Brave or just stupid?

HikingNinja, BSN, MSN, DNP, RN, APRN, NP · Apr 26, 2017

My information about willingness to hire has come from recent grads of the program who have remained local and had job offers upon graduation, in spite of lack of RN experience (usually with their preceptors). I also know it's not all roses and some have graduated, worked as an RN, and after that experience, THEN gotten their NP jobs.
What about the idea of going PT during the MSN portion in order to work as an RN? Would that be enough? I realize it's not as much as others, and maybe more is always better, but could it at least provide that essential experience as well as getting me over the hump of complete and total disrespect/disdain from my peers?

I truly believe you could work fulltime and complete the NP part time. ICU experience would be ideal and most places require a fulltime 2 year contract to be hired into the ICU. As a previous poster said, I would not mention you are in an NP program at time of hire. I work pretty much full time in my NP program and I know of many others in full time NP programs who work full time also.

Ruby Vee, BSN · Apr 26, 2017

A few things:
Have you checked with local physician's groups, hospitals, etc. to see if they'll even hire you as an ACNP without RN experience? Where I'm from, ACNP's must have RN ICU/ER experience. Or they simply don't get hired. In the ER, we've hired FNP's who were med/surg first with no critical care experience. But that was unusual. It does make sense though because in the ER mostly FNP's & PAs complete the rapid medical exam and run the fast track area.
Honestly, all NP programs are the same. Some are more organized than others. Rankings, IMO, mean nothing and when you graduate most employers only care if you are licensed and what experience you have. It's really the practicum experiences that teach you what you need to know. I'd thoroughly research the practicum sites they use. Maybe interview the preceptors, ask to talk NP's who have graduated from the program.
If you ever plan to move or do travel assignments say after your kids are out of the house and the husband retires. You won't be able to in Oregon or Colorado. These are two states that require RN experience to grant an NP license. There may be others and this seems to be popping up now as a trend.
You will have to fight tooth and nail for respect, anywhere that may hire you. In my experience, those entering the NP field without having "paid their dues" as a nurse first are treated quite poorly by other nurses.
I am currently wrapping up my NP program. I am a mid career changer too. IMO my RN experience has been invaluable. In my previous career I thought I was organized and had mad critical thinking skills. You don't really know what critical thinking is until each and every decision you make could kill someone. Whole different ballgame. I am extremely thankful I spent these past 8 years in critical care.

This is good advice.

I'm happy to see that two states (two great states for living and working) require RN experience to grant an NP license. Hopefully that trend will continue and more will jump on board.

There's a reason that NPs without RN experience have to fight tooth and nail for respect, and it really isn't about "paying your dues." It's because without experience at the bedside, you don't know what you don't know. The NP education model is based on the idea that NP students have that bedside experience. I've seen some truly terrifying "near misses" perpetuated by NPs with no bedside experience, a couple of them by "experienced" NPs -- a year or more off orientation. In almost every case, the NP missed some red flags that were glaringly obvious to the experienced bedside nurses and had been charted on by the bedside nurse and drawn to the NP's attention. They just didn't "get it".

As an experienced RN, it is sometimes difficult to convey the urgency of a situation in the ICU to a new NP who doesn't have bedside experience and hasn't encountered this particular problem before. It is especially difficult if the NP involved has pride invested or believes that her degree makes her "better than" (I've actually heard this from new NPs) or "smarter than" the nurse who stays at the bedside. Unfortunately, it seems that most of the NPs without bedside experience that I've encountered have this issue.

One of my orientees, a career changer in her 40s, decided that ICU wasn't for her. "One of my professors told me that second career nurses have difficulty with the urgency of situations in the ICU," she told me. "I've been talking to other second career orientees and nurses, and I can see that she was right. I see the situation developing, but I don't have that same sense of urgency that you do, and the other preceptors." I see that same situation with brand new NPs who have no bedside experience and sadly, experience in the NP role doesn't always fix that problem.

Back in the day when NPs were entering the ICU as mid level providers, I was an enormous fan. Given my previous master's, I was invited to join one of those NP programs and graduate in a year. I wasn't interested in that role, and declined. In those days, you needed five years of bedside experience to even be considered for admittance into an NP program. But times have changed, experience is no longer necessary and NPs are no longer the asset that they once were. The OP will do what she thinks is best. I'm just wary of new NPs these days. I don't trust them or respect them as providers until they've proven themselves.

Polly Peptide, BSN, MSN, RN, APRN · Apr 26, 2017

There's a reason that NPs without RN experience have to fight tooth and nail for respect, and it really isn't about "paying your dues." It's because without experience at the bedside, you don't know what you don't know. The NP education model is based on the idea that NP students have that bedside experience. I've seen some truly terrifying "near misses" perpetuated by NPs with no bedside experience, a couple of them by "experienced" NPs -- a year or more off orientation. In almost every case, the NP missed some red flags that were glaringly obvious to the experienced bedside nurses and had been charted on by the bedside nurse and drawn to the NP's attention. They just didn't "get it".
As an experienced RN, it is sometimes difficult to convey the urgency of a situation in the ICU to a new NP who doesn't have bedside experience and hasn't encountered this particular problem before. It is especially difficult if the NP involved has pride invested or believes that her degree makes her "better than" (I've actually heard this from new NPs) or "smarter than" the nurse who stays at the bedside. Unfortunately, it seems that most of the NPs without bedside experience that I've encountered have this issue.
One of my orientees, a career changer in her 40s, decided that ICU wasn't for her. "One of my professors told me that second career nurses have difficulty with the urgency of situations in the ICU," she told me. "I've been talking to other second career orientees and nurses, and I can see that she was right. I see the situation developing, but I don't have that same sense of urgency that you do, and the other preceptors." I see that same situation with brand new NPs who have no bedside experience and sadly, experience in the NP role doesn't always fix that problem.
Back in the day when NPs were entering the ICU as mid level providers, I was an enormous fan. Given my previous master's, I was invited to join one of those NP programs and graduate in a year. I wasn't interested in that role, and declined. In those days, you needed five years of bedside experience to even be considered for admittance into an NP program. But times have changed, experience is no longer necessary and NPs are no longer the asset that they once were. The OP will do what she thinks is best. I'm just wary of new NPs these days. I don't trust them or respect them as providers until they've proven themselves.

I appreciate the honesty in your post.

Neuro Guy NP, DNP, PhD, APRN · Apr 26, 2017

Yes, I obtained my ADN and then got hired in to a nurse residency program. The condition of the program was that I had to complete the BSN within 2 years of hire date. However, my employer reimbursed me for the tuition for my BSN. I was able to work full time and take BSN courses full time. When I finished the residency program, I was hired on in the ICU after working on the progressive care respiratory unit with trach/vent patients. I had to get my ACLS certification to work on that unit and that helped me to get my foot in the door in ICU.
I know you say you're not as interested in ICU, but I know our hospital only uses ACNPs for ICU/trauma & ER. FNPs are hospitalists. You can also work in the ER as an FNP if you already have experience as an ICU or ER RN. The "intensivist" certification is more applicable to the ICU, so if that's not what you want to do, I don't think it would be the right route to go. If you're interested in the ER, also know that many require dual FNP/ACNP certification so you can see patients of all ages. ACNPs can only treat patients age 13 & up.
As far as age goes, I was 45 when I finished my ADN. I just finished my BSN in December. I'll be 49 when I finish my FNP program. I wouldn't let age be your defining guide to your career path. I was initially interested in being done as quickly as possible. However, now that I'm an RN, I see the value in having RN experience before embarking on a career as an NP. By the time I graduate, I will have a little over 4 years of experience as an RN, 3 of those in the ICU. If you have the opportunity to work as an RN, I would definitely consider doing so.
I know someone said in a previous reply that MDs aren't required to be PAs or RNs first. True, but the schooling for an MD is not the same as an NP. We are expected to have baseline knowledge gained from being an RN. MDs are schooled as a blank slate. It's comparing apples to oranges. While the NP role is definitely very different from being an RN, the background knowledge you gain, especially if you're going the ACNP route, it certainly a solid foundation. I just know the ACNP curriculum is going to expect that baseline ICU/ER acute care knowledge.

Just to clarify something, as an ACNP it is more correct to say we see patients who are PUBERTY (the point in which the patient becomes an 'adult') and up, which may or may not be age 12 or 13 for some kiddos. Could be younger.

Neuro Guy NP, DNP, PhD, APRN · Apr 26, 2017

I admire what you've done and think it's pretty incredible you were able to get in the ICU so quickly.
It is not age so much that I am concerned about. I'm sure that's in the back of my mind, but I had sort of locked in on this time in the lives of my children to spend a few years in school, knowing that I could still help them with the last few years of preparing for college and so forth. But perhaps I am limiting myself unnecessarily.
I understand that ICUs strictly hire ACNPs. My program offers various sub-specialties and two specific (optional) tracks: Intensivist and Hospitalist. They only offer those to ACNPs and not FNPs. I'm not sure if that's the new way of things or just how my particular program is handling it. From my research, it would appear that things are moving towards ACNPs in general in the hospital setting. As well, ACNPs are hired in various surgical specialties, and others, like cardiology, endocrine, even IM. I like the flexibility that ACNP offers. Many people talk about FNP as the ultimate in flexibility, but to me, that is only if you want to work with kids and stay primarily OP. I still may be interested in getting FNP some day.
You state at the end, "I just know the ACNP curriculum is going to expect that baseline ICU/ER acute care knowledge." I guess my program, since it allows non-nurses, is set up to deal with those of us who don't. I am very interested in learning how they do it. I have a friend who went through this program as a non-nurse, straight out of undergrad at that, and she had a job offer upon graduation with one of her preceptors (in IM). It wasn't her dream job, but who cares? I'm not expecting any first job to be The One. For the whole story though, she turned it down, went to work as an RN in LTC, and got a job as an NP that she really loves after a year.
Ultimately...I do think what you've done is ideal.

If your program offers the two tracks, intensivist and hospitalist, do yourself a favor and do the ICU track! Please heed that advice because you'll get ICU knowledge that can easily be translated into a hospitalist role because of the broader knowledge base and it will help you respond better to deteriorating floor patients. However, if you do the hospitalist track, you'll still learn however but without the additional critical care knowledge. If you ever did work in an ICU or rapid response or ER, you'd have a steeper learning curve.

PANYNP · Apr 26, 2017

Speaking as a faculty member in both primary care and acute care NP programs for the past 18 or so years...

One of our primary care preceptors is an NP who graduated from an MSN program at a top-rated university in New England. Her prior degree is in graphic design; she had no health care experience prior to becoming an NP.

When I have done site visits for students who are precepting with her, it's been fascinating, and a little unsettling, to observe her thought processes as she and a student work up a patient.

It is very clear that her clinical perspective is different from an NP who has worked as an RN. Her viewpoint comes across as less holistic (i.e. less "nursey") and far more focused on the medical model of assess, diagnose, test, prescribe, document, onto the next patient. Scant attention is paid to the patient's home circumstances, socioeconomic status, family situation, employment - factors that affect general health and well-being, as well as potential for compliance with a health regimen - -nurse-y considerations.

This NP provider is clinically brilliant, but seems (to me) to be a hybrid, rather than a "nurse" practitioner. More like a PA. Not that there's anything wrong with that, as JS would say.

In relation to OP's acceptance into an ACNP program for non-nurses, I tend to agree with the poster who observed that to be able to walk into an ICU patient's room and immediately discern, from among drips, invasive lines, ventilator settings, and monitors, which of these supportive functions demands immediate attention, after looking at patient and cardiac monitor, requires experience gained as an RN staff nurse.

Even outside an ICU, in a hospitalist model of care, inpatients are sicker and more complex than ever - some hanging by a thread, without the support of drips and vents. These patients, with chronicity and multiple comorbidities, can be just as complicated as ICU patients. Again, sorting out what to tackle first requires the experienced intuition/gut of a seasoned RN.

Your ACNP program likely requires ~ 800 hours of clinical. I'm unconvinced that this is a sufficient practicum for the responsibility you will have when you've graduated and are ready to enter practice.

You had mentioned working in an outpatient setting as well. Even in a specialty clinic, ACNP training may not be necessary. Many of these types of positions are filled by primary care NPs.

One last comment, I promise. FNPs are educated to take care of individuals across the lifespan, from birth to old age, not just kids, as you've mentioned. There are many FNPs who work in LTC.

My view, since you asked for feedback, is that an Accelerated BSN, with a gap year of full-time RN work experience, followed by matriculation into the ACNP program would be ideal in your situation.

Or PA school, since the medical model was your first interest back when.

I'm a second-career person, as well.

Best of luck to you.

Here.I.Stand, BSN, RN · Apr 26, 2017

I look at it this way: Do MD's start out as a PA, or RN routinely first? Probably not..

Apples to amphibious vehicles comparison.

Polly Peptide, BSN, MSN, RN, APRN · Apr 27, 2017

If your program offers the two tracks, intensivist and hospitalist, do yourself a favor and do the ICU track! Please heed that advice because you'll get ICU knowledge that can easily be translated into a hospitalist role because of the broader knowledge base and it will help you respond better to deteriorating floor patients. However, if you do the hospitalist track, you'll still learn however but without the additional critical care knowledge. If you ever did work in an ICU or rapid response or ER, you'd have a steeper learning curve.

I actually thought about this in the past but then worried that it might pigeonhole me, and prevent me from getting other jobs as well as still leave me unqualified for the ICU (without RN experience). But I think you're right and appreciate this pointer. Get trained for the highest level of critical care and then be able to work there or in lower levels.

Polly Peptide, BSN, MSN, RN, APRN · Apr 27, 2017

Speaking as a faculty member in both primary care and acute care NP programs for the past 18 or so years...
One of our primary care preceptors is an NP who graduated from an MSN program at a top-rated university in New England. Her prior degree is in graphic design; she had no health care experience prior to becoming an NP.
When I have done site visits for students who are precepting with her, it's been fascinating, and a little unsettling, to observe her thought processes as she and a student work up a patient.
It is very clear that her clinical perspective is different from an NP who has worked as an RN. Her viewpoint comes across as less holistic (i.e. less "nursey") and far more focused on the medical model of assess, diagnose, test, prescribe, document, onto the next patient. Scant attention is paid to the patient's home circumstances, socioeconomic status, family situation, employment - factors that affect general health and well-being, as well as potential for compliance with a health regimen - -nurse-y considerations.
This NP provider is clinically brilliant, but seems (to me) to be a hybrid, rather than a "nurse" practitioner. More like a PA. Not that there's anything wrong with that, as JS would say.
In relation to OP's acceptance into an ACNP program for non-nurses, I tend to agree with the poster who observed that to be able to walk into an ICU patient's room and immediately discern, from among drips, invasive lines, ventilator settings, and monitors, which of these supportive functions demands immediate attention, after looking at patient and cardiac monitor, requires experience gained as an RN staff nurse.
Even outside an ICU, in a hospitalist model of care, inpatients are sicker and more complex than ever - some hanging by a thread, without the support of drips and vents. These patients, with chronicity and multiple comorbidities, can be just as complicated as ICU patients. Again, sorting out what to tackle first requires the experienced intuition/gut of a seasoned RN.
Your ACNP program likely requires ~ 800 hours of clinical. I'm unconvinced that this is a sufficient practicum for the responsibility you will have when you've graduated and are ready to enter practice.
You had mentioned working in an outpatient setting as well. Even in a specialty clinic, ACNP training may not be necessary. Many of these types of positions are filled by primary care NPs.
One last comment, I promise. FNPs are educated to take care of individuals across the lifespan, from birth to old age, not just kids, as you've mentioned. There are many FNPs who work in LTC.
My view, since you asked for feedback, is that an accelerated BSN, with a gap year of full-time RN work experience, followed by matriculation into the ACNP program would be ideal in your situation.
Or PA school, since the medical model was your first interest back when.
I'm a second-career person, as well.
Best of luck to you.

Interesting. I definitely understand the differences between the medical and nursing model, and the focus on holistic care in the latter. I wonder if it's an issue in her particular school, or a matter of the lack of experience.

It seems like you are encouraging me to get an FNP certification rather than ACNP, as if it's not really 'necessary.' My POV, right or wrong, was that the ACNP program would get me the 'most training', as it relates to bedside nursing, that I could possibly get...considering I lack the bedside nursing experience. Yes, it is NP training. But FNP would focus on entirely different skills and settings, and I would never see certain things if I went that route. By choosing to specialize in ACNP, I can at least be trained in the higher acuity patients and settings. If I want to work in a specialty clinic, I can still do so. But at least I will have been exposed.

I was just hunting through my school's website and discovered that they have started a new DNP/Critical Care Fellowship for new MSN ACNP grads. The school, in conjunction with the affiliated teaching hospital, is allowing new grads to enroll in the DNP program while also working a paid fellowship in Critical Care. THAT is very appealing. I know, I know, they want my money. But it would benefit me too, in extra training.

Needneedle · Apr 27, 2017

I would not pursue being a NP until I had worked as a nurse for at least a year. How will you know whether you like it, or not? Many nurses drop out of nursing within 5 years, even though they had made such an effort to be a RN. It is like people who want to be a photographer and go out and buy thousands of dollars of equipment before they take their first picture. The job side of any career is very different from the schoool side, and see if you like nursing before you invest years and thousands of dollars pursuing advanced degrees.

LadysSolo · Apr 27, 2017

The reason it is better to have nursing experience is that patents have not "read the book" - "normal" is not always what the books say it is. If you have a patient come in whose blood pressure is 200/100, and functioning with no headaches, no deficits, no issues, are you going to realize that this is normal for this person right now, and if you drop their blood pressure to normal they will have headaches, pass out, never trust you, and not be back. You need to bring it down slowly over several months. Or if you have a COPDer in what we called the 50/50 club (50% CO2, 50% PO2) and you raise their oxygen saturation too much you will shut down their drive to breathe, that the blue complexion is normal for them. That normal is what is normal for that person, and you need to experience a range of normal before you will know what to treat and what not to. I always recommend 4 years med-surg experience when asked by prospective NP students.

Cococure · Apr 27, 2017

Makes sense...the LTC setting would offering some higher-acuity patients I would think.

Keep in mind the hospital that you are interviewing for does not need to know every detail of your life i.e. That you are a NP student ...I am a student and I just got a very good PRN gig and they don't know that I am in school ...they keep asking me to go part time ...I just simply say that PRN gives me a better work/life balance with my family. I say go for it! If this has been your dream do it to the way of your ability...what u get out of the program is what you put in ...also go to a good school and do more than the required clinical hours

All the best :)