Experience to Enter CNM Program

suzanne4, RN · Oct 16, 2006

Your biggest issue is going to be finding a place that will hire you as a CNM without the normal years of experience in that area. Have you actually been accepted into the program?

Or hoping to go there?

Trauma Columnist · Oct 16, 2006

Hi and welcome. Any advanced practice nursing position is just that: advanced practice. They are not geared to learning the basics - they plan on you having that when you get to the school.

Would you consider at least one year in a high acuity, high volume L&D before even applying? What does the school suggest?

SebagoLaurel · Oct 17, 2006

I am getting very frustrated at the constant comments and advice to those considering advanced practice with no experience. While I do not for one minute doubt that 1 or more years of experience as an RN is a good thing, or even that they probably do have an advantage over those of us with no experience.

However, I just graduated with about 20 GM students with no experience in a Family Nurse Practitioner program. We have 100% pass rate on the exam and I believe just about 100% hiring rate after graduation. Many of us did clinicals with NP's with no RN experience (nor interest in it, nor felt anything missing).

I think the area you work in makes a difference. If planning to work in acute care or ER, probably experience as an RN in such a fast pace environment probably helps.

My only point is that more and more of us are joining the ranks with no RN experience (I had almost a year, but am SO thankful to skip any more - I think nurse managers have an obligation to treat new nurses like sh&*^, looking only for what you do wrong - heaven forbid a compliment for a rough, busy night spend successfully helping very sick patients). I am SOOO much happier working directly for a doctor - feel like I am being treated like a professional with a lot left to learn, versus a peon with no brains.

Some of my class got the NP (finished school and passed test), but are choosing to keep jobs as RN to continue getting the experience for their area, but at least dont have to worry about going back to school later.

I am sure I will be blasted for this, but I think we all need to get to the end of the journey in our own way. I just hate to see anyone motivated to move on stop and quit now. So many people find it hard to go back to school later - people get married, have kids, life happens. If you have the means and motivation to go on, go for it.

It is similar to getting your MBA. When I got mine, after several years of experience, it frustrated me to meet those who had the nerve to go for it with no work experience. How dare they! I had to work hard before I went - why shouldnt they? Well, I got over it. Yes, I brought a lot of experience to the table due to real world experience first, but you know what? Those I kept in touch with did alright. Just took a different route than I did.

Editorial Team / Admin · Oct 17, 2006

having rn experience prior to np school is, imho, a must. i've had experience with nps coming from both backgrounds, with and without rn experience prior to np school.. the ones who possess the exceptionally higher critical thinking skills are the ones with adequate rn experience. this cannot be obtained with little or no experience and certainly not something one can sharpen in an np program.

yes, you will get a wonderful education as np. but, the ones without any experience will not have that smooth transition as they "advance" their practice. and, that is the whole idea, to advance ones' practice.

for example:

as an rn, especially one seeking the np career, one will gain much knowledge on the whys and hows of medicine. as an rn seeking the np role, one should be able to logically and systematically obtain an adequate health history applicable to the disease process. if one has never done this prior to np school, one will be less than prepared for the complex nature of the disciplined physical assessment tool.

as an rn, one will obtain valuable knowledge on why certain diagnostic tests are ordered and how they apply to the disease process. how to interpret said diagnostic values and how these interpretations guide the health care provider (hcp) to tweak the treatment of the patient. this is something you learn in any np program, but believe me, prior experience in this area allows for a better understanding during the learning process while in the np program.

as an rn, one will learn how to interact with members of the healthcare team and understand the valuable role each play in the management of the patient. the rn will learn how each develop and manage treatment modalities for the patient.

as an rn, one will observe firsthand how the hcp consults and when, when referral is necessary and why; all necessary to the role of the np.

again, this is siri speaking from years of experience as an np. an np who serves as mentor for newly graduated nps coming from both backgrounds and is privy to the difficulties of each. an np who believes the difference between a good np and a great np is a systematic process: the rn living and working in the world of advanced practice.

naggytabby, BSN, RN · Oct 17, 2006

i attend a highly ranked cnm program with an excellent pass rate. the class is composed of students with and without rn experience- and historically yes, they DO find jobs. i have experience as an rn and i agree with sebagolaurel.

Trauma Columnist · Oct 17, 2006

I am a very experienced RN who went back for an APN (adult health CNS). I totally agree with Siri that having experience is what makes the difference between a good NP (or other APN) and a great NP.

Another area to consider is how it looks to the employer, especially if you are in an area where competition is fierce. I just graduated from my CNS program in May 06 in an area where APN's aren't utilized much. I interviewed at several places (both hospitals and private practices) up to 60 miles away. The reason I got the job that I did was because the doctors and office staff liked the idea that I had experience handling emergencies and could think on my feet. With that in mind, I negotiated for a higher salary ($20k more) than what was initially offered.

Without experience, I would have had nothing to negotiate with - see my point? Experience as an RN is mandatory (IMHO) in order to hit the ground running in that first APN job.

Home Health Columnist / Guide · Oct 17, 2006

advanced practice developed because practicing rn's had a thirst to learn more about nursing and healthcare and could see ways that their expertise could be used in a different way to help patients. they "kicked it up a notch" and roles of nurse practioner's, clinical nurse specialists and nurse midwives developed.

how do you really know what area of advance practice will interest you and will keep you satisfied if you not been exposed to varrious nursing postions?

so many students say " i want to be a mom-baby nurse...want to work icu...want to do oncology, but when they get that first job find out they dislike position, not what they thought etc and switch to another postion which they find satisfying. as moderator here, i see many posters wanting to skip that first step, go to the top then are frustrated and going back to school as "not what they expected".

all new grads from any educational program are novices.

having the solid knowledge of rn + experience one has moved away from beginning practioner towards expert level. there are so many situtations using critical thinking and problem solving skills one has engaged in with at least a year of practice that one can get if they've never been exposed to beginning practive. advanced practice is meant to add another layer of skills.

from benner's stages of clinical competence

stage 1: novice

beginners have had no experience of the situations in which they are expected to perform. novices are taught rules to help them perform. the rules are context-free and independent of specific cases; hence the rules tend to be applied universally. the rule-governed behavior typical of the novice is extremely limited and inflexible. as such, novices have no "life experience" in the application of rules.

stage 2: advanced beginner

advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. these components require prior experience in actual situations for recognition. principles to guide actions begin to be formulated. the principles are based on experience.

stage 3: competent

competence, typified by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware. for the competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic contemplation of the problem. the conscious, deliberate planning that is characteristic of this skill level helps achieve efficiency and organization. ... the competent person does not yet have enough experience to recognize a situation in terms of an overall picture or in terms of which aspects are most salient, most important..

stage 4: proficient

the proficient performer perceives situations as wholes rather than in terms of chopped up parts or aspects, and performance is guided by maxims. proficient nurses understand a situation as a whole because they perceive its meaning in terms of long-term goals. the proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. the proficient nurse can now recognize when the expected normal picture does not materialize...

this is why i and most mod team members here feel strongly that at least a year of nursing experience is so important before embarking on higher level practice.

suzanne4, RN · Oct 17, 2006

And if you happen to notice who is posting above, it is the Moderators and Administrators from Allnurses.com who happen to have years of experience.

We all have years of experience under our belts, many starting before you were even born, and we have seen all of the changes being made to the field. And we see quite a few that have gotten the NP title after their name and are working at the bedside as a staff nurse because they could not find a job without experience. You are free to do as you please, but we are telling you from experience.............

NNP programs are back to requiring hospital experience in the NICU, CRNA programs require a year of experience at the very least to get into a program; they know that it is needed.

Please listen to what we are trying to tell you, if we did not care, we would not be volunteering our time and mentoring new nurses. There is a reason for it and why we do what we do. And we are entitled to make our statements known as well.

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And for those of you that are so keen to become CNMs right away: How many of you have done a pelvic exam on a patient? How many of you have done breast exams? And then the idea of being legally responsible for any problems that may occur with the delivery? What do you say in a court of law when asked about your experience?

MUOStudentNurse · Oct 17, 2006

Wow! I did not know this would be such a heated topic! Thanks to everyone who replied!! I appreciate your time and thoughts!

Just to say, I am planning to work as an RN during school! That will be about 2 years of part time or as close to full time as I can handle. I know that's demanding but I can handle it:wink2:. Also, OSU does not have any requirements or recommendations for experience and I will apply in February. I know there is a chance I could not get in, in which case I will go to plan B, whatever that may be!!

I really know that experience pays off... but I guess the fear that I will always regret not going right to school is there! Keep posting if you have any thoughts and thanks again!!

babycatcher2B · Oct 19, 2006

IMO I think experience is extremely helpful in becoming an APN although I do not think it should be a hard-and-fast requirement. As far as CNMs go (and all other midwives) I have always seen them as wise, older women who have many, many years under their belts. Having been through RN school though my opinions have changed since I have met some wonderful younger CNMs with minimal experience who are very bright and have the ability to think crtically and truly believe in normal birth.

I work in a birth center and one thing I've noticed is that the CNM students who went right through to a MSN program lack clinical skills that an RN would only gain from experience like IV start skills and labor coaching skills. Working for a year before school certainly would be to your advantage.

I plan on applying to midwifery school next year. By that time I'll have had nearly 1 year experience as an RN plus 7 years as a doula along with misc. experience apprenticing with a midwife and teaching CBE. I could have applied to start this year but I really felt better about working first which has turned out to be a lot of fun!!

Best of luck to you and remember that you need to decide what's best for you and your situation.

rtoi123 · Oct 21, 2006

I am currently in a CNM/FNP program that does not require students to have any experience. I personally have almost 7 years as an RN and 2 years as a nurse tech in L&D. I would not have felt comfortable going back without any experience and I was very surprised at orientation when I realized how many students did not have any experience. I will say that my fellow students are all very smart and they for the most part are working part-time or doing the program part-time. School is hard no matter where you are in your career. I don't think I personally could be doing this without experience, however with waiting I now have a husband and small children which make my experience harder for me. You have to decide what is best for you and how you learn best. I think a new grad. does have some advantages to going back because you are fresh and not tainted by the "real world" and you are already in the school mode. I also feel that if you can get experience it can only enhance your learning. Good Luck on your decision and the most important thing is to follow your dreams and know, know, know that this is what you want to do!!

Rachel