NP education - a rant

Gennaver, MSN · Feb 1, 2005

Okay, okay, I'll admit it: I was one of those stars-in-my-eyes tykes wanting to do a direct-entry NNP degree.
I've changed my mind for a lot of the reasons already listed: though there may be prodigious NPs out there who did the direct-entry MSN route and did just fine, I didn't want to take the chance and possibly compromise a patient's right to quality healthcare because I wanted to take shortcuts,

Hello Annabelle,

I can see there are a lot of myths about graduate entry nurse programs.

The course and program that I am choosing is not a shortcut by far. It will take me as long to work on my nursing graduate studies to become a nurse practitioner as it would for a medical student to become a doctor.

I mentioned in a previous post that it is another route towards a graduate nursing degree, not a quick or easy one and definately not a short-cut.

I am grateful for this thread and for everyone who had the courage to respond. I have heard and experienced 'status' style discussions before from LPNs to RNs to Diploma Nurses to BSN's and so on. This seems like a similar version of the same 'ol, same 'ol.

Clearly, not everyone who applies to these graduate entry programs is going to be qualified or accepted or graduate, just as not everyone who applies to diploma, LPN, RN, or BSN programs is going to be qualified or accepted or will graduate.

If nursing is truly about patient care and quality of nursing then this divisiveness against truly qualified nurses seems like nothing more than ego based self-inflation. If this is about patient care and advocacy then definately push to promote qualified standards and procedures for maintaining them, right?

Thanks,

Gennaver

DidiRN · Feb 1, 2005

Your "years of hands on hospital care experience" working as a nursing assitant and phlebotomist is not going to give you a big edge on being an RN,let alone an NP, sorry to say. I've worked with so many NA's who later became RN's who tell me time and time again how even though they worked side by side with RN's, they really had no idea of what they truly did until they became an RN themselves. There is a lot of critical thinking skills (which don't develop overnight; in fact for me it took a few years on the floor) and experience that comes into play here, and basic nursing assistant care of patients and phlebotomy skills do not even begin to give you the scope of what a bedside RN does.

For the record I don't want to appear like I think these skills are nothing (ie nursing assistants/phlebotomists) and I can't begin to tell you how I appreciate so much a good NA. They are worth their weight in gold, pardon the cliche.You are reading some great insight from other experienced RN's here, I wouldn't completely discount these things that they are saying. I agree with the ones who say they cannot even imagine someone fresh out of school starting an NP program (or even with a year's experience)...IMHO it's dangerous.

Sherri

Hello there,
I hope your rant helps you gain some perspective. I feel it was a good rant and cannot imagine anyone trying to become a nurse practitioner without some serious desire to work as an NP, (versus just for salary or because they are on a whim.)
Hopefully also you will find out that it is not so easy to go from BA in anything towards the MSN, it takes years. It is another route...not an easy or quick route but, another route towards the MSN.
I am most likely the enthused person you are talking about, (the one completing her BA in Sociology.)
Lest you think I am on a whim let me share some more about myself, your potential cohort.)
I am 38 and have been working in health care for over 15 years. I started out as an ambulance technician, then also became a nurses assistant and later a phlebotomist and medical assistant.
I have worked in over four hospitals through the years, (hard worker and usually always had a part time job on the side, although, never worked at target.)
As an adult I returned to school to pursue my RN degree but, found so much more that I also wanted to pursue. My associates is in Biology, my BA will be Sociology and my minor is Psychology, (have a minor in Spanish too.) All the while I have been completing the nursing pre-reqs at a gpa of 3.8. Meanwhile I continued to watch the waiting lists for local programs grow and yes, I am very happy to find this masters entry program.
Meanwhile I was wracking up years of hands on hospital care experience. I am very secure in my choice to work as an Adult NP and to continue to certify as a nurse colposcopist. I worked in oncology and hospice for a year, in ortho and ortho day surgery for about a year, in med/surg and physical rehab for about three years and in a women's health care office setting for just under a year.
The graduate entry program I am applying for is intense and competitive. We should be prepared to take the NCLEX-Rn after a rigorous 15 months courseload. Then we can begin the core courses while we work as nurses. After we have a year of clinical experience we can start our NP portion, approximately three to four years to become NPs.
Do you still feel that all of us are flippant about our desires to become NPs? I hope not, and hope that you will find that those of us who gain acceptance and complete our degrees like this are indeed going to be able, caring, dedicated NPs.
If your attitude stays so restricted, that is your perogative,
Gennaver

Jess RN · Feb 1, 2005

How is it ok for a med student to spend 4 years in school and at the end of the process become a doctor with a wide scope of practice- but graduates of 3 year direct entry NP programs (which, including prereqs are more like 4 years) are a shortchanging of the nursing profession? Someone said it before and I totally agree- what's missing is a residency after graduation.

Am I missing something here?

-Jess

Gennaver, MSN · Feb 1, 2005

Your "years of hands on hospital care experience" working as a nursing assitant and phlebotomist is not going to give you a big edge on being an RN,let alone an NP, sorry to say. I've worked with so many NA's who later became RN's who tell me time and time again how even though they worked side by side with RN's, they really had no idea of what they truly did until they became an RN themselves. There is a lot of critical thinking skills (which don't develop overnight; in fact for me it took a few years on the floor) and experience that comes into play here, and basic nursing assistant care of patients and phlebotomy skills do not even begin to give you the scope of what a bedside RN does.
For the record I don't want to appear like I think these skills are nothing (ie nursing assistants/phlebotomists) and I can't begin to tell you how I appreciate so much a good NA. They are worth their weight in gold, pardon the cliche.You are reading some great insight from other experienced RN's here, I wouldn't completely discount these things that they are saying. I agree with the ones who say they cannot even imagine someone fresh out of school starting an NP program (or even with a year's experience)...IMHO it's dangerous.
Sherri

Hi,

I think you may not have read the part where I noted how it would be a year before we are allowed to start the NP portion. Hopefully in our 2 to 3 years after that point we can glean these precious critical thinking skills. If only to prevent the danger you foresee.

Now, how about integrating? Or is this just doomsday bawling?

Gennaver

p.s. even if I hadn't had my previous hands on experience, (working with great mentors, nurses and doctors alike,) you seem so willing to discount the ability of graduate entry program NPs? Why? is there some specific case you know of?

DidiRN · Feb 1, 2005

Let me ask you this, Gennaver. Why do you think experienced RN's who disagree with the direct MSN program, like you have read in the previous posts, have no idea what they are talking about? Why do you argue with their logic? What personally do you know that they don't?

The consensus of this thread from multiple experienced RN's is that this is a poor idea. I tend to believe it, after reading so many negative posts on it.

And what do you mean by "integration"??

Hi,
I think you may not have read the part where I noted how it would be a year before we are allowed to start the NP portion. Hopefully in our 2 to 3 years after that point we can glean these precious critical thinking skills. If only to prevent the danger you foresee.
Now, how about integrating? Or is this just doomsday bawling?
Gennaver
p.s. even if I hadn't had my previous hands on experience, (working with great mentors, nurses and doctors alike,) you seem so willing to discount the ability of graduate entry program NPs? Why? is there some specific case you know of?

Jess RN · Feb 1, 2005

Why do you think experienced RN's who disagree with the direct MSN program, like you have read in the previous posts, have no idea what they are talking about? Why do you argue with their logic? What personally do you know that they don't?

Just a general disclaimer at first to say that I for one do not think the previous posters "have no idea what they are talking about". They are voicing their informed opinions, based on thier experience. I think it is possible for Gennaver to also have an informed opinion that differs from the majority of the posters on this thread, based on her research and experience. I don't know what Gennaver thinks specifically in response to your questions above, but I'll have a go at this:

1. Direct Entry NP programs aren't being offered at a few fly by night schools. They've been around for a while and are at established, excellent schools like Yale and Columbia. I just kind of assume that they know what they are doing and know how to train competant, safe NPs.

2. It's unclear to me how many of the pps are in fact NPs themselves. Since the scope of practice of an RN vs a NP is quite different, I wouldn't take what a long time RN says are essentials for NP as the absolute unchanging gospel truth.

3. For the previous posters who are NPs and were RNs first, it strikes me as a kind of- "this is how I did it so this is the best way to do it" kind of argument. From all I'm aware, studies of NPs show that they give primary care with outcomes equal to or better than physicians. One would have to assume that some of those NPs were direct entry pathway NPs. Also, I haven't heard an outcry from BONs or professional organizations or the public for that matter about shoddy direct entry NPs out there making medical mistakes. Maybe this is a perception vs. reality thing, but I tend to doubt it.

My kids are clamoring for dinner so I have to run- I could go on an on... IMHO more nurses at the primary care level are a good thing, not a bad thing. And as long as they are well trainied and competant to practice safely within their scope of practice- and I've seen no evidence to the contrary- especially in this thread- why the rant?

Just my 2c- putting on my flame-retardant gear now....

-Jess

RN4NICU, LPN, LVN · Feb 1, 2005

3. For the previous posters who are NPs and were RNs first, it strikes me as a kind of- "this is how I did it so this is the best way to do it" kind of argument. From all I'm aware, studies of NPs show that they give primary care with outcomes equal to or better than physicians. One would have to assume that some of those NPs were direct entry pathway NPs. Also, I haven't heard an outcry from BONs or professional organizations or the public for that matter about shoddy direct entry NPs out there making medical mistakes. Maybe this is a perception vs. reality thing, but I tend to doubt it.

No flaming here, just an observation. Many MSN programs are beginning to require experience within the specialty area prior to allowing students to take their clinicals. For example, neonatal nurse practitioners (beginning this year, if I understand the new requirements correctly) must have 2 years of level III NICU experience before beginning their clinicals. From what I have observed in researching various programs, many NP specialties are starting to require RN experience. Just my opinion, but I believe that is why such roles are referred to as ADVANCED practice nursing.

Jess RN · Feb 1, 2005

No flaming here, just an observation. Many MSN programs are beginning to require experience within the specialty area prior to allowing students to take their clinicals. For example, neonatal nurse practitioners (beginning this year, if I understand the new requirements correctly) must have 2 years of level III NICU experience before beginning their clinicals. From what I have observed in researching various programs, many NP specialties are starting to require RN experience. Just my opinion, but I believe that is why such roles are referred to as ADVANCED practice nursing.

Yeah, I'm totally with you here. I think acute care is a different ball of wax entirely. And from what I've seen in direct entry programs here in the Boston area, critical care pathways involve extra clinical time- to the tune of one or two extra years. I think that is totally appropriate. But primary care is just different- and I still think a post-MSN residency would be a great boon and make direct entry grads much more comfortable in their practice and more marketable too.

-Jess

DidiRN · Feb 2, 2005

No flames here, Jess. Everyone has a right to an opinion :) But quoting from you, that you are "voicing their informed opinions based on their experience" is what concerns me. My understanding is that direct entry MSN-NP is fairly new. I have no problems at all with anyone who has no RN experience wanting to be an NP, but I'll tell you... when I see nursing schools churn out ill-prepared new grads year and year (and it's gotten so much worse) I really do not trust institutions that want to do something like this. Whether it be Yale or Columbia or whatever. They can't even properly prepare a new bedside RN, and that is why I personally am concerned about this new way of teaching NP's that you speak of. I am frustrated by these poor new grads who spend all this money for an education and come out into the real world completely ill prepared and totally stressed out and cry how they wish they wouldn't have gone into nursing. I see this more and more every year, and it saddens me. I feel really bad for them. I guess I would assume too that nursing school and NP school would prepare me too for whatever, but IMO I am not seeing them come out prepared at all on the basic level.

Maybe I would change my mind of allowing the direct entry MSN-NP if you could have two years of clinical "residency" of some sort, along the lines of physicians. But I don't see that and don't hear of that happening anytime soon.

Just a general disclaimer at first to say that I for one do not think the previous posters "have no idea what they are talking about". They are voicing their informed opinions, based on thier experience. I think it is possible for Gennaver to also have an informed opinion that differs from the majority of the posters on this thread, based on her research and experience. I don't know what Gennaver thinks specifically in response to your questions above, but I'll have a go at this:
1. Direct Entry NP programs aren't being offered at a few fly by night schools. They've been around for a while and are at established, excellent schools like Yale and Columbia. I just kind of assume that they know what they are doing and know how to train competant, safe NPs.
2. It's unclear to me how many of the pps are in fact NPs themselves. Since the scope of practice of an RN vs a NP is quite different, I wouldn't take what a long time RN says are essentials for NP as the absolute unchanging gospel truth.
3. For the previous posters who are NPs and were RNs first, it strikes me as a kind of- "this is how I did it so this is the best way to do it" kind of argument. From all I'm aware, studies of NPs show that they give primary care with outcomes equal to or better than physicians. One would have to assume that some of those NPs were direct entry pathway NPs. Also, I haven't heard an outcry from BONs or professional organizations or the public for that matter about shoddy direct entry NPs out there making medical mistakes. Maybe this is a perception vs. reality thing, but I tend to doubt it.
My kids are clamoring for dinner so I have to run- I could go on an on... IMHO more nurses at the primary care level are a good thing, not a bad thing. And as long as they are well trainied and competant to practice safely within their scope of practice- and I've seen no evidence to the contrary- especially in this thread- why the rant?
Just my 2c- putting on my flame-retardant gear now....
-Jess

Gennaver, MSN · Feb 2, 2005

Let me ask you this, Gennaver. Why do you think experienced RN's who disagree with the direct MSN program, like you have read in the previous posts, have no idea what they are talking about? Why do you argue with their logic? What personally do you know that they don't?
The consensus of this thread from multiple experienced RN's is that this is a poor idea. I tend to believe it, after reading so many negative posts on it.
And what do you mean by "integration"??

Hi,

Let me ask you this as well, did you read the intial poster who claimed that direct entry program participants were basically, "target salespeople" who want a quick and easy way to earn big money? All apologies to all target salespeople working with integrity and earnestness.

Did the negativity of that rant escape you?

So, if you find this to be a negative route I think it would not be my place in this forum to try to sway you. As for integration...various health care providers but.

Exiting from this thread since the concensus here is indeed negative.

Gennaver

Jess RN · Feb 2, 2005

I guess I would assume too that nursing school and NP school would prepare me too for whatever, but IMO I am not seeing them come out prepared at all on the basic level.

sherrimrn, thanks for your response. Actually, the number of clinical hours in the two programs I've applied to worries me. To the point that I even looked at a PA program in my area simply because the clincial componant was double that of direct entry programs. We're talking 1600 vs 700 clincal hours prior to graduation. I ended up decising that I will treat my programs as two halves. I'll use it to get an RN in 18 mo- which I think no one would argue is totally do-able esp for a college grad who doesn't have to take the general non-nursing classes that would be involved in an ADN. Then I will work for a year or so as an RN before starting the advanced practice componant and continue to work part time as an RN while I take that second half nice and slow. In both of the programs I've applied to I can take upto 5 years to complete the advanced practice piece. That will give me the clinical experience that I personally think I would need and want- and also make me (hopefully) more marketable as an NP.

The thing is for college grads- for some it doesn't make a lot of sense to spend more time to get an associate's degree then it would to get an RN as part of an advance practice pathway. Many would see an ADN as backtracking from an educational perspective- I'm not saying I do, but some would make that case. Anywho.. as long as you are well trained, confident in your abilities within your scope of practice and willing to be a lifelong learner, it's all good! :)

-Jess

medsurgnurse, RN · Feb 2, 2005

I came to the site today and saw lot's of posts of wonderfully excited people interested in becoming NP's. The vast majority of the tones of education were: "I have the opportunity to become and NP through an advanced MSN program" or "I'm sales person at Target with a Bachelors in sociology, and with just one year of school I can become an RN then get my NP degree!!!"
Sorry about this but....Being a nurse practitioner is more than just getting the degree. The job requires experience. Not a year of med surg, not a two year Master's, but some real NURSING experience. We are NURSE PRACTITIONERS, that's nurses with additional skill to allow the diagnosis and treatment of patient problems. It requires the inate skill that makes a nurse magnified to the 'nth degree. What makes good providers as NP's is the same characteristic that made them good nurses. It's experience.
I'm not on a high horse, just an NP that has seen too many "rammed through the system, get their money" NP's. This job is serious. It's serious on several levels. First and formost, you are being entrusted with the care of people that put their complete fath in you to make good decisions and provide quality care.
This IS different that being a nurse. How many times have you sat back as a nurse and berrated a provider about their choice of treatment plan or pushed for the provider to make a decision and get on with it. That all changes when you're the one with the RESPONSIBILITY for the decision. Yeah, it's an ear infection, yeah amox should do the job. Are you ready to commit fully to giving someones most honored item, their child, a drug that could kill them??? It's not cook book. It requires a base of knowledge, experience, reponsibility, and a committment to furthering your skills. It's a lifestyle!
The second group you matter to is the professional community. As NP's, we let the schools go freaking haywire in putting out as much crud as they wanted. They saw dollar signs and began pumping out graduates without regard to job markets or the economy of NP's. Boom, a flood of NP's. Fully half of them are transfer's in from "associated science's". Read sociology, psychology, earth sciences...all able to take their bachelors in science, convert to an RN in one year, and complete their master's in two more. These people may ultimately make good NP's, but not in three years!!!! What makes anyone think that this is the way to put NP's on the map??? What kind of fodder is given to the medical community, especially, to denounce the practice of NP's as being amateurish, poorly skilled, etc. It really opens us up to all kinds of flaming by other medical groups.
If you're an RN, thinking about becoming an NP, don't do it for the salary, chances are you're going to make more as an RN in the right setting. If NP is for you, go out and work, get a job, get several and work in areas like the ER(still, in my opinion, the best experience), community health care, critical care, etc. Then after a couple of years, think about going the MSN/NP route. You will be a better provider, it gives more credence to the profession, and ultimately the little kid with the OM will thank you for your skills.
I know a rant, but it makes me nuts to think that being an NP is anything less than the greatest honor innursing you can become.

Thank you, thank you.

I agree with your post. I actually believe that Nursing schools should incraese the experience requirement for application to NP school. currently one year experience required. I am also deeply disturbed by the numbers of first semester nursing students who state that they will be a CRNA in 5 years. They say 'I graduate, get my one year of experience and start CRNA school." It absolutely scares me.