Direct Entry GRADUATE NPs

czyja, MSN, RN · Sep 26, 2007

CZJA- I am obviously in the minority here, but I do think that you can succeed as a DE NP. If you are working as a nurse for two years, I believe that is enough experience to learn what nursing is all about. It is also enough experience to hone assessment skills. However, be aware that you may have to work f/t for at least six months before an employer will allow you to drop down to p/t. As a new nurse, it is difficult to learn all you need to know only working p/t and most managers will not allow that. Have you considered working f/t and taking the MSN classes p/t?
I think that you have a lot to offer nursing and I am confident that you will succeed as a nurse leader and a clinician.

Thank you for your kind support. Forunately p/t nursing positions -even for new grads - are abundant in my area (San Francisco Bay). I will, however, cross that hurdle when I get to it.

I am sorry to have taken this thread into a new realm but hey, things happen.

To the earlier poster - Actually, several of the programs I am looking at (UCSF, Yale, Mass General) have been around for quite a few years - ie more than a decade, several in some cases. These are presigious institutions with significant reputations to protect. Perhaps I am naive, but I think it is safe to assume that if they were turning out dangerous, poorly trained grads for the past decade the feces would have hit the HVAC and the programs would be no more.

I gotta go study Anatomy now....

HealthyRN · Sep 26, 2007

I just want to point out that direct entry programs are not new. Check out this publication on Accelerated BSN and MSN programs by the American Association of the Colleges of Nursing at http://www.aacn.nche.edu/Publications/issues/Aug02.htm. According to this, the first generic master's entry program was started in 1974 at Yale University. It does not give a date specific to the start of direct entry NP programs, but I am certain that they have been in place for at least 10 years. It also says that follow-up of direct entry APN graduates at Vanderbilt University found that employers rated direct entry graduates as being just as highly prepared for APN positions as those who entered the traditional programs.

I realize that this is the view of just one nursing organization (AACN), but it is one that is highly respected in the nursing education community. Direct entry programs do bring in money to universities, but I seriously doubt that universities would continue these programs if they were producing unsafe or incompetent practitioners. I believe that the majority of nursing leaders have the best interest of both patients and the nursing profession as a whole in mind.

Advanced Practice Columnist / Guide · Sep 26, 2007

...and there have actually been studies (although not very extensive) on some DE programs as I've pointed out in a response to this thread:

https://allnurses.com/forums/2234494-post3.html

core0 · Sep 27, 2007

...and there have actually been studies (although not very extensive) on some DE programs as I've pointed out in a response to this thread:
https://allnurses.com/forums/2234494-post3.html

With respect, only one of the studies is really relevant. The Cook article involved 13 students and their socialization into nursing. The Munro article if I am not mistaken was not specific to NP practice.

The Smith paper is interesting. Here is the citation:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=1996179&dopt=Citation

While the sample size is limited the there are several interesting items:

"More non-traditional than traditional FNP graduates were employed initially as nurse practitioners. Similarly, more non-traditional FNP graduates were currently employed as nurse practitioners in primary health care settings. Fewer non-traditional FNP graduates expressed satisfaction with their initial or current nursing positions."

I am not sure how to interpret this.

There are a couple of more recent papers by Ellen Rich:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=16052903&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=15052883&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

You can read the original articles here:

http://www.nysna.org/images/pdfs/communications/journal/fl_wntr01.pdf

http://www.nysna.org/images/pdfs/communications/journal/fl_wntr02.pdf

Unfortunately as Rich states the research on this is lacking.

David Carpenter, PA-C

CraigB-RN, MSN, RN · Sep 27, 2007

With respect, only one of the studies is really relevant. The Cook article involved 13 students and their socialization into nursing. The Munro article if I am not mistaken was not specific to NP practice.
The Smith paper is interesting. Here is the citation:
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=1996179&dopt=Citation
While the sample size is limited the there are several interesting items:
"More non-traditional than traditional FNP graduates were employed initially as nurse practitioners. Similarly, more non-traditional FNP graduates were currently employed as nurse practitioners in primary health care settings. Fewer non-traditional FNP graduates expressed satisfaction with their initial or current nursing positions."
I am not sure how to interpret this.

My gut responsed based off of anectodal information is that the Direct Entry people are going into the field to do Primary Care not to specialize. I think that if you look at labor statistics in genearl 2nd career people are happier also. I also wonder if it's an age related thing also. At 50 I'm much more fault tolerant than my 20 some coworkers. It's a perspective thing. I rmember the days when 4 RN's took care of 35 ER patients. But then again Dixi McCall was my hero. :)

Direct entry, traditional, Online are all just labels and I never hired anyone based on a lable, I hired them based on the knowledge and abilities. I've interviewed grads from big name program who couldn't assess their way out of a hole in the ground and a DE who's knew her limitations and knew when to holler for help.

rnav32 · Sep 27, 2007

wow, this thread has really taken off since i posted last. i have read all of the posts and i want to say thanks for everyone's opinion. i really enjoy this forum because we have a lot of people that keep up with what is going on in their profession. i always get something out of reading others thoughts on a particular subject. with that being said, i want to comment on a few of the posts.

someone brought up the subject of diversity. i think that is a great point. i can't count the number of times i have joined a business organization and have noticed that a lot of folks think the same way in that particular business organization. now i'm not saying everyone is exactly alike, but the way they view things and make decisions are very similar. one could argue that people with different experiences could bring something new to that type of organization. at the same time, if someone follows the "if it ain't broke, don't fix it" ideology and has been successful over many years, it would be hard to convince someone of changing or accepting new ideas or ways of doing things.

most of the folks in my prereq classes are late teens early 20s and are pursuing for the most part some type of nursing. several of the older non traditional students are lvns and cnas. i believe there are only a few students like myself that have worked in other fields for several years and are coming into nursing without following the traditional steps. i'm sure there are many out there like myself, but i just haven't encountered them in my classes.

another topic in these posts that peaked my interest was leadership. wow, that one word has been a point of interest since my undergrad days and is really stressed in today's business environment. it usually brings about more questions than answers and has so many definitions that it is hard to get an exact meaning of what it is or how it can be attained. i'm not sure if anyone has looked how many books are out on that subject or how many mba programs are now geared towards that area, but rest assured, it is quite a few. looking back on my ten years since leaving college, if one had offered me a management training program, i would have jumped all over it. i have seen it time and time again in different organizations where folks come in at management trainee and surpass quite a few folks who have had more experience, more knowledge, and a better grasp of how things work in that organization. did some of those leaders/management trainees succeed? yes. did others fail? yes. did some employees question their abilities? yes. after a year or two on the job, the ones that stayed adapted quite well. maybe it was because they had no choice. it was either sink or swim. no one could really tell that they came in as a management trainee. did they have to come in on the ground floor and pay their dues and learn how things worked before they took those positions? no. would it have helped? yes. i kind of relate it to the lvn to rn to apn or msn or np route (generic example) vs the no nursing experience to np or cnl (just generic examples). i think another reason someone might be successful at being an np without a lot of nursing experience is because although they do build on each other, one is practicing medicine and the other is nursing. that is just what i have gathered from reading other threads on allnurses. i'm not sure if that is a fair comparison, but those are my thoughts.

i still want to hear others thoughts on this subject. i know that book learning is a lot different from real world.

i sure wish some de nps would weigh in on this conversation. i think one de np has stated his opinions on another thread i read, but i'm not sure which one.

and someone is right about some schools requiring work experience before getting an mba. i do know that many of my friends went straight ahead with their mbas after undergrad as well without any work experience.

sorry for the long post.

rnav32 · Sep 27, 2007

Just want to say thank you to core0. I have read your responses on many posts and you always bring some really good studies or articles to back up or discredit points being made. It reminds me of my debate days in high school many years ago. Passion and emotion always started great debates or arguments, but facts and reason always won them! Thanks for all the links to the studies and articles.

ILoveIceCream · Sep 28, 2007

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

I don't know... If my infant was in the NICU, I would rather have a NNP than a dermatologist caring for her.

And what about psych NPs who are called into the ED for consults? Is it not because the NP has superior knowledge over the ER doc in mental health?

On a similar note, I'd rather have a CNM deliver my baby than a neurologist, and I'd rather have a CRNA anesthetize me than an internist.

Just my two cents. :)

core0 · Sep 28, 2007

I don't know... If my infant was in the NICU, I would rather have a NNP than a dermatologist caring for her.
And what about psych NPs who are called into the ED for consults? Is it not because the NP has superior knowledge over the ER doc in mental health?
On a similar note, I'd rather have a CNM deliver my baby than a neurologist, and I'd rather have a CRNA anesthetize me than an internist.
Just my two cents. :)

We were discussing the depth of education. The dermatologist did peds rotations (NICU is kind of specialized) the ED doc did psych rotations, the Neurologist delivered babies, the internist did anesthesia. They were all exposed to all aspects to medicine in residency and medical school.

I did not say that an NP could not have more expertise in a given area than a physician. I was stating that you have to look at the overall education. Look at it this way, who would you rather have anesthetize you, the internist or the psych NP?

David Carpenter, PA-C

ILoveIceCream · Sep 28, 2007

No...you did say that a specialized NP could not have the expertise of an MD. That was the whole point of your post. AK556 APRN wrote: "I think a specialized NP in anything has a more focused and solid education than say an FP or ER MD, etc." and you rebutted.

core0 · Sep 28, 2007

No...you did say that a specialized NP could not have the expertise of an MD. That was the whole point of your post. AK556 APRN wrote: "I think a specialized NP in anything has a more focused and solid education than say an FP or ER MD, etc." and you rebutted.

I'll be honest. it was three months ago and I'm not sure exactly what I meant there.

David Carpenter, PA-C

jjjoy, LPN · Sep 28, 2007

ILoveIceCream, the crux of your argument seems to in regard to whether or not tihs statement is valid:

"I think a specialized NP in anything has a more focused and solid education than say an FP or ER MD, etc."

Like many arguments, it depends on what one means by "focused and solid education."

It sounds like David disagreed, arguing that such a statement dismisses the depth of MD education.

Anyone with extensive current practice in a specialty area is (generally) going to know more off hand about that particular specialty, no matter what their formal education is. Heck, I'd rather an experienced lay midwife (with no formal training or certification) delivery my baby than an ENT doctor who hasn't touched a delivery in 20 years, especially if this was taking place in some backwater area without a slew of modern medical technology at hand. That doesn't mean that I advocate tossing out formal midwife/obstetric training and certification.

I might agree that NP specialty training is more focused but I don't know if I'd agree that it's "more solid" than general MD training.

It might be interesting to compare the content of an NP program and MD program in regards to the specific area in question. Once you toss in actual work experience, the person with more experience will generally (hopefully, but not always) be a better practitioner in that field, at least in regard to what they've been working with. Just like experienced RNs can give guidance to new doctors even though nurse training isn't as in depth as MDs.