Nursing students who want to be NP's

Nurses General Nursing

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Anyone else notice that many of their nursing students are becoming nurses as a stepping stone to being a nurse practitioner but have little interest in being a floor nurse? I'm worried we won't have bedside nurses before long.

Specializes in ED, psych.

I mentioned before on the other thread that the percentages of entry level, brand spanking new grads applying to grad programs are pretty dang high where I'm from (my undergrad program LOVES to send out the stats). Heck, even before I graduated, they had someone from the DNP program come down to chat with our cohort, during class time, about applying "in the near future."

As a brand spanking new nurse myself, I'm confident in BOOK knowledge. This *does not* in any way translate into on the job, super awesome nursing knowledge. Nope nope no sirree. And it's going to be that way for quite some time.

Several of my former classmates, and one of my coworkers (same start date, new grad) are already applying to grad school. Good luck to them. I'm certainly not ready (but I have no plans to anyway).

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I just wonder what would you do if your Ob/Gyn introduced a first year, first rotation resident to you while you were in labor and asked your permission for him "just to be there" and the next thing you know is that this guy is actually preparing to help you in delivery. And you have no means to know if he ever saw a laboring woman in his entire life (contrary to popular opinion, there are options to avoid this experience during medical school, especially for male residents. But, if against their wishes they end up in less desirable FP residency, they are stuck with it).
Loaded question, but okay. Of course most reasonable people would allow the doctor to assist if s/he was the ONLY ONE THERE. However, most REASONABLE PEOPLE also want someone with experience and who knows what the heck they're doing taking care of them in situations like surgery, childbirth, and the like if given a choice.

Yes, there are people with no experience here who are going into NP school, and they don't like what I'm saying (or the other posters). I'm still gonna say it. Hurt feelings or not. Experience matters.

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Specializes in ICU, LTACH, Internal Medicine.
Loaded question, but okay. Of course most reasonable people would allow the doctor to assist if s/he was the ONLY ONE THERE. However, most REASONABLE PEOPLE also want someone with experience and who knows what the heck they're doing taking care of them in situations like surgery, childbirth, and the like if given a choice.

Yes, there are people with no experience here who are going into NP school, and they don't like what I'm saying (or the other posters). I'm still gonna say it. Hurt feelings or not. Experience matters.

I appreciate your responce, thnk you!

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Specializes in ICU, LTACH, Internal Medicine.

BTW:

Exploring the Factors that Influence Nurse Practitioner Role Transition

among 352 NPs, there was only one factor associated with more or less successful transition to advanced practice role, and it was structure of orientation into that advanced role. Somehow, any previous experience didn't seem to matter that much - at least for non-highly specialized practices. If they would consider CNMs or NNPs, that would be probably another story.

The truth is, the easiest way to make a real, fatal, unforgivable mistake in clinical practice is to be totally assured in oneself. This is quite a rare condition among NPs, and especially so among novice and least experienced ones. I work with some of them every day, and when I find something worthy at most to document, report and move to back burner as expected and self-evident facts of pathophysiology (new, soft, blowing 2/6 systolic murmur on patient with new anemia after GI bleed, intence skin itching with "uremic frost" on patient with ESRD and the likes), they jump off and order at least a specialty consult. That will cost money, for sure, but cover their behinds 110% should it be something else (and I realize too that one case out of 1000 it sure will be, so I'll be doing the same when my time comes).

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BTW:

Exploring the Factors that Influence Nurse Practitioner Role Transition

among 352 NPs, there was only one factor associated with more or less successful transition to advanced practice role, and it was structure of orientation into that advanced role. Somehow, any previous experience didn't seem to matter that much - at least for non-highly specialized practices. If they would consider CNMs or NNPs, that would be probably another story.

The truth is, the easiest way to make a real, fatal, unforgivable mistake in clinical practice is to be totally assured in oneself. This is quite a rare condition among NPs, and especially so among novice and least experienced ones. I work with some of them every day, and when I find something worthy at most to document, report and move to back burner as expected and self-evident facts of pathophysiology (new, soft, blowing 2/6 systolic murmur on patient with new anemia after GI bleed, intence skin itching with "uremic frost" on patient with ESRD and the likes), they jump off and order at least a specialty consult. That will cost money, for sure, but cover their behinds 110% should it be something else (and I realize too that one case out of 1000 it sure will be, so I'll be doing the same when my time comes).

Lovely. Glad you'll be practicing responsibly. Experience matters.

Edited to add: The study you reference discusses the feelings of the NPs questioned and how they felt their transition from RN to NP went. It does not address how safely they practice or how sound their clinical judgment is. How well they transition from one role to the other doesn't interest me. How safe they are at the bedside does.

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The better schools require acute care experience for admission and that really isn't debatable.

This isn't d ebatable it's just false. The top nursing schools not only do not require bedside RN experience, they also tend to have direct entry NP programs for non-nurses.And your comments about schools only being in it for the money demonstrates that you know nothing of higher education financing. Basically, tuition makes up a MINORITY of school's operating budgets.

Any of you who claim that one cannot know what one doesn't know without experience were obviously poorly educated. I know that I don't understand the theory of relativity and I didn't have to work in any profession to realize that. New nurses may tend to shy away from asking for help or afraid they will look bad if they admit to not knowing something. That doesn't mean they don't know what they don't know, it means they don't want to show what they don't know. To assume all new nurses are ignorant of they own shortcomings would mean we are all fools. If you want to wear that hat, be my guest but I know exactly what I do and do not know and it didn't take me a day on the job to figure that out.

All of you harping that nurses need bedside experience to be a competent APN are clueless. Sure some APNs who happened not to have bedside experience (or bedside experience in a different area) haven't been up to snuff out of the gates. That is anecdotal, there is no reason (other than your assumptions and prejudices) believe that is a systemic issue. There is no evidence that beside RN experience makes for a better, safer, or more competent provider. I'm not saying it might not be helpful but it can also be a hindrance. If you think I'm wrong, I challenge you to provide a shred of (real) evidence rather than some vague story of somebody you came across once and what your opinion of them was. Anecdote times two (or more) does not equal evidence.

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Specializes in Med-Surg, NICU.

Everyone and their dog seems to be going to school these days.

Not only do I have a problem with nurses with little to no bedside experience becoming NPs, I have a problem with nurses applying to specialty NP programs where their nursing experience is completely irrelevant and unhelpful. I work in both med/surg (adult) and NICU. I know many NICU nurses who have zero adult experience going to school to become FNPs. Funny thing is, the only population an FNP can't work with is the NICU population. The idea of NICU RNs becoming FNPs and caring for adults without any adult experience is frightening, much like a person with only adult experience deciding to become a NNP without any NICU experience.

I believe we should not only require bedside experience, but experience that pertains to the graduate program in mind. Psych NP- a few years in psych ward/or med-surg (where you will see a LOT of psych patients), Pediatric NP-a few years working in peds, Adult Acute Care NP-work a few years in Adult ICU or step down, CNM- a few years in L/D, NNP- a few years in NICU, FNP- a broad program that should require broad (not super-specialized) experience, such as ER nursing, med/surg and maybe even ICU. Clinic/public health nursing may also be relevant for FNP work.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

To prostudent: "clueless", "poorly educated".....

NOWHERE did I insult anyone disagreeing with me.

You don't get a free pass, insulting others' education or intelligence. That is not good debate. This issue *is*debatable or else we would not be talking here. Just because you disagree does not mean opposing points of view are not salient.

You lost the argument sinking so low.

And it *is* true, we don't know what we don't know. Overconfident nurses with no experience do not great NPs make. Sure, some can slide by, but again, they do not stack up against the NP with nursing experience.

But we are stuck in this situation either way. I just hope such NPs are smart enough to learn from the nurses around them, and take their advice when they need guidance. (unlike the NP mentioned in a prior post). That is the best any of us can hope for. I am sure some of the nurses defending this situation would. I am sure they are going into this wanting to do the right thing.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Everyone and their dog seems to be going to school these days.

Not only do I have a problem with nurses with little to no bedside experience becoming NPs, I have a problem with nurses applying to specialty NP programs where their nursing experience is completely irrelevant and unhelpful. I work in both med/surg (adult) and NICU. I know many NICU nurses who have zero adult experience going to school to become FNPs. Funny thing is, the only population an FNP can't work with is the NICU population. The idea of NICU RNs becoming FNPs and caring for adults without any adult experience is frightening, much like a person with only adult experience deciding to become a NNP without any NICU experience.

I believe we should not only require bedside experience, but experience that pertains to the graduate program in mind. Psych NP- a few years in psych ward/or med-surg (where you will see a LOT of psych patients), Pediatric NP-a few years working in peds, Adult Acute Care NP-work a few years in Adult ICU or step down, CNM- a few years in L/D, NNP- a few years in NICU, FNP- a broad program that should require broad (not super-specialized) experience, such as ER nursing, med/surg and maybe even ICU. Clinic/public health nursing may also be relevant for FNP work.

Yes, this.

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This isn't d ebatable it's just false. The top nursing schools not only do not require bedside RN experience, they also tend to have direct entry NP programs for non-nurses.And your comments about schools only being in it for the money demonstrates that you know nothing of higher education financing. Basically, tuition makes up a MINORITY of school's operating budgets.

Any of you who claim that one cannot know what one doesn't know without experience were obviously poorly educated. I know that I don't understand the theory of relativity and I didn't have to work in any profession to realize that. New nurses may tend to shy away from asking for help or afraid they will look bad if they admit to not knowing something. That doesn't mean they don't know what they don't know, it means they don't want to show what they don't know. To assume all new nurses are ignorant of they own shortcomings would mean we are all fools. If you want to wear that hat, be my guest but I know exactly what I do and do not know and it didn't take me a day on the job to figure that out.

All of you harping that nurses need bedside experience to be a competent APN are clueless. Sure some APNs who happened not to have bedside experience (or bedside experience in a different area) haven't been up to snuff out of the gates. That is anecdotal, there is no reason (other than your assumptions and prejudices) believe that is a systemic issue. There is no evidence that beside RN experience makes for a better, safer, or more competent provider. I'm not saying it might not be helpful but it can also be a hindrance. If you think I'm wrong, I challenge you to provide a shred of (real) evidence rather than some vague story of somebody you came across once and what your opinion of them was. Anecdote times two (or more) does not equal evidence.

Yes, when I was a younger nurse it really rubbed me raw to hear that I didn't know what I didn't know. I thought I knew a lot more than people gave me credit for. I have the benefit of experience now (20 years) and can reflect honestly back on those first few years, and know that those more experienced nurses were correct. It may have stung my ego, but it was indeed correct. I thankfully have the self awareness to be able to admit that now: they were right, I was wrong. I was inexperienced and it did, in fact, affect my practice. It took gaining my own experience to be able to see that, however. APRNs are supposed to be experts in their fields of practice. According to nursing theory and the concept of growing from novice to expert (Patricia Benner), a new graduate with no experience is not an expert. It is up for debate, regardless of how upsetting the opposing views may personally be to you. Patricia Benner's From Novice to Expert
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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Thank you Quazar!

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Specializes in Critical Care; Cardiac; Professional Development.
Yes, when I was a younger nurse it really rubbed me raw to hear that I didn't know what I didn't know. I thought I knew a lot more than people gave me credit for. I have the benefit of experience now (20 years) and can reflect honestly back on those first few years, and know that those more experienced nurses were correct. It may have stung my ego, but it was indeed correct. I thankfully have the self awareness to be able to admit that now: they were right, I was wrong. I was inexperienced and it did, in fact, affect my practice. It took gaining my own experience to be able to see that, however. APRNs are supposed to be experts in their fields of practice. According to nursing theory and the concept of growing from novice to expert (Patricia Benner), a new graduate with no experience is not an expert. It is up for debate, regardless of how upsetting the opposing views may personally be to you. Patricia Benner's From Novice to Expert

This.

I find it telling that a student refers to another nurse already in possession of an advanced nursing degree as "clueless" and "poorly educated" and yet claims to know everything they do not know already as well as what to do about it and basically demanding validation. My dear, you have not offered any evidence yourself while chastising others for not catering to you. I am smiling.

Best of luck in your studies and I wish you a long, safe, successful career.

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