I'm an NP student - How did you choose your specialty?

allnurses Guide · Apr 2, 2018

Well, consider it. Columbia has a well-known DE program, right? Why wouldn't we be as scrutinizing of their results as we are of studies funded by drug companies?
There's no need to sensationalize my comment with a "fake news" follow-up.

All studies can and should be critically evaluated. That is completely different from assuming a study which hasn't even been done yet is somehow biased or useless or "fake".

The_Salty_Cat · Apr 2, 2018

We need to do better for ourselves. PAs are adding on more education - see the PA doctorate at Lynchburg and the DMS at LMU - while we are lessening ours?

To those who has the belief that PAs are more trained than NPs, they are mistaken big.

PAs are trained to help physicians in doing their work, while NPs are trained to do what physicians do independently except surgical procedures.

NP programs vary in length more than PA programs as both master's and doctorate level tracks are available. The length of education/total time training for a MSN, DNP educated nurse practitioner ranges from 5 to 8 years. It is 6 to 6 1/2 years for PAs.

I'd also like to point out, NP students choose a specialty when applying for programs. PA students have clinical hours spread out over multiple specialties, whereas NP students spend their clinical hours in the field they will be working on. This allows NPs much more time to learn what it is they will be practicing once they graduate.

Trauma Columnist · Apr 3, 2018

To the OP:

Nursing is a second career for me but I've been at it for 26 years now (read: I'm old and mean). I did nephrology for 11+ years and am now in cardiology. I'm already looking for my next big thing because this job isn't that great.

Notice - I said "job" not "career", not "the epitome of my existence" or some other nonsense. Its a job - a way to pay the bills; thats it. Don't look to your job for your life's fulfillment because you won't find it there.

I went thru a very life-changing situation last year and it has made me realize exactly whats important in life and it ain't any job.

I wish you the best in your decision.

Dodongo, APRN, NP · Apr 3, 2018

That is not the scientific process. The sources of the funding should not matter if there is good scientific rigor.

OH come on. So you have no idea why disclosures are important. You've no idea why bias or conflict of interest matters?

The source of funding is very important in evaluating research. Especially when the studies are low quality to begin with. There was a thread a long while back where you posted a lot of this "research" you so often cite, and I explained quite thoroughly why all of it was heavily biased towards the null.

Look, my original point is there are 3 provider level professions. NPs have the lowest educational rigor - objectively. There is no good research showing they are better or worse than the other providers, so, in the absence of this research, do we really want to be in that position?

allnurses Guide · Apr 3, 2018

OH come on. So you have no idea why disclosures are important. You've no idea why bias or conflict of interest matters?
The source of funding is very important in evaluating research. Especially when the studies are low quality to begin with. There was a thread a long while back where you posted a lot of this "research" you so often cite, and I explained quite thoroughly why all of it was heavily biased towards the null.

There are no listed financial disclosures for any of these studies. We are not talking about disclosures rather the fact that the authors work in academia and therefore are somehow biased. The majority of research is conducted by academia. Furthermore, I have never seen anyone make a convincing argument that not requiring RN experience is somehow more financially lucrative to academic institutions.

I have no problem with critically evaluating research, it is very important. In doing so, you must be objective yourself.

So please, enlighten us, go through each of the studies I posted here and show where the obvious/heavy bias is.

And lets be totally honest here: did you have a preconceived belief that RN experience was of vital importance in NP practice prior to reading a single one of these studies (assuming you have even read them)? What was that belief based on? Direct experience as a practicing NP or via direct experience with NP education? If you had no preconceived belief prior to reading the studies, what it the "heavy bias" in "all" the studies that made you conclude the opposite?

djmatte, ADN, MSN, RN, NP · Apr 3, 2018

Furthermore, I have never seen anyone make a convincing argument that not requiring RN experience is somehow more financially lucrative to academic institutions.

How on earth would it not be more lucrative? There's no better guarantee of a steady student base than pushing someone through some accelerated RN program with the guarantee of advance education regardless of experience. The amount of student loss to the career field goes way down if they lose anyone ever. That's a lot they save on recruitment and improves their bottom line with a steady student population that will be charged more at the specific intervals studies call for.

allnurses Guide · Apr 4, 2018

How on earth would it not be more lucrative? There's no better guarantee of a steady student base than pushing someone through some accelerated RN program with the guarantee of advance education regardless of experience. The amount of student loss to the career field goes way down if they lose anyone ever. That's a lot they save on recruitment and improves their bottom line with a steady student population that will be charged more at the specific intervals studies call for.

You don't have to work in academia to understand there is a huge demand right now for NP programs. The majority of that demand is by practicing RNs not direct-entry: the largest cohort of NP graduates has 2-10 years experience.

There are also a number of difficulties with DE programs from a student loan perspective that academic programs would prefer not deal with and that don't exist for RN-MSN programs.

There are diploma-mill programs that probably do try to rope as many students in are are driving by sales numbers on rotating admissions but these are a minority and generally of poor quality.

Jules A, MSN · Apr 4, 2018

You don't have to work in academia to understand there is a huge demand right now for NP programs. The majority of that demand is by practicing RNs not direct-entry: the largest cohort of NP graduates has 2-10 years experience.
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Not re: DE but the push to remain enrolled from undergraduate through DNP by discouraging working as a RN is a significant money maker. Large, well respected brick and mortar universities have been this doing for several years now.

gaarnp · Apr 5, 2018

It is imperative that you get hands-on clinical hospital experience before going for your MSN. 3-6 months rotations do not cut if for nursing skill experience. 2 years of hospital nursing experience (nothing less than 1 year) in your potential nursing areas of study will help assist you to decide and you will get so much more out of your MSN.

I truly believe that nursing education is doing a disservice in pushing students in the BSN-MSN track without mandating 2 years of hospital experience. How can you decide what area of nursing you love if you don't have the hands-on experience? Why spend money on education not knowing for sure the area you want to be an expert in? Try the areas you are interested in for a year or two first before you get that MSN. Your money will be better spent and the education will be better retained in area that you love.

As a preceptor in Women's Health for more than 30 years, I have seen a deterioration in the students we now get. I am having to teach them nursing skills they should have received in their nursing education and clinical experience. Instead nursing education is encouraging the education over the nursing skills and the students are not at all prepared for preceptorship. Preceptorship should be the honing of the NP nursing skills that you have learned and attained, not the place to learn nursing basics. The NPs do not have time to teach general nursing skills. That is why so many NPs are having second thoughts in precepting, because the current NP students do not have the clinical skills they should have gained from hospital experience.

The fee charging of students to get preceptorships is the cause of our nursing education failing students. If they were better prepared for the preceptorship, the teaching and mentoring would be more efficient and effective and have less an impact on the clinical portion for the NP, who precepts.

You have LTC experience, but I would still advise to get the experience in the area of your nursing interest, so that the MSN can be better focused in your nursing interest area. The BSN is the generalist nurse. The MSN should focus on your nursing subject you love. The doctorate to provide an expertise in the selected field you chose as a NP. The experience you gain in between these degrees helps you formulate your course of study.

My NP path was I realized that working nights was not good for me. I wanted to be a midwife, but because of night call realized that would not be a good choice for me. So being a WH NP was my goal. I worked for a private OB/GYN and loved the teaching aspect of providing WH information and pre- and post- op teaching. He eventually offered me the opportunity to go to NP school. At that time it was a certificate program. He had me help out with GYN procedures in the office. When I went to the Women's Health NP Program at the University of Colorado, I had some awesome skills, but the didactic I learned helped me understand the process so much more and improved my ability to provide patient education. The NP program I attended had 3 instructors and we were 5 students. The learning I received was awesome. In my opinion a MSN/NP program will never match what I received in that Women's Health NP Certificate Program. We learned physical assessment on each other and live models. Then we had classes on in- and out- patient OB & GYN and after each session we had a 4 wk clinical that followed the 4 aspects of Women's Health. The preceptors watched us perform the skills we learned in our labs and supervised & provided suggestions for improvement. This was followed by a 9 month internship with the OB/GYN who put me through the program. By the time I got out I was performing ob/gyn exams and went to the physician to verify what I thought the diagnosis was and how I would treat so that I could meet the goals of the course. It was a very supportive and encouraging method of learning. It helped that I had a very supportive mentor in the OB-GYN I worked for.

My undergraduate BSN focused on learning, political activism, research, and psychology. I then worked in a Maternal-Child unit at 2 different hospitals, and a gyn oncology unit for 3 years. This background provided me with a solid background that allowed me flexibility in my NP career that included basic OB/GYN care, Drug and Device research in the area of WH; officer in our State's NP organization to get prescriptive authority, the implementation of a NP and NP protocols in a methadone treatment facility, and Public Health/Community nursing. My varied career is a testament to the excellent nursing training I received. I attribute it to the blending of my education with hospital experience in the areas of my nursing interest.

I wish you every success. Being a NP has been a very rewarding career for me. I just recently retired from Public Health nursing having managed 13 counties in a SE State as the WH Coordinator. Now I am looking forward to pursuing a nursing education career after having completed my MSN in nursing education. My focus is on NP preceptorship from the perception of NP faculty. Each job I have had has led me to another area of interest within nursing. I wish the same for you.

gaarnp · Apr 5, 2018

It's not that we are not supportive, it is that the slack of not getting that hospital experience is expensive on all involved. Does your school get your preceptor or do you have to find one? Because of the schools pushing nurses through the system a price is being paid. Your delay in getting certified because you can't find a preceptor or the charges that a preceptor will charge you because of the impact the teaching is now required of the preceptor, which in turn will impact the clinic.

On this issue the problem becomes one of competency and the excellent reputation us "old" NPs were lucky to have established so that we could get the long sought recognition that we are still fighting for. Remember, many of the NP schools that are out there are interested in their bottom line. Nursing is a desirable major for many of the for-profit schools. So the longer you are continuously in school the better their bottom line. It is very sad that knowledge and reputation is not the goal as it use to be for universities, but money talks more.

gaarnp · Apr 5, 2018

I truly like and concur with this response. Thank you.

Godsgirl73, MSN, NP · Apr 6, 2018

If you can assure us, then cite your sources. If anyone can show me data that shows, in aggregate, prior RN experience makes any significant difference in NP role socialization, I will change sides and argue for it being a requirement (and perhaps in some specialty settings it should be)! My professional experience has been different (with the caveat that clearly this could also be grossly affected by my location, practice area and the programs I have worked with) and while I have had excellent SNPs with years of RN experience and poor SNPs with no RN experience, the reverse is also true, and I have never found that prior RN experience predicted if a student would excel or fail or be average. Same is true of my experience with prior healthcare experience for medical students.
The problem with a blanket requirement for RN experience, as I see it (and aside from a total lack of evidence it would be statistically beneficial) is that the quality and type of RN experience is so variable it is difficult to assess the contribution of that experience. There is one clear place in my experience that RN experience helps novice NPs: dealing with other nurses. We can see evidence of that here on this thread in the assumption of nurses that an novice NP with any type of RN experience is better than a novice NP without any experience regardless of how talented the individual is. Can ED experience as an RN help an novice NP working in the ED? Absolutely. Does that mean is is necessary? How much of it? Does the novice NP in the ED get the same kind of help from RN experience in a different setting like a dermatology clinic?
Obviously, I can't *assure* you. There are always going to be outliers when it comes to jobs and life experience. Yes, for sure a scant few new grad nurses could be great working as NPs with no actual RN experience to back them up. But my experience working as an advanced practice nurse and/or NP in four provinces/territories and 12 different small communities tells me that nurses with little to no nursing experience attempting to do an outpost nursing or NP job failed miserably. They just didn't have the basic skills solidified enough to even grasp what the advanced skills required of them. Not only that, but they also didn't have the knowledge that comes with experience. They missed too many important signs/symptoms that more experienced nurses likely would have caught. (Although it is true that some experienced nurses simply don't have the ability to deal with advanced skills either!) Patients were harmed because of this. Are there studies to prove this? I don't know. I guess I'll have to look. But my experience, and that of all of my advanced practice nursing colleagues tells me that there is a certain baseline of knowledge and expertise expected when one is a NP. If a nurse can't take a BP, (s)he has no business trying to run a code on their own, prescribe medications that they've never seen before, or deliver a baby by themself.
Isn't the moral to that story that you were challenged and succeeded? Or are you arguing you should have been help back from that career until you had more experience?
I was challenged and I did succeed. Why? Because my first nursing position involved working in 3 very small (read: less than 10 bed + emergency department) hospitals where we encountered a little bit of everything. I had the advantage of working with trauma patients, emergency deliveries, and all kinds of different "ward" nursing by virtue of working in small hospitals. I worked with some amazing nurses there who took the time to mentor me so I really did have a fairly solid knowledge base when I started outpost nursing after only 2.5 years of nursing experience. That said, even with 2.5 years of varied experience, it would likely have boded well for me to wait a bit longer before I started outpost nursing.