Education vs Experience

[Airforce1]

Hello Everyone,

I am a BSN student who is interested in pursuing a graduate degree in the future, probably a year after I graduate. I have read some posts and found that many here believe that an RN with that little experience has no place in Advanced Practice programs. This is where I disagree.

I believe that Nursing culture is shooting itself in the foot here, and here's my cents why. A prospective doctor does not have to leave college after a bachelors degree to gain experience in the field of biology or chemistry before going on to Med school. A prospective college professor does not have to leave college after his bachelor's degree to get experience teaching at the grade school level. So WHY do so many believe that an RN has to leave school after their bachelor's degree to gain whatever many years of experience at the clinical level before going on to grad school?

:nono:I believe that it is counterproductive for the nursing profession as a whole to discourage students who wish to complete their education (MSN or beyond) before beginning clinical or other types of practice. You would think that the sensible thing to do is get your education, and THEN get your experience. Am I the only one who feels like this?

[misplaced1]

I am aware of no graduate programs that require to "major" in a certain subject prior to applying. My roomate/med student was an English major. That said it is rare to see people with advanced degrees in say engineering but that is mostly because most people, if they are majoing in say history, are not going to go ahead and take extra classes in engineering. My ex went straight from getting his engineering degree into a maters program and actually did so to get a lucrative sales position of high tech equipment. Worked exactly three months as an engineer.

I understand that one needs experience to do an advanced practice job in the hospital and that makes sense. I think though that what we will eventually see is something similar to JUST ABOUT EVERY OTHER FIELD THERE IS. And that is, that anyone, with the grades and the prereqs will be able to get into an masters program in nursing. There are lots of fields where practice makes perfect. In this one it may be life or death especially in the acute setting and that makes it a bit different. But nurses are not the only ones working in acute care.

I understand the experience issue and I also understand the people that may be upset as they feel they had to work harder, longer or simply did not have the opportunties that younger people may have today. I by the way am older and really paid my dues in the first field I was in an didnt plan on leaving but, I digress.

The thing is, the focus on advanced degrees is new, the kinks are being worked out. I suspect eventually there will be more clinical hours involved in the advanced clinical degrees so that one may have time to collect experience in their field. Similar to a PA degree. I am not familiar with the DNP but suspect that is part of what is going here in addition to trying to elevate the profession through extending educational requirements. Its a great method that just about every other real profession uses. I think it is also highly likely that NPs will eventually have to do some sort of residency.

I also suspect though that sadly, nothing short of 20 or 30 years of experience will be good enough for a good portion of hospital nurses and that is extremely sad. This is not to discount experience because certainly experience account for a lot, especially in the acute care setting. But I could work for 30 years as Physical therapy assistant and that still would not make me a Physical therapist.

It is sad to see so many here "p*ssing on each other's shoes" so to speak. Very disheartening and seeing in IRL is one of the reason I work in a nonhospital setting and question every day what I am doing here.

By the way last I looked about a month ago there were three open positions for acute care nurse practitioners- NO EXPERIENCE REQUIRED at my local hospital but not one for an RN. Part of this is business. ANP's can prescribe, RNs cannot. The hospital can bill for an ANPs services. This means that ANPs are on the "income" side of the ledger and RN's are on the expense side.

Medicine is a business, like it or not. And income and expenses will matter with or without national healthcare because even a nonprofit has to stay afloat.

Advanced education uplifts the profession and it will be nice to see nursing receives the regognition it deserves- even it it appears the only way it will go there is kicking and screaming!.

[PostOpPrincess, BSN, RN]

I am aware of no graduate programs that require to "major" in a certain subject prior to applying. My roomate/med student was an English major. That said it is rare to see people with advanced degrees in say engineering but that is mostly because most people, if they are majoing in say history, are not going to go ahead and take extra classes in engineering. My ex went straight from getting his engineering degree into a maters program and actually did so to get a lucrative sales position of high tech equipment. Worked exactly three months as an engineer.

I understand that one needs experience to do an advanced practice job in the hospital and that makes sense. I think though that what we will eventually see is something similar to JUST ABOUT EVERY OTHER FIELD THERE IS. And that is, that anyone, with the grades and the prereqs will be able to get into an masters program in nursing. There are lots of fields where practice makes perfect. In this one it may be life or death especially in the acute setting and that makes it a bit different. But nurses are not the only ones working in acute care.

I understand the experience issue and I also understand the people that may be upset as they feel they had to work harder, longer or simply did not have the opportunties that younger people may have today. I by the way am older and really paid my dues in the first field I was in an didnt plan on leaving but, I digress.

The thing is, the focus on advanced degrees is new, the kinks are being worked out. I suspect eventually there will be more clinical hours involved in the advanced clinical degrees so that one may have time to collect experience in their field. Similar to a PA degree. I am not familiar with the DNP but suspect that is part of what is going here in addition to trying to elevate the profession through extending educational requirements. Its a great method that just about every other real profession uses. I think it is also highly likely that NPs will eventually have to do some sort of residency.

I also suspect though that sadly, nothing short of 20 or 30 years of experience will be good enough for a good portion of hospital nurses and that is extremely sad. This is not to discount experience because certainly experience account for a lot, especially in the acute care setting. But I could work for 30 years as Physical therapy assistant and that still would not make me a Physical therapist.

It is sad to see so many here "p*ssing on each other's shoes" so to speak. Very disheartening and seeing in IRL is one of the reason I work in a nonhospital setting and question every day what I am doing here.

By the way last I looked about a month ago there were three open positions for acute care nurse practitioners- NO EXPERIENCE REQUIRED at my local hospital but not one for an RN. Part of this is business. ANP's can prescribe, RNs cannot. The hospital can bill for an ANPs services. This means that ANPs are on the "income" side of the ledger and RN's are on the expense side.

Medicine is a business, like it or not. And income and expenses will matter with or without national healthcare because even a nonprofit has to stay afloat.

Advanced education uplifts the profession and it will be nice to see nursing receives the regognition it deserves- even it it appears the only way it will go there is kicking and screaming!.

I keep restating this and I feel that I am misunderstood. There is nothing wrong with going further with the education. I just know (and I have to point this out because you are working on theory, and I am working IN REAL LIFE with REAL PEOPLE LIFE OR DEATH--NOT MACHINES OR QUANTUM PHYSICS OR NUMBERS--REAL PEOPLE) that what I have seen personally with MY OWN EYES...most of those who go straight into nursing without the experience can do the job...but there is so much lacking and I SEE IT..all the time...all day...and it is so obvious....THEY ARE MISSING A LOT.

You can think what you want. I like the idea of education. I am going for advanced practice myself and so are a lot of people I know who have multiple years of experience. I think the DNP is a great idea. For the RIGHT PEOPLE. Just like an MD has to put in residency hours, I think the nurse needs too also. I think our basic entry level of "ZERO" is unacceptable.

I do not doubt that they will be theoretically qualified, but for the most part, I wouldn't let ANYONE with an APN without the background go near my family member. I just wouldn't. I don't like the new APNS who lack experience having "aha" moments when they should already have had those "aha" moments---in their own clinical experiences. SEE IT EVERYDAY. I know this for a FACT. I don't like the new APNS trying to "avoid" bedside because honestly, they are not the best of nurses--clinical diagnosticians? Perhaps; even that is questionable. Often they doubt themselves and have to THINK--it's not automatic--like I've seen with experienced ARNPs.

Sorry. The truth is the truth.

Since you aren't even in school yet, how can you beg to differ????? YOU can't. YOU don't know. You are, again like most, basing it on theory.

I will say this again, and again, and again...you will have credibility issues, it can't be helped, it is the way it is. Perhaps when they mandate a minimum of 5 years...it won't be an issue then...but until then, expect it.

[BmoreCRNP]

I am aware of no graduate programs that require to "major" in a certain subject prior to applying. My roomate/med student was an English major. That said it is rare to see people with advanced degrees in say engineering but that is mostly because most people, if they are majoing in say history, are not going to go ahead and take extra classes in engineering. My ex went straight from getting his engineering degree into a maters program and actually did so to get a lucrative sales position of high tech equipment. Worked exactly three months as an engineer.

I understand that one needs experience to do an advanced practice job in the hospital and that makes sense. I think though that what we will eventually see is something similar to JUST ABOUT EVERY OTHER FIELD THERE IS. And that is, that anyone, with the grades and the prereqs will be able to get into an masters program in nursing. There are lots of fields where practice makes perfect. In this one it may be life or death especially in the acute setting and that makes it a bit different. But nurses are not the only ones working in acute care.

I understand the experience issue and I also understand the people that may be upset as they feel they had to work harder, longer or simply did not have the opportunties that younger people may have today. I by the way am older and really paid my dues in the first field I was in an didnt plan on leaving but, I digress.

The thing is, the focus on advanced degrees is new, the kinks are being worked out. I suspect eventually there will be more clinical hours involved in the advanced clinical degrees so that one may have time to collect experience in their field. Similar to a PA degree. I am not familiar with the DNP but suspect that is part of what is going here in addition to trying to elevate the profession through extending educational requirements. Its a great method that just about every other real profession uses. I think it is also highly likely that NPs will eventually have to do some sort of residency.

I also suspect though that sadly, nothing short of 20 or 30 years of experience will be good enough for a good portion of hospital nurses and that is extremely sad. This is not to discount experience because certainly experience account for a lot, especially in the acute care setting. But I could work for 30 years as Physical therapy assistant and that still would not make me a Physical therapist.

It is sad to see so many here "p*ssing on each other's shoes" so to speak. Very disheartening and seeing in IRL is one of the reason I work in a nonhospital setting and question every day what I am doing here.

By the way last I looked about a month ago there were three open positions for acute care nurse practitioners- NO EXPERIENCE REQUIRED at my local hospital but not one for an RN. Part of this is business. ANP's can prescribe, RNs cannot. The hospital can bill for an ANPs services. This means that ANPs are on the "income" side of the ledger and RN's are on the expense side.

Medicine is a business, like it or not. And income and expenses will matter with or without national healthcare because even a nonprofit has to stay afloat.

Advanced education uplifts the profession and it will be nice to see nursing receives the regognition it deserves- even it it appears the only way it will go there is kicking and screaming!.

I think residency would be a great idea! Like I've stated ad nauseum on this site, I'm a new NP. Now that I'm working I realize there is no way 2 years of education and 800+ hours of clinical experience (some of which was crappy to say the least) is going to fully prepare you for what's ahead. You really do learn on the job. I wish my clinical experience had been more well rounded and better suited for what I'm doing now. But clinicals for NPs is a tricky thing. We do not have everything laid out for us like the med-students and residents. NPs often have to find their own preceptors, which is HELL! Most people don't want to be bothered with a NP student. Quite a few MDs are opposed to the idea of NPs altogether and refuse to have any part in their training. Some of my classmates and instructors were told this flat out by some MDs. Not only that, many NPs and MDs have no incentive for taking on a NP student. However, if they have a med-student they often get paid for taking them on.

[kanzi monkey]

I don't like the new APNS who lack experience having "aha" moments when they should already have had those "aha" moments---in their own clinical experiences. SEE IT EVERYDAY. I know this for a FACT.

All clinicians, regardless of education or experience, have "aha" moments. What "fact" are you talking about, specifically?

Often they doubt themselves and have to THINK--it's not automatic--like I've seen with experienced ARNPs.

The minute I realize the HCP that is treating me lacks the capacity to doubt her decisions or think her way through a clinical dilemma is the minute I switch HCPs. I know NO good clinician that treats patients "automatically". Patient care isn't based on order sets, or even evidence-based guidelines (or previous experiences with patient care-which SHOULD go without saying). Those things are great, but cannot and should not prevail in clinical decisions when the patient's circumstance warrants a different approach. Each patient needs to be considered every time a decision is made. It doesn't always have to take a lot of time, often the choice is clear. But you have to MAKE that choice, which requires, well, thinking.

Can you give some examples? Do you know any new ANPs that come from years of nursing experience that feel immediately comfortable and 100% confident in their roles?

Sorry. The truth is the truth.

Your experiences are anecdotal. And you haven't named those experiences.

[kanzi monkey]

A women's clinic would bore me to tears. Anything that didn't involve intensive and high acuity would bore me to tears-- that is just me. I do not think we are telling the OP NOT to go to school--I say go for it. Just don't expect to work for that heart surgeon up the road and putting in lines and what have you without getting that necessary bedside experience. Our two ARNPs that work for the surgeon's group have a combined 40 years of experience.

They are that damn good. and I mean damn good.

If you think the skills are good enough to work in a clinic, go for it. The really experienced ARNPS are grabbed by the high acuity areas and get the best of both worlds.

You obviously work in acute care and wish to pursue an advanced NP career in an acute care setting. This is a specialty. I doubt the person who works in the women's clinic cares if her job would bore you. Why would she? Acute care is not the ultimate arena for advanced practice nurses (you do not, for example, get the best of primary care in a high acuity area). But your opinions regarding education vs. experience in an advanced role are clearly directed at this specialty. Your argument would make more sense if you clarified this more often, and if you wouldn't espouse your opinions in every conversation about fast track NPs (since many people aren't talking about acute care and want nothing to do with it).

[PostOpPrincess, BSN, RN]

All clinicians, regardless of education or experience, have "aha" moments. What "fact" are you talking about, specifically?

The minute I realize the HCP that is treating me lacks the capacity to doubt her decisions or think her way through a clinical dilemma is the minute I switch HCPs. I know NO good clinician that treats patients "automatically". Patient care isn't based on order sets, or even evidence-based guidelines (or previous experiences with patient care-which SHOULD go without saying). Those things are great, but cannot and should not prevail in clinical decisions when the patient's circumstance warrants a different approach. Each patient needs to be considered every time a decision is made. It doesn't always have to take a lot of time, often the choice is clear. But you have to MAKE that choice, which requires, well, thinking.

Can you give some examples? Do you know any new ANPs that come from years of nursing experience that feel immediately comfortable and 100% confident in their roles?

Your experiences are anecdotal. And you haven't named those experiences.

My experiences are anecdotal. What else can they be? I have 4 (4 CVICU nurses who work for two cardiothoracic groups.)that were immediately comfortable, running codes, intubating putting in lines, pulling chest tubes. 4 of them were the first ARNPs around--hospital paid for them to go to school. Two nurses I know working for University of Miami--neurosurgeon. They are 2 of four. They were selected SPECIFICALLY because of their background. They are ASTOUNDING clinicians and educators.

I'm not allowed to name them here. But yes, MY anecdotal experience can tell you that. Also know of TWO ARNPS who RUN the ER on nightshift...between them they have about 50 years of experience. They are so good that the MDs RARELY question their decisions. I've followed them--seen them in action. AMAzing.

The only ones I know with minimal experiences are the CRNAS (1-3 years) and a couple of NPs for docs. Those specific CRNAs do most of the Moderate sedation cases (they are very, very uncomfortable in their role as of right now--they are new grads less than 6 months; and the two NPs work for two internal meds. They discharge the ones ready to go home. That's all I ever see them do. And adjust meds.

The ARNP I go to see for my OWN health (definitely prefer the ARNPS to the doc) are the best. They are 20 plus years of experiences and are so thorough they put the doctors to shame.

They are more in demand than the doctors.

So, I see very, very experienced ARNPs. They are even better then some docs.

Anecdotal? We need to do studies. Because I know after we collect data for a few years, my anecdotal experiences will be proven right.

[PostOpPrincess, BSN, RN]

An "aha" moment?

When an ARNP was ready to place a patient under a care of a urologist and invasive therapy when all the patient needed was a "chill out" you will be fine--because he couldn't pee. She did only wait 16 hours post op to address it and the young man was freaking. His bladder was rock hard and no one could pass a foley cath--after 10 people--LITERALLY--I went to check on him and found him a crying wreck, and his mother a crying wreck.

Nobody asked him if he was afraid his member was going to fall off. NOPE. No one. I asked him;he was "FREAKED"

A little Ativan IV--fixed it all.

That WAS ALL he needed. Instead, the ARNP was ready to call in the

troops--urology was already called.

"Aha moment?"

BIG TIME.

Too many "aha" moments. If you need more, I'll list more.

[SiennaGreen]

Just a monkey wrench. I can say that I am no sure that I would prefer my CNM to have years and years of experience prior to going to midwifery school. I have heard it more than once from very experienced CNM's that bein in L&D just doesn't make one a better midwife. In fact, it is had been suggested to me that the more experience an RN gets in hospital birth, the more fear based and medical model she becomes when it comes to her own birth philosophy and practice.

I just was reminded of this when the previous poster discussed different types of NP's and certainly, yes, there likely is a difference.

[SiennaGreen]

Just curious here. I'm avoiding studying.

What kind of surgery did he have? Something that involved his member? Why was he afraid it would fall off?

[PostOpPrincess, BSN, RN]

you obviously work in acute care and wish to pursue an advanced np career in an acute care setting. this is a specialty. i doubt the person who works in the women's clinic cares if her job would bore you. why would she? acute care is not the ultimate arena for advanced practice nurses (you do not, for example, get the best of primary care in a high acuity area). but your opinions regarding education vs. experience in an advanced role are clearly directed at this specialty. your argument would make more sense if you clarified this more often, and if you wouldn't espouse your opinions in every conversation about fast track nps (since many people aren't talking about acute care and want nothing to do with it).

acute care is where many of these nps try to end up. we are in a committee meeting now and reviewing the credentialing of these new arnps and gathering evidence on their pros and cons for our specific areas.

i was reading earlier about someone going into a neonatal practitioner role without nicu experience.

wow; that's unbelievable. i have nicu experience, and i wouldn't even think that would qualify me--not even the 3 years i was in level 3.

all the nursing students that i've been orienting with to the hospital has been incredible in their resolve that they won't be around long because they want to go for their arnps and crnas.

wow and i mean wow.

so now the op wants to go "directly" to nursing without the experience and compares it to an engineering degree.

seriously?

these are people.

this career isn't just so someone can be a diagnostician or someone can get paid well.

this is about lives.

these are people.

they have kids.

they are someone's child.

they are someone's mother.

they are someone's daughter/son/uncle/father/friend/neighbor/sister/brother.....

how come in all of this--it never comes across that this is what it is about??????

i know for a fact, having been a nurse for a long time, there were times that i don't know why i do what i do. but i wouldn't even think for a second that what i did wasn't important--enough for my advanced practice that i know would eventually help. and i mean truly help--acute care or not.

this profession is a people profession and no comparisons to engineering should even be brought up.

[PostOpPrincess, BSN, RN]

Just curious here. I'm avoiding studying.

What kind of surgery did he have? Something that involved his member? Why was he afraid it would fall off?

He was a lap appy.

Why? Because 10 people tried to put in a foley.

TEN.

Yes, if you are 19--that is YOUR BIGGEST FEAR.

No one went to the basic.

I told him to chill out...gave Ativan IV....he started peeing...2 hours later he was having his dinner and getting ready to go home.

What got me was the 16 hours of no peeing....

What the heck did everyone miss here?????????

[misplaced1]

Not sure why you think I am not in school yet but I have been through school and came out the other side successfully. I have as many years in the medical field as you do but I am a new nurse. My background is very different from anyone else I have met that was a nurse and where I want to end up is probably a little different because of that. I think this is a great profession as far as what the job is and it is also an interesting job. But, I still say nurses shoot themselves in the foot and are so competitive with each other, it is not good for "the team". I worked in other areas before and never in my life seen people try to drag each other down so hard - like crabs in a barrel. I am sorry to say I have also never seen so many people bragging about their years of experience and how anyone without a thousand years of experience is not able to do their job or that

In most other professions people brag about their accomplishments not their time in. They also dont need to list every single degree or certification they ever earned on their badge, or letter heading or whatever. I think this comes from nurses being unappreciated and feeling like they have to prove something all the time. Which is also probably the reason for the excessive bragging.

Honestly it does not matter what I say because the writing is on the wall. There already are direct entry programs and more will follow. I by the way did not graduate from one. The profession will be elevated regardless of whether everyone wants that or not. It has to be, its the only way the hospital is going to be able to bill all these extensive nursing services they are offering and are going to continue to offer.

I dont know why I get involved in these discussions. I guess sometimes I start thinking that this profession will start coming together and support each other. So far I dont see it happening. Perhaps there is hope that APNs will decide to work together instead of trying to pull each other back into the basket.

As far as putting in lines etc etc. No NP I work with is putting in lines etc etc. Not everyone is in acute care.

As an aside, when I had a serious chronic health problem I made the round of doctors for years and YEARS, highly educated, very experienced, heads of departments etc etc. In the end a chiropractor that was treating me for an injury diagnosed one of my illnesses, that is he kindly told me off the books what he thought was wrong with me. After reading up on it, I then went to my primary doctor (with years of experience) and told him what I thought I had which he confirmed through blood tests. I improved but was still ill. Eventually a friend of a friend called and told me she had had similar symptoms to the ones I still had. I went to a specialist who confirmed that she was correct.

So much for experience being the end all for diagnosis and treatment. And as a long term patient I HAVE been there. For diagnosis I definitely would like some experience but mostly I want THE SMARTEST PERSON IN THE ROOM. Cause that is what the chiropractor I saw was.