Published Jun 22, 2017
4 members have participated
nurse4life4ever
20 Posts
I'd like to work in urgent care as an NP. However, I have no acute care RN experience. Finished my FNP. Shall I pursue ENP program?
Anyone in ENP program can shed some lights please? Do you think it's worth the investment if all I want to do is urgent care/fast track ER only?
Thanks!
~Mi Vida Loca~RN, ASN, RN
5,259 Posts
I thought acute nursing experience was required to do NP programs, is that no longer the case? That's crazy if it's not the case. So you have never worked as a nurse only in school? Never in an ER either?
Honestly this is a bad idea if you have no ER experience. I have never heard of a ENP program, I am gonna guess it's a specialty training for NP's that want Emergency training?? I have heard of ACNP but I know things vary region to region and school to school. If this is more specialized training ER specific and you have no nursing experience, than absolutely it's worth the investment.
Thank you!
Guest374845
207 Posts
Our ED group hires FNPs for fast track with experience ranging from med/surg to ICU to ED. Some of our own have gone on to work at urgent cares. I've known career med/surg nurses who got multiple urgent care offers right out of school. If you have your FNP, just go right ahead and apply. You'll either get offers you weren't expecting or you'll know whether more experience is worth pursuing.
Something to consider, even if it's "only" urgent care and fast track you plan on doing, that's the thing, you have to be able to differentiate between the two and that's where experience comes into play. You surely can't expect patients to know. Example, middle age woman comes in with some neck and jaw pain, you look her over and think maybe she pulled a muscle, or how weird her teeth are hurting on one side out of the blue with no obvious reason. She should see a dentist or lets give her some motrin. Maybe we will x-ray her arm and shoulder.
Experience will tell you to do an EKG. that woman present with bizarre MI symptoms sometimes. Men can too, but you will learn that a good amount of people that truly need to go to the ER go to urgent care and a lot of people that can go to UC go to the ER. You have to be able to pick up on the sick from not sick and that comes from experience and specialized training.
I and others here can list hundreds of examples of the woman above. So my post is no knock on you, but anyone that would allow a nurse to be a nurse practioner without any acute care experience is an idiot IMO. Any Urgent care or ER (even to fill the fast track roll) that would hire a FNP without any acute care experience is an idiot as well. If they aren't going to require any experience than they dang sure better be requiring specialized training,. I would also make sure your malpractice insurance is on point.
Again, not a knock on you. You don't know what you don't know.
I appreciate your feedbacks. The only reason I was wondering because I was thinking of applying to ENP program but some NP's and MD's advise that I should start working in urgent care first and get the experience before going back to school. Also, there are NP's I know who have no acute care RN experience or even any non-acute RN experience at all who have been working as NP in urgent care/internal medicine (kinda similar to PA). Therefore, I thought I should ask some questions before committing to another year of ENP.
I get what you're saying: sometimes we have patients showing no tachy, swollen legs, coughing, etc. and end up having PE. And, sometimes pt going to urgent care ending up having a hemorrhagic stroke. It's scary. I think I need more training.
I appreciate your feedbacks. The only reason I was wondering because I was thinking of applying to ENP program but some NP's and MD's advise that I should start working in urgent care first and get the experience before going back to school. Also, there are NP's I know who have no acute care RN experience or even any non-acute RN experience at all who have been working as NP in urgent care/internal medicine (kinda similar to PA). Therefore, I thought I should ask some questions before committing to another year of ENP. I get what you're saying: sometimes we have patients showing no tachy, swollen legs, coughing, etc. and end up having PE. And, sometimes pt going to urgent care ending up having a hemorrhagic stroke. It's scary. I think I need more training. Thanks!
That is scary, it speaks a lot of the integrity of the company that would do that.
If it were me I would not go get a job in UC. But go get a job in the ER for 2 years as a nurse, then go back to school. PA's usually have a lot more clinical training than a FNP. (in my experience) a lot more and would be more comparative to a ACNP education.
But you need the ER experience more than the urgent care experience if you're going to plan on working at the provider level. IMO.
JKL33
6,952 Posts
If it were me I would not go get a job in UC. But go get a job in the ER for 2 years as a nurse, then go back to school.
As a bare minimum, that's what I was thinking while reading this..."this person needs ED RN experience."
Another angle to all of this - I'm not sure why people are ever enthusiastic about obtaining advanced positions in nursing for which they are not well-qualified in a way that would put them on solid footing as they do the work they've been hired to do. Aside from the safety factors, there's also the issue of it not being a secret that nurses with no working experience are not well qualified for the kind of position you describe: I think it's a set-up for being taken advantage of, being asked to do things that are fraudulent, illegal, or very unwise, as well as a set-up for being second-guessed and critiqued (probably rightfully) by anyone and everyone, and just generally poor treatment.
I agree that there is no denying that RN experience in acute care is helpful. However, to say PA is more worthwhile than an NP with no acute care experience is something to be reconsidered. To say that an NP doesn't know that typical symptoms of chest pain (jaw pain & arm pain) not to mention the atypical of chest pain in women (epigastric discomfort, etc.) is really undermining the Np education. Even tho you learned it as ED RN in real life clinical as RN , we as NP student learned it in our NP clinicals and education. I had jaw pain patient, I don't just came in empty-handed with X-ray in my head, I have a list of differentials in my head right at the door after reviewing the chart or chief complaints.i talk to patients/family to tease out the the excluding and inclusive factors to guide my differential list and to narrow down on my diagnoses list. Then I use physical exam to further confirm my differentials. Then I order tests, if any, as needed to further support my working diagnoses. Then based on the symptoms and the clinical pictures, I provide the treatments. Of course, I have my basics. For any suspected outliers, I confer to my preceptor and have my mentor guide me more. I also judge he clinical pictures based on risk factors and calculated risk factors to come to conclusion. even tho PA has more clinical hrs as PA, NP student had RN clinical experience too on top of their NP experience. NP don't just jump in empty handed and blindly order tests without considering and putting all pieces of symptoms to have a clinical picture. Just thogut to do NP education some justice before disregarding the entire NP education. I do not disagree that RN experience in ED or other acutecare setting won't help. I'm just stating that to give Np education some credits before being disregarded as totally useless compared with PA. Thank you!
also, I'm saying that I do not have acute care RN experience but I'm not saying that I don't have any rN experience. It's just not acute. This is just to clarify because it was stated in previous post '' working experience', I feel lacking of acute care RN experience but I have RN experience in other non-acute care. This is similar for a few other NP student. Of course, because of the lack of acute care RN experience, I don't do acute care NP, only outpatient NP (FNP) and wanted the ENP to supplement my experience but I may do PA instead.
I guess it makes more sense when one actually. Does NP with good instructors, preceptors and effort. Of course, due to my inexperience, I can't be an independent provider yet like other NP with lots of RN acute care experience, I would need to have a lot of guidance and training before I come to that level. Still I feel the need to speak for TheNP education on he nurses forum.
Lunah, MSN, RN
14 Articles; 13,773 Posts
What kind of nursing experience do you have, and how much? Just curious. Most of NPs I have worked with in the ED were FNPs with ED/ICU backgrounds.
I agree that there is no denying that RN experience in acute care is helpful. However, to say PA is more worthwhile than an NP with no acute care experience is something to be reconsidered. To say that an NP doesn't know that typical symptoms of chest pain (jaw pain & arm pain) not to mention the atypical of chest pain in women (epigastric discomfort, etc.) is really undermining the Np education. Even tho you learned it as ED RN in real life clinical as RN , we as NP student learned it in our NP clinicals and education. I had jaw pain patient, I don't just came in empty-handed with X-ray in my head, I have a list of differentials in my head right at the door after reviewing the chart or chief complaints.i talk to patients/family to tease out the the excluding and inclusive factors to guide my differential list and to narrow down on my diagnoses list. Then I use physical exam to further confirm my differentials. Then I order tests, if any, as needed to further support my working diagnoses. Then based on the symptoms and the clinical pictures, I provide the treatments. Of course, I have my basics. For any suspected outliers, I confer to my preceptor and have my mentor guide me more. I also judge he clinical pictures based on risk factors and calculated risk factors to come to conclusion. even tho PA has more clinical hrs as PA, NP student had RN clinical experience too on top of their NP experience. NP don't just jump in empty handed and blindly order tests without considering and putting all pieces of symptoms to have a clinical picture. Just thogut to do NP education some justice before disregarding the entire NP education. I do not disagree that RN experience in ED or other acutecare setting won't help. I'm just stating that to give Np education some credits before being disregarded as totally useless compared with PA. Thank you!also, I'm saying that I do not have acute care RN experience but I'm not saying that I don't have any rN experience. It's just not acute. This is just to clarify because it was stated in previous post '' working experience', I feel lacking of acute care RN experience but I have RN experience in other non-acute care. This is similar for a few other NP student. Of course, because of the lack of acute care RN experience, I don't do acute care NP, only outpatient NP (FNP) and wanted the ENP to supplement my experience but I may do PA instead.I guess it makes more sense when one actually. Does NP with good instructors, preceptors and effort. Of course, due to my inexperience, I can't be an independent provider yet like other NP with lots of RN acute care experience, I would need to have a lot of guidance and training before I come to that level. Still I feel the need to speak for TheNP education on he nurses forum.Thanks!
Can you please show me where I stated that a PA is more worthwhile than a NP???
First of all a PA program will have a lot more acute care clinicals than a FNP is required. That is not me demeaning a NP or stating they aren't "worth while" this is a fact. In fact a lot of PA programs will require prior recent health care related work as a pre req doing patient care. Pretty standard requirement is a minimum of 1000 hours. PA's focused more on ICU and ER settings or specialty acute care settings they want those hrs to be in similar settings, maybe as a Medic or ER tech. The PA program is very comparable to the ACNP program (which is a phenomenal program and properly prepares a NP to work in Urgent cares, ER, ICU etc. but they also require a few years of experience in these areas to get into the program as well, because they see the value of experience more than anything) which would make sense since it's training NP's for acute care. In fact a lot of FNP programs can be completed online with non acute care clinicals.
There is a HUGE difference between what you learn in a text book and what you actually experience in an acute care setting such as an ER. That is the point I was making and you would know this if you had acute care experience.
So if I am going to plan on working at a family practice office then my FNP education and lack of acute care experience, and only my non acute care experience may be sufficient. However, that is a completely different realm when you are talking about ER's. When you work Urgent care you don't know what you don't know. Majority of things don't present textbook. There are always varying components and you learn all this from experience. You might get along fine without the experience for a while and without the proper training, but make no mistake, you will get that atypical patient and you inexperience and lack of training could cost that patient their life.
I have worked in a couple ER's that will hire a FNP for their fast track area but ONLY if that nurse had years of ER experience prior. They would never even consider a FNP without any acute care experience or specialty training obtained after FNP. The Urgent cares primarily hire PA's for this same reason or ACNP's or FNP with years of acute care ER experience.
But hey I am sure you know what's best. You asked for opinions and I offered it and you comeback to respond as if I was putting down FNP's and stating they weren't worthwhile when compared to PA's. Which is never what I said.
What do I know though, you're the NP.
As a bare minimum, that's what I was thinking while reading this..."this person needs ED RN experience."Another angle to all of this - I'm not sure why people are ever enthusiastic about obtaining advanced positions in nursing for which they are not well-qualified in a way that would put them on solid footing as they do the work they've been hired to do. Aside from the safety factors, there's also the issue of it not being a secret that nurses with no working experience are not well qualified for the kind of position you describe: I think it's a set-up for being taken advantage of, being asked to do things that are fraudulent, illegal, or very unwise, as well as a set-up for being second-guessed and critiqued (probably rightfully) by anyone and everyone, and just generally poor treatment.
I was being generous with the 2 years, I don't think even that's enough. Also would depend on the ER setting as well.