Little experience as an RN

Mark Hill BSN · Nov 6, 2013

I guess I have to ask... More experienced in what? DO I AS A NURSE WHO WANTS TO WORK IN A CLINIC NEED MORE HOSPITAL EXPERIENCE?

Ok....Will only working in a clinic setting before NP school give you adequate venipuncture kills, teach you to place a catheter in both male and female patients, place an NG tube, start an IV, medication dosage calculations, how to manage the occasional MI, or cardiopulmonary arrest etc... If you believe that none of these skills will be needed in the clinic then go for it! All I have said and will continue to say is the "anyone", in my "opinion" who enters NP school with little or no hospital experience, will be doing themselves and injustice. Nursing school does not teach you to be a nurse, it only teaches you to pass the state boards. You will learn to be a nurse on the job, as in most professions. I have recently worked with RNs who had not started an IV or placed an NG tube prior to graduation. I have even met nurses who had not placed a Foley in nursing school. Not to mention having no real idea of how t interact with the patient at the bedside, communicate with doctors and other healthcare professional. Even with all of these negative points, I still believe it is feasible to thrive as an NP without hospital experience, if that person is very bright, and is capable of learning very quickly.

allnurses Guide · Nov 6, 2013

Coming from a perspective of three years working in a dual role as PCP with hospital privileges, there are ways that nursing experience can be a help for you. There are ways is can be a hindrance.

The way RN experience helps, from my experience, is not in knowing how to do tasks (IV starts, catheter placements, setting up an IV pump). I was pretty good with starting IVs and cathing coming from a onc floor nurse job. In the past three years of APN practice in both clinic and ward settings I have not once done either of these tasks and now I am far enough removed from them I would always leave it to an expert: the RN assigned to the patient. The benefit comes from staying calm under pressure, seeing disease states at different stages, understanding when a patient is about to crash, etc. if you have RN experience doing joint taps or steroid injections or I&Ds or paps etc then that may more directly translate.

If you are shooting for a ED position this might be different.

Mark Hill BSN · Nov 8, 2013

Coming from a perspective of three years working in a dual role as PCP with hospital privileges, there are ways that nursing experience can be a help for you. There are ways is can be a hindrance.
The way RN experience helps, from my experience, is not in knowing how to do tasks (IV starts, catheter placements, setting up an IV pump). I was pretty good with starting IVs and cathing coming from a onc floor nurse job. In the past three years of APN practice in both clinic and ward settings I have not once done either of these tasks and now I am far enough removed from them I would always leave it to an expert: the RN assigned to the patient. The benefit comes from staying calm under pressure, seeing disease states at different stages, understanding when a patient is about to crash, etc. if you have RN experience doing joint taps or steroid injections or I&Ds or paps etc then that may more directly translate.
If you are shooting for a ED position this might be different.

Critical thinking skills are (for the most part) not taught in nursing school, or graduate school. I would be interested to know how having extensive RN experience will "hinder" an NP in their day to day practice? My next question would be, if you had a family member who went to see an NP in the clinic who was having vague neurologic (stroke like) symptoms, or vague chest pain (MI like). Would you feel more comfortable having an NP with extensive hospital experience, or one with very little or no hospital experience? If you will look at job boards (and I have) most will say they will hire NPs with 2 years or more of experience, but some will say they will hire a new graduate NP with extensive, nursing experience. "Most" universities will not allow admission into their programs without, at least, a year of nursing experience.

Again, I reiterate my position, given all of the negatives that I believe exist, a nurse with little or no hospital experience "can" thrive in the primary care setting, but in my opinion they will be doing themselves an injustice.

allnurses Guide · Nov 8, 2013

I would be interested to know how having extensive RN experience will "hinder" an NP in their day to day practice?
My next question would be, if you had a family member who went to see an NP in the clinic who was having vague neurologic (stroke like) symptoms, or vague chest pain (MI like). Would you feel more comfortable having an NP with extensive hospital experience, or one with very little or no hospital experience?
If you will look at job boards (and I have) most will say they will hire NPs with 2 years or more of experience, but some will say they will hire a new graduate NP with extensive, nursing experience.
"Most" universities will not allow admission into their programs without, at least, a year of nursing experience.
Again, I reiterate my position, given all of the negatives that I believe exist, a nurse with little or no hospital experience "can" thrive in the primary care setting, but in my opinion they will be doing themselves an injustice.

1. Role confusion. It's in the literature. Check it out.

2. I would want the NP with the best clinical preparation at the graduate level.

3. I am sure you have read what the "job boards" say. I have not only actually been through the job search process I am involves in hiring NPs for both the clinic and hospital. We hire the candidate with the best clinical reference, we don't even look at prior experience unless that's how they have the reference.

4. Most traditional NP programs won't. That doesn't mean it's based on evidence. Ask them why they won't....

Mark Hill BSN · Nov 8, 2013

1. Role confusion. It's in the literature. Check it out.
2. I would want the NP with the best clinical preparation at the graduate level.
3. I am sure you have read what the "job boards" say. I have not only actually been through the job search process I am involves in hiring NPs for both the clinic and hospital. We hire the candidate with the best clinical reference, we don't even look at prior experience unless that's how they have the reference.
4. Most traditional NP programs won't. That doesn't mean it's based on evidence. Ask them why they won't....

For every anecdotal response you give I can give another, and the realities of the discussion will not change. You believe that (essentially) a new graduate, can enter NP school, graduate, start practicing and function just as well as a seasoned ER/ICU nurse, and I do not. The only literature that can be found is qualitative, self evaluation studies, that are admittedly flawed. You say that having experience will cause the nurse to have "role confusion"....? I was expecting a long list of negatives that would certainly discourage any veteran nurses from pursuing a career as an NP because of all the horrible things they might do wrong as a result of all their experience.

I will say that an NP with no hospital experience may be able to function in the primary care setting, but in the acute care setting they will not be prepared at all...which is an entirely different argument all together.

BlueDevil,DNP, DNP, RN · Nov 9, 2013

I spent 20 years in Critical Care, ED, and Life Flight at Duke. It was worthless insofar as being a NP goes, I don't feel it had any significant impact outside of knowing my way around the units and the campus while everyone else looked lost. It meant I got to the destination 10 minutes faster!

Being a Nurse and being a Provider have zilch in common, which some Nurses don't internalize until they are Providers. I do not feel my nursing experience gave my any advantage in NP school after the first week, lol, and it sure doesn't give me any advantage in practice.

Someone asked how one would choose a provider, experience or training: my answer is training each and every time. Nursing experience would be absolutely meaningless in my opinion. Having changed a million and one bedpans is not going to help them with the differential and treatent plan. I want the one that went to the best school. Now, years of provider experience is valuable, of course. but plain old Nursing experience like mine before NP school? pshaw. I may as well have been selling used cars for all the good it does my patients.

Trauma Columnist · Nov 9, 2013

Interesting reading everyone's perspective.

Personally I thought my 14 yrs as a nurse helped tremendously as a provider.

Bluedevil DNP may I ask how long you've been an NP? Thanks

BlueDevil,DNP, DNP, RN · Nov 10, 2013

6 years next month, still a newbie.

Mark Hill BSN · Nov 10, 2013

While working in a small 17 bed ER 2 years ago, I had the misfortune of working with 2 providers who had no previous clinical experience. they were both "deer lost in headlights". They would constantly coming to me and other veteran nurses asking what they should do. One of these, was a 23 year old lady who took the direct rout, going strait into NP school right out of nursing school. I was a running joke in the ER about how unprepared she was to function in the fast-track, not to mention when she had to come out and work in the main ER. The other provider was a PA, and although he was lost at first too, he learned very quickly, and became pretty effective by the time I left that position. This was compounded by the fact that NONE of the veteran nurses had any respect for them. I just don't buy this idea that bedside experience doesn't help you as an NP. I cant imagine a loved on being taken care of in ER/ICU/clinic ect. by an NP 2 months out of NP school with little or no real world experience.

allnurses Guide · Nov 10, 2013

I always ask the nurses what they think. It's not because I don't know what to do.

BlueDevil,DNP, DNP, RN · Nov 10, 2013

Mark, that story speaks more poorly of the nursing staff than it does of the NP and PA you speak of, although I doubt that is what you intended. What shameful, adolescent behavior. I'm embarrassed to be a nurse when I read anecdotes like that.

Mark Hill BSN · Nov 11, 2013

Mark, that story speaks more poorly of the nursing staff than it does of the NP and PA you speak of, although I doubt that is what you intended. What shameful, adolescent behavior. I'm embarrassed to be a nurse when I read anecdotes like that.

Regardless of how you feel, this scenario plays out all of the time. It is one of the unintended consequences of NPs coming out of school with little or no real world experience, then giving orders to expert nurses who, in many cases, have worked in trauma ERs, and ICU for 20 and 30 years. Often these nurses are old battle axes anyway, very jaded, aggressive, opinionated, but also very good at what they do. It can be a nightmare for the inexperienced provider. Regardless of your opinion of this situation, it is not likely to change. My intent was not to make the new PA or NP look bad, but to simply give a perspective on a situation that I personally witnessed. It was obvious that these new providers were not prepared for the rigors of that position, and I feel that they would have been more prepared having had experience. Ultimately, this argument will continue for many years to come, and regardless of the studies done there will always be those of us who will believe that more experience is better, as with most things in life. Now, I will say that experience is probably less important in the primary care setting, but I still don't see how it can hurt.