would disagree that NP clinical requirements of 500-1000 hours is sufficient to take a person from zero medication knowledge to competently diagnosing and prescribing regardless of how well regarded the university is so imvho you will need to be the exception rather than the rule.

Rocknurse, MSN, APRN, NP · Apr 25, 2017

I'll give you my input, purely from a personal standpoint. I'm a nurse with 25 years experience, 15 of them in critical care, the rest in ER, informatics and dialysis and I am in my final year of the acute NP program. I've worked in almost every area over the years and yet after just having completed a clinical rotation in the ICU, I don't know how anyone with no nursing experience could function at that level. Just being able to walk into a room and understand at a glance what's going on...what the vent's doing, what the drips are, how the patient is ventilating, what the rhythm is, how the wound looks etc. How can you process all that information and still be able to formulate a differential diagnosis, understand quickly and thoroghly all the nomenclature and medical abbreviations, how and what to document in Epic, and gather, process and disseminate all the patient infomration in rounds without any prior medical experience?

I know what's going on in the ICU, and yet it was still a challenge to understand the new role and to pick out from the vast sea of information that which is important and vital and be able to sort out the noise of other data that would cloud the picture. I can't imagine walking in there not even knowing what I was looking at and still function at a level of a provider. It's madness to me. I had a fellow student with me who was on an accelerated MSN and had no nursing experience, and while she was very book smart, she would literally run away any time she had to do a procedure. While I jumped at the chance to place central lines and arterial lines, she would almost cry and request not to do it because the whole practical aspect of getting in near the patient freaked her out. One other guy who was also on a fast track MSN just didn't have a clue about most of the questions he was asked by the attending because he had no knowledge or experience to pull from. This did not go unnoticed by the attending and when he applied for a job there the attending mentioned that this was a concern for him and so he was passed over. When I was asked a question I could at least make an educated guess because I'd been exposed to it at least once in my career.

I'm not trying to be negative or dissuade you, but from my own standpoint I don't see how it's possible, at least not in acute care. My school requires 2 years experience in acute care to be admitted to the acute NP program, and each one of us is working in an acute environent all the way through school, most of us in ICU. You'll be up against some of the best and brightest and you'll be expected to keep up. I am feeling the pressure even with all my experience and certifications, so I can't imagine walking in there completely new. Maybe it's just my program that's particularly tough...it's one of the top schools in the North East...perhaps other schools would be less demanding, I can't say. Kudos for you wanting to do this, but peronsally I'd do your BSN first and get a foothold into the acute arena first.

CrunchRN, ADN, RN · Apr 25, 2017

I think your salary wish for your region is unrealistic. Salaries are rarely that high here except maybe for CRNA's.

Now, I want your previous job. How do i get a non-medical job with that kind of pay?

chacha82, ADN, BSN · Apr 25, 2017

I have no doubt you can succeed in your program, it may be afterwards that is more difficult.

Where I live, there job market is saturated with NP grads who have nursing experience and THEY are having difficulty getting the in hospital jobs they want. Obvious benefits of knowing nursing aside, if you work a few years as a hospital RN, you will make connections and have a better chance of getting an acute care NP job (if this is what you want). Because of the job market, I worked with NPs at an urgent care center who complained they had made MORE as a bedside RN when they worked in hospitals than they did as urgent care NP. They were also seeing upwards of 40+ patients daily in that setting.

It just depends the job you are willing to take after you graduate. Best of luck to you.

blackribbon · Apr 25, 2017

Just a comment... I am "only" a ADN at this time because this is a second career and my husband died so I needed the fastest way to get to work earning money to raise my kids alone. I did already have a BS in Bioengineering and years experience in hospital sales where I actually spent time on the floor working with nurses & doctors.

My experience is that all nursing students are smart people. You have to get very high grades to get accepted and have critical thinking skills to survive the programs and graduate. Probably some schools are better than others and I was in a very difficulty program....one where the nurses in the hospitals saw our scrubs and smiled because they knew the standards we were held under. Just because you did well on the tests or prereq, does not mean that school will be easy. Studying for a nursing class is totally different than studying for any other class I ever took. Those who adjusted fast, were the ones who finished. Almost every one of my classmates started the program with a 4.0. Many were quickly struggling to keep the B minimum they needed to complete the program.

Anyway, all I wanted to add is that intelligence only gets you so far. The part that is hard to teach is the part that comes on the floor. It is walking into a room where the vitals all are within normal limits but you realize that "something has changed". It is knowing the difference between someone who has a low pain tolerance and someone whose surgery went wrong...both with the same complaint of uncontrolled pain. It is being able to tell the difference from a physical condition and anxiety ... and being able to have a relationship with the patient so that they feel safe to admit the deep dark secrets of their life. It is the real life habits of remember to always check the foley bag and watch the output...know what to do when the output is low (which involves calling for an order)...and the experience of knowing how to break a vapor lock in that foley bag to get the urine flowing if it is just a mechanical problem.

If they accept people with no experience, they must have a way they feel comfortable overcoming this issue. I'd ask the school what is their record of having NPs with no RN experience getting hired. I might also go to a couple areas hospitals and ask if they have a problem hiring NPs with no RN experience. I did this with my ADN program and found out the hospitals want to hire nurses from my program but we did have to wait through the first tier hiring process where they looked at BSN applicants first (necessary for their magnet status). I had a hard time finding my first RN job because I had no Nursing Assistant experience. I was actually hired at a small hospital where the DON (director of nursing) was an instructor in our program and liked to hire us older "non-traditional" grads for our real life experience. I promised to stay a minimum of a year to justify the cost of my training. Six months in, the hospital declared bankruptcy and let her go and I wasn't getting regular hours. I was hired in a week at a huge magnet hospital since I now had a track record and a shining recommendation to go with my degree from this program which was known for preparing nurses to work independently. I will admit in spite of my "magna cum laude" and passing the NCLEX with the minimum questions allowed, it was hard learning how to manage on the floor.

Good luck with following your dream...regardless if you go straight through or do it in stages.

FYI: in the hospital setting, my BS means nothing...even though it is in a medical field. I am struggling to find the finances to complete my BSN (9 months online) while I am also paying to put two kids in college. I do think it helped me get my current job but mostly I can only do laterally job changes...that BSN is coveted and mandatory for so many jobs...and I have heard that it can count against me even if I went into a MSN program that allowed me to bypass it based on my current degree. Maybe that is just in my area of the country though.

missdeevah, NP · Apr 25, 2017

The PA role isn't superior, but it also isn't based on the idea that you already have basic nursing experience and are looking to "advance" your practice. Schools are continuing to make a path for non-nurses to become "advance practice nurses" because it's all about the money.
You will do as you think best, of course, but you're going to have an uphill battle working with nurses who have been in ICU or ER and know and have experienced things you've only read about. Taking the attitude that "I have an advance degree so I'm better than you" is going to make your working experience (presuming anyone will hire you without experience) miserable. If you go into the job very, very humble it's possible to learn the job and forge good working relationships, but you don't come across as humble.
And here's more food for thought -- the people who know better -- nurses -- aren't going to want care provided by an NP with no nursing experience.

I haven't seen anything that demonstrates that the OP is not humble. I see someone that has been very successful, and is hoping for a good fraction of what she is capable of making outside of nursing. She is just listing what she perceives as pluses for her in going into a direct entry program. Additionally it seems like OP has done a lot of research, and now wants to know the opinions of people in the field, considering that she does not have a lot of alternative options with regards to attending PA school (which she already looked into), or getting her BSN first (because of time and age- valid points IMHO).

While I am of the opinion that nursing experience is extremely valuable, I do understand OP's points, and can somewhat empathize with OP. OP is already in a position where she has been accepted into a good program.

I agree with those who stated that you should work as an RN along the way. The experience will be invaluable, and I see no downside to it, other than going part time with your coursework, but something's got to give. You don't have to work full time. Plenty of people work at least part time while in school. You have the added advantage of being an empty nester, so no toddlers pulling you away from school work, as mine do. I wish you all the best in achieving your dreams, OP.

For the record, I'm still in NP school. And I'm sure that many people have gone through direct-entry programs and turned out just fine. It's just not the ideal way to go about it, IMHO. It is an advanced degree that is supposed to build on existing nursing knowledge and experience.