Minimum level of experience for FNP

tablefor9, RN · Feb 7, 2011

So, is a new grad as good as a clinician with 5 years experience? If not, what's the difference? I'll tell you what...the 5-10 year nurse looks at a patient, knows what he/she is looking at, and can tell you what is going to happen next, and what intervention is needed, usually right down to the last med and dosing information of the same.

Reading about a process, seeing it in clinicals a few times in a limited capacity, is a vastly different animal than seeing it week in, week out for *years*. No offense to your friend, but I know who my provider will be, and it *won't* be someone with limited bedside experience.

Devie06 · Mar 18, 2011

I'm not a nurse yet or an NP but honestly I feel that it's not always about experiece,it depends on the care provider. I have seen MDs with *years* of experience who really dont know what they are doing. And not to brag, but I bet I know more about women's health than your average MD out there. I am 23 years old and finishing my pre reqs for nursing school, but I am passionate about womens health and know all the details of the menstrual cycle, pregnancy, birth simply because I have read so much, talked to obgyns in depth, and its like a hobby to me(dork alert!)so when I go for either my CNM or WHNP I feel I could definitely help my patients. And if I am this passionate, why should I wait *years* to do what I feel I am called for?

lckrn2pa · Mar 18, 2011

I think its a good thing to have a year or 2 of nursing experience, no offense to Physician Assistants, but I think that is one benefit to patients with a NP is that they have previous nursing experience dealing with the entire patient. Also once you get into NP school, you generally work part-time or full-time somewhere as a nurse, so the 2-4 years you take to finish the NP program you automatically have extra experience under your belt.

I am all for having good quality HCE prior to any midlevel provider program. It's a growing trend in both NP and PA world of cutting short the HCE to put more providers in the office and I just wonder if we are doing a huge disservice to the patients we care for. Direct entry NP programs and PA schools dropping their HCE to 1000 hours or some have even gone to as low as 500 hours. Previous experience is the basis both of these professions were founded on and now in this world of I have to have it now, I'm not going to wait on anything kind of mentality, I fear, will lead to a diluted, ill prepared provider that may cause more harm than good.

Now to the PA vs. NP argument that really isn't an argument except in either the academic or student world. Real world NP's and PA's work together in many settings and will often collaborate with each other and the attending to come to an agreement on the best approach to caring for the patient. The idea that one is better than the other is just fodder for the academic and student masses to argue about. Can't we all just get along lol.

Just remember this though, PA education is extensive and rigorous during the didatic year we are physically in class 36 hours per week and I usually study about 30-40 hours on top of that. The clinical year we have a minimum requirement of 128 clinical hours per month or about 32 hours per week. In actuality we will have done in the area of 1700 clinical hours by the end of our clinical year. We are at the mercy of our clinical site and will work whatever hours they work. Until a few months ago one of the ER rotation sites was a 15 hour 3 day per week shift because that is what the preceptor worked so that is what the student did as well. Make no mistake about it, a new grad PA may not go in with the level of experience afforded by being a nurse but coming out they have extensive experience in all areas of medicine.

just my 2 cents on the topic

ConscientiousFNP · Aug 13, 2011

This whole argument about new grads without nursing experience practicing is precisely what is dividing nurses from nurse practitioners in the first place. There seems to be this underlying notion that in order to be a good NP, you need to have nursing experience (which ironically no one who says this can agree on a number of years). It really just doesn't make sense. I mean, becoming an NP is not a promotion from being an RN. It's not charge nurse we are talking about her, it is a totally different career. Should MDs and PAs be nurses before practicing? Absolutely not. Certainly any previous patient care is going to make an MD, PA or NP more knowledgeable or "experienced" as the argument goes. So then when do you start? When a kid is 3 years old?

Again, an NP is NOT a senior or graduated RN. NPs do not have to "pay their dues" as RNs first and who is to say the "experience" that is said to make an NP better can only come from working as a nurse? There are a multitude of ways that NPs can gain experience and obtaining an advanced NP education is one of them. Once nurses and nurse practitioners can understand this and work together regardless of credentials and "experience", maybe we'll find ways to work better with patients regardless of our credentials. Isn't that what's important anyway????

Furthermore, if NPs could not provide safe and effective practice without becoming RNs first, why would our government allow it and why would MDs agree to "collaborate" with NPs as opposed to "supervise"....just food for thought.

Honestly, I believe that if NPs could go by any other name and drop the word Nurse out of the title, the arguing and bickering over this would stop. Maybe the title could be General Practitioner and then everyone would get along.

Trauma Columnist · Aug 13, 2011

I do respectfully disagree with you conscientiousFNP: I've been an APN since 2006 and I can honestly say that the assessment skills and time management skills I learned as an RN. I was an RN for 12 years prior to becoming an APN and had been an LPN for 2 years prior to that.

Do I think you need that much experience? Probably not. However, as APNs, we are advanced practice nurses. They are not two careers. I do CPR as an APN just like I did as an RN (and even as an LPN), I assess my pts the same way as an APN as I did as an ER RN. Most of all, I learned how to tell a "sick" pt from one that can wait from my RN experience.

The caveat to this is that I have never worked an APN that didn't have RN experience. I work in several different clinics: my main one is located in the inner city and these pts can spot inexperience a mile off! They keep me on my toes.

Just a different opinion.

subee, MSN, CRNA · Aug 13, 2011

If you don't need nursing experience to be an "advanced practice nurse" then don't call it nursing. Bite the bullet and go to PA school where the education has to be more rigorous because you DON'T bring any experience with you. The NP programs should be as vigorous as the CRNA programs because their workload is going to become increasingly complex. to Conscientious

FNP, your ignorance of what nurses do is showing. Working in the trenches is where you get your judgement... one can't go to school to learn judgement. If you want to be called a General Practitioner, then go to med school. And after med school those new grads have to go through internship and residency. That's where they just to learn that all important judgement thing. A NP is a promotion from RN...you see, you have to be an RN first and then you can become a NP. You're just gonna have to admit that you're an RN. I don't have a lot of respect for NP programs that require no nursing or only 1 year. I think the patients deserve advanced nursing services from schools that provide a more vigorous curriculum and you can't do that when you have to re-hash the basics because the students don't already know labs, 12-lead EKG interpretation, etc.

CCRNDiva, BSN, RN · Aug 14, 2011

I agree with you, TraumaRUs. It's called advanced practice nursing for a reason. I feel that my 7 yrs of ICU experience will provide a strong foundation for completing my ACNP program and later, functioning as an ACNP. I may not prescribe drugs for my patients now but I do know what drugs they need 80-90% of the time and most of our docs expect us to know. That knowledge comes in handy when working with new residents or hospitalists, etc. who are not strong in critical care. Learning something from a textbook is totally different from treating it in practice. Not to brag, but I can run a code in my sleep. I may not order vent settings or intubate now, but I can usually determine what vent settings are needed before the doc tells me. My nursing experience has taught me how to look at my patient not just the #s. I've had several patients with normal ABG values that I knew required intubation by assessing them and drawing on nursing experience. Our intensivists are glad we have clinical insight that has saved lives and prevented codes in countless situations.

The powers that be are pushing for independent NP practice while often citing that many NPs have yrs of nursing experience prior to becoming NPs but there are many programs that no longer require prior nursing experience. They are pushing all these different agendas to attract more "professionals" to nursing but I feel that they are shooting the profession in the foot. They are pushing for a DNP as an entry to practice claiming that the complexities of today's patients require a higher level of education but they have no problem with a NP who has no nursing experience being independent in practice. I'm sorry, but that does not make sense!

You know what's ironic? The very universities that have these direct entry programs are usually affiliated with medical centers that require or strongly prefer NPs with at least 2 yrs of nursing experience if they don't have NP experience. I've looked at several job descriptions at Vandy Medical Center, Hopkins, etc and they all want NPs with nursing experience. What does it mean when the very medical centers they are affiliated with want a NP with nursing exeperience?

linearthinker, DNP, RN · Aug 14, 2011

I added it up, and I had over 30,000 hours of nursing experience before NP school, 25,000 of it in critical care. I don't know if it was all that helpful in school, and I don't know exactly how helpful it will be as a NP b/c I have yet to take my first NP position (I'm holding out for something GREAT). I do know that I can tell in 5 seconds if someone is acutely ill or not, lol, and I had a very easy transition in clinical assignments b/c I already know how to communicate therapeutically, and assess patients. The rest, the differential and prescribing, was mostly all new to me and my RN experience didn't really give me that much of an edge.

I think it is like learning to walk. Some kids walk at 9 months, and some learn to walk at 15 months, but all adults walk and it isn't evident when you see us walking down the street who learned it earlier, and early walkers are not better walkers in adulthood. So, 5 years out, I don't think my 25 years of nursing is going to make me a better NP than the one who had 6 months and has also been an NP for 5 years. I may have an easier first year, yes, but the curve is going to flatten out and s/he will catch up in short order.

subee, MSN, CRNA · Aug 14, 2011

Linearthinker:

Walking is a psycho-motor skill that can't be compared to an intellectual skill. You haven't even been out of school yet..how could you possibly even be able to think the issue through? School is school...it's not the job. I respectfully disagree that the curve flattens in "short order." For someone with no experience, compared with your experience, I would give it a decade! It's a disservice to our profession and to patients, to allow students to become advanced practitioners without even experiencing the basics.

linearthinker, DNP, RN · Aug 14, 2011

First of all, it was allegory. Secondly, I've been out of school for 9 months. I just chose not to "work" for money, I do mission work. Thirdly, with regard to the "flattening" curve, I've seen it. I understand and accept that you may not have. In my experience, 5 years in, it has been impossible to distinguish the NP with 1 year prior RN experience from the NP with 10 years. I believe my experience has earned me the right to hold an opinion.

I respect that you disagree, and I'll thank you not to patronize me.

Advanced Practice Columnist / Guide · Aug 14, 2011

You know what's ironic? The very universities that have these direct entry programs are usually affiliated with medical centers that require or strongly prefer NPs with at least 2 yrs of nursing experience if they don't have NP experience. I've looked at several job descriptions at Vandy Medical Center, Hopkins, etc and they all want NPs with nursing experience. What does it mean when the very medical centers they are affiliated with want a NP with nursing exeperience?

That's an astute observation. I've never worked with direct-entry ACNP's until I moved to California where these programs are prevalent. The institution we are affiliated with has direct entry NP programs (including one for ACNP's). Sure the entry requirements are rigorous and the ACNP students are required to work preferrably in the ICU after completion of the RN portion of the program (without getting a BSN). However, many of the graduates end up working at the bedside as ICU nurses upon graduation and transition to NP later. This is how my co-workers who are direct entry grads did it. Some (who graduated from east coast programs - Columbia, Yale, Case) got jobs as NP's right away but brought their NP experience to the table when they got hired here. So you're right, some of the very same universities that offer the direct entry option have "direct-entry unfriendly" hiring practices in their affiliated medical centers.

ConscientiousFNP · Aug 14, 2011

What should be understood is that FNPs have credibility and reliability in primary care. Most of the responses to this post are related to NPs that work in hospitals. Perhaps with increased knowledge of the field, the distinctions of the two can be better understood and more accurate judgement made. Primary care is where you find your FNPs, PNPs, and WHNPs and hospitals are where you find your ACNPs. There is a special program for that. That being said, NP programs prepare their students rigorously for whichever track the student is taking. As for FNPs, do we have clinicals in hospitals, well, do you provide PRIMARY CARE in hospitals. No and No. It's just that simple. We are in the office doing WELL patient visits, preventative care and referring to specialties as needed. Once one understands this and understands the difference, they might say "hey, yeah, about that nursing experience....maybe not so helpful there." Furthermore, I worked in outpatient as a nurse because of this whole ridiculous and at times ignorant notion of needing experience and the only thing I got from it is difficulty in switching my mind over from carrying out orders as supportive staff to being the final decision-maker as a Primary Care Provider.