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]

Oh I certainly hope not. I don't get how you're supposed to be an 'Advanced Practice Nurse' when you haven't even become a 'Basic Practice Nurse.' [/quote']

All NPs are RNs first. I don't know of any states that allow an APN license without an active RN license.

As far as having worked as an RN, that is quote varied. No national certifying bodies for nurse practitioners require it. No state BON require it. Many academic programs do require it.

[Mark Hill BSN]

Oh I certainly hope not.[/b']

I don't get how you're supposed to be an 'Advanced Practice Nurse' when you haven't even become a 'Basic Practice Nurse.'

Good question! Now we just need a GOOD answer.

[Yuppers21]

So discussing the merits of experience prior to entry of advanced practice for individuals is one thing, but what about the effect it has on the profession as a whole? I always thought that one of the strong points of the advanced practice nurse was the experience they bring with them as a RN? One argument I often see for CRNAs vs Anesthesia Assistants (PAs of the anesthesia world) is that nurse anesthetists use their critical care experience to improve their practice. Thats why at least 1 year is required of any CRNA program. AAs don't have that. For years political battles have been fought to bring the nurse into the advanced practice role and it seems that one of our strongest arguments is that our skills and abilities as nurses prepare us to be competent providers. Why soil that reputation just so students can start NP school sooner?

I could be wrong, please don't tear into me if you disagree. A simple "I disagree because...." will do :)

[Riburn3, BSN, MSN, APRN, NP]

So discussing the merits of experience prior to entry of advanced practice for individuals is one thing, but what about the effect it has on the profession as a whole? I always thought that one of the strong points of the advanced practice nurse was the experience they bring with them as a RN? One argument I often see for CRNAs vs Anesthesia Assistants (PAs of the anesthesia world) is that nurse anesthetists use their critical care experience to improve their practice. Thats why at least 1 year is required of any CRNA program. AAs don't have that. For years political battles have been fought to bring the nurse into the advanced practice role and it seems that one of our strongest arguments is that our skills and abilities as nurses prepare us to be competent providers. Why soil that reputation just so students can start NP school sooner?

I could be wrong, please don't tear into me if you disagree. A simple "I disagree because...." will do :)

Wow, very well said and I couldn't agree more. This RN experience is to me what allows us to have these important advanced roles in healthcare in the first place. We all can sling an anecdote about a great NP we know that started right after becoming an RN, but I doubt when the first NP programs were taking place back in the 1960's, that baby RN's with no experience were the type of nurses they had in mind.

[Mark Hill BSN]

Wow, very well said and I couldn't agree more. This RN experience is to me what allows us to have these important advanced roles in healthcare in the first place. We all can sling an anecdote about a great NP we know that started right after becoming an RN, but I doubt when the first NP programs were taking place back in the 1960's, that baby RN's with no experience were the type of nurses they had in mind.

In fact, if my memory serves me correctly, NPs were not formally prepared in the beginning, but were chosen by physicians for their "experience", and "clinical expertise", and then trained under that physician to assist in that particular practice.

[Mark Hill BSN]

I could be wrong, please don't tear into me if you disagree. A simple "I disagree because...." will do :)

Unfortunately, we have established (the hard way), that personal attacks based on alternate perspectives will be met with, nothing less than, aggressive rebuttal.

I personally don't "think" that 1 year of critical care experience is enough to prepare a nurse for CRNA school. I know from personal experience that takes several years to get an even adequate grasp of critical care. Of course, I have no evidence based research to back up my "opinion" but its is still my opinion none the less.

[Mark Hill BSN]

The Nursing Midwifery Boards definition of an Advanced Practice Nurse:

'Advanced practice nursing' (APN) is the term used to define a level of nursing practice that uses comprehensive skills, experience and knowledge in nursing care.

The basis of advanced practice is the high degree of knowledge, skill and experience applied in the nurse-patient/client relationship in order to achieve optimal outcomes through critical analysis, problem solving and accurate decision-making.

[Riburn3, BSN, MSN, APRN, NP]

In fact, if my memory serves me correctly, NPs were not formally prepared in the beginning, but were chosen by physicians for their "experience", and "clinical expertise", and then trained under that physician to assist in that particular practice.

You're exactly right. I had to write a paper on the history of the NP profession, and when the first school was started up in Colorado, admission was based soley on your experience as a nurse and physician reference.

[Yuppers21]

I personally don't "think" that 1 year of critical care experience is enough to prepare a nurse for CRNA school. I know from personal experience that takes several years to get an even adequate grasp of critical care. Of course, I have no evidence based research to back up my "opinion" but its is still my opinion none the less.

I agree, mostly because this is the sentiment i have seen shared by a number of CRNAs who are very concerned with upholding the tradition of proving the worth and expertise of the nurse anesthetist. A number of current anesthetist and anesthetist educators would like to see the minimum requirement increased to at least 2 years. At the very least the AANA feels that some critical care is essential to producing competent providers. I guess I am just surprised that the same sentiment isn't shared by more NPs.

[Riburn3, BSN, MSN, APRN, NP]

I agree, mostly because this is the sentiment i have seen shared by a number of CRNAs who are very concerned with upholding the tradition of proving the worth and expertise of the nurse anesthetist. A number of current anesthetist and anesthetist educators would like to see the minimum requirement increased to at least 2 years. At the very least the AANA feels that some critical care is essential to producing competent providers. I guess I am just surprised that the same sentiment isn't shared by more NPs.

Part of it might be that NP is a whole different ballgame. CRNA is a very specific field where critical care experience, and more importantly, hemodynamic monitoring experience is essential beforehand. Some CRNA schools even require that you have your CCRN as a minimum for admission as it proves you know a thing or two about hemodynamics. When I interviewed with TCU they required it, and even asked how many questions I got right on the exam. Although it didn't happen to me, I've had friends asked in CRNA school interviews very specific questions about hemodyanmics.

With the NP role, and especially the FNP role, the scope of practice is incredibly diverse so although experience is important, there's no real way to lock in on the type of experience you need for the role beforehand short of shadowing a physician in a family practice clinical as your job. At lease as a CRNA, before you apply you have likely done a good amount of hemodyanmic monitoring, assisted in intubation, and know a good amount the surgical and anesthesia process.

[Mark Hill BSN]

Part of it might be that NP is a whole different ballgame. CRNA is a very specific field where critical care experience, and more importantly, hemodynamic monitoring experience is essential beforehand. Some CRNA schools even require that you have your CCRN as a minimum for admission as it proves you know a thing or two about hemodynamics. When I interviewed with TCU they required it, and even asked how many questions I got right on the exam. Although it didn't happen to me, I've had friends asked in CRNA school interviews very specific questions about hemodyanmics.

With the NP role, and especially the FNP role, the scope of practice is incredibly diverse so although experience is important, there's no real way to lock in on the type of experience you need for the role beforehand short of shadowing a physician in a family practice clinical as your job. At lease as a CRNA, before you apply you have likely done a good amount of hemodyanmic monitoring, assisted in intubation, and know a good amount the surgical and anesthesia process.

I agree that the role of the family nurse practitioner is very broad, but I still believe that the more experience, and diverse experiences the nurse has can only help to enhance the clinical expertise of any NP, and for that matter any advance practice nurse. To claim categorically, that experience does not improve the nurses understanding of disease processes, and treatment options is just not telling the whole truth. W

When I got out of nursing school, I thought I was pretty smart. Despite, and maybe due to my self-assumed intelligence, it didn't take long for me to gain a solid understanding of how little I actually knew. How can that not be the same with an inexperienced NP who is stepping out into the practice arena with little or no real world "bedside" experience. It sounds a little scary and dangerous to me. However, I have not, said nor am I saying now that some people cant make it work, but it has to be a hindrance on some level, maybe not as much for the FNP (but still some), but certainly for more specialized APNs.

[Yuppers21]

Sorry, I should have explained myself better. I think critical care specifically is extremely beneficial experience to draw from for the nurse anethestist, not all advanced practice nurses. However, NP programs could still put a minimum required time in the field as a RN before allowing admittance. It could be as generic as any position in which you use your RN license, a bit more restricted such as RN work that includes direct patient care, to as specific as working in an environment directly related to the specialty desired. Acute care for the ACNP, psych care for the psych NP, pediatric care for the pediatric NP. But this kind of push should come from within the profession.