NP before CRNA, or straight to CRNA?

[HealthyRN]

If you want to go to med school, you should. Again, there are a lot of posts on this subject if you do a search. Many people do get MS degrees before going to med school, but an MSN is not necessarily the "best" degree to have. Med schools consider a lot of factors and being a nurse and having an MSN will not necessarily give you an edge. Nursing is a distinct profession from medicine.

ICUs may utilize NPs in a variety of ways. However, this experience would probably not be accepted by CRNA schools. CRNA schools usually ask for at least 1-2 years of ICU experience as an RN. I would imagine that the NP would not be utilizing the same skills learned by the RN that is necessary for CRNA school. For example, calculating drips, administering the meds, etc. The NP would be writing the orders, but this is not the same as actually doing it. And in an area like the ICU, an NP would probably have to have experience as a critical care RN to be hired.

However, if you have the opportunity to get your MSN in a shorter period of time, I would do it. You can still work as an RN for a few years before getting an NP job.

[lalaxton]

Whoa! Looks like you like going to school! First of all if your ultimately goal is med school go directly there, you will be repeating lots and lots of the same classes that you would get in your BSN/MSN/NP course and med schools don't give any credit for any other classes besides theirs so you'd be wasting your time, although I know of some med schools that like to admit nurses.

As far as trying to avoid working as an RN and going straight to MSN/NP it can be done but it is alot easier with some experience under you belt. There has been lots posted on this subject on this board so look back at those. You would probably not get any type of management position without RN experience either, and if you did it would be hard in my opinion to be an effective manager without knowing what your staff did.

If your goal is to be a CRNA why not bite the bullet and get some RN experience in an ICU, instead of once again taking two years after your MSN to go back to school. I think you would get more out of working as an RN in an ICU for two years instead of doing the MSN/NP and then going to CRNA school. They would still want to see you have some experience as an ICU nurse. I also don't know of any ACNP's in ICU who have never been ICU nurses. Sure, there are jobs out there but there are lots of NP's out there too, and most of them have experience as RN's, they would almost definitely be hired over you.

Sorry to say there's no easy way around it! Experience goes a long way in this business!

[Gompers, BSN, RN]

You know what? We've all got to do our time being "new grads" at some point. Just deal with it, seriously. All the education in the world isn't going to get you as much respect as just starting your first nursing job with a good attitude. Be open to new learning experiences, respect those nurses who've been at this a lot longer than you, and just be a part of the team. You are worrying way too much about what other people think. You're going to have to get your hands dirty and your feet wet before you can ever expect to have ANY respect from your coworkers. Honestly? If a new grad came onto our unit, with a brand-new MSN but absolutely no work experience? I'm telling you, the term "know-it-all" is the nicest thing I can think of. What people in nursing school don't understand is that school is one thing, work experience is another. You will learn more during your first year working as an RN than you learned in all those long years of school put together.

Besides, don't a lot of NP programs require you to have bedside nursing experience before you get into your masters-level clinicals? I don't know that you'd be able to complete your MSN without working as an RN. Maybe different specialties have various requirements. And if they don't require experience, maybe they should!!!! JMHO.

And I agree that the whole prescription-writing thing is a red flag. Doctors and NPs are not supposed to just write scripts for people without examining them. Yes, they CAN and DO write those scripts, but they're risking their license every time they do it. To become an NP or MD because being able to write prescritions sounds cool...kinda scary.

I don't mean to be critical, but you seem to be way more concerned with what others think of you than you are about actually being a part of the nursing field. You worry what the nurses are going to think about you when you start working, you seem to want to have the power to give your family and friends prescriptions, etc. How do you even know you want to be a CRNA if you've never spent time working in an ICU or OR?

Maybe I got up on the wrong side of the bed today, I don't know. But something about this whole thread is very irritating to me for some reason...

[Nursing P.]

I have read posts by NPs saying that NP school didn't help them out in CRNA school at all. Go for the CRNA and if you don't get in maybe some of the credits might transfer to the NP school. I think NP school is easier to get into because there are more schools. Financial speaking NP school is not worth it in my opinion.

[Critical Care-Bear]

Thanks for the advice everyone. I think you're right katyosu2006 -- I didn't take into consideration that an NP's role in the ICU would be different than an RN's. CRNA schools stress the ICU experience. ER or PCU experience is not acceptable to them. They would probably question what exactly I was doing as an NP in an ICU. I doubt writing orders for ICU patients would be acceptable. Plus, I probably wouldn't get a job in ICU as an NP without the RN experience. I was thinking that the NP and masters degree would give me an edge in terms of respect among other nurses. Say, for example, I get the NP and work as a regular RN in ICU. I would hope the staff would be more hospitable to me and have more respect for me. Kinda like how in the armed forces more ribbons on your chest are respected. I read a lot of posts on here and I remember one, I think it was called "nurses eat their young," or something, and it addressed the fact that new nurses out of college often get, well, "chewed-up," so to speak, by older nurses with years of experience. In my hospital I hear talk amongst other nurses that so-and-so doesn't know what she's doing and the word "new" is often used in their discussion. I would be very angry if that happened to me. That's where I think credentials would come in handy. I don't want to come out of school and work part-time, I don't want to float, or work med-surg. I just want to work ICU full-time. I asked my school if I would be prepared for that with a BSN and they said yes, however, my hospital doesn't hire new grad's on ICU and the new nurses that I see almost always float around. I wanna move anyway (not float, but actually relocate to a different area), so that's not a big deal, but whenever I get to where I'm going I want to be respected and taken seriously once I get there.

[Critical Care-Bear]

I took this qoute from a previous thread found in this forum titled, "NP or CRNA." It raised an interesting point that a lot of people have brought up regarding the benefits of being an NP. Let's take a look

I am a FNP and my brother in law is a CRNA. There is a world of difference in our practice. I teat acute and cronic illness, and can prescribe any and all drugs in my state. I have a knowledge of all systems and see all type of patients. My brother in law (also in the same state) only sees 1 kind of patient, only has to really know about sedation, and he makes almost 3x the money I do. I have total autonomy. He works directly under a MD. I can prescribe for my family and friends. He can't. It depends on what you want. I do hate all the controversy over NP's. It seems that physicians are threatened by us and try to force all kinds of legislation. They also have a lot of low blows "pseudo doctors" "dumb-doctors" My brother in law doesn't experience any of this. NP's are a threat to all primary care family physicians. We do the same thing for a lot less. They can't accept that and want to put a lot of regulations on the NP. It's funny, if you are in a very rural setting, MD's are all for you doing anything (because they don't want to go there) If you are in their town, they don't want you to do anything without their supervision. (which by the way, we don't need, only their consultation if we NEED it) They want to call it supervision.

It's still a tough road as a NP, but I think with increasing medical expences, insurances will be forced to accept us.

Good luck!!!

The benefit I'm referring to is that NP's can write prescriptions. When I first entered my nursing school and was registering my classes the lady in the registrar's office told me I picked a good school because I could be an NP. I never heard of "NP" previously, so I asked what that was. She said, "you can write prescriptions." Subsequently, many aspiring NP students I've talked with have also stated this fact in defining the role of an NP and it seems to be a major motivating factor in their pursuit of becoming an NP. Now, I don't mean to pick on npkae1 or take the subject matter out of context, but I was particularly interested in the statement, "I can prescribe for my family and friends."

I've known a few people growing up whose parents were doctors. In fact, a girl in my nursing class who I'm good friends with has a father who is a doctor. She said that this happens and I'm sure doctors and NP's probably write prescriptions for friends/family all the time. Notes to excuse absences are also written, however, the girl in my class said such things aren't really "right." Growing up, I always looked at the situation by thinking, "that's pretty cool. . . having a parent who's a doctor." Granted, I still think the sameway to a large extend, but I have more questions now.

Namely, can prescriptions be written without actual visits to the facility or practice in which an NP/MD works, and, if so, how accurate would the diagnoses be? I assume most prescriptions would be written for common colds. Without any lab tests to specify the cause of the cold, how would you know what to prescribe? Yeah, antibiotics can often treat acute respiraory infections that result from a number of different pathogens, but wouldn't it be safer to do some testing? I would think it would be better to identify the culprit as a rhinovirus or influenza or staph. aureus. I know when I was in college for my BS, I went to Albany Medical Center after contracting a virus. The MD, who I suspect was a resident, told me there was nothing they can do for a virus. I now work in a pharmacy & have access to a few online services such as uptodate online and micromedex. I have to say, he was incorrect: There are drugs that can be prescribed other than tylenol that would be effective against viral infections. In fact, there's a whole class of drugs called "antivirals" (okay, so they're mainly aimed at the flu). Still, other prescription drugs are effective in treating symptoms of viral infections other than the flu. In fact, I went to the mall one time to get my hair cut and the girl cutting it told me the guy who's hair she was cutting before me gave her a Vicodin tablet for pain she was experiencing in her throat due to a cold. She was excited because it was a "big one." This brings up an interesting topic that's all to often hidden or undiscussed. Let me explain. . .

It's a known fact that people generally like medications that cause a perceptible change in the way they feel. At the extreme are addicts, but, used responsibly, these medications can also be of benefit. I'm talking about controlled substances. The hairdresser went on to explain that she normally goes to a doctor whenever she has a sore throat to get a better painkiller (such as Vicodin, although I guess she must normally get the "small ones") than over-the-counter painkillers. Her reasoning, "why should I have to suffer when I could take something that makes me feel better?" Until this conversation, I was unaware that Vicodin was used for sore throats. I've heard of cough solutions with codeine, so I figured it was probable. I didn't have any concern over any problems associated with this. I work in healthcare, but I'm not the DEA. Even if she was excited that she got a Vicodin pill for reasons other than the sore throat, what do I care? Nurses at my job joke around with me all the time about drugs. Joint Commission passed around a memo about a year ago stating that a large number of nurses abuse or have abused drugs. In fact, I think it was ~60%. They also stated that many times it was the best nurses. Now, that's not to say these nurses are "addicts." I'm sure they are using them more or less for a recreational "buzz," much like most people have a few beers on a saturday night or after a long day at work. I make no judgement as to the ethics involved with this situation. But it does bring up an interesting issue regarding the role of NP/MD's as prescription dispensers.

The people ab-using these drugs were defined as nurses (I'm offended now as a nursing student and future nurse). I've heard stories of doctors who have been found doing the same. In fact, one doctor wrote a lot of precriptions for cocaine injection and it was investigated. Turns out he was using it himself. Still practicing. He just got a "slap on the wrist." I've seen news articles about Med students found sloched over in a bathroom stall with a needle in their arm -- passed out after experimenting with drugs such as propofol (and this was the 2nd offense -- why was he still in med school after the 1st???). Plus, as mentioned above, I went to UAlbany for four years. Major college town. From that experience alone I'm lead to conclude that upwards of ~80% or more of ALL MAJORS have some experience with using drugs for non-therapeutic purposes. The problem that concerns me is that maybe a group of nursing students become good friends. They study and work hard together, but they also go out to bars and clubs and campus parties together. They may smoke together. Not cigarettes, mind you. They may buy some Zany bars (Xanax). Naturally, if they're aiming towards an NP/MD, the thought must cross their minds that they could write prescriptions for each other for drugs used to help them "relax." The use of drugs for non-therapeutic purposes could potentially put NPs/MDs in an awkward position if their friends request such prescriptions. How is this approached? Obviously a dilemma ensues because you know it feels "wrong," yet you know this person, they are responsible, they're not a drug addict, and it's not like they are asking for a prescription for Oxycontin or something that could cause a serious physical addiction. How do you react, honestly?

[sirI, MSN, APRN, NP]

Hello, Critical Care-Bear,

Well, what you are talking about is immoral and unethical. To go into a profession for the sole purpose to support one another's habit. And, it would be illegal to do so once you are NP, so, I would think this is a non-issue to pursue the career track.

I can sum up in one equation the NP, or the physician for that matter, writing prescriptions: Treatment + Prescription - Diagnosis = Malpractice (to the infinite power).

[elkpark]

I was thinking that the NP and masters degree would give me an edge in terms of respect among other nurses. Say, for example, I get the NP and work as a regular RN in ICU. I would hope the staff would be more hospitable to me and have more respect for me. Kinda like how in the armed forces more ribbons on your chest are respected. I read a lot of posts on here and I remember one, I think it was called "nurses eat their young," or something, and it addressed the fact that new nurses out of college often get, well, "chewed-up," so to speak, by older nurses with years of experience. In my hospital I hear talk amongst other nurses that so-and-so doesn't know what she's doing and the word "new" is often used in their discussion. I would be very angry if that happened to me. That's where I think credentials would come in handy. I don't want to come out of school and work part-time, I don't want to float, or work med-surg. I just want to work ICU full-time. I asked my school if I would be prepared for that with a BSN and they said yes, however, my hospital doesn't hire new grad's on ICU and the new nurses that I see almost always float around. I wanna move anyway (not float, but actually relocate to a different area), so that's not a big deal, but whenever I get to where I'm going I want to be respected and taken seriously once I get there.

Coming into an ICU as a new grad ANP with no (or negligble) prior nursing experience will not get you "more respect" or a warmer welcome from the other staff. Like everyone else, you will earn respect over time based on your skills, knowledge, and abilities. Those ribbons on the chests of military personnel are earned over time and represent real accomplishments -- I don't think you get too many for just signing up and completing basic training! (Which is the position you would be in.) You will need to "pay your dues" like everyone else; gain some experience, and develop some competence. Many hospitals do not hire new grads into ICU and other critical care areas. They also operate on seniority, which means that new grads (and other new hires) get offered the less desirable shifts and opportunities. That's the real world. Keep in mind that what you learn in nursing school is just the "tip of the iceberg," just enough to get you in the door and started at an entry level -- the first year or more of working as a nurse is a necessary continuation of your education. New grads are more of a burden to a hospital, in terms of what they cost vs. how much productive they are, than an asset for quite some time, and the hospital is doing you a big favor by hiring you and providing you with extensive orientation, preceptor, etc., all of which costs them a lot of $$$. I've been in nursing a long time, and can tell you that, in most cases, the new grads who get "chewed up" by the other staff are people who come into the workplace as neophytes, pretty close to helpless, need tons of help and support from all the other staff (you end up doing all your own work plus half of theirs ...) -- and yet seem terribly impressed with themselves and display an openly condescending, patronizing attitude toward the older, experienced, seasoned staff. I'm sorry to say that, in (just!) my personal experience (not making any sweeping generalizations here), when I've run into that situation (and I have ...), it has always been a BSN graduate. All we old-timers are looking for is a little humility, perspective, and appreciation for the extra efforts having new grads around requires of us (oh, yeah, and maybe a little smidge of respect for how much more we know about nursing than the new grad does ...). Frankly, some of your statements about "step(ping) onto the floor and direct(ing) the other staff instead of visa versa," and "be(ing) treated much more differently than say a new Associate degree RN" set off some red flags in my head.

ANP training will not do anything to better prepare you to be an ICU nurse (you will still be an inexperienced new grad), and there is another issue that has not been mentioned. Grad school in nursing (advanced practice training of any variety) is the same "tip of the iceberg" as basic nursing school. You come out of the graduate program with the most basic preparation to enable you to start working as (in this case) an ANP and start developing the skills and expertise you need to actually be competent. If you complete an ANP Master's program and then work in an ICU as a "regular" RN, you will not only not be gaining that necessary experience to develop into a competent ANP, but you will be forgetting much of what you learned in school (does the expression "use it or lose it" ring a bell? :) ) Even if you were to go looking for an ANP position at some point in the future, you would probably be at a marked disadvantage because of that gap. If you want to be a CRNA, be a CRNA. (Or, by all means, go to med school and become a physician. It's your life.) The MSN you will take to become a CRNA will open the same management and teaching doors that you mentioned as part of your interest in the ANP option. However, don't expect to be hired into a management position as a new grad, even a new MSN grad -- frankly, any facility that would do that to you would not be doing you a favor, and would be pretty much setting you up to fail. Don't bother with the ANP training unless you want to be an ANP (and then practice as one, not a "regular" RN!)

I don't intend any of this to sound mean or critical of you personally. You asked for advice and I am just attempting to offer some honest, realistic feedback to the ideas you've presented. Good luck with your schooling and whatever you decide for your future. :)

[brownrice]

Another question to think about: How do you know you will even like being a CRNA? I had at one time thought about going this route. But after spending my last clinical rotation in school (the most hours of all rotations) in a cardiac icu, I quickly changed my mind. I decided I definitely did not like being around patients who were in for their second heart surgery because the clogged up again after being cleaned out. The dim lights of the ICU would have put me to sleep if it weren't for the beeping of the heart monitor. Most patients slept all day, and talk about cleaning up poop!

Yet, this was a unit for the highly skilled, very experienced nurses. Many of the doctors relied on them to titrate IV's, etc. There was not a single nurse there that was just out of school. They had many years experience under their belt, and it was needed. I would not want a relative of mine in the ICU to be cared for by a new nurse. Even if you do find a hospital that would put you in ICU to begin with, you are compromising your license with the inexperience.

Thank God there are expereinced nurses that love ICU, they are needed. I hope this helps you in your journey of decision.

[Critical Care-Bear]

You're probably right elkpark. I didn't mean to raise any red flags or annoy you. It's just kinda scary for me with all the stigma's associated with being a new nurse. I was hoping to bypass this by more education and what not, but nothing really compensates for years of experience. I probably shouldn't be so worried about it, but it concerns me. In another military analogy, I remember reading a book about Vietnam and new soldiers arriving there were often referred to as FNG. I feel it's a similar situation with nursing. I feel like the skinny guy entering prison. I hope these nurses don't tear me apart. On a positive note, there are probably lots of nurses who have come out of school, got an ICU job, worked there for a year or two and then pursued the CRNA route. And they have to do be competent, otherwise they wouldn't get letters of recommendation. I'll try to find a hospital that hires new grads for ICU and also has a good training/preceptorship program to introduce me to the job.

As for the condescending attitude of some BSN's, the reason I choose to go the BSN route was on the recommendation of one of the nursing supervisors at my hospital. She told me not to get an Associate degree because I may not be able to get a job with it in the future. I guess there is some concern that such a highly clinical field like nursing is hiring people with a two-year degree. Other areas of healthcare have been changing their requirements. For Pharmacy, you now need a doctors degree. I think the same is true for physical therapy too. I don't know how they are gonna pull that change off considering the HUGE nursing shortage, but I hear that's the direction things are headed in. Also, at my school they emphasize that we, as BSN's, will be "professional nurses" vs. ADN's which are considered "technical nurses."

Personally, I think it's a lot of BS. Still, you can see how the crap they fill our heads with could potentially give a BSN nurse the feeling that they are superior to an ADN nurse. And that might explain the condescending attitude.

This is all just stuff I've heard, so don't be offended. I'm sick with a cold so I've come here to take my mind off of it.

I just took BLS the other day and the thing that really hit me was when our instructor turned off the video and told us to forget all the techniques for holding the mask on the patients face. He said not to worry if it doesn't form a perfect seal or if you're using the proper gripping technique. Just make sure you see that chest rise. "Bottom line," he said, "don't worry if you're doing it the 'right way,' as long as it works." I think that's a philosophy that can be applied to a lot of areas of life. It makes me wonder why in healthcare they keep trying to change things or complicate things. Nurses do the same job regardless of whether they are a BSN or ASN, so why are they trying to impliment changes? I don't know who "they" are, but someone came up with that professional/technical nurse line. Plus, I've never seen separate job offers for professional and technical nurses. It always the same: RN. The same for pharmacy, why did they have to change the requirements to a Pharm.D? Was it not "working" having pharmacists with BS degrees? I think you can either be a "by the book" type of person or a "get the job done" type of person and seeing people that are so meticulous about the most insignificant things makes me want to be one of those "get the job done" type of guys. And that's something you can't learn in a book. Only experience gives you that.