Direct Entry GRADUATE NPs

AK556 APRN · Jun 21, 2007

I don't love the idea of DE - but can say the people that attended the one at my school were anything but lazy. The "boot camp" first year, and then 2 years of the master's program must be like learning a new language and culture for them. I often wondered how any of them made it through what they did! One must be very determined and committed to endure what I saw them go through......that in and of itself is a contributor to why most of them will probably be great providers - a lazy person no way could have made it through. Be prepared for therapy!

What I liked most is the diversity of personalities DE brings to nursing - very atypical from the experience I had in nursing school where everyone fit the "typical caregiver" mentality.

Just like everything in life.....pros and cons. You will be as excellent as you want to be. I'd rather have a passionate non-nurse women's health provider than the other side of the coin.

I think, but I'm not sure, that two years of a specialty focus is more exposure than a GP MD receives?

PS - PAs have to work under direct MD supervision, so not as scary without experience. They generally also have quite a bit of science pre-reqs the non-nurse NPs don't - regardless, programs are pretty competitive, so it seems it would "weed out" many right away, but I know many NP programs take Any and Everyone that meets the requirements.....mine did.

caldje · Jun 22, 2007

I think, but I'm not sure, that two years of a specialty focus is more exposure than a GP MD receives?
PS - PAs have to work under direct MD supervision, so not as scary without experience. They generally also have quite a bit of science pre-reqs the non-nurse NPs don't - regardless, programs are pretty competitive, so it seems it would "weed out" many right away, but I know many NP programs take Any and Everyone that meets the requirements.....mine did.

a GP recieves four years of medical school,a broad, generalist training.. then does a 3 years residency either in family medicine or internal medicine. depends on what you consider a "GP". That residency, as well as medical school, provides a BROAD exposure to MANY specialties. The intesnity of the education that an MD recieves is also very different. Clinical training for MDs is two years long.. often times consisting of 80 hour work weeks. PA clinical education is usually 3 semesters long (vs. MD 4 semesters) and also consists of workweeks that can easily exceed 60 hours a week.

Also, PAs do not require "direct" supervision. Far from it actually. It varies from state to state, just like NPs, but PAs can write Rxs in all 50 states and in many states require no chart cosignature.. in NC, the "supervision" requirements are a meeting with the MD supervisor once every 6 months to discuss medical matters. http://www.aapa.org

core0 · Jun 22, 2007

a GP recieves four years of medical school,a broad, generalist training.. then does a 3 years residency either in family medicine or internal medicine. depends on what you consider a "GP".

A GP is an old term for general practitioner. Traditionally after medical school a physician could do their internship then hang up their shingle as a GP. Most states will not let an IMG practice without a formal residency. A number of states are moving toward prohibiting practice without a residency. The military still uses this model with the GMO (general medical officer). Either way you are looking at 2 years full time didactic training and two years of clerkships plus one year of full time residency. More training than a specialized NP degree.

David Carpenter, PA-C

AK556 APRN · Jun 22, 2007

.....sorry about any PA mistakes, things have changed since I looked at it. I have worked with PAs who were awesome in the ER and my PCP growing up was a PA who was very sweet and gentle. The PAs in the ERs I have been in have always had to run and get things (incl. RXs) co-signed. I didn't think a PA could go into private practice, can they now? Do you guys have any "specialty" certification exams, or is it still just done through experience? I like the medical model of the PA programs. I think they're a little tougher to get into than NP, right? Nothing worse than trying to get into Vet school though!

As far as the MD thing....I almost married someone I endured med school/residency with - any one that makes it through that.....whew! Anyway, my comment was about the exposure of a GP MD (pre-residency)....I do know I received more specialty training (and exposure) in my NP program than he did in med school AND residency combined (he was ER) - comparing apples and oranges, maybe. I think a specialized NP in anything has a more focused and solid education than say an FP or ER MD, etc.

core0 · Jun 22, 2007

.....sorry about any pa mistakes, things have changed since i looked at it. i have worked with pas who were awesome in the er and my pcp growing up was a pa who was very sweet and gentle. the pas in the ers i have been in have always had to run and get things (incl. rxs) co-signed. i didn't think a pa could go into private practice, can they now? do you guys have any "specialty" certification exams, or is it still just done through experience? i like the medical model of the pa programs. i think they're a little tougher to get into than np, right? nothing worse than trying to get into vet school though!
pas have independent rx privileges in all 50 states (thank you indiana). there are still 5 states where pas cannot prescribe controlled substances. as far as going into private practice, pas still need a supervising physician, but there are quite a few pas that own their own practice (especially in hspa areas). specialty exams are an area of controversy. pas still have to take a general certification test every six years. there are currently two specialty recognition programs (in derm and cv). em will probably be added this year. these are not required and the standard is still for the practice to train the pa (although there are a growing number of post graduate training programs). as far as tougher to get into, i have no idea. the top pa schools are very difficult to get into, but i would imagine the top np schools are also.
as far as the md thing....i almost married someone i endured med school/residency with - any one that makes it through that.....whew! anyway, my comment was about the exposure of a gp md (pre-residency)....i do know i received more specialty training (and exposure) in my np program than he did in med school and residency combined (he was er) - comparing apples and oranges, maybe. i think a specialized np in anything has a more focused and solid education than say an fp or er md, etc.

i would respectively disagree. any physician who has done a residency will have a more focused and solid education than a specialty np. it simply comes down to exposure. physicians will have 4000 hours of exposure as med students to all areas of medicine. they will have another 3-4000 hours of exposure to inpatient medicine and some outpatient medicine as interns. a fp or er physician will have a very solid background in all areas of medicine because of what they do. there is some difference in how much independence medical students are given vs. np students, but the transition in residency is quite dramatic.

what you may have noticed is the tendency of physicians to lose these general medical skills as they specialize. a fnp will probably have better skills managing htn or dm than an orthopod. however to say a specialized np has a more focused and solid education really dismisses the depth of physician education.

david carpenter, pa-c

AK556 APRN · Jun 22, 2007

Just stating what my experience was in the case of my ex-fiance' (now friend) in reference to psychiatry. He had very little in med school (Finch U.) and probably less while "we" were in his residency (Oregon HSU). Lots of ER time, but very liitle in OB/GYN, psych.....maybe others? It was 10 years ago.

SparklyGirl · Jun 23, 2007

Not me, but my best friend from highschool did her undergrad at UC Berkeley, then did the direct entry masters at Yale.

She was hired immediately after graduation to be the NP in a pediatricians office in Berkeley. She worked there for about 7 years and just took a leave after the birth of her 2nd son.

It was the first job she interviewed for, and got it.

PediASL · Jun 23, 2007

to answer the orignial question: I was offered more than one position upon graduation from a direct-entry program. I did end up accepting and have been there since. Primary care pediatrics was my in-school training with internships in Neurology and other specialty. I accepted a position in a hospital setting.

Trauma Columnist · Jun 25, 2007

Good - I'm so glad to hear that there are jobs out there. I think some of the opportunities depend on where you're at too. In my area (central IL), the mid-level market is very tight - so they have the choice of many applicants. However, in some of the bigger cities (i.e. Chicago), there are more openings than qualified applicants.

VivaRN · Jun 26, 2007

A good friend of mine came straight to grad school without RN experience. Her goal is to manage a free clinic.

In her first clinical she was paired with an older NP who does just that. The NP decided to hire her, then turn the clinic over to her after they have practiced together for a few years. I don't know about other people, but she didn't have a problem.

I agree with Trauma that it probably depends on the market. I wonder, also, if it is different if you want a job doing inpatient or the ER vs. primary care. It seems that prior experience plays more of a role for those areas.

mvanz9999, RN · Jun 27, 2007

I just met a women yesterday who is a direct entry ACNP. She gave me some good advice and absolutely loves her job. She is in the ER of two hospitals.

The advice is basically to keep your head up through the DE bootcamp and realize that the first year is a struggle, but definitely worth it in the end.

We shall see.

utexas08 · Jul 2, 2007

Did she receive job offers after graduating the direct-entry ACNP program? My only fear is that most places will want at least 1 year RN experience to apply as a ACNP. Thanks!