Experience

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

Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
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 am well aware that ER nurses are not providers, no one is saying they are - but they do work off of protocols based upon a "presumed diagnosis" or presenting complaint. They have to use their in-depth assessment skills and history-taking ability to determine the best rabbit-hole to jump down and get labs and other diagnostic tests started while waiting for the patient to be seen by the provider. Do not discount the physical assessments that RN's can do. Did you not learn how to do a thorough neuro assessment in your BSN program?

Have you ever worked with an occupational health nurse? Some don't have providers at their worksite everyday yet they are supposed to assess and treat work-related injuries on their own per protocols. They base their decision-making off the history of the injury and their assessment. They then decide if the patient needs to be sent to another location or can stay on site and provided recommended treatment (per protocol). 
 

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
FullGlass said:

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.  

Many of the schools don't agree because they saw the DE NP programs as cash cows. They realize how much money students are willing to pay and used that to their advantage to be able to churn out higher numbers.

Quote

 

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

...and just like your anecdotal interview experiences on here and in previous threads where you've posted about this, my anecdotal experience is that employers LOVED the fact that I was a former ER nurse. They knew I could think on my feet, prioritize things quickly, handle myself well when the s*** hit the fan, and respond calmly and quickly if a patient presented to the clinic who should have gone to the ER instead. I just think it's absurd to hear that some employers frown upon NP's who have previous nursing experience. Sounds like they wanted a PA instead. 

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Specializes in Psychiatric and Mental Health NP (PMHNP).
Spacklehead said:

 I just think it's absurd to hear that some employers frown upon NP's who have previous nursing experience. Sounds like they wanted a PA instead. 

PAs must have about 3000 hours of healthcare experience to get into PA school

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Specializes in Psychiatric and Mental Health NP (PMHNP).
Spacklehead said:

...and just like your anecdotal interview experiences on here and in previous threads where you've posted about this, my anecdotal experience is that employers LOVED the fact that I was a former ER nurse. They knew I could think on my feet, prioritize things quickly, handle myself well when the s*** hit the fan, and respond calmly and quickly if a patient presented to the clinic who should have gone to the ER instead. I just think it's absurd to hear that some employers frown upon NP's who have previous nursing experience. Sounds like they wanted a PA instead. 

You seem rather defensive.  No one is putting down your ER RN experience.  It's great that you benefited from your ER RN experience when you became an NP.  However, that does not mean that NPs w/o ER RN experience are unprepared to be NPs.

In addition, your comments could be interpreted to mean that all future NPs must first work as ER RNs.  That would simply be impossible.

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Specializes in Psychiatric and Mental Health NP (PMHNP).
Spacklehead said:

Many of the schools don't agree because they saw the DE NP programs as cash cows. They realize how much money students are willing to pay and used that to their advantage to be able to churn out higher numbers.

Please provide evidence for this statement.  I went to Johns Hopkins.  They are not exactly desperate for applicants.  So when schools like Hopkins, Yale, UCLA, etc., decide that RN experience is not necessary for primary care NPs, I would say they know what they are talking about.  And they based it on the evidence. 

You have not provided one single shred of evidence to support that RN work experince should be required for primary care NPs.

You have, instead, made a number of allegations to muddy the waters.  For example, you complained too many non-emergencies are referred by primary care and Urgent Care to ERs, implying this was because of NPs w/o RN experience working in those locations.  But when pressed, you admit you have no idea who is wrongly referring non-emergent cases to the ER.  With regard to this, it must also be considered that given the US is now a highly litigious country, some cases will be referred to the ER for CYA purposes, and that could very well be by primary care MDs.  Or do you feel MDs aren't qualifed to work in primary care because they did not work as ER RNs?

None of this is a personal attack on you or your experience.  The evidence indicates that most primary care NPs w/o RN experience do just fine in school and on the job.  They have a steeper learning curve initially, but they do catch up.  There are also NPs w/RN experience who struggle to adapt to the NP role.

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
FullGlass said:

PAs must have about 3000 hours of healthcare experience to get into PA school

They don't necessarily need 3000, but as much as possible helps. I'm well aware of the PA process, my dd is going through it now. Alas, you missed the point of my post. 

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
FullGlass said:

Please provide evidence for this statement.  I went to Johns Hopkins.  They are not exactly desperate for applicants.  So when schools like Hopkins, Yale, UCLA, etc., decide that RN experience is not necessary for primary care NPs, I would say they know what they are talking about.  And they based it on the evidence. 

You have not provided one single shred of evidence to support that RN work experince should be required for primary care NPs.

You have, instead, made a number of allegations to muddy the waters.  For example, you complained too many non-emergencies are referred by primary care and Urgent Care to ERs, implying this was because of NPs w/o RN experience working in those locations.  But when pressed, you admit you have no idea who is wrongly referring non-emergent cases to the ER.  With regard to this, it must also be considered that given the US is now a highly litigious country, some cases will be referred to the ER for CYA purposes, and that could very well be by primary care MDs.  Or do you feel MDs aren't qualifed to work in primary care because they did not work as ER RNs?

None of this is a personal attack on you or your experience.  The evidence indicates that most primary care NPs w/o RN experience do just fine in school and on the job.  They have a steeper learning curve initially, but they do catch up.  There are also NPs w/RN experience who struggle to adapt to the NP role.

Wow, you really put a lot of words in my mouth. I never implied that NPs without RN experience were the ones specifically sending patients to the ER. That is totally on you if you took it that way. You made it a point in your OP to talk about the RNs with experience who did no better than you academically or clinically, and how your preceptor would not hire an RN with acute care experience due to their inability to adapt to an outpatient practice. You also specifically called out an ER RN who got fired from their NP role due to terrible patient interaction skills and being lazy and sloppy. I would think you could figure out that those issues were not because the nurses had experience, but because they had character flaws. 
 

MD's who work in primary care did residencies in hospitals, so I'm pretty certain they do have hospital-based acute care training under their belts - not just primary care only. As a matter of fact, I know they do as I currently work with them at a large teaching hospital. I think they are very qualified to work in primary care. Please stop grasping at straws and being obtuse by saying I insist all NP's (and PA's and primary care docs) should work as ER nurses first. I never stated that anywhere in this thread. Do I think ER experience is great to have and would only help? Yes, absolutely! But again - you are greatly misinterpreting my posts. 
 

I'm not taking anything as a personal attack - but just remember - you decided to quote my post first and then tried to educate me about the existing evidence which you keep saying you'll post on here. Keep in mind that I still have not dismissed NPs without nursing experience, I have only defended those that do have nursing experience under their belts. 
 

And now let's bring up the schooling…….congrats on graduating from JHU. My cousin attended undergrad and med school there, so very familiar with them. Great school - but I'm pretty sure my education was just as good from the local state college where RN experience was required for admission.

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

Oh, and just to add - your JHU FNP program prefers applicants with nursing experience as listed on their Web site. 
 

ETA: https://nursing.jhu.edu/programs/doctoral/MSN-DNP/DNP-family/#requirements

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Specializes in Psychiatric and Mental Health NP (PMHNP).
Spacklehead said:

Oh, and just to add - your JHU FNP program prefers applicants with nursing experience as listed on their Web site. 
 

ETA: https://nursing.jhu.edu/programs/doctoral/MSN-DNP/DNP-family/#requirements

Prefers, yes, but it is not a requirement.

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Specializes in Psychiatric and Mental Health NP (PMHNP).
Spacklehead said:

Wow, you really put a lot of words in my mouth. I never implied that NPs without RN experience were the ones specifically sending patients to the ER. That is totally on you if you took it that way. You made it a point in your OP to talk about the RNs with experience who did no better than you academically or clinically, and how your preceptor would not hire an RN with acute care experience due to their inability to adapt to an outpatient practice. You also specifically called out an ER RN who got fired from their NP role due to terrible patient interaction skills and being lazy and sloppy. I would think you could figure out that those issues were not because the nurses had experience, but because they had character flaws. 
 

MD's who work in primary care did residencies in hospitals, so I'm pretty certain they do have hospital-based acute care training under their belts - not just primary care only. As a matter of fact, I know they do as I currently work with them at a large teaching hospital. I think they are very qualified to work in primary care. Please stop grasping at straws and being obtuse by saying I insist all NP's (and PA's and primary care docs) should work as ER nurses first. I never stated that anywhere in this thread. Do I think ER experience is great to have and would only help? Yes, absolutely! But again - you are greatly misinterpreting my posts. 
 

I'm not taking anything as a personal attack - but just remember - you decided to quote my post first and then tried to educate me about the existing evidence which you keep saying you'll post on here. Keep in mind that I still have not dismissed NPs without nursing experience, I have only defended those that do have nursing experience under their belts. 
 

And now let's bring up the schooling…….congrats on graduating from JHU. My cousin attended undergrad and med school there, so very familiar with them. Great school - but I'm pretty sure my education was just as good from the local state college where RN experience was required for admission.

Thank you for the congratulations.

I never intended to attack NPs with RN experience as a group.  Just because RN experience is not necessary to become a good primary care NP; that does not devalue RN experience.

MDs do clinical rotations in pretty much all specialties while in medical school.  However, primary care MDs are expected to do their internship and residency in a primary care discipline.  Just like psychiatrists are expected to do their internship and residency in psychiatry, and so on.

I'm sure you got  a good education from your state school.  Was it just as good as Hopkins?   Who knows?  Personally, I believe the most important factor in a student getting a good education is what they put into it (assuming a decent school).  However, Hopkins is a world leader in research and they are one of the top nursing schools.  The top schools tend to set the trends in nursing education.  Those schools make major decisions carefully.

And as I have repeatedly stated, there is no actual evidence that RN work experience should be required for primary care NPs.  More research has been done on this in recent years and the conclusion has not changed.

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Specializes in oncology.
toomuchbaloney said:

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.  

For the last 100 years, anecdotal accounts drove the direction of nursing practice. Now we continue to engage with anecdotal experience and the universities flaying for tuition dollars, figure "if it is not broken, why fix it?" Oh, wait, we can enhance our enrollment because the US is crying out for more providers;  we cannot generate/educated enough MDs for our aging baby boomers.. 

New in the future of this century  (21st century) providers will find out about the birth curve and the impact on patient availability Medicare payouts, insurance payouts and so it goes.. 

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