do NP programs adequetly prepare you for your career?

elkpark · Aug 27, 2004

Keep in mind, also (to add to the confusion and ambivalence), that there are NP programs that will take you with no experience (direct entry programs, for non-nurses).

While I am not a big fan of direct entry programs, I will say that advanced practice involves an entirely different role/responsibilities and generalist nursing experience is of limited usefulness. It's not like you just "work your way up" to being an NP ... I was a long-time psych nurse when I returned to school for an MSN in child psych nursing at a school that also had a direct entry program. Many of my fellow students were not nurses (the direct entry program was a 3-year program, the first year being a "quick 'n dirty" basic nursing program that would enable them to sit boards), but that didn't seem to make a huge amount of difference. While I knew lots of useful stuff about child psych nursing, most of my experience didn't really apply to the new stuff we were studying and practicing, or the roles we were going to assume after we graduated.

Best wishes with your career -- :)

elFNP · Aug 27, 2004

I heard and seen many people ask that question. How much experience do I need? How many nurses know about the JNC 7, Framingham risk score, running coumadin clinics, coding office visits, performing punch biopsy, intra articular injections, etc. Even if you have years of nursing experience behind your back, you are not guaranteed to pass the program. The only area where i've seen years of experience makes a difference is a RN with tons of cardiology experience the will work cardiology as a NP. But that experience will only carry you so far. From what I've have seen as a nurse practitioner, having years of nursing experience compared to someone with 2-5 years is not that big of a difference. For example, I have NP friends the work Infectious disease, HIV clinics, and Dermatology. The years of nurisng practice did not prepare them for that. Their NP program, preceptors, and collaborating physicians did. How will 10, 15, and 20 years of acute care or ER expereince help you there. I'm a FNP working with Internists and it is a totally different ball game than nursing. Nursing experience will give experience with patient/family interactions and how to handle some minor complications. The best experience you get is when you get out of school and get with a physician or nurse practitioner that is willing to teach you.

fergus51 · Aug 27, 2004

Elkpark, I think you'll find those direct entry programs are only in the US. I haven't heard of any in Canada.

DMR, I think it will depend on you and what type of experience you get when you start as a new nurse. My advice would be to wait and see. You might find you feel very confident after one year of nursing experience. You may need more. A lot will depend on what area of nursing you choose to go into, and I know in Saskatchewan there is still a push for new nurses to go into med/surg. You might do a year of that and then decide you want some ER or ICU experience before the NP. It's really impossible to predict. I know for me, I wasn't really comfortable and confident enough to even consider the NP until I had worked for 3 years. I still haven't done it due to financial reasons, but I think I could now and I know I was not ready after one year:)

Finally2003NP-C · Aug 27, 2004

I saw this posting yesterday and was not going to respond. During today's practice I was asked by two separate NP students I precept how I knew so much about taking care of people. At first I thought they were just being students.Then the thought crossed my mind about the posting I had read from DMR1. Pondering on it for a few minutes I realized that my experiences as a RN prior to becoming an NP increased my knowledge about procedures and critical thinking...blah,blah,blah. What my experiences really did was to allow me to "experience" hands on the way to APPLY the academic knowledge taught to me in school. Elkpark related that "generalist nursing experience is of limited usefulness". This may be true in psych nursing, but my background is ER/ICU, twenty years worth. My knowledge of diagnostic lab/procedures/treatments/and pharmacology was first introduced while seeing patients in the ER/ICU. As far as my NP training in the same areas while in school... well, let's say that the academic programs were "somewhat lacking" in those areas. I actually corrected one professor who proposed volume replacement of one liter IV in a patient with CHF and very obvious 3+ edema. Her response to my challenge was that the lungs were essentially clear, and a "little" fluid would make the patient comfortable.

In addition, the countless hours of triage, assessment, and interventions I performed helped me to weed out superfluous and time wasting steps taught to me in school by academicians who "talked the talk" but had not practiced on actual patients for many years. No, I am not talking about shortcuts but actual practice techniques that reduce the amount of time required to perform procedures and actions. So, once I started the NP program I knew what was actually needed to take care of the patient as well as being exposed to some new and very different "scope of practice" areas concerning the NP role. Those "different" areas being diagnosis, treatment, and medication. My previous experience had me performing the orders, but in the NP role you give the order as well as take responsibility for the order. It is entirely different when you are the one who has to come up with the diagnosis/treatment/medication... and it better be right. Yes, my experience prior to entering NP school helped me greatly.

Now for the kicker... not only do I practice as an NP, but I also teach Med/Surg and OB as an assistant professor at a Nursing College. What do I tell my students about practice and experience? First, get your RN degree.

Afterwards practice anywhere you want for at least a year, preferably two. That way you get your feet wet, and apply some of that book knowledge just crammed into your head. Plus, you may find out that Advanced Practice is not exactly what you want to do, or that it is exactly what you want to do. Take a little time to expose yourself to what you think you want to do, precept with an NP for a couple of weeks. I actually had a nurse who decided to not continue with school once she saw my workload and what was expected and demanded of me as an NP.

Yes, the Advanced Practice role/responsibility is entirely different than the general RN role. Previous experience in the RN role helps to ease the introduction into Advanced Practice by allowing time to practice and apply the necessary critical thinking and application of nursing knowledge taught in school. As a result I very much recommend that any nurse considering the Advanced Practice role get some actual time and experience practicing the role of nursing prior to moving up the ladder to NP. So go get some experience...

Dixiecup · Mar 13, 2010

IN A WORD, noooooooo!

allennp · Mar 13, 2010

I agree with Finally2003NP-C, having myself spent 20 yrs in ICU, ED airlift etetetet when I went to work in a ED (as a ARNP), I knew what was expected, No I did not feel I had the NP part nailed done......do not know if I ever will !!! My first couple weeks one day with my point person for backup in my orientation, I was juggling three admits, writing admit orders, and calling hospitalist, she stared at me to ask how did I know to do all that................

She was a direct fasttrack ARNP, great NP and sharp as a whip, but no RN experience. For me yrs of ICU?ED covering residents and helping with all those "mundane" nuirsing issues builds a wealth of knowledge in which to apply to the new role I am in.

Spacklehead, MSN, NP · Mar 13, 2010

I agree with Finally, I couldn't imagine being a NP without my ER background to help me. I honestly feel that it does take a few years of performing assessments to know which subtle abnormalities can mean the difference between a potential serious condition where an admission is warranted as opposed to being able to watch the patient closely as an outpatient. Yes, you may learn all of the basics in your NP program and the role is completely different, but do you honestly think as a new NP grad without any previous nursing experience you would be able to think critically, prioritize efficiently, and know when something truly is beyond your scope/comfort level?

I also feel that as a former ER nurse, I learned a lot through patient triage (even though you aren't techinically diagnosing, you are gathering a quick H&P on the patient to determine if their complaint is urgent or something that can wait to be seen), reviewing labs, guessing as to what is wrong so you can choose the correct protocol to follow, etc.

Also, there are just so many different presentations of the same disease process (think MI, appy, etc.) that you only learn through dealing with them and being exposed to them several times. The textbook is only going to teach you the most common presentation, which can set you up to miss a very potential life-threatening condition if you have no prior experience with them. Yes, clinicals will expose you to some things, but IMHO, definitely not enough to where I would feel comfortable (without previous experience) making the final judgement call. To those NPs who can do that and had no previous nursing experience - I give you the utmost respect! I know I wouldn't feel comfortable doing it!

I do realize that there probably are some very good NPs who never had any previous nursing experience - but I also wonder how they find jobs. I do know in my area, new grad NPs are having a very difficult time - even with years of nursing experience on their resume. Luckily, at least if you have years of nursing experience behind you, you can promote yourself to a potential employer who is looking for someone with NP exprience (if your nursing experience it similar to the NP role - think cardio NP, ER NP, etc). A recruiter here would just put that resume aside if there is no history of any type of nursing experience on there for those types of positions.

That's just my 2 cents on the issue, as I'm sure many others feel differently.

marty6001, EdD, EMT-P, APRN · Mar 15, 2010

Keep in mind, also (to add to the confusion and ambivalence), that there are NP programs that will take you with no experience (direct entry programs, for non-nurses).
While I am not a big fan of direct entry programs, I will say that advanced practice involves an entirely different role/responsibilities and generalist nursing experience is of limited usefulness. It's not like you just "work your way up" to being an NP ... I was a long-time psych nurse when I returned to school for an MSN in child psych nursing at a school that also had a direct entry program. Many of my fellow students were not nurses (the direct entry program was a 3-year program, the first year being a "quick 'n dirty" basic nursing program that would enable them to sit boards), but that didn't seem to make a huge amount of difference. While I knew lots of useful stuff about child psych nursing, most of my experience didn't really apply to the new stuff we were studying and practicing, or the roles we were going to assume after we graduated.
Best wishes with your career -- :)

I respectfully disagree with you. Being a RN first directly correlates how you prepare for, and practice as an APRN, at least in the acute care track. I worked as an ICU nurse before finishing my masters and getting my ACNP. Now I cover a 12 bed ICU and a 20 bed tele unit as the night APRN Intensivist. I use what I learned as a RN every night, while of course using my advnaced practice knowledge base, including intubation, central line placement, radiological interpretation, lab interpretation, and order entry. If I hadn't worked as a nurse first, I would have been lost when first starting out. I think any APRN should first work in their specialty as a RN, if not only to be able to mix well with the staff you will be working with.

Dixiecup · Mar 15, 2010

I think it's what you put into it. i literally hated clinical rotations and just wanted to get through the day. I did not assert myself as I should have and now I'm kicking myself in the bottom as I feel I am not prepared!