Minimum level of experience for FNP

[grumpygorillaface]

I am a nurse on a tele/med-surg floor. I am interested in becoming a family nurse practitioner eventually, but I was wondering if anyone has a recommendation on the minimum years of experience one should have before trying to become a FNP. I plan on transferring to the ER before I go to round out my experience.

[CCRNDiva, BSN, RN]

I don't think that any of us here are slow and unable to understand the difference between a FNP and an ACNP. Your post seems to ignore the fact that many FNPs are working in environments managing sick patients. Most FNPs are not just caring for well, healthy patients. Several are working in hospitals, clinics and the like. Many illnesses are now managed on an outpatient basis as patients are living longer with chronic illnesses.

Again, it is called advanced practice nursing for a reason and I, for one, find it disappointing when someone has chosen to pursue advanced practice nursing when they have such a negative attitude towards the role of nurses. It's unfortunate that you feel that you did not benefit from your time as a nurse.

[ConscientiousFNP]

My viewpoints and comments come from obtaining an education and experience as a nurse as well as that for a nurse practitioner. The offense that I initially spoke of that some nurses take when having this discussion has been made clear as you have chosen to believe one is saying that you are slow and unable to understand the difference. Instead of considering a different viewpoint, you have chosen to take offense. And this action is precisely what fuels the continued dissension between nurses and nurse practitioners. On the other hand, I considered all that was offered through people's opinions and responses to my post. I thought to myself "wow, that is correct. ACNPs are in the hospitals, but most FNPs are in primary care." However, that realization (not offense-taking) did not change my view of what my role is, where I belong, and what experiences will help me to become an efficient health care provider.

Why don't we try this? Why don't we learn to support and build each other up in ways that strengthen the field of nursing. Let's face it. There isn't a whole lot of comradery that exists among the nursing profession as a whole....historically and present day. In fact, it was an MD that came up with the idea of having nurse practitioners, but he said when he saw all the bickering and fighting among the nurses with regard to this, he viewed nurses as antagonistic and decided instead to create the physician assistant. And guess what? These nurses he was trying to train to become nurse practitioners had been working as nurses all their lives, so what ever could have been the problem?

How about this? Instead of fighting amongst ourselves on the topic of experience, advocate for what you believe in. If you think that nurse practitioners should have nursing experience first and you feel it is better for our patients, then move this conversation from this post and bring it to you legislatures. Until there is evidence-based practice that can supports your views and opinions, NPs will continue to begin practicing as primary care providers regardless of experience because research, statistics and patient satisfaction surveys have shown that it is highly efficient.

I am totally open to evidence-based hypotheses and theories that will influence my decision on how and when to practice. Until such a time, I will operate with regard evidence-based practice and research and will continue to practice healthcare with confidence, pride and understanding that I am making a positive impact in the lives of my patients.

If I am supported by nurses and nursing-experienced NPs, great. If not, that is fine too because strong opinions not backed by evidence do not carry that much weight.

[linearthinker, DNP, RN]

I agree with ConscientiousFNP. Not in every detail, but generally speaking anyway. I have recently applied for a PT FNP position and for payscale purposes, they are counting my 25 years of experience. I'll make more money than the FNP with 10 years advanced practice experience because she was a RN for "only" 8 years before becoming a NP. If I were the other FNP I'd be pi$$ed as he//. They are telling her in effect, that my RN experience is literally more valuable than her NP experience, and everyone posting on this thread knows that is hogwash. I think it's ridiculous, but I'll cash the checks.

[CCRNDiva, BSN, RN]

My viewpoints and comments come from obtaining an education and experience as a nurse as well as that for a nurse practitioner. The offense that I initially spoke of that some nurses take when having this discussion has been made clear as you have chosen to believe one is saying that you are slow and unable to understand the difference. Instead of considering a different viewpoint, you have chosen to take offense. And this action is precisely what fuels the continued dissension between nurses and nurse practitioners. On the other hand, I considered all that was offered through people's opinions and responses to my post. I thought to myself "wow, that is correct. ACNPs are in the hospitals, but most FNPs are in primary care." However, that realization (not offense-taking) did not change my view of what my role is, where I belong, and what experiences will help me to become an efficient health care provider.

Why don't we try this? Why don't we learn to support and build each other up in ways that strengthen the field of nursing. Let's face it. There isn't a whole lot of comradery that exists among the nursing profession as a whole....historically and present day. In fact, it was an MD that came up with the idea of having nurse practitioners, but he said when he saw all the bickering and fighting among the nurses with regard to this, he viewed nurses as antagonistic and decided instead to create the physician assistant. And guess what? These nurses he was trying to train to become nurse practitioners had been working as nurses all their lives, so what ever could have been the problem?

How about this? Instead of fighting amongst ourselves on the topic of experience, advocate for what you believe in. If you think that nurse practitioners should have nursing experience first and you feel it is better for our patients, then move this conversation from this post and bring it to you legislatures. Until there is evidence-based practice that can supports your views and opinions, NPs will continue to begin practicing as primary care providers regardless of experience because research, statistics and patient satisfaction surveys have shown that it is highly efficient.

I am totally open to evidence-based hypotheses and theories that will influence my decision on how and when to practice. Until such a time, I will operate with regard evidence-based practice and research and will continue to practice healthcare with confidence, pride and understanding that I am making a positive impact in the lives of my patients.

If I am supported by nurses and nursing-experienced NPs, great. If not, that is fine too because strong opinions not backed by evidence do not carry that much weight.

First, for clarification, I did not take offense to your post. I chose to disagree with you, but no personal offense was taken. Second, your argument continues to be based upon the premise that all FNPs practice in primary care offices, managing well patients and health promotion. My point was and is that many FNPs practice in EDs, clinics, outpatient care services while managing patients with episodic and chronic illnesses. That is a fact, not a strong opinion. Employers tend to prefer NPs with nursing experience; that is a well established fact, not an opinion. Third, I don't believe that I ever questioned your role in primary care. I chose to disagree with your belief that requiring nursing experience to enter a FNP program was a "ridiculous notion". Not once did I question your practice as a FNP while I explained my position. I stated that it is disappointing to me when an advanced practice nurse has a negative view of the role of nurses.

The OP asked for opinions and we happen to have opposing views. Does that mean that I don't support you in your role as a NP? No, and I'm sorry if that is how you perceived my post. We are not fighting, but instead disagreeing. I do not have to agree with your stance and you have no obligation to agree with mine.

[elkpark]

In fact, it was an MD that came up with the idea of having nurse practitioners, but he said when he saw all the bickering and fighting among the nurses with regard to this, he viewed nurses as antagonistic and decided instead to create the physician assistant.

Do you have some documentation of Dr. Silver saying this? I'm v. skeptical.

[Corey Narry, MSN, RN, NP]

Nobody's really taking offense here. Allnurses is all about making your opinions heard and if you happen to read a post and disagree, that is OK. Nobody's trying to break any camaraderie either. No poster ever stated in this forum that it is a waste of time to attend a direct entry program for NP's and only experienced nurses should pursue the NP role. The fact is direct entry programs for NP's have been around for a while and will not go away. With that said, I just wish we nurses as a whole, admit the fact that we can no longer own the claim that we NP's are "better" because we were nurses at the bedside first. That statement does not apply to every single one of us anymore since we have been allowing individuals who never worked as nurses to fast track into a career as NP's. Unfortunately, we also could not claim that we are following the PA model of education when we defend the direct entry option because our clinical hours are significantly lesser and our programs vary in content considerably.

I should apologize to the OP for getting sidetracked with the direct entry issue when the intent of the original post is to ask what the minimum level of RN experience is for an FNP. My response would be that experience can only help and it is really up to the individual to self assess what is enough. For me, the point of having the "bedside" experience is to allow self realization of where one's interests lie. NP's are advanced practice providers who are "specialized" into a field of healthcare such as caring for families, the acutely ill, women, children, neonates, and the promotion of mental health while still rooted in the profession of nursing. You get locked-in to a specialty as NP. It would only benefit one to have some experience in the field you want to get locked-in to and hopefully a desire for advancement in that field.

I also know that we have invoked the word "evidence" in these posts and have questioned that there is no research that proves that experience as a bedside nurse create better NP's and that inversely, direct entry grads who enter the NP workforce are unsafe. But is it even possible to come up with sound research that can challenge these hypotheses? That's impossible to prove because human variables are just too difficult to control.

Let your own self be the judge of that while armed with the knowldege of what is true about NP training and the job market you will have to face, seek the advice of individual NP's, and follow what you feel will work for your future.

[RNLady115]

That is a bit of a ridiculous statement. To be a good nurse, you need to do more than just task. You have to understand the meaning as to why you're doing what youre doing and esuring the therapy you are doing is appropriate. Critical thinking is a key skill along with a strong knowledge base. A "Floor" RN has to constantly use those skills.

[futureeastcoastNP]

Admitting that someone NEEDS nursing experience before going to NP school is admitting that NP school does not do a good job of preparing providers. If schools required as much clinical as PA schools, we wouldn't need to have this discussion. More clinical hours working as an NP would certainly do more for knowledge base than RN hours anyway.

For what it's worth, I don't see the issue with direct entry nurse practitioners.

[MurseJJ]

Admitting that someone NEEDS nursing experience before going to NP school is admitting that NP school does not do a good job of preparing providers. If schools required as much clinical as PA schools, we wouldn't need to have this discussion. More clinical hours working as an NP would certainly do more for knowledge base than RN hours anyway.

For what it's worth, I don't see the issue with direct entry nurse practitioners.

Actually look at PA forums. They have the same discussion about quality healthcare experience prior to PA school, without the ridiculous notion about grad school not doing a good job preparing providers. Both NP and PA concepts began with the idea of preparing an experienced clinician (RN for NP, medic/RT/RN/etc for PA) to be a provider.

[BostonFNP, APRN]

There are a half-dozen small studies, both qualitative and quantitative, that have examined the role of prior RN experience in advanced practice, if anyone is interested in reading the extant literature.

Probably the most notable of them:

Rich, E. R. (2005). Does RN experience relate to NP clinical skills?. The Nurse Practitioner, 30(12), 53-56.

[zmansc, ASN, RN]

Are you suggesting we keep discussions fact based? That would take all the fun out of it!

[Gentleman_nurse, MSN]

Groan...

Without a long term research study, there will never be a clear answer on this issue. Everybody is going to have an opinion.

With that being said, I talked to about 20 nurse practitioners from various specialties and RN backgrounds for their insight about this issue. The general consensus was that RN experience is preferable but not absolutely necessary to be a proficient NP. Without RN experience, the road to competence will be longer and harder but definitely reachable.