Experience

[MoLo]

Curious -  how many years did you work as a nurse prior to NP, and how does it impact your NP practice?

[FullGlass, BSN, MSN, NP]

I did not work as an RN, just went straight through from ABSN to MSN AGPCNP.  It did not hinder my NP practice at all to not have worked as an RN.

During the primary care NP Program, the students with RN experience did no better academically or clinically.  Interestingly, in labs for learning physical exam, those with RN experience also did no better.  I was one of the top students and ended up helping others who had RN experience.

This may have been due to being in primary care.  I just don't see that working in a hospital as an RN would be of any benefit to being a primary care NP.  In one of my clinical rotations, my preceptor, a physician, said he would not hire a new grad NP who had worked as an acute care RN.  He had done that and complained that they had the hospital mindset and had difficulty adapting to an outpatient practice.

Once I started my new job, I was consistently given excellent performance reviews.  Of course, I had a lot to learn as a new primary care NP, but didn't feel my lack of RN experience hurt me in any way, and neither did my physician supervisors and mentors.  One of the NPs, who had a lot of ER RN experience, was fired because she had terrible patient interaction skills and frankly, was lazy and sloppy.  

I then switched to psych and am now a PMHNP.  I am told I am the top PMHNP in our very large outpatient psych practice.  

I think RN experience is important for an NP in acute care.

[offlabel]

This does make a lot of sense. There is a cultural mindset that must be shed when an RN enters advanced practice. I tell my DNP students the need to stop thinking like a nurse. That sounds like an insult, but it's not meant to be. No matter how excellent the clinical skill/knowledge and experience of an RN is, he or she still has to wait for the order. It is very easy to carry on as to what the right thing to do is because the consequences of something going wrong does not belong to him. Way more care goes into clinical decision making when the buck stops with the APP/physician. I think its called something like 'the courage of the non-combatant'.

[MoLo]

It has been interesting to be in the field as advanced practice RNs have come into existence. (Yes I am old). At first I thought that experienced nurses brought something to the profession that was missing otherwise, as it was a beautiful blend of nursing insight and mentality and advanced practice. But now, not so sure as I saw the inexperienced (as RNs) APRNs coming into the hospital and gaining the respect and trust of the staff. It may be the teaching that makes it work.  But it works!

[NYC Nurse]

FullGlass said:

I did not work as an RN, just went straight through from ABSN to MSN AGPCNP.  It did not hinder my NP practice at all to not have worked as an RN.

During the primary care NP Program, the students with RN experience did no better academically or clinically.  Interestingly, in labs for learning physical exam, those with RN experience also did no better.  I was one of the top students and ended up helping others who had RN experience.

This may have been due to being in primary care.  I just don't see that working in a hospital as an RN would be of any benefit to being a primary care NP.  In one of my clinical rotations, my preceptor, a physician, said he would not hire a new grad NP who had worked as an acute care RN.  He had done that and complained that they had the hospital mindset and had difficulty adapting to an outpatient practice.

Once I started my new job, I was consistently given excellent performance reviews.  Of course, I had a lot to learn as a new primary care NP, but didn't feel my lack of RN experience hurt me in any way, and neither did my physician supervisors and mentors.  One of the NPs, who had a lot of ER RN experience, was fired because she had terrible patient interaction skills and frankly, was lazy and sloppy.  

I then switched to psych and am now a PMHNP.  I am told I am the top PMHNP in our very large outpatient psych practice.  

I think RN experience is important for an NP in acute care.

Thank you for sharing this experience

[Spacklehead, MSN, NP]

I worked as an RN for about 7 years before going back to school to become a NP - mostly ER experience. I have stated this many times in the past on here - my nursing experience taught me that sixth sense, that gut feeling you get when you just know something is off that needs more investigation. ER nursing taught me the uncommon presentations for common conditions such as MI, sepsis, appendicitis, etc. When you work in the ER you develop very good listening and assessment skills in order to decide which protocol to follow before the MD or APP sees the patient. You learn what needs to be ordered to arrive at a diagnosis. Since the ER tends to be the stop for a lot of non-emergent cases anymore you learn how to treat what could have easily been handled in a PCP office. I also learned to know what I don't know, when to ask questions, and when not to just assume things.

The NP role was developed originally for nurses who were considered experts. The NP education was an expansion to build upon their years of clinical experience. To say it is a different way of thinking is just ludicrous, as I still to this day, after 15 years of NP practice rely on skills and experience that I embraced while practicing as a RN. NP practice is based upon the nursing model - there will always be things you learned as an RN on the job that you will use as a NP.

We all have our own anecdotal stories about NP students who had lots of nursing experience vs those who had no nursing experience. I tend to take them with a grain of salt.

 

 

 

 

 

 

[MoLo]

Ideally I would like to see a set number of years as an RN prior to advanced practice. A lot depends on the person, but in the big picture, I think the value is worth it.

[Nurse Ratched PMHNP]

I worked as an RN for 12 years ( 2 years ER; 10 years all Psych in various areas) before going to PMHNP school. I decided to go to school because I felt I had "mastered" all that I could with my RN. I recently graduated with my MSN, PMHNP-BC and I couldn't imagine practicing as an APRN without my valuable RN experience, in both ER and Psych. I have worked with many psychiatric NPs over the past 16 years. You can tell which ones are "wet behind the ears" from those of us who have "seen some sh*t".

Experience counts. Period.

*Just my 2 cents

[offlabel]

Nurse Ratched PMHNP said:

 You can tell which ones are "wet behind the ears" from those of us who have "seen some sh*t".

Experience counts. Period.

*Just my 2 cents

No argument. There does need to be a separation and contextualization of nursing experience translated to advanced practice, though. In anesthesia, the baseline/advanced technical knowledge, especially CC knowledge and experience is irreplaceable. Where the separation of the 6-12 year CC veteran student and the more 'green' trainee' comes is the ability to recognize that he or she is in a completely different setting and while general medical principles still apply, the way objectives and goals for how those principles are applied are very different. It's a wisdom thing, which is not having all the answers, rather it's knowing you don't. Some RN's never get that and the trend seems to be the longer you're an RN, the more confident in the 'my way or no way' you are. That doesn't go over well. 

[londonflo]

Spacklehead said:

my nursing experience taught me that sixth sense, that gut feeling you get when you just know something is off that needs more investigation. ER nursing taught me the uncommon presentations for common conditions such as MI, sepsis, appendicitis, etc. When you work in the ER you develop very good listening and assessment skills in order to decide which protocol to follow before the MD or APP sees the patient. You learn what needs to be ordered to arrive at a diagnosis. Since the ER tends to be the stop for a lot of non-emergent cases anymore you learn how to treat what could have easily been handled in a PCP office. I also learned to know what I don't know, when to ask questions, and when not to just assume things.

 

Nurse Ratched PMHNP said:

I recently graduated with my MSN, PMHNP-BC and I couldn't imagine practicing as an APRN without my valuable RN experience, in both ER and Psych. I have worked with many psychiatric NPs over the past 16 years. You can tell which ones are "wet behind the ears" from those of us who have "seen some sh*t".

Experience counts. Period.

 

Spacklehead said:

We all have our own anecdotal stories about NP students who had lots of nursing experience vs those who had no nursing experience. I tend to take them with a grain of salt.

It is the same as teaching nurses in an BSN program. One faculty member  anecdotally stated their blank handouts listing headings of Nursing Diagnosis, Goals, Interventions and Evaluation to complete after a lecture  were so highly praised by the students but actually were never mentioned in the course evaluations. She repeatedly said what she thought in her head a la a delusion that she was a great educator.  All anecdotal but I choked it down over the years. 

She moved onto a for-profit college, moved on after that at least 2 times. 

[Spacklehead, MSN, NP]

londonflo said:

 

 

It is the same as teaching nurses in an BSN program. One faculty member  anecdotally stated their blank handouts listing headings of Nursing Diagnosis, Goals, Interventions and Evaluation to complete after a lecture  were so highly praised by the students but actually were never mentioned in the course evaluations. She repeatedly said what she thought in her head a la a delusion that she was a great educator.  All anecdotal but I choked it down over the years. 

She moved onto a for-profit college, moved on after that at least 2 times. 

Yeah - once people need to throw in how great they are or toot their own horn is where they lose credibility to me. 

[Spacklehead, MSN, NP]

offlabel said:

It's a wisdom thing, which is not having all the answers, rather it's knowing you don't. Some RN's never get that and the trend seems to be the longer you're an RN, the more confident in the 'my way or no way' you are. That doesn't go over well. 
 

**That's more a personality flaw versus an experienced RN thing.