Experience

FullGlass, BSN, MSN, NP · Feb 6

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.

The OP asked for the experiences of users of this forum. That is, by definition, anecdotal. So each response here is anecdotal. Each response is the writer's lived experience. I did not feel that my lack of RN work experience negatively impacted developing NP competence. If I had worked as an RN, I likely would feel that my RN experience was helpful in developing NP competence.

The existing evidence is that:

1. Prior RN experience can be helpful to NPs if the RN experience was directly related to the NP specialty, but this is not definitive.

2. Intuitively, it makes sense that RN experience is important and useful for acute care NPs, and most acute care NP programs require RN work experience.

3. However, only 9% of US RNs work in primary care. In contrast, the vast majority of NPs work in primary care. Therefore, RN experience is not required for primary care NPs. That is the existing evidence.

I will be writing a separate post shortly about what the evidence says about whether RN experience should be required for NPs

FullGlass, BSN, MSN, NP · Feb 6

Nurse Ratched PMHNP said:

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

Your RN experience is laudable. However, my experience differs from yours. I have personally seen no difference in PMHNP competence, or general primary care NP competence, between NPs who had prior RN work experience or not. The evidence supports my position. I will be writing a post shortly on this topic, which will share the existing evidence.

Spacklehead, MSN, NP · Feb 6

FullGlass said:

The OP asked for the experiences of users of this forum. That is, by definition, anecdotal. So each response here is anecdotal. Each response is the writer's lived experience. I did not feel that my lack of RN work experience negatively impacted developing NP competence. If I had worked as an RN, I likely would feel that my RN experience was helpful in developing NP competence.

The existing evidence is that:

1. Prior RN experience can be helpful to NPs if the RN experience was directly related to the NP specialty, but this is not definitive.

2. Intuitively, it makes sense that RN experience is important and useful for acute care NPs, and most acute care NP programs require RN work experience.

3. However, only 9% of US RNs work in primary care. In contrast, the vast majority of NPs work in primary care. Therefore, RN experience is not required for primary care NPs. That is the existing evidence.

I will be writing a separate post shortly about what the evidence says about whether RN experience should be required for NPs

The difference is I shared how my RN experience was extremely beneficial to my career as an NP without being negative regarding NP's who had no RN experience. I didn't have to share those stories to make my experience sound better.

As far as being a NP in primary care and how nursing experience is related, reread what I posted regarding my ER experience. So many cases in the ER and especially urgent care facilities can be handled in a primary care office, so the nurses getting the experience in those environments are most definitely able to have it translate to their primary care NP role. What's really sad is how many cases are turfed out to urgent care or the ER because that should have been handled by a PCP office.

I worked alone as an NP in a couple of different settings where my only contact with my collaborating physician was either by phone or twice per month in person. I thank god that I had my ER nursing background to fall back upon when the more urgent, emergent and complex cases came into the clinic.

FullGlass, BSN, MSN, NP · Feb 6

Spacklehead said:

The difference is I shared how my RN experience was extremely beneficial to my career as an NP without being negative regarding NP's who had no RN experience. I didn't have to share those stories to make my experience sound better.

As far as being a NP in primary care and how nursing experience is related, reread what I posted regarding my ER experience. So many cases in the ER and especially urgent care facilities can be handled in a primary care office, so the nurses getting the experience in those environments are most definitely able to have it translate to their primary care NP role. What's really sad is how many cases are turfed out to urgent care or the ER because that should have been handled by a PCP office.

I worked alone as an NP in a couple of different settings where my only contact with my collaborating physician was either by phone or twice per month in person. I thank god that I had my ER nursing background to fall back upon when the more urgent, emergent and complex cases came into the clinic.

It is good that you found your RN work experience helpful when you became an NP. My point is that you don't know if you would have done just well as an NP w/o RN experience - perhaps you would have done just as well.

Your experiences with PCPs sending cases unnecessarily to the Urgent Care or ER is sad to hear. However, it is also anecdotal. In addition, do you know if those unnecessary referrals were all made by NPs w/o RN experience? Furthermore, not all RNs have ER experience. What if an RN worked in psych - would have they been as well prepared to handle these types of cases as you? What if their RN experience had been in aesthetics? What about other types of healthcare experience - it seems a former EMT would also bring valuable experience to bear if they became an NP. A former psychologist would bring a wealth of experience and knowledge to bear if they became a PMHNP.

I was fortunate in that my first NP job, primary care, was in an extremely remote rural location. Our clinic also provided Urgent Care, by necessity. And we also handled a lot of cases that would normally have been sent to an ER, because we had to. As a result, I got to handle those types of cases and learned how to provide a significant amount of Urgent Care and stabilize patients prior to transfer to a specialist or an ER. In bad weather, it might be impossible to transport emergent patients to the hospital. We had a very small rural hospital and also developed good working relationships with doctors and nurses there, who were always happy to have us shadow when we could. My experience highlights that one can't make sweeping generalizations about the value of different experiences for new NPs.

Spacklehead, MSN, NP · Feb 7

FullGlass said:

It is good that you found your RN work experience helpful when you became an NP. My point is that you don't know if you would have done just well as an NP w/o RN experience - perhaps you would have done just as well.

Your experiences with PCPs sending cases unnecessarily to the Urgent Care or ER is sad to hear. However, it is also anecdotal. In addition, do you know if those unnecessary referrals were all made by NPs w/o RN experience? Furthermore, not all RNs have ER experience. What if an RN worked in psych - would have they been as well prepared to handle these types of cases as you? What if their RN experience had been in aesthetics? What about other types of healthcare experience - it seems a former EMT would also bring valuable experience to bear if they became an NP. A former psychologist would bring a wealth of experience and knowledge to bear if they became a PMHNP.

I was fortunate in that my first NP job, primary care, was in an extremely remote rural location. Our clinic also provided Urgent Care, by necessity. And we also handled a lot of cases that would normally have been sent to an ER, because we had to. As a result, I got to handle those types of cases and learned how to provide a significant amount of Urgent Care and stabilize patients prior to transfer to a specialist or an ER. In bad weather, it might be impossible to transport emergent patients to the hospital. We had a very small rural hospital and also developed good working relationships with doctors and nurses there, who were always happy to have us shadow when we could. My experience highlights that one can't make sweeping generalizations about the value of different experiences for new NPs.

I don't know who is/was sending the patients to the ER from the PCP office, for I don't find it necessary to keep a tally of who sent who where be it an NP with nursing experience vs one without vs the PA, MD, or DO. It's just an observation of how it's been for several years and it's why ER nursing experience is a great primer for NP programs.

I am all for EMT's advancing their knowledge and career. I'm also pretty certain most of them go the PA vs NP route because then they don't need to become a BSN first. However as a PA student, they would need many patient contact hours before applying to school - the average being 1000+ hours (the best candidates do a lot more than the bare minimum required to have a competitive application) on top of the average of about 3000 hours+ clinical hours they get during school.

Would I have been as good of an NP if I didn't work as an RN first? I can confidently answer that question with a big "no way.” When I first step foot in the hospital as an RN student at the age of 19 I was terrified to go into my patient's room.

So, when you worked in that rural clinic were you completely alone as a new NP (no other nurses, med assistants, docs, other NP's onsite to help) or did you have at least one other staff member there with you?

FullGlass, BSN, MSN, NP · Feb 7

Spacklehead said:

Would I have been as good of an NP if I didn't work as an RN first? I can confidently answer that question with a big "no way.” When I first step foot in the hospital as an RN student at the age of 19 I was terrified to go into my patient's room.
So, when you worked in that rural clinic were you completely alone as a new NP (no other nurses, med assistants, docs, other NP's onsite to help) or did you have at least one other staff member there with you?

Couple of points:

1. My first week of my first NP job, I was sent to the most remote clinic in that system because the doctor was out sick or something. There were no other providers present. I walk in the door and see drops of blood in a trail leading to an exam room. The M.A.s were in a tizzy. Going into the exam room, a woman was lying on the exam table; a fair amount of blood everywhere. She was rancher, who had been riding her horse that morning to herd her cattle. The horse fell on some steep terrain, throwing the patient off her horse. When the patient fell, she hit her head on some rocks, as well as suffering some other scrapes and bruises. It really looked quite frightening. Upon examination, her cuts and scrapes were superficial and we cleaned and bandaged those. I did a neuro exam and there was a finding that concerned me. We sent for the ambulance to take her to the rural hospital ER for a CT scan. She suffered a concussion, no surprise, and was kept overnight for observation, but was OK, thank goodness. As this was my first week on the job, I called the CMO, who confirmed my approach. This ended up being a great story for my friends - treating a real cowgirl! LOL

2. It is certainly understandable that most 19 year olds would be intimidated at their initial exposure to direct patient care. However, that is not comparable to direct-entry (w/o RN work experience) NP students. These are generally people who have already completed a Bachelor's degree, or higher, in a non-nursing field. Most have work experience in another field as well, They are not teens. I was 53 when I started nursing school! I had been a business executive, and my responsibilities had included managing my own practice, as well as sales. Management consultants can be viewed as "business doctors" that assess an organizations health, then development treatment plans, and implement them. I also cared for my terminally ill mother prior to starting nursing school. So I brought extensive life experience, as well as directly transferable skills, to becoming an NP. While I was one of the older NP students in that cohort, most of the other direct-entry students were in their 30s or 40s.

Spacklehead, MSN, NP · Feb 7

FullGlass said:

Couple of points:

1. My first week of my first NP job, I was sent to the most remote clinic in that system because the doctor was out sick or something. There were no other providers present. I walk in the door and see drops of blood in a trail leading to an exam room. The M.A.s were in a tizzy. Going into the exam room, a woman was lying on the exam table; a fair amount of blood everywhere. She was rancher, who had been riding her horse that morning to herd her cattle. The horse fell on some steep terrain, throwing the patient off her horse. When the patient fell, she hit her head on some rocks, as well as suffering some other scrapes and bruises. It really looked quite frightening. Upon examination, her cuts and scrapes were superficial and we cleaned and bandaged those. I did a neuro exam and there was a finding that concerned me. We sent for the ambulance to take her to the rural hospital ER for a CT scan. She suffered a concussion, no surprise, and was kept overnight for observation, but was OK, thank goodness. As this was my first week on the job, I called the CMO, who confirmed my approach. This ended up being a great story for my friends - treating a real cowgirl! LOL

2. It is certainly understandable that most 19 year olds would be intimidated at their initial exposure to direct patient care. However, that is not comparable to direct-entry (w/o RN work experience) NP students. These are generally people who have already completed a Bachelor's degree, or higher, in a non-nursing field. Most have work experience in another field as well, They are not teens. I was 53 when I started nursing school! I had been a business executive, and my responsibilities had included managing my own practice, as well as sales. Management consultants can be viewed as "business doctors" that assess an organizations health, then development treatment plans, and implement them. I also cared for my terminally ill mother prior to starting nursing school. So I brought extensive life experience, as well as directly transferable skills, to becoming an NP. While I was one of the older NP students in that cohort, most of the other direct-entry students were in their 30s or 40s.

With regards to point #1, you essentially did what ER nurses who work in small, remote, community hospitals do on a daily basis, minus making the "official" diagnosis. At least you had other staff to assist.

Regarding point #2, so you are saying your previous life and work experiences (non-nursing) brought directly transferable skills to becoming a NP, but those of us with years of previous nursing experience did or do not?

Got it.

toomuchbaloney · Feb 7

Of course experience in patient assessment, patient interview or care management skills benefit newly licensed nurse practitioners. Does that experience make them a better practitioner? That depends upon the individual.

Nurses transition from acute care professional thinking and working every day. Using experience as an excuse to not hire people is weak.

Snowranger19, MSN, APRN · Feb 7

This is my opinion.. I was a Psych Nurse for about 12 years before obtaining my PMHNP...

I do believe that RN experience offers valuable experience for the PMHNP. Not only in dealing with patients but also the knowledge of medications, procedures, and processes that come with being a psychiatric nurse. I ran groups, took crisis calls, did a lot of case management, safety planning, restraints, etc. that helped and continue to help me as a NP.

In school, it was a boost up for sure. I already knew most of the psych medications, their classes, doses, and a general understanding of how they worked. It was not necessary, but it was a leg-up. I also had a general working knowledge of common side-effects, why patients don't like certain medications, etc. from working so long in the field. I have experience with seeing these things first-hand versus studying/reading about them. It doesn't make me better than the NPs without it but it does add to my practice.

I could say the same about residency. I did a PGY-1 Residency after NP school. It was extremely valuable and I learned a ton. I saw/did things that NPs don't even do... but it expanded my knowledge. Should residency be required? I am not sure. But do I feel it made me a better NP? Definitely.

TL:Dr It is my opinion that RN experience does prepare you to be a better NP but is not required or the only factor.

FullGlass, BSN, MSN, NP · Feb 7

Spacklehead said:

With regards to point #1, you essentially did what ER nurses who work in small, remote, community hospitals do on a daily basis, minus making the "official" diagnosis. At least you had other staff to assist.

Regarding point #2, so you are saying your previous life and work experiences (non-nursing) brought directly transferable skills to becoming a NP, but those of us with years of previous nursing experience did or do not?

Got it.

First, ER RNs are RNs. They do not have the practice authority to perform certain provider functions, such as detailed assessment, diagnosing, developing tx plans (including ordering labs, tests, prescribing meds, etc), and so on. An ER RN does not equal a provider. I gave a brief synopsis of what happened a few years ago and I did not remember everything. There is no reason to assume that any ER RN could have done exactly what I did. This area had a small rural hospital and it was staffed by MDs and PAs, including the ER. It was never staffed only with an RN.

I never said that previous RN experience does not provide important skills and knowledge. In fact, I complimented you on your experience. Please reread my comments. My point is that RN work experience is not necessary to become a primary care NP. Whether or not you agree with that, the schools do. While acute care NP programs usually require prior RN work experience, most primary care NP programs do not. The reason for that is that the evidence does not support RN work experience as a requirement for admission to primary care NP programs. Within the next few days, I will post an article that reviews the current evidence.

Furthermore, while ER RN experience can be helpful for an NP in Urgent Care situations, most RNs are not ER RNs!

In short, an RN is not a provider. An NP is. These are 2 completely separate jobs.

It is not my intention to denigrate previous RN experience. I greatly admire and respect RNs. RN work experience not being required for admission to primary care NP programs in no way belittles RN work experience. We need RNs. California has a desperate shortage of RNs and organizations are really trying to recruit them.

Also, it really is not fair to dedicated RNs who truly want to be RNs as their career, to have a bunch of people cycling through RN work just so they can check off a box when applying to NP school. There are a lot of RNs who have trouble finding jobs. Why increase job search competition for them? It takes months and thousands of dollars to train a new RN. Organizations don't want to do that for someone who has no intention of working as an RN for very long. In addition, churn in the RN ranks is disruptive to colleagues.

One of the reasons driving direct-entry NP programs is that in many parts of the country, there is a dire shortage of primary care providers. Direct-entry NP programs are a good way to attract college-educated individuals to the NP profession, and it allows primary care providers to be educated and trained faster. There is no evidence that this is a bad idea. Some on this forum provide their opinions and anecdotes, but that is not evidence. If you have actual evidence that direct-entry NP programs for primary care is a bad idea, then please share it.

londonflo · Feb 7

FullGlass said:

2. It is certainly understandable that most 19 year olds would be intimidated at their initial exposure to direct patient care.

Who is saying a 19 year old would be not be intimated in direct patient care, as any other nursing professional without 'on the ground' experience would be(in a place where real, practical work is done.)? Being a direct-entry with a non-nursing bachelor's who has experience in areas such as finances, banking, religious studies, biology professors does not qualify anyone to become a nursing provider with zero post BSN experience.

You have told me in the past that I am just an academic. Knowing college finances and the determination to make more tuition dollars as I do, I can tell you colleges/universities will create new programs with minimal entry standards to increase tuition $$$$ no matter where they stand as a leading institution. May be they think you will do okay as you know the education game, know how to study, how to game the system, know how to pass standardized test.

Please send those articles with context in full.

toomuchbaloney · Feb 7

FullGlass said:

First, ER RNs are RNs. They do not have the practice authority to perform certain provider functions, such as detailed assessment, diagnosing, developing tx plans (including ordering labs, tests, prescribing meds, etc), and so on. An ER RN does not equal a provider. I gave a brief synopsis of what happened a few years ago and I did not remember everything. There is no reason to assume that any ER RN could have done exactly what I did. This area had a small rural hospital and it was staffed by MDs and PAs, including the ER. It was never staffed only with an RN.

I never said that previous RN experience does not provide important skills and knowledge. In fact, I complimented you on your experience. Please reread my comments. My point is that RN work experience is not necessary to become a primary care NP. Whether or not you agree with that, the schools do. While acute care NP programs usually require prior RN work experience, most primary care NP programs do not. The reason for that is that the evidence does not support RN work experience as a requirement for admission to primary care NP programs. Within the next few days, I will post an article that reviews the current evidence.

Furthermore, while ER RN experience can be helpful for an NP in Urgent Care situations, most RNs are not ER RNs!

In short, an RN is not a provider. An NP is. These are 2 completely separate jobs.

It is not my intention to denigrate previous RN experience. I greatly admire and respect RNs. RN work experience not being required for admission to primary care NP programs in no way belittles RN work experience. We need RNs. California has a desperate shortage of RNs and organizations are really trying to recruit them.

Also, it really is not fair to dedicated RNs who truly want to be RNs as their career, to have a bunch of people cycling through RN work just so they can check off a box when applying to NP school. There are a lot of RNs who have trouble finding jobs. Why increase job search competition for them? It takes months and thousands of dollars to train a new RN. Organizations don't want to do that for someone who has no intention of working as an RN for very long. In addition, churn in the RN ranks is disruptive to colleagues.

One of the reasons driving direct-entry NP programs is that in many parts of the country, there is a dire shortage of primary care providers. Direct-entry NP programs are a good way to attract college-educated individuals to the NP profession, and it allows primary care providers to be educated and trained faster. There is no evidence that this is a bad idea. Some on this forum provide their opinions and anecdotes, but that is not evidence. If you have actual evidence that direct-entry NP programs for primary care is a bad idea, then please share it.

I don't know that our outcomes, morbidity and mortality or falling lifespans are evidence that what we have been and are doing is evidence that it's good, either.

Everything must be examined.