Nursing students who want to be NP's

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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.

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
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.

Thank you for this articulate, thoughtful and knowledgeable response. This indeed did go over very well with me. I hope that more students, both undergrad and NP, can benefit from your and your colleagues' knowledge and guidance.

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...I've been working in critical care as an NP for 18 years with the past 10 being with an surgical intensivist team....

You are no doubt foremost among men; when you walk into a room and give a speech, men grow chest hair :smokin:, women curl their toes :o, birds chirp :singing:and cloudy sky turns blue :cool: revealing a twinkling sun as if it's giving you a wink--scratch that--multiple winks ;) ;) ;)

Now that you've spoken for the 7.7% NP's,...I digress.

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Specializes in LTC, Rehab.

I don't think that'll be a problem given the simple fact that only a small percentage of people become NP's compared to the numbers of RN's.

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Specializes in SICU, trauma, neuro.
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.........................

I think I love you.

I don't get the idea that someone who has not practiced can then complete an online program that will take anyone with a license and a pulse, and then claim to be an advanced practice nurse. What exactly about this person's nursing practice is advanced??

Not a direct comparison, but I thought of singing. The vast majority of singers who receive training while in high school are nowhere near ready for a role in an opera company. They may have all the potential in the world, but the 18 yr old voice still needs more training and practice and TIME to develop. A brand new nurse, likewise has not developed solid assessment skills, hasn't seen the variety of ways the human body responds to meds, has only seen the pathophysiologies in a relatively small number of clinical pts. Even that spidey sense that tells us "I can't pinpoint exactly, but something is very wrong" -- that is developed with time and experience. A new nurse by definition cannot be an expert, which is what the APRN needs to be.

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Specializes in Cardicac Neuro Telemetry.
Yes. It was very, very scary. It was a small community hospital, too, so we didn't have the luxury of things like in house attendings or residents, etc.. She was such a kind soul, and thank goodness she wasn't arrogant or rude and she really LISTENED to the nurses. I have also had the unfortunate experience of attempting to work with an APRN who had little to no experience who was the caregiver for my very sick parent. When I expressed my concerns about my parent's condition and the symptoms my parent was exhibiting, she was dismissive, condescending, and rude. She totally blew me off and didn't care at all. It later turned out that my fears were correct, and she should have taken my concerns more seriously. Fortunately no one was seriously hurt (we were lucky), but I already had a plan in my head of exactly what I was going to say to her and DO (legal-wise) if things went south. She was going to be the very FIRST person I threw under the bus.

I agree. I had to work with a midwife who went to midwifery school with literally ZERO L&D experience and zero maternal child experience other than what she had in nursing school. She'd had approximately 1 year at the bedside out of nursing school, in med surg. She was very, very sweet, but very very frustrating to work with in that we (the nurses) had to hand feed her orders and teach her things like why she should be worried about a particular fetal monitor tracing, etc. etc.. Things that an experienced bedside nurse would know. It took well over a year of her working with us before we felt comfortable working with her in that we trusted that if the poo hit the fan in the delivery room (which when it does, things go south FAST), we had a competent provider there with us.

Experience matters.

What kind of crap school allows this kind of nonsense? That is just flat out dangerous. Bare minimum requirement should be at least TWO SOLID years of full time experience as a labor and delivery registered nurse. If I were to ever use a CNM to deliver my baby, it wouldn't be someone with just a year of med surg experience who decided one day she wants to "birth babies".

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This. Exactly this. Also, a lot of people I have met who decide to continue their careers onto DNP were also ones who considered medschool (and fulfilled every admissions requirement for the MD/DO). For whatever reason, approach to medicine, greater relationship with patients, etc. they settled upon DNP as opposed to MD or DO.

Dear OP,

I am so sorry to tell you what you probably wouldn't like, but here is the reality:

- it is schools which lure students into nursing by promices of crisises-secure, well-paid jobs.

- it is schools which set uselessly high standards for admission.

- it is schools which spread lies about "job security" for nurses and thus attract adult, mature second-career seekers there

- it is schools which fill schedules with academuc fluff which takes a lot of time and brain to study but has zero practical importance

- it is schools which tell students about 500 things they can do with their BSNs

- and then it is workplace which treats these VERY bright, VERY highly motivated, still young, ambitious people like underhumans.

Do you really expect that someone bright enough to pass college stats with A (plus all other hard science classes) will allow himself to be treated like the worst crap in human history for long when he sees the same sort of dude drinking coffee and putting orders online 8 to 5 weekdays for twice more money? That someone who was a boss himself for years will allow someone twice younger yell on him for breathing 0.652 times/min more than "we always do here"? It's not gonna happen, and NP schools know it. That's why they are so darn successful.

My NP program did a test on my MSN class for a group of DNP students. The questionnaire was about NETY and lateral violence. 90+% students stated that they had experienced it, 70% of them "more than just a few times" or "systemically". Mean class GPA cumulative 3.89, mean nursing work stage 2.5 years at the moment of admission (the program requires at least 12 months). Does it tell you something?

Since, with healthcare as it is today, the standards of nursing education cannot be decreased, you can reasonably do only one thing: make students and new grads loving bedside. Make them welcome. Invite the brightest, the most daring and ambitious with open hands. Make academical achievement seen and matter. Weed out any remnants of NETY and lateral violence. Make job more physically and mentally tolerable. Make nurses more autonomic, more responsible, make their voices heard. Stop customers' and policies' kissing. And stop singing into school's lies.

There always will be some who go to nursing school with the single goal of getting advanced degree. Accept it. But for the rest, you can make this change if you and everyone else treats them good enough.

Sorry for being blunt. But when a majority of MSN class in a quite high-ranking institution openly states that all of them practically run away from bedside due to unhuman conditions there, it means something.

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Specializes in Med-Surg, NICU.
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 :)

That is also a good point. Thanks for pointing it out! Yes, I think for psych NP, inpatient psych experience would be the most optimal. Unfortunately, I know some people jump into psych NP programs thinking they will be "easy" who have never ever dealt with a psych patient in crisis.

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Specializes in Med-Surg, NICU.
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:

ER is good mainly because you see just about everything and it provides an incredible range of experience. You also see what happens when a chronic illness is not being well-managed (either via lack of resources, pt non-compliance or provider incompetence).

It is good that you plan to work while going to school. It may help solidify concepts you are learning and make it easier for you to retain information and see the big picture.

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Specializes in Psych, Peds, Education, Infection Control.
Good post, Zyprexa. I like your user name too. :yes:

I'm quite fond of it myself. :)

After multiple years on the floors and in psych crisis centers, I'd definitely prefer a psych NP that had psych floor/crisis experience vs just general experience with psych patients or sole book knowledge. There are moments that knowing the subtle difference between a unipolar depressed patient improving or a bipolar depressed patient cycling into mania can be crucial, and it's something you learn SEEING it over and over.

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Specializes in Psych, Peds, Education, Infection Control.

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.

Yes, gero-psych is big these days, and that's another great point that it really does help to have experience on both sides. (I just typed "psyches," can you tell it's been a long day?) Too many medical providers blow off all medical issues when they get a whiff of a mental health diagnosis, and too many psych providers don't stop to consider medical causes of behavior.

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What kind of crap school allows this kind of nonsense? That is just flat out dangerous. Bare minimum requirement should be at least TWO SOLID years of full time experience as a labor and delivery registered nurse. If I were to ever use a CNM to deliver my baby, it wouldn't be someone with just a year of med surg experience who decided one day she wants to "birth babies".
I know what school she went to, but would rather not name it. They may have changed their standards since she attended, I don't know. We (my L&D coworkers and I) were SHOCKED when we discovered this as well. It was very disheartening to us. It was fortunate that she was a kind soul and a humble person as well who did not think she was "above" learning from the floor nurses. She took what we (and of course the physicians and seasoned midwives) said to heart, listened, and truly made an effort to learn. Her bedside manner was outstanding, that I will say. Her first year was distressing for us as nurses, though.
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Oh no. That sounds scary! I hear what everyone on this board is saying... I see both sides. I'm currently in a DNP program at the #4 school for midwifery in the country. I have a year of L&D under my belt and I dont graduate until 2020. Just based on my curriculum now, i dont see how more time in L&D and not being in school would help me. People are neglecting to realize that there are years of pre requisites before you ever even see a patient. Im taking advanced physiology, statistics and epidemiology, nursing informatics....nothing i do as a floor nurse even reaches that stuff. I plan to work my way through school because I know my experience is ESSENTIAL to midwifery. I can read a strip and intervene. I just dont think waiting would be beneficial as im in a place in my life where I can focus on grad school. When it's all said and done, I'll have 4+ years of L&D experience (and7 months of mom baby) when this program is over. Waiting would make me less likely to do it. Just my 2 cents.

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