MSN for Non-nurses, your opinion...

Chris-FNP · Mar 22, 2001

jt,

I hear you and I respect your opinion...but I disagree with your idea that an NP "has" to be an RN for years in order to be a good NP. You, I assume, are not an NP. If you are, then I stand corrected. If your not an NP, then you do not know what it is that an NP does on a daily basis. You may know NPs, but if you don't practice as one, its not the same thing.

An RN does not utilize his/her knowledge of the pathphysiology of disease to diagnose and treat medical illnesses on a daily basis. An RN does not understand the intensive pharmacology involved, nor have a DEA number, to prescribe medications on a daily basis. An RN's role and an NP's role, IN REALITY, are completely different.

You can be a fantastic NP without ever being a floor nurse...because the role is different. If you were an NP, you would see this. If you are an NP and still feel the way you do, then I respect that and we just won't ever agree on the matter.

Nurses are so resistent to accept the fact that NPs practice more medicine than nursing. This is just a fact today. Is it the way it should be? Maybe not. But its a fact. Personally, I do feel that I integrate some core nursing beliefs in my practice, but overall, I practice more medicine on a daily basis. A lot of what you learn in NP school is medical. What HMOs want of NPs today is medically based. HMOs want to have someone that they can pay less yet bill medical codes so they can make more money...this is the reality of the situation. I didn't make the rules.

One can spend 20 years as an RN and still be a bad NP because he/she just cannot grasp material like pathophysiology or pharmacology...or how to integrate the abnormal findings in a physical exam to the actual treatment of the disease. These are skills not taught in BSN programs. Why? Because RNs don't medically diagnose or prescribe. That is my point.

The core of an NP may still be a nurse, but, what an NP does today (in most places) is practice medicine on a lower level than that of an MD.

As far as these non-RN to NP programs are concerned, I think that they consistently produce great NPs. Probably because they only accept the best and the brightest. The programs are intense and time-consuming. And remember, we still take the same NCLEX as everyone else. Incidently, my non-RN to NP program had the highest NCLEX pass rate in the country (from what I was told). Does that mean a test makes someone a better nurse? No, I'm not implying that. But, it is important to have a strong knowledge base when your actually diagnosing and treating diseases.

Moral...

RNs and NPs are both nurses, but practice in very different ways. Both play a very important role in healthcare today. Neither one is better than the other. A good NP can be someone who worked 20 years as an RN or someone who worked 6 months as an RN.

Chris-FNP

[This message has been edited by Chris-FNP (edited March 21, 2001).]

-jt · Mar 22, 2001

Originally posted by Chris-FNP:
jt,
still feel the way you do, then I respect that and we just won't ever agree on the matter.
Nurses are so resistent to accept the fact that NPs practice more medicine than nursing. A good NP can be someone who worked 20 years as an RN or someone who worked 6 months as an RN.
Chris-FNP

The above statements are not accurate. We wont ever agree on this so I will end my part in this conversation here:

The fact that NPs have more medical responsibilities is not what RNs are resistant to. NPs were created to do more medicine ALONG WITH Nursing - especially for those areas of the country where there were physician shortages & lack of healthcare.

The field was established to be a combination of NURSING as well as medicine. Its supposed to be about taking care of people - not just writing prescriptions. The RNs role is not completely different from the NPs role. The NP is supposed to be an RN too & in that regard they are the same. The NPs role is merely expanded beyond the RN role but it still is to encompass the RN role. Which, if you dont know this, leads me to wonder just what you think an "RN role" is anyway????

Maybe you have a misconception about RNs but as a non-nurse I can see why you might. It seems that whenever you refer to the "RN", you are thinking of those RNs who work in hospitals & also I might add, you seem to be looking down on them. What I am talking about is all RNs in all settings - not just hospitals.

RNs are not "resistant" to the field of Nurse Practicioner. But NPs are expected to BE NURSES - first & foremost - with advanced training, and know how to take care of people - not be MDs & not just write precriptions.

An NP is a nurse - not a doctor.

If you have never taken care of people in any setting as an RN, I dont know how you can be an NP and function as a NURSE with advanced training. FYI, all RNs are required to know pharmacology - side effects, compatibilities, efficacy, dosages, routes, etc. Im sure its easy to write prescriptions but that is not what Im talking about.

RNs object to non-nurses becoming NPs (which are nurse specialists) & never having touched a pt, cared for a pt, or seen the subtle signs of early symptoms of anything. Just as I believe the head of the Police Dept Forensics Squad who has never been a cop is going to be lacking in the job, I believe an NP who has never worked as an RN or only worked as an RN for a short time is not going to be as "good" an NP as an RN with 20 yrs experience providing hands-on care to pts and their families.

Its simple logic. Experience in the field counts & you cannot be a specialist in your field without it. Now you may say "but I am an NP & nursing is not my field"... but THATS where you are wrong.

I think the problem is that non-nurse NPs have a very different view of what NPs are /should be than the real nurses do - how NPs were created to be in the first place. RNs expect NPs to be REGISTERED NURSES with advanced training - as it was intended. Non-nurse NPs expect to be MDs without going to medical school. And non-nurse NPs are the only ones who do not see a difference between NPs & PAs.

2 BSN bridge participants in my school, who never worked a day as an RN or anything else and who will be graduating NPs in May just went to a womans health NP in the area & asked if she would take them on to get in their required # of pelvic exams. These perpetual students are GRADUATING in May & have NEVER done a pelvic exam or even touched a pt outside of their clinicals. Yet they will be expected to function as NURSES with ADVANCED training & function independently. This is "quality care"? These NPs are going to be "just as good" as an RN woth experience? No they are not.

Also, I know someone who had an MBA & was bored with her job. Read an article in Crane's Business Weekly on up-&-coming fields to work in & from that article decided to be an NP. She bridged & was an NP in 2 yrs. What does she know about taking care of people? Even medical interns provide more pt care in training than this "nurse expert"

THIS is what RNs object to. Do not insult them by saying that this caliber of NP is "just as good" as they & their RN experience means nothing.

I completely disagree with this kind of program & think they should be banned. Pt care experience of a certain number of years should be required before being allowed into the program.

SeasonedRN · Mar 22, 2001

Dear Chris and others like you:

Those of us who are REAL Nurses by degree, licensure, and practice-have little if any respect for those who come into the profession as an afterthought and try to profit off the hard work of the REAL RN's who have come and gone long before you.

Indeed, we are recognizing now that those that come into our profession with a BS or MS in other non nursing fields are gaining these delusional credentials through our hard work professionally, and legislatively.

Do you think you got those prescriptive rights you so superiorly wave around by an act of a magic wand? No, Chris. they are bought and paid for by the REAL NURSES who have been paying dues to ANA, and others SNA's and specialty NURSING organizations for YEARS to promote our profession and advance us legislatively.

You should be THANKING us for your job and the wanna be physician glory you seem to basking in, not trying to convince [yourself?] that you are among the same caliper as those who have advanced themselves via legitimate nursing practice and education, or better than those who choose to continue to provide clinically based nursing care.

And yes, Chris-RN's DO indeed utilize the entire nursing process in assessing and intervening on our patients behalf-take a peek into any critical care unit or ER from behind your desk and watch real nurses in action saving lives based upon their critical assessment and interventional skills.

To actually suggest that RN's do not have an understanding of physiology, pharmacology, diagnosis, etc., is so pompous and WRONG

I shall end here because I just realized educating you is not my problem.

More appropriate would be PRAYER for the patients entrusted to the wanna be MD's who call themselves NP's.

RHinesRN · Mar 22, 2001

I have read most of these postings and what I find most ironic is that its NURSE practitioner. This is just another example of how the nursing profession continues to pull itself down. If you look in any nursing magazine you will find numerous listing and programs on how to advance your "nursing" career. From LPN to RN, From RN to BSN, from RN to MSN, and from "do it by mail", to "do it on line." If I keep looking I'm afraid I will find an UAP to RN program and probably it can be completed as a correspondence course with a weekend clinical. Where will it end, probably when they certify any college graduate that knows what the initials RN stand for as a NP. I can say I am certainly biased as I have come from a traditional 4 yr. BSN program, but I give you this thought. Logic would say that before you become an Advanced practice nurse (NPs,CNMs, CNAs), you should be a nurse, and not just by initials but by experience gained in the trenches. How can we promote our profession when there are so many inconsistencies across the Nursing field. I have met and worked with many competent and professional nurses that came to our profession from various communities using the back roads and two lane highways and I have no problem with that, but I sure would like to see them leaving on the same interstate. This road would have many off-ramps (NP, CNM, CS) but no on-ramp other than the one coming from the community of REGISTERED NURSE.

mud · Mar 22, 2001

Holy cow people!!! If I wanted to hear all this bitching and complaining, I would go to work!!!

-jt · Mar 22, 2001

Originally posted by Chris-FNP:
An RN does not utilize his/her knowledge of the pathphysiology of disease to diagnose and treat medical illnesses on a daily basis. An RN does not understand the intensive pharmacology involved, nor have a DEA number, to prescribe medications on a daily basis. An RN's role and an NP's role, IN REALITY, are completely different.

How can you, a non-nurse sit there & tell us what we do or do not do or understand as Registered Nurses? The only thing true about your comment above is that as a direct-care Rn in a hospital ICU, I do not have a DEA number and do not prescribe - yet. However, we are the ones who inform the MDs which drugs to consider & in what dosages. We not only know & understand pharmacology & the pathophysiology of diseases- some of which you may never even see in your entire practice, we also diagnose & treat on a daily basis. Do you think the NP is the only NURSE to use the NURSING process??? How arrogant can you be in thinking that because you do a different NURSING job, you are the only kind of nurse who understands nursing. And what you just described IS nursing. The problem is you as a non-nurse have no concept of what RNs are or the work they do. But what can we expect from programs that bring in non-nurses & tells them they are the experts.

patty26 · Mar 22, 2001

Since I started this whole thing, I wanted to clatify one point(although it most likely will not matter to any of you). Even though the graduates that these programs produce are ultimately NP's or CNS's, each person must become and RN at some point in the program. Also, these students are encouraged to work as RN's both while going to school and during the summers, and in some programs 32 hrs a week is required. Personally, one year working as an RN is nothing when compared with 20 years as one, but that is all that is required for entrance into most NP programs for RN's. Just because the decision to continue through the masters degree has been made at the beginning does not mean that these graduates have less education than some other NP students. But you probably think that these RN's haven't put enough time in either.

-jt · Mar 23, 2001

Originally posted by mud:
Holy cow people!!! If I wanted to hear all this bitching and complaining, I would go to work!!!

or you could just go to another thread

fergus51 · Mar 23, 2001

Oh, come on now Chris, you and Patty just about had me won over on the idea of these programs... Then came the remark about us RNs not understanding pharm and patho... now I am going to have to be bitter about these programs and their grads for a few more days.

Seriously, I wasn't aware of the time you had to work as a nurse and that has changed my opinion quite a bit.

SeasonedRN · Mar 23, 2001

Patty makes the point that her particular bridge program, that allows non nurses to become practicing NP's in a period of 2-3 years requires that after ONE year, they are eligible to sit for the RN boards and obtain an RN license.

Then they get to work if they choose as an RN until the next year when they can become NP's.

I see this as incredibly scary, and unsafe.

WHY is it OK for someone with a BS in accounting [or other non nurse career] to require only ONE year of RN training before they sit for the boards & practice?

In addition, I think this is program specific. This is not an across the board requirement.

My bet is most programs do not have this work as an RN after one year provision.

I am going to contact a few of my colleagues in the nursing education and advocacy community and ask them how we can find out.

If anyone else can take the time to contact their local bridge programs and ask them to provide them with program requirements, contact, etc.-and give us the feedback, it would be a great research project for us.

And Patty, you are right-the "general community" [AKA poor innocent unsuspecting patients] may not know about the difference-as we did not-but is incumbent upon those of us who now do to educate them accordingly.

Chris-FNP · Mar 24, 2001

You know, the comment about pathophysiology and pharmacology was not meant to be insulting. Moreover, everyone seems to have ignored the fact that I said I integrate nursing into my practice...as any good NP should.

This is ridiculous. Most of what I have posted was a defense to what is being said about my degree. You people (well, some people) take what I have said as a personal attack. Learn to debate.

I am a nurse, first and foremost. If I'm not one's idea of the "ideal" nurse, then get over it and find something else to whine about because our programs are growing in number and continue to produce good NPs.

Back to the pathophysiology and pharmacology comment. Not that this even matters, but, RNs do not study these subjects in the the same depth as NPs...period. This is not an insulting comment.

I personally do not appreciate the kind of personal comments made about me. This is a debate people. Treat it like a debate. A good debate fosters a better understanding of a subject and if you cannot participate in a mature fashion then keep your comments to yourself.

I have never insulted the nursing profession or the RN's role. I have simply defended my institution and explained how most NPs function in today's healthcare system.

Much of what has been said here in this thread just proves the point that most of the people that complain are older RNs that have practiced for years and are now bitter because there are new programs out there that run against the traditional grain of nursing. Let's open our minds a bit and accept things for the way they are today.

Here is another option...spend a day with an NP from one of these "bridge" programs and give he or she a real chance to show what they can do. If you have not done that, then you really have no right to criticize anybody.

Chris-FNP

[This message has been edited by Chris-FNP (edited March 23, 2001).]

Chris-FNP · Mar 24, 2001

SeasonedRN,

Before you make blanket accusations regarding the safe practice of "bridge" program NPs, why don't you spend a day with one and watch he or she practice. The comments you make about "poor unsuspecting patients" is just low. You have no idea how well we function. Its your opinion. You do not have any concrete data to support your accusations other than your own personal beliefs about how NPs should be educated.

Obviously, these programs are successful because they produce very competent NPs.

I am not implying that you are not entitled to your opinion, but to make outright accusations and to say that the patient's safety is in jeopardy...well, that's just unfair, especially when you are just speculating.

If we have to use a comparison, its like saying that PAs are putting patient's at risk. PAs go to school for about the same time. This is just an example regarding safety, I am not comparing the way PAs and NPs practice.

Who do you think has the right to be an NP? Only someone with 25 years of RN experience? That's absurd and such an elitist belief. I had less than one year of experience as an RN prior to becoming an NP, and I am doing very well.

I define "well" as providing quality care to people in need. I do this in a safe and effective manner with the support of the supervising physician as needed. Patients enjoy seeing me and the physicians in the practice trust my judgement. As a matter of fact, there are two NPs in the practice and we both attended "bridge" programs.

Chris-FNP

[This message has been edited by Chris-FNP (edited March 23, 2001).]