Nursing students who want to be NP's

Long Term Care Columnist / Guide · Apr 15, 2017

Good post, Zyprexa. I like your user name too. :yes:

Zyprexa · Apr 15, 2017

Good post, Zyprexa. I like your user name too.

Thank you :)

pixierose, BSN, RN · Apr 15, 2017

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 :)

My floor is Geri-psych/adult psych, and I find it fascinating how and when you treat the psych issues and physiological issues. We have a woman on bi-Pap, a host of wound care issues, IVs (which is unheard of on our unit because of suicide potential) ... and her psychological issues were too much for the medical floor (despite all these physiological needs, she sent a nurse on another unit to the ED with a broken nose ... among others).

I love the mix of med-surg and psych on my unit, and I truly agree with you that a few years in med surg or the ED is important for those entering the psych NP field as well. You do keep using these skills, at least to some degree. With the population getting older, floors like mine are becoming more popular than ever.

kwootten14 · Apr 15, 2017

I have to agree with OP. I'm in nursing school now and I do plan on becoming an APN (specifically a CRNA) in the future. Most programs I have looked at only require 1 year of ICU experience to be accepted. That blew my mind. I have friends who were in classes ahead of me who graduated and got jobs in an ICU immediately. I can't imagine getting hired, working, and moving on to start administering ANESTHESIA after only 1 year bedside.

Some of my classmates have talked about doing online RN to MSN programs right after they graduate and I just cant imagine that that makes a well-rounded APN. Bedside nursing isn't really my passion either, like some others have posted, but I have a good attitude and genuinely care for my patients and I'll put my 3-5 years in so that I can be sure that I'll be the best CRNA I can be.

Having goals outside of bedside nursing isn't bad or wrong, but trying to make all that happen too quickly (before you get enough RN experience), possibly at the expense of your future patients' care is wrong. You have to ask yourself. Do I want to become a mediocre APN now? Or do I want to become an exceptional APN a little later? Seems obvious to me...

Boomer MS, RN · Apr 15, 2017

I have to agree with OP. I'm in nursing school now and I do plan on becoming an APN (specifically a CRNA) in the future. Most programs I have looked at only require 1 year of ICU experience to be accepted. That blew my mind. I have friends who were in classes ahead of me who graduated and got jobs in an ICU immediately. I can't imagine getting hired, working, and moving on to start administering ANESTHESIA after only 1 year bedside.
Some of my classmates have talked about doing online RN to MSN programs right after they graduate and I just cant imagine that that makes a well-rounded APN. Bedside nursing isn't really my passion either, like some others have posted, but I have a good attitude and genuinely care for my patients and I'll put my 3-5 years in so that I can be sure that I'll be the best CRNA I can be.
Having goals outside of bedside nursing isn't bad or wrong, but trying to make all that happen too quickly (before you get enough RN experience), possibly at the expense of your future patients' care is wrong. You have to ask yourself. Do I want to become a mediocre APN now? Or do I want to become an exceptional APN a little later? Seems obvious to me...

Well said, Kwootten. You have a good attitude, which is a huge plus in your success. Good luck in your journey; it's all doable. One step at a time.....

Not_A_Hat_Person, RN · Apr 15, 2017

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.

Remember, too, that new grad nursing jobs were hard to get for a long time, and still are in some places. Faced with a choice of not using their hard-earned degree or getting another degree, some nurses went for the higher degree, in hopes of finally finding a nursing job.

2mint · Apr 15, 2017

From aanp [dot] org/all-about-nps/np-fact-sheet

220K+ NP's in the US

7.7% in Acute Care

1.7% in Neonatal

(for argument's sake, let's exclude CRNA since they require ICU exp)

Majority are in primary care (i.e. preventative medicine).

Specifically for FNP's, I think 0-1 yr MS/ER experience is good enough--some nurses here "seem" to think that an MD would let a brand spanking new FNP run wild day one, as if a hospital would let a new grad RN run wild day one :rolleyes:

I personally will have about 9 months MS; 12 months ER; X months parttime ER while doing FNP program. (ER is something I always wanted to do--will I use my ER experience in my future FNP job? Possibly, but ER nursing is about stabilization, not prevention).

RN is an entry-level position (that happens to pay very well here in California).

Bottom line: roughly 90% of APN's do not work in hospital setting.

New grad FNP managing DM/HTN vs New grad FNP with 5 yr RN exp managing DM/HTN... :roflmao:

lebelesprit_ · Apr 15, 2017

Well im coming to find you! lol. In my experience, maybe it was because I was just family of a patient but the younger nurses, Id say 30 and under from just their looks, were super helpful. As a matter of fact, my grandmas back int he hospital and I got ready to re position her in bed today and thought I had disarmed the bed alarm but didnt. When the nurse walked in. she said "oh, youre good. I know you know what youre doing" that made me feel so good! It renewed my passion.

marylou5 · Apr 16, 2017

Not fun...the rudimentary knowledge is sorely lacking ;-)

Have no problem with advancement, but skipping bedside experience is a huge mistake.

They don't know ...what they don't know...and try to cover...doesn't work!!

CriticalACNP · Apr 16, 2017

I'll preface this post readily admitting that my opinion isn't going to go over well with many on this forum. Nevertheless, I feel compelled to address this issue. I've been working in critical care as an NP for 18 years with the past 10 being with an surgical intensivist team within a highly regarded hospital system in the Texas Medical Center. Numerous NP programs continually seek us to take their students. However, with the glutton of these ridiculous online programs and the gross lack of experience many (actually, most) of the nurses presenting to us, we are highly selective in who we choose after having "fired" a handful of said students. For the few here who have said these programs have very little to nonexistent standards in taking students, you are absolutely correct. So many people jump into nursing schools with the idea that they're going to immediately leap frog into an NP program. Moreover, there are (sadly) many programs who not only accommodate these students, but actually encourage it. At the end of the day, it's about the almighty dollar and it's absurd. Here's the bottom line - I couldn't care less how "experienced" or "confident "nurses" feel coming out of school (or even with a few years experience) because the fact of the matter is, it takes several YEARS of various experiences before you'll be prepared to enter into an NP program, much less practice at an advanced level - period. Is that to say you couldn't pass the class curriculum? Of course not... the curriculum in large part for most programs is an absolute joke (and particularly in comparison with PA programs). For example..Nursing theory? Seriously?? Sadly, I've seen some online programs advertise on Facebook that "NPs can practice in 20 states without the need of a collaborating physician". SMH... you have got to be kidding me. In addition to my primary employment, I moonlight at various hospitals and I'm often approached by newly minted nurses (and even nursing students) seeking advice on the NP profession and my response is always the same - "Don't even think about it. Learn to be a nurse first. Respectfully, you don't even know what you don't know. You must create a solid foundation of nursing experience from which to build from because quite frankly, an NP program isn't going to provide even a fraction of what you will need to practice autonomously as an NP." That's not an opinion - that's simply a fact. I strongly encourage nurses to have a solid eight years of nursing experience before pursuing a graduate degree because it takes that long to hone the necessary critical thinking skills, an asset woefully lacking in more than 90% of nurses today. Yes, I realize that's not a popular stance or what most of nurses want to hear. However, it's a statement based on years of hardcore experience in dealing with nurses and NP students. Also, a couple of pro tips - as preceptors, we are not there to educate/train you on the fundamentals of nursing. My team (as well as all good preceptors) FULLY expect you to come to the plate with a very strong knowledge base and solid experience from which we can help you to build upon. We're a busy team and haven't the time or the inclination to carry dead weight all day long. Secondly, if your nursing experience has always been in adult practice, please don't fool yourself into thinking that your semester in pediatrics and your ultra-light rotation in a pediatric clinical setting is going to prepare you to see children independently - it's more than ear infections and colds. I've digressed.

Let's face it... there are plenty of professional organizations such as the American Medical Association (and numerous others) who have railed against the NP profession for many years and quite honestly, with the lack of standards in NP programs, it's hard to argue with them. Becoming an NP is more than achieving a glamours title. It's about practicing at an advanced level with the knowledge and skills obtained over many years and being accountable for YOUR actions and decision making. With that said, entering into a profession that you don't have the experience to support it does nothing to elevate your career but certainly does much to undermine the APN profession when costly mistakes are made (and yes, it happens regularly).

Lastly, allow me to reiterate why I feel eight years of good experience is the benchmark for NP programs. Again, it comes from years of experience of working with NPs with various levels of experience. However, these highly profitable NP programs realize that motivated students are much more likely to continue their education immediately post baccalaureate versus gaining many years of experience, with life changes happening along the way. If you're not familiar with the book, "From Novice To Expert" by Patricia Benner, you'd do well to read it. As I said, nurses lacking in experience are also lacking in critical thinking, which only becomes honed with experience. Thus, to compensate for this lack of these skills and knowledge, NPs will, for example, order every test under the sun as if they're casting a wide net to see what they can drag up. It's incredibly costly and extremely wasteful and only serves to strengthen the argument of physicians opposed to APNs in practice. To be clear, this example only begins to scratch the surface. There are too many reasons to discuss at this point. Also, this post is not meant to be offensive to anyone. However, what little I've written is absolutely spot on and backed by the best NPs around. Thus, if it saves you any trouble, I'm not doing to debate the subject with anyone here as it would be an exercise in futility. Best of luck.

quazar · Apr 16, 2017

I'll preface this post readily admitting that my opinion isn't going to go over well with many on this forum. Nevertheless, I feel compelled to address this issue. I've been working in critical care as an NP for 18 years with the past 10 being with an surgical intensivist team within a highly regarded hospital system in the Texas Medical Center. Numerous NP programs continually seek us to take their students. However, with the glutton of these ridiculous online programs and the gross lack of experience many (actually, most) of the nurses presenting to us, we are highly selective in who we choose after having "fired" a handful of said students. For the few here who have said these programs have very little to nonexistent standards in taking students, you are absolutely correct. So many people jump into nursing schools with the idea that they're going to immediately leap frog into an NP program. Moreover, there are (sadly) many programs who not only accommodate these students, but actually encourage it. At the end of the day, it's about the almighty dollar and it's absurd. Here's the bottom line - I couldn't care less how "experienced" or "confident "nurses" feel coming out of school (or even with a few years experience) because the fact of the matter is, it takes several YEARS of various experiences before you'll be prepared to enter into an NP program, much less practice at an advanced level - period. Is that to say you couldn't pass the class curriculum? Of course not... the curriculum in large part for most programs is an absolute joke (and particularly in comparison with PA programs). For example..Nursing theory? Seriously?? Sadly, I've seen some online programs advertise on Facebook that "NPs can practice in 20 states without the need of a collaborating physician". SMH... you have got to be kidding me. In addition to my primary employment, I moonlight at various hospitals and I'm often approached by newly minted nurses (and even nursing students) seeking advice on the NP profession and my response is always the same - "Don't even think about it. Learn to be a nurse first. Respectfully, you don't even know what you don't know. You must create a solid foundation of nursing experience from which to build from because quite frankly, an NP program isn't going to provide even a fraction of what you will need to practice autonomously as an NP." That's not an opinion - that's simply a fact. I strongly encourage nurses to have a solid eight years of nursing experience before pursuing a graduate degree because it takes that long to hone the necessary critical thinking skills, an asset woefully lacking in more than 90% of nurses today. Yes, I realize that's not a popular stance or what most of nurses want to hear. However, it's a statement based on years of hardcore experience in dealing with nurses and NP students. Also, a couple of pro tips - as preceptors, we are not there to educate/train you on the fundamentals of nursing. My team (as well as all good preceptors) FULLY expect you to come to the plate with a very strong knowledge base and solid experience from which we can help you to build upon. We're a busy team and haven't the time or the inclination to carry dead weight all day long. Secondly, if your nursing experience has always been in adult practice, please don't fool yourself into thinking that your semester in pediatrics and your ultra-light rotation in a pediatric clinical setting is going to prepare you to see children independently - it's more than ear infections and colds. I've digressed.
Let's face it... there are plenty of professional organizations such as the American Medical Association (and numerous others) who have railed against the NP profession for many years and quite honestly, with the lack of standards in NP programs, it's hard to argue with them. Becoming an NP is more than achieving a glamours title. It's about practicing at an advanced level with the knowledge and skills obtained over many years and being accountable for YOUR actions and decision making. With that said, entering into a profession that you don't have the experience to support it does nothing to elevate your career but certainly does much to undermine the APN profession when costly mistakes are made (and yes, it happens regularly).
Lastly, allow me to reiterate why I feel eight years of good experience is the benchmark for NP programs. Again, it comes from years of experience of working with NPs with various levels of experience. However, these highly profitable NP programs realize that motivated students are much more likely to continue their education immediately post baccalaureate versus gaining many years of experience, with life changes happening along the way. If you're not familiar with the book, "From Novice To Expert" by Patricia Benner, you'd do well to read it. As I said, nurses lacking in experience are also lacking in critical thinking, which only becomes honed with experience. Thus, to compensate for this lack of these skills and knowledge, NPs will, for example, order every test under the sun as if they're casting a wide net to see what they can drag up. It's incredibly costly and extremely wasteful and only serves to strengthen the argument of physicians opposed to APNs in practice. To be clear, this example only begins to scratch the surface. There are too many reasons to discuss at this point. Also, this post is not meant to be offensive to anyone. However, what little I've written is absolutely spot on and backed by the best NPs around. Thus, if it saves you any trouble, I'm not doing to debate the subject with anyone here as it would be an exercise in futility. Best of luck.

I wish I could "like" this post more than once. Thank you, thank you, THANK YOU for saying it so well, so thoroughly, so eloquently, so perfectly. Thank you. You are so on the mark.

cleback · Apr 16, 2017

Experience is always helpful. But the only issue I see with requiring extensive experience prior to NP school is that practice settings vary widely. My years at the medsurg bedside isn't very helpful for formulating a medicaton regimen for the newly diagnosed diabetic patient at the clinic. Nursing judgment doesn't always translate to the different practice settings. So how do we determine what experience should be required? What is the minimum rn competency required before pursuing an np?