Nursing students who want to be NP's

[Teaching the future]

Anyone else notice that many of their nursing students are becoming nurses as a stepping stone to being a nurse practitioner but have little interest in being a floor nurse? I'm worried we won't have bedside nurses before long.

[quazar]

Pro-student, you keep claiming we are ignorant, have false assumptions, are demanding to see data, etc. etc., so I would counter thusly: do you have a peer reviewed, actual scientific study that shows data on the clinical judgment of APRNs with prior nursing experience versus APRNs without? As in, hard data that analyzes things like failing to properly diagnose or missing critical signs/symptoms that would have been picked up by a more seasoned nurse, because the nurse performing the initial assessment in the office is inexperienced. If there is such a study out there, I would love to see it, it would be a great reassurance to me both as a nurse, and a healthcare consumer who utilizes APRNs as a patient.

If such a study does not exist, then you are not arguing with hard data either. You are merely going off anecdotal data and opinion, and the jury is still out. Therein lies the problem: we are turning out (in some cases) APRNs with little to no experience, and crossing our fingers that they are prepared enough in school to deliver expert care. You may be comfortable with this scenario for yourself and your loved ones. I am not.

ETA: note that I am not asking for a study documenting the quality of care provided by APRNs. That is not what is in question. The question is, is there a study you can show me that has hard, factual, measurable data that shows less/inexperienced APRNs have just as good clinical judgment and assessment skills as APRNs with prior experience?

[RN-dancer]

I have seen this before as a RN Intern. My precepting nurse graduated with her BSN in May and started her DNP/FNP program in June that same year. So basically she will graduate her DNP program with 2 1/2 years of bedside experience. I don't have single doubt in my mind that she's going be an awesome NP because she's also a great nurse. I don't think her working the floor a few additional years making or breaking her NP care.

I also started my ASN to MSN/FNP program right after graduation and will have littler under 3 years of bedside experience when I complete my program.

I remember one nurse told me, that new nurses can be overly ambitious and forget that experience will make you a better clinician. I totally agree with her that experience makes a world of difference. On the contrary, if you have goals and opportunities to pursue those goals then do it. Why wait. Plus the NP role is of a provider so you learn more advanced dynamics, pharm, patho ect. Especially if you work and go to NP school it can make you a better nurse because you have that in depth knowledge and can apply it to your practice.

A different perspective is that med/PA school is the same process at np school but doctors/PA don't need years of medical experience prior to med school to be great providers because the focus is being the best you can be in the role you are training for. I think its all relative to how you want to pursue your role as an NP. Theres no right or wrong way or required years to be a good NP.

Good Luck to all you nursing students and NP students :)

[RN-dancer]

This isn't d ebatable it's just false. The top nursing schools not only do not require bedside RN experience, they also tend to have direct entry NP programs for non-nurses.And your comments about schools only being in it for the money demonstrates that you know nothing of higher education financing. Basically, tuition makes up a MINORITY of school's operating budgets.

Any of you who claim that one cannot know what one doesn't know without experience were obviously poorly educated. I know that I don't understand the theory of relativity and I didn't have to work in any profession to realize that. New nurses may tend to shy away from asking for help or afraid they will look bad if they admit to not knowing something. That doesn't mean they don't know what they don't know, it means they don't want to show what they don't know. To assume all new nurses are ignorant of they own shortcomings would mean we are all fools. If you want to wear that hat, be my guest but I know exactly what I do and do not know and it didn't take me a day on the job to figure that out.

All of you harping that nurses need bedside experience to be a competent APN are clueless. Sure some APNs who happened not to have bedside experience (or bedside experience in a different area) haven't been up to snuff out of the gates. That is anecdotal, there is no reason (other than your assumptions and prejudices) believe that is a systemic issue. There is no evidence that beside RN experience makes for a better, safer, or more competent provider. I'm not saying it might not be helpful but it can also be a hindrance. If you think I'm wrong, I challenge you to provide a shred of (real) evidence rather than some vague story of somebody you came across once and what your opinion of them was. Anecdote times two (or more) does not equal evidence.

Amen to all that!

[RN-dancer]

My own daughter is applying for a BSN in the fall (she finished her associate's degree while in high school). Her end goal is NP or CRNA. Told her get experience first to be the best.

I am not backing off this opinion. She will be a better NP for it.

Theres not a single CRNA school in America that will accept a student without at least ICU experience. However there are dozens of FNP schools that will accept students with no experience. I think it depends on the speciality.

Good luck to her, she will do great things :)

[pro-student]

If such a study does not exist, then you are not arguing with hard data either. You are merely going off anecdotal data and opinion, and the jury is still out. Therein lies the problem: we are turning out (in some cases) APRNs with little to no experience, and crossing our fingers that they are prepared enough in school to deliver expert care.

Not true at all. The evidence presented so far that RN experience is needed to be an APN has consisted of a few stories about a few providers and personal options on their quality. On the contrary, I have suggested that the literally thousands of ANPs in practice who did not have experience as an RN and the concomitant lack of major errors, evidicent of ineffective care, or malpractice claims suggests these anecdotes are by no means representative. Furthermore, NPs without RN experience have been participants in studies that have demonostated APNs provide at least as good or, in a number of instances, better care than physicians. If the care they provide was so anything like what has been suggested from a very few limited examples and personal assumptions, how would these results be possible. This evidence, while not direct, head-to-head comparisons, is far beyond the level that has been provided to the contrary.

I do think it's cute that despite being able to provide no support other than a couple anecodotes and "I think..." you're willing to dismiss higher level evidence because it's not perfect. Maybe the little bedside brigade on here could organize a study of APN quality based on RN experience since so far it's just an assumption but one you're willing to argue feriously is a threat to patient safety.

[Boomer MS, RN]

A different perspective is that med/PA school is the same process at np school but doctors/PA don't need years of medical experience prior to med school to be great providers because the focus is being the best you can be in the role you are training for. I think its all relative to how you want to pursue your role as an NP. Theres no right or wrong way or required years to be a good NP.

If we're going to bring MDs into this discussion, please be aware that MDs today do anywhere from 2-7 years of training after medical school. And many do Fellowships after their residencies. My husband did two Fellowships, one right after completing his residency of five years and the second Fellowship at age 56. The PA role is a whole other discussion. Many NPs can practice independently, where as PAs cannot. PAs work under an MD. I am a huge supporter of NPs, but I want him or her to have experience an an RN. Although the Advanced Practice role of an NP is different from a staff RN, they are both nurses. My daughter had five years full time as an RN in a Level I trauma center on nights and then went to the #1 rated graduate program in this country to become an ACNP. She still talks out how she wishes she knew more, that the experience as an RN was and still is invaluable, that the responsibilities are considerable as an NP. It's isn't about a right or a wrong way, IMO; it's about how to best prepare our providers, whether that is an NP, a PA or an MD. I applaud nurse anesthesia programs that insist on ICU experience, preferably at a very high acuity facility. Academic institutions, however, have not asked my opinion about any of this!

[pixierose, BSN, RN]

Not true at all. The evidence presented so far that RN experience is needed to be an APN has consisted of a few stories about a few providers and personal options on their quality. On the contrary, I have suggested that the literally thousands of ANPs in practice who did not have experience as an RN and the concomitant lack of major errors, evidicent of ineffective care, or malpractice claims suggests these anecdotes are by no means representative. Furthermore, NPs without RN experience have been participants in studies that have demonostated APNs provide at least as good or, in a number of instances, better care than physicians. If the care they provide was so anything like what has been suggested from a very few limited examples and personal assumptions, how would these results be possible. This evidence, while not direct, head-to-head comparisons, is far beyond the level that has been provided to the contrary.

I do think it's cute that despite being able to provide no support other than a couple anecodotes and "I think..." you're willing to dismiss higher level evidence because it's not perfect. Maybe the little bedside brigade on here could organize a study of APN quality based on RN experience since so far it's just an assumption but one you're willing to argue feriously is a threat to patient safety.

Oh, for pete's sake.

So far I've seen 1 link from you, ProStudent, on projections. Not seeing the 'evidence presented thus far.'

The only "evidence" I've seen is disparaging remarks about how other posters are 'ignorant' and now 'cute.' Quit it, show some respect and please provide some links so we can debate this in a rational and reasonable manner. "Suggestions" you provided are not evidence-based until we actually see what you're talking about.

Sincerely,

Pixierose (new grad, no interest in APRN because she doesn't feel qualified for at least 3-5 years, maybe more and maybe never)

who is married to ...

an APRN (who went to grad school right after he graduated with his BSN and is incredible at what he does)

[Boomer MS, RN]

Oh, for pete's sake.

So far I've seen 1 link from you, ProStudent, on projections. Not seeing the 'evidence presented thus far.'

The only "evidence" I've seen is disparaging remarks about how other posters are 'ignorant' and now 'cute.' Quit it, show some respect and please provide some links so we can debate this in a rational and reasonable manner. "Suggestions" you provided are not evidence-based until we actually see what you're talking about.

Sincerely,

Pixierose (new grad, no interest in APRN because she doesn't feel qualified for at least 3-5 years, maybe more and maybe never)

who is married to ...

an APRN (who went to grad school right after he graduated with his BSN)

Thank you, Pixie Rose.

[Ellie G]

Personally I think that experience at the bedside is a good thing before NP school but a good strong clinical experience is even more important. Clinicals can vary so much and with some of the online schools the admission criteria is so lax that a person could conceivably get through being book smart enough to pass boards but with little real world experience to draw upon. We all know that most patients didn't read the book.

[quazar]

Not true at all. The evidence presented so far that RN experience is needed to be an APN has consisted of a few stories about a few providers and personal options on their quality. On the contrary, I have suggested that the literally thousands of ANPs in practice who did not have experience as an RN and the concomitant lack of major errors, evidicent of ineffective care, or malpractice claims suggests these anecdotes are by no means representative. Furthermore, NPs without RN experience have been participants in studies that have demonostated APNs provide at least as good or, in a number of instances, better care than physicians. If the care they provide was so anything like what has been suggested from a very few limited examples and personal assumptions, how would these results be possible. This evidence, while not direct, head-to-head comparisons, is far beyond the level that has been provided to the contrary.

I do think it's cute that despite being able to provide no support other than a couple anecodotes and "I think..." you're willing to dismiss higher level evidence because it's not perfect. Maybe the little bedside brigade on here could organize a study of APN quality based on RN experience since so far it's just an assumption but one you're willing to argue feriously is a threat to patient safety.

Sooooooooooooooo.........you DON'T have a study with facts and figures. Got it. Yet you're still being nasty. Yep, we're done. Flounce away. I wish you the best of luck. We are most definitely done here.

[Zyprexa]

I believe we should not only require bedside experience, but experience that pertains to the graduate program in mind. Psych NP- a few years in psych ward/or med-surg (where you will see a LOT of psych patients), Pediatric NP-a few years working in peds, Adult Acute Care NP-work a few years in Adult ICU or step down, CNM- a few years in L/D, NNP- a few years in NICU, FNP- a broad program that should require broad (not super-specialized) experience, such as ER nursing, med/surg and maybe even ICU. Clinic/public health nursing may also be relevant for FNP work.

I agree with you, however, coming from someone who has worked in both med-surg/tele and now psych, there is a big difference between having a psych patient on a medical floor and a psych patient on a psych floor. You will definitely see LOTS of psych patients on the medical floors, but you won't really learn about their psychiatric diagnosis, medications, or treatments to the extent that you would on a psych floor. On the medical floors, the goal is to treat the medical issue, the underlying psych problem is still there but is often not the reason for admission. Now there will be ETOH withdrawals, suicide attempts/OD that require medical clearance prior to admission to psych, but again, the medical issue is the priority. For psych NP school, I would recommend getting some initial experience in med-surg or ED, and then a few years on an inpatient psych unit. Understanding the psych diagnoses and manifestations, interventions, managing difficult behaviors, assessing for SI/HI, safety, pharmacology, deescalation, and recognizing medication side effects, among other things, is very important. Psych is not for everyone, and that goes for Psych NP as well :)

[phoenixrn]

This is also fueled by the fact that there is a PHYSICIAN shortage..... this is why APNs are in demand. Many bright young people considering medical school will also look at the APN pathway and think that it makes more sense for them.

Not necessarily a bad thing..... except when they have the attitude that *they* are too good to be wiping butts.