This is a long post, but I'm really looking for input from nurses, NPs, or any other providers. I'm a couple months into my nursing career and have just been accepted into an NP Program, and am wondering if I am making a mistake. I feel ready, but others have told me I shouldn't.
For a little background, I went to a second degree BSN program, and got my first degree in biomedical neuroscience. I graduated my BSN with a 4.0, tutored all med-surg and critical care classes in my program, spent a year working in an ED during school, and currently am in orientation as a nurse in a level 1 trauma ED at a big university health center. I got into adult-acute care NP school in the same university that I work at. It has a great reputation consistently ranking in the top 5 for NP schools in my specialty and was ranked #1 this year for AGACNP. I was approved to attend on a part time basis so I can hold full time work through the program, and get to spend the first year attending non-clinical foundational classes (physiology/pathophysiology, healthcare economics, introduction to practice, etc) then start my core classes the second year. I'll be starting the program as a new grad, but by the time I ever see a patient in school as a NP or take clinical classes I'll have nearly 1.5 year of experience (nearly 3 years by the time I graduate). In my limited time so far as a nurse, I am definitely humbled by how much I don't know in the realm of nursing, but still feel as confident as ever in my understanding of fundamental sciences (Patho/pharm/physiology) so I still just feel ready to move onto further education. I've gotten pushback from a lot of nurses, but encouragement from my professors, preceptors, and my nurse educator in my previous ED job.
I am wondering if I am just being too naive in thinking I am ready for this. I want to go on to NP solely because I really enjoy diving deeper into diseases and their treatment. I want to go onto outpatient cardiology after school and attend a cardiology fellowship to get a more structured and hands on patient care at the NP level. I think my first undergrad degree prepared me to take on the graduate classes quicker, as I got a lot more exposed to organic chemistry/biochem/physiology, but am wondering if this is too quick, even attending part time. In no way do I want to cut corners to becoming a provider and would never want to jeopardize patient safety, but I just feel ready to take on the additional responsibilities.
First, I do really appreciate this comment, because I am trying to work through my own line of thinking on the topic and am open to criticism! But I never fully understood the idea of needing experience to be an NP, because the jobs are so fundamentally different. There is obvious connections between them, but the core aspects of being an NP (diagnosing, prescribing, procedures) you don't do as a nurse. I see it more valuable 5 years down the line to be an NP with 5 years of NP experience than an NP with 1 year NP experience and 4 years RN experience. I've almost found that information that will be relevant at the next level (pathophysiology, pharmacology, biochemistry, etc) is more fresh in my mind coming right out of school than experienced nurses I've worked with.
I also don't want to completely diminish the need for experience on the next level, which is why I intentionally applied to attend part time so I can keep working full time for the 2.5 years in the program. I'm not saying I don't need any experience, but is 2.5 years isn't enough what is?
on top of that, I made sure to avoid any "degree mill" programs. The school I would be attending is a well established university with a massive medical system, associated med school (which offers opportunity for inter-professional learning between the two), and a large world-class academic medical center right next door with guaranteed and pre-arranged rotation sites in any sub-specialty we decide to pursue.
I am generally not in favor of new grad nurses going straight to NP school without experience. Although you are correct that the RN role vs the NP role is different, I don't see how anyone can deny that RN experience is valuable to an NP. New grads don't know what they don't know. There is a reason that CRNA schools require critical care experience before being accepted.
However, you are the first person to post this question that I would say it's probably not a mistake; primarily because you will have 3 years of experience by the time that you graduate NP school, but also because of your prior education, your prior work experience, the fact that you are working in the ER, and you do have some life experience. In addition, you write well (a sign of intelligence IMO, and is skill that some nurses lack), seem to have given a great deal of thought to this issue, and come across as more mature for your age than some others. For all of those reasons, my opinion would be that you would do well as an NP with relatively little experience. As another poster suggested, I think it would serve you well try to get at least a year of experience in a CCU before you graduate.
I am generally not in favor of new grad nurses going straight to NP school without experience. Although you are correct that the RN role vs the NP role is different, I don't see how anyone can deny that RN experience is valuable to an NP. New grads don't know what they don't know. There is a reason that CRNA schools require critical care experience before being accepted.
However, you are the first person to post this question that I would say it's probably not a mistake; primarily because you will have 3 years of experience by the time that you graduate NP school, but also because of your prior education, your prior work experience, the fact that you are working in the ER, and you do have some life experience. In addition, you write well (a sign of intelligence IMO, and is skill that some nurses lack), seem to have given a great deal of thought to this issue, and come across as more mature for your age than some others. For all of those reasons, my opinion would be that you would do well as an NP with relatively little experience. As another poster suggested, I think it would serve you well try to get at least a year of experience in a CCU before you graduate.
Best wishes!
Thank you for the response! And I didn't mean to minimize the need for RN experience, I picked the part time program specifically to get experience. But for critical care experience, the ER I work in is a level 1 trauma center. I haven't had experiences other than an ER, so would a level 1 center be adequate for critical care, or is there stuff seen in an ICU that isn't seen in an ER?
Thank you for the response! And I didn't mean to minimize the need for RN experience, I picked the part time program specifically to get experience. But for critical care experience, the ER I work in is a level 1 trauma center. I haven't had experiences other than an ER, so would a level 1 center be adequate for critical care, or is there stuff seen in an ICU that isn't seen in an ER?
In a perfect world, ICU would be a better experience to get to see more long term effects of the therapies. But you are a smart person and cardiology involves thinking like a plumber:). You will be fine with either background.
In a perfect world, ICU would be a better experience to get to see more long term effects of the therapies.
A perfect world would be following patients after inpatient. Don't the NPs want to follow them home? There are so many health care providers that want to be involved in an inpatient experience.
A perfect world would be following patients after inpatient. Don't the NPs want to follow them home? There are so many health care providers that want to be involved in an inpatient experience.
Is there a big advantage having NP's making home visits over visiting nurse services? I think the preferred model for NP's is working as a money machine for someone else....at least in their employers' eyes.
Is there a big advantage having NP's making home visits over visiting nurse services?
I misspoke (or miswrote) I was actually referring to NPs not tied to the ICU and actively involved with the patients on the general floor. Not just in the ICU:
subee said:
In a perfect world, ICU would be a better experience to get to see more long term effects of the therapies.
The ICU may be a a day or two. A general floor would focus on whether the patient has made good progress, have medication adjustments, teaching on meds, and a schedule for further appointments.... short term and as you said "long term effects of the therapies.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
There is no 100% right or wrong answer here. I'm sure there are NPs that were brand new to nursing that have been successful in their role. I can only answer from my perspective that I would be struggling much more right now if I did not have the 10 years of RN experience behind me before transitioning to NP.
Here's my story that I'll try to abbreviate but keep relevant information. I am a second career nurse, first career was 17 years in pharmaceutical research with my MS in molecular and cell biology with extensive biochemistry. When I enrolled in NP school I was working in critical care and by the time I finished my NP Program I had four years of critical care experience. I'm seven months into my ICU NP orientation and if I didn't have my nursing experience, titrating pressors, managing vents, understanding when I need inotropy/chronotropy/straight up pressor, seeing patients experience a change in condition, emergent situations, etc. I would have failed already. For me, the book learning that explains the information does NOT directly translate into knowledge that has truly sunk in and become part of me. It's like sitting in ACLS class, but not putting it all together until I had participated in dozens of codes. But that's just me.
No one else can tell you what will work for you. There are people that will judge no matter what you do. Not enough experience, wrong experience, too young, too old, whatever. For what it's worth, I finished my NP degree at 47. I understand that desire to be stable before you have a family, but you never know what life will throw at you. I was laid off at 38 years old with three kids under 10 and changed careers. You can do what you have to when you need to get it done.
Good luck with whatever you choose.
Edited to add- my mistake, I thought you were looking to work inpatient, since you mentioned your school has a well ranked AGACNP program. If you're not working inpatient/ICU, much of what I mentioned would be irrelevant. I think that outpatient cardiology wouldn't necessarily require ICU experience, but I do think that more exposure to inpatient treatment could give you a stronger foundation for what your cardiac patients have experienced in their outpatient follow ups.
Specializes in Physical Medicine & Rehabilitation.
subee said:
Is there a big advantage having NP's making home visits over visiting nurse services? I think the preferred model for NP's is working as a money machine for someone else....at least in their employers' eyes.
The NP can diagnose and prescribe on the spot, whereas an RN cannot. As we know, information takes time to communicate. I do agree with your second comment though haha. We still make good money nonetheless and it's way more non-physical labor which is one of things I was looking forward to when I got my NP. I wish I went for my NP sooner rather than breaking my back on the floor for 7 years.
@ OP
I won't say it's a mistake, but I would still recommend (to my former self and others) to at least get like 1 or 2 years of experience first before going for your NP. One can argue that by the time you finish your NP school, you will be at least 2 years experienced as an RN already. This is true, but in NP school, you will likely be starting clinical rotations very quickly. While there is huge amount of information to learn as a new RN, a new ED employee, and the world of healthcare, your preceptor will already be expecting you to provide some sort of plan of care including diagnosing and treatment. It's also important to note that why nursing and medicine can overlap, acute care/ED is very different that primary care (assuming your program is an FNP program as most are). Providing a treatment plan was my initial struggle because as a telemetry nurse, I had been program to fix this now/asap, but primary care, that's far from the truth (unless it's an emergency of course). I had to separate my knowledge from acute care and primary care. If you think you are able to do all this, then more power to you. There are many stories I've had from both the floor and in clinical where I was glad to have the # of RN years behind my back. Experience will help you in the long run, what's the rush?
The NP can diagnose and prescribe on the spot, whereas an RN cannot. As we know, information takes time to communicate. I do agree with your second comment though haha. We still make good money nonetheless and it's way more non-physical labor which is one of things I was looking forward to when I got my NP. I wish I went for my NP sooner rather than breaking my back on the floor for 7 years.
@ OP
I won't say it's a mistake, but I would still recommend (to my former self and others) to at least get like 1 or 2 years of experience first before going for your NP. One can argue that by the time you finish your NP school, you will be at least 2 years experienced as an RN already. This is true, but in NP school, you will likely be starting clinical rotations very quickly. While there is huge amount of information to learn as a new RN, a new ED employee, and the world of healthcare, your preceptor will already be expecting you to provide some sort of plan of care including diagnosing and treatment. It's also important to note that why nursing and medicine can overlap, acute care/ED is very different that primary care (assuming your program is an FNP program as most are). Providing a treatment plan was my initial struggle because as a telemetry nurse, I had been program to fix this now/asap, but primary care, that's far from the truth (unless it's an emergency of course). I had to separate my knowledge from acute care and primary care. If you think you are able to do all this, then more power to you. There are many stories I've had from both the floor and in clinical where I was glad to have the # of RN years behind my back. Experience will help you in the long run, what's the rush?
I understand what NP's can do but are any working as post discharge follow up NP's? IMHO, it would be difficult to have 2 practitioners taking care of 1 patient at home. You might as well just cut the other VN's out of the equation entirely. I don't see how the economics would work either
Thank you for the response! And I didn't mean to minimize the need for RN experience, I picked the part time program specifically to get experience. But for critical care experience, the ER I work in is a level 1 trauma center. I haven't had experiences other than an ER, so would a level 1 center be adequate for critical care, or is there stuff seen in an ICU that isn't seen in an ER?
I work in a level 1 trauma hospital. ED nurses may care for an ICU patient for a short/brief time while awaiting an ICU bed but it is not comparable. An ICU gives you experience that will greatly help you if going into acute care NP track ( I think cards is what you are interested in I thought I saw). You will learn how to do invasive hemodynamic monitoring, understanding shock states and gain the experience of managing unstable crashing patients while titrating multiple drips at the same time, while managing them on a vent, and maybe a ballon pump, impella, lvad, etc. I worked in a progressive telemetry unit and then went to the CICU before applying for acute care NP school. You don't understand what you don't know until you learn it! It's only after my ICU experience do I feel ready to go into acute care NP because even if I was working on the floors as an NP (not that I plan to) I would still find my ICU experience invaluable and readily useful for unstable patients on the floors or during RRT/Codes. My ICU training was not just moving to an ICU unit and being trained but a full 6 month fellowship with classroom training/simulations/skills training/certifications to use specialized machines for advanced therapies.
I strongly recommend you try to get experience in an ICU, even if it is while in the program. Best of Luck! Hope this helped to answer your question.
I've thought a lot about both, but med school just isn't for me. Already being late twenties and getting ready to start a family, the commitment for medical school and residency is just not something I could (or want to) fit into my life. I also like the role of a mid level provider. I love being on the diagnostic/prescriptive side of timings, but also like working with a team where I have someone above me to consult and continuously learn from. And PA school is an option I've considered quite a bit, but I like the role of the NP more. I know what I don't want to do (Peds, psych, OB, primary care) so I find it a better use of my time to dive deeper into acute care than spend more time getting a broader education.
A big upside for me that I didn't know about then when deciding which path to take, but I do now...no partners' meeting!!!:)
InHisImage, BSN
83 Posts
I am generally not in favor of new grad nurses going straight to NP school without experience. Although you are correct that the RN role vs the NP role is different, I don't see how anyone can deny that RN experience is valuable to an NP. New grads don't know what they don't know. There is a reason that CRNA schools require critical care experience before being accepted.
However, you are the first person to post this question that I would say it's probably not a mistake; primarily because you will have 3 years of experience by the time that you graduate NP school, but also because of your prior education, your prior work experience, the fact that you are working in the ER, and you do have some life experience. In addition, you write well (a sign of intelligence IMO, and is skill that some nurses lack), seem to have given a great deal of thought to this issue, and come across as more mature for your age than some others. For all of those reasons, my opinion would be that you would do well as an NP with relatively little experience. As another poster suggested, I think it would serve you well try to get at least a year of experience in a CCU before you graduate.
Best wishes!