Little experience as an RN

[trein]

Is it feasible to get a job as a FNP in an office/ clinic setting with only one year hospital experience? I worked in medsurg for a year and hated it. Now I am going to work in a cardiology office. I want to get my FNP but refuse to work in the hospital. Is this possible?

[BostonFNP, APRN]

I think is feasible but you are doing your self an injustice by not having more experience as an RN before entering NP school. I am graduating from NP school in few months. One of my preceptors (an MD for 40 years) told me that he can tell the difference in an experienced NP student, and an inexperienced NP student in the first 5 minutes of practicum. He said there are simply a lot of learned nuances about medicine, that only experience can teach. I have also worked with NPs that had very little previous experience, and those who had a lot, and there is no comparison in knowledge, and confidence. I'm not saying you won't be able to function and do well, but you will be at a disadvantage initially. I can also tell you, that you shouldn't let people know that you don't have much experience when you get out and start practicing, because there are a lot of old (20 years under their belts) battle axes who will not let you forget it.[/quote']

So your sample size of two and your clinical time as a student have demonstrated to you that novice NPs with little-to-no RN experience are disadvantaged? Have you read the studies in the topic?

[TashaLPN2006RN2012, ASN, RN]

I think is feasible, but you are doing your self an injustice by not having more experience as an RN before entering NP school. I am graduating from NP school in few months. One of my preceptors (an MD for 40 years) told me that he can tell the difference in an experienced NP student, and an inexperienced NP student in the first 5 minutes of practicum. He said there are simply a lot of learned nuances about medicine, that only experience can teach. I have also worked with NPs that had very little previous experience, and those who had a lot, and there is no comparison in knowledge, and confidence. I'm not saying you won't be able to function and do well, but you will be at a disadvantage initially. I can also tell you, that you shouldn't let people know that you don't have much experience when you get out and start practicing, because there are a lot of old (20 years under their belts) battle axes who will not let you forget it.

I'm a bit curious about this and wonder (though have not looked for any) what research has been done on this?

As far as the "medical nuances" are you certain he wasn't just referring to being comfortable talking to patients/being around patients?

I am in the application process and awaiting word of acceptance for FNP school. I was a CNA from age 17 to 23, then an LPN from 23-29, then an AAS RN 29-31, and am finishing my BSN at age 32...i have not worked as an LPN or RN in hospital setting at all. I've done skilled LTC, rehab, home health, family practice, neuro/tbi specialty clinic, derm clinic, and podiatry clinic (BTW hubby was army so we moved so many times over 10yrs it makes my head spin LOL- hence the long "job" list), and now case management so where would that put me? Experienced or Non-Experienced?

I too was worried that without working in a hospital setting I may be disadvantaged, but after speaking with several NP's I know, they told me that the only thing I might have difficulty with will be pharm because i haven't dealt with all those medications in a long time, everything else will be taught within the program guidelines. Two NPs I know personally did their BSN then straight into NP with no experience (other than their clinicals for school) and I completely trust their judgement and care of my children, so it's sort of hard to generalized that little hospital experience makes it "harder" for someone to be successful at NP school and/or after don't you think?

[myelin]

I'm a bit curious about this and wonder (though have not looked for any) what research has been done on this?

One research study has been done. It found that RN experience did not contribute to NP competence, as measured by MDs and NPs themselves. Everything else is anecdote.

[TashaLPN2006RN2012, ASN, RN]

Thanks, I love reading research on things =) I'll have to take some time to look that up and read it!

[BostonFNP, APRN]

One research study has been done. It found that RN experience did not contribute to NP competence as measured by MDs and NPs themselves. Everything else is anecdote.[/quote']

There are actually several studies, but the Rich 2004 study you mention is one of the better ones.

[myelin]

Interesting. I'd love to read the other studies, if you have the authors available.

[Mark Hill BSN]

So your sample size of two and your clinical time as a student have demonstrated to you that novice NPs with little-to-no RN experience are disadvantaged? Have you read the studies in the topic?

If you had read my statement, you would have seen that I said "I think" (which would imply my opinion...duh) that it would be feasible. Now, I would also "think" that in my 23 years as an ER/ICU nurse I might have learned a thing or two about the importance of practical bedside experience, especially since I have worked with numerous NPs over the years, both with and without extensive experience. In my "opinion" there is a significant difference in the experienced versus the inexperienced. No matter how condescending you attempt to be in your statement, I wont change my opinion on the subject. Even if you cite some anecdotal evidence to the contrary, I know what I have seen in my own practice. So stow your attitude sailor, and save it up for someone who might care, or at least for someone who might be intimidated by it.

[Mark Hill BSN]

I'm a bit curious about this and wonder (though have not looked for any) what research has been done on this?

As far as the "medical nuances" are you certain he wasn't just referring to being comfortable talking to patients/being around patients?

I am in the application process and awaiting word of acceptance for FNP school. I was a CNA from age 17 to 23, then an LPN from 23-29, then an AAS RN 29-31, and am finishing my BSN at age 32...i have not worked as an LPN or RN in hospital setting at all. I've done skilled LTC, rehab, home health, family practice, neuro/tbi specialty clinic, derm clinic, and podiatry clinic (BTW hubby was army so we moved so many times over 10yrs it makes my head spin LOL- hence the long "job" list), and now case management so where would that put me? Experienced or Non-Experienced?

I too was worried that without working in a hospital setting I may be disadvantaged, but after speaking with several NP's I know, they told me that the only thing I might have difficulty with will be pharm because i haven't dealt with all those medications in a long time, everything else will be taught within the program guidelines. Two NPs I know personally did their BSN then straight into NP with no experience (other than their clinicals for school) and I completely trust their judgement and care of my children, so it's sort of hard to generalized that little hospital experience makes it "harder" for someone to be successful at NP school and/or after don't you think?

I'm not sure that hospital experience is any more important than experience in general. It looks to me that you have a significant amount of experience on different levels. The MD did not expound on the word "nuances" so I really cant comment on that. What I gleaned from our conversation on the subject was that he felt, as I do, that "experienced" nurses have a distinct advantage in general when it comes to practicing as an NP. This advantage will, of course, lose its potency as time goes by, in which I feel most studious and intelligent nurses will make up the "stagger" quickly.

[BostonFNP, APRN]

If you had read my statement you would have seen that I said "I think" (which would imply my opinion...duh) that it would be feasible. Now, I would also "think" that in my 23 years as an ER/ICU nurse I might have learned a thing or two about the importance of practical bedside experience, especially since I have worked with numerous NPs over the years, both with and without extensive experience. In my "opinion" there is a significant difference in the experienced versus the inexperienced. No matter how condescending you attempt to be in your statement, I wont change my opinion on the subject. Even if you cite some anecdotal evidence to the contrary, I know what I have seen in my own practice. So stow your attitude sailor, and save it up for someone who might care, or at least for someone who might be intimidated by it.[/quote']

What exactly was condescending? Is challenging you considered condescending ? Be prepared to be challenged frequently in advanced practice. And have some rationale for your defense. Obviously you are very defensive about this, but instead of fuming and calling me "sailor" you could think about the actual content of the post.

Part of making the transition into advanced practice is learning to make decisions based on evidence.

If you read the literature, you would see that there has been no quantitative data and limited qualitative data that supports the notion that RN experience plays a significant role in novice NP role socialization.

I have no doubt your 25 years of ED and unit experience will help you along the way. I also have no doubt it will lead you astray along the way. Overconfidence in advanced practice is dangerous. Soon you will step out into advanced practice and you may change your mind about me being a "sailor" with an "attitude".

[Mark Hill BSN]

There are actually several studies, but the Rich 2004 study you mention is one of the better ones.

When you can cite several hundred, or even dozens of quantitative, and qualitative studies, then you can bore us with your claims. Until then, you are simply demonstrating anecdotal evidence at best, and an attempt to justify the extreme responsibility of providing healthcare for the public with little or no practical nursing experience, which is not only bad advice, it can be dangerous I some cases....and yes I have seen those situations as well. I'm not suggesting that there may not be some very bright, accomplished nurses out there who can pull it off, but the majority wont be able to, and shouldn't even try.

[TashaLPN2006RN2012, ASN, RN]

I can see where someone who had no experience as far as patient care would be a bit off at first I suppose. I was even nervous as a brand new CNA, however, excelled as a brand new LPN and then RN because of my past patient care to draw from. I guess one can't really put a number to the amount of experience one should have, but it would make the transition easier if you have some past to pull from.

[BostonFNP, APRN]

When you can cite several hundred or even dozens of quantitative, and qualitative studies, then you can bore us with your claims. [/quote']

Several hundred quantitative studies is what it would take to supersede your experience?

That pretty much rules out about every hot-topic issue in the past decade, as I can't think of any topic that has hundreds of relative studies in the course of 10 years.