Direct-Entry NP Success Stories

[arockenhaus1]

I am currently applying to several direct-entry nurse practitioner programs. I have my bachelor's degree in biology and I fell in love with nursing after I graduated. I am, obviously, very interested in becoming a nurse practitioner, specifically an AGACNP.

I have seen, only on this forum really, several nurses talk about how direct-entry programs can't produce very good nurses because of the lack of actual nursing experience you have while going through the program. This frightens me a bit, but I consider myself very motivated and smart enough to get through the rigors of the program.

Are any of you products, or know someone who is a product, of a direct-entry program, and if so, is it something you recommend? Would you do it the same way, or would you go the more traditional route if given the choice? Also, where did you go to school, and how difficult was the program?

[djmatte, ADN, MSN, RN, NP]

That is a fairly large assumption isn't it? How familiar were you with their prior RN experience? Do you think there are other factors involved other than RN experience? Doesn't nursing and the NP model kind of hang their hat on treating both the disease and the individual, spending more time, being more approachable? Is that soley tied to prior experience as an RN or is it part of the education and practice model?

This is a very honest comment but it also points out exactly what the problem is: personal bias not a lack of competency or outcomes data or a lack of adequate preparation.

But understand that "lack of trust" you have is completely based on your own bias. One day when you enter advanced practice, I hope you don't have to deal with nurses with extensive personal bias impacting your work like some DE grads do right now.

There are no studies that show actual patient outcomes (be it actual or satisfaction) in regards to whether de or experience based are superior. So without that most of us understandably have anecdote or personal bias to go off of.

[BostonFNP, APRN]

There are no studies that show actual patient outcomes (be it actual or satisfaction) in regards to whether de or experience based are superior. So without that most of us understandably have anecdote or personal bias to go off of.

There are data on novice NP role socialization though, it's been shared numerous times. So there is that to go off of.

[djmatte, ADN, MSN, RN, NP]

There are data on novice NP role socialization though, it's been shared numerous times. So there is that to go off of.

Nothing of what I consider valuable to patient access or outcomes.

[BostonFNP, APRN]

Nothing of what I consider valuable to patient access or outcomes.

Which studies have you read that you find lack value? Is that based on your professional practice experience as an APN?

The truth is that the vast majority of people that weigh in on this issue: 1. have never read any of the extant data on the topic as their minds were already made up and 2. have little to no experience with NP education or advanced practice experience.

[djmatte, ADN, MSN, RN, NP]

Which studies have you read that you find lack value? Is that based on your professional practice experience as an APN?

The truth is that the vast majority of people that weigh in on this issue: 1. have never read any of the extant data on the topic as their minds were already made up and 2. have little to no experience with NP education or advanced practice experience.

I read the studies posted earlier. None talk to patient outcomes our patient satisfaction. All of them are about ability to get through school and pass boards which were about equal aside from those who were farther removed struggled more. Just one that suggests that doctors are somehow more happy with de (borderline laughable).

[BCgradnurse, MSN, RN, NP]

Which studies have you read that you find lack value? Is that based on your professional practice experience as an APN?

The truth is that the vast majority of people that weigh in on this issue: 1. have never read any of the extant data on the topic as their minds were already made up and 2. have little to no experience with NP education or advanced practice experience.

Agree-it's all about "feelings" or "perceptions". Keep in mind that the plural of anecdote does not equal data. Aren't we an evidence based profession? The personal biases of many here, including those who have not practiced as a NP, really have little correlation with how DE grads perform in practice. No one is saying DE grads are superior, so not sure why djmatte chose that phrase.

buttercup9-you are still in school and have not practiced as a NP, yet you seem pretty sure that you're going to be much better than a DE grad. That seems pretty self congratulatory. My guess is that you will likely be at a similar level as a new grad DE NP when you graduate. You will both be novices, regardless of how much nursing experience you have, and how much life experience and other skills the DE grad has. I've seen seasoned nurses flounder as NPs and DE grads turn into rock stars. The reverse is also true.

Having "feelings" or "opinions" about something doesn't necessarily make it so.

[BostonFNP, APRN]

I read the studies posted earlier. None talk to patient outcomes our patient satisfaction. All of them are about ability to get through school and pass boards which were about equal aside from those who were farther removed struggled more. Just one that suggests that doctors are somehow more happy with de (borderline laughable).

Role solcialization studies provide important data to the educational and clinical preparedness of novice graduates. There is more to research than clinical outcomes studies (which would be exceedingly difficult to design and fund) and "customer satisfaction" studies.

You mention that a study (which demonstrated physicians rated clinical competency was inversely proportial to RN experience - not that physicians "preferred des") is laughable. What is this based on? How long have you been in practice and in what setting? Have you hired and trained novice NPs in your practice? Have you preceptor students with varying RN experience? Trying to get where you are coming from?

[djmatte, ADN, MSN, RN, NP]

Role solcialization studies provide important data to the educational and clinical preparedness of novice graduates. There is more to research than clinical outcomes studies (which would be exceedingly difficult to design and fund) and "customer satisfaction" studies.

You mention that a study (which demonstrated physicians rated clinical competency was inversely proportial to RN experience - not that physicians "preferred des") is laughable. What is this based on? How long have you been in practice and in what setting? Have you hired and trained novice NPs in your practice? Have you preceptor students with varying RN experience? Trying to get where you are coming from?

You've read these forums and responded to my previous posts. So while your attempt here is clearly to somehow make me look/feel unqualified to have an opinion, I won't bitte. But thanks for playing. No studies indicate any path is specifically superior or Equal in patient outcomes. And while some want to presume that they are just as good (just as much based off "feelings"), they still have nothing to even base that on. Just that both can get through school at the same rates.

[BostonFNP, APRN]

You've read these forums and responded to my previous posts. So while your attempt here is clearly to somehow make me look/feel unqualified to have an opinion, I won't bitte. But thanks for playing. No studies indicate any path is specifically superior or Equal in patient outcomes. And while some want to presume that they are just as good (just as much based off "feelings"), they still have nothing to even base that on. Just that both can get through school at the same rates.

To be honest I have no idea if I have responded to your previous posts nor do I take the time to search though every posters posting histories to try and determine what their experience is; I hope they would be transparent about that when giving their opinion. I am not sure what there is to bite on here it was a simple question, what is your rather pointed opinion based on?

As to the extant published data, it includes much more than "getting through school" at the same rate. It addresses NP clinical competency, preparedness in novice practice, numerous other factors that effect novice NP role socialization, etc. As far as something to base it on, they have the body of published data on role socialization which suggests there is no significant difference based on RN experience. Again it comes back to: what do you have to base your opinion on if not data?

[djmatte, ADN, MSN, RN, NP]

To be honest I have no idea if I have responded to your previous posts nor do I take the time to search though every posters posting histories to try and determine what their experience is; I hope they would be transparent about that when giving their opinion. I am not sure what there is to bite on here it was a simple question, what is your rather pointed opinion based on?

As to the extant published data, it includes much more than "getting through school" at the same rate. It addresses NP clinical competency, preparedness in novice practice, numerous other factors that effect novice NP role socialization, etc. As far as something to base it on, they have the body of published data on role socialization which suggests there is no significant difference based on RN experience. Again it comes back to: what do you have to base your opinion on if not data?

I've based my opinion on my own anecdote like most people here have. Even reading those articles doesn't sway my overall thought that RN experience is invaluable in forming the np experience be it primary care or other. "Clinical competence" is rated by ability to pass boards. Anyone who gets through school and passes those boards is clinically competent to work as an entry level np. Those studies focused on abilities on getting through school and starting the job. I stated earlier I care more about impacts on patient outcomes and patient satisfaction... To which the two groups have never been studied/contrasted.

[Jules A, MSN]

In upcoming years I suspect a majority of all NPs will be direct entry thanks to the universitities' ingenious retention plans and number of As Seen On TV schools offering anyone a degree who can pay tuition. I would agree direct entry students appeared to be established, educated professionals who were likely designed to be more successful than the fresh faced 23 year olds they are graduating now. The direct entry NPs of recent years will likely become concerned about the lack of standards in upcoming years also.

Consider the authors of many of these "nursing research articles". Work full time for universities much? I don't feel most nursing research articles pitting NPs against MDs are impressive in particular because many focus on patient satisfaction. It is sad that we pride ourselves so much on the handholding factor when that seems to overshadow a world of incompetence in some cases. Thankfully it is difficult to actually kill a patient which supports, across the board, less than competent providers managing to stay in business.

Regardless of the program I suspect overall NP quality will decline because so many are being admitted with little to no admission criteria. If only considering the increased number of NPs and states with full practice authority it is likely our percentages of malpractice suits and adverse outcomes will increase. I think we need to take the time to allow this new trend to settle in before we congratulate ourselves on our great quality. Although rarely acknowledged here there is data indicating we are lacking in some areas:

http://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract

Comparison of Diagnostic Imaging Ordering Patterns | Cardiology | JAMA Internal Medicine | The JAMA Network

http://www.journalofnursingregulation.com/article/S2155-8256(17)30071-6/fulltext

Not sure why it wasn't taking this link but:

Sanchez, G. V., Hersh, A. L., Shapiro, D. J., Cawley, J. F., & Hicks, L. A. (2016). Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants. Open Forum Infectious Diseases, 3(3), ofw168. Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants | Open Forum Infectious Diseases | Oxford Academic

[BostonFNP, APRN]

I've based my opinion on my own anecdote like most people here have. Even reading those articles doesn't sway my overall thought that RN experience is invaluable in forming the np experience be it primary care or other.

Anecdote based on your NP practice? Or your RN practice? Or on experience in didactic or clinical education?

"Clinical competence" is rated by ability to pass boards. Anyone who gets through school and passes those boards is clinically competent to work as an entry level np. Those studies focused on abilities on getting through school and starting the job. I stated earlier I care more about impacts on patient outcomes and patient satisfaction... To which the two groups have never been studied/contrasted.

That is not at all what clinical competency means. In the study you are referencing, how did they define clinical competence? Do you have access to the full study or just the abstract?