I am an undergraduate student studying a non-nursing major and would like to ultimately pursue a MSN via direct entry program. For a good chunk of my life, I always thought I wanted to go to medical school until my mother grew chronically ill. After spending a lot of time with her at so many different hospitals and in various settings, I discovered what NPs do and have never looked back since--I knew this is what I wanted to pursue after graduating.
With that being said, I've gotten a lot of mixed opinions about direct entry MSN graduates ranging from "yes, they're great, there is a great lack of APPs in the US" to "don't even think about getting your master's without having X amount of years of experience as a bedside nurse first." Honestly, after doing the math, I figured that it would be more reasonable for me to just get my MSN rather than a second bachelor's and then having to eventually having to reapply to get my master's when I'm much older.
I know for a fact there are a lot of successful APPs who never had experience being a bedside nurse, but are still thriving as providers. However, it just seems like I get a LOT of backlash from some students/older nurses who are incredibly critical about my ambitions and it borderline feels like they're bullying me into becoming "one of them first" by telling me that my current plans are "not respectable in their field".
I guess what I'm wondering is--is this what the majority of the healthcare industry thinks of NPs who did direct entry programs? I already know I'm gonna get bombarded with the "you need bedside experience first" on this post, but my question is, why do established universities like UCSF, Johns Hopkins, Yale, Columbia, Vanderbilt, Emory, (the list goes on) offer these programs if they didn't produce well-rounded, competent individuals?
Are there any NPs who went through one of these direct entry programs? Am I gonna have to spend my entire career justifying my academic/career decisions to people who can't handle that nursing is changing? I'm not even in the program yet and I already feel like I have to keep my plans on the "down low" from fear of backlash.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I've also known a number of nurse practitioners (and worked closely with them) who had no bedside experience before becoming NPs. Some of them graduated from prestigious MSN programs such as Duke, Yale, Johns Hopkins, Vanderbilt, Emory. Almost without exception, the lack of bedside experience was detrimental to their role as nurse practitioners. One or two of them was blessed with excellent listening skills and managed to overcome that handicap. Most, however, flat out stated that they "didn't have to listen to the experienced bedside nurse" because they "had more education" and, occasionally, "because I went to Duke (or Johns Hopkins or Vanderbilt". As one might guess, they had a very long and difficult road ahead of them. Some actually learned to listen to the bedside nurse, the RT, the PT or the pharmacist and eventually did OK. Others lost their jobs. One NP who graduated from Hopkins was overheard on her cellphone telling someone that "The nurses here don't like me because I'm better than them."
Many direct-entry nurse practitioners will tell you that they didn't need the bedside experience, that they're doing just as well as their classmates or colleagues who had the experience. I wonder what their colleagues would say.
Established and prestigious universities have those direct entry programs so that they can collect the tuition money. Or so I hear from friends who teach in those programs.
Wow, where do you work that a lot of these so called DE NP's from "prestigious" programs end up there? I work with a mix of DE and traditional program grads. I have to say I haven't worked with DE grads from Duke, Johns Hopkins, and Vanderbilt but I personally know DE grads from UCSF, Yale, Columbia, and UPenn and none of them act the way you described at all. Nobody name drops their school or program. Many recognize their limited RN bedside experience and defer to nurses when writing orders that can affect the delivery of bedside nursing care. There isn't such an animosity between experienced RN's and new grad NP's. In fact, even our charge nurses on both shifts are always welcoming of new NP's when they see them at our ICU's. Sounds like more of a unit culture issue.
I personally think RN experience is helpful when starting out as an NP for reasons others have stated. You can get a feel for what you're dealing with in different situations after you've seen several MIs, COPD exacerbations, seizures, hypoglycemias, etc etc etc. The repeated exposure will definitely help you early on as an NP AND in school. Will you eventually level out in your career to that of an RN that had experience before becoming an NP? Likely yes. But I was like you- I didn't go to med school because I had to take care of my ailing grandfather, so I chose nursing school instead and did a second degree BSN, then worked as a nurse and went back to get my MSN. I was an NP by 27. Trust me, you'll be fine doing this route.
I've precepted both DE and "traditional" students who are RNs and the RNs are by far and away the better students in clinicals. The DE students, I found, needed lots of hand-holding and just didn't really get "it" during clinicals. They just were way far behind simple things like knowing how to do a good physical assessment that the RN had to do several times a week at their job. It definitely took some work getting them up to speed on diagnosing and by the end of the semester they were usually where the RN students were 2-3 weeks in to the semester with intensive teaching/guidance. They slowed down my days so much that I really only take students who have significant RN experience under their belt now though. I've seen DE NPs who are newly graduated also struggle for the first 2-3 years at their jobs as well until they finally start to find their feet, while I do not know of any of my classmates that had similar issues graduating having worked as RNs. Again, this is all anecdotal, but RN experience is definitely worth it.
I dont see what the OP stated to be bullying. Its a real opinion and may even be a concern.
To be completely honest many of these DE MSN programs are diploma mills and not preparing folks to handle a panel of patients. NOT ALL but many. There definitely some very solid and proven programs but the lack of standardization in nursing education is the main issue. 500/600 or even 800 clinical hours in an MSN program is NOTHING when compare to the 2000 hours that PA programs have or the 10,000 hours an MD has with a residency. Thats where experience comes is helpful to nurses. NP's coming out to practice unprepared does NOTHING but bad to the profession as a whole.
Another point that college recruiters will not tell you is of the over saturation of NP's in many areas. DE NP's are finding themselves unemployable in many areas as they have no NP experience and cant be hired as an NP and they have no RN experience and most places won't hire them as RN's. Meanwhile those prestigious degrees need to be paid for.
Specializes in Psychiatric and Mental Health NP (PMHNP).
DE NP here - Adult/Geri Primary Care. I went to Hopkins and had 9 job offers for first job. About 90% of my class had job offers before graduation, from one or more clinical rotations. There is no evidence that DE NPs in primary care provide lower quality care than NPs that have RN experience. However, this only pertains to primary care. Someone who wants to be an Acute Care NP is generally required to work as an RN first before being admitted into an AC NP program, which makes sense. There are also some specialties, like Oncology, that require RN experience. Don't let the negativity rampant here deter you.
To be completely honest many of these DE MSN programs are diploma mills and not preparing folks to handle a panel of patients. NOT ALL but many.
What percentage of DE programs do you think are diploma mills that are under-preparing folks? Out of the programs in our state, all of the top programs offer a DE path.
500/600 or even 800 clinical hours in an MSN program is NOTHING when compare to the 2000 hours that PA programs have or the 10,000 hours an MD has with a residency.
Thats where experience comes is helpful to nurses. NP's coming out to practice unprepared does NOTHING but bad to the profession as a whole.
Just to put things on an even playing field:
Most quality NP schools are well over the required 500-600 clinical hours at the graduate level and those hours are all within the specialty and are all 1 on 1 direct patient care hours. PA programs have 2,000 hours but the are spread out across every specialty and they are often not 1 on 1 hours. Residency hours shouldn't count for MD/DO because those are post-graduate training hours (similar to collaborative practice for NPs); if you want to compare, use the clinical clerkship hours during medical school, which is 4,000 or so if memory serves.
So the "lack" of clinical hours is what makes RN experience valuable? First, if you are going to make that argument you need to factor undergraduate clinical hours into the NP clinical hours. Second, how similar do you find the roles of RN and NP? Should we just allow all RNs with more than 10 years experience automatically be APNs? By that time they have more hours of experience than a physician at the end of residency.
Another point that college recruiters will not tell you is of the over saturation of NP's in many areas. DE NP's are finding themselves unemployable in many areas as they have no NP experience and cant be hired as an NP and they have no RN experience and most places won't hire them as RN's. Meanwhile those prestigious degrees need to be paid for.
The difficulty I see with novice NPs finding work is the ones that went to sub-par programs not the ones that went to DE programs. Several of the top DE-NP programs in this state have employment rates of 100% at 12 months post-graduate; that's better than nearly all undergraduate nursing programs. NPs shouldn't be taking jobs as RNs as a consolation prize for not finding NP work.
Most quality NP schools are well over the required 500-600 clinical hours at the graduate level and those hours are all within the specialty and are all 1 on 1 direct patient care hours. PA programs have 2,000 hours but the are spread out across every specialty and they are often not 1 on 1 hours. Residency hours shouldn't count for MD/DO because those are post-graduate training hours (similar to collaborative practice for NPs); if you want to compare, use the clinical clerkship hours during medical school, which is 4,000 or so if memory serves.
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Where are all these "quality" programs are that require clinical hours that exceed the minimum number? I went to two well respected brick and mortar state universities and neither exceeded the required hours, nor do I know any of my peers' schools that did either.
C'mon Boston you seriously aren't comparing residency hours to working as a NP in collaborative practice. My state's collaborative practice requirements back when we had them were laughable. The collaborating physician for each location was on paper only. It was usually the medical director who didn't spend one minute of time with me nor did they review my charts. In fact the BON didn't even require them to sign the collaborative agreement or specify any terms. I could have gotten any name and license number of the board of physicians website and no one would have been the wiser. I was practicing without any oversight so not at all like a residency.
Where are all these "quality" programs are that require clinical hours that exceed the minimum number? I went to two well respected brick and mortar state universities and neither exceeded the required hours, nor do I know any of my peers' schools that did either.
C'mon Boston you seriously aren't comparing residency hours to working as a NP in collaborative practice. My state's collaborative practice requirements back when we had them were laughable. The collaborating physician for each location was on paper only. It was usually the medical director who didn't spend one minute of time with me nor did they review my charts. In fact the BON didn't even require them to sign the collaborative agreement or specify any terms. I could have gotten any name and license number of the board of physicians website and no one would have been the wiser. I was practicing without any oversight so not at all like a residency.
I've been a clinical or adjunct faculty for four local programs in the past 6 years; all of them require more than 600 hours minimum, and 3 of them also required 60-80 hours of standardized patient time. I am sure there are some local junk programs that do the minimum though.
So your example is that you had the bare minimum number of hours of clinical time, went to work in essentially independent/non-collaborative practice, and you consider yourself successful (better than most MDs). So what's the issue with NP programs then?
I'm not comparing collaborative practice to a structured residency in terms of learning; my comparison is that medical residents are licensed physicians practicing medicine, albeit in the confines of an elaborate collaborative agreement. Many also practice outside of this concurrently with their residency ('moonlighting').
So your example is that you had the bare minimum number of hours of clinical time, went to work in essentially independent/non-collaborative practice, and you consider yourself successful (better than most MDs). So what's the issue with NP programs then?
While I consider myself a successful NP I haven't ever said I would consider myself better than most MDs. Some sure but there are some bad psychiatrists out there. I believe I'm as good or better than most psych NPs but only about as good as an average psychiatrist, largely due to the deficiencies in my NP education as compared to physicians. I do the same job as MDs in my specialty but that is a far cry from feeling as if I'm on par with their knowledge or skill set.
My issue with the NP schools is that few prepare NPs to practice upon graduation. The only reason I felt I even had the minimum competency was due my experience as a RN and physician preceptor who I spent more time with than required. I'm not sure if your area is unique or maybe mine is but I doubt most programs require more than the minimum. It would make an interesting survey though.
I am an undergraduate student studying a non-nursing major and would like to ultimately pursue a MSN via direct entry program. For a good chunk of my life, I always thought I wanted to go to medical school until my mother grew chronically ill. After spending a lot of time with her at so many different hospitals and in various settings, I discovered what NPs do and have never looked back since--I knew this is what I wanted to pursue after graduating.
With that being said, I've gotten a lot of mixed opinions about direct entry MSN graduates ranging from "yes, they're great, there is a great lack of APPs in the US" to "don't even think about getting your master's without having X amount of years of experience as a bedside nurse first." Honestly, after doing the math, I figured that it would be more reasonable for me to just get my MSN rather than a second bachelor's and then having to eventually having to reapply to get my master's when I'm much older.
I know for a fact there are a lot of successful APPs who never had experience being a bedside nurse, but are still thriving as providers. However, it just seems like I get a LOT of backlash from some students/older nurses who are incredibly critical about my ambitions and it borderline feels like they're bullying me into becoming "one of them first" by telling me that my current plans are "not respectable in their field".
I guess what I'm wondering is--is this what the majority of the healthcare industry thinks of NPs who did direct entry programs? I already know I'm gonna get bombarded with the "you need bedside experience first" on this post, but my question is, why do established universities like UCSF, Johns Hopkins, Yale, Columbia, Vanderbilt, Emory, (the list goes on) offer these programs if they didn't produce well-rounded, competent individuals?
Are there any NPs who went through one of these direct entry programs? Am I gonna have to spend my entire career justifying my academic/career decisions to people who can't handle that nursing is changing? I'm not even in the program yet and I already feel like I have to keep my plans on the "down low" from fear of backlash.
I looked into direct-entry NP/MSN and entry-level RN/MSN programs a couple years ago. I chose an ADN program because of costs, and will likely pursue advanced practice within 5 years in a program that doesn't require a BSN.
I think you are absolutely right in that there are direct-entry NPs who are excellent providers right out of the gate - they busted their butts off during school,and fully applied and engaged themselves during clinical rotations. If you think you will fit in this category, I'll be a cheerleader rooting you on. I think much of the disdain for these programs stem from people wanting an easy way to one of the many tops of the nursing career ladder - there's almost an elitist sense in wanting to bypass the RN role. Please don't think RN experience is valuable. I think it is, but perhaps not always necessary.
On a different note, I'm not sure what to think about the title of your post, "Anti-intellectualism..." Personally, this rubbed me the wrong way. I don't think the majority of nurses are anti-intellectual at all (actually, quite the opposite); perhaps you meant "anti-nonexperienced" in regard to RN work?
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
One benefit, and potential drawback, to nursing is all the points of entry to practice. When I was in nursing school and first starting to practice, there were many times I wished that I had CNA experience before starting my RN schooling. Not because I couldn't be a competent RN without that experience, but the classmates and coworkers I had that were once CNAs had a level of ease with basic patient care that I was lacking. After a while I developed more of those skills as well, it just took me a little more time. Some of my coworkers refuse to participate much in aspects of patient care like changing patients, and helping to toilet them, so it wouldn't have hampered their practice in the same way as mine. Similarly, as a student and new RN there were LPNs that could run rings around me, and most RNs on the floor, because their technical education gave them some excellent time management skills. Unfortunately, most hospitals have chosen to phase out all LPNs in our area so their expertise in their practice limits their scope. And as an ADN prepared nurse, I think I came out of school slightly better prepared to run a floor shift than some of my coworkers that had BSN degrees where more of their education was theory focused and they had never been assigned more than two patients in clinical rotations.
My point is, you don't need to experience each level of the nursing ladder in order to be successful at a level with a higher scope of practice. However, I know that for me, I would not even be considering my APRN education without the time I have had to experience RN level nursing. If others don't have the same concerns, that doesn't really affect me, and it doesn't mean anything definitively about their care. There are good and bad nurses at all levels of certification, regardless of their experience or education. What works for you may not work for someone else. Good luck.
To the OP, I am a graduate of a non-nursing degree, and am also seriously considering a DE MSN degree, and hitting blocks like you when I mention I want to change my career as a nurse. It is frustrating and depressing to hear when other nurses that you think would support you in entering healthcare would suddenly shut you down.
Have you considered doing a double major or doing nursing as your major and the other field as your minor? If you’re still doing your undergrad but really have your eyes set on nursing and NP, then that would be my advice for you.
But if you’re set on DE MSN, then go for it and know I’m going with you.
Corey Narry, MSN, RN, NP
8 Articles; 4,475 Posts
Wow, where do you work that a lot of these so called DE NP's from "prestigious" programs end up there? I work with a mix of DE and traditional program grads. I have to say I haven't worked with DE grads from Duke, Johns Hopkins, and Vanderbilt but I personally know DE grads from UCSF, Yale, Columbia, and UPenn and none of them act the way you described at all. Nobody name drops their school or program. Many recognize their limited RN bedside experience and defer to nurses when writing orders that can affect the delivery of bedside nursing care. There isn't such an animosity between experienced RN's and new grad NP's. In fact, even our charge nurses on both shifts are always welcoming of new NP's when they see them at our ICU's. Sounds like more of a unit culture issue.