GN to NP in <1yr

[OhioCCRN]

I read a recent post regarding new graduates who cannot find work jumping on the NP bandwagon.

At work the other day, a new grad co-worker (less than 5 months experience) launched into a bitter tirade against a well known school for having the gall to expect her to have 2 years experience, have been involved in EBP, Committees and to have precepted before being allowed to even apply to join their ACNP program.....

Mind you, this nurse can barely handle her assignment... what makes her think that the NP is going to be an easy way out of floor nursing.... The courses take time and dedication and contrary to popular belief, graduation and subsequent employment are not a given..

[PMFB-RN, RN]

This seems like a great opportunity to scrutinize my own following bias: namely, that outside of a few exceptional circumstances, new grade straight to aprn is discrediting the profession and undeserving future patients. Having said that, how does the practice of similarly prepared new PA's compare? (ie a fresh PA who's only healthcare experience is PA school) If said PA would not elicit similar nail-biting, then why? Would it be more a case of artificially inflated perception vs a tangibly superior preparation? On a related tangent, how common are PA's without prior healthcare experience overall?

Here in the upper Midwest the PA schools don't even suggest prior health care experience. However I am under the impression that PA students have a lot more clinical hours than NP students.

[futureeastcoastNP]

1. What a lot of you don't realize is not everyone lives in an area of the country where they can just "go work" for two years. So many people on here are criticizing people who go straight from RN to NP, but for people in oversaturated markets, they may have no choice. After looking for an RN job for 1+ year, it is unrealistic to expect people to continue to be unemployed if becoming an NP will help them find a job.

2. I do think being a bedside RN is overrated for NP. Beyond learning to deal with patients and maybe do assesments, there's little overlap. Having said that, I think NP school is lacking on clinical hours anyway, whether the student has RN experience or not, so I think residency should be required.

3. Even if you can find a job, some people just hate bedside nursing. It's certainly not easy, and if someone's ultimate goal is to be an np anyway I see no reason to delay that while dealing with 12 hour, minimal break shift work that wears down the body. I was miserable as a bedside nurse.

4. It is not schools that take inexperienced students that are hurting the profession. Many of the schools graduating the best NPs have graduate entry programs where students get their BSN and MSN in one swoop with no experience. This is at schools such as Columbia and UPenn, both known for amazing NPs. The real issue hurting the profession is for profit online schools that have no standards for admission and crank out NP degrees like candy. It is the accreditation boards, giving full accreditation to these half baked programs that do not even provide clinical instructors, that is ruining the profession.

5. I still think much of the vitriol aimed at NPs without bedside experience is from experienced nurses who think it is "unfair" they didn't pay their dues. There's a belief that a new nurse NEEDS to be miserable for a few years before moving on to greener pastures. Some of the "eat their young" style nurses are sad they didn't get a chance to berate that person for a few years first and are jealous that despite 0 bedside experience they now have no control over them. All part of the abuse culture in nursing - advancing and achieving higher degrees is not celebrated, but attacked.

[nataliethenurse, BSN, RN]

I know each program is different, but my cousin is finishing up PA school in AZ and she had veeerry minimal experience in the health field prior to starting her program. She might have shadowed someone in a clinic once or twice, otherwise she just had stellar grades. I believe she'll do fine, but I'm a little concerned that someone would get accepted just because they're a good student but has almost literally no clinical experience.

[JenTheSchoolRN, BSN, RN]

I entered a direct entry MSN program with the goal to go straight through from RN to NP. Whoa, did my perspective change! I passed the NCLEX last January and was so burnt out from nursing school, I decided to work and take my NP portion part time. 1 month later I found myself in school nursing and love it.

But I when working in the schools - on my own, sometimes the only health provider some of my kids really get a chance to see - I realized I was not ready to jump right into my NP. I wanted time to be an RN, practice and refine those skills. Do I want to become an NP down the road? Probably. Do I personally feel I will be a better NP in 2-5 years? I do, I really do. Therefore, I stepped back and will be getting my BSN issued from my program and working full-time for at least the next 2 years.

Of course, I speak only for myself. Every person is different. The year above me a couple of students were doing a research project on whether or not RN experience made an NP a better NP; their final results were pending, but I was intrigued at what the data might reveal.

[Ruby Vee, BSN]

5. I still think much of the vitriol aimed at NPs without bedside experience is from experienced nurses who think it is "unfair" they didn't pay their dues. There's a belief that a new nurse NEEDS to be miserable for a few years before moving on to greener pastures. Some of the "eat their young" style nurses are sad they didn't get a chance to berate that person for a few years first and are jealous that despite 0 bedside experience they now have no control over them. All part of the abuse culture in nursing - advancing and achieving higher degrees is not celebrated, but attacked.

What a nasty post!

As an experienced nurse who has a Master's and has no need to see anyone be miserable, I can assure you that my belief that NPs without bedside experience are vastly inferior to NPs with bedside experience has nothing to do with "unfairness", "young eating" or needing to berate anyone. Had I wanted to be an NP, I had every opportunity -- including free tuition -- to become one. I didn't wish to be an NP, and I'm not jealous of anyone who IS an NP. I'm pretty sure most of us would say the same.

As for the "abuse culture in nursing " -- I think that says far more about the person claiming abuse than it does about nursing in general or the culture of any one unit.

[Susie2310]

Lastly, there IS a demand for midlevel practitioners in healthcare today. Hey guess what? People and hospitals save ALOT of money by using NPs/PAs who can often provide the exact same service as an MD. And guess what? Even if the person has less experience or perhaps provides less quality services, well that's actually the point. That is why they are paid less than doctors.

This is a pathetic argument. Your post is all about what's good for you. Yes, it's all about money, and sadly, because it's all about money, there is a demand for midlevel providers. Patients deserve to receive quality medical care from experienced physicians. Quite often lives are at stake. My family and I, and everyone we know, want to receive quality care from physicians, not from people who are not trained as physicians and are basically clueless (which is what we have experienced). If I want cookbook medicine I have a copy of an Emergency Medicine manual on my ipod.

Here's a personal example. Family member with severe sepsis: midlevel spends an inordinate amount of time doing the work up, has to consult with the doctor multiple times, the whole thing takes forever and we are there for hours in the office. Finally the smiling idiot thrusts paperwork in my hands and says my family member needs to be admitted to hospital. How about expediting the admission? No, my critically ill family member has to be admitted through the admission office which takes a further hour or more. Now multiple hours have passed since we first presented at the Urgent Care. Then finally my family member gets a bed, and guess what, there are no orders for an hour or more. Meanwhile my family member is barely clinging to life. And sepsis requires prompt treatment. I could go on and on.

To further illustrate my first paragraph, recently my family member was very sick with what appeared to be a bad infection. On calling the specialist's office (we had been told by the doctor to come in to see him right away if we experienced any further problems), and relaying all of the above to the receptionist, the receptionist says "You can see the PA this afternoon." I said, "We don't want to see the PA; my family member has a lot of medical problems; we'll go to the Urgent Care." Suddenly the receptionist asks me to wait while she speaks to the doctor, and guess what, my family member was told to come in immediately. And yes, it turns out that after the doctor's assessment my family member needs surgery very soon. I refuse to play around with seeing midlevel providers when my family's lives are at stake.

[Dranger]

2 years experience seems a bit much to me, perhaps one year. Frankly, I think they should handle it the same as physicians fresh out off med school, meaning that they should have to work under another NP for at least a year, perhaps two.

So you are suggesting new NPs and MDs are on equal levels provider skill wise? Lol...funniest joke I have heard all day

[OCNRN63, RN]

1. What a lot of you don't realize is not everyone lives in an area of the country where they can just "go work" for two years. So many people on here are criticizing people who go straight from RN to NP, but for people in oversaturated markets, they may have no choice. After looking for an RN job for 1+ year, it is unrealistic to expect people to continue to be unemployed if becoming an NP will help them find a job.

2. I do think being a bedside RN is overrated for NP. Beyond learning to deal with patients and maybe do assesments, there's little overlap. Having said that, I think NP school is lacking on clinical hours anyway, whether the student has RN experience or not, so I think residency should be required.

3. Even if you can find a job, some people just hate bedside nursing. It's certainly not easy, and if someone's ultimate goal is to be an np anyway I see no reason to delay that while dealing with 12 hour, minimal break shift work that wears down the body. I was miserable as a bedside nurse.

4. It is not schools that take inexperienced students that are hurting the profession. Many of the schools graduating the best NPs have graduate entry programs where students get their BSN and MSN in one swoop with no experience. This is at schools such as Columbia and UPenn, both known for amazing NPs. The real issue hurting the profession is for profit online schools that have no standards for admission and crank out NP degrees like candy. It is the accreditation boards, giving full accreditation to these half baked programs that do not even provide clinical instructors, that is ruining the profession.

5. I still think much of the vitriol aimed at NPs without bedside experience is from experienced nurses who think it is "unfair" they didn't pay their dues. There's a belief that a new nurse NEEDS to be miserable for a few years before moving on to greener pastures. Some of the "eat their young" style nurses are sad they didn't get a chance to berate that person for a few years first and are jealous that despite 0 bedside experience they now have no control over them. All part of the abuse culture in nursing - advancing and achieving higher degrees is not celebrated, but attacked.

I don't think most experienced nurses feel that a prospective NP student needs to be "miserable" before becoming a NP. Neither are we "sad" we didn't get the chance to become NPs, nor does our criticism of someone with no experience going straight into NP school equate "NETY." It certainly has nothing to do with not having the chance to "abuse" that new grad. What a load of foolishness this is, and it reflects the lack of maturity necessary for one to become a NP.

[dudette10, MSN, RN]

In my opinion, lack of an NP residency program should require RN licensure and working acute care for at least three years. MDs and DOs aren't cut loose the day they earn their MD, so why should NP be any different?

[Dembitz, APRN]

This is a pathetic argument. Your post is all about what's good for you. Yes, it's all about money, and sadly, because it's all about money, there is a demand for midlevel providers. Patients deserve to receive quality medical care from experienced physicians. Quite often lives are at stake. My family and I, and everyone we know, want to receive quality care from physicians, not from people who are not trained as physicians and are basically clueless (which is what we have experienced). If I want cookbook medicine I have a copy of an Emergency Medicine manual on my ipod.

Here's a personal example. Family member with severe sepsis: midlevel spends an inordinate amount of time doing the work up, has to consult with the doctor multiple times, the whole thing takes forever and we are there for hours in the office. Finally the smiling idiot thrusts paperwork in my hands and says my family member needs to be admitted to hospital. How about expediting the admission? No, my critically ill family member has to be admitted through the admission office which takes a further hour or more. Now multiple hours have passed since we first presented at the Urgent Care. Then finally my family member gets a bed, and guess what, there are no orders for an hour or more. Meanwhile my family member is barely clinging to life. And sepsis requires prompt treatment. I could go on and on.

To further illustrate my first paragraph, recently my family member was very sick with what appeared to be a bad infection. On calling the specialist's office (we had been told by the doctor to come in to see him right away if we experienced any further problems), and relaying all of the above to the receptionist, the receptionist says "You can see the PA this afternoon." I said, "We don't want to see the PA; my family member has a lot of medical problems; we'll go to the Urgent Care." Suddenly the receptionist asks me to wait while she speaks to the doctor, and guess what, my family member was told to come in immediately. And yes, it turns out that after the doctor's assessment my family member needs surgery very soon. I refuse to play around with seeing midlevel providers when my family's lives are at stake.

And I saw a patient recently who refused to see a particular MD (one known nationally as a thought leader in his field) because previously, the MD had told the patient repeatedly that he had a strain when he in fact had a major musculoskeletal injury that required surgery. I've been an NP for one year. I saw the patient for another injury, listened and did a thorough exam, ordered appropriate imaging and got him in to see the right specialist to fix the problem. And I still think that MD is brilliant academically, just not with people.

There are good and bad apples in every field.

[Susie2310]

And I saw a patient recently who refused to see a particular MD (one known nationally as a thought leader in his field) because previously, the MD had told the patient repeatedly that he had a strain when he in fact had a major musculoskeletal injury that required surgery. I've been an NP for one year. I saw the patient for another injury, listened and did a thorough exam, ordered appropriate imaging and got him in to see the right specialist to fix the problem. And I still think that MD is brilliant academically, just not with people.

There are good and bad apples in every field.

From my earlier post on this thread:

If someone is holding themself out as a medical authority to me or my family I insist that they are trained as a medical doctor. Physician training involves first obtaining an undergraduate degree, usually in a science, then generally four years of medical school and 3-8 years residency. Nurse practitioner training at a master's degree level, according to one prominent university web site that I checked, has around 600 hours of clinical training. Obviously there is no comparison between the education and training a physician and a NP/PA receive. I have found this very large difference in education and training directly reflected on the quality of care I and my family have received, including outcomes, from a physician versus a mid-level provider. Whenever possible, which is almost all the time, my family and I only receive our medical care from physicians.

If people choose to receive their medical care from mid-level providers, that is their choice. My family and I strongly object to being forced to receive medical care from mid-level providers for the reasons I have given above.

[BostonFNP, APRN]

From my earlier post on this thread:

I have found this very large difference in education and training directly reflected on the quality of care I and my family have received, including outcomes, from a physician versus a mid-level provider. Whenever possible, which is almost all the time, my family and I only receive our medical care from physicians.

If people choose to receive their medical care from mid-level providers, that is their choice. My family and I strongly object to being forced to receive medical care from mid-level providers for the reasons I have given above.

Everyone should be afford the opportunity to see whatever provider they choose. If your family chooses to see only MDs than I have no problem with that. I am sure you would have no problem paying 20% more on your insurance premium for this if it came to that as well, though at current time it is not a concern.

I do however have a few comments:

Are you an RN? I assume so and will respond as such.

1. First I challenge you to cite a paper demonstrating that physician outcomes are any better for MDs vs NPs or PAs. I would like to know how you judge outcomes on your own family members?

2. As an RN, if you use the term "midlevel" to refer to NPs what level does that make you? This is an incorrect term and really should not continue to be used.