Direct Entry GRADUATE NPs

mvanz9999, RN · Sep 28, 2007

Part I:

I don't really understand the point of the argument. A specialized NP has more specialized training than an FNP for a particular area of work. Therefore, an ACNP would have more specialized training that might be appropriate to asses or prep patients for cardiac procedures. A PNP would have more specialized training for treating children under 13 years of age.

A FNP has more specialized training for a different area of work - functioning as a primary care giver across the entire age range.

How can you say "more specialized"? In relation to what? The same holds true of MD's. A neurosurgeon has more specialized training in the area of neurosurgery, and an Internist has more specialized training in primary care.

I would argue that I would rather have an Internist (although I REALLY prefer an FNP) manage a complaint about high cholesterol than a neurosurgeon.

Part 2:

I'm tired of the MD vs. NP vs. PA argument. The only thing I would like to point out is that yes, an MD has more in depth training. Is that always necessary or even relevant? Probably not.

What I do know is that the relatively recent involvement of government agencies, insurance companies and MBA's in general have turned medicine from a human focused practice into a factory, where patients are nothing more than pods on an assembly line. MD's might have more "solid" training (whatever that means), but they have far less time, energy, or even desire to focus on the human interaction part. Their job is to churn out as many billable patients as possible, in as short a time as possible. You can argue that it isn't so, but in 90% of cases, that's a fact.

I have some experience with this as a patient, but I think the details are best put somewhere else.

I prefer, by far, NP's and PA's to MD's.

jjjoy, LPN · Sep 28, 2007

What I do know is that the relatively recent involvement of government agencies, insurance companies and MBA's in general have turned medicine from a human focused practice into a factory, where patients are nothing more than pods on an assembly line. MD's might have more "solid" training (whatever that means), but they have far less time, energy, or even desire to focus on the human interaction part. Their job is to churn out as many billable patients as possible, in as short a time as possible. You can argue that it isn't so, but in 90% of cases, that's a fact.

Isn't that also true of NPs and PAs? Originally they could take more time with patients because they were getting paid less than MDs. Then those number crunchers start to push NPs and PAs in the same way they did MDs, creating again, an environment where the practioner is being pressured to see more patients in less time.

mvanz9999, RN · Sep 28, 2007

You're asking ME? I have no idea. In my experience, PA's and NP's DO spend more time. I guess it's only a matter of time until they are exactly the same with time and production.

In either case, is the extreme depth of knowledge really all that relevant when 99% of the time it isn't used?

boston-kevin · Feb 21, 2008

I'm not sure if this discussion is still alive, but I am hoping to revive the original intent from back in Sept.

I am a current 1st year student (and class representative) at the MGH program and I am trying to poll any recent alumni to see how many people got their first job as an NP or if they had to work as an RN first. The goal of these direct entry programs is to take someone without RN experience and churn them out as practicing NPs.

I have only heard from a few alumni, but I would love to hear from any graduate of an MSN (nurse practitioner) direct entry program. I am working on side project with the administration of the school and the hospital to see if something similar to a medical residency would be needed provide more solid NP experience. While gaining experience as an RN may be helpful, I think the NP role is more independent and different and I think it would be better to gain specific NP experience (in a residency like program) rather than working as an RN and then try to apply for an NP job and here them say, "well you have RN experience, but no NP experience."

In sum, I'd love to get some sense of how many direct entry graduates actually secured an NP position pretty soon after graduation.

Radam222 · Feb 22, 2008

I applied to UIC GEP program. To those accepted, what kinds of stats did you have going into it (i.e gpa, gre scores, etc)? I am getting antsy and am waiting to hear from them to see if I even will be granted an interview.

boston-kevin · Feb 22, 2008

Radam222,

I may not be the best person to ask about statistics. I didn't have to take the GRE for my program as I already have my MBA and MHA degrees. My GPA for both those degrees was about 3.65. I think being a guy helps a bit as there are only 9 or 10 guys (out of 75) in my entire program. I don't think I actually heard from the admissions office until March. Hope that helps.

Radam222 · Feb 23, 2008

thank you very much for your response. I was thinking that being a male may help my cause somewhat too.

butch228 · Feb 23, 2008

Hi there Kevin..

I'm a grad, from the MGH MSN program..but unfortunately I was one of the few RN students (compared to the number of Direct Entry NP students).

Since I was an RN-MSN student..we were kind of isolated from the Direct Entry Students..

.the few direct entry students that I have run into since graduation have for the most part secured NP jobs in the Boston area. One works in acute care setting, another works in a community health clinic. There may be a bias out there for NP students with little RN experience....but my impression of the Direct Entry students (esp at MGH) is that many had other advanced degrees..most of the students were pretty mature in their clinical reasoning/diagnosing, which helped in getting NP jobs.

As for me...when I completed my MSN degree, I had over 5 years working on a acute medical floor at MGH..it gave me nice snapshot what to expect in a acute care setting,and what are the latest cutting edge treatments for various diseases. In fact I still work there per diem as a Staff Nurse.just to keep my feet wet in a acute medical environment. I view my work as staff nurse on a medical floor as a "residency". Am I diagnosing..prescribing..no..but I can pick the medical resident or the attending's brain..on why are they treating such disease with a certain medication. I work now as an NP in the community..but my patients have very complex medical problems..and frequently they get sent to the hosptial. More clinical time in a residency..or in other situations can only enhance one's practice. I mean..can you imagine..medical school grads practicing medicine without residency? Scary..but if you think about it , NP's are doing it now.

The bottom line is that depending on certain areas of NP care, a Residency can only enhance our profession and our outcomes.

jjjoy, LPN · Feb 23, 2008

Heck, I think new grad RNs could use a residency as well. Some schools have instituted a senior practicum that functions similarly, but many new grads are given 8-12 weeks of preceptorship/orientation and then given a full patient load. This after never having been responsible for more than two patients with a clinical instructor that they had to share with 8-9 other students. The difference between 3-page care plans taught in school that emphasize patient education, therapeutic listening and the like and being responsible for 6+ patients with barely time to familiarize oneself with each patient's condition is vast. Hospitals don't want to pay full price for half a nurse for several months so new grads are pushed hard to be up a full load ASAP. Many new grads are quickly disillusioned. So I'm all for all types of residencies!

Miss Mab · Feb 23, 2008

It's interesting to note the current trends in mid-level education in regard to whether residencies will become either necessary or even become the norm.

It's my impression from personal observation and also from the student forums here that an increasing number of NP direct entry students are coming immediately from their undergrad experience while at the same time many PA schools are loosening or eliminating their own patient care experience requirements.

Should be interesting to see how mid-level education continues to evolve...

Kensington · Feb 23, 2008

I'm very interested in the idea of having a residency upon becoming an NP. Do any hospitals offer anything similar now?

core0 · Feb 23, 2008

I'm very interested in the idea of having a residency upon becoming an NP. Do any hospitals offer anything similar now?

Here is an article from OJIN. I believe that the author has started a residency program for NPs in their health center but I cannot find the announcement.

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/Number3/tpc28_516029.aspx

I will reply to this as I don't think that it is completely accurate:

It's interesting to note the current trends in mid-level education in regard to whether residencies will become either necessary or even become the norm.
It's my impression from personal observation and also from the student forums here that an increasing number of NP direct entry students are coming immediately from their undergrad experience while at the same time many PA schools are loosening or eliminating their own patient care experience requirements.
Should be interesting to see how mid-level education continues to evolve...

PA programs have always been divided roughly between those that require experience and those that don't. Currently the PA programs are roughly divided into thirds with 1/3 requiring experience, 1/3 recommending experience and 1/3 with no experience requirements. The consolidation of programs in the early 80's probably had the highest percentage of programs requiring experience. In the early 90's (probably the time of greatest growth) many programs did not require experience. Currently the trend seems to be the other way. Of the last 10 or so programs that have started 80% (roughly) have required experience. What has also changed is the new programs are longer. The average program has changed from 23 months to 26 months full time. That represents an increase of 384 hours of didactic time or 560 hours of clinical time (or a combination of above). That is probably the bigger change in PA education.

David Carpenter, PA-C